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Claimed Co-Founders L to R: Zach Veigeiles, Alicia Graham and Warris Bokhari.
Beau Grealy for Claimable
TheIndustry observers predict that generative AI could lead to an administrative battle of the robots between doctors and health insurers on care decisions. This leaves patients in limbo without access to medications or other treatments while facilities issue prior authorization and denial letters by fax, phone or algorithm. Warris Bokhari is trying to change that by putting the power of AI in the hands of the patients.
Bokhari, a physician executive who has worked at Amazon, Apple and Anthem (now Elevance Health), saw that large language models like the GPT-4 could be useful for summarizing information for patients at different reading levels. The idea behind Claimablehis startup, which launched on Wednesday, is to use these models to turn the tables. Or in his words, to “take a patient story and transform it into something compelling for an insurance company.”
The company is starting in partnership with rheumatology clinicssince many patients with diseases such as arthritis take expensive drugs known as biologics, which are often subject to prior authorization. For Bokhari, this struggle is personal, his mother had rheumatoid arthritis, but because he grew up in England, his family didn’t have to go bankrupt to afford the medication.
While building in stealth mode, he discovered that health insurers often issue denials because guidelines for certain diseases are clearly out of date. Bokhari said that Claimable is incentive and fine-tuning GPT-4 with the latest clinical guidelines from American College of Rheumatologyas well as all FDA labels and trial data for specific drugs in order to generate appeal letters for a flat fee of $39.95.
After testing the technology and generating “hundreds and hundreds” of letters with a human-in-the-loop for quality assurance, the software’s fully automated pilot phase has generated about 50 appeal letters for real patients with a denial turnaround of 80 %. rate, said Bokhari. Most cases are resolved in less than 10 days. With a seed round led by Ventures Walkabout (he declined to disclose the amount), Claimable hopes to add more than a hundred conditions by 2025, for patients with multiple sclerosis, heart disease, diabetes, obesity, asthma and certain types of cancer. “We think we can achieve a lot just by making patients listen,” Bokhari said.
How Epic’s 81-Year-Old Billionaire Founder Plans to Keep Her Health Data Empire Private Forever
Judy Faulkner, founder and CEO, Epic Systems.
GUERIN BLASK FOR FORBES
Judy Faulkner, who founded the electronic health data giant Epic in 1979, has bucked convention from day one, starting with the company’s dress code: “When there are visitors, you have to wear clothes.”
While competitors like Cerner (now Oracle Health), Allscripts (now Veradigm) and Athenahealth grew by taking venture capital money, executing mergers and acquisitions, going public and then private again, Faulkner has avoided any outside interference. . And she intends to keep it that way. Faulkner said Forbes it has put a plan in motion to ensure that Epic remains private, independent and employee-owned in perpetuity with a unique trust structure.
Read more here.
Pipeline and deal updates
Health insurance: Centivo, a startup that offers employers a primary care-focused health plan aimed at reducing costs, has raised $75 million in equity and debt funding from investors including Cone Health Ventures, MemorialCare Innovation Fund and Morgan Health (a division of JPMorgan Chase).
AI for clinical trials: Astrazeneca has entered into an agreement with Immunai to use the latter’s AI models to optimize clinical trials for oncology products. Immunai will receive 18 million dollars for the first phase of cooperation.
Cancer care: VieCure, which is building an AI-powered cancer care platform to make it easier for community hospitals to use personalized care options, announced it has raised $45 million in funding.
Immune disorders: Triveni Bio, which is developing antibody treatments for inflammatory and immune disorders, announced that it has closed an oversubscribed $115 million Series B round.
Quantum drug discovery: Quantum computing company D-Wave announced that it has entered into a research collaboration with the pharmaceutical division of Japan Tobacco to develop AI-driven drug discovery processes that use quantum computing.
Cardio Images: Boston-based Elucid’s cardiovascular imaging software, PlaqueID, was cleared by the FDA. The software classifies plaques in order to provide doctors with insight into the best treatment pathways for their patients.
Cell therapy: Prime Medicine has entered into a collaboration with Bristol Myers Squibb to develop reagents for use with T-cell therapies. Prime will receive $110 million in upfront payments and potentially up to $3.5 billion in milestone payments.
Metabolic disorders: Kailera Therapeutics, which is developing next-generation drugs for obesity and related metabolic disorders, announced its startup with $400 million in funding.
Genetic Medicine: Flagship Pioneering has launched a new company, Mirai Bio, with $50 million in backing to develop an end-to-end platform for genetic medicines.
Forbes 400
Forbes 400: The Ultimate Ranking of America’s Richest People 2024
Illustration by Alice Lagarde for Forbes
The richest people in America have never been richer. Forbes’ final ranking of America’s richest people released this week found that 400 richest are worth a record $5.4 trillion, almost more 1 trillion dollars from last year.
- Best Dog: The highest-ranked healthcare billionaire at No. 29 was 86-year-old Thomas First, Jr., who co-founded the for-profit hospital chain HCA Healthcare with his father in 1968, with an estimated $31.5 billion.
- Returned: 80-year-old pharmaceutical billionaire Robert Duggan returned to the 400 list this year with a net worth of $9.3 billion after falling in 2021. Duggan’s fortune saw a big boost as shares of his biotech firm Summit Therapeutics soared thanks to good news about a drug candidate to treat a type of lung cancer. (Read more here.)
- Heirs: The three grandchildren of Homer Stryker, who founded medical device company Stryker Corporation in 1941, are all on the Forbes 400. Ronda Stryker, 70, worth $8.2 billion; Jon Stryker, 66, worth $5.4 billion and Pat Stryker, 68, worth $3.9 billion.
Read more here.
Other health news
Healthcare Software Company Epic Faces First Antitrust Lawsuit for Alleged Monopoly Activity
‘Conversion therapy’ puts LGBTQ+ people at greater risk of mental health disorders, new study suggests
Judge strikes down Georgia’s 6-week abortion ban
For 2025, insurers pull back slightly from the Medicare advantage footprint
CVS Health will cut 2,900 jobs, but mom has a potential breakup
Via Forbes
What else are we reading?
Deadly Marburg virus: scientists race to test vaccines in outbreak (Nature)
A hospital kept a brain-damaged patient on life support to boost statistics. His sister is now suing for malpractice. (ProPublica)
California Sues Hospital That Denied Patient an Emergency Abortion (The New York Times)