How a new RCM company supported by PE plans to repair the “transactional intestines for American health care”

Hospitals find it more difficult than ever to receive the payment of the care they provide, which is one of the many factors causing generalized financial pressure among the country’s suppliers. Many hospitals have invested considerably in income cycle optimization technologies, whether autonomous tools or those integrated into DSE systems – but the situation has not improved.

This week, New Mountain Capital has launched a new company that will compete with the management companies of the established income cycle and will try to beat them at their own game. The capital-investment company has formed the new entity, called Smarter Technologies, combining three distinct platforms that it had already acquired: Smarterdx, Pensimemel.ai and Access Healthcare.

With established players like Epic, Change Healthcare and R1 RCM in the running for customers, one wonders: do health care really need another income cycle management company?

Jeremy Dekinsky, CEO of Smarter Technologies, thinks that the answer is yes – and he explained why Tuesday during a conversation by the fireside with Arundhati Parmar, News from Medcity“Editor -in -chief, during the publication investment conference in Chicago.

The Dekinsky Society promises to improve the accuracy of payments and to provide cost reductions measurable by automation fueled by AI.

Health care represents almost 20% of the country’s GDP, but it offers a frustrating and opaque experience for patients-often involving surprise bills and points between suppliers and payers, he said.

“We are at a time of deep fear of society about how care is provided in this country,” said Dekinsky.

He described something that happens every day in the United States: despite insurance, a patient receives a confusing surprise bill for months after receiving care and is forced to navigate between the supplier and the insurer to solve the problem for themselves.

Dekinsky also reminded the audit

“The transactional chassis that we use to rule on health care in this country has been approved and created by the Balanced Budget Act in 1997, where we came live with a series of standard transactions for complaints, eligibility, prior authorization and payment. And it is now 2025, and we execute the same transactions.

In addition to this, the increase in labor costs and the transition from traditional health insurance to the advantage of health insurance-which pays less and is more difficult to charge-erod the margins of suppliers, added Dekinsky.

In addition, denial rates have almost doubled in the past five years, as payers are using AI to examine complaints, often asking providers to submit additional medical records to determine medical need, he said. He noted that payers “also have an entire series of AI tools that have been deployed to recover the complaints that have already been paid”.

Despite a widespread adoption of the DSE in the past two decades, the infrastructure to support the exchange of transparent data is lacking, with too common delays and allegations, said Dekinsky.

“When you add it all, I cannot think of a better use case for the application of AI than the transactional intestines for American health care,” he said.

In her opinion, the United States does not only need another healthcare healthcare management company – it needs it that is more profitable. Most suppliers of income cycle management invoice their suppliers to represent 5 to 9% of collections – but Smarter Technologies aims 1 to 1.5%, said Dekinsky.

The company is able to provide this affordable model due to its AI agents operating between paid portals and billing systems, as well as its low-cost and evolutionary bpo offshore, he said.

Dekinsky added that smarter technology agents are trained not to make mistakes.

“”[BPOs] Let’s say that we will make a quality audit of 5% and we will guarantee you a quality score of 95%. This means that an extraordinary number of errors pass, and these are [surprise] Bill or authorizations that have not been completed for a visit, “he said.

He said that intelligent technologies agents do not make these same mistakes because they follow strict procedures, reasons when necessary and increases on -board cases to a human team in a loop so that they can be resolved in an appropriate manner.

Many companies have promised to repair the broken income cycle of Healthcare before – but Dekinsky thinks that smarter technologies will be distinguished from its ability to offer both precision and affordability.

The company currently serves more than 200 customers, including more than 60 health systems.

Photo: Nick Panion, Breaking Media