Companies use AI to fight insurance denials

People infrequently challenge health insurance denials even though appeals are often successful. A new batch of startups, like Claimable and FightHealthInsurance.com, is trying to change that, STAT's Casey Ross reports. These companies use artificial intelligence and other technology to help to analyze coverage requirements and help draft appeal letters for doctors and patients. Nine companies have raised about $36 million from investors in recent years, according to Rock Health.

For years, insurance companies have increased their use of algorithms and predictive software in the process of making coverage decisions, often leading to higher rates of denials. The advent of companies to fight denials could be the harbinger of an AI arms race in which two sides use imperfect and ever-changing technology to fight each other.

telehealth

Eli Lilly inks Zepbound deal with Ro

Telehealth company Ro this week announced a new deal with Eli Lilly that will allow customers to get access to vials of weight loss drug Zepbound through its app. Until now, Lilly had only made these vials, which are priced lower than its injectable pens, available to patients who filled prescriptions through an online portal created by Lilly, called LillyDirect.

The move comes amid ongoing tension between drugmakers and telehealth providers over the future availability of compounded versions of popular GLP-1 drugs now that shortages are winding down. Ro for a few weeks offered compounded Tirzepatide, the active ingredient in Zepbound, but stopped after the Food and Drug Administration removed the drug from the shortage list. Eli Lilly has criticized compounding pharmacies and threatened legal action.

Ro CEO Zachariah Reitano told STAT's Elaine Chen that his company assured Lilly "that it is committed to following the law and will only offer compounded versions of FDA-approved medicines if the medicine is on the FDA shortage list."

Policy

Telehealth policy wonks on EDGE

The American Telemedicine Association is currently holding its annual EDGE policy conference in DC, amid industry concern that Congress will not cement a long-term extension of Covid-era telehealth policies before they expire at the end of the year. During the pandemic, lawmakers expanded where and what kind of care Medicare enrollees could receive over telehealth, and while there's bipartisan support for extending those rules, and even for making them permanent, getting it done during a lame duck session has proven difficult.

With momentum in Washington heading toward a short-term deal to fund the government into next year, policy insiders tell me a three-month extension for telehealth rules is a possible path forward, which would push talks on a longer-term policy to next year. Last night, a coalition of advocacy groups, including ATA, the Alliance for Connected Care, and the Consumer Technology Association, collectively representing hundreds of organizations, issued a plea to lawmakers to find a way to extend rules for "at least" a year, arguing that providers and patients need certainty and that an unstable policy picture could cause care disruptions. Bills that made headway in congress would extend the rules for two years.

business

Redesign Health's $175 million new fund and more

Redesign Health, which creates and launches startups, raised $175 million for a new fund which will focus on artificial intelligence. Investors in the fund include Declaration Partners, Euclidean Capital, and True North Ventures. Redesign has launched over 60 companies with notable exit being hearing aid company Jabra Enhance. Since the health tech boom, Redesign has gone through several rounds of layoffs and was reportedly hunting around for up to $250 million earlier this year.
Cala Health, maker of a wrist-worn neurostimulation device that's FDA cleared to help with essential tremor and Parkinson's tremors, raised $50 million to fund commercialization. The round was led by by Vertex Growth Fund and Nexus NeuroTech Ventures. Cala earlier this year received a positive coverage determination from Medicare for its essential tremor indication. CEO Deanna Harshbarger told me the funds would be used to scale the company's commercialization efforts including sales, support infrastructure, and manufacturing. Cala is currently at work on securing Medicare coverage for its Parkinson's indication and is supporting research into other applications for its proprietary neurostimulation tech.
Virtual mental health company Talkspace this week announced a deal with the city of Seattle to make its services available to young people aged 13 to 24. The city will announce additional providers soon. The deal follows similar Talkspace arrangements with Baltimore and New York.

research

AI drug design showdowns reveal some promise

STAT's Brittany Trang writes to tell us about the results of two recent contests testing how well computers can design potential drugs. The showdowns indicate that computation and AI-powered approaches sort of work, but not well. These contests give a level playing field for all sorts of methods to test their mettle.

In the most recent CACHE (Critical Assessment of Computation Hit-finding Experiments) challenge, 23 competitors used computational methods to predict what small molecules might be good Covid-19 drugs. While the top four experimentally performing molecules were chemically novel, "discovering truly novel chemical scaffolds proved to be a nearly insurmountable challenge," said Matthieu Schapira, the lead scientist for the CACHE program.

Three of the four were similar to previously discovered Covid drug candidates, a result similar to the Leash Bio contest from earlier this year. A team from Cradle, an AI protein engineering platform company that recently raised a $73 million Series B, had the highest binding affinity to the target protein in the Adaptyv Bio protein design competition. However, don't think that they designed it from scratch — the team introduced 10 mutations into an existing Merck antibody and improved its binding only slightly (8.2x better). The Cradle team cautioned that better binding is "one early step in a complex journey" in drug development.

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