Tech Startup OODA Working With Insurers Toward Real-Time Claims Payments

Giving patients the capability to pay for healthcare upfront is typically hamstrung by the claims process. OODA Health aims to change that.

Tech startup OODA Health is working with Blue Shield of California to build a cloud-based software platform to provide real-time claims payments to healthcare providers immediately after they deliver care to patients.

"OODA is partnering with payers and providers to create a system of real-time payments," Sophie Pinkard, OODA Health's cofounder and Head of Product, tells HealthLeaders via email. "Our goal at OODA is to address the $500B spent in the US every year just to move money between payers and providers."

Blue Shield and OODA Health plan to roll out the new technology as a pilot program with Dignity Health and Hill Physicians in Oakland.

Giving patients a way to pay their healthcare bills up front is a key element that hospital revenue cycles need to employ to catch up with the larger healthcare consumerism trend.

But giving patients that capability is typically hamstrung by the claims process. OODA Health aims to change that.

"We believe that the doctor's office or hospital payment experience should be like checking out of the grocery store," Amanda Wardell, media relations manager for Blue Shield of California, tells HealthLeaders via email. "Everything is settled when you walk out the door."

Wardell says that Blue Shield is in the early stages of its collaboration with OODA Health, designing the pilot program "using our deep understanding of the claims process, paying special attention to the pain points of insurers, providers, and patients."

Blue Shield is also providing a $1.5 million equity investment to OODA Health and says its ownership stake in OODA Health may increase pending the results of the claims payment pilot project. In addition, OODA Health has successfully raised $40.5 million in its Series A fundraising round.

"We believe that reducing the time and money required to submit and pay claims will enable payers and providers to dedicate those resources to patient care instead," Pinkard says.

OODA Health's strategic partners include Anthem, Blue Cross Blue Shield of Arizona, Blue Shield of California, Zaffre Investments, a subsidiary of Blue Cross Blue Shield of Massachusetts, Dignity Health, and Hill Physicians.

Stay tuned next week when HealthLeaders publishes a more in-depth discussion with Dignity Health and OODA Health about the pilot's revenue cycle implications.