The Partnership will fund new products, expand the number of insurers and policies Penelope covers, and move coverage determination upstream to the point of care

NEW YORK: Penelope Health (“Penelope”), a real-time provider and payer policy intelligence platform, today announced a partnership with Thoreau, which is building healthcare’s foundational compute, rules, and research infrastructure platform, to create a shared infrastructure layer for real-time payments and clinical rules. Thoreau, along with other investors, has committed $100 million in funding to Penelope. Penelope will use the capital to create new products that bring administrative efficiency to navigating payer requirements. Additional investors include existing backers Bertelsmann Healthcare Investments (BHI), Twine Ventures, and Seedcamp.

Payer coverage policies, prior-authorization requirements, medical-necessity criteria, and coding rules are spread across thousands of sources and change continuously, creating costly administrative work for healthcare organizations and delays for patients. Removing that work, and understanding what insurance companies require before care is delivered, rather than after a claim is denied, returns time and attention to the clinicians and staff. Of the $5.3 trillion spent on healthcare in the United States each year, administrative activities account for approximately one-quarter. We believe that a significant majority of that administrative spend can be automated. Penelope’s platform covers policies for over 200 million Americans, spanning more than 15,000 procedures and drug codes.

Penelope was founded by Dr. Sohum Patel and Mattijs De Paepe, who started the company after seeing how much of the work in healthcare goes into determining what is covered rather than delivering care.

“The rules that determine whether care is covered by insurance are foundational to the healthcare system, yet they remain opaque, fragmented, difficult to interpret, and are constantly changing. Penelope was founded to turn that complexity into a dependable, up-to-date reference that healthcare companies can use in real time,” said Dr. Sohum Patel, Chief Executive Officer of Penelope Health.

Penelope converts this complex web of disparate data into a single infrastructure layer for healthcare. The platform enables healthcare companies to check coverage requirements, compare policies across payers, and streamline their internal operations, providing organizations with instant, structured access to payer medical coverage policies across the majority of insured Americans.

Mattijs De Paepe, Chief Technology Officer of Penelope Health, added, “Realizing our vision requires a deep technical understanding of constantly evolving payer rules. We are excited to build the infrastructure for AI to power a more efficient healthcare system. The opportunity extends far beyond any single workflow. We believe that a shared infrastructure layer can remove administrative burden for both payers and providers.”

Penelope is building the platform where those rules live, replacing the custom, one-off connections and manual searches for policy information today, with a single connection any system can use. That removes work providers and insurers currently do and gives teams on both sides dependable data to build on.

The partnership will support Penelope’s growth and future initiatives, including new products, coverage of more insurers and more types of policy, and further investment in its platform.

About Penelope

Penelope Health tracks the coverage rules U.S. health insurers publish and turns them into structured data that providers and payers can use directly, through an API and through endpoints that AI assistants can query. Penelope gives both sides instant access to the rules governing coverage for the majority of insured Americans, removing administrative burden from both sides of the provider-payer ledger. For more information, visit https://penelope.health/.

Penelope was co-founded by Dr. Sohum Patel, Chief Executive Officer, and Mattijs De Paepe, Chief Technology Officer. Before founding Penelope, Dr. Patel practiced in both inpatient and outpatient settings in the UK’s National Health Service at the Royal Free London and University College London hospital systems, where he saw firsthand how administrative complexity interferes with patient care. Mr. De Paepe leads the Penelope intelligence platform’s development. He previously spent nearly four years at Via Transportation, where he built machine-learning systems for the company’s transit products.

About Thoreau

Thoreau is a technology platform that creates, invests in, and acquires platforms across provider, payer, employer, life sciences, and government markets. Focused on building healthcare’s core compute, rules, and research infrastructure, Thoreau’s initial platform partnerships include Ensemble Health, which manages over $55 billion in net patient revenue, and Penelope Health. Thoreau’s mission is to simplify the administration of healthcare, and improve and extend the lives of patients in the U.S. and globally.

Fonte: Business Wire