Startup Guidehealth buys Arcadia's value-based care division, plans to build out predictive, gen AI tech

Guidehealth, a value-based care enablement startup, bought Arcadia's managed service organization and value-based care service division to build out its tools and service for providers.

Guidehealth also is partnering with Arcadia, a healthcare technology company that provides a data platform to providers and payers, to use the company's data analytics platform to power its newly acquired offering. 

Terms of the deal were not disclosed

As a new player, Guidehealth has big ambitions to help providers succeed in value-based care models and improve their performance in risk-based contracts. The advancement of artificial intelligence also opens up opportunities to use technology to develop predictive analytics and insights for providers.

The Dallas-based startup says it supports physicians by strengthening relationships with affiliated networks, improving financial performance of value-based risk contracts, enabling growth of high-value referrals and reducing administrative burden.

Guidehealth's co-founders bring deep expertise in healthcare technology and value-based care. Sanjay Doddamani is the former CEO of value-based care startup Upstream. Michael Gleeson, who also serves as Guidehealth's chief technology officer, was previously chief strategy and innovation officer at Arcadia.

The company, which launched about six months ago, embeds people and technology, virtually embedded "healthguides" and AI native workflow, directly in providers' operations to predict those patients most in need of support in and beyond the exam room.

"It's a cloud-based solution that allows our 'healthguides' to use generative AI risk predictive models in engaging patients and coordinating their care. And, where the coordination opportunity that we have recognized and pushed forward on with this acquisition is to harness the capabilities of an MSO to help with the referrals, scheduling, prior auths and utilization management, and then add a number of AI solutions and a lot of data infusion to create the right connections between the community access and the centralized resources of the MSO," Doddamani said in an interview.

"This is particularly helpful to health systems who are struggling with access and struggling with their community connectivity, They're also struggling with referrals and prior auths, those are big pain points. This takes the guesswork out for them," he added.

Key services that Guidehealth’s newly acquired MSO currently provides improves processes for visit access and referrals, management of prior authorizations and utilization management, network administration and paying claims to healthcare providers—especially in two-sided risk arrangements. 

With the acquisition, Guidehealth gains Arcadia's 25-year-old MSO and value-based care services division, which now supports 250,000 patients across a variety of payer-delegated patient care services, according to the companies.

"We will be the leader in disrupting the status quo, using an MSO model, AI and other advanced technology solutions to augment performance in value-based care,” said Dr. Mark Selna, Guidehealth chief operating officer and co-founder, who will oversee operations along with current MSO leader Brian Croegert.

By partnering with Arcadia, Guidehealth now has access to one of the "best platforms for value-based care," according to Gleeson.

"This foundation allows us to focus on predictive and generative AI, through a combination of Guidehealth’s proprietary models and industry-leading AI point solutions. As a result, we can address a number of pain points along the patient journey and help our customers achieve predictable sustained savings in value-based care," he noted.

Gleeson added, "We're going to focus on predictive analytics and targeting the right patients for our care management interventions and the approaches that our 'healthguides' take. We'll be deploying generative AI to create and consolidate care plans that are personalized to the needs of that patient and then wrapping all of that into improved workflows that are tailored specifically to our 'healthguides' and the health systems we work with."

Guidehealth designed its platform to help providers value-based care arrangements while also maintaining financial stability, Gleeson noted.

"Our target market is very much health systems and health systems have both administrative challenges and financial challenges. They also have pressure to be successful in value-based care," he said. Success in value-based care models means keeping more patients out of the hospital, but's a tricky financial situation for hospitals that need revenue from higher patient volumes.

"The MSO was so critical to us because as we help health systems be successful in value-based care, we need to support them with returning volume back to the system," he said.

Guidehealth plans to leverage the MSO to improve providers' connections to affiliated networks and enable referral growth, Gleeson said.

"This MSO allows us to take the capabilities and approach that they've taken around utilization management, referral management, prior auths and support within that community and integrate it into the approach we take with value-based care, so that the health system can get the performance savings that they need and want out of value-based care, but do so while keeping volume and activity happening in the hospital system," he said.

Doddamani added, "Having a larger network that is supported with a value-based payment model allows us to support their community, patients and physicians with greater resources, whether those are addressing social determinants, food insecurity or medical transportation for their patients. In return, [health systems] will see higher referrals of appropriate surgeries and other tertiary care opportunities but also reducing avoidable hospitalizations for those with chronic illnesses and allowing a much more vibrant connection between the community and the health care system."

Guidehealth also is partnering with generative AI company Hippocratic AI as one of its early access partners. The collaboration enables Guidehealth to get wellness and clinical updates directly from patients, executives said.

Hippocratic is working to build out what it calls the first safety-focused large language model (LLM) designed specifically for healthcare.

Guidehealth primarily works with providers in Illinois but plans to expand its clinical networks to other states, Doddamani said.

The startup also is gearing up to raise a series A funding round, he noted.

"We've been in sort of the pre-seed stage. The company is positioning itself with the right sets of clinical partners and the right sets of contracts to go out to raise capital for the broader expansion plans that we have," Goddamani said.