Diaspora's Promise: Accelerating AI Diffusion in US Healthcare

The story and success of modern mankind is really the story of technological innovation. Following the introduction of the printing press in 1440, cities that adopted the technology had 60% higher economic growth than those that didn't. Before the Industrial Revolution, it would have taken over a thousand years at the historical growth rate of 1.5% for the global economy to double. Following this, it has doubled on average every 50 years. In 15 years, the internet revolution increased real GDP per capita by $500 per person, a feat that the former industrial revolution took 50 years to achieve. In all of these cases, the technological revolution not only defined a generation but also improved the quality of life for all humans. This takes us to the current moment: The Age of Intelligence.

No one knows exactly what is going to happen in the age of intelligence, but one thing is certain: it is going to transform every industry. Whether it is autonomous supersonic jets, manufacturing robots, or driverless vehicles roaming the streets, it will severely impact how humans live their lives. We believe there is no place that is more profound than health care. Historically, healthcare has been a laggard in adopting new technology. This is due to a combination of factors, including high amounts of compliance, the fee-for-service reimbursement model, old operating systems, and complex interoperability constraints. For example, EHRs, which are essentially CRMs for healthcare, were adopted only after the HITECH Act in 2009, roughly a decade after other industries adopted similar technologies. We believe the diffusion of AI will happen much quicker in healthcare than prior technological shifts because of the advantages it gives patients and providers, even under the fee-for-service model, for the following reasons:

1. Financial incentives: A National Academy of Medicine report estimated that the US spends about twice the necessary amount on billing and insurance-related costs, roughly $248 billion in excess spending annually. Even under the fee-for-service model, AI produces measurable cost savings for providers.

2. Burnout: According to an Athenahealth survey in 2024, 93% of physicians reported burnout, with 49% citing an overly large administrative workload. AI will cut this down and improve patient care.

3. Unifying Data: Healthcare has historically had many siloed, legacy systems. AI can serve as an intelligence layer over all of them, providing providers with intelligence on separate unstructured data.

We believe these impacts of AI will be especially strong within behavioral health, and more specifically, within behavioral residential health. A 2023 survey by the National Council for Mental Wellbeing found that more than 9 in 10 workers in behavioral health experience burnout. This is mostly due to work-related stress, such as administrative burden. Behavioral residential facilities also face an acute problem in estimating what reimbursement will be. Behavioral residential facilities are largely out of network due to low in-network payouts, and claim payout information is siloed in EHRs or clearinghouses, with no unified layer. The combination leaves behavioral residential facilities open to employee turnover and also financial ruin. This is what Diaspora is looking to solve.

In the immediate term, Diaspora solves many of the financial issues facing behavioral residential facilities. By aggregating claims reimbursement data from various clearinghouses, Diaspora can provide behavioral residential facilities with an accurate picture of what insurance will pay per day, per level of care, and per HCPCS code, rather than taking patients in blind. Even understanding a single patient's reimbursement can save behavioral residential facilities thousands of dollars per month in revenue leakage. Diaspora also provides instant insurance verification via APIs for VOB checks. This saves providers time on insurance verification calls, which can take up to an hour. Having an accurate picture of what insurance reimbursement will be per day also prevents patients from holding the bag; in many cases, patients are the ones hit hardest by surprise charges due to insurance reducing reimbursement for care.

In the long term, we plan to reduce the administrative burden on behavioral residential facilities by redesigning the RCM workflows. Providers will be able to hire a team of AI agents that will handle: VOBs, prior authorizations, submitting claims, remittances, and denial adjudication—all through our proprietary system. No longer will behavioral residential facility providers have to call insurance companies, submit prior authorizations, or understand the logic behind denials. All this will happen autonomously within our system, and providers will only need to click a button. Providers will be able to focus on what matters most: providing the highest quality of care to their patients.

There's also a financial incentive for providers. Currently, over 90% of behavioral residential facilities outsource their RCM operations to third-party billing companies. These companies tend to take an increasingly high margin, sometimes taking 6% to 8% of reimbursement revenue. We believe that we can also do these RCM workflows, but at a fraction of that cost. This will improve the bottom line for already margin-sensitive behavioral residential facilities by allowing them to put more capital into improving patient care.

To conclude, we know that adopting new technology can be scary. Whether it was the printing press, the steam engine, or the internet, in all these prior technological revolutions, the diffusion of technology can seem abstract. In all these waves, the beneficiaries were those who adopted early and made it part of their daily lives. We're on a mission to ensure behavioral health is one of the beneficiaries of this adoption curve by saving operators time and improving bottom lines. If this resonated with you, email us at joindiaspora.ai.

— Diaspora Team