Sponsored by: Stedi

Stedi is a modern healthcare clearinghouse. They help you process eligibility checks, claims, and remits.

On January 1, many patients will change their health plans. To get ahead of coverage issues, providers run eligibility checks to refresh their coverage data. But when everyone runs checks at once, payers struggle to keep up. Outages are common.

Their annual refresh tips can help you prepare. They’re also offering a limited number of free consultations.

If you're interested in sponsoring the newsletter, let us know!

One Big Thing

CMMI, HHS, and FDA launch new initiatives supporting technology-enabled care, headlined by ACCESS

All eyes were on DC this week, as CMS announced its new CMMI ACCESS model on Monday morning. Then, at a broader launch event on Thursday, the FDA and HHS also announced related new programs. Across the three agencies, the announcements were:

  • CMMI’s ACCESS Model: a new ten-year voluntary outcomes-based payment model designed to support technology-enabled care models. 250+ startups have already indicated interest in participating.

  • FDA’s TEMPO pilot: an effort to fast-track approval of digital health devices within the sandbox of the ACCESS model. The FDA intends to approve ~10 manufacturers in each of the four ACCESS clinical use areas.

  • HHS’s AI Strategy: an initiative to use AI to empower the federal workforce and drive innovation.

If you’ve been on social media this week, chances are you’ve already seen perspectives on these programs from your favorite thought leader, as these announcements generated a lot of interest. In general, it seems there were two reactions: folks mostly expressed excitement about the general direction here, with a few expressing concerns about how a specific detail will play out. Here were a few perspectives that I found most helpful in digesting the news:

  • A discussion between CMMI Director Abe Sutton and AMA CEO John Whyte. The two discussed the model and what CMMI aims to achieve with it.

  • Matt Kamen’s LinkedIn posts on the time it takes to drive adoption of new technologies (here) and the strategic decisions ACOs will need to make (here)

  • Harry Saag penned a thoughtful post musing about the various integration points that will be important for the rollout of the model

If you haven’t already gotten your fill of early takes on this model and want to hear two nerds digesting it live, Martin and I spent 30 minutes chatting it through on Friday afternoon here:

✍️ Going Deeper

The excitement from the startup and investor community around this news was palpable this week, and specifically at the launch event on Thursday. In some ways, the launch reminded me of the launch of the Global and Professional Direct Contracting model a few years ago. At that time, advanced primary care organizations like Oak Street and Clover talked breathlessly about the market-expansion opportunity at hand by expanding from MA to traditional Medicare. The initial startup and investor excitement backfired in that scenario in predictable ways — i.e. recall Elizabeth Warren calling for an end to that program because of concerns over turning Medicare over to “corporate profiteers”. Ultimately, the program was rebranded as ACO REACH, with design changes to make it more appealing to other stakeholders. The net result was still a meaningful program, but not quite as transformational as hoped for when it was announced.

To that end, I found one of the most notable aspects of the announcements this week was the endorsements from the various associations highlighted below, as well as the panel discussion on Thursday featuring leaders from the AMA, ACC, and APA discussing their support for the model (I think I got those three associations right). Featuring a panel of leaders from various associations discussing their enthusiasm for the model struck me as both intentional and wise.

So while the slide highlighting how 250+ startups have indicated interest in participating received a lot of attention, this slide highlighting the endorsement of various provider and payor organizations struck me as the more important one:

These endorsements, in many ways, seem more important to keep an eye on for the ACCESS program than the startup interest. CMMI appears to be signalling its willingness to support the creation of a new profit pool for companies that provide tech-enabled care. Given that, if ACCESS is going to achieve CMMI’s mandate of not increasing costs, then, by definition, that also means an existing profit pool will need to shrink. Which most likely means that one of those associations on that screen would have constituents who see profits decline.

That dynamic seems like the game of 3D chess that CMMI leaders are playing as they launch ACCESS, attempting to move the industry forward in a positive direction while hopefully avoiding some of the political challenges that models like GPDC have historically faced.

Other Top Headlines

  • Sword announced that its AI Care Management division, Sword Intelligence, is being deployed in Greece as the country's front door to healthcare. It appears the initial use case centers on a new National Health Information Line in Greece, 1566, with Sword’s AI agents powering the hotline. The rollout of 1566 earlier this fall appears to have been plagued by issues, as 200,000 visits were scheduled within the first five days of operation. The hotline experienced long wait times and booking errors, which appear to have led to this partnership with Sword. Sword’s CEO told Bloomberg that it is on a path to build a trillion-dollar business that will change healthcare worldwide.

  • Best Buy reported another $192 million impairment charge on its Best Buy Health business in Q3 FY26 earnings. Best Buy’s US services business, which accounts for ~7% of its domestic revenue, saw revenue decline by 1% YoY primarily due to Best Buy Health. The press release noted that the impairment charge reflects “downward revisions in the company’s longer-term projections in part due to pressures in Medicaid and Medicare Advantage markets”, with the 10-Q noting that pressure is both on revenue and margins. While Best Buy exited the Current Health business earlier this year, it also made a few other acquisitions over the last decade, including GreatCall and Critical Signal Technologies, which appear to be driving the impairment charge here.

  • On the same week the House passed a 5-year extension for hospital-at-home, former employees shared on LinkedIn that hospital-at-home provider Inbound Health abruptly shut down. Inbound originally spun out of Minneapolis-based health system Allina Health in 2022 with $20 million in funding to scale Allina’s hospital-at-home model to other health systems. If you’re looking to understand the challenges of care delivery innovation, I think Inbound makes for a great case study. From the conceptual appeal of the hospital-at-home model and COVID-19 as a catalyst driving early adoption to the challenging reimbursement environment and the challenges of operationalizing health system JVs, there’s a lot to unpack and learn here.

  • Mark Cuban apparently shared on a panel at the Forbes Health Summit this week that Mark Cuban Cost Plus Drugs and Humana are exploring a partnership, with Cuban seemingly excited about the distribution that Humana could provide to bring volume to Cost Plus Drugs. Which… what? I guess I am impressed by the level of cognitive dissonance that Cuban apparently is able to handle, given his public schtick that vertically integrated insurers are the root problem of healthcare in this country. As I think I recall reading in Sun Tzu once, if you can’t defeat your arch nemesis, instead partner with them to leverage their scale to your economic advantage.

  • Hims & Hers announced the acquisition of YourBio Health, a blood-sampling technology company that Hims will use to simplify blood sampling. Hims also completed the acquisition of Livewell this week, which will become the center of its Canadian offering.

  • Aledade announced its $500 million credit facility from Ares Commercial Finance, which was first reported back in September by Bloomberg. Aledade noted in the press release that the capital will be used to “accelerate shared savings distributions to our clinician partners, enabling them to reinvest in their patients and practices sooner to sustain our momentum in value-based care”.

  • Mercy Health and WellVana signed a 20-year partnership to launch a Clinically Integrated Network for primary care physicians and advanced practice providers who aren’t employed by Mercy to participate in VBC contracts.

Featured Jobs

Regional Director, TN at Diana Health, a network of women’s health practices. Learn more.
Hybrid (TN) or remote (with travel to TN)

Lead Data Engineer at Hopscotch Primary Care, delivering tech-enabled primary care to rural communities. Learn more.
$130k - $180k | Remote (CT/ET preferred)

Product Manager, Integrations at Third Way Health, an AI-enabled medical practice and payer operations solution. Learn more.
$135k - $170k | In-person (preferred) or hybrid

Telehealth Primary Care Physician at Chronius Health, virtual primary care for patients with complex, chronic conditions. Learn more.
$190k - $230k | Remote (EST)

Chief Medical Information Officer at Assort Health, agentic AI for patient access. Learn more.
Remote, hybrid, or in-person (SF)

Contact us to feature roles in our newsletter.

Chart of the Week

The North Carolina State Health Plan, which has been the subject of much discussion given its various efforts and associated challenges in managing rising healthcare costs for 750,000 state employees in North Carolina, provided a fascinating update last week: the plan will not be in a deficit in 2026 or 2027. At one point, the state had projected a $1.3 billion deficit in 2027. Quite the improvement!

This Health Affairs article from October provides some fascinating insight into how the plan has turned around — adjusting premiums, adjusting the network, and how primary care is paid for, and contracting for specialty care via bundles, including a contract with Lantern to manage these bundles.

Looking at the slide above, it also seems necessary to discuss the 11.9% decline in the net prescription drug trend between 2023 and 2024, while the benchmark trend increased 13.7% in that same period. Removing coverage for GLP-1s for weight-loss and Humira, as well as prescription drug rebates, seemed to play a meaningful role in this story in 2024 as well.

Funding Announcements

  • Curative, a health plan offering fully-insured and level-funded plans for employers, raised $150 million at a $1.275 billion valuation. Curative pivoted to this model after initially launching as a COVID-19 testing provider. The model offers $0 out-of-pocket costs for in-network care for members who complete a Baseline Visit within 120 days of joining the plan. While the press release notes this is an annual preventative health visit, the Curative website Q&A notes this is not an annual wellness exam with a PCP; it’s a meeting with a Curative Care Navigator. Curative reports serving 1,200 employer clients and 165,000+ members, while also achieving profitability. It’ll use the funding to expand from Texas, Florida, and Georgia to other mid-Atlantic states in the near term. This Reddit thread seems to do a good job of providing reasonable views on the model from folks in Texas.

  • Angle Health, an AI platform for employer healthcare benefits, raised $134 million. Per Modern Healthcare, this consisted of $84 million in equity financing and $50 million in debt financing. Angle, which focuses on small- to medium-sized businesses, notes that it now serves 3,000 employer customers across 44 states. The company uses its AI model to predict future healthcare risks, helping brokers and employers to better design health plans for employees.

  • Paradigm Health, a platform for clinical trials, raised $78 million. Paradigm also announced this week that it is acquiring Flatiron’s Clinical Research Business and entering a long-term partnership with Flatiron to integrate the offering into Flatiron’s oncology EMR. It will reach 2.4 million patients across 25 academic centers/health systems and 100 community oncology practices.

  • Artera, an AI platform for patient communications, raised $65 million in funding. Per the press release, it has engaged 200+ million patients and expects to have $100 million in Contracted Annual Recurring Revenue by the end of 2025.

  • Reema, a platform that engages hard-to-reach members in Medicaid managed care and other health plans, raised $19 million.

  • Empathy Health Technologies, the company behind the addiction recovery app Sober Sidekick, raised $7.6 million. This Fortune article from Empathy’s last funding round in 2024 does a really nice job describing the business then, highlighting how Sober Sidekick chose not to chase dollars from referring patients to rehab centers and instead started working with Medicaid plans.

What I’m Reading

Company size is warping the healthcare market by Olivia Webb
A good analysis of how Eli Lilly switched PBMs from CVS Caremark to Rightway and the various implications of such a move. Read more

The Future of North Carolina’s Healthy Opportunities Pilots and What it Means for Other Medicaid Programs Considering Social Needs Programs by Joanne Kenen
An interesting read on the Healthy Opportunities Pilot as an example of the challenging decisions facing Medicaid programs ahead. Read more

‘Downcoding’ tensions rise as AI, private equity proliferate by Noah Tong
This was a nice read in Modern Healthcare about how the stories of insurers automatically downcoding claims are so similar to experiences 25 years ago. Read more

A Vision for Healthcare AI in America by Sebastian Calliri
An interesting case for the importance of AI-supported care and the opportunity ahead. Read more

Hallucinating about AI by Ben White
An interesting article making the case that, despite what Jensen Huang apparently might think, the growth in radiologists has nothing to do with AI. Read more

Oregon’s first-in-the-nation hospital price cap cut costs without comprising care by Juan Siliezar
This article discusses an analysis by folks at the Brown University School of Public Health on how the Oregon state health plan implemented a cap on hospital payments at 200% of Medicare rates. The study finds that the move saved the plan $50 million annually while having little impact on hospital or care delivery operations. Read more

Want to comment or share feedback?

Login or Subscribe to participate

If this newsletter was forwarded to you, subscribe here or see more from Health Tech Nerds.

Reply

or to participate

Keep Reading

No posts found