Matt Bettonville, Investor at Yosemite

Startups

Turquoise Takes $30M Step Along Path To Transparency

Healthcare pricing looks like it’s on its way to becoming more transparent, with Turquoise Health landing $30M in Series B funding to shine an AI-powered light through the fog of medical costs.

Since launching in 2020 prior to hospital and payor transparency regulations, Turquoise has built a comprehensive database of negotiated prices for healthcare services, allowing patients to understand costs beforehand… similar to pretty much every other industry.

• While that information is publically available through Turquoise’s website, payors and providers use the Turquoise platform to ensure they’re well-armed at the negotiating table and compliant with current regulations.

• Turquoise also recently expanded its platform to include Clear Contracts, a tool that leverages AI to streamline the direct contracting process and uncover relevant insights from its dataset.

Over 160 partners already work with Turquoise, ranging from payors and providers to employers and device manufacturers looking to understand their markets. The latest funding will help onboard these recently-added clients into Turquoise’s growing product suite.

• The funding will also accelerate the introduction of new AI features aimed at making Turquoise’s data as intuitive to use as possible, such as by allowing hospitals to upload their contract documents before asking the AI how certain terms compare.

• Although transparency compliance has been heading in the right direction, Turquoise is also gearing up to help more organizations meet new reporting requirements that are just around the corner (which it did a great job outlining here).

Now that Turquoise seems to have cracked the code on compiling negotiated rates, it’s setting its sights on moving past data toward an integrated platform centered on administrative efficiency. New AI tools are almost purpose-built to wade through the PDFs where pricing policies hide, and Turquoise won’t be wasting any time incorporating those tools into its platform.

The Takeaway

Price transparency data has come a long way since 2021, and it’s safe to say that AI has come just as far. With transparency requirements only set to become more stringent, demand for platforms using AI to transmute that data into operational gold will only continue to grow, and Turquoise now has $30M to help ensure it’s healthcare’s alchemist of choice.

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The Wire

• Financial Distress Boosts Hospital M&A: US hospital mergers and acquisitions accelerated in 2023, with ongoing financial challenges helping drive 65 M&A transactions totaling $38.4B (up from 53 the year prior). According to Kaufman Hall, financial distress accounted for 28% of transactions – almost double 2022’s rate – and is impacting a growing number of larger systems as opposed to the historical concentration of distress in smaller hospitals. Health systems are also increasingly focused on organizing regional markets to better leverage complementary capabilities, a trend that’s expected to intensify in 2024.

• UnitedHealthcare Debuts UHC Hub: UnitedHealthcare debuted its new UHC Hub benefits solution that’s open access to any self-funded employer with over 1,000 employees. UHC Hub makes it easier for employers to manage their health benefits by streamlining the evaluation, selection, and oversight of multiple vendors. For employees, UHC Hub helps highlight available programs to address their needs, such as Welldoc (chronic care), Brightside (mental health), and Maven Clinic (women’s health).

• Deliberate AI First to Join FDA Pilot: For the first time since launching in 2020, the FDA’s new ISTAND pilot program for unconventional drug development solutions has accepted its first AI-powered tool: Deliberate AI’s depression and anxiety assessment. Deliberate AI’s AI-COA solution takes in patient data (e.g. facial expressions, speech behaviors, pupil changes) to generate zero-bias mental health assessments that can be used during clinical trials, and its ISTAND inclusion means that it’s now on the path to becoming a qualified drug development tool.

• Older Adults Shy Away From DTC: Only 7.5% of people aged 50 to 80 have used a direct-to-consumer healthcare service – mostly for prescriptions and convenience reasons – according to the latest National Poll on Healthy Aging. Almost half of those over 65 had never heard of DTC healthcare, while 36% said their usual provider doesn’t know about their use of it. DTC is however poised to become more popular, with those aged 50 to 64 more than twice as interested as those over 65.

• Onera Raises $32M: Netherlands-based startup Onera Health raised $32M in Series C financing (total funding now over $60M) to accelerate the commercialization of its self-applied, no-wire diagnostic technology that allows clinicians to conduct at-home sleep studies. The latest funding is also earmarked to expedite the regulatory approval of Onera’s second generation polysomnography system in the US and Europe, bringing clinical-grade PSG diagnostics and monitoring to more patient homes.

• DispatchHealth + Instacart: DispatchHealth and Instacart are teaming up to tackle food insecurity through a fresh approach to food-as-medicine. Using the Instacart Health platform, DispatchHealth’s in-home providers can now easily prescribe nutritional interventions by offering patients medically tailored food lists with items that can be delivered directly to their home, potentially boosting adherence by taking food curation and grocery trips out of the equation.

• Racial Differences in Avoidable Hospitalizations: Black Medicaid patients are far more likely than White patients to be hospitalized for preventable conditions (e.g. COPD, diabetes, heart failure), according to a new Urban Institute report. In 2019, nearly 13% of Black Medicaid patients with previously diagnosed heart failure experienced a potentially avoidable hospitalization (vs. 7% of their White counterparts), which the authors say highlights a glaring need to improve outpatient care for chronic conditions among Black enrollees.

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• Lobbying Watch: A Politico analysis of newly filed fourth-quarter lobbying disclosures found that the top 10 healthcare lobbyists ramped up their budgets last year, with more PBMs jumping into the mix due to heightened scrutiny from lawmakers. The Pharmaceutical Care Management Association ($15M, +78%) and Cigna ($10M, +21%) were the only newcomers on the list, while also both recording the largest year-over-year increases in lobbying activity.

• Don’t Mess With the FDA: A regulatory affairs specialist in charge of medical device submissions to the FDA was sentenced to one year in prison for falsifying 510(k) clearance documents for surgical drill products. The defendant, who pleaded guilty to all charges, was working for B. Braun’s Aesculap subsidiary in 2017 when he created fraudulent clearance letters with forged FDA signatures for the ELAN-4 air drill and JS Series SterilContainer S2 sterilization container – causing “the introduction of misbranded and adulterated medical devices into interstate commerce.”

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