Value Based Care Intelligence

Onpoint Healthcare Partners sells the Iris Medical Agent AI platform, which pairs AI agents with a human review workforce to take over charting, coding and follow up work for medical groups and health centers. The company describes the split as 80 percent AI and 20 percent expert in the loop. ChartFlow drafts the note from the encounter and prepares the chart beforehand, clinical auditors check the output, and the provider signs. Around ChartFlow sit CodeFlow for coding and HCC capture, CareFlow for care gap closure and medication prior authorizations, NetworkFlow for referrals and care coordination, SignalsFlow for remote patient monitoring run by US nurses, and a revenue cycle service. Earlier product names include IRIS Cloud, IRIS Virtual Clinical Assistant and IRIS ReferralAuth. The bundle is sold as a managed service the company calls PMaaS, on a subscription priced by practice size, specialty and workload. The company reports more than 2,000 providers across more than 35 specialties, from federally qualified health centers to academic medical centers. KLAS named it to the 2025 Emerging Solutions Top 20 and published an ROI validation in June 2026 at Southwest Care, a federally qualified health center in Santa Fe and Albuquerque. Two facts belong in any evaluation. The human review layer is partly offshore: the company lists delivery entities in Hyderabad, India, and in Mexicali and Monterrey, Mexico, alongside its Plano, Texas office. And its assurance claims are badges rather than documents. The site shows HIPAA Compliant and SOC 2 Certified marks and a 99.5 percent clinical accuracy figure, but publishes no privacy policy, no business associate agreement, no audit report and no method behind the figure.

RadiantGraph sells proactive member engagement to health plans and health systems: it decides which members to contact, about what and through which channel, and then places the call itself. The platform combines a Health Data Engine that unifies member data from the customer's own AWS, Google Cloud, Snowflake and Databricks environments, per person personalization models, segmentation and campaign tools, AI Voice Agents launched in June 2025, and Care Guidance Agents announced in September 2026 for ongoing coaching, education and adherence support in chronic conditions. Named programs include care gap closure, health risk assessment completion, risk adjustment visits, onboarding, retention, clinical program enrollment and Medicaid redetermination, and the company announced approval for the CMS ACCESS model alongside the Care Guidance launch. The evidence behind it is a peer reviewed study run with Oshi Health, a virtual first gastrointestinal clinic, covering nearly 8,800 members over seven weeks in late 2025 and published in Lecture Notes in Artificial Intelligence from the 2026 International Conference on Artificial Intelligence in Medicine. It reports appointment completion up 3.4 times overall and 24.7 times among members who had registered without scheduling, and no safety escalations. The study is a collaboration with the company's own customer, and its figures are multiples without stated baselines. The company describes itself as HITRUST certified, SOC 2 Type 2 compliant and HIPAA compliant. Founded in 2023 in San Francisco by Anmol Madan, who previously co founded Ginger and was chief data scientist at Livongo, it raised an $11 million Series A and won Databricks' Built on Databricks Startup Challenge grand prize in 2025.

Cedar Gate Technologies runs value based care arrangements end to end on one platform, from data management and analytics through to adjudicating the payment. Enterprise data management ingests more than 50 data types, claims, clinical, eligibility and benefits among them, into a single data lake on Amazon Web Services, cleanses and normalizes them and stitches records to members. Analytics sits above it, covering value based care performance and benefits analytics for self funded employers, with benchmarking against a proprietary database the company describes as covering more than 12 million member lives. Care modules supply care management, clinical decision support and utilization management. Payment modules adjudicate bundled and capitated arrangements, converting fee for service claims into a single bundled claim and administering capitation against changing eligibility. Actuarial consulting and bundles program management are sold as services. Much of the estate was bought. David Snow launched the company in 2014 with backing from GTCR and released a value based care analytics tool, Isaac, in 2016. Global Healthcare Alliance followed in 2018, bringing the bundled payment engine, then Citra Health Solutions, Deerwalk and Enli Health Intelligence in 2020. The company is now an IQVIA business and still sells under its own name, with more than 1,000 employees: more than 300 in the United States and more than 700 in Nepal. Buyers span health plans, provider organizations from accountable care organizations and clinically integrated networks to federally qualified health centers, and self funded employers with their brokers, consultants and third party administrators, across commercial, Medicare and Medicaid lines including MSSP, ACO REACH, Medicare Advantage and TEAM bundles. Named customers include Kairos Health Arizona and a cardiovascular care network reporting lower cardiac spend per patient under bundles. What a buyer should weigh: the information security page names SOC 2 Type II and HITRUST r2 certification without dates or reports, and no price or unit of charge is published.

Inovalon is a data business that sells analytics and software on top of its data. Its real world data draws closed claims from more than 160 national, regional and local health plans, open claims refreshed daily and electronic record data across more than 295 million encounters, and the company holds Medicare data under a CMS designation. Inovalon ONE is the platform layer, with connectivity into record systems and health information exchanges and more than 100 solutions reached through a single sign on portal. Four markets are served from it. The payer products carry the value based care work: Converged Quality for HEDIS and Star rating measurement and improvement, Converged Risk and Converged Record Review for risk adjustment, outreach, provider enablement, submissions and digital quality measures. Provider products, built on the acquired ABILITY Network, cover revenue cycle, care quality and workforce management. Pharmacy products serve specialty and infusion operations, and life sciences products license data for research and trial work. VigiLanz, acquired in February 2024, is still sold under its own name. Converged Quality has held NCQA HEDIS measure certification for more than two decades of consecutive years, and NCQA has validated its digital quality measure engine. The company says 12 of the top 15 health plans use it and that its customers achieved 11 percent higher 2026 Star ratings than plans using other solutions, a comparison it sources to its own press release. Inovalon was taken private in 2021 by a consortium led by Nordic Capital with Insight Partners, 22C Capital and founder Keith Dunleavy, and is headquartered in Bowie, Maryland. What a buyer should weigh: the same data that serves health plans and providers feeds a research licensing business, and no published statement explains the permissions or de identification standard behind that second use; and no price is published for the quality and risk products.

Lightbeam Health Solutions assembles a value based care operating system largely by acquisition, and the pieces it bought explain what it is. The core platform aggregates data from many sources, normalizes it, mines it for care gaps, stratifies risk and returns the result to providers at the point of care. Its risk engine combines the Johns Hopkins ACG System, the NYU avoidable emergency department algorithm, the Charlson Comorbidity Index and the CMS HHS HCC models with Lightbeam's own predictive and prescriptive insights and an engageability score. CareSignal, acquired in November 2021, contributes what the company brands deviceless remote patient monitoring, now run through text message, voice and conversational AI agents. Jvion, whose operating assets were acquired in 2022, contributed prescriptive analytics and social determinants capability. Syntax Health, acquired in December 2025, contributes contract modeling, incentive design and actuarial services, and the company also offers clinical and financial advisory services and an ACO optimization service under the Wakely name. The monitoring product was ranked first in its KLAS category in 2024 and 2025, and Microsoft gave the platform a Healthcare AI Certified Software designation in 2025; the suite runs on Azure and can be bought through Microsoft's marketplace. The company announced NCQA prevalidation of its population health platform, and its HITRUST r2 certification was last announced in February 2024. Named customers include Saint Peter's University Hospital, Integrity Health, Kootenai Care Network and Harris County Public Health. Founded by Pat Cline, with Ben Stilwill named president in January 2026, backed by Hearst and Primus Capital, and headquartered in the Dallas area. Two things a reader should weigh. The branded monitoring category is described as deviceless, and federal remote physiologic monitoring reimbursement generally requires data transmitted automatically from a medical device, so a buyer should establish whether a given program is billable under those codes or funded another way. And no price or unit of charge is published.

Persivia sells health systems, accountable care organizations, physician groups and health plans a single platform for running value based contracts, and it is open about building that platform on a long rules and content lineage. CareSpace aggregates clinical records, claims, health information exchange feeds, admission and discharge messages, patient reported data, device readings and social determinants information into a longitudinal patient record, then layers risk stratification, care management, quality reporting, care gap identification and patient engagement on top. Around it sit a data cloud for aggregation, CareTrak at the point of care, SmartLab for laboratory results exchange, a marketplace, and Soliton, which the company calls its AI engine: predictive, prescriptive and generative AI for cohort prediction, diagnosis code extraction from notes, and generated worklists, notes and patient communications. The distinguishing asset is a library of more than 200 evidence based programs covering chronic disease, care transitions, preventive care, behavioral health and social determinants, which customers deploy as shipped or adapt. The company describes CareSpace as resting on more than a decade of clinical rules engine and analytics work, and says customers go live in as little as nine weeks. The certifications page lists NCQA Data Aggregator Validation and HEDIS measure certification, CMS public health reporting certification, HITRUST certification and a SOC 2 Type 2 report. Named customers include McLaren Health Care, HCA Florida Oak Hill Hospital, Prime Healthcare and Harmony Cares. The company presents itself as a Niche Player in a Gartner Magic Quadrant for healthcare provider cloud platforms, is headquartered in Marlborough, Massachusetts, and was recapitalised in April 2025 with Aldrich Capital Partners alongside Petrichor Healthcare Capital Management. What a buyer should weigh: the customer results on the home page carry no period, denominator or method, the case studies behind them are gated, and no price or unit of charge is published.

Health Catalyst sells health systems the data layer beneath their improvement work, plus the people to run it. Its filings describe two segments: technology, covering a cloud data platform, analytics applications and support sold as cloud subscriptions and term licenses, and professional services, covering analytics, implementation, advisory, outsourcing and improvement work. The improvement results it markets are attributed to software and expert labor together. Ignite is the current platform. It ingests record, claims, financial and operational data through prebuilt connectors for more than 40 systems with FHIR, HL7 and OMOP support, profiles it for quality, resolves patient and provider identity and exposes a unified data model that customers can query with their own tools. Ignite Intelligence adds shared models, agents, benchmarks and comparison services; its Clinical Cost Intelligence application runs language model agents and statistical models to find cost variation. The company says its AI work is built on Microsoft Azure and Azure AI Foundry, names Databricks as its model deployment foundation, and sells Ignite through the Azure Marketplace. For value based care it offers contract performance analytics, population health and care management tools, and Daniel Samarov is its Chief AI Officer. Much of the estate arrived by acquisition and is co branded: Twistle for patient engagement, Upfront for patient experience, Lumeon for care orchestration, and an interoperability and health information exchange platform acquired as Medicity. The information security page lists certifications and audited reports product by product with dates, and links public SOC 3 reports. More than 1,100 organizations are stated to use the offerings. Headquartered in Salt Lake City and listed on Nasdaq. What a buyer should weigh: trailing twelve month revenue of roughly $302 million as of March 2026 against a market capitalization of roughly $154 million at the end of July 2026, with growth described as modest and restructuring under way, which matters to a buyer signing a multi year data platform contract; and a headline claim of billions of dollars in measurable results that carries no method, period or breakdown.

Arcadia sells the data foundation underneath value based care, and increasingly the models that run on top of it. The platform ingests clinical records from more than fifty record systems, payer claims, admission and discharge feeds, pharmacy data and social determinants information, resolves them to a single member through a proprietary master patient index, applies natural language processing to unstructured text, and presents the result to population health, risk, quality and network teams. Named components include a data gateway that monitors ingestion for quality anomalies, a lakehouse, Arcadia Vista for value based care insights, Network Modeler, Contract IQ, benchmark reporting, care management, and an HCC Risk Suspecting App that surfaces suspected diagnoses inside Epic and writes them to the problem list for the clinician to reconcile. A generative assistant built on OpenAI models summarizes records for care teams. Two ownership events shape the company now. CareJourney, acquired in June 2024, supplied national benchmark data derived from Medicare claims. In July 2025 Nordic Capital took ownership, and the brand is still sold under its own name. Arcadia publishes its prices on AWS Marketplace: the data platform lists at $1,275,120 per 100,000 members over 36 months, with analytics, care management and health plan packages priced on the same basis. The home page shows NCQA Data Aggregator Validation and HEDIS and AMP measure certifications, and security badges for ISO 27001, a SOC 2 Type One report and HITRUST i1. Buyers are health systems, provider groups, accountable care organizations, health plans and state and local governments working under shared savings, ACO REACH, Medicaid and commercial risk contracts. Named customers include Southwestern Health Resources, Tandigm, Castell, Rush Health, Beth Israel Lahey Health and Belong Health. What a buyer should weigh: the published outcome figures carry no denominator, period or method; the security report shown is a SOC 2 Type One rather than a Type Two; and implementation is not priced.

Astrata reads clinical charts so quality teams do not have to. The company builds natural language processing for healthcare quality measurement, aimed at the HEDIS reporting that determines health plan star ratings and quality bonus payments. Chart Review performs NLP assisted abstraction for year round prospective HEDIS work. Constellation exposes the same unstructured data capability for risk adjustment and other chart based activities, and can sit inside a customer's own data architecture. eMeasure is a digital HEDIS engine built natively on FHIR and CQL. Outreach targeting applies the analysis to surveillance and member outreach, and readiness assessments help plans prepare for digital quality measurement. The technology was developed over almost two decades with NIH funding and spun out of UPMC Enterprises in January 2021, with the first product built alongside UPMC Health Plan. NCQA certified eMeasure for digital measures in July 2022, with Smile CDR as the FHIR platform partner, and designated Astrata a certified data partner in its Data Aggregator Validation program in June 2023; the company says it is the only recipient of that designation for NLP assisted clinical document enrichment. It holds HITRUST r2 certification, announced in 2022 and renewed in September 2024. The company publishes its pricing model: a fixed price subscription per HEDIS performance year plus a set up fee, driven by the measures selected, the members in their denominators and the data integrations, with no charge by user or chart volume. Customers include CDPHP, AmeriHealth Caritas and UPMC, and the Association for Community Affiliated Plans named it a preferred vendor in 2025. Based in Pittsburgh and led by president Rebecca Jacobson, who co chairs NCQA's Industry Council; NCQA's founder Margaret O'Kane joined the board in February 2026. Buyers are health plans and accountable care organizations. What a buyer should weigh: no accuracy figure is published before contracting, though customers receive accuracy reports; and no rate sits behind the published pricing model.

Clarify Health now describes itself as a healthcare outcomes company that partners with health systems, a change from how it sold until recently. Two offers sit on one data layer. Clarify Meridian is presented as an outcomes based partnership rather than software: market data, prioritization the company describes as AI driven, and a field team working beside the health system's own to move referral volume, affiliations, sites and rates in its favor. Its scope includes performance under value based contracts: the Meridian page describes one view across fee for service, Medicare Advantage, MSSP, TEAM and commercial agreements, with episode level quality assessed against each contract. Clarify Arrival works the patient side, following referrals until the patient is booked and seen, reaching patients with documented need who are not seeking care, and converting patients who are already searching through a digital front door powered by Loyal Health, which Clarify acquired and which still sells under its own name. Underneath both is the Clarify Atlas Platform, which the company says holds more than 300 million patient journeys drawn from Medicare, commercial and managed Medicaid claims, more than 270 million prescription records, 5.6 trillion price transparency rates and social factors, with more than 20 billion AI predictions in production. The company says it works with more than 60 health systems and ties its economics entirely to measured results against a baseline agreed before the work starts. It has published annual public reports on quality measures across Medicare, Medicaid and commercially insured populations since 2020. Based in San Francisco and led by chief executive and co founder Todd Gottula. What a buyer should weigh: the headline figure of $3.2 billion in documented customer ROI comes with no method, period or customer breakdown, and no customer is named on the home, about or resources pages.

Behavioral health integration infrastructure sold to risk bearing organizations, health systems and health plans rather than to patients. Founded 2016 in Philadelphia by Chris Molaro, chief executive, and Adam Pardes, chief operating officer; one source gives 2017. Funding totals roughly $58 million, including a $20 million Series B led by Magellan Health and a $25 million growth round led by SEMCAP Health, with a later private equity round. The premise is that behavioral health need surfaces in physical care settings not equipped to handle it. The company describes its capability in four stages. Identify applies what it calls transparent machine learning across claims, record system, admission discharge transfer and assessment data to surface undiagnosed and undertreated behavioral health conditions across a population and stratify it by acuity. Engage reaches members and patients between visits with an acuity driven next best action. Connect routes each person to a level of care and a provider through referral flows, described as spanning self guided support through crisis response. Measure tracks outcomes longitudinally for pay for performance reporting and return on investment. The platform is sold as IntegrateBH for health systems, health plans and accountable care organizations, expanded in February 2026 with referral matching that NeuroFlow describes as AI powered and weighing more than 100 clinical, logistical and preference variables; BHIQ, a behavioral health analytics product released in June 2025; and TxProgress, measurement informed care for behavioral health providers. The home page presents the four stages without these names. NeuroFlow has grown through four acquisitions. In 2023 it bought Capital Solution Design, the parent of Behavioral Health Lab (BHL) and BHL Touch, the measurement based care platform used across the Department of Veterans Affairs. In June 2024 it acquired Owl, a measurement based care platform for behavioral health providers; the combined business reported more than 17 million lives covered and more than 400 assessments offered. In January 2025 it acquired Alluceo, Intermountain Health's team based platform for integrating behavioral health into primary care, together with the behavioral health risk model Intermountain developed over a decade, which NeuroFlow is incorporating into its analytics. Later that month it acquired Quartet Health, a value based behavioral health enablement company with a provider network and referral management, and is bringing Quartet's payer and provider customers onto its platform. The owl.health and quartethealth.com sites now say each is part of NeuroFlow. Four buyer types are addressed separately: health plans and payers, health systems with accountable care organizations and integrated delivery networks, the federal government, and behavioral health providers. Named customers and references include Independence Blue Cross, Jefferson Health, Atlantic Health System, Emory Healthcare, Intermountain Health, Magellan Health, Prudential and the Department of Defense, with platform reach reported at roughly 15 million patients, 6.61 million assessments collected, and 55,000 instances of suicidal ideation and rising risk identified. Published case studies report $28 per member per month in reduced total cost of care at Independence Blue Cross and a 34 percent fall in emergency department utilization at Jefferson Health. A journal item in the Academy of Consultation-Liaison Psychiatry and eight conference presentations between 2022 and 2024 sit alongside them, all company authored. Magellan Health is both a customer and the investor that led the Series B, so that reference is not disinterested. The company was a finalist in a federal grand challenge to reduce veteran suicide, receiving $250,000 and advancing to a second phase, which is competitive government evaluation rather than a marketing award. Security credentials are stated correctly and with their tiers: health specific certification at the implemented one year level, a controls report at the second type, and privacy compliance. A dated subprocessor register is published, revised November 2025, though it covers the marketing and support stack rather than the clinical platform. The gaps are measurement and commerce. No accuracy, sensitivity or calibration figure is published for the risk identification models, the transparent machine learning claim is not explained, and nothing about pricing is disclosed.

AccuCode AI, founded in 2023 in Little Rock, Arkansas, with a second office in Seattle, runs autonomous medical coding and clinical quality abstraction on one engineering stack. The coding product assigns ICD-10, CPT and HCPCS codes across specialties with a cited passage for every code and hands off to the billing system without per chart review, keeping coder review for deployment validation, compliance sampling and rule based routing; a joint cardiovascular product with MedAxiom is sold as AccuCode CV. The quality product abstracts, calculates and submits measures to CMS programs including Hospital IQR, Value Based Purchasing, MIPS and MVP, to The Joint Commission and to NCDR, STS and Get With The Guidelines registries. Nathan Myers is president and chief executive; Scott Roper is chief operating officer and also leads Professional Consulting Services, the Arkansas billing firm AccuCode was founded inside. The company argues that most healthcare AI summarizes a chart before the model sees it and that its architecture reads the whole record, including handwriting, binding every output to a source passage. It says its models were never trained on patient data or licensed coding content. It publishes a live Drata security report, names SOC 2 Type II, commits to United States only data and personnel, and writes those commitments into every business associate agreement. What a buyer should weigh: the published accuracy figures come from audits by a partner and a related party, with no sample sizes; coding and quality submission run without per case review and the routing threshold is unpublished; and the company is small, so continuity terms deserve attention.

Autonomous medical coding through the XpertCoding product, paired with a business intelligence platform reporting coding accuracy, billing levels and provider performance, with dashboards for risk adjustment (HCC and RAF) and outpatient quality measures. Founded 2015 in Birmingham, Alabama by two physicians, originally to improve clinical trial access; the first product was XpertTrial, a trials database and patient recruitment platform. Corporate headquarters is now Scottsdale, Arizona with a Birmingham regional office, and company press materials variously give Scottsdale and Phoenix. Led by co founder and chief executive Sameer Ather, a physician with a doctorate, with Mateo Montoya as chief technology officer. The architecture is explicitly hybrid: ensemble machine learning models, neural networks and symbolic reasoning over payer guidelines, rather than a single end to end model. Integration covers API, SMART on FHIR, HL7 ADT messaging and robotic process automation, with listings on the Epic Showroom and the athenahealth Marketplace. Published accuracy and turnaround figures have not agreed across the company's own materials: older claims include 95 percent of claims coded within 12 hours at 95 percent accuracy and 98 percent accuracy within 24 hours, and the current home page states accuracy above 99 percent with more than 94 percent of claims submitted within 24 hours. Quote the current figure with its date. XpertDox targets federally qualified health centers, urgent care, primary care and pediatrics rather than academic medical centers and large integrated delivery networks. Named customers include Community Health Programs of the Berkshires (announced November 2025), Lone Star Circle of Care, Nao Medical and PM Pediatric Care, and the company also distributes through billing companies, including a 2024 alliance with Positive Results Billing. Funding is small, roughly $2.5 million in total, including $1.5 million in 2022 led by the leadership of TN3, an Arizona private equity firm.

mPulse reaches health plan members at very large scale and uses models to decide which members to reach. Based in Los Angeles, backed by PSG and previously trading as mPulse Mobile, it describes itself as a health experience and insights company and reports more than four billion consumer touchpoints a year across more than 450 healthcare organizations, including over 50 of the 60 largest health plans and 80 percent of top rated Medicare Advantage plans. It was named a Strong Performer in the Forrester Wave for customer experience platforms in healthcare in the first quarter of 2026, and reported year on year revenue and profitability growth in the same quarter. The platform combines predictive analytics, more than 140 machine learning models estimating each member's risk of missing quality measures, adverse outcomes and disenrollment, with two way conversational AI and omnichannel delivery across text, voice, web, portals and print. A member who texts asking for help finding a doctor receives a provider directory link without a person intervening, and campaigns can hand off to a live agent mid conversation. Real time integration with Epic scheduling supports appointment workflows. The platform is described as HITRUST certified. Much of the current shape came from acquisition. HealthTrio and Decision Point Healthcare Solutions were bought in December 2023, adding member portals and predictive analytics, and Clarity Software Solutions followed in August 2025, contributing cross channel communication and data from 150 million member communications. Use cases center on the measures that determine health plan revenue: medication adherence for Star Ratings, preventive screening and quality measure gap closure, the federal member experience survey, member acquisition and retention, and access to care. What a buyer should weigh: the models decide who is contacted and nothing is published on their features, performance or results by member group; the headline results come from anonymous client plans; and the terms disclaim that the services are error free and cap liability at fees paid.

RxAnte predicts which health plan members will stop taking their medication, and then sells the plan a way to intervene. It is a portfolio company of UPMC Enterprises, the venture arm of the health system, and its president is Aaron McKethan. The analytics come first. Predictive models identify members who are already non adherent and, more usefully, those likely to become so while there is still time to act, scored against the Medicare Star Ratings medication measures, HEDIS measures and patient experience surveys. The company states its analytics cover more than 14 million lives and that it manages Part D star performance for 70 percent of the lives in five star Medicare Advantage prescription drug plans nationally. The targeting criterion is named openly in the product itself. The Value of Future Adherence score, produced by the company's VFA software, identifies members with the greatest cost savings potential, and the company describes it as letting a plan engineer the return on its pharmacy care management program. Members are ranked by what their non adherence would cost, not by how sick they are. Since 2019 the company has also owned the intervention. Mosaic Pharmacy Service is a working pharmacy for medically complex Medicare members on multiple chronic medications: a virtual visit and enrollment offer, a pharmacist medication review using its Therapeutic Decision Support tool, 30 day supplies delivered in pre sorted pouches including over the counter items, and monthly follow up with prescribers and caregivers. The company has published a matched control analysis of Mosaic within a Medicare Advantage plan, comparing enrollees against members who filled prescriptions elsewhere on total cost of care, unplanned care events and adherence at six months, with a pre stated hypothesis that savings would be greatest in the high scoring subgroup. Named health plan relationships include Aetna and UPMC Health Plan, and its work has appeared in NEJM Catalyst.

HiLabs, founded in 2014 by chief executive Amit Garg and Neel Butala and based in Bethesda, Maryland, with offices in Pune and Bangalore, sells AI that cleans and reconciles health plan data. Its MCheck platform spans provider data (roster automation, directory accuracy that validates more than 60 attributes per clinician across thousands of sources, network intelligence, contract analysis and an agentic outreach product that calls provider offices), clinical data extraction, and MCheck VBC CareSphere, a value based care suite that simulates contract terms before go live, audits member attribution, reconciles settlements, predicts member churn and tracks CMS rule changes. The company says it serves six of the ten largest United States health plans, cites more than $1.5 billion of annual value based care payments monitored, and says its method was the instrument in peer reviewed research published in JAMA on directory inconsistency. The platform holds HITRUST e1 and HITRUST AI Security certifications (September 2026) and runs on AWS. It raised a $39 million Series B in March 2024 led by Denali Growth Partners and Eight Roads Ventures. What a buyer should weigh: the value based care page promises CareIntel ensures no signals are missed; no correction accuracy or payment flag precision is published, and the published research measures the problem rather than the fix; the site publishes no privacy policy, HIPAA statement or business associate agreement although several products handle member and clinical data; and offices in India sit inside the certified scope.

ActiumHealth is the healthcare patient communication product of Syllable, which acquired it in March 2024 and runs it as a division. It began in 2017 as SymphonyRM, a predictive outreach company, and now sells conversational AI agents that answer every inbound call 24/7/365 and run outbound campaigns by text and voice. Inbound agents book appointments directly in the record system, process refill requests, answer billing questions and escalate complex calls to staff with context; outbound agents mine the record for care gaps, open referrals and canceled appointments, schedule screenings and wellness visits, and target high risk patients. ActiumHealth Insights monitors the agents' own calls and flags problematic interactions. The company cites 70 percent of routine inbound calls automated end to end, 91 percent intent accuracy and five languages, and names MemorialCare, Virtua Health, Nebraska Medicine and Houston Methodist as customers. The parent's trust portal lists HITRUST, SOC 2 Type 2 and a named subprocessor list including its language model and speech providers. What a buyer should weigh: the home page promises zero data hallucinations while publishing an intent accuracy that shows requests are misunderstood; no escalation rule for urgent or distressed callers is published for an always answered line; the agents are said to understand dialects better than a human with no per language result; and the parent is repositioning as a general voice platform, which bears on the healthcare line's future.

Authenticx, founded in Indianapolis in 2018 by former healthcare executive Amy Brown, analyses the conversations healthcare organizations have with patients, members and professionals across telephony, chat, messaging, email and CRM notes, and reports what they reveal at a system level. It says it runs more than 20 proprietary models trained only on healthcare conversations labeled by experts, sold as three products: Business Insights, built around its Eddies friction model that ties points of confusion to outcomes such as prescription fills and retention; Quality and Coaching, which scores every interaction against rubrics; and Safety and Compliance, which detects adverse event and compliance signals. Services sit alongside the platform: client success, insight workshops led by its experts and conversation analysis. Customers span pharmaceutical and device manufacturers, health insurers, where it pitches Star Ratings and member experience, and provider contact centers. The company cites 97 percent AI accuracy and more than 500 million conversations analyzed, runs on Microsoft Azure with each client in a dedicated environment, lists SOC 2 Type I and II and HIPAA compliance, and commits not to sell or train its models on sensitive healthcare data. Its last announced round was a $20 million Series B in January 2023 led by Blue Heron Capital. What a buyer should weigh: the accuracy figure names no task or method and no adverse event detection sensitivity is published, though a missed signal carries a reporting consequence; the models are said to be trained on real healthcare conversations beside a promise not to train on sensitive data, which a buyer should reconcile; agent quality scores come from a model with no published route to contest them; and the terms disclaim accuracy and cap liability at a year's fees.

Attune, based in Chicago, launched publicly in January 2026 under chief executive Matt Coughlin and sells an agentic engagement platform for healthcare: Agentic Voice, a conversational voice agent for inbound and outbound calls, with Flow Builder, Campaigns and Analytics modules around it. For providers the agent schedules appointments, sends reminders, coordinates referrals, runs pre operative and post discharge check ins and handles preventive outreach; for health plans it handles onboarding, benefit and claims calls, Stars aligned campaigns, outreach for screenings and gaps in care, and health risk assessments. It reads and writes through interfaces and webhooks, navigates phone trees, detects voicemail and passes the full conversation to staff when it escalates. The company describes conversations as following deterministic flows the customer configures, with transcription on a self hosted layer and multilingual synthetic voices. It reports a Medicare health risk assessment program at an unnamed major health plan (every member dialed, 49 percent answered, 75 percent completion) and quotes Gold Kidney as a customer. The home page states HITRUST and ISO 27001 certification and HIPAA compliance, with a trust center. What a buyer should weigh: the home page promises complete accuracy and says every interaction is accurate, which a speech system calling an older population cannot guarantee; multilingual operation is marketed with no per language result; no escalation rule is published for a patient who answers a check in by saying they feel worse; the only privacy document covers the website; and the company is young and does not state its funding.

Laguna Health, founded in 2020 by Yoni Shtein and Yael Adam and based in New York, applies conversational AI to the calls care managers hold with members. Its roots are in contextual care after a hospital discharge: a member's record describes their medicine but not their life circumstances, caregiver situation or the obstacles that decide whether a recovery plan is followed, and those surface in conversation. Laguna Companion prepares the care manager before a call, offers hints during it, drafts documentation afterward in each organization's format and updates member information automatically. Laguna Insight analyses every interaction for team leaders, replacing manual quality review with scores and coaching feedback on each care manager. LISA automates follow up tasks, and the Laguna Reef platform configures all three to an organization's methodologies, quality standards and summary formats, with data stored and processed in United States data centers. Buyers named on the site are health plans and virtual care organizations, including outsourced care providers and third party administrators. The company has raised over $21 million, including a $15 million Series A in 2023 co led by SemperVirens and HC9 Ventures, and co-authored a 2023 randomized trial of its post discharge coaching model. What a buyer should weigh: the company describes its solution as accurate and hallucination free while its home page reports accuracy above 99 percent with no method; its published trial tested human delivered coaching, not the software; and Insight's scores about care managers carry nothing published on validation or how a care manager can contest them.

Popai Health, founded in 2024 by chief executive Eyal Gurion, chief product officer Michael Latar and chief technology officer Elad Levy and based in New York and Tel Aviv, builds what it calls patient context from everyday care team conversations. It listens across mobile and call center calls, in person visits and text messages in more than 70 patient languages and sells three functions on that layer. Capture composes notes to each organization's own templates and delivers them into record, care management and CRM systems once reviewed and approved, with each claim linked to the moment in the conversation that supports it. Coach reviews every patient interaction, whether handled by a person or an AI agent, against the customer's standards. Reach identifies emerging needs and rising risk across a population to prioritize outreach, escalate and close care gaps. Patient Context combines those signals with what the record already holds to recommend the next action, channel, timing and message for each patient. The company raised $11 million in November 2025 led by Team8 and New Enterprise Associates, and names Essen Health Care, New Horizons and Clover Health as customers. What a buyer should weigh: the site promises notes that are accurate every time in every language and publishes no per language results, model supplier or method behind that; the only privacy document covers the website rather than the service; and the footer shows a SOC logo and a HIPAA badge without the report type, period or business associate terms behind them.

Oatmeal Health, founded in May 2022 by Jonathan Govette and based in San Jose, runs lung cancer screening programs for federally qualified health centers and the imaging centers and hospitals that scan their patients, serving Medicaid and Medicare populations that screening has historically reached least. LungIQ reads FQHC record exports, using a large language model and a classifier to recover smoking history and risk factors from clinical notes, and produces a ranked worklist of patients likely to meet the USPSTF screening criteria. A consortium model connects FQHCs without CT scanners to partner imaging centers. LungAI, a vision transformer trained on National Lung Screening Trial data, scores nodule malignancy from 0 to 100 inside the imaging center's existing CADe viewer, with Coreline Soft among the CADe partners. The company is precise about regulatory status: LungAI is an investigational device, not FDA cleared and not commercially available in the United States, with a 510(k) pre submission filed in March 2026 and a pivotal study at Mass General Brigham launching in the second quarter of 2026. Its business associate agreement is published as a click through on its site. What a buyer should weigh: the performance figures (0.96 area under the curve for both models) come from the company's own retrospective validation with no published report; the language model that reads clinical notes is not identified; and no price or contracting model is published, only the reimbursement routes buyers can bill.

Carna Health is a Boston company founded in 2021 by Dr Salvatore Viscomi that builds screening and care management infrastructure for chronic kidney disease and the wider cardio kidney metabolic cluster. It pairs point of care testing, through an exclusive agreement with Siemens Healthineers, with a cloud platform that ingests results from laboratories, testing devices, record systems and health information exchanges, stages patients, and routes those who need specialist care into a referral pathway. A provider app gives nurses and primary care providers guided workflows and decision support, and a patient app shows people their risk and tracks their measurements. It runs national or regional screening programs in Bermuda, Cameroon, the Philippines, the Dominican Republic and Turkey, with entry into the United States underway, and a May 2026 partnership brings the Renalytix kidney risk test onto the platform. The company markets itself as AI driven throughout, with AI predictive analytics, AI clinical decision support and AI guided workflows. Its own end user license agreement describes AI features as something it may integrate in future, and no model or method is described anywhere on its site. What a buyer should weigh: the decision support is marketed in clinical terms (recommendations on drug interactions and interventions, managing complex cases without a nephrologist) with no regulatory position stated; the security posture is described as SOC 2 ready rather than attested; and the privacy policy carries unfilled template text.

Arine sells medication intelligence to health plans rather than to hospitals. The platform ingests clinical, socioeconomic and behavioral data across a plan's membership, identifies members at risk of medication related problems before they produce an event, generates personalized care plans for clinical pharmacists to act on, and separately analyses prescriber behavior so a plan can direct education and recommendations at the clinicians writing the prescriptions. A third product line targets the Medicare Advantage and Part D quality measures, particularly the triple weighted adherence measures that carry disproportionate weight in the CMS Star Ratings that determine a plan's bonus payments. The solutions can be bought separately or combined. The company was founded in San Francisco by Yoona Kim, a doctor of pharmacy with a doctorate who serves as chief executive, alongside Penjit Moorhead as chief technology officer and David de Vries as chief operating officer, and it launched under the Arine name in 2019 after operating as Akeso. Its platform runs in Amazon Web Services data centers and holds HITRUST risk based two year certification announced in July 2024. Named clients span Medicaid, Medicare Advantage and behavioral health, including the Oklahoma Health Care Authority, Magellan Health, VNS Medicare and MDX Hawaii. Every outcome figure the company publishes is its own, and it names the analytic method behind them, matched pair statistical analysis.

FeelBetter applies machine learning to polypharmacy, the problem of an older patient accumulating enough medications that the regimen itself becomes the hazard. The platform synthesizes longitudinal pharmacy and clinical data across a whole population, identifies the patients at highest risk of near term deterioration or hospitalization attributable to their medication regimen, recommends specific regimen changes to a clinical pharmacist, and monitors what happens after the intervention. It is organized as four tools: Insight for risk stratification, Navigator for workflow, Action for the pharmacist facing recommendation engine, and Impact for post intervention monitoring. The company was founded in 2018 by Liat Primor, previously VP of global portfolio and chief of staff at Teva Pharmaceuticals, and Yoram Hordan, and operates from Boston and Tel Aviv. It raised $5.9 million in July 2023 bringing total funding to roughly 8 million, which is modest relative to the health systems it serves. Named customers span three distinct buyers: Atlantic Health System in New Jersey across its accountable care organizations, Americare in long term care, and Leumit Health Services, an Israeli health maintenance organization. The evidence position is unusual for a company this size, since investigators at Brigham and Women's Hospital published a retrospective cohort of 108,817 patients in the American Journal of Managed Care evaluating the platform's recommendations. The company markets its approach under a coined term, Pharmaco-Clinical Intelligence, which describes a market position rather than a method, and almost no technical, security or compliance detail is published alongside it.

Credo Health, based in Denver and led by founder and chief executive Carm Huntress, retrieves and assembles patient records for value based care. Its Acquire agent identifies where a patient has received care and pulls records through national exchange frameworks (the eHealth Exchange, Carequality, CommonWell and TEFCA) and regional exchanges, and where those networks return nothing, recovers records from source providers by telephone, secure portal and fax; its affiliates include Medical Records Exchange LLC, doing business as Chartfast. The Inspect agent analyses the assembled record to improve coding and documentation and raise quality scores, surfacing suspected risk adjustment conditions for physicians to review; Engage copilots put a searchable, source cited history inside the clinician's record system, which the home page lists as including athenahealth, eClinicalWorks, Elation Health, Greenway Health and NextGen; and Optimize dashboards show how that work translates into risk adjustment factor scores. Buyers are value based care providers, MSOs, ACOs and health plans, and the home page shows ChenMed, Clover Health and Imperial Health among its customers. Credo publishes its business associate addendum and master terms, and raised a $5.25 million seed round in early 2024 led by FCA Venture Partners. What a buyer should weigh: the terms license customer data to train Credo's models and create de identified data sets, with no retention period stated; no security attestation is published; the home page promises to help physicians perfectly diagnose and treat every patient while the terms leave every risk adjustment code with the customer; and the retrieved records feed retrospective risk adjustment, where audit scrutiny concentrates. Name collision: credo.health is an unrelated product; this record concerns credohealth.com.

Kennar Health, operated by Toothpicker Holdings, Inc. of Hicksville, New York, sells what it calls an AI workforce for value-based care. A scribe listens to the patient interaction and structures clinical data in real time; an analysis layer surfaces open HEDIS quality gaps and HCC risk adjustment opportunities during the visit so a provider can act without switching systems; and a transitions-of-care function pulls discharge data, builds clinical summaries and creates follow-up tasks the same day. It is sold to four audiences: clinicians and practices, IPAs, ACOs and provider networks, health plans and payers, and digital health companies consuming structured point-of-care data through an API with published OpenAPI specifications. Deployment is a hosted multi-tenant architecture with EHR-agnostic integration; no record system vendor is named and no customer deployment is identified anywhere. Four figures are published: a 70 percent HEDIS capture rate across deployed networks against an industry-typical figure given as about 25 percent, half of quality measures closed autonomously, a 0.2 RAF lift stated as an annual estimate derived from an average of two additional HCC codes captured per encounter, and two hours a day returned to physicians and support staff. None carries a customer, denominator, baseline, period or method. On audit exposure the company gives a mechanism rather than a reassurance: it captures HCC codes prospectively at face-to-face encounters with MEAT-compliant documentation support, states that retrospective chart review is the primary driver of RADV clawback risk, and argues its point-of-care model eliminates that exposure by design. It adds that every code traces back to a face-to-face encounter with an approved provider type, meeting CMS encounter-level evidentiary standards, and that output is standardized audit-ready supplemental data rather than manual submission. No audit outcome from any customer supports it. The company announces SOC 2 and publishes a trust center listing it as compliant alongside a controls inventory and policy documents, without naming the attestation type, period, assessor or report. The privacy policy describes receiving protected health information and the restrictions HIPAA places on it, but the phrase business associate appears nowhere across the site, trust center, privacy policy or terms. The home page states there is no work left uncaptured and that gaps close in the room every time; no review step, confidence signal or escalation threshold is published for either the scribe output or the surfaced coding opportunities.

Zus Health assembles a longitudinal patient record from national data networks and delivers it to care teams, analysts and developers. The Zus Aggregated Profile queries CommonWell and Carequality for medical history, adds pharmacy fill data, admission and discharge feeds and lab results, matches records to one person through a proprietary universal patient index, deduplicates and normalizes everything to FHIR, and shares a customer's contributed data back to the networks. It is delivered through a standalone app, embedded views inside athenahealth, Elation Health, Canvas Medical and Healthie, REST and GraphQL APIs, webhooks and analytics data marts. The Generated Patient Summary, released in beta and now free to existing customers, is a language model summary of the profile with a citation on every clinical statement. A risk adjustment add-on, launched in October 2025, suggests HCC recapture and suspect codes with linked clinical evidence and calculates CMS-HCC risk scores for value-based care organizations' Medicare Advantage populations. Access to shared data is confined to treatment, payment, operations and public health activities, gated on each customer asserting a relationship with the patient and on a use-case review. Founded in 2020 by Jonathan Bush, the company names customers including Tennessee Oncology, Firsthand, Pair Team, Author Health and Homeward Health. It states SOC 2 Type 2 and a HIPAA-compliant data store; no hosting location, model provider, match rate, retention period or price is published.

Anterior sells clinical AI to health plans and to the organizations that run clinical review for them. Its system, Florence, is built on frontier models and reads charts, faxes, structured feeds and policy text to support utilization management and prior authorization, case management, HEDIS gap closure, risk adjustment, payment integrity, policy management, and appeals and grievances, packaged as four programs: Triage, Flow, Relay and Steward. Each outcome carries its reasoning, the record findings and the policy criteria applied, and every action is written to an immutable ledger. Work completes automatically only where criteria are clearly met, and the company's July 2026 partnership announcement with Stellarus says the AI will never deny care. The company names MedWatch (three times clinician productivity and 97 percent clinical accuracy), Geisinger Health Plan, HealthHelp and Stellarus, cites 99.24 percent clinical accuracy that it attributes to validation by KLAS Research, and says it supports organizations covering more than 50 million lives. The site lists SOC 2 Type II and HITRUST e1 and a trust center. Founded in 2022 and based in New York, it has raised about $64 million, including a $40 million round in February 2026. What a buyer should weigh: the home page sells payment integrity as accurate every time while the company's own figures show it is not; the home page offers automated approvals while the partnership announcement says licensed clinicians make every final determination; production cases feed back into the system, and whether member records train models or cross between plans is not stated; the accuracy figures carry no published method; and no URAC or NCQA accreditation is named, so a plan should expect to carry delegation oversight itself.

Neurotrack describes itself as a cognitive care enablement platform: digital cognitive assessments, an adaptive layer it calls Smart Logic, and care planning support, sold to help providers assess, diagnose and care for people with mild cognitive impairment and dementia. The assessments are Symbol Match (processing speed and visual attention), Path Points (a digital trail making task for executive function) and Word Recall (verbal memory); the first step takes about three minutes and can be taken in clinic, remotely or at home. Smart Logic chooses which assessments to give from the patient's responses, combines the results with EHR context to surface a DSM-5 aligned diagnostic pathway, and drafts a care plan; the company does not say how it works. The company describes the product as an FDA registered Class II medical device and reports 94 percent sensitivity and 90 percent specificity for the Symbol Match and Path Points battery in a Frontiers in Aging Neuroscience study comparing healthy people with people diagnosed with Alzheimer's disease. It sells to health systems, primary care networks and health plans, and to plans it positions the assessments as documentation for V28 risk adjustment, Medicare Advantage in-home health risk assessments and Annual Wellness Visits. Customers named on the estate include Desert Oasis Healthcare and Sutter Health, and Nationwide reports using the three minute screen in long term care insurance underwriting. Founded in 2012 by Elli Kaplan with academic co-founders including Elizabeth Buffalo and Stuart Zola, Neurotrack began with eye tracking based cognitive assessment; the current products use the patient led tests above.

RAAPID is a Louisville, Kentucky risk adjustment company whose platform is built on what it calls neuro symbolic AI: machine learning combined with a clinical knowledge graph that links every suggested hierarchical condition category code to MEAT based chart evidence, and flags codes the record does not support as well as missed ones. It covers prospective risk adjustment before and during the visit, retrospective coding, RADV audit response and AI by API, sold as a managed program run by its certified coders, as a platform for a customer's own coders, or as an API. The platform runs natively on Microsoft Azure, including inside a customer's own Azure tenant, uses Azure AI Foundry and Azure OpenAI Service, and is transactable on the Microsoft Commercial Marketplace. It holds HITRUST r2 and SOC 2 Type 2, and is backed by Microsoft's M12, UPMC Enterprises and CareFirst's Healthworx. What a buyer should weigh: the published accuracy figures (92 percent before coder review, 98 percent after) carry no independent validation; the guaranteed 10 to 1 return does not say what it pays if missed; the company markets autonomy while coder validation produces final accuracy; and whether customer charts train its models is unstated.

Reveleer is a Glendale, California company founded in 2009 as a medical record retrieval business and since rebuilt as a value based care platform for health plans and risk bearing providers across Medicare Advantage, ACA Marketplace and Medicaid. Its products cover retrospective risk adjustment with RADV audit support, prospective risk adjustment that surfaces possibly undocumented conditions into point of care workflows for clinician confirmation, quality improvement with HEDIS abstraction and care gap management, provider directory validation and member management, sold as platform software or as end to end managed services. All of them run on EVE, its Evidence Validation Engine, which combines generative evidence extraction with clinician authored logic, supervised models that score how well each finding is supported, agentic pipelines and clinical language processing, and links every suggestion to its source page for a coder or clinician to confirm. A clinical data repository launched in 2026 keeps retrieved charts as a persistent member level record reused across programs. The company describes itself as HITRUST certified. What a buyer should weigh: the models behind EVE's generative and language layers are not named on its own site; accuracy is reported as vendor figures with no method, including a noise reduction described as both 3X and half; the repository makes a durable clinical asset of charts released for single purposes, with retention and model use unstated; and whether any fee is contingent on conditions captured is not published.

Clinician copilot that ingests data across the EHR, health information exchanges, insurance claims, and care gap files, then uses proprietary language models to classify documents and extract structure from free text, producing a consolidated Patient Portrait at the point of care. Surfaces suspected chronic conditions never explicitly documented, infers hierarchical condition categories for risk adjustment, and supports HEDIS care gap closure, with every insight linked back to the underlying clinical evidence. Also combines ambient transcription with historical data to draft visit documentation, and sells analytics tracking risk adjustment and quality performance. Sold to value based primary care groups, ACOs and MSOs, and health plans.

Guidehealth is a Dallas based operating platform for value based care and benefits administration, formed in 2023 and built partly on the acquired value based care services division of an analytics vendor. It sells to health systems and doctors, payers and employers under two pillars. Health enablement combines STEM, predictive intelligence that targets the patients most in need; RoseConnect, a conversational voice AI that speaks with patients, closes care gaps and escalates to people; and Healthguides and nurses who turn guidance into action. Benefits enablement applies agentic AI to prior authorization decisioning, medical necessity, claims and plan design. In August 2026 URAC named the company among the first to earn its Health Care AI Accreditation. What a buyer should weigh: RoseConnect talks to patients and prior authorization decisions are marketed as running in minutes and straight through, with human oversight described only as a phrase; the terms disclaim accuracy and exclude liability; no security attestation or hosting detail is published; and the home page results carry no method or named customer.

Health benefits navigation and care platform for self insured employers, health plans and labor unions, indexed for its AI navigation layer with the surrounding care services as context. WayFinding is a generative AI experience launched in 2024 and scaled through 2025, combining benefits navigation, clinical guidance, and care access in one interface, delivering tailored recommendations from a member's own history so a member can determine what is covered, what it will cost, and where to go. Agentic capabilities added from January 2026 include symptom triage, finding a provider, scheduling, follow ups and pharmacy coordination, with memory carrying context between interactions. The company completed a $621 million merger with Accolade in April 2025, taking the formerly NASDAQ listed company private and combining WayFinding and the Cancer Care, Surgery Care, Weight Health, and pharmacy benefit experiences with Accolade's health advocacy, 2nd.MD expert medical opinion, virtual primary care, and its True Health Actions platform, which draws on employer data, health plan data, and electronic health records for targeted guidance. The combined organization reports serving more than 21 million members across more than 1,700 employer and health plan clients. Buyers should be clear that this is a hybrid: a substantial share of what is delivered is human advocacy, virtual clinical care, and second opinion services rather than AI. A $126 million Series D in May 2024 was raised specifically to build AI capability. Led by Glen Tullman.

Particle Health sells access to patients' medical records through a single API. It queries CommonWell, Carequality, eHealth Exchange and state HIEs, with ADT feeds and pharmacy fill data, returning FHIR R4, C-CDA or its own tabular format, and reports 320 million patients across more than 70,000 organizations, finding on average 90 percent of patients nationally. On top sit Snapshot (AI summarization of retrieved records), Signal (nationwide admission and discharge alerts), Workbench, Navigator, curated FOCUS datasets and Med Rec. Its buyers are value-based care organizations, payers, health systems and developers building digital health products, used for appointment preparation, referrals, eligibility, care gaps, risk stratification and readmissions. The company names HITRUST certification and SOC 2 compliance, runs on Google Cloud, and states that PHI is de-identified when used for internal analytics. Its insights page says matching algorithms guarantee every retrieved record belongs to the intended patient. A 2024 exchange framework dispute with a major record system vendor over customers' purpose of use was resolved with those customers removed, and the company's antitrust action continues. No business associate agreement, retention policy, match rate or price is published.

Innovaccer, founded in 2014 and headquartered in San Francisco, sells what it calls an agentic cloud for healthcare: the Gravity platform, which unifies record system, claims, pharmacy, laboratory, monitoring and social determinants data (a reported 80 million patient records) and runs applications and AI agents on top. Its solutions include Flow for revenue cycle, Atlas for population health, Galaxy for payer risk and quality, Cured and Comet for customer relationships and access centers, PQS for pharmacy quality, Humbi for actuarial intelligence and Story Health for managed specialty care, several arriving through acquisitions, most recently an ambulatory revenue cycle services business in May 2026. Value based care is a core line, with solutions for risk adjustment, quality and Stars, contract management and the CMS LEAD, TEAM and ACCESS models, and Story Health Partners accepted into the ACCESS model as a participant. In the 2026 Best in KLAS awards Gravity, Galaxy and Cured took the top score in their categories. Customers include Kaiser Permanente, Banner Health, Ascension and Trinity Health; the company has raised $675 million. Its trust center lists SOC 2 Type II, HITRUST CSF and ISO 27001, publishes a subprocessor list, an AI governance framework with a four tier impact assessment, and a commitment not to train its models on customer data. What a buyer should weigh: no per agent accuracy or threshold is published for agents that hand work to one another; the utilization management product's human review point is not stated; affiliates in India and the United Arab Emirates appear on the subprocessor list with their role unstated; the company is now also a participant in a federal care model where its software serves other participants; and no pricing is published.

AI agent platform for health system and health plan operations. Agents work patient access (intake and registration, scheduling, referrals, order transcription, pre-procedure instructions by voice), revenue cycle (patient estimates and copay collection, prior authorization, appeal letters, denials), care operations (care gap outreach, chart review, risk adjustment) and the contact center, including a voice assistant answering patient calls around the clock. Underneath sit Flow Builder, a no-code tool for building, testing and publishing automations; Flow AI and Sidekick assistants; a skills library; dashboards; and a Connector Hub that reads and writes across Epic, Oracle Health, MEDITECH, athenahealth and payer portals through APIs, robotic process automation and HL7. A trust center lists HITRUST, SOC 2 Type 2, PCI DSS and ISO/IEC 27001:2022. Named customers include CommonSpirit Health, MUSC Health, Security Health Plan, Southwest General, Montage Health and Gillette Children's; the company reports 12,000 sites of care and 1.5 million tasks automated a day. Founded 2017 in San Mateo, California by Pranay Kapadia; backed by ICONIQ Growth among others.

Upside (UpsideHOM, Inc.) is a housing stability service sold to Medicaid and Medicare Advantage health plans, health systems and employers, addressing housing instability as a driver of avoidable emergency and hospital use. Care Guides, housing navigators who work cases by phone and in the field, take a referred member from eviction or homelessness through a housing plan, applications, deposits and the move to a signed lease and stable tenancy, drawing on a curated network the company sizes at more than 750,000 properties. Software supports them: AI sorts new referrals by urgency, generates a preliminary housing match before the first call, and summarizes cases, while a Care Guide reviews and owns every decision and AI is not used for clinical decisions. Plans refer members through a Salesforce native portal and pay fees tied to case completion. Founded in 2020, it raised a $20 million Series A in June 2026 led by Aquiline with Flare Capital Partners, and reports a Medicaid housing supports contract with UnitedHealthcare of New Jersey. What a buyer should weigh: the urgency sort and matching allocate a scarce good with nothing published on what they optimize or how outcomes distribute; the home page promises 24/7 coverage while the terms say the service is not monitored for emergencies; security rests on controls described as SOC 2 aligned rather than attested; and employer programs sit outside the business associate agreement that protects plan members.

Pearl Health is a New York value based care enablement company for Medicare primary care. Its platform analyses claims, ADT feeds and record system data to rank the patients who need attention first, suggests next steps such as follow ups and diagnosis gaps, automates routine outreach and scheduling, and tracks cost, quality and benchmark performance; its actuarial and data science teams match practices to the Medicare program and risk level that suits them across ACO REACH, MSSP and Medicare Advantage. Pearl also bears risk alongside its practices, offering implementation advances, monthly payments and pooled risk arrangements, or the technology alone. It reports 250,000 beneficiaries, 10,000 providers in more than 40 states and $3.6 billion of premiums managed, names customers including BayCare Health System, Holzer Health System and Hudson Headwaters, holds HITRUST r2 certification for the Pearl Health Application, and raised $110 million in July 2026 ($50 million of equity led by Andreessen Horowitz and a $60 million credit facility). This record covers the platform. What a buyer should weigh: the prioritization algorithm is documented only in a gated report and nothing says what a clinician sees behind a ranking; the company has a financial stake in the outcomes its models steer; no business associate agreement or platform privacy terms are published; and the savings figures carry no method.