What You Should Know: - Capital Rx, a health technology company changing the way prescription drugs are priced and patients are serviced raises $106M in a Series C round to end drug price distortion. The Series C round was led by B Capital with participation from General Catalyst and existing investors, Transformation Capital and Edison Partners, bringing the total amount raised to $175M. - Capital Rx will continue to invest in the technology backbone for claims processing and benefit
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KAID Health Raises $4.25M for AI-Powered Provider/Payer Whole Chart Analysis Platform
What You Should Know: KAID Health,makers of anartificial intelligence-enabled clinical analysis and provider engagement platform,today announced its $4.25M in Series A funding bringing their total capital raised to $6.45M. - The funding will fuel growth of the provider/payer platform that integrates with the electronic medical records (EMR) to identify high-value tactical care and coding interventions. The company will also expand its Boston, MA office and will hire new team
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Free Market Health Secures $13.5M for Advance Specialty Pharmacy Ecosystem
What You Should Know: Free Market Health, a Pittsburgh-based healthcare technology company transforming the specialty pharmacy ecosystem with a care-driven marketplace platform, today announced its $13.5M in Series A financing led by Alta Partners and with participation from existing investors Highmark Ventures and 653 Investment Partners. - The capital will enable the company’s team of specialty pharmacy industry experts to scale beyond the hundreds of millions of dollars in specialty
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GuideWell Becomes First U.S. Payer to Automate Prior Authorizations
What You Should Know: - GuideWell, one of the 10 largest health insurance providers in the U.S., became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews from Olive, resulting in faster care for patients — up to 10 days faster — and greater provider satisfaction. - After launching a pilot with Olive in Florida, GuideWell saw its time to decision reduced by 10 days when immediate responses were available, decreased unnecessary prior
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Prior Authorizations: 3 Ways to Reduce Administrative Burden & Burnout
Medicare’s annual enrollment period has started, and you know what that means: a slew of commercials suddenly appearing on television for Medicare Advantage plans. The advertising appears to be working. Enrollment in Medicare Advantage has more than doubled over the past decade to more than 26 million people this year. The private health plans, which are an alternative to traditional Medicare, account for 42% of the total Medicare population. The growth of Medicare Advantage, though, has
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Cohere Health, Humana Expand Partnership to Transform Prior Authorization Process
What You Should Know: - Cohere Health announced that Humana Inc. is embarking on a nationwide expansion of Cohere's digital prior authorization platform for musculoskeletal (MSK) services, based on the success of its initial implementation. - After rolling out the platform across 12 states in January 2021, Humana has made significant progress toward achieving its vision to reimagine and modernize processes for prior authorization by reducing approval times, increasing provider
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Banjo Health Lands $5M for AI-Driven Prior Authorization Platform
What You Should Know: - Banjo Health, a Washington-based provider of AI-driven prior authorization ("PA") solutions, announced today it has raised in excess of $5 million in Series A financing led by Epsilon Health Investors, with participation from Spark Growth Ventures and Tau Ventures. Epsilon Health Investors Co-Founder and General Partner, Gregory Epstein, will be joining Banjo Health's Board of Directors. - Banjo Health is focused on bringing transparency and automation to PA through
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Cohere Health Raises $36M to Automate Prior Authorization Between Payers & Providers
What You Should Know: - Boston-based health IT company Cohere Health has closed a $36 million Series B funding round led by Polaris Partners, with additional participation from new investors Longitude Capital and Deerfield Management, as well as existing investors Flare Capital Partners and Define Ventures. The round comes less than a year after the company launched, and only 3 months after a Series A extension. - Cohere Health’s AI-based, fully
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Healthcare Can Save $16.3B Automating Administrative Transactions, Report Finds
What You Should Know: - Each year, the US healthcare industry spends $39 billion on 9 administrative transactions, according to a new report from CAQH. - The 2020 CAQH Index also uncovered that by automating these transactions, the industry could save $16.3 billion annually--a 42% cost reduction. CAQH, released the eighth annual report measuring the progress made by healthcare payers and providers in automating administrative transactions. The 2020 CAQH Index found that, of
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How Automation is Key to the Future of Healthcare Operations
As the saying goes, necessity is the mother of invention. A similar correlation is seen in the quest to leverage innovation and out-of-the-box thinking to address key problems facing the healthcare industry. The ongoing COVID-19 pandemic has brought the immense pressure the U.S. healthcare system is under into sharp focus. Recent dynamics are compounded by the industry’s efforts to adopt newer ways of working and digitizing patient records, while implementing automation throughout their business
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