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We are hosting conversations with Rep. Greg Murphy (R-N.C.), Oscar Health CEO Mark Bertolini, award-winning journalist Katie Couric, Zocdoc CEO and co-founder Oliver Kharraz, Hers chief medical officer Jessica Shepherd, Sen. Tammy Baldwin (D-Wis.), senior White House advisor on MAHA Calley Means and Children's National Hospital's Anthony David Sandler.
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Axios
16 hours ago
- Axios
RTP startup uses AI to fight health insurance denials
A Research Triangle Park startup wants to make appealing health insurance denials easier through a new artificial intelligence tool. Why it matters: A growing number of startups are turning to new AI tools to help patients navigate complex policies and byzantine processes to appeal insurance denials, according to NBC News. The number of prescription drug claims denied by insurance grew by 25% between 2016 and 2023, according to the New York Times. And in 2023, Affordable Care Act insurers denied 20% of claims, Axios reported. Driving the news: Enter Counterforce Health, a startup founded at the Frontier coworking campus in Research Triangle Park. The company's AI assistant drafts customized appeal letters that comb through a patient's policy, looking for the best line of defense, greatly reducing the amount of hours many patients spend drafting appeals. At the moment, few patients appeal denied claims at all, according to an analysis by KFF. Zoom in: Neal Shah, a former hedge fund manager turned startup founder, has been trying to change the health care industry he has found frustrating for years, through a succession of startups run by a handful of employees in RTP. Shah, who left his job on Wall Street to move back to North Carolina to take care of sick family members, is the founder of CareYaya, an online platform that helps connect people looking for at-home care workers with students studying health care. That platform has taken off in the past three years, growing from hundreds of workers based at Triangle-area universities to thousands across the country. Now, he's focused on expanding Counterforce Health, which he co-founded last year to provide free AI tools to patients and funding through several grant awards. The company's platform uses a variety of AI models to run its appeals process, pinging medical journals and insurance review commission data to make a case for why a patient's appeal should be granted. He views it as a way to counteract the algorithms that insurance companies use to deny claims. (Some insurance companies are currently being sued for using algorithms to deny claims, Axios previously reported.) What they're saying: "You end up spending hours and hours researching, fighting on the phone and just stressing the hell out," Shah told Axios about the current appeals process. "And many people will be too intimidated and scared to do that." In some ways, it's become a battle of AI versus AI in the insurance world, Shah added, and if the patient doesn't have a tool, "you lose." What's next: Right now, the Counterforce tools are free for patients and clinics to use. Some clinics are using the service, like Wilmington Health, to make it easier to draft appeals for its patients, and some pharmaceutical companies have begun reaching out to the team about the tools.
Axios
3 days ago
- Axios
Only imported Lyme in Arizona
Justin Timberlake's recent diagnosis put a spotlight on Lyme disease, but if you've got it in Arizona, you almost certainly brought it from somewhere else. Why it matters: Especially during the most active tick season (April through October), it's important to be mindful of the tick-borne illness that — if left untreated — can lead to long-term neurological problems and body aches. State of play: In 2023, Arizona had 16 documented Lyme disease infections in Cochise, Coconino, Gila, La Paz, Mohave, Pima, Pinal and Yavapai counties. Yes, but: To date, there haven't been any confirmed cases contracted from tick bites within the state, Arizona Department of Health Services spokesperson Magda Rodriguez told Axios. Residents sometimes get infected while traveling where the disease is endemic. The tick species that transmits Lyne disease lives in higher-humidity areas and isn't found in most of Arizona, Rodriguez said. The "western tick vector" has only been found in Arizona in Mohave County's Hualapai Mountains, she added, and there's no evidence that those ticks carried any pathogens. What's happening: Lyme disease is caused by the bite of a tick that carries a bacterium called Borrelia burgdorferi. In the U.S., mainly deer ticks (aka the blacklegged tick) spread this bacteria — they're most common in the Northeast, Upper Midwest and mid-Atlantic. Along the Pacific Coast, the western blacklegged tick can spread infection, according to the CDC. Zoom in: Lyme disease can present with a rash or flu-like symptoms. People with late-stage infections may experience more severe issues, from facial paralysis to arthritis. Most Lyme cases caught early can be treated with antibiotics. But diagnosing the disease early can be difficult because not all infected people get rashes, and early testing can produce false negatives. Stay safe: If you find a tick attached to your body, remove it with tweezers — don't squish it. And if you don't need to preserve it, flush it.
Axios
3 days ago
- Axios
As Virginia's kindergarten vaccination rates rise, so do exemptions
As kids head back to school, Virginia is bucking the nationwide trend of declining vaccination coverage among kindergarteners — but while coverage is increasing, exemptions are too. Why it matters: A growing portion of families actively opting out of vaccines causes pockets of vulnerability that risk outbreaks, even with vaccination rates rising overall. By the numbers: There were 84,335 kindergarteners in Virginia's public schools during the 2024–25 school year, per the state Department of Education. New CDC data shows that 2.7%, or about 2,277, had either medical or non-medical exemptions in that year. In the 2023–2024 school year, it was 2.2%. In 2014–15, it was 1.1%. Zoom out: Virginia's exemption percentage for kindergarteners is lower than the national rate of 3.6% and U.S. parents still overwhelmingly support childhood vaccinations. Meanwhile, Virginia's vaccination rate for kindergarteners steadily increased between fall 2023 and fall 2024 from 88.9% to 90.7%. The big picture: There's a slew of factors for why parents get vaccine exemptions for their kids. An Axios review of Virginia Department of Health data found that Virginia parents largely seek them for religious reasons, which requires only a signed form. Medical ones need documentation from a licensed medical professional. Anti-vax sentiments, once considered a liberal trend, also gained ground among conservatives during the COVID pandemic. The top 10 elementary schools with the highest religious exemption rates for kindergartners in 2024–25 were all in counties that voted for President Trump, per an Axios review of VPAP data. Zoom in: None are in the Richmond metro, but the state's second-lowest kindergarten vaccination rate was reported last fall at Henrico elementary school Fair Oaks. It's in a precinct that voted for Kamala Harris, and is near areas that went for Trump. And while no Richmond-area school districts pass the 95% threshold generally accepted as high enough to make outbreaks unlikely, some individual schools do and Hanover is close. Some local elementary schools also have religious exemption rates higher than the state average. Case in point: Hanover had the highest local vaccination coverage among kindergartners last fall at 94.9%. The school with the highest religious exemptions: 7.5% at Pole Green Elementary.
