Can you talk about the inception of Exponential AI? What were the factors that contributed to the emergence of the firm?  

Exponential AI was founded in 2016 by leading healthcare and AI experts to apply AI to solve the toughest problems in healthcare, focusing on enabling delivery of care at scale.  At that time, like most other industries, Digital Transformation was the primary focus of healthcare organizations.  However, we realized that traditional rule-based approaches would not sufficiently support these digital transformation efforts. With new realities such as consumerization of healthcare, shift from reactive to proactive care and the tremendous amounts of data being generated, you need technologies like AI that are more robust, flexible, and dynamic to be the cornerstone of this digital transformation. With AI as the foundation, we were sure to deliver better cost and quality outcomes for healthcare.   

What are the current pain points Exponential AI is trying to address for its clients? 

Healthcare organizations are constantly looking to apply new technologies such as AI to digitally scale their processes to succeed in this new customer-centric ecosystem. While AI promises great results, it’s quite a struggle to get there. Organizations face challenges with solution design, solution orchestration, and productionizing and often have little clarity on speed to market, expected value and time-to-value. More importantly, organizations mostly use AI as a predictive tool, seriously restricting its potential. AI used for decision-making can change how healthcare processes are currently run and transform them into autonomous processes that deliver better cost and quality outcomes at scale.   

While today AI is witnessing accelerated adoption within healthcare, using it for decision making remains a challenge. For AI to be used for decision making, it needs to be used in collaboration with rules, optimization and other decision-making techniques and embedded into processes as Decision Intelligence. Building, training, and managing decision pipelines is complex and operationalizing it even harder. This stems from the limited capabilities in orchestrating complex systems, lack of the necessary decision infrastructure and complexities in monitoring and maintaining these systems. To solve these challenges, we offer Enso, a healthcare AI platform that delivers pre-trained decision agents that enable autonomous processes at scale.  

Among the emerging trends, which are the ones that have kept you interested and which among those according to you could make a significant impact in the coming future? 

We are excited about the overall direction in which healthcare is changing. There’s a shift towards proactive, preventative approaches and an increasing share and acceptance of digital care delivery.  AI solutions are going to be crucial to these efforts.  

Similarly, as personalized treatments find wider adoption, health systems will need to scale decision-making across administrative and clinical functions. AI will play a critical role in the success of personalized care delivery. 

Even with AI adoption, interesting changes are happening; investments concentrated in care delivery are now going to administrative simplification of operational, corporate functions.  That is something that we are very keen to enable.  

How does your Enterprise-grade AI platform ENSO help in achieving business transformation for your clients? Kindly elaborate. 

As we talked about earlier, there is a need for healthcare organizations to run smarter autonomous processes that can continuously adapt and respond to changing business needs while continuously improving on efficiency and cost metrics.   

We enable this transformation through our platform Enso, which simplifies the building, training, orchestration, and management of decision agents, essentially intelligent digital workers who can be trained to make decisions like humans. Our decision agents can comprehend any kind of data, are flexible to training on client-specific data, are reusable across processes that use similar data and continuously learn from feedback and transactional patterns.  

Enso comes with several prebuilt, pre-trained agents that can easily be assembled along with custom-built agents to build Decision Intelligence solutions that deliver autonomous processes. Unlike human-intensive processes, decision agent-driven processes easily scale to current and future needs and enable true digital scale for modern healthcare organizations.  

Kindly elaborate on the impact that your solution Audit is creating for your clients in the healthcare sector? 

Our Audit solution enables payers to scale their audit capability from a sample-based audit to a 100 % claims audit using AI algorithms. It also allows them to move from postpay audit to prepay audit and reduce revenue leakage. More importantly, the learnings that are available through audit can be applied to prepay processes such as adjudication and payment integrity to improve accuracy and processing efficiencies. It can also be applied to provider environments to cut back on administrative costs related to rebilling, rework, and denial management.  

How does your solution Payment Integrity help combat fraud and ensure timely and accurate payments for your clients? 

Our Payment Integrity suite of solutions focus on improving payment accuracy and reducing waste and fraud in the healthcare environment. Our Decision Agent-driven PI solutions continually learn from data, decisions, and feedback to offer new insights on potential savings across the prepay and postpay Payment Integrity Value Chain. We help clients predict savings and reduce a huge amount of administrative and clinical waste from the healthcare system.      

It takes a lot to be ahead of the curve all the time. What does it take for Exponential AI to consistently be on the top and surpass client expectations with your innovative product portfolio? 

Our platform is very easy to use and empowers clients to own their AI journey by building, deploying, and managing AI solutions themselves. We are also investing in platform capabilities and assets to further simplify and accelerate adoption for our clients. For us, this means we are building and training decision agents for both domain-agnostic functional processes and domain-specific operational processes. These agents can be embedded and extended within current systems to solve the most pressing problems in healthcare.  

Our approach also enables us to be fast with product innovation and lets us introduce new use cases to market and client environments in quick cycles.  

What are the differentiating factors that separate Exponential AI from the rest in your marketplace? 

Our biggest differentiator is that we are the only Healthcare focused enterprise AI platform. Most competitive AI offerings are either point solutions or horizontal platforms.  We have a unique decision agent approach that enables collective knowledge to be shared, retained, grown, and leveraged within multiple solutions across transactional, operational, clinical, and corporate functions.  

With our technology, organizations can now execute evidence-based decision-making that is connected and contextual, accelerate the automation of complex enterprise processes, and continuously gather feedback to nurture and curate strategic and operational knowledge from the models they operate across the enterprise.   

What I think is also worth mentioning is that we are one of the few platforms that enable scale in real-time transactions. Doing things in real-time is needed if we are to change our current healthcare processes from being retrospective and reactive to prospective and proactive.  

One other advantage we offer clients is greater control over their operations. Many healthcare processes are vendor-driven or operate in silos with little to no transparency and insight on what’s being done and how. By allowing organizations to validate such processes or replace them with autonomous ones, we enable Whitebox operations, where spending typically drops but quality improves.  

How has Exponential AI managed to cater to various industry requirements? Kindly talk about the innovation and design behind the founding of your product portfolio. 

There’s a lot of complexity in the healthcare industry due to regulation, the increasing variety of care touchpoints, and a large number of players. Health systems are quite fragmented as well; there are thousands of hospitals and physician groups, and payers. This fragmentation can drive errors and misspending due to the sheer number of coordination and transaction points among multiple organizations. Besides fragmentation, regulation is the other main driver of complexity.  The US healthcare system is highly regulated. So, there is a lot of administrative spending for compliance adherence, and this often becomes another layer of expense into which inefficiencies and errors can creep.  

AI can have a transformative impact here. It can enable simplification, cost avoidance and savings. For that reason, we have focused on innovation and transformation of PI and Claims functions. We have seen fantastic results across Claims Adjudication, Coordination of Benefits, Claims Audit, Payment Integrity, Contract Management, Utilization Management etc.   

Kindly tell us about any client testimonials Can you give us an example/illustrate how your platform/solutions catered to your client’s needs and challenges and what was the change experienced by your client? 

In one instance, a Fortune 50 company approached us to assist in applying AI to transform a process in their Claims Value Chain. Upon onboarding the client, we helped them build an AI-driven solution that delivered on their savings expectation in less than 6 months.  

With this success and the opportunity to replicate this success across processes, they chose the platform to be their one-stop destination for all things AI and, they went on to build and manage over 30 solutions.  

Moreover, more than 80 per cent of those solutions were built by the client’s internal team. The client was able to scale their AI solutions across processes in 18 months with Exponential AI’s Enso. Our platform enabled them to build AI solutions three times faster. They could launch more solutions than they planned and generate more ROI from AI solutions.  

What is the roadmap for Exponential AI from here on? 

Moving ahead, we will build on the momentum for AI adoption… it’s grown substantially since COVID. There are going to be more scaled AI implementations in the future through our platform, and we are working hard to enable that. We have several robust features in pipeline and plan to augment the platform in the next two years. Also, we will continue to focus, investigate, and solve for challenges that engineering and data teams face in adapting AI to their business environment.  

As a business, we have continuously grown these past few years and our clientele has doubled in size. It has helped us attract top industry talent and also to have a strong presence in the Fortune 500 segment. In addition to that, we have built strategic partnerships with several global systems integrators and consulting groups specialized in niche areas of Healthcare. Multiple technology and industry associations have also recognized Exponential AI’s contributions and innovation.  

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