Medicare Advantage-in-a-box startup running in Amazon cloud

Medicare Advantage is now so big that startups are being formed to sell software and services to other startups as a go-to-market strategy.

Digital health startup nirvanaHealth on Monday launched Aria Medicare, a cloud-based platform designed to serve as a one-stop-shop for a fast-growing and lucrative privatized government program for seniors. Aria Medicare claims to use artificial intelligence and machine learning to automate the administrative, financial, and medical operations of Medicare Advantage plans, and uses tools to oversee risk adjustment. The company claims that its system manages sales of Medicare Advantage payers and general and administrative costs of less than 8% of the total premiums collected. By outsourcing and automating these functions, the company said, insurers can improve their quality ratings and reduce operating and patient costs by improving outcomes.

“Using our cloud-based Aria platform, we can streamline Medicare Advantage operations from start to finish for any health plan, whether new to Medicare Advantage or a major operator,” CEO Ravi Ica said in a press release. “The architecture facilitates flawless adaptation.”

NirvanaHealth was unable to respond to the interview request on time.

But the company was founded in 2013 to offer software as a service to payers and managed care companies. It operates as an independent holding company under RxAdvance, which was launched by former Apple and PepsiCo CEO John Scully to offer a cloud infrastructure platform for pharmacy benefit managers. Scully is the chairman of Aria Medicare nirvanaHealth.

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“This is truly a Medicare package,” Scully said in a press release. “No other single platform on the market today can manage Medicare Advantage as comprehensively and intelligently as Aria.”

Startups that help larger healthcare companies fill technology gaps are increasingly attracting investor interest.

In September, Amazon Web Services announced a program that healthcare systems can use to automate patient communications, making it easier for hospitals to market to individuals and remind them of appointments. The company also recently made Health Lake available to all customers, allowing healthcare systems to aggregate individual patient data across systems and use AI and machine learning to create public health programs.

In June, former Athenahealth CEO Jonathan Bush launched Zus Health, a medical record data platform and software service product that healthcare providers can use to build their own workflow applications. Bush stepped down as head of Athenahealth in 2018 after reports of violence against his ex-wife, as well as allegations of sexual harassment and inappropriate behavior, surfaced.

Last November, the Capable Health program was launched, which provides the infrastructure to help healthcare system developers create applications for patients.

Aria Medicare is now focusing on building infrastructure for Medicare Advantage operators. Its launch comes as more payers, providers and technology companies enter the Medicare Advantage marketplace, which is increasingly attracting investor interest.

In 2021, at least three new venture-backed plans entered the market: the Clever Care Plan, which raised $ 103 million to offer Medicare Advantage for Asian Americans; Troy Medicare, which raised $ 21.3 million; and Zing Health, which raised an unknown amount of funding, according to the Chartis Group.

Ochsner Health, Louisiana’s largest provider system, announced last week that it is launching its Medicare Advantage plan.

In early October, Devoted Health announced the completion of a $ 1.23 billion Series D funding round, bringing the Medicare Advantage insurtech estimate to $ 11.5 billion.

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