What You Should Know
- The Raise: Keebler Health, an LLM-native risk adjustment platform, has raised a $16M Series A funding round led by Flare Capital Partners, with participation from Sands Capital and a syndicate of venture funds. The company has raised $23M since its founding in 2023.
- The Technology: Unlike legacy platforms that use retrofitted Natural Language Processing (NLP) to scan for keywords, Keebler is built entirely on Large Language Models (LLMs). It processes the raw clinical narrative to surface accurate Hierarchical Condition Category (HCC) coding opportunities.
- The Future Roadmap: Beyond immediate risk adjustment, Keebler plans to use the funding to expand into compliance and audit workflows—specifically targeting AI-enabled RADV (Risk Adjustment Data Validation) audit readiness as CMS scrutiny intensifies.
Solving the “Approach Problem” in Risk Adjustment
Traditional risk adjustment is often hampered by fragmented data. While approximately 80% of healthcare information is unstructured—residing in provider notes, imaging reports, and discharge summaries—most legacy systems rely on retrofitted NLP or coded fields that fail to capture the full patient story.
Research highlights the severity of this gap, with one study finding that only 59.4% of chronic conditions are consistently captured across EHR sources. Keebler’s platform was built from the ground up on Large Language Models (LLMs) to process the patient narrative directly.
“Risk adjustment doesn’t just have an awareness problem, it has an approach problem,” said Isaac Park, CEO and co-founder of Keebler Health. “We built Keebler to bring that medical story forward so decisions about risk and reimbursement reflect the holistic view of each patient’s health”.
Seamless Integration for Value-Based Care
Keebler enables healthcare providers and value-based care organizations to surface accurate Hierarchical Condition Category (HCC) coding opportunities through both retrospective and concurrent workflows. Key features include:
- Actionable Point-of-Care Insights: Clinicians receive data-driven insights within their existing clinical workflows, enabling appropriate revenue capture without operational disruption.
- Accuracy and Compliance: By unlocking raw clinical narratives, the platform ensures reimbursement reflects the true complexity of the patient population.
- Scalable Infrastructure: The platform is designed to handle the massive volume of documentation generated by nationwide healthcare organizations.
Beyond Coding: The Future of Population Health
While risk adjustment is the initial focus, the Series A funding will fuel expansion into adjacent areas. Keebler is laying the foundation for proactive risk management and Next Best Diagnostic Action by building an infrastructure that can read and act on the full clinical narrative.
Future use cases include AI-enabled RADV audit readiness and compliance workflows as regulatory scrutiny of risk adjustment continues to evolve.
