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Heidi, PBMs the Rightway, and a GLP-1 Slowdown
By Jason Barry and Virginia Hunt
September 28, 2026
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Together with
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“AI will make uncertainty cheap to explore without making it cheap to resolve.”
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MDCalc Co-Founder Dr. Graham Walker
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Webinar week has finally arrived! Grab your spot for this Wednesday at 12pm ET to learn what virtual-first care actually means, why the market is moving toward it, and the strategic case for health systems to own their own strategy. I’ll be hosting it live (and taking down the names of anyone who doesn’t come out to support;)
– Jason Barry, Managing Editor
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Heidi Health just raised $340M at a $900M valuation, which is about $1.4B in their native AUD so they might technically koala-fy as a unicorn.
One round, two vehicles. The funds were split between a $100M Series C led by Blackbird, and $240M in growth financing from General Catalyst’s Customer Value Fund.
- GC’s Customer Value Fund takes a capped slice of revenue instead of equity so that “companies with good unit economics can push their growth engine without spending their own balance sheet on it.”
- That not only suggests that GC views Heidi as one of the fastest horses in the ambient scribe race, it also shows that Heidi would rather take on a revenue-share than a company-share. Confidence is key.
The scribe days are over. Heidi was one of the early pioneers of direct-to-clinician AI with its ambient scribe, but it’s since evolved into a complete AI Care Partner for the entire enterprise.
- This video from CEO Tom Kelly, MD has a great overview of that journey, and explains why Heidi developed its task-specific models that “run circles around the frontier labs” on safety and accuracy.
- That allowed Heidi to move beyond documentation into aggregating medical evidence at the bedside, routing tasks across the care team, and answering millions of clinical questions every month.
It also helped the platform spread like wildfire. Heidi hit 90% retention before it even had a sales team, and hiring one turned it into one of the most rapidly adopted platforms in healthcare:
- Supporting 2.8M visits every week across 190 countries and 110 languages.
- Scaling ARR from $1M to $50M in two years.
- Expanding in the U.S. with partners like Beth Israel Lahey, MaineGeneral, and Monash.
What’s on the horizon? Clinical work. Heidi is honing its focus on getting the clerical paperwork off clinicians’ desks, while keeping the medical judgment solely on human shoulders.
- That means introducing new AI agents to perform the tasks weighing down clinicians outside of visits. “Pre-charting. Chasing diagnostics. Operational friction.”
The Takeaway
Heidi exists “to double the world’s capacity for care.” It’s a big mission, but fair dinkum, and Heidi knows it won’t get there by compiling a list of tasks then handing it back to a clinician to complete. That’s why it raised $340M to build the agents that complete them.
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Making the Case for AI
Healthcare organizations have a lot to gain from implementing AI that can enhance coding accuracy and quality metrics, but securing buy-in from leadership is a crucial first step. Check out Navina’s new guide by Dr. Michael S. Barr to see exactly how to demonstrate clear financial benefits, ROI potential, and alignment with organizational priorities to help ensure AI projects are successful.
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Telehealth Has a Ceiling. Here’s How MetroHealth Broke It
For too many patients, traditional telehealth visits often lead to a dead end. To reach its full potential, virtual care needs a reboot. The MetroHealth System partnered with Ovatient to do just that with a new virtual-first care model built on the EHR and connected to patients’ ongoing care journeys. A study of 50k patient encounters shows the results: 100% of patients were able to have a new appointment within 3 days, 35% of virtual primary care patients were net new or re-engaged, and virtual urgent care achieved 17% lower 72-hour ED use than in-person visits. Read the report to learn more about MetroHealth’s approach.
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- GLP-1 Slowdown: New data from the Massachusetts Health Policy Commission showed that commercial payers in Massachusetts spent $1B on GLP-1s in 2025, but the MHPC apparently expects that number to drop significantly this year. Several MA-based employers and health plans grappling with skyrocketing costs apparently stopped covering GLP-1s for weight loss for this year, including BCBS of Massachusetts. The data might only be from one state, but the trends are definitely being felt across the country.
- PBMs the Rightway: Transparent PBM startup Rightway hauled in $155M to “lead the next generation of pharmacy benefits.” The strategy for making that happen combines an aligned financial model that removes all incentives on higher drug spend with a clinical model that puts pharmacists to work guiding members to the most appropriate medications at the lowest cost. Rightway already counts 45 Fortune 500 companies as clients, and it sounds like the next stop is the public markets.
- AI Big Brother: A majority of nurses now feel watched or tracked by AI. The Black Book survey of 202 nursing professionals found that 65% of hospital RNs feel like AI is consistently keeping tabs on them, but not necessarily helping them. It was surprising to see that a similar share (63%) said AI has been adding tasks without removing old ones. The survey also found that 52% have changed documentation timing or care sequencing to avoid negative metrics, while 49% reported using workarounds to reduce alerts.
- Are Payers Gaming the IDR System? Amid controversy over high costs of the independent dispute resolution process in the No Surprises Act, the ACR and other physician specialist groups sent an analysis to Congress laying the blame mostly on insurance companies. Payors make bad-faith offers of $1 on many IDR claims, limit their provider networks unnecessarily, and fail to negotiate fair rates with physicians. This drives IDR volume before disputes ever begin.
- Urgent Utilization: Despite heavy investment in the market, new data from Trilliant shows that urgent care utilization didn’t show strong sustained growth in the aftermath of COVID, and instead returned to pre-pandemic levels. Visit rates increased from 187 per 1k patients in 2019 to 198 visits in 2025, peaking at 288 visits per 1k patients in 2021. The analysis also showed that in 2025, 64% of urgent care patients utilized primary care compared to only 56% of non-users, suggesting that urgent care isn’t replacing primary care in the current model.
- EZ Funding: EZ Health closed $26M of seed funding to address the dwindling number of providers caring for a growing number of seniors. The AI-powered navigation platform reportedly helps seniors manage everything from visit transportation and medications to meal plans and scheduling. EZ says its advantage over the long list of care navigation products already on the market is that it isn’t embedded inside of a health plan or PBM, but instead sits on top of these existing systems to get the holistic context of everything patients need.
- Neko Opens NYC Center: Whole-body scanning startup Neko Health opened its first U.S. center in New York City last week. The opening marks the start of the company’s effort to bring its preventive health concept to the world’s largest market, after first growing the business in Sweden and the U.K. Neko plans to roll out additional centers across the country using the $700M it raised in July. Worth noting that radiologists still aren’t sold on whole-body screening as a whole.
- Vitality’s U.S. Health Revamp: Vitality is bringing its Google-powered behavioral health platform stateside to help users map out individualized care plans. The system uses Gemini and a set of 2.8k behavioral variables to understand a patient’s greatest risks, then offers action steps to address them and keep them engaged with care. The move comes on the heels of Vitality scooping up Icario and Ramp Health earlier this year.
- e-Screening Helps Veterans: New research in JAMA Internal Medicine showed that NeuroFlow’s BHL Touch closed a 30-point screening gap for unhealthy alcohol use among veterans. Among the 848 vets in the study, a single text message 24 hours before telehealth visits increased visit screening completion rates from 43.9% to 74.4%, while also quadrupling the likelihood of a positive screen result (10.6% for e-screening vs 2.7% for usual care.
- Xsolis Goes Peer-to-Peer: Phone calls between physicians and payers to sort out denials are meant to speed up claims, but that only happens if providers put in the call prep. Xsolis is trying to lighten the load with their AI-enabled GenAI Peer-to-Peer Clinical Synopsis platform that takes patient records and helps put together a clinical case to back-up treatment plans. The capability is built into Xsolis’ broader Dragonfly Advise system, which is designed to streamline the medical claims process from start to finish.
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Unlock Better Care With LOLA
Whether you’re looking to augment your team’s capacity or capabilities, Tucuvi’s clinically validated LOLA voice agent is purpose-built to make it happen – and has the success stories to prove it. Hear first-hand from Tucuvi’s customers how LOLA is empowering clinical teams to care for patients while maximizing ROI.
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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.
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Evidence, in the Flow of Care
Heidi brings trusted guidelines and peer-reviewed research directly into clinical workflows so decisions don’t stall care. Clinicians get clear, evidence-based answers without leaving the conversation. No ads, no limits, and no outside interests getting in the way of care. Find out how with Heidi Evidence.
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- Making Healthcare Feel More Human: Abridge has always believed that the best healthcare technology should make healthcare feel more human. That means focusing on the most human signal we have: the conversation. Head over to CEO Shiv Rao’s latest blog to see Abridge’s vision for bringing the broader healthcare ecosystem into the picture, so clinicians can focus more on the practice of medicine and less on the process of medicine.
- 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.
- 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.
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