Pluto Health expanding payer partnerships to address care gaps

Artificial Intelligence-enabled health services company Pluto Health is partnering with payers and expanding its payer relationships, in an effort to extend its care model to patients with a wide range of insurance coverage. 

The company now has relationships with Medicare, Medicaid, and major commercial plans, such as UnitedHealthcare, Aetna, Blue Cross Blue Shield, Ambetter and Cigna in select states. 

"There is rampant misuse, overuse and underuse of health resources due to lack of visibility. For those with unmet health needs, especially those with chronic conditions or limited access to consistent care, tools like Pluto are imperative to delivering accessible options for people," said Dr. Joy Bhosai, founder and CEO of Pluto Health. 

Pluto shared KFF research showing nearly half of adults agree that it's difficult to afford healthcare, leaving many patients concerned about out-of-pocket expenses or unforeseen medical bills. 

Because of this, over one-third of people postpone receiving care, exposing those patients to worsening health outcomes and more severe conditions, such as comorbidities.

Pluto said it's helping patients mitigate costs and improve their access to preventative care.

According to the company, many patients are unaware that insurers cover preventive services, such as screenings, vaccines and wellness visits at no cost. Pluto said it will connect patients to critical services they may not know are already covered under their current plan, or are available at a low cost.

Insurers then reap the benefits of more efficient operations through automation of care alerts, scalable patient outreach via AI-integrated clinical workflows, and data-driven tracking of gap closures and outcomes, said Pluto.

Pluto Health unifies fragmented health data – including medical, pharmacy and social factors – to identify care gaps. From there, its artificial intelligence models facilitate personalized action plans and evaluate if patients are meeting guideline-based care. That may include assessing for overdue cancer screenings, at-home labs, referrals to speciality care, chatting with a clinician in real-time or medication reconciliation.

These partnerships come on the heels of Pluto's latest launch, the announcement of its C.A.R.E. On Deck offering last month.

Patients can use C.A.R.E. – Connect, Assess, Review and Engage with health information from various sources to view options for care such as clinician chats and telehealth visits.