Q&A: Reveleer CEO Describes Evolution of Value-Based Care Platform

In October 2024 value-based care software platform company Reveleer announced the acquisition of Curation Health, which provides clinical insights to help health systems deliver optimal care. Glendale, Calif.-based Reveleer’s CEO Jay Ackerman, recently sat down with Healthcare Innovation to discuss the platform his company is building to support both payers and providers in value-based care arrangements. 

Healthcare Innovation: Could you give a little background about the company and and how long you’ve been there? 

Ackerman: I joined the company in 2016 when the company was focused on building software to help health plans manage their annual HEDIS audits. Our intent was to bring software inside a health plan so they could take control over this critical annual program. 

But over the last eight years, we've broadened our toolset to go from focusing on the annual HEDIS audit to year-round quality improvement on behalf of their members, and to risk adjustment, which is obviously a critical component of managing value-based care programs, to member enrollment and now to clinical improvement and really moving from looking retrospectively to prospectively and trying to impact patient outcomes at the point of care.

HCI: Has your customers’ emphasis on those aspects grown exponentially with the number of value-based care arrangements they have?

Ackerman: Sure. If you look at what's going on inside of the payer, a greater percentage of their business is in these value-based care arrangements. So to succeed, they've got to understand the health burden that they're responsible for managing. And if they don't do that, they're going to get compensated incorrectly, and they're going to have a high cost burden without the revenue to support that. 

They also realize that they need to work collaboratively with their providers. In a fee-for-service world, they don't really need to have a collaborative working relationship with a provider, but in a value-based care world, it's a must, so we're, helping them be successful in managing those critical workflows. We're also helping them improve and strengthen that flow of data and the working relationship between the payer and the provider. We started in this little corner of value-based care, but our mission now is to be the technology platform for value-based care. If you follow our story over the next three to five years, you'll see a continued broadening of our tech stack to ensure that payers and providers are joining hands to support better care of members and patients. We want to be a critical component in that. 

HCI: I saw on your website that you have a chief AI and data officer. You talked about broadening the tech stack. What role is AI playing in the services you provide?

Ackerman: It's massive. So Dave Meyer, our chief data and AI leader, has  built an amazing data science and AI team. Over the last 12 months, we've, ingested 1.2 billion pages of clinical data into our platform. So Dave's team’s mission is to make sure that we have the most sophisticated tools to bring in claims data, clinical data, pharmacy data, lab data, member data, and to stitch that, collate it, synthesize it and distill it down to actionable insights at the point of care with providers or the point of action inside of a health plan, as they try to manage some of the other workflows around value-based care.

HCI: I understand you work with many large health plans, but do you also work with provider-led ACOs? 

Ackerman: Yes. This gets into our acquisition of Curation Health, which we can talk more about in a minute. So up until 2022 we were exclusively focused on addressing the needs of payers. We support national payers, regional players, payers in Medicare and those in Medicaid, like LA Care, a large Medi-Cal player here in Los Angeles. We’ve also built up a strong footprint with the Blues plans. We're really proud to now be working with close to 50% of the Blues. 

But in 2022 we started to have inbound interest from provider groups taking risk, and we weren't focused on them, weren’t thinking about how our solutions could support them. But our ears and eyes opened up, and we saw an opportunity to move into the provider space. We did that in 2022 and we took a bolder move in 20223 with the acquisition of a company, MDPortals, which works to do things similar to Curation, and by bringing in Curation Health in 2024 I think we've really built a juggernaut solution to help providers succeed in closing risk and quality gaps at the point of care.

HCI: So Curation’s focus had been working with provider groups already?

Ackerman: Yes, it was. Interestingly, they started working with mature health systems taking on risk. Baylor Scott & White's a good example of one. Then they started to shift to engage payers that had relationships with scaled provider groups in their network. A Blues plan in a state will have a couple of key provider groups that they're deeply connected to, so they would try to sell to the payer, and the payer would kind of walk them into the provider and either pay for or perhaps subsidize some of these tools and capabilities. 

We've brought these two sets of capabilities together that do a couple of things for us that are unique in the market. We have the ability to capture community clinical data, data that might sit in HIEs, because a member doesn't just go to their primary care provider. They might go into an urgent care; they might walk into an ER; they might go into a Minute Clinic. We’re able to capture that data. Curation had a superpower of connecting into large EMRs — Epic, Cerner, athena, eClinicalWorks and others. So we're able to take the community data, data from direct EMR, bring it in holistically and have a more precise view of what's going on with the patients. 

HCI: There is a shift being phased in in the Medicare Advantage risk model coding from V24 to V28. What does that involve?

Ackerman: You need to be more precise in assessing what's happening to the member. V28 introduced the need to understand prescription data, pharmacy data. You're now mapping and trying to identify the pharmacy burden, the pharmacy costs, based upon the health conditions with the member. We’re able to bring that information together to more accurately predict what's happening. 

We surface that to the provider and say, ‘Hey, we see shortness of breath may be identified in a PCP visit. We see lab results that might say that they have elevated blood sugar levels, and we're seeing pharmacy data that shows hypertension medication. We think that you really need to check this person for Type 2 diabetes, as an example. That’s what we're trying to bring together to allow a provider to be more targeted and more successful in that short visit. 

CMS is sunsetting some HCC codes that they are no longer going to reimburse for. They wanted to make sure that people are more precise in how they diagnose. And if you don't do that well, you will probably see a dip in your reimbursement. And if you follow earnings calls with the major payers over the last three to five weeks, you've seen some of that fall-out. 

HCI: Do some of these big payers have the capabilities to do this work that you're describing in-house? 

Ackerman: Traditionally, I would say that the majority of them have relied upon tech-enabled service providers to support them, but they do have large teams of clinically trained people to review these medical records and understand what's going on. We are trying to drive a massive change in productivity, so you don't need an army of clinical reviewers. We're seeing really strong demand from all sizes and types of payers. We're talking about the health of their members. We're talking about mission-critical work streams for them that, if they're mishandled, can create tremendous disruption.

HCI: I noticed that in the beginning of this year, you guys raised over $65 million in new capital. You’ve described a few acquisitions. Could there be more acquisitions down the road?

Ackerman: We've made three acquisitions since April of 2022. All of them have been product-driven, where we see adjacent technology that aligns with the way we think about how to serve a payer or now providers. We have to think about how the data flows back and forth. We have the Reveleer data lake that sits at the core. The companies we have acquired, their data all sits at rest inside of our core repository. We absolutely do remain active in considering future opportunities, and I expect that we will do something again as we turn the page and enter 2025.