Legislative changes such as the No Surprises Act and the Centers for Medicare and Medicaid Services’ price transparency rule have promised to improve patients’ understanding of the process of paying for healthcare. But these promises remain mostly unfulfilled — patients in the U.S. still have an incredibly hard time determining what their care costs will be.
Careviso is a Falls Church, Virginia-based company tackling this issue by advancing transparency and access for diagnostic testing. On Wednesday, it raised $17 million in a Series B funding round led by Ballast Point Ventures. Mercury and Lytical Ventures also participated in the round, which brings Careviso’s total amount of funds raised to date to about $30 million.
Investors and healthcare companies might recognize Careviso from a few different names. When it was founded in 2017, the startup was called CoverMyTest. After realizing that it was a little too close to CoverMyMeds, the company quickly changed to CMT Solutions, said Andrew Mignatti, CEO and co-founder of the company, in an interview.
In August, the company rebranded to Careviso. To Mignatti, this name reflects the fact that Careviso has a vision for the future of care, one in which patients feel more comfortable accessing healthcare services and have less anxiety about surprise bills.
Careviso sells its technology platform mainly to laboratories. The platform automates prior authorizations for diagnostic testing and provides pricing information about the tests.
“If prior authorization is required, the platform then reflexes into a workflow system to help identify where that prior authorization has to go,” Mignatti said. “Is it fax? Is it a portal? Can we send it directly through an API? We then have a team that does that prior authorization, submits it, and then finalizes it back to the laboratory.”
Careviso’s laboratory customers say that over the past couple years, there has been a large increase in physicians demanding to know what their patients’ out-of-pocket costs will be before they run a test. To address this, the company’s platform also provides real-time cost estimates for diagnostic tests, as well as information on administrative requirements and approvals.
“Instead of the laboratories picking up the phone and calling the insurance companies to figure that out, they can get that information on a real-time basis through us,” Mignatti said.
Careviso will use most of the funds it raised in its Series B financing round to enhance its price transparency tool, according to Mignatti. He said the company is working with payers to get more information on their pricing and prior authorization requirements for diagnostic tests, with the hopes of soon deploying the tool into physician offices so it can be used at the point of care.
There are companies like Cedar that champion price transparency for hospital care, but the industry needs a company to innovate price transparency for office visits as well, Mignatti declared.
On the prior authorization side of things, Mignatti admitted his company is not the only one to automate this process for laboratories — he said Infinx and Lydian do this as well. To Mignatti, these companies focus solely on prior authorization automation, whereas Careviso focuses “on the full front end of integrating transparency with prior authorization and the identification of prior authorization.”
Photo: invincible_bulldog, Getty Images