Meet the startup using AI to reduce healthcare’s trillion-dollar administrative burden

Anterior, a clinician-founded healthtech startup, has raised $20 million in Series A funding to address inefficiencies in U.S. healthcare delivery. The round was led by New Enterprise Associates (NEA), with participation from existing investors including Sequoia Capital.

Founded by Dr. Abdel Mahmoud, a physician with a background in computer science, Anterior aims to use artificial intelligence to streamline health insurers’ prior authorization processes. The company’s AI system acts as a “co-pilot” for nurses reviewing medical records, potentially increasing productivity from 10 cases per day to 20-30.

“Our mission is very much (to reduce) the trillion dollars spent on administrative processes, half of which is spent by payers, which we’re going to focus more on,” Mahmoud explained in an exclusive interview with VentureBeat.

From Fax Machines to AI: The Technology Behind Anterior’s Healthcare Revolution

Anterior’s technology combines narrow AI systems with large language models to handle unstructured medical data. “What we’ve really done is combine the decades of progress we’ve made in AI with some of the energy that large language models bring, bridging these unstructured environments,” Mahmoud told VentureBeat.

The company’s approach involves three key elements: structuring unstructured medical records, converting complex clinical criteria into computer-executable logic, and applying clinical reasoning to make initial decisions that are then verified by human nurses.

Although initially focused on prior authorizations, Anterior sees potential applications in other areas of healthcare administration, including care management, payment integrity and claims adjudication.

“Anywhere a company hires a doctor not to provide care but to make business decisions … that’s a place where they’re paying for some kind of clinical reasoning work,” Mahmoud said.

Clinicians Turned Engineers: Anterior’s Unique Approach to Building AI for Healthcare

One of the unique aspects of Anterior is the integration of clinical expertise into its technical teams. According to Mahmoud, about half of the company’s staff are clinicians or have clinical training, including some who have transitioned into AI engineering roles.

The funding comes at a time when the healthcare industry is facing staff shortages and rising administrative costs. If successful, Anterior’s technology could significantly reduce the time and resources insurers spend on administrative tasks, potentially leading to cost savings across the healthcare system.

However, the company will need to navigate complex regulatory environments and gain the trust of healthcare providers and insurers to expand its reach. With AI playing an increasingly important role in healthcare decision-making, ensuring accuracy, security, and transparency will be crucial for companies like Anterior.

With this new funding, Anterior is well-positioned to expand its operations and bring its AI-powered solutions to more health insurance plans in the United States. As the healthcare industry continues to digitize and seek efficiencies, startups that can effectively combine clinical expertise with cutting-edge AI technology can find significant growth opportunities.