Apixio
Vendor Review for Medicaid Vendor Partner Readiness
- Overall Assessment
- Basic Info
- Relevant Leadership Experience
- Brand Perception
- Clarity of Value Proposition
- Scalability
- Funding Model
Overall Assessment
Summary
- RA vendor trying to build out solution using AI.
- Limited/no Medicaid experience across leadership team. Strong healthcare experience and moderate Medicare experience.
- Moderate brand recognition. Deal with Gateway PA increasing Medicaid brand perception, but most interest still in investment community due to AI value prop.
- Internal reviews suggest reactive nature tied to large contract delivery.
- Value prop for MA space (HCC, RA) may not translate well to Medicaid. Developing gap closure play for Medicaid space.
- Staffing analysis shows positioning for growth, but operational and product delivery teams show moderate experience.
Scoring

Composite

Leadership Medicaid Experience

Scalability

Brand Perception
Category
Risk adjustment assistance, Artificial intelligence
What they do
Natural language processing (reading text notes in EMR data, etc)
HCC / RA audits for CMS compliance (for traditional MA offerings)
Risk Adjustment

current vendor logo (for identification purposes only)
Self-stated value proposition
Apixio is a data science company focused on healthcare whose artificial intelligence-driven software solutions enable health plans and providers to pull novel insights from both medical text and codes in order to improve healthcare delivery to their populations. Apixio’s HCC Profiler and Code Compliance Auditor leverage its platform's proprietary algorithms to help coders achieve unprecedented accuracy and efficiency for risk adjustment, and help providers ensure their patients are matched with the best care possible
Founded
2009
Annual Revenues
Estimated @ $7M
# employees
Estimated @ 150
Points Possible: 212
Points Earned: 58.5

click to enlarge
Role | | |
---|---|---|
CEO | ![]() Darren Shulte | Click for Bio (self-reported)Darren Schulte, MD, has more than eleven years of industry experience in healthcare analytics and technology. Darren served as the Chief Medical Officer and President of Apixio prior to being appointed CEO in 2014. Before joining Apixio, Darren served in executive leadership roles at Alere, Anvita Health, and Resolution Health. Darren co-developed 25 clinical measures endorsed by the National Quality Forum to assess ambulatory care quality measurement using electronic data. Darren is a nationally recognized speaker on the topics of healthcare analytics and quality improvement. Darren received his Bachelor of Science from Berkeley, his MPP degree from Harvard, and his MD from Stanford. He trained in Internal Medicine at UCSF and is the co-author of one US patent. |
Operations Executive | ![]() Meg Holland | Click for Bio (self-reported)Meg is a seasoned healthcare professional committed to improving quality of care. She is a strategic thinker whose pragmatic and customer-centered approach has been cultivated from 25 years of experience with technology startups, service companies, and government agencies. Most recently Meg was COO at HealthLoop, Inc., where she spent four years building a team and a company and creating a new market of patient engagement solutions for healthcare. Previously Meg was VP of Business Operations at Epocrates, where she was a key member of the team that developed and launched the Epocrates EHR. Meg also held the role of VP of Client Services during a period of high company growth and profitability that culminated in the Epocrates IPO. Prior to Epocrates, Meg was a strategy consultant with Accenture’s Health Services Group and a Medicaid policy analyst with the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). |
Information Systems Executive | ![]() John Schneider | Click for Bio (self-reported)John Schneider has more than 25 years of software technology and product development experience with special skills in cross-functional management across research, product, and engineering. Most recently John was the General Manager of the Adaptive Learning Products and the Chief Product Architect at Apollo Group. Prior to Apollo, John was CTO of CloudTalk, Inc., where his team developed a multi-tenant web and mobile messaging communications platform. At GE Healthcare, John was a director of software development and VP, developing instrumentation and informatics solutions that helped produce the human genome and discover gene function. John holds a BSE degree from Columbia University’s School of Engineering and Applied Science. |
Sales Executive | ![]() Tom McNamara | Click for Bio (self-reported)Tom has 25 years of experience building successful sales organizations for healthcare technology and analytics companies. Prior to joining Apixio, Tom served as head of sales for GNS Healthcare, Connance, and Silverlink Communications. He also led sales at HPR, a medical payments company, up to and through a successful IPO. Tom is a results-oriented executive who excels at motivating field teams, providing solutions to client requirements, and clearly positioning the value of technology services. He holds a BS from the University of Vermont and an MBA from the University of Chicago’s Booth School. |
Product/Solution Executive | ![]() Andy Crowne | Click for Bio (self-reported)Andy is an entrepreneurial product leader who uses data and a unique blend of technology experience, domain knowledge and leadership capabilities to drive rapid product innovation. He possesses a global mindset, exemplary organization/collaborative skills and the commercial experience to lead the transformation from an idea on a whiteboard into a product generating revenue. |
Finance Executive | ![]() Sachin Patel | Click for Bio (self-reported) |
Points possible: 95
Points earned: 75

Analyst Notes
- No negative press or litigation in past 3 years identified.
- Gateway PA deal establishes some interest in Medicaid space.
- Glassdoor reviews raise some concerns over reactive delivery cycle based on big contracts.
- Low volume of organic search for company outside of investment community in Silicon Valley.
Points possible: 60
Points earned: 40

Analyst Notes
- RA/ HCC lift seems to be solutions offered, but then most publishing is on AI.
- Solution does not draw clear connection to Medicaid space.
Points possible: 50
Points earned: 26

Analyst Notes
- Moderate client base
- Delivery teams experience rated as moderate
- Organizational hiring path is increasing
- Low annual revenue (<$10M)
Analyst Notes
Ownership model
Venture Capital
Stage
Early
Trend in funding rounds
Significant increases in recent rounds, 4 total. $41M tot funding so far
Major investors
Bain Capital Ventures, First Analysis, SSM Partnerts