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Hospital Margins, MA Denials, and Catching the Right Innovation Wave
June 12, 2025
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Together with
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“When’s the last time you saw big pharma put out a Limited Time Offer like Novo just did for Wegovy? Yes, healthcare is different than other industries. New products can actually involve life and death. BUT, is healthcare so different that legit supply and demand curves can’t exist and competition can’t change everything? The lessons of GLP-1s could finally bring consumerization to the biggest market in the world.”
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Sloane & Company CEO Darren Brandt
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2025 Top Leaders in Digital Health Awards
Nominations for the 2025 Top Leaders in Digital Health Awards are officially LIVE!
We’re teaming up with Slice of Healthcare to spotlight the innovators shaping the future of digital health across our combined network of over 75,000 followers.
From rising stars to industry titans, this is your chance to celebrate the change makers in healthcare.
- Nominations: LIVE through June 18th
- Voting: June 23rd – July 2nd
- Awards Announced: July 9th
Nominate a 2025 Top Digital Health Leader Here!
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The ocean of digital health innovation seems to have a wave of new trends breaking every year, which is why Rock Health teamed up with LG NOVA to give enterprises a framework for “discerning promising currents from passing swells.”
Riding the wrong hype cycle can strain health systems’ limited resources with costly implementations or investment mistakes, so Rock Health divided the digital health landscape into 50 segments to see which show the most promise based on:
- Value potential (VP) – share of total digital health venture funding, disease burden (degree of economic cost), and addressable population size.
- Capturable opportunity (CO) – funding velocity, funding concentration (share of capital already held by large companies), and market maturity.
The “Goldilocks” waves include segments that are big enough to support a large market and ripe enough (but not too ripe) for new entrants to gain traction. [Chart: Strongest DH Segments]
- High VP, High CO: Weight Management stood out with the highest scores in both VP and CO. The disease burden and funding levels don’t get much higher, and the balance of early- and late-stage companies signals a strong market with room for new entrants.
- Low VP, High CO: Patient Adherence was docked for its smaller share of overall digital health funding, but stood out for its favorable funding concentration and market maturity.
- High VP, Low CO: Disease Monitoring had the opposite mix. The segment enjoys a large slice of the funding pie, but most of that is getting eaten by a few mega companies.
- Low VP, Low CO: Dermatology received the low marks across the board, with poor scores for funding velocity, disease burden, and overall share of funding.
To complement its framework, Rock Health analyzed over 70 digital health unicorns to find other success signals from waves that the industry is already riding. Unicorns tended to:
- separate from the herd with larger Series C rounds (ex. Abridge)
- support care delivery or access and are often consumer-facing (ex. Wheel)
- be therapeutic area agnostic w/ broad addressable markets (ex. Included Health)
The Takeaway
Timing the digital health market is no small feat, but Rock Health’s framework provides a helpful tool for those looking to catch the best wave with their investments and implementations.
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Navina AI “May Be Essential for Thriving” in VBC
Innovation lab Phyx Primary was left with one conclusion after its independent evaluation of Navina’s AI Copilot: AI “may be essential for thriving” in value-based care. Physicians using Navina saw a 40% reduction in clinical review time, a 32% decrease in burnout, and lifted STAR quality ratings by 1.9 points. The experience scores were just the icing on the cake. Get the full report to learn more.
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Ensuring Compliance With Medical AI Scribes
AI scribes are transforming how providers document patient encounters, but new innovations come with new compliance risks. Head over to Playback Health’s quick-start guide to maintaining compliance in the age of AI, and see how Playback Health Pro is giving providers peace of mind with 100% data ownership, SOC 2 verification, and HIPAA-compliant encryption every step of the way.
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- myLaurel Closes $14M: Home-based care startup myLaurel closed another $12M after quadrupling its patient volume and revenue over the last year. myLaurel and Ochsner Health jointly developed the Acute Care at Home model in 2024, which has reportedly “outperformed expectations” in both clinical and operational metrics. Details were sparse, but we’ll take their word for it given that Oschner participated in the round.
- MA Plan Denials: The percentage of medical claims denied by Medicare Advantage plans now stands at 17%, at least according to a Health Affairs study of 2019 data covering 30% of the MA market. The study found that 57% of those denials were eventually overturned, although providers still took a big hit. Denials resulted in a 7% net reduction in provider MA revenue, based on the dollar-weighted share of denials that weren’t overturned.
- Capital Rx Acquires Amino: Transparent PBM Capital Rx is breaking into the broader healthcare benefits arena through the acquisition of Amino Health and its comprehensive care navigation platform. Amino will power Capital Rx’s Judi Care patient-facing navigation solution, which gives members access to a centralized hub to engage with their benefits and provider-level insights across 200 specialties. That’ll combine with Capital Rx’s Judi Health unified claim processing platform to create a fully integrated solution for managing pharmacy and medical benefits.
- Guidehealth Lands $10M From Emory: Guidehealth landed a $10M investment from Emory Healthcare as the duo looks to scale high-quality primary care to hundreds of thousands of new patients in Georgia. Guidehealth supports risk-based contracts by equipping patients with AI “Healthguides” that help coordinate treatment plans and encourage preventative care. That’s apparently been a successful formula for Emory’s Population Health Collaborative, which used Healthguides to successfully lift Medicare quality scores.
- Neuroflow Unveils BHIQ: Neuroflow bolstered its behavioral health suite with the release of BHIQ, a new analytics solution designed to improve payor and provider risk management strategies. BHIQ surfaces fresh insights from existing healthcare data sources (claims, EHRs, pharma, consumer-generated), revealing population behavioral health needs and potential improvement areas that might otherwise get missed. The ultimate goal is to better identify behavioral health risk cohorts to optimize condition-specific programs, incentivize appropriate utilization, and lower costs.
- Nurses Ready for GenAI: A Wolters Kluwer survey found that nurses are consistently “the most ready and willing to see how GenAI can work for them.” About half of nurses (45%) agreed that GenAI will help reduce burnout by assisting with repetitive tasks, yet only 18% of respondents were aware of their org’s formal policies governing GenAI use. The top concern about implementation was that “an overreliance on GenAI may erode clinical decision-making skills (57%).”
- Somnee Seed Extension: Somnee bolted on another $10M through a seed round extension as it gears up to launch the second generation of its neuroscience-based sleep tech wearable. The Somnee headband was originally developed in 2022 by sleep expert Matthew Walker and a team of UC Berkeley scientists, leveraging a combination of AI and electroencephalogram tech to deliver personalized stimulation that apparently helps people fall asleep faster and maintain higher sleep quality.
- Hospital Margins Improve: Hospital financials continued to improve in April, with Kaufman Hall’s latest Flash Report recording an average operating margin of 3.3% through the first four months of 2025. That’s up from 1.4% last year, due to both rising patient volumes and more efficient throughput as hospitals “are getting more serious” about addressing bottlenecks in their transfer and discharge processes. Discharges per calendar day increased by 3% YoY, while the average length of stay dipped 3% YoY.
- Ovatient + MUSC: MUSC Health is teaming up with Ovatient to expand the reach of its virtual-first primary, urgent, and behavioral health services across South Carolina. The partnership follows hot on the heels of Ovatient launching MyCare Anywhere, its omni-channel patient engagement experience powered by League’s CX platform that equips patients with personalized telehealth, live chat, mental health tracking, and guided care journeys.
- Data Security Prevents Portal Use: LexisNexis polled over 3k adults to find out what motivates them to log on to their patient portal, or avoid it altogether. Over 60% of respondents cited viewing test results as a top reason for using patient portals, while half pointed to scheduling capabilities. About 15% said they’d never accessed a patient portal, with half of the non-users reporting that they avoid portals because they don’t trust the security of their data (vs. just 11% of users).
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Elevate 2025: Medallion’s Virtual Conference Returns September 17
Now in its fourth year, Medallion’s annual conference is back – bringing together healthcare leaders to explore this year’s theme: Elevate the present. Reframe the future of healthcare. Hear from industry voices like Tom Lawry, author of Hacking Healthcare, UPMC Chief Medical Information Officer Robert Bart, and many more. Reserve your spot now.
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What Nurses Are Teaching Us About Ambient AI
Nurses are the backbone of healthcare, and their tools need to keep up with the growing complexity of their roles. For nurses, documentation isn’t just about compliance – it’s how they track key observations, ensure care continuity, and support billing. Nabla’s ambient AI is already helping 8,500 nurses streamline documentation and reclaim time for patients across 30+ orgs. See what Nabla’s building for the fast-paced needs of nursing workflows.
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- Create Efficient Primary Care Access With K Health’s Clinical AI: Keeping up with patient access feels like a losing battle? Hartford HealthCare, Cedars-Sinai, and Hackensack Meridian Health found a new approach. K Health partners with health systems to scale high-quality 24/7 primary care access without sacrificing quality. Learn how K Health’s peer-reviewed clinical AI and Virtualist model are transforming how leading systems deliver care.
- BPM Pro 2 – Unparalleled Reliability: BPM Pro 2 increases data reliability with two new features that ensure patients are taking their reading properly and prompting them to rest and retake it if their first reading was abnormally high.
- Why Health Systems Are Reevaluating Earlier Ambient AI Choices: A third of health systems are now implementing AI, but not all AI technologies are equivalent. Learn about why and how three health systems—UNC Health, Tanner Health, and MaineHealth—decided to reevaluate earlier ambient AI choices and ultimately choose Abridge. Read more here.
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