Category: Startups

Medallion Lands $43M and Unveils First National Credentialing Clearinghouse

Posted on by Jason Barry

Medallion keeps building its case to be the go-to platform for provider network management after locking in another $43M and unveiling the industry’s first national credentialing clearinghouse, CredAlliance.

Less friction, more healthcare. Providers have to jump through countless operational and compliance hoops before they can start caring for patients, and Medallion specializes in AI-powered hoop jumping.

  • Medallion helps automate away the back-office workflows that delay care – and revenue – such as credentialing, enrollment, and monitoring.
  • The platform not only onboards providers 40X faster (cutting intake time from 8 days to under 2 hours), but it also serves as a unified system of record that allows customers to verify credentials, stay in-network, and connect patients to care more efficiently.

Own the market by shrinking it. There’s roughly 4M credentialed providers in the U.S., and they’re each contracted with an average of 19 payors. That adds up to about 25M times a year that providers need to get credentialed.

  • The launch of CredAlliance will allow payors to verify providers once and syndicate results, eliminating duplicative work and reducing costs for everyone involved.
  • That has the potential to eliminate $1.2B in duplicative spend annually, but it could also shrink the exact market that Medallion exists to serve. It’s a risk they’re willing to take.

What’s next? The fresh funds will bring Medallion’s AI automation to thousands of state-, provider-, and payor-specific workflows, while simultaneously scaling CredAlliance across more payors.

  • CredAlliance already has dozens of payors signed on, and it’s in talks to bring on five of the nation’s 10 largest health plans.
  • If that ends up making credentialing so efficient that there’s less of a need for automation, we’ll chalk it up as a good thing for the industry and Medallion will be just fine (enterprise ARR is up 106% in the wake of launching three new products – Privileging, Integration Engine, and CAQH Management).

The Takeaway

Medallion had a front row view of the wasteful spending in the credentialing trenches, and it raised $43M to help eliminate it with the first national credentialing clearinghouse. Bravo.

Ambience Healthcare Joins Unicorn Club With Series C Raise

Posted on by Jason Barry

Another week, another ambient AI mega-round – this time from none other than Ambience Healthcare and its massive $243M Series C.

Welcome to the unicorn club. The round vaulted Ambience’s valuation to $1.25B, making it the second-highest valued startup in the ambient arena behind Abridge, which was valued at an eye-popping $5.3B during its recent $300M Series E.

  • Funnily enough, a16z led both rounds. We don’t usually see VCs cut a check for a startup then turn around and fund their biggest competitor, but playing both sides is a great way to not lose a race.

Ambience isn’t just a scribe. It’s an ambient AI platform for documentation, coding, and clinical documentation integrity.

  • The platform was “architected with the understanding that health systems are not monolithic enterprises” and adapts to the unique context of different care settings.

If you ain’t first, you’re last. Ambience was one of the only ambient AI players to lean in on the revenue cycle component right out of the gate, and the head start is reflected in the results from head-to-head pilots.

  • During a six month bake-off at Cleveland Clinic (now a happy customer), Ambience saw 80% clinician utilization and an NPS of 60, both the highest by a wide margin.
  • Ambience Co-Founder Nikhil Buduma told us that the secret sauce is the platform’s ability to make clinicians feel like “it’s almost reading their minds,” which is made possible by continuous fine-tuning the model for individual specialties.

Where do we go from here? If the launch of Doximity’s free scribe taught us anything, it’s that documentation is officially a commodity. Ambience’s new funds will help it do everything else.

  • That includes diving deeper into the revenue cycle and clinical trials, as well as moving upstream into taking care of patients outside of the four walls of the clinic.
  • It also includes scaling up operations, and Ambience has already begun hiring dozens of former startup founders to lead its new verticals.

The Takeaway

We’re now in a world where perfect transcripts are table stakes, which means the winners of the ambient AI race will be the companies that can help carry the tasks happening after the clinical conversation. Ambience just bulked up to do some heavy lifting.

Fortuna Closes Series A to Modernize Medicaid Access

Posted on by Jason Barry

It never hurts to be at the right place at the right time, and Medicaid navigation platform Fortuna Health just landed $18M of Series A funding in the wake of one of the biggest shakeups the safety net coverage program has ever seen.

Medicaid is complicated. Each of the 56 Medicaid programs in the U.S. has its own evolving eligibility rules, documentation standards, and renewal timelines – none of which are easy for anyone to keep track of.

  • Fortuna consolidates these programs into a single interface for patients and members, allowing them to manage their eligibility and applications while getting guided through the obstacle course.
  • For anyone with some time to spare for an exhaustive overview of Fortuna and the broader Medicaid market, look no further than HTN’s stellar interview with CEO Nikita Singareddy.

“TurboTax for Medicaid.” That’s the basic pitch to Fortuna’s payor and provider customers. 

  • Managed care plans and payors get a way to offload backend compliance work and “become invaluable to their members” by putting a Medicaid navigator in their pocket.
  • Health systems and other provider orgs get a way to maximize revenue / retention by helping more patients get (and stay) enrolled in Medicaid or navigate their way to financial support from partners like Cedar.

Over 71M people are currently covered by Medicaid, and One Big Beautiful Bill just reshuffled the rulebook for all of them.

  • OBBB includes roughly $1T in cuts to safety net coverage, as well as new proof-of-work restrictions, documentation requirements, and more frequent eligibility checks.
  • The CBO expects 10M people to lose coverage by 2034 as a result, and Fortuna plans to use its Series A to scale nationwide (it’s currently in 10 states) and invest in AI features that will help respond to the policy shifts.

The Takeaway

As long as Medicaid exists, there’s a place for software that makes enrolling easier. Medicaid infrastructure is long overdue for a healthy dose of AI modernization, and an extra $18M certainly won’t hurt Fortuna’s chances of being the company that makes it happen.

OpenEvidence Locks in $210M Series B in Second Raise of the Year

Posted on by Jason Barry

OpenEvidence might just be the hottest startup in healthcare after locking in another $210M of Series B funding and tripling its valuation to a whopping $3.5B.

Déjà vu. If that sounds familiar, it’s probably because OpenEvidence first joined the unicorn club just five short months ago when it notched a $1B valuation through its $75M Series A.

  • Since then, the LLM-powered medical search engine inked a multi-year content agreement with JAMA to bring full-text articles directly to its platform, and continued to add new doctors at the breakneck pace of 65k per month.
  • It turns out that getting doctors to use a sleek new AI tool isn’t the hardest thing in the world when you make it available at no cost, and over 40% of doctors in the U.S. apparently don’t mind a few pharma ads if you can make their job easier.

Does that justify the valuation? Depends what physician trust is worth. OpenEvidence has added over 430k verified physicians since launching in 2023, and they’re now supporting over 8.5M clinical consultations every month.

  • The volume of medical research published annually is doubling every five years, and physicians are flocking to OpenEvidence so that they can search once, skip the scavenger hunt, and surface the science in seconds.
  • That type of growth is nearly unprecedented in healthcare, and investors are looking to capitalize by dogpiling into startups like OpenEvidence and Abridge, which also raised back-to-back megarounds in the first half of the year.

OpenEvidence is only ramping up from here. CEO Daniel Nadler told Forbes that he views the commoditization of AI copilots similar to TV streaming services, which have to differentiate around content and partnerships.

  • The Series B funds will help OpenEvidence add more strategic content to its medical knowledge library, and fuel new products that can take advantage of it – including its new DeepConsult research assistant.
  • DeepConsult helps physicians get up to speed on a topic by cross-referencing hundreds of studies to deliver comprehensive Ph.D.-level research reports in a matter of hours.

The Takeaway

OpenEvidence is off to the races, and “the fastest-growing platform for doctors in history” still hasn’t even started charging doctors to use it.

Abridge Moves Upstream With $300M Series E

Posted on by Jason Barry

The ambient AI segment is turning into a bigger spectacle than the NBA Finals, and Abridge just dunked on it with $300M of Series E funding.

Big-time startups have big-time valuations. The latest round doubled Abridge’s valuation to $5.3B, up from a paltry $2.5B when it closed its last nine-figure round four short months ago.

  • We’ll leave it to the VCs to decide whether Abridge is worth twice as much as it was in February, but it’s now deployed at 50% more health systems – over 150 in total.
  • Abridge also reportedly hit $117M in contracted annual recurring revenue as of Q1, and is on pace to support upwards of 50M medical conversations this year alone.

Abridge is aiming upstream. The new capital was earmarked for “automating more of what happens behind the scenes and enabling revenue cycle management teams to operate with unparalleled efficiency.” 

  • That means embedding revenue cycle intelligence earlier in the clinical conversation, and eliminating unnecessary back-and-forth between clinicians and billing teams.
  • In Abridge’s own words, the ultimate aim is to “help achieve faster reimbursement cycles and minimize the risk of denials.”

The ambient AI race needs a rebrand. As Abridge and its competitors start lunging toward every workflow within arms reach of the clinical conversation, their platforms are quickly pushing past documentation. Within just the last week:

  • Ambience Healthcare announced that its coding-aware ambient AI platform saves St. Luke’s Health System $13k+ per clinician annually, then followed that up by launching Patient Recap for pre-visit chart summaries.
  • Commure raised $200M and rounded out its RCM and documentation capabilities with AI agents that handle scheduling, referrals, and prior auths. 
  • Nabla closed $70M to build out an Adaptic Agentic Platform that enables real-time coding assistance, direct EHR commands, and new capabilities for nurses.
  • There’s also the 1,000 pound gorilla formerly known as Nuance, but the incumbent scribing champ hasn’t been too vocal since rolling out Microsoft Dragon Copilot earlier this year.

The Takeaway

The hottest segment in digital health is boiling over into revenue cycle management, and Abridge is cranking up the heat with its Series E funding. Topping off the warchest comes with golden strings attached, so expect the pace to only accelerate from here as Abridge looks to live up to its valuation by coming out on top in the RCM landgrab.

Tennr Raises $101M Series C for AI-Powered Referrals 

Posted on by Jason Barry

Tennr just raised $101M of Series C funding to have AI help solve one of healthcare’s most timeless challenges: fax machines. 

Tennr got its start in 2021 improving the patient intake and documentation review process, but has quickly expanded its capabilities to make sure that patients don’t get lost in a “black hole” during the referral process.

  • More than one-third of Americans receive a medical referral each year, half of which aren’t completed due to miscommunication, misdirected referrals, or missing information.
  • Tennr’s orchestration platform and proprietary language models automate these workflows to help providers convert more patients, cut denials, and deliver care without growing their teams.

The secret sauce is Tennr’s specialized language models (RaeLM), optimized to understand the nuanced data in medical determinations and evaluate it against strict payor criteria.

  • Tennr integrates with over 50 types of e-faxes, phone lines, emails, and portals to collect patient information, then leverages RaeLM to structure the data into usable information that can be shared with EHRs and pharmacy management systems.
  • The thesis was that if Tennr could read the documents and structure the data, it would be in a good spot to bolt-on more services – such as its eligibility benefits product, patient communication solution, and referral management suite. 

The fresh funds will fuel the launch of the Tennr Network, designed to equip referring providers, receiving providers, and patients with real-time visibility into the referral status.

  • Referring providers can see the status of every patient they’ve sent out, eliminating phone tag and guesswork.
  • Receiving providers can track the status of every referral, see which need more documentation, and identify which sources are driving the most conversions.
  • Patients can see when their referral was accepted, when it’s scheduled, and what to expect to pay – matching the “transparency we take for granted in food delivery or e-commerce.”

The Takeaway

Faxes are here to stay, and Tennr has $101M to make sure that they’re actually serving the practices using them. The plan isn’t to give healthcare a new AI tool, but to use AI to help the industry get more out of the tools it already has.

Nabla Series C Brings Agentic AI to the Heart of Healthcare

Posted on by Jason Barry

Healthcare’s “zero-screen future” is looking closer than ever after Nabla locked in $70M of Series C funding to put AI agents to work restoring the human connections at the heart of the industry.

Ambient AI is hot, but Agentic AI is hotter. The round follows a wave of adoption across U.S. health systems as Nabla sets its sights on growing beyond its roots in ambient documentation.

  • Nabla’s AI assistant is now used by 85k clinicians across 130+ healthcare orgs, ranging from FQHCs and rural hospitals to academic medical centers and national providers.
  • In the past six months, Nabla’s grown its Live ARR by over 5X (meaning its annual recurring revenue from clients that have already gone-live, not “contracted” revenue, and definitely not annual run rate).

The key to Nabla’s success has been its ability to deliver highly personalized AI experiences without compromising on reliability, and the fresh funds will help build out an Adaptive Agentic Platform that brings that same ethos to new use cases:

  • Proactive Coding Agent – a real-time coding assistant that flags billing issues and surfaces compliance nudges.
  • Context-Aware Agent – strengthens existing support for patient summaries and pre-charting with direct EHR commands and the ability to initiate orders.
  • Custom Care Setting Agent – adds new capabilities for nurses and inpatient teams to bring tailored support to frontline workers.

The Agent Era has arrived. The days when every ambient scribe demo got a standing ovation are long gone, and health systems are looking for AI that can automate increasingly complex workflows (or better yet, generate revenue that justifies its cost).

  • Nabla clearly got the memo, but so did competitors like Abridge, Ambience, and Suki – all of which are actively working to add coding and other new features to their platforms.
  • The race is on, and the entire healthcare industry – patients and providers alike – should be better off because of it.

The Takeaway

Nabla’s been making quick progress toward some ambitious goals, and agentic AI just raised the goalpost even higher. In the words of CEO Alex LeBrun, “Our mission: bring agentic AI to clinicians in a safe, compliant, and ethical framework. The journey?‍ 1% done.”

Ellipsis Health Closes Series A, Unveils Sage AI Care Manager

Posted on by Jason Barry

Care management gaps are becoming a pressing problem as the provider shortage deepens, and Ellipsis Health just raised $45M of Series A funding to show why empathy is the answer. 

Ellipsis put Sage front and center in the announcement, unveiling its emotionally intelligent AI care manager that expands staffing capacity through proactive patient engagement.

  • Sage’s Empathy Engine leverages Ellipsis’ patented vocal biomarker tech and training from millions of real clinical conversations to support the patients driving a majority of healthcare costs: those with complex physical, behavioral, and social needs.
  • Unlike traditional AI agents, Sage adjusts its tone and approach based on a patient’s emotional state, exactly how a human care manager would when conducting health risk assessments, post-discharge follow-ups, or care transitions.

The Series A investor roster suggests that Ellipsis has some strong tailwinds working for it.

  • The round was led by Salesforce (workflow integration through Salesforce Health Cloud), Khosla Ventures (tech validation from an AI fund and early investor in OpenAI), and CVS Health Ventures (plenty of Aetna members to reach meaningful scale).
  • Those investors will only help Ellipsis land and expand across more enterprises as it continues building evidence that Sage moves the needle with patient outcomes.

Competition is heating up. Companies like Hippocratic and Innovaccer have been rolling out fleets of AI agents that can handle routine tasks like appointment scheduling, but Ellipsis is setting out to prove that empathy is a difference maker in actual case management.

  • It’s the little things between visits that can decide whether a patient gets their hypertension under control, like walking them through lab results or making sure they take their medication.
  • It’s also the same little things that slip through the cracks when you have a staff shortage or burned out clinicians, and a little empathy could go a long way toward filling these gaps and driving the behavior change that leads to better outcomes.

The Takeaway

Ellipsis envisions a future for healthcare where AI can “extend human capabilities while preserving the empathy and clinical judgment that defines great care.” Sage is the tool that Ellipsis built to carve that future, and it now has $45M to put it in the hands of more providers.

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.

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