We have an adversarial, zero sum, payment system in US Healthcare. Providers spend entirely too much money trying to bill and get paid. No one is happy with it, everyone knows it’s broken, it's time it changed. No single actor created this system. Both health systems and insurers are trapped in it, fighting every day to ensure their “piece of the pie” is bigger.
There is a better way. For the first time, we have the technology to create a better future. A future where AI makes seamless, transparent transactions possible, where both sides can “win.” This is the future we built Anomaly to deliver. Every other industry already transacts this way. Healthcare can too. The market isn’t ready, but it's getting there. To accelerate it, we chose a side: health systems.
After more than two decades in this industry, I know the system’s complexity isn’t an accident. Increasingly, it is engineered. Health systems have massively consolidated, so payers are no longer able to control costs effectively at the negotiating table. They also can’t keep raising prices on employers and are facing incredible scrutiny from federal and state governments.
That leaves them with manipulating the payments themselves, at scale. They aren’t going it alone either. Payment integrity vendors are in on it, profiting from every payment insurers don’t make.
This is why health systems consistently see net negative financial impacts of negotiated wins. Payers will give it up at the table, and win it back through denials, retractions, delays and downgrades. This is a deliberate instrument of financial strategy.
Traditional RCM platforms, denial management tools, claims editing software, and a growing wave of AI-powered automation vendors have all promised to close the gap between what providers are owed and what they actually receive. None of them have because they are all trying to automate a broken system. The real promise of AI shouldn’t be faster processes. It should be eliminating the broken processes themselves.
And yet, the arms race between payer AI and provider tools continues - and in that race, the side with the structural knowledge advantage wins.
Providers know this. The intuition that the game is rigged runs through every health system CFO, every managed care director, every revenue cycle executive who has watched denial rates climb despite every investment in tools, staff, and process improvement. What they have not had is the ability to prove it systematically, at scale, in a way that changes what is possible in their conversations with payers and start winning for a change.
So today, we are announcing a $17 million raise to equip providers with a platform that gives them the intelligence to know their payers as well as their payers know them, and take action.
Anomaly’s technology is the first to catch up to the complexity of the problem. What was not humanly possible to process at scale - billions of claims, across dozens of payers, in formats that change constantly, governed by logic that is deliberately impenetrable - is now technically possible.
At the Advisory Board Company, I spent years in rooms with virtually every major health system CEO in the country — not as a vendor pitching a product, but as an advisor learning what was keeping them up at night and earning their trust. The answer, almost universally, was some version of the same thing: smaller and smaller margins, climbing denial rates, and a grinding sense that no matter how much they invested in fighting back, the fight never seemed to end.
At Optum Insights, I sat on the other side of that equation. I saw the analytical infrastructure that the payer ecosystem deploys to understand provider behavior: the data, the modeling, the systematic intelligence that informs how claims get adjudicated and how payment policies get set. It was sophisticated. It was continuous. And it was almost entirely invisible to the providers on the receiving end of its conclusions.
That imbalance never left me. And when I joined Anomaly in 2023, it was because I had finally seen the technology that could close it. Not “optimize” the system. But change the game.
Here is what that actually means in practice.
Anomaly's AI engine analyzes billions of healthcare transactions to decode how payers actually behave - not how their policy documents say they behave, but what the data shows they do. It surfaces the patterns, the policy shifts, the adjudication deviations that determine what providers actually get paid. It tells revenue cycle teams which denials are worth fighting and why (and conversely, which claims were properly denied, and how they can fix their internal processes). It tells managed care executives which payer behaviors are systematic and what the contract-level cost of those behaviors actually is.
For the first time, a provider organization can bring receipts to a payer negotiation. Not anecdotal complaints about specific denials. Documented, structured evidence of how a payer has behaved across every interaction with that organization, and the leverage that evidence creates.
Anomaly’s platform is not a denial management tool. It is not a claims editor. It is the intelligence infrastructure that the provider side of the healthcare payment equation has never had and has always needed.
The question I get asked most often - by investors, by journalists, by health system executives who have seen what the platform does - is some version of: why hasn't someone built this before?
The honest answer is that the data was always “dirty fuel” - the formats are too inconsistent, the payer logic too deliberately obscured for earlier generations of technology to process at the speed and scale the problem demands. Building an engine that runs on dirty fuel, that actually gets better as the data gets messier and more complex, took years and a specific kind of technical ambition that most companies in this space have not brought to bear.
That technical foundation is now built. It is proven. We’ve shown one large customer we could identify $18 million in annual net revenue impact in three months, and deliver 600,000 novel payer rules their existing infrastructure had never seen. We’ve helped provider organizations produce payer behavior changes that they told us were not possible before they worked with us.
We often start our customer relationships with an initial, limited term consult, recovering millions of dollars of value for them in a span of weeks. We are a company that wants our prospects to say “prove it to me” - because we will do exactly that.
That track record is what this funding is built on. It accelerates our ability to deploy that proof at scale, continue our expansion from revenue cycle operations into managed care, and give health systems the intelligence to engage their payers not just at the claim level, but at the contract level, the negotiation table, and every strategic conversation in between.
The goal here is not to demonize payers. They are operating under their own pressures and the system incentivizes both sides into an adversarial dynamic that ultimately serves neither. So, don’t hate the player, hate the game…but make sure you can win it.
The receipts are in. It's time to use them.
