• Healthcare-focused AI startups are raising billions to help improve the US system.
• AI can help streamline clinical documentation, drug research, and medical billing.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

The founder of Suki, a startup that uses artificial intelligence to automate healthcare documents, raised $70 million in funding from investors in a Series D round that was disclosed this past fall.

He said it really didn't take that much persuading: With an epidemic of stressed- and burned-out physicians, there was an obvious need for their AI software, he added.

"Most of the investor conversations over the last year and a half have been, 'Well, it looks like the market is here,'" said Punit Singh Soni, Suki's founder. "Are you going to be the winner or not?"

Suki sells an AI-powered assistant that takes notes during a conversation between patients and clinicians. The notes can be reviewed by the doctor and submitted as an electronic health record. This saves time on administrative tasks and allows physicians more time to take care of patients, a resource that's becoming increasingly limited among healthcare professionals.

Surveys have consistently found that doctors and other medical workers are burned out from working in an often overloaded, convoluted, and inefficient system. The US spent $4.8 trillion on healthcare in 2023, according to a January report from the Peter G. Peterson Foundation. The US also spends more per person than nearly all other developed nations, according to a report by the Organization for Economic Co-operation and Development. Despite this, health outcomes were poorer, with Americans facing a lower life expectancy, higher rates of treatable and preventable excess deaths, and less efficient healthcare systems.

Cash-strapped hospitals and private practices have lagged behind the financial-services and telecommunications industries in applying newer technologies, but the healthcare industry is increasingly considering artificial intelligence as it contends with high labor costs and a lot of opportunities to automate routine tasks. The pandemic exacerbated these challenges with staffing shortages as overworked doctors and nurses quit the profession.

To make healthcare more efficient, AI startups like Suki, Zephyr AI, and Tennr have raised millions with vast promises, including making repetitive tasks like billing and note-taking easier, improving the accuracy of clinical diagnosis, and identifying the right patient population for emerging treatments.

But the challenges are vast. The healthcare industry's budget allocations for generative AI are trailing those of many other core industries, such as energy and materials, consumer goods, and retail. Clinical diagnosis will continue to require a human in the loop, so the process can't be fully automated. The healthcare industry is highly regulated, and quite often, venture capitalists will wait for clarity on laws from the federal government before aggressively pushing AI tech advancements forward.

A $370 billion bet on boosting the healthcare sector's productivity

The consulting firm McKinsey estimates that generative AI can boost productivity for the healthcare, pharmaceuticals, and medical-products industries by as much as $370 billion by accelerating drug research, making clinical documentation easier, speeding up medical billing, and helping doctors make diagnoses.

Some big funding rounds announced in 2024 highlight the diverse use cases for AI in the healthcare sector. They include $150 million raised by the clinical-documentation AI startup Abridge in February, the drug-discovery AI startup Xaira Therapeutics bringing in $1 billion before its launch in April, Atropos Health's $33 million Series B in May to help doctors analyze real-world evidence with generative AI, and the medical-billing-automation provider Candid Health raising $29 million in September.

Parth Desai, a partner at Flare Capital Partners, has steered investments into healthcare startups such as Photon Health and SmarterDx. He said that healthcare organizations had been dedicating more money to bolster their AI strategies, beginning in late 2022 and accelerating through 2024. That's boosting demand for the tools these startups are developing. There's also less pressure to immediately prove a return on investment, which budget-conscious health systems have closely monitored in the past when allocating dollars for technology.

"The thing that we're really studying before making an investment decision is: Do budgets exist today to pay for this technology?" Desai told Business Insider. "Or are they going to exist in a large-enough fashion in the next five to 10 years to support this technology?"

Candid Health and Akasa aim to cut costs and automate medical billing

One area of particular promise has been medical billing, which could benefit from large language model automation. An LLM could, for example, analyze a large volume of claims in a client's system and accurately match them with insurers' unique billing codes, a process required for repayment to a physician for their services. Hospitals have traditionally relied on human medical coders to hunt down reimbursements from insurers.

"The software used to do billing was built a long time ago and basically wasn't kept up to date," Nick Perry, a cofounder and the CEO of Candid Health, said.

Malinka Walaliyadde, the CEO of Akasa — another medical-billing-focused AI startup — said the company builds customized LLMs for each healthcare institution it serves. Typically, the aim for these LLMs is to lower costs by lessening the reliance on human medical coders. This often reduces errors in billing and speeds up repayment cycles.

"We looked at what are the biggest pain points for health systems," Walaliyadde told BI. He said that Akasa's focus is on developing LLM products for medical coding and simplifying prior authorization, a process that requires approval from a health-plan provider before a patient can receive a treatment. "Those are the ones where you could really move the needle," Walaliyadde said.

AI for health screenings

George Tomeski, the founder of Helfie AI, is in the middle of pitching investors to raise as much as $200 million in a new round of funding that he hopes to close by the first half of 2025.

Tomeski said the funding would help Helfie scale as it exits beta testing for the company's app. The app, also called Helfie, uses a smartphone camera to do medical "checks" that screen for illnesses including COVID-19, tuberculosis, and certain skin conditions.

"We're targeting all the health conditions that lead to avoidable mortality," Tomeski said, adding that the app focuses on respiratory and cardiovascular conditions. The intention is for these checks —which can cost as low as $0.20 a person per screen — to serve as a form of preventive care and as an incentive to go see a doctor in person.

While some funding is going toward sales and marketing, talent acquisition, and ensuring adherence to regulations around privacy and healthcare data, a large chunk is still being allocated to product development as AI tech advances quickly.

Dr. Brigham Hyde, a cofounder and the CEO of Atropos Health, said his latest funding announcement, in May, was timed to coincide with the geared-up launch of ChatRWD, an AI copilot that can answer doctors' questions and quickly churn out published studies based on healthcare data. Hyde said he's keen to bring in big partners this time, including the pharmaceutical giant Merck and the medical-supplies and equipment maker McKesson.

But Hyde also had to show some restraint. He said that when Atropos Health moved forward with its Series B rounds, dozens of venture capitalists expressed interest in leading the round. The company was offered up to $100 million but took only one-third of that amount.

"I don't always think that's a good idea," Hyde told BI. "As a founder, you want to raise the right amount of money for your business and for the stage you're at."

It may be tempting to take more, as many healthcare AI startups — a vast majority still in the seed and early-stage funding rounds — are racing to outmaneuver rivals. Even if the technology is right, it has to get past regulatory approvals and persuade cautious hospitals and health systems to open up their wallets.

"You can build as much product as you want, but you can never build a market," Soni of Suki said. "It shows up, or it doesn't show up."

• Many workers struggle with choosing their health-insurance plans during open enrollment.
• Some healthcare companies are employing mobile apps and generative AI to help smooth out the process.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

During open-enrollment season, Reddit users inundate the platform's forums on health insurance and personal finance every day, asking how to best pick from their health-insurance options.

In one post, a recently unemployed married woman in Texas asked whether she should enroll with her husband's employer or stick to COBRA, which provides benefits to people who have lost their jobs. Another married person requested advice on which coverage to pick if they're planning to have a baby in 2025. For an employee in California, fellow Redditors were a sounding board as they navigated dental-plan options, with costs ranging from $0 to nearly $440 annually.

Open-enrollment season typically takes place between October and December, and companies have their own set periods within those months. During this time, Americans elect their health-insurance coverage through either a private employer or marketplaces via subsidies offered under the federal government's Affordable Care Act. Nearly all open-enrollment selections made this fall will go into effect on January 1 and be set until the following season, with a few exceptions.

The process can be immensely confusing.

Employees are expected to look both backward and forward, said Dan Beck, the president and chief product officer for SAP SuccessFactors, a cloud-based software platform that oversees HR, payroll, and talent management.

He told Business Insider that employees are tasked with reflecting on whether they maximized their benefits in the past year based on how much they tapped into the healthcare system. At the same time, they must anticipate health-related events, such as having a child or a major surgery.

To complicate matters further, workers may move to new roles with different insurance options or their employers could change providers or plan options, forcing employees to acquaint themselves with new choices. The makeup of their families could change, too: As employees' marital statuses change and they raise children, they'll likely want to optimize their healthcare plans for those life stages.

On Reddit, people making health-insurance decisions try to make sense of the complexities. If they choose health plans mismatched with their needs, they run the risk of overspending in two directions: shelling out for a premium-coverage plan they don't really need or skimping on coverage and then experiencing an expensive life change.

Employees also need to keep track of life events that could change their coverage, including moving, having a baby, or adopting a child. There is a special enrollment period, outside of open enrollment, for those life events, but also a limited period of time to make the changes and retain health care coverage.

Increasingly, employers are encouraged — by both their employees and their HR-benefits companies — to share more easily digestible benefits information.

"What employees are telling us, overwhelmingly, is that they need help when they are enrolling," Karen Frost, a senior vice president at the cloud-based employee-benefits vendor Alight, told BI.

Some employers are partnering with third-party companies that handle things like payroll and health benefits and have built software with with clear step-by-step prompts — which can help workers be confident about their healthcare elections.

Young workers want more employer support in demystifying healthcare

In Alight's 2024 annual survey of 2,500 employees in the US, the UK, France, Germany, and the Netherlands, 63% of workers said they felt confident about their most recent health-plan election.

There are, however, some generational splits in the data. In the survey, 70% of Gen Z and 72% of millennial workers said they wanted personalized support for navigating the health system versus just 46% of baby boomers.

Before the mass digitization of benefits elections, employers would hand their employees printed packets outlining their medical-insurance offerings and ancillary benefits such as dental and vision, retirement plans, commuter reimbursement, gym memberships, and other wellness programs. Employees would pick from that menu, largely without guidance or input on what they'd like to see as alternative or additional benefit options.

Though the paper-packet method is much less common now, the enrollment process can still be overwhelming to navigate.

Life changes, like moving to a new state or employer, or a company picking new insurance providers to work with can complicate the enrollment process.

"You have a narrow window to actually get benefits, and you want to be successful," Beck told BI.

Mobile apps and generative-AI tools aim to smooth out the open-enrollment process

To help employees sort through their options during the open-enrollment period, some healthcare startups are leveraging mobile apps and generative-AI chatbots.

Alight, for example, aims to learn more about employee preferences and the needs of their families through a Q&A and then make recommendations. Throughout this process, Alight's recommendations coincide with clear definitions of complex benefits, like a health savings account, which lets workers set aside pretax money for qualified medical expenses.

"Instead of just letting people make their own choice, we guide them," said Frost. As an example, if an employee were to pick a high-deductible health plan, Alight would guide them to an HSA and explain why enrolling in it may make sense to budget for potential healthcare expenses.

SAP SuccessFactors said it's not yet comfortable with offering suggestions for health-insurance elections, citing concerns about data privacy.

Instead, the company — which has customers including McDonald's, L'Oréal, and Delta Air Lines — said it's focusing on further developing its recently launched mobile app.

The SuccessFactors mobile app is targeted at two demographics: workers under 40 who tend to be mobile-first in nearly every aspect of their lives and frontline workers of all ages with jobs in manufacturing and other sectors where they may be without frequent access to computers.

SAP SuccessFactors is also using generative-AI chatbots to answer policy questions to improve the user experience. In the future, the company plans to use these chatbots to automate some open-enrollment processes.

To bolster the company's abilities to help employees navigate this process and other healthcare questions that may arise throughout the year, SAP earlier this year paid $1.5 billion in cash to buy WalkMe, a tool designed to provide real-time website navigation for healthcare, onboarding, and other employee-focused tasks.

AI-based virtual assistants are also becoming more pervasive in the open-enrollment process. Alight has Ask Lisa, SAP SuccessFactors is leaning on the company's artificial-intelligence copilot, Joule, and the HR- and financial-software provider Workday uses Wex, an AI chatbot that internal employees can access on Slack to get automatically generated responses to their benefits questions. The same tool is offered to customers but branded as Workday Assistant.

"We try to appeal to all generations and age groups," Ben Carter, the senior vice president of business partners and rewards at Workday, said. "Some people, the last thing they want to do is actually talk to somebody on the phone."

This emerging technology benefits employers, too. Earlier this year, Workday unveiled an AI-enabled tool called Workday Wellness, which integrates with insurance providers like Aetna and Cigna. It allows Workday's customers — like The Hartford, Guardian, and MetLife — to understand which wellness benefits employees are using and which ones aren't resonating so they can invest more strategically.

"It brings a nice story," Carter said, "to say, well, if I'm going to go invest another $20 million in my benefits programs next year, here's where I need to go, or here's where I need to double down, or here's where I need to stop investing."