Category: Startups

Cohere Raises $90M for AI Prior Authorizations

Posted on by Jason Barry

Cohere Health just locked in $90M of Series C funding to keep doing what it does best, offloading painful prior authorization processes from humans to AI.

Cohere works with health plans and risk-bearing providers to automate prior auth workflows and accelerate time to care… or at least quicker denials.

  • The platform’s “precision clinical insights” mean up to 90% of requests can be auto-approved, slashing administrative burden and opening up bandwidth for more collaboration between physicians and payors on critical cases.
  • Cohere’s been moving quickly. It’s raised 200M since launching in 2019, and now processes over 12M prior auths for 600k+ providers annually.

As an early mover in the booming segment, Cohere is doing more than digitizing an outdated prior auth system.

  • Its AI facilitates new ways for plans and providers to collaborate while incorporating the best clinical evidence / guidelines, an approach that seems to be working.
  • Cohere boasts a 93% provider satisfaction rating, and is now setting its sights on other areas of the healthcare ecosystem.

The Series C funds will accelerate Cohere’s next phase of growth, which involves scaling up its Cohere Unify platform and adding a thick layer of AI paint to the entire portfolio.

  • Cohere Unify not only streamlines payor-provider collaboration, but also modernizes utilization management by personalizing provider workflows and optimizing engagement with real-time performance data.
  • These capabilities are the foundation for Cohere’s broader vision of transforming clinical decision-making, and it sounds like we won’t have to wait long to see them expand to new use cases like synthesizing records when multiple departments are involved.

The Takeaway

Prior authorizations are a pain, full stop. If Cohere can use its Series C to give clinicians more time practicing at the top of their license instead of going back and forth with payors, that seems like a great outcome all around.

Chronic Care Startup Omada Files for IPO

Posted on by Jason Barry

The IPO winter might finally be over after chronic care startup Omada Health filed to go public just a few short weeks after Hinge broke the ice.

The digital health darling is best known for its virtual diabetes management programs, but has grown into a comprehensive offering for hypertension, MSK (courtesy of its 2020 Physera acquisition), and a GLP-1 Care Track that drives sustainable results through behavior change.

The S-1 vital signs are mostly encouraging:

  • Omada generated $55M in Q1 revenue, up 57% YoY.
  • Gross margin is strong and getting stronger at 60%.
  • 2024 revenue climbed 38% to $170M.
  • Profitability remains elusive with a $47M loss last year.

Omada has more than 2,000 customers, primarily employers and health plans, with 679k members enrolled in at least one of its programs.

  • Members engage an average of 30 times per month, and over half are still active at the one-year mark.

A key part of Omada’s growth story is its partnership with Cigna, which made the GLP-1 Care Track a core component of Evernorth’s EncircleRx program for employers looking to manage the explosion of interest in the drugs.

  • Most of Omada’s 2024 revenue came directly from Cigna (55%), a double-edged sword considering that investors don’t exactly love having that many eggs in one basket.

Looking ahead, Omada plans to keep producing more evidence that its behavior change interventions make a meaningful impact on long-term success with GLP-1s.

  • The first wave of digital health IPOs – think Teladoc and Amwell – banked on convenience over outcomes and eventually got burned.
  • Omada is setting out to prove that the second wave can truly move the needle on outcomes and costs, making them non-negotiables rather than nice-to-haves.

The Takeaway

There’s a lot riding on these IPOs. If Omada and Hinge can stick the landing, it could be the spark that reignites investor confidence in digital health. No pressure, we’re all rooting for you.

Carta Healthcare Closes $18.25M for Data Abstraction AI

Posted on by Jason Barry

Manual clinical data abstraction is a prime target for AI automation, and Carta Healthcare is looking to hit the center of the bullseye after raising $18.25M of Series B1 funding.

Carta’s data abstraction platform leverages AI and a team of expert abstractors to automate the collection of clinical data and surface actionable insights.

  • The platform converts both structured and unstructured data into standardized datasets, giving healthcare orgs a foundation of high-quality data to build on. 

Although AI’s potential in the data abstraction arena has attracted an army of new competitors, Carta’s been duking it out against manual workflows since 2017.

  • That gave it a big head start to refine its tech and build trust with partners, many of which participated in the round, including MemorialCare, Memorial Hermann, and MGB.
  • Carta plans to put the new capital toward expanding its customer footprint, particularly in the life sciences market where it can help match patients to clinical trials using AI it acquired from Realyze.

The Takeaway

Traditional methods of data abstraction are about as labor-intensive and time-consuming as you can imagine, which makes them ideal targets for AI solutions and startups like Carta that are bringing them to market.

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hellocare.ai Growth Round Fuels Smart Hospital Transformation

Posted on by Jason Barry

The shift from point solutions to platform approaches has been one of the defining trends of the past few years, and hellocare.ai is positioning itself to capitalize on the transition with $47M of growth funding from prominent health system backers.

hellocare.ai’s unified virtual care platform transforms any hospital room into a connected care environment, enabling a wide range of use cases seamlessly embedded into existing EHRs, infrastructure, and care delivery models. That includes:

  • Virtual Nursing
  • Virtual Sitting
  • Virtual Consultation
  • Ambient Documentation
  • Hospital-at-Home

By keeping its full technology stack in-house, hellocare.ai aims to differentiate itself through speed, customization, and continuous innovation.

  • Everything from the hardware and software to the EHR-integration engine is baked into the platform to make it as enterprise-ready as possible for smart hospitals.
  • By pairing the platform with a flexible hybrid clinical care team model, hellocare.ai enables health systems to quickly scale AI-enabled hybrid care across their entire organization.

Over 70 health systems are already using hellocare.ai to consolidate various telehealth solutions – many of which were adopted out of pandemic-driven necessity – into a unified experience for both patients and clinicians.

  • AdventHealth not only participated in the round, but also announced that it’s rolling out hellocare.ai across more than 50 hospitals and 13k patient rooms as part of an enterprise-wide implementation.
  • Both Bon Secours Mercy Health and UCHealth also came on as investors and are actively deploying the platform across their systems. Votes of confidence don’t get much stronger than that.

The Takeaway

Health systems have been vocal about needing a unified virtual care platform to simplify care delivery and increase patient engagement – and that’s exactly what hellocare.ai designed its platform to do. Meeting those needs while demonstrating a measurable ROI is another challenge entirely, but hellocare.ai’s investor roster is a clear sign that some major players believe in its roadmap.

Thatch Raises Series B to Dislodge Health Coverage From Employment 

Posted on by Jason Barry

Help is on the way for employers grappling with rising healthcare costs after Thatch locked in $40M of Series B funding to help tailor benefits to the needs of employees.

Thatch is dislodging health coverage from employment by providing individual coverage health reimbursement arrangements (ICHRA) that let employees choose their own benefits.

  • By blending fin-tech and health-tech tools, Thatch gives employers a way to “abstract away the complexity” of the ICHRA law that passed in 2020, which enabled them to provide a monthly budget to employees for selecting their own health benefits.
  • The Thatch platform streamlines budget setting, plan selection, and lowers costs through pooled purchasing power. If employees spend less than their budget, they receive a Thatch debit card to use for things like prescriptions, copays, and therapy.

Thatch CEO Chris Ellis shared on LinkedIn that one of the reasons why health coverage feels so broken is because it wasn’t designed for humans, it was designed for HR departments. 

  • Ellis has a different vision, and it’s being met with open arms: “Imagine choosing your health plan like you choose your car. Imagine keeping it when you switch jobs.”
  • Although Thatch hasn’t revealed any official revenue numbers, it’s reportedly onboarded over a thousand companies in the last 18 months – including big names like Jersey Mike’s and Dave’s Hot Chicken – and grown revenue by 8X year-over-year.

The Series B funding will allow Thatch to “double down” on its vision to make health benefits  accessible for every American through deeper integrations with carriers and payroll systems.

  • That includes an API service that allows partners to embed ICHRA directly within their own product, which already has QuickBooks signed on as a marquee client.
  • Thatch is also bringing on Gary Daniels, the former CEO for UnitedHealthcare’s Pacific Northwest division, as its new Chief Growth Officer to help make it all happen.

The Takeaway

Most current health benefits solutions were designed for a workforce that stayed with a single company for most of their careers, and have had a tough time keeping up with today’s dynamic labor market. Thatch is among a new pack of startups building the infrastructure for a modern experience, and it seems like both employers and employees have a lot to look forward to.

Layer Health Takes AI to Chart Review With Series A

Posted on by Jason Barry

The healthcare AI momentum isn’t showing any signs of letting up, and chart review automation startup Layer Health just added another $21M to the segment’s quickly growing venture total.

Layer’s AI platform leverages LLMs trained on longitudinal patient data to automate data abstraction for the medical chart reviews that underpin a wide range of clinical and administrative workflows, including: 

  • Quality Reporting & Clinical Registries – extracting data from clinical registries and quality measurement programs to improve accuracy and ensure compliance
  • Hospital Operations & Revenue Cycle – enhancing clinical documentation integrity and coding processes to optimize reimbursement and reduce denials
  • Clinical Decision-Making & Patient Care – providing physicians with real-time insights that synthesize a patient’s full medical history to support personalized treatments
  • Clinical Research & Real-World Data – accelerating patient cohort identification for research studies and improving real-world evidence generation 

Chart review has been a longstanding challenge for most health systems, which can spend upwards of $6M per hospital on personnel costs for care quality data reporting.

  • At the same time, this data represents an invaluable resource for unifying care data with clinical and financial outcomes, enabling treatment decisions to be mapped to their real-world impact.

Flare Capital Partners’ investment memo for Layer laid out how the clinical registries that map chart information to direct outcomes have historically been hamstrung by their unstructured source data.

  • Abstracting this data into a usable format is a time-consuming manual process, and most technological fixes have usually only involved automating small parts of it.
  • By combining the reasoning ability of large language models with the cost-efficiency of small language models, Flare believes that Layer can capture a major slice of the multi-billion dollar care quality reporting market (plus another chunk of the life sciences sector’s growing appetite for real-world data).

The Takeaway

Surfacing insights from medical charts requires peeling back countless layers of structured and unstructured data, which makes it particularly well-suited for both AI solutions and ambitious startups like Layer that are bringing them to market.

Navina Lands $55M to Bring AI Insights to VBC

Posted on by Jason Barry

As the number of providers transitioning to value-based care continues to grow, the need for timely clinical intelligence is climbing right alongside it, and Navina just landed $55M in Series C funding to become the definitive source for AI-driven insights.

Navina’s AI clinical intelligence platform aggregates data from a wide range of sources like the EHR and medical claims to equip clinicians with real-time recommendations for improving care quality and financial outcomes.

  • The copilot supports decision-making from the back office to the bedside, delivering insights directly within existing workflows at the point of care. This article does a good job laying out some of Navina’s levers for driving success in VBC.
  • By surfacing relevant patient information in an accessible format, Navina aims to not only improve diagnostic accuracy and care gap closure, but also to reduce burnout and administrative burdens.

Some of providers’ biggest barriers to VBC adoption are the overwhelming amounts of disparate data sources and the documentation requirements needed to produce results. It turns out that offloading these pain points is a solid strategy.

  • Navina has quickly grown to serve over 10k medical professionals delivering care to 3M patients across 1,300 clinics, and was just named #1 Best in KLAS for Clinician Digital Workflow.
  • It’s also racking up a lengthy partner roster of big names in the VBC-enablement arena, including both Agilon and Privia Health.

Navina is now setting its sights on larger provider orgs and health systems, as well as expansion into new markets across specialty care, payors, and pharmaceuticals.

  • The fresh funds were also earmarked for the 2025 flavor of the year – AI platform enhancements – and it sounds like ambient scribing is first up on the docket.

The Takeaway

Providers are increasingly getting compensated for the quality of the care they deliver rather than the volume of services they provide, but fragmented data and inefficient manual workflows have been holding back the transition. Navina now has another $55M to connect the dots to VBC success for any organization looking to make the leap.

DispatchHealth Acquires Hospital-at-Home Provider Medically Home

Posted on by Jason Barry

DispatchHealth is acquiring fellow hospital-at-home provider Medically Home to give more patients access to their preferred hospital bed: the one they already have at home.

DispatchHealth delivers full-service high-acuity care to patients across the country by sending clinicians directly to the patient’s own bedside.

  • The company’s tech platform supports diagnostics and treatment, as well as care coordination with health systems and payors.
  • Since being founded in 2013, Dispatch has treated over 1.2M people in 20 states, reportedly resulting in 58% ED avoidance and a 98% patient satisfaction rating.

Medically Home has a similar value proposition, with technology, logistics, and support services that “are unmatched in making hospital-level care possible outside of a hospital’s four walls.”

  • It also boasts an impressive list of health system investors like Cleveland Clinic, Mayo Clinic, and Kaiser Permanente.
  • The financial terms of the agreement weren’t disclosed, but Medically Home appears set to be folded into DispatchHealth when the acquisition closes mid-year 2025.

The combined company – AKA DispatchHealth – will provide in-home care across 50 major metropolitan areas through partnerships with nearly 40 health systems.

  • The move brings both companies’ tech and clinical expertise under one roof, which is expected to open up over 62k bed days and reduce total cost of care by up to 30% over a 30-day period (unclear how much of that is offloading work to family members).
  • The merger also reflects a growing trend toward consolidation in this space, where scale is crucial for reaching sustainable growth, even if it means joining forces to get there.

The clock is ticking. The acquisition arrives as the future of the federal hospital-at-home program hangs in limbo. Congress extended the program just a jew weeks ago, but only for another six months.

The Takeaway

The U.S. population isn’t getting any younger, and aging patients have been vocal about preferring care from the comfort of their own homes. In that context, DispatchHealth’s acquisition of Medically Home makes a lot of sense, and a successful merger could support the case for a long-term extension when the current hospital-at-home waiver expires in September.

Hinge Files for Long-Awaited IPO 

Posted on by Jason Barry

When the digital health market needed a hero, Hinge Health answered the call.

Hinge officially filed for its IPO, braving the biggest stock market downturn in recent memory to pull the tech-enabled services category out of a years-long slump.

  • It’s a bold move, but Hinge has the business to back it up. Using a combination of virtual care and AI, Hinge delivers MSK treatment programs with comparable outcomes to traditional physical therapy at a fraction of the cost.
  • Hinge has apparently been able to automate 95% of MSK care delivery, saving its clients (primarily employers and payors) an estimated $2,387 per member per year.

Diving into the S-1, Hinge grew its revenue by 33% to $390M in 2024. It also managed to cut its net loss from $108M down to just $12M, generating 77% gross margins in the process.

  • Hinge reported 532k members and ~200M contracted lives across 2,250 clients, and counts nearly half of the Fortune 500 as clients. 
  • Great stats all around, but a nice soundbite from the S-1 was that “current contracted lives only represent 5% of our total addressable market,” and Hinge is now on the hunt for more growth through commercial plans and Medicare Advantage.

Even with the impressive metrics, Hinge’s last private valuation came in at a rich $6.2B at the height of the pandemic, meaning that it’ll need around a 15X revenue multiple just to match it.

  • It’s not out of the question, but Hims & Hers has been one of the lone bright spots for public digital health companies, and it’s trading at just 5X revenue.

The entire tech-enabled services market feels like it hinges on this IPO, at least if you’ve been following this week’s reaction to the S-1.

  • Hinge is going to be the first health tech startup to go public since Waystar last June, and VCs have been hesitant to invest in the category given the lack of major exits.
  • If Hinge’s debut goes well, it would restore some much-needed confidence in the market, and potentially even kick off a revival in the dormant IPO landscape.

The Takeaway

Hinge is a true disrupter, with an outcomes-driven alternative to traditional physical therapy and a ton of momentum in one of healthcare’s largest markets. We’ll definitely be rooting for them when they ring the bell.

OpenEvidence Closes $75M in Series A Funding

Posted on by Jason Barry

OpenEvidence might be the new kid on the medical chatbot block, but it’s already “the fastest-growing platform for doctors in history,” and $75M of Series A funding just made it the youngest unicorn in healthcare.

Founder Daniel Nadler describes OpenEvidence as an AI copilot, with an experience that feels similar to ChatGPT yet is actually a “very different organism” due to the data it was trained on.

OpenEvidence functions as a specialized medical search engine that helps clinicians make decisions at the point of care, turning natural language queries into structured answers with detailed citations.

  • The model was purpose-built for healthcare by exclusively using training data from strategic partners like the New England Journal of Medicine – no internet forums or Reddit threads in sight.
  • The kicker? It’s available at no cost to verified physicians and generates its revenue through advertising. 

Happy users are their own growth strategy, and OpenEvidence claims that 25% of doctors in the U.S. have already used the product since its launch in 2023. It’s also adding 40k new doctors each month through word-of-mouth referrals and glowing reviews of its ability to:

  • Handle complex case-based prompts
  • Address clinical cases holistically
  • Provide really good references

The 1,000 pound gorilla in this space is Wolters Kluwer and its UpToDate clinical evidence engine. 

  • Although Wolters Kluwer has been inking partnerships with companies like Corti and Abridge to bring new AI capabilities to UpToDate, OpenEvidence is built from the ground up as an AI-first solution.
  • If WoltersKluwer is an encyclopedia, OpenEvidence is ChatGPT, and it’ll be interesting to watch the plays that both sides make as they battle for market share.

The Takeaway

OpenEvidence isn’t a solution in search of a problem, it’s a sleek new tool addressing an immediate need for plenty of providers. It’s rare to see the type of viral adoption that OpenEvidence managed to generate, which is a good reminder that many areas of healthcare change slowly… then all at once.

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