Commure CEO Tanay Tandon

Bad day to be on Commure’s PR desk. Nobody’s in trouble, unless of course this turns out the same way as STAT’s other investigations into UnitedHealth… or Cerebral… or Purdue Pharma…  or Biogen…

Get ready for a spicy one.
Jason

Revenue Cycle

Commure in the Crosshairs

Nobody’s having a longer week than Commure after STAT published a scalding investigation into the company’s growth (at all costs) engine. Turns out it’s a lot easier to be a happy customer when you’re getting paid to be one.

Here’s the backstory. Commure set out in 2020 to build an AI operating system for healthcare that takes power away from payors and hands it back to clinicians. 

• CEO Tanay Tandon summed up the Robin Hood pitch on the YC podcast by saying he’d love a world where UnitedHealth’s market cap is a fifth of what it is today, but every doctor is a millionaire.
• Fast forward a few years and $800 million VC dollars (acquisitions are expensive), and Commure’s grown into a $7B juggernaut helping 130+ health systems automate administrative tasks.

Now comes the investigation. STAT revealed that Commure offers large incentives to clinics and other parties that refer its products to new prospects.

• One physical therapy clinic’s contract required it to refer $750k of new business within a year, or face a $66k “referral obligation fee.”
• Affiliate partners earn 2% of any contracts they bring in, so they have plenty of motivation from both carrots and sticks.
• The catch is that STAT found some especially enthusiastic customers that deliver booth testimonials in company quarter-zips, have Commure email addresses, and hang out in internal Slack channels.

That gets shaky when you have mixed reviews. Some customers credit the platform with driving massive collection boosts. Others either “don’t have a positive thing to say about it” or have absolute horror stories. 

• The article cites particularly unflattering reviews from a Wyoming rehab clinic that fell $500k behind on collections after handing the keys to Commure, as well as an Arizona FQHC that watched $1M in dental claims get denied without receiving a single notification about the issue.

That could be a problem. Former federal prosecutors told STAT that paying for referrals to products funded by Medicare or Medicaid doesn’t sit well with the anti-kickback statute.

• This isn’t the DOJ’s first rodeo, and some major players have been lassoed into settlements over kickback allegations.

Commure’s response? Everything is fine, and everybody is doing it. The company called its referral practices industry standard, chalked the complaints up to a small minority of customers, and lashed out at STAT for giving readers a distorted view of the business.

The Takeaway

Commure’s internal mantra is apparently “speed above all else,” so maybe a few not-technically-kickbacks are just the cost of doing business. A jury might not see it that way, but then again Commure isn’t on trial (at least not yet).

Clinician-First Copilot for Value-Based Success

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How Clinicians Are Using AI to Find Relief

Clinicians are facing a documentation burden that’s outpaced every attempt to contain it, and they’re adopting AI to tackle the crisis faster than health systems can keep pace. Download Heidi’s new report to see how over 1,800 clinicians around the world are already using AI to find relief, and what that means for the institutions still catching up.

The Wire

• K Health Lands Atlantic: K Health is officially on a heater after signing its tenth health system partnership with Atlantic Health. The duo kicked off the collaboration with the launch of Atlantic Health PatientGPT, a K-powered clinical AI tool that’s fully integrated with the system’s EHR and MyChart portal to let patients ask health questions, get answers informed by their own records, and connect with clinicians that already have that full conversation context. This marks K Health’s third PatientGPT launch, and it sounds like the partnership tempo is only going to pick up from here.

• OpenLoop Expands (Again): OpenLoop is expanding its whitelabel telehealth infrastructure into higher-acuity care for patients managing complex conditions. The expansion includes medical nutrition therapy for diabetes and heart failure, employer health benefits, health system programs (post-discharge, disease management, RPM), and clinical support for digital health, DME, and pharmacy partners. Gotta respect the ambition, especially after an already huge year.

• Mental Health Startup Graveyard: A great report from Mentalium provided probably the largest analysis we’ve ever seen of mental health startups – and why they eventually disappear. The report started in 2010 and counted 542 startups that are no longer with us, including 242 acquisitions (45%), 201 “deaths” (37%), and 99 records in the gray zone of pivots and consolidation (18%). Mentalium rounded up some awesome data on every company ranging from business models to clinical evidence, as well as some cool comparisons like B2C startups dying 2.2x more often than B2B (53% vs. 24%).

• Flagler Series B: Flagler Health bagged $50M in Series B funding for its AI-native operating system for MSK practices. The OS is trained on “one of the largest MSK patient data sets” and reportedly orchestrates the full patient lifecycle across triage, care management, billing, and communications. Investors love MSK-focused startups because of the massive total addressable market, and Flagler has the added bonus of a co-founder and CEO with leadership experience at the Spine and Wellness Centers of America.

• Oracle Debuts AI Patient Portal: Oracle Health’s AI-powered patient portal is now available in the U.S., roughly a year after it was first unveiled. Built on OpenAI foundation models and fully integrated with Oracle’s EHR, the portal lets patients review records, message providers, schedule appointments, and get AI-generated plain-language explanations of diagnoses, labs, and treatment paths. Guardrails prevent the AI from dispensing medical advice, and all AI-generated text is highlighted to distinguish it from provider notes.

• Portal Message Black Hole: Patient portal messaging has become increasingly popular since the pandemic, but a new study in Health Affairs shows that the extra work hasn’t been distributed evenly. The study of 224k physicians found that the top quartile of PCPs had a Herculean workload of 53.3 messages weekly, compared to the median of 9.6 messages. That amounts to ~2.6 hours of homework for providers. On top of that, just 5% of the patients sent 53% of the messages, so it’s hard to say the extra work is helping extra patients.  

• Assort Automates Referrals: Assort Health launched Referrals, an AI agent that helps specialty practices and health systems recover patient volume and revenue lost in manual referral workflows. The agent ingests inbound referrals from EHRs, faxes, PDFs, and phone calls, then verifies eligibility and matches patients with the most appropriate provider. Referrals reportedly identifies a better-fit provider than the original in 50% of referrals and drives a 79% referral-to-appointment conversion rate through proactive outreach. It’s the latest addition for the recently-minted unicorn, which crossed a $1.2B valuation with June’s $120M Series C.

• Redox + Lapsi: Redox is teaming up with clinical AI company Lapsi Health to plug the Keikku Clinical Platform directly into more EHR workflows. Keikku is Lapsi’s AI clinical platform that combines AI-powered documentation, contextual clinical reference, diagnostic support, and purpose-built clinical hardware within a single connected workflow, while Redox’s Connection Network of 12k+ healthcare organizations and 100+ EHRs handles the integration heavy lifting.  

• CHCs Close Care Gaps: Community health centers are doing their part to provide insurance-blind healthcare to underserved communities, and the patients are showing up. One in seven Americans use these clinics, per an announcement from The National Association of CHCs. A 2023 report showed CHCs meet a crucial need: over 90% of their patients face financial insecurity, which puts them at risk for worse health outcomes primarily due to a lack of the exact type of affordable, quality care that CHCs provide. 

• ModMed Targets the RCM Tax: ModMed took the lid off its ModMed RCM AI Platform, an agentic AI system built to help specialty practices fight what it calls the “RCM Tax” – the denials, delays, and manual work that quietly erode financial performance. The platform pairs human-in-the-loop billing teams with AI agents that generate appeal packages, validate claims, navigate payor portals, and recommend next-best actions, all powered by hundreds of millions of de-identified claims. Early internal analysis suggests up to a 57% reduction in manual A/R follow-up.

• Galaxy Buds Are Now Hearing Aids: Samsung received FDA clearance for its Galaxy Buds Hearing Aid feature, which lets Galaxy Buds3 Pro and Buds4 Pro function as OTC hearing aids for adults with perceived mild-to-moderate hearing loss. A five-minute self-administered Hearing Test uses clinical-grade pure-tone audiometry to assess each ear, then automatically personalizes the Hearing Aid’s sound to the results. Samsung follows Apple’s 2024 AirPods Pro clearance in turning everyday earbuds into hearing health devices, with both features arriving in the U.S. later this year.

A New Path for ACCESS Model Participants

Building your CMS ACCESS program? Withings was accepted into the inaugural cohort as both a participant and a device partner via the ACCESS Tools Directory. Bring the same FDA-cleared, cellular-enabled devices into your program, including BPM Pro 2, capturing clinical measurements and patient-reported outcomes at the point of reading, purpose-built for value-based cardio-kidney-metabolic care.

Full Context for Complex Patients

Clinicians want to walk into the exam room fully prepared, without the nights and weekends spent poring over charts. Abridge’s Care Signals makes this possible. Co-developed with Kaiser Permanente, the risk-adjustment technology flags risk gaps pre-visit, tracks discussion topics, and creates audit-ready documentation of confirmed conditions. Check out Abridge’s latest move beyond clinical notetaking.

How MetroHealth Reduced Barriers to Care

Modern consumers want easy access to healthcare. MetroHealth met the moment with a patient-centered model where there’s no wrong door to care. The system partnered with Ovatient to offer virtual urgent, primary, and behavioral health care, while leveraging Ovatient and Phox Health to provide same-day prescription delivery. Read the case study to learn more. 

The Resource Wire

• Turning Ideas Into Action: Healthcare has never been short on great ideas. What is new is the ability to turn them into reality at the pace patients need. Discover how Bunkerhill Health is closing the distance between knowing and doing, so providers can get back the two things they never have enough of: the time and the clarity to care for people.

• Pre-Round Preparation Without the Noise: Abridge delivers pre-round preparation with complete context. Before stepping into the room, inpatient clinicians get a concise summary of what matters most – drawing from nursing assessments, ED notes, labs, and the patient’s broader history – so every encounter starts with signal, not noise. See the capability in action here.

• State of Payor Enrollment and Credentialing: Over half of provider orgs are losing revenue due to credentialing delays – with many missing out on over $1M annually. Medallion’s new report unpacks the forces quietly undermining operational and financial performance, and how leaders across the industry are addressing them. Head over to the full report to get insights tailored to your role and org type.

The Industry Wire

1. WHO says Congo’s Ebola outbreak is on track to become the deadliest.
2. Claims data transparency spurs affordability action.
3. Sharp HealthCare lays off 260 employees.
4. OpenAI gives researchers access to frontier models.
5. HHS says fraud crackdown behind ACA enrollment declines.
6. CMS cuts Medicaid funding for transgender youth procedures and therapies.
7. Gunra ransomware targets hospitals.
8. California stonecutters contract lethal disease from artificial countertops.
9. UC San Diego Health, West Health start $40M care initiative.
10. Humana taps ex-Johns Hopkins exec as Medicaid leader.