Category: Digital Health

HLTH 2025 Recap and Major Announcements

Posted on by Jason Barry

Hard to believe that was already Digital Health Wire’s fourth trip to HLTH – a few more flights out to Vegas and we might be getting close to “legacy media” status.

The more the conversations change, the more they stay the same. Last year’s “Be Bold” theme and LLM mania gave way to tales from healthcare’s “Heroes and Legends” and an AI agent avalanche.

The industry is still facing most of the same challenges, but it was amazing to see how quickly new innovations are compounding in the solutions that it’s using to conquer them.

Here’s our (non-exhaustive) roundup of some of those solutions from the expo hall:

  • Arbital Health debuted its Merlin AI value-based care assistant built to make actuarial analysis transparent and actionable. Merlin AI interprets complex risk contract data, explains performance drivers, and instantly recommends next best steps.
  • Abridge is bringing CDS into the flow of clinical conversations through a partnership with Wolters Kluwer. The UpToDate integration adds to a white-hot October for Abridge, which already included heavy-hitter roll outs at UPMC and Northwell.
  • Brook.ai hauled in $28M of Series B funding to expand its personalized remote care platform to more patients and conditions. Providers can get up and running on the platform in 30 days with no CapEx required, and the results in the announcement speak for themselves. More to come on this one next week.
  • Cedar debuted an aptly named Cedar Cover enrollment tool to make sure patients aren’t caught in the rain when the dark cloud of Medicaid cuts gets here. Cedar Cover’s key capabilities include Medicaid enrollment, proactive renewal, and denials resolution.
  • Ellipsis Health is teaming up with NVIDIA to leverage its Parakeet ASR model and build out the AI infrastructure supporting Sage, an emotionally intelligent AI care manager that expands staffing capacity through proactive patient engagement.
  • GE HealthCare is collaborating with The Queen’s Health Systems and Duke Health to advance the development of its upcoming AI-driven hospital operations solution. The solution will leverage insights from both systems and the 500+ hospitals using Command Center to surface actions for improving care quality, patient flow, and resource utilization. 
  • hc1 unveiled hc1 IQ to deliver precision insights that transform lab data into life-saving action. hc1 IQ unifies lab, clinical, and supply chain data into a single AI-powered platform to produce enterprise-wide intelligence for improving outcomes.
  • IntelePeer launched a SmartAnalytics Starter Pack that gives providers the most approachable entry-point we’ve seen to the AI agent ecosystem. It includes one patient engagement automation from IntelePeer’s menu, along with real-time dashboards and call analysis to drive immediate operational improvements.
  • League introduced League Agent Teams to its AI-first consumer experience platform. The multi-agent system guides users through complex health journeys using a suite of AI agents fine-tuned for specific tasks and an orchestration layer to coordinate them.  
  • Lorikeet debuted a healthcare-specific extension for its Team of Agents (deja vu, definitely one of the biggest themes at HLTH), which coordinates actions across multiple agents to call vendors, text doctors, and take action to “actually solve customer issues.”
  • Nabla debuted Nabla Connect, a plug-and-play module that enables any EHR to seamlessly integrate ambient AI. Nabla already has one of the widest EHR footprints in the space, and CEO Alex LeBrun gave us the live walkthrough of how Nabla Connect extends that foundation to smaller EHRs looking to unlock the same capabilities.
  • Optum took the lid off its Optum Real claims system that delivers instant coverage validation. The multi-payor platform enables real-time data exchange between payers and providers, allowing any issues to be intercepted at the point of submission.
  • Penguin Ai is joining forces with UPMC Enterprises and leveraging its Ahavi data platform to validate new AI models in a secure testing environment. Ahavi will allow Penguin to refine its Small Language Models for real clinical use cases like record summarization and prior auth optimization.
  • Solera Health showcased its Precision Insights Suite for AI-driven cost containment and care navigation. The two core components include Precision Intercept, which identifies patients at risk of significantly increasing costs within a year, and Precision Navigate, which delivers personalized provider recommendations based on similar patients.
  • Suki launched a nursing-focused AI consortium with several leading health systems and AvaSure on the inaugural roster. The consortium will co-develop Suki for Nurses while integrating ambient AI capabilities into AvaSure’s virtual care platform.
  • Vital announced the launch of Vital Urgent Care, an AI-powered platform that provides patients in urgent care settings with real-time updates, wait times, and personalized guidance – without requiring a single download or additional staff bandwidth.
  • Wellsheet is rolling out across Ascension to give providers a unified view of previously overlooked data. The “GenAI front-end” allows care teams to access patient-specific EHR data on a single screen, accelerating diagnoses and clinical decisions.
  • Withings Health Solutions unveiled best practices for obesity care management programs built on a decade of partnerships across the segment. Those include: (1) continuous monitoring for real-time adjustments, (2) on-device communications, (3) data-driven outcome tracking, (4) addressing comorbidities, (5) measuring more than traditional BMI metrics. All great practices for maternal health as well!

Welcome to all the fresh faces scrolling through DHW for the first time, and shoutout to all the long-time readers we caught up with at the show – the OGs have officially been here longer than a lot of the exhibitors have existed!

We picked up as many announcements as we could carry, but if we missed anything exciting and you don’t see it below, hit reply and let us know what to circle back on next week.

2025 State of Digital Health Purchasing

Posted on by Jason Barry

What better way to kick off HLTH week than with a new survey from the Peterson Health Technology Institute showing that healthcare decision-makers are still hungry for new solutions?

PHTI’s 2025 State of Digital Health Purchasing Survey showed that health plans, employers, and health systems are all investing heavily in digital health, but spending patterns are starting to diverge.

  • The headlining stat: 61% of health plans and 44% of health systems plan on increasing digital health spending in the coming year, compared to just 14% of employers.

Employer spending has leveled off. Two-thirds of employers plan to hold spending steady as they maintain their current suite of solutions.

  • In contrast, health plans and health systems are ramping up to offer a wider variety of solutions (81%) and keep up with patient engagement (77%).
  • The top priorities across the board? Improve access, reduce costs, and strengthen user experiences, especially in areas like diabetes, mental health, and primary care.

Purchasers are more hawk-eyed than ever… especially when it comes to their contracts. Nearly half of purchasers are already using performance-based contracts, and the majority plan to use them in the next year.

  • 73% of contracts now have a duration under two years – up from 59% last year – leaving a short window for solutions to prove their value.
  • Short-term contracts, annual portfolio reviews, and a laser focus on engagement and ROI are the new normal. Building long-term relationships hinges on demonstrating both.

Vetting isn’t getting any easier. When comparing vendors, employers (66%) are more likely than health plans (23%) and health systems (42%) to cite cost as the deciding factor.

  • Payors and providers both prioritize a proven track record above cost, but the report points to other ways to gain an edge.
  • Although performance-based contracts are gaining traction, few purchasers are satisfied with their current models, and they’re looking for vendors that can offer either better outcome thresholds or attribution methods.

The Takeaway

Health plans, employers, and health systems all still have an appetite for new solutions, and PHTI just gave vendors a way to stack their decks with more data on each of their unique priorities.

2025 Trends Shaping the Health Economy

Posted on by Jason Barry

Trilliant Health just released its 2025 Trends Shaping the Health Economy Report, delivering a uniquely holistic perspective on the healthcare market through the lens of supply and demand.

Here’s the state of play. Health expenditures are growing faster than the rest of the economy, and they’re projected to represent 20.3% of GDP by 2033. 

  • The U.S. spends more and gets less than peer nations, which might have been tolerable when our federal debt was at $800B in 1980, but definitely isn’t now that it’s at $37T.

What levers can we pull? This year’s 115 page analysis looks into six macro trends driving the healthcare economy, and underlines each of them with concrete stories from real-world data.

  • 1) Affordability concerns are reshaping demand. Medical prices are up 54.5% since 2009, and they’re pressuring patients and employers to weigh their options – especially when rates for an inpatient procedure can vary as much as 7x within the same facility depending on the payor (p. 19).
  • 2) Stakeholders are slow to adapt to demographic trends. Mortality rates among adults aged 18-44 have been rising as the fertility rate falls, shrinking the share of Americans with employer-sponsored coverage (p. 22).
  • 3) Specialty care intervention is incentivized over primary care prevention. In 2024, behavioral health visits rose 11.4%, while primary care visits declined 5.6%, marking the first time behavioral health utilization surpassed primary care (p. 43).
  • 4) Fraud, waste, and abuse are pervasive. The share of high-complexity ED visits has risen sharply, increasing from 36.6% to 47.8% of visits between 2018 and 2024, underscoring the financial impact of upcoding (p. 57).
  • 5) Alternative therapies are accelerating. GLP-1 utilization increased 745% from 2018 to 2023, while bariatric surgery volumes were flat to declining, illustrating how high-margin procedures face growing competition from medications (p. 86).
  • 6) If the industry won’t deliver value, the government will. Federal programs have consistently failed to bend the cost curve (MSSP savings are less than 1% of Medicare spending), and there’s mounting political pressure for top-down structural reform (p. 89).

The Takeaway

The U.S. healthcare system is at a crossroads. As Trilliant put it so nicely, the choice for all health economy stakeholders is whether to implement “radical change from the inside” or “to be subjected to such change by external forces.”

Bain & Company: Top Healthcare IT Priorities

Posted on by Jason Barry

Payors and providers are fighting different operational battles, but they’re using the same two-letter weapon to come out on top: AI, you guessed it. 

A joint report from Bain & Company and KLAS found that 80% of payors and 70% of providers now have an AI strategy in place, up from just 60% last year.

  • Providers are up against structural workforce shortages and rising patient volumes, while payors are contending with higher medical loss ratios and more regulatory scrutiny.
  • Bain and KLAS’ survey of 228 U.S. healthcare execs suggests that all signs point to one solution, and that’s deploying tech to improve margins.

Where are payors investing? Care coordination (57%) and utilization management (55%) were the top IT investment priorities for the second straight year.

  • Payors place total cost of ownership, functionality, and scalability ahead of suite convenience, so best‑of‑breed is still the default buying motion.
  • Plans are leveraging AI for everything from member engagement (35%) and enrollment (26%) to risk adjustment (26%) and prior auth automation (20%).

Where are providers investing? Revenue. Cycle. Management.

  • Half of providers ranked RCM among their top IT priorities, placing it above clinical workflows (34%) and EHRs (32%).
  • RCM = ROI. Accurate documentation and coding results in cleaner claims and fewer denials, which directly translates to higher revenue and lower expenses.
  • It’s also a match made in heaven for AI automation, and RCM currently represents the four most common AI use cases: ambient documentation (62%), clinical documentation improvement (43%), coding (30%), and prior authorization (27%).

Here’s the kicker. Providers cite EHR integration and interoperability as their biggest pain points, so most of them prioritize their EHR vendors for new solutions.

  • Only 20% of providers are primarily best-of-breed buyers, and two-thirds of Epic customers would choose an Epic option that’s “good enough” over a better competing product.

The Takeaway

It’s getting pretty hard to not be bullish on AI. There’s still plenty of uncertainty, but both payors and providers now seem to agree that inaction is the riskiest action.

Rock Health Q3 Overview: Signals Out of Sync

Posted on by Jason Barry

Rock Health’s always-excellent digital health market overview painted an interesting picture for Q3, with venture funding continuing to climb despite several “signals out of sync.”

We’re steady on the surface. Digital health startups raised $3.5B across 107 deals in the third quarter, outpacing last year by a decent margin and bringing the year-to-date total to $9.9B across 351 rounds [Chart: Q3 Funding].

  • Deal volume continued to slow, but fewer raises yielded larger checks. Q3 saw 107 funding rounds, down from 120 in Q2 and 124 in Q1.
  • The average raise in 2025 now stands at $28.1M (up from $20.4M in 2024), and we’ve already seen 19 mega-rounds above $100M – surpassing last year’s total with a quarter left to go.

The middle is murky. Rock Health rolled up its sleeves and calculated widely variable trends in mid-market funding.

  • Series B deal flow has thinned, with just 30 raises through Q3, compared to an average of more than 60 annually over the past three years.
  • As fewer startups reach Series B, those that do are stretching the range of what a B round can be. Series B deal sizes so far in 2025 spanned $11M–$210M ($199M) – the widest spread since the boom of 2021.
  • Pair that with the persistent prevalence of unlabeled raises, and the thinning Series B pipeline suggests that startups are traveling increasingly winding roads to reach scale.

Activity is concentrating around workflows. The biggest theme of the Q3 report was that Clinical Workflow and Non-Clinical Workflow are now 2025’s two most-funded value propositions, capturing a combined 42% of the total funding [Chart: Value Propositions].

  • A $1.3B lead separates these value propositions from the rest of the pack, and workflow tools now appear to be in a league of their own.

Startups are heading horizontal. The report also highlighted a growing group of startups pushing into adjacent workflows, such as Abridge’s partnership with Highmark Health (expanding into prior auths) and Judi Health acquiring Amino (moving into patient navigation).

  • M&A volume is up 37% from last year, with 166 acquisitions through Q3 (already topping 2024’s 121 total), in large part due to these horizontal moves. 

The Takeaway

The numbers look steady, but the market is also steadily splitting in half. That means that the real story going forward won’t be whether digital health startups can attract investors (they can), but whether companies can demonstrate the impact needed to land on the right side of the divide. 

Penguin Ai Raises $30M to Arm the AI Agent War

Posted on by Jason Barry

Payors and providers are in an AI arms race, and Penguin Ai just raised $30M to supply both sides with agents to outcompete each other.

Penguin goes far beyond point solutions. The enterprise AI platform combines proprietary LLMs with AI tooling that both payors and providers can use to configure custom agents for their own back-office processes. 

  • The platform enables customers to prep their data for AI, use pre-built LLMs via APIs, or start with a ready-made agent for medical coding, prior auths, claims adjudication, appeals management, risk adjustment, medical chart summarization, or payment integrity.
  • The ultimate goal is streamline high-volume workflows and cut down on the billions of dollars of administrative waste that the healthcare industry generates every year.

The agent wars have begun. Payors and providers across the country are racing to enlist AI agents to fight for an advantage in a system that’s historically been plagued by inefficiencies and headbutting.

  • Providers vs. Payors: Doctors and hospitals are leveraging agents to fight back against billing denials – filing floods of appeals and automating responses faster than any human could manage alone.
  • Payors vs. Providers: Health plans are rolling out agents to instantly review claims, prior auths, and appeals requests – enabling mass, automatic care decisions that overwhelm providers.

Penguin CEO Fawad Butt has been in the buyer seat. He spent his career serving as the chief data officer at some of the biggest names in the industry: UnitedHealthcare, Kaiser Permanente, and Optum.

  • He founded Penguin to build the platform he saw was missing, and that adds a lot of credibility as Penguin takes on incumbent admin agent dealers like Innovaccer and Autonomize AI.

The Takeaway

The agent wars are in full swing, and Penguin is bringing a comprehensive platform to a battlefield full of point solutions. 

Particle vs Epic: The Lawsuit Moves Forward

Posted on by Jason Barry

For the first time in history, Epic will have to face antitrust claims in court after it failed to dismiss Particle Health’s allegations that the EHR giant has been wielding its monopoly power to stifle competition.

Here’s the overly-simplified version. Particle combines health data from 270M+ patients’ medical records by aggregating “thousands of sources”… sources like Carequality.

  • Carequality is effectively one of the largest health information networks, facilitating data exchange between network members (like Particle) who agree to only query patient data for “Permitted Purposes” such as Treatment, Health Operations, or Public Health Activities.
  • The problem at the heart of the lawsuit arises due to the fact that Treatment is the only purpose that organizations like Epic are actually required to respond to, causing all sorts of companies to warp their true purposes to Treatment-shaped requests.

Particle vs. Epic. Particle’s case alleges that Epic used its EHR monopoly to hamstring competition in the market for “payor platforms,” which allow payors to retrieve patient data to make decisions about care and coverage.

  • Last spring, Epic said that Particle was allowing its customers to inappropriately label their Carequality data requests as Treatment, then proceeded to stop responding to EHR requests from 34 Particle customers.
  • Particle’s lawsuit alleged that Epic trumped up the Carequality accusations in order to block it from serving its payor platform customers.

Epic filed to dismiss all nine of Particle’s claims. On Friday, the judge sided with Epic on five of the nine claims, dismissing the allegations that Epic maintained a conspiracy to uphold its market dominance, as well as claims of defamation and trade libel.

  • However, the court declined to throw out all three of Particle’s federal monopolization claims, as well as a state claim that Epic had interfered with a business contract.
  • Those claims will move forward into discovery, and Epic will now have to turn over documents that can shed light on whether its practices withstand legal scrutiny.

The Takeaway

Get the popcorn ready. Epic’s motion to dismiss was only partially successful, meaning it will now have to actually admit, deny, or qualify Particle’s remaining allegations. That deadline is quickly approaching on September 16th – then the real legal fireworks can get started.

Justifying Healthcare AI Valuations

Posted on by Jason Barry

A stellar report from Flare Capital Partners suggests that there’s some surprisingly sound justifications for the sky-high valuations we’re seeing with healthcare AI companies.

Numbers talk. The report – based on an analysis of 4,500 digital health VC rounds and an exec survey – found that a record 58% of deals involved AI companies in H1 [Chart: AI Funding].

  • Over 10 healthcare AI startups joined the unicorn club in the last year, and the investor enthusiasm only kept surging after five exits over $1B: SmarterDx, Iodine Software, Machinify Health, Office Ally, and Tempus AI.
  • That’s resulted in AI-focused companies commanding valuations 50% higher than the healthcare industry average [Chart: Valuations]. 

What’s fueling the fire? Companies that handle administrative tasks like revenue cycle management and contact center operations are leading the pack, at least for now.

  • Administrative AI companies are shining by having LLMs help turn messy data into measurable ROI, but clinical support based on structured sources (ex. OpenEvidence) continues picking up steam [Chart: Category Adoption]. 
  • One of the best charts unpacks the DNA of market leaders, and it turns out quick deployments and immediate ROI work well regardless of category [Chart: Leaders]. 

It’s not just FOMO. Flare’s exec survey found that half are already carving out over 10% of their IT budget for AI, and 83% plan to dial that percentage up going forward.

  • There’s a meaningful level of product-led “pull” driving AI adoption, especially compared to the “push” that drove past cycles like EHRs.
  • There’s also a high amount of confidence that AI startups will push into new areas (ex. scribing to RCM), and investors are giving them a lot of credit for unrealized growth based on what customers are saying about future budgets and expansion plans.

The Takeaway

Healthcare AI has moved from experimentation to execution, with wider adoption, bigger budgets, and value concentrating around market leaders. Flare doesn’t necessarily believe that justifies billion-dollar valuations for companies that are years away from profitability, but it at least sheds light on why the top players are blasting into orbit.

Make Health Tech Great Again

Posted on by Jason Barry

CMS just wrapped its Make Health Tech Great Again event at the White House, and it unveiled an ambitious new strategy to modernize how healthcare data is exchanged.

This time is different. We’ve heard similar promises before, but the administration plans to “stop theoretical debates and start delivering real results” by taking a two-pronged approach.

  • The first priority is establishing a CMS Interoperability Framework to enable seamless information exchange between patients and providers. 
  • The second step is building a Health Tech Ecosystem to improve access to personalized tools so that patients have the resources they need to make better health decisions.  

The CMS Interoperability Framework includes voluntary criteria for data sharing across different network types – health information exchanges, EHRs, and tech platforms.

  • The blueprint covers everything from patient and provider access to transparency and security, complete with implementation guidelines co-developed with the early adopters. It’s completely aligned with TEFCA, which CMS is still participating in.
  • Over 20 networks pledged to meet the criteria to become CMS Aligned Networks, such as delivering data through FHIR APIs, updating the national provider directory, and providing metrics on network queries for patient records.

The Health Tech Ecosystem is a “standards-based digital health environment” that will integrate apps, EHRs, and care delivery organizations with the new CMS Aligned Networks. 

  • The ecosystem will leverage these integrations to develop new solutions for: (1) managing diabetes and obesity, (2) conversational AI to help check symptoms and navigate care, (3) “killing the clipboard” by replacing paper forms with digital solutions.
  • Over 30 companies and 11 major health systems signed on to “deliver results for the American people” by the first quarter of 2026, and the full roster includes some of the biggest names in healthcare.

The Takeaway

We apparently won’t have to wait long for the CMS Interoperability Framework and Health Tech Ecosystem to deliver results, although what those deliverables will look like remains to be seen.

Samsung Leans In On Healthcare With Xealth Acquisition

Posted on by Jason Barry

It was already shaping up to be a great year for digital health exits, and Samsung just kicked things up another notch by acquiring tech integration platform Xealth.

Xealth was the first spin out from Providence’s Digital Innovation Group back in 2017. The platform integrates 70+ partner solutions for everything from RPM to patient engagement into a single user interface that allows providers to manage them within their existing workflows.

  • That not only allows clinicians to avoid juggling separate apps, but it also gives health systems an orchestration layer for controlling the data and painting a complete picture of their patients.
  • Over 500 hospitals are already in Xealth’s network, and they’ll now be gaining access to Samsung’s connected care ecosystem when the acquisition gets finalized.

Samsung’s no newcomer to healthcare. It’s fresh off another acquisition with prenatal ultrasound startup Sonio, and has been loading up its wearables with FDA-cleared features like sleep apnea detection and irregular heart rhythm monitoring.

  • It’s also developing a new health hub to let users share Galaxy Watch and Galaxy Ring data with their providers between visits, which would be a solid step toward making the data clinically useful – assuming they can get docs to use it.
  • A standalone Samsung health hub sounded like a tough pitch without a way to plug into provider workflows, which happens to be exactly what Xealth brings to the table.

Samsung isn’t just acquiring an integration platform, it’s acquiring a bridge between its consumer ecosystem and actual healthcare delivery.

  • Xealth CEO Mike McSherry said the move will enable “health data from wearables to fill in context that is missing to hospitals and bring more data analysis possibilities that were not available just with clinical records.”
  • Decent enough reason for an acquisition, but then again so is hitting a growth ceiling and needing a Korean tech giant with deep pockets to help you keep scaling, which is the logic that McSherry gave to MedCityNews.

The Takeaway

Samsung and Xealth are keeping the M&A momentum rolling, and we’re already on pace to double 2024’s deal volume. So far this year we’ve seen an end to the IPO drought thanks to Hinge and Omada, Arcadia just got scooped up by a PE firm, and now Big Tech is coming in hot with platform plays. Who said there’s no exit in digital health? 

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