The ‘Medicare Advantage-in-a-box’ startup that runs on Amazon’s cloud

October 18, 2021


Medicare Advantage is now so big that startups are forming 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 that aims to serve as a one-stop shop for the fast-growing and lucrative privatized government program for seniors. Aria Medicare claims to use AI and machine learning to automate Medicare Advantage plans’ administrative, care management and financial operations, as well as use the tools to oversee risk-adjustment. The company claims its system manages Medicare Advantage payers’ sales, general and administrative costs for less than 8% of the total premium collected. By outsourcing and automating these functions, the company says it helps insurers improve their quality ratings and cut plan operating and patient medical expenses through improved outcomes.

“By leveraging our cloud-native Aria platform, we can simplify Medicare Advantage operations end-to-end for any health plan, whether it be a newcomer to Medicare Advantage or a large carrier,” CEO Ravi Ika said in a news release. “The architecture facilitates flawless onboarding.”

NirvanaHealth was unable to respond to an interview request by deadline.

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

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“This is truly Medicare Advantage-in-a-box,” Sculley said in a news release. “No other singular platform in the market today is capable of managing Medicare Advantage as comprehensively or intelligently as Aria.”

Startups that help bigger healthcare companies fill the technology gaps have increasingly been attracting investor interest.

In September, Amazon Web Services announced it was launching a program health 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 for all customers, allowing health systems to aggregate individual patient data across systems and use AI and machine learning to build population health programs.

In June, former Athenahealth CEO Jonathan Bush launched Zus Health, a health record data platform and software services product that healthcare agencies can use to build their own workflow apps. Bush stepped down as head of Athenahealth in 2018 after reports of violence against his ex-wife surfaced, along with allegations of sexual harassment and inappropriate conduct.

Last November, Capable Health launched to provide the infrastructure to help health system developers build apps for patients.

Now Aria Medicare is focusing on building the infrastructure for Medicare Advantage operators. Its launch comes as more payers, providers and tech companies enter the Medicare Advantage market, which is increasingly capturing investor interest.

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

Last week, Louisiana’s largest provider system Ochsner Health announced it was launching its own Medicare Advantage plan.

In early October, Devoted Health announced it closed a Series D funding round of $1.23 billion, bringing the Medicare Advantage insurtech’s valuation to $11.5 billion.