Guidehealth
Guidehealth is an AI-native value-based care platform combining predictive analytics (STEM), a conversational AI voice gateway (RoseConnect), and human care teams (Healthguides) to serve health systems, payers, and self-insured employers, managing 500,000+ lives across four states.
- Company typePrivate
- Founded2023
- HeadquartersDallas, United States
- Headcount101–250
- GTM typeB2B
- OfferingSoftware
What Guidehealth does
Guidehealth is a Dallas-based, fully remote AI healthcare technology company founded in 2023 that operates an AI-native platform combining predictive intelligence, conversational AI, and human care teams to deliver value-based care and benefits administration for health systems, payers, and self-insured employers. The platform unifies three core components: STEM, a predictive intelligence engine that identifies and targets patients most in need of intervention; RoseConnect™, a clinically intelligent conversational AI voice gateway that engages members across text and audio channels, closes care gaps, activates care plans, and escalates to human judgment when required; and Healthguides™ — a human care team of nurses and care managers who turn AI-generated guidance into direct patient action outside the exam room. Additional modules include Health Enablement (population targeting, omnichannel engagement, risk and quality improvement) and Benefits Enablement (agentic AI for benefits and claims, prior authorization decisioning in minutes, and straight-through claims processing with 70-90% auto-adjudication rates).
The company monetizes through a combination of managed services for value-based care delivery, subscription-based platform licensing, performance-based contracts tied to STARS, HEDIS, and medication adherence outcomes, and transaction-fee-based employer benefits administration including 3.5M+ claims processed annually at >99% accuracy. As of 2025-2026, Guidehealth supports 500,000+ lives across four states through a network of 500+ provider organizations, with flagship health system customers including Emory Healthcare (400,000+ lives in Georgia), Memorial Hermann Health System, Ascension Care Partners Illinois, Endeavor Health, Northwestern Medicine, and University of Chicago Physician Partners. The company was formed via the December 2023 acquisition of Arcadia's value-based care division, has raised approximately $34M across three strategic rounds led by Memorial Hermann and Emory Healthcare, and was selected in April 2026 for the CMS ACCESS Model — a 10-year national chronic care initiative. Operational credentials include URAC Health Utilization Management accreditation, SOC 2 Type 1 certification, HIPAA compliance, and a KLAS Research #1 ranking in Value-Based Care Managed Services.
Guidehealth firmographics
Firmographics- Name
- Guidehealth
- Legal name
- Guidehealth, LLC
- Website
- https://guidehealth.com
- Company type
- Private
- Founded year
- 2023
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Guidehealth is an AI-native value-based care platform combining predictive analytics (STEM), a conversational AI voice gateway (RoseConnect), and human care teams (Healthguides) to serve health systems, payers, and self-insured employers, managing 500,000+ lives across four states.
- Ownership category
- akta.pro rank
Guidehealth industry classification
Industry- Product category
- Healthcare Value-Based Care Platform
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Services for the Elderly and Persons with Disabilities (624120), Other Individual and Family Services (624190)
- SIC
- Services-Health Services (8000), Services-Prepackaged Software (7372), Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Care Management & Coordination Platforms (case/disease management workflows) (HLACAHAD)
- akta.pro secondary industries
- Employer/Member Engagement Platforms for Provider-Sponsored Plans (HLACAEAM), Healthcare & Wellness Personalization (HDAAAGAI)
Keywords
Where Guidehealth is headquartered
LocationHeadquarters
- HQ city
- Dallas
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Guidehealth business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- Value-Based Care Managed Services: Platform fee and performance-based revenue from managing healthcare delivery for health systems and clinically integrated networks under value-based contracts. Revenue tied to quality outcomes, cost reduction, and Stars performance improvement.
- AI Platform Services: Subscription-based access to AI-powered tools including RoseConnect™ conversational AI, predictive analytics, and benefits enablement solutions. Revenue model combines platform licensing with usage-based components for care management services.
- Payer Quality Improvement Programs: Performance-based revenue from improving STARS ratings, HEDIS measures, and medication adherence for health plans. Revenue aligned to measurable quality improvements.
- Employer Benefits Administration: Third-party administration and claims processing services for employer health plans, generating fees from claims processing volume and administrative services.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | Enterprise platform agreements with custom pricing based on covered lives and service scope |
Go-to-market motion2 records
Distribution channels4 records
Marketing channels5 records
Guidehealth product offering
Product offeringCore offering
Guidehealth provides an AI-powered healthcare operating platform that combines proprietary conversational AI (RoseConnect™), predictive intelligence (STEM), and human care teams (Healthguides™) to deliver value-based care management for health systems, payers, and employers. The platform handles clinical engagement, care gap closure, utilization management, prior authorization, claims processing, and benefits administration, processing over 3.5 million claims annually and supporting more than 500,000 lives across four U.S. states.
Differentiator
Problem solved
Functional benefit
Brands
- RoseConnect™: AI voice gateway platform - a clinically intelligent, outcome-driven conversational AI built for real-world care that identifies who needs support, knows what to say and when, closes gaps and activates care plans, and escalates when judgment or empathy is required.
- Healthguides™
- STEM
Products and services
- RoseConnect™ Clinically intelligent, outcome-driven conversational AI voice gateway built for real-world healthcare. Identifies who needs support, knows what to say and when, closes care gaps, activates care plans, and escalates to human Healthguides when judgment or empathy is required.
- STEM Predictive Intelligence Predictive intelligence engine that analyzes patient, claims, and clinical data to identify and target individuals most in need of care interventions, supporting population health stratification and proactive care management.
- Healthguides™ and Nurses Human care team members (Healthguides and nurses) who work alongside AI to provide empathetic support, turning AI-generated guidance into direct patient action, care coordination, and continuous engagement outside the exam room.
- Benefits Enablement Administrative intelligence module featuring agentic AI for benefits and claims processing, prior authorization decisioning in minutes, integrated medical necessity review, configurable plan design, and straight-through claims processing achieving 70-90% auto-adjudication rates.
- Health Enablement Clinical intelligence module integrating whole-person patient targeting, personalized care plans, omnichannel engagement, human-in-the-loop escalation, documentation accuracy, and risk and quality improvement for care outside the exam room.
- Guidehealth Member Portal Self-service web portal for health plan members to access eligibility information, view and appeal claims, manage authorizations, find in-network providers, and download forms and tutorials.
- Guidehealth Provider Portal Secure portal for healthcare providers to manage claims, enter and track authorizations, verify member eligibility, request IPAs and TINs, and access clinical documentation tools.
- AI-Native Utilization Management Platform AI-native Utilization Management and Prior Authorization platform deployed with GenHealth.ai that automates clinical data extraction from PDFs, faxes, and transcripts, evaluates policy criteria, and delivers decisioning within minutes.
- Value-Based Care Managed Services Platform fee and performance-based managed services for healthcare delivery under value-based contracts, tied to quality outcomes, cost reduction, and Stars performance improvement for health systems and clinically integrated networks.
Quantifiable outcome
- Lower inpatient admissions through proactive AI-guided intervention
- +9 more outcomes
Companies that use Guidehealth
Customer profileNamed customers7 records
Segments3 records
Ideal customer profiles3 records
Guidehealth technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability7 records
Feature6 records
Guidehealth partnerships and signals
Strategic signalPartnerships
Three partnerships are on record, tiered core.
- Centers for Medicare & Medicaid Services (CMS)coreSelected as one of 150 digital health companies to participate in the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), a 10-year national initiative for technology-supported chronic condition care starting July 2026.
- GenHealth.aicoreCollaboration deploying GenHealth.ai's AI-native Utilization Management and Prior Authorization platform with Guidehealth, resulting in up to 60% reduction in UM workload and $1.2M in annual cost savings. Platform maintains over 90% decision-making consistency and regulatory compliance.
- Firstsource SolutionscoreStrategic partnership combining Guidehealth's clinically intelligent AI with Firstsource's automation capabilities to accelerate value-based performance for health plans and providers.
Scale indicators7 records
Recent moves6 records
Expansion highlights6 records
Guidehealth competitors and assessment
Company assessmentDirect peers
- Arcadia: Healthcare data and analytics platform for value-based care. Guidehealth acquired Arcadia's value-based care division in Dec 2023, and many Guidehealth assets, customers, and the KLAS #1 ranking trace directly to Arcadia.
- Innovaccer: Healthcare data activation platform serving health systems, payers, and providers with AI-driven population health and value-based care workflows. Directly comparable product offering and enterprise GTM motion.
- Aledade: Value-based care enablement platform partnering with independent primary care physicians and health systems. Operates in a similar ACO-focused VBC enablement category with comparable target customers.
- Agilon Health: Public value-based care platform partnering with primary care physicians to manage Medicare Advantage populations. Directly comparable in senior-focused VBC enablement with health system partnerships.
- Stellar Health: Value-based care enablement platform for primary care providers, helping close care gaps and improve quality scores. Closely comparable product category, target customer, and value-based reimbursement model.
- Wellvana: Value-based care enablement company partnering with primary care physicians and health systems to manage risk arrangements. Comparable in physician enablement, population health, and ACO support.
Broad incumbents
- Health Catalyst: Public healthcare data and analytics company offering population health, value-based care, and analytics platforms to health systems. Broader portfolio than Guidehealth but significant overlap in the VBC enablement category.
- Privia Health: Public physician enablement company supporting value-based care across multiple states. Serves health systems and physician groups with comparable ACO, population health, and risk-bearing capabilities.
- Evolent Health: Public specialty care and value-based care services company serving health plans and providers. Overlapping capabilities in payer-provider enablement and population health management.
- Carelon Health: Elevance Health's value-based care services arm operating primary care, home health, and care management for Medicare and Medicaid populations. Overlaps with Guidehealth's payer-aligned VBC capabilities at much larger scale.
Market position
Strengths4 records
Weaknesses4 records
Competitive moat5 records
Key risks5 records
Key highlights7 records
Customer concentration
Guidehealth social profiles
Digital presenceGuidehealth compliance and trust
Trust signalCompliance4 records
Guidehealth financial estimates
Financial estimateRevenue estimate
Valuation estimate
Guidehealth leadership team
Management profileNumber of profiles
Profiles7 records
Guidehealth funding detail
Funding detailFunding overview
Funding rounds3 records
Investors3 records
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Guidehealth M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Guidehealth
What does Guidehealth do?
Guidehealth provides an AI-powered healthcare operating platform that combines proprietary conversational AI (RoseConnect™), predictive intelligence (STEM), and human care teams (Healthguides™) to deliver value-based care management for health systems, payers, and employers. The platform handles clinical engagement, care gap closure, utilization management, prior authorization, claims processing, and benefits administration, processing over 3.5 million claims annually and supporting more than 500,000 lives across four U.S. states.
Is Guidehealth a public or private company?
Guidehealth is a private company. It is classified as venture growth investor backed and is currently operating.
When was Guidehealth founded?
Guidehealth was founded in 2023. It employs 101 to 250 people.
Where is Guidehealth based?
Guidehealth is headquartered in Dallas, United States, in the North America region.
How does Guidehealth make money?
Four revenue lines are on record. Value-Based Care Managed Services are the primary driver. The others are AI Platform Services, payer Quality Improvement Programs and employer Benefits Administration.
Who are Guidehealth's main competitors?
Direct peers on record are Arcadia, Innovaccer, Aledade, Agilon Health, Stellar Health and Wellvana. Broad incumbents are Health Catalyst, Privia Health, Evolent Health and Carelon Health.
Does Guidehealth have an API?
No public API is recorded for Guidehealth.
What industry is Guidehealth in?
Guidehealth's product category is Healthcare Value-Based Care Platform. Its primary akta.pro industry code is HLACAHAD, Care Management & Coordination Platforms (case/disease management workflows), with a secondary code of HLACAEAM, Employer/Member Engagement Platforms for Provider-Sponsored Plans. Its NAICS code is 524292 and its SIC code is 8000.