Weekly Health Tech Reads 4/26/26

HCA stock dipped this week after missing Q1 expectations, driven by flu and the January storm — it noted that respiratory admissions were down 42% and respiratory ER visits were down 32% year-over-year. February and March appear to have rebounded, and the rest of the year remains in line with guidance. Between the slow end to flu season and the storm, it caused a $180 negative impact on EBITDA in the quarter for HCA. This impact was offset by a $120 positive development in unexpected state supplemental payment programs from Georgia and Texas. HCA seems to expect another meaningful win here in Florida, even if analysts seemed a bit concerned about how long it is taking CMS to approve the grandfathered application. HCA noted a 15% drop in ACA coverage in the quarter, at the low end of its expectations, but also reported an uptick in patient pay among individuals with ACA coverage. There was a brief discussion about HCA’s North Carolina market and how it is recovering from Hurricane Helene — it is lagging behind profitability expectations. Demand is higher than expected, but HCA is incurring higher expenses as it struggles to recruit staff. Meanwhile, the payor mix is off in the market because of the commercial market dislocation post-hurricane. It’s an interesting lens into the ripple effects of storms like this in a market.

Elevance raised guidance for the year after its outperformance in Q1 given the operational outperformance it is seeing. Elevance noted this is due to a few reasons: revamped leadership structure, AI in clinical, operational, and admin workflows, and integrating CareBridge and home health capabilities into a single risk-based model in Carelon. Elevance seems pleased with medicaid cost management, citing targeted care coordination efforts, clinical oversight of the ABA market, and predictive analytics to identify members with substance use disorder. In MA, Elevance is tracking to 2%+ operating margin for 2026 and is working with CMS on its enrollment freeze; currently expecting to resolve that without any impact on the business. In ACA, Elevance expects 1.2 million members, above its initial outlook, although it is not yet revising its expectation of 900k given market uncertainty. Lastly, Elevance seems to be seeing strong momentum in commercial insurance sales. It noted that it has a very strong pipeline at near-record levels for 2027. They also noted that they’re seeing wins among clients who are consolidating carriers — Elevance is replacing multiple carriers. It was interesting to see Elevance play down the Second Blue Bid opportunity on this call, noting that while, for 2026, it was a big boon for Elevance, the majority of its growth is from other sources.

Molina outperformed in Q1 on better-than-expected trend performance, but didn’t raise guidance for the year. Molina’s earnings featured an interesting breakdown of medical cost trends and how they develop over time — with Molina noting that in 2025 it reported a 7.5% trend in Medicaid, with 2.5% of that being acuity shift from redeterminations. Molina noted on this call that the acuity shift went away in late 2025, and it is assuming a 5% trend for 2026 as a result. Also in Medicaid, Molina noted higher-than-expected attrition, as it is seeing more Medicaid disenrollments than anticipated in a handful of states, specifically California, Illinois, and Texas. It now expects a “same-store” decline of 6% membership in 2026, up from 2% previously. In Medicare, Molina seems pleased with its repositioning of the Medicare book into D-SNP, HIDE and FIDE products only, and while it hopes to move its MAPD business to another strategic entity, it will shut it down if not. In the ACA business, membership came in slightly higher than expected at 305k, but it feels good about the profile, and expects to be cautious on pricing heading into 2027. There was an interesting discussion of “low utilizers” in Molina’s Medicaid book, with Molina suggesting that people with coverage who are not using it is at an all-time low, with those members having moved out of its book over the past several years.

United beat analyst expectations and raised full-year guidance, as all of its major business segments outperformed. UHC reported that its pricing initiatives are paying dividends in Medicare, while Medicaid continues to work through pressure in rates from states. UHC noted that underlying utilization trends appear consistent with 2025, while it is seeing modest favorability in trend. Optum Health significantly outperformed in the quarter, attributed to operational improvements and the reshaping of its VBC contract portfolio. Interesting to note the operational improvements in the FFS business, with a 12% YoY increase in patient-facing hours in the organization. The OptumRx update was brief, noting the important role the PBM plays as complex, high-cost, specialty drugs come to market. Optum Insight highlighted its AI capabilities while noting its “untapped potential”, with Optum Real again cited as an example. Optum Financial acquired Alegeus Technologies, a platform for managing HSA / FSA dollars, another good indicator of the momentum around consumer-directed payments.

OpenAI is launching a new clinical search tool for clinicians. In an interview with Endpoints, OpenAI's head of health, Nate Gross, noted that it is targeting clinicians who don’t have access via enterprise relationships. It’s hard not to note here that Gross was formerly the co-founder of Doximity, and seemingly that statement clarifies that. It’s worth checking out the interview here for thoughts on OpenAI’s strategy more generally.

The issues facing Utah’s pilot for AI-based medication refills with Doctronic escalated this week, as Utah’s Medical Licensing Board sent a letter to the Office of AI Policy strongly recommending the program's immediate suspension pending further discussion. The concern is exactly what you might expect — the Medical Board is responsible for keeping people safe and moving forward without its approval puts people at risk. I personally find that argument pretty unconvincing — when I chatted with Doctronic’s Dr. Adam Oskowitz just after the pilot was announced, he walked through why Doctronic’s approval is almost certainly safer than the standard of care today. Doctronic leadership went further in a post this week with a blog post titled “The Status Quo Is the Biggest Risk.” Among other things, it notes doctors are still reviewing every medication prescribed as part of the Utah pilot, while it earns the right to operate autonomously. I find Doctronic’s argument quite compelling here, but at the same time, I still think it is a losing argument given the politics of pissing off the Medical Board.

A Senator in Washington state has issued a report slamming the WISeR model and the issues it has faced in the state since it rolled out earlier this year. The report referred to WISeR as “an administrative labyrinth for WA hospitals and doctors.” It cites increased wait times, suggests that AI is denying care, and that the model is putting profits over patients. It’s interesting that the noise out of Washington state is so loud compared to the other states where WISeR is being piloted — it makes me curious whether these are issues other states are having, or are isolated to Washington state. If these issues are broader, it seems like another example of a logical program thwarted by the politics at hand.

A new AI healthcare accelerator, Treehub, is launching alongside an early-stage venture fund, AI Health Fund, also focused on healthcare AI investments.

After a rumor last week, IKS Health acquired TruBridge for up to $565 million. TruBridge provides RCM and EHR for the rural healthcare market.

EHR platform ModMed acquired Bonsai Health, an AI patient engagement platform. ModMed will deploy Bonsai’s engagement capabilities to its customer base of specialty practices.

Courier Health, a company that helps pharma companies manage patient experiences, raised $50 million. Oak HC/FT led the round. Courier cites some impressive outcomes for pharma companies — 15% - 20% increases in patient starts, 10% - 12% increase in 6-month persistency, and 5x - 7x increases in team productivity. Seems like a very logical opportunity to support drugs coming to market at high price tags.

Tava Health, a behavioral health startup, raised $40 million. Centana Growth Partners led the round. The press release notes that Tava is repositioning from a mental health network to a full-stack platform. Tava is in-network for 90% of the commercially insured market, working with 200 health plans.

Amperos Health, a denial management and revenue recovery platform for providers, raised $16 million. Bessemer led the round. Amperos serves 3,000 clinical locations and reports it has recovered $700 million in revenue across 500,000 claims for its providers. It is seeing 22% higher revenue recovered per claim at a 50% lower cost.

Zocalo, a community health worker model for Hispanic populations, raised $15 million. The press release notes Zocalo has grown revenue 4x YoY and expanded from 2 regional health plan contracts in 2024 to 12 in 2025. Zocalo is currently working with Medicaid Managed Care orgs like Anthem Blue Cross and Health Net, and is working on Cal AIM.

Coral, a company automating administrative workflows, raised $12.5 million. Lightspeed and Z47 led the round. Coral is working to automate patient intake processes that currently rely on fax machines.

Almanac Health, an AI platform for clinical decision support, raised $10 million. F-Prime led the round.

Signals, an AI platform making large enterprises more efficient, raised an undisclosed amount and announced its launch. Lightspeed led the round.

An editorial in Nature Medicine suggested that evidence supporting AI tools is lagging behind adoption, and that the evidence should be presented in scientific journals like Nature Medicine. Despite feeling like I should be getting a circular reference error after writing that sentence, I can’t disagree with the sentiment.

Last weekend, a WSJ editorial piece highlighted how Viz.ai’s algorithm is helping to identify strokes earlier. It is expanding beyond strokes to implement other pathways, citing 55 that are now available on the platform from a variety of companies, including Microsoft. The article notes that 90% of Viz.ai’s care pathway uses have been triggered by EHR data, which is an interesting stat. VIz.ai notes it is essentially replacing 90% of the work of providers.

An article in SF Standard highlights how doctors earning $375k a year in San Francisco are taking second jobs training AI models to boost their salaries, noting that the high cost of living in the Bay Area is driving many doctors (40%) to do so. The article also notes the median income in San Francisco is $140k.

KFF’s Larry Leavitt pondered whether health insurance companies are responsible for the ills of our health system in JAMA Forum this week. It does a nice job of wading into the complicated role insurers play, pondering what institutions we collectively entrust with oversight of healthcare spending in this country.

Bloomberg’s John Tozzi told the story of Claimable, a startup that has raised $10 million from Mark Cuban and others. I find it interesting to think about how the business model will need to evolve over time, as patients are currently paying $50 per appeal, which doesn’t exactly support VC math. The article notes that Claimable is starting to sign contracts with pharma as a business model moving forward. That move seems both logical for a business owner and entirely inconsistent with Cuban’s populist schtick on social media.

Community Brain Trust: Earnings season coverage, FDA begins process of easing peptide restrictions, legal standards for digital patient consent, and more. Read here.

Weekly Health Policy Briefing: A real tragedy of the commons situation in the IDR process and state-level "public options.” Read here.

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