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Moe Alkhafaji – Discovery Health Partners

Working to answer the question: Who pays?

A technologist by profession and education, Moe Alkhafaji has a passion for technology and problem-solving. But he acknowledges that, in his younger days, his goal was to “start a company to build something cool and make money.”

That inclination led him to design and develop an intelligent decision-support engine using contextual patient data—medCPU Advisor—that, when deployed in Africa, saved the lives of newborns and prevented mother-to-child HIV transmission.

Moe Alkhafaji – Discovery Health Partners

“Early success through medCPU gave me a different perspective,” says Alkhafaji, who holds a master’s degree from the University of Chicago. The focus moved to, “let’s build something cool with a purpose. It created a different meaning to building software.”

Tackling the health care payment quandary

From that point on, Alkhafaji decided to participate only in startups that were focused on making a positive impact. Today, he is the chief information officer for Discovery Health Partners, whose technologies take on the health care payment domain.

Based in Itasca, Illinois, Discovery offers payment and revenue solutions that examine claims and member data and help identify the correct payer (or order of payers). The company serves more than 70 health care clients, including six of the largest health payers in the nation. Discovery Health Partners is dominant in the Medicare Advantage market, as well.

Moe Alkhafaji – Discovery Health Partners

“Finding out appropriate coverage is not a straightforward exercise,” Alkhafaji says. “Payers (health insurance companies) pay for claims submitted from providers (physicians and hospitals), then they waste 10 to 20 percent of the original claim amount paying for resources to analyze the accuracy of the payment.” Those costs are then indirectly funneled down to patients through higher premiums or deductibles, he says.

Discovery’s case identification algorithms and analytics help to expand claim investigations by looking at eligibility factors related to patient demographics, claims data, coverage at the time of care, along with many other factors.

By identifying payment liability more effectively, Discovery’s clients can avoid excessive costs, eliminate waste and overhead, and improve revenues and operations, Alkhafaji says.

Looking ahead, Discovery is developing an expanded eligibility product suite, and is also building innovative technology solutions that can help payers administer their Medicare Advantage populations more efficiently and more cost effectively.

Celebrating its 10th anniversary in 2018, the company is poised for significant growth—both “inorganic and organic”—and has been named among Inc. Magazine’s 5,000 fastest-growing private companies for five years in a row.

Innovating, improvising, saving lives

Joining Discovery in 2017, Alkhafaji leads technical initiatives. These include optimizing operations; automating repetitive and expensive processes; creating and contributing to new business capabilities; implementing new products to expand Discovery’s portfolio; and establishing requirements and controls to secure clients’ data.Moe Alkhafaji – Discovery Health Partners

“I’m a data person—the role at Discovery is exciting for me because it provides me with an opportunity to improve big data ingestion and transformation pipelines through the use of cutting-edge and novel technologies,” he says.

He is particularly influenced by his experience launching startups—most notably medCPU, which he launched in 2008 while working as a software engineer, after shifting his focus from trading and securities to the health care space.

As he explains, medCPU offers a contextual natural language processing (NLP) and decision support engine for hospitals. Basically, it is a “virtual doctor advisor” offering real-time information and access to the most up-to-date clinical guidelines and best practices.

In working on a contract with a hospital system out of New Jersey, medCPU’s team was asked to pilot the technology in Botswana, which has one of the highest HIV rates in the world. Over a period of roughly six months, the medCPU Advisor eliminated 70 percent of HIV mother-to-child transfers and saved the lives of 50 percent more children. This first client was the toughest, he recalls, but he kept reminding himself and others around him that, “if it were easy, everyone would have done it.”

Alkhafaji was also a co-founder of CancerIQ, which offers an easy-to-use cancer risk assessment web-based portal. It was built based on the notion that clinics did not have access to the latest and greatest cancer research, including more diversified sets of risk assessment scoring algorithms.

Alkhafaji points out that, while billions of dollars are spent regularly on cancer research, there is no effective channel to make this data available to clinics and no “feedback loop” from real-world clinical scenarios and their outcomes.

All told, he says of his contributions, “I like the opportunity to be able to innovate and improvise in approaching new business models and new innovative solutions,” he says.

And he likes helping people pay less for health care, too.

Published on: January 3, 2019

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