Exclusive: Careviso gets $17M to boost health care transparency

Careviso has raised over $17 million in Series B funding led by Ballast Point Ventures alongside insiders Mercury and Lytical Ventures, the health care transparency startup tells Axios exclusively.

Why it matters: The costs and administrative requirements associated with health care diagnostics have historically been opaque and difficult to understand, with the consequences felt by both physicians and patients.

• "Right now patients and physicians don't know if [testing] is going out-of-network, in-network, and what does that cost? And patients get the bills — large bills — three, four, five, six weeks after a test," CEO Andrew Mignatti says.
• Reducing those complexities, Falls Church, Virginia-based Careviso aims to improve patient access to diagnostics while lifting the non-clinical burdens facing providers.

The backstory: The five-year-old company, formerly CMT Solutions, started out by working with physicians to streamline prior authorizations for laboratories — which ultimately highlighted problems associated with out-of-pocket costs.

Context: Physicians are increasingly calling for real-time cost transparency capabilities as the No Surprises Act gains more traction.

• The legislation, passed in December 2020, intends to protect patients from receiving surprise medical bills months after a service or procedure.
• Careviso in July 2021 launched seeQer, a new product whose solutions aligns with what the No Surprise Act is requiring.

How it works: Using seeQer, labs and physician offices (and increasingly other constituents) enter patient information to identify what tests they are going to order. In real-time, seeQer spits out the patient's out-of-pocket cost and what the insurers will pay.

• Additionally, the platform determines all the administrative requirements around prior authorizations and medical policy, streamlining those processes into workflow.

By the numbers: Careviso currently provides financial transparency to some 70,000 to 80,000 patients a month, while navigating prior authorizations for about 40,000 to 50,000 individuals, Mignatti says.

• Careviso employs 150 and grew revenue by 3x this year over last. Mignatti declined to disclose revenue.

What's next: The funding will enable Carviso to propel its technology into the physician office and work increasingly with health insurance companies, Mignatti says.

• As more physician offices bring laboratory testing in-house, doctors want to be able to understand the cases in which they should run testing themselves, versus those requiring a referral, the CEO says.

Yes, and: Careviso plans to double down on an already deep foothold in women's health care, working with over 50% of the country's OBGYN clinics today. Oncology is another big focus area.

• Mignatti sees a larger opportunity over the next five years to address transparency issues in multiple specialties, with expansion into radiology on the current agenda, the CEO says.
• This round of capital is meant to drive Careviso to profitability, he adds.