Desjadon highlighted the extraordinary complexity of the healthcare system, particularly its reliance on coding and claims. The U.S. is unique in requiring clinicians to justify procedures to payers—whether insurers or the government—through a labyrinth of codes. With 4.5 trillion combinations of codes in use, the system is riddled with inefficiencies that delay care and obscure costs.
Anomaly’s AI-driven platform connects directly to healthcare providers' data systems to interpret claims, analyze how payers respond to codes, and anticipate approval or denial outcomes. This creates transparency by helping providers understand in advance what insurers will cover. By identifying discrepancies between expected and actual payments, Anomaly ensures providers are accurately reimbursed while reducing administrative burdens.
Administrative costs in the U.S. healthcare system account for $300 billion annually. Desjadon compared this process to “cogs in a broken wheel,” where inefficiencies pile up through layers of third-party interactions and paperwork. By streamlining these transactions with AI, Anomaly helps providers avoid costly delays and missteps, ultimately driving down overall system costs.
While Anomaly's current focus is business-to-business, Desjadon envisions a future where consumers directly benefit from improved accuracy and transparency. He described a scenario where patients could know upfront what their insurance covers and what they owe, akin to shopping for groceries where prices are clear at checkout. For now, Anomaly works behind the scenes to ensure the billing process is seamless for patients.
Looking ahead, Desjadon outlined his vision for a healthcare system without claims—a revolutionary model where procedures and payments are seamlessly handled without the need for back-and-forth paperwork. This would make the process more transactional and transparent, where patients know exactly what they’re getting and how much it will cost before undergoing a procedure.
Desjadon remains optimistic about the role of AI in transforming healthcare. By addressing inefficiencies, increasing transparency, and leveraging data in innovative ways, Anomaly aims to create a more equitable and functional healthcare system for providers and patients alike. While the ultimate vision of a claims-free system may take time, Desjadon believes it’s a feasible and necessary goal within the next five years.
