Santa Ana-based Advantmed LLC aims to help doctors get paid in the wake of reform-fueled changes in payment processes.
It’s a health information management company that offers products and services, such as software, data collection and analysis. It also recently branched into helping doctors coordinate healthcare through management of care plans and by providing electronic communication for their chronically ill patients as required by the federal Center for Medicare and Medicaid Services.
The company’s main goals include helping doctors and providers “optimize their revenue,” or making sure they are fully paid while improving quality of care, according to founder and Chief Executive Akash Patel.
“There’s this transition [to] value-based reimbursement for care, so we’re at the center of it. … The health plans and the government [are] saying, ‘I’m going to pay you more if you show me quality’” as defined by whether a patient gets better, Patel said in an interview last week.
Advantmed works with a variety of health plans, including commercial plans, Medicare Advantage, health insurance exchanges, Medicaid and accountable care organizations. Health plan clients come mainly from referrals; Patel said he couldn’t give specific names for contractual reasons.
Its role is influenced by how a particular contract is structured, he said.
Advantmed’s efforts include collecting medical records and clinical data from health plans and putting the data through its algorithms to check things such as whether a diabetic patient is getting eye care.
“Depending on what the contract with the health plan is, we can call that member and get them to go see their [doctor],” Patel explained.
Advantmed also collects data and gives it to its health plan clients or collects and analyzes without patient engagement, depending on contract structure.
The company is in a market that tends to be regional in nature and includes several publicly traded companies, such as Inovalon Holdings Inc. in Bowie, Md., and Jersey City, N.J.-based Verisk Analytics Inc., which is in the process of selling its healthcare business to New York private equity firm Veritas Capital.
It now employs about 1,700, with 80% in overseas locations, such as the Philippines, India and Puerto Rico. Patel noted, however, that health plan member and provider engagement functions are done domestically, while the offshore jobs involve extraction and analysis of data.
About 50 people work at Advantmed’s corporate office on East Garry Avenue.
Patel estimates that his privately held company will have $25 million to $50 million in revenue this year and said the company is profitable, though he wouldn’t elaborate.
Advantmed was established in 2005 by the certified public accountant and alumnus of California Polytechnic State University-Pomona who previously served as chief financial officer at Irvine-based consumer electronics company Aluratek Inc.
Advantmed started out primarily in medical records retrieval and clinical coding, doing business under the name RecordFlow.
“Two years ago, we realized that we were doing more than collecting [medical records],” Patel said, prompting the company to drop RecordFlow and use the Advantmed name exclusively.
“Clients and employees have already gravitated towards us because of our growing service offerings,” Patel said at that time, adding that the company is now “so much more than a medical record review vendor.
“Now that we’ve grown, we’ve decided to invest in branding and messaging.”
