Cadence’s Chris Altchek
Cadence
Cadence reached a $1.2 billion valuation by using AI to track seniors’ chronic health conditions and improve their care.
Caring for people with chronic disease accounts for the vast majority of the $5.3 trillion the U.S. spends every year on healthcare. AI can help keep seniors healthier and cut costs by monitoring common chronic illnesses like hypertension and diabetes, argues Chris Altcheck, cofounder of Los Angeles-based startup Cadence. The goal: Help people over 65 get the right medications and earlier treatment, keeping them out of the ER.
“Everyone is trying to figure out how we improve outcomes for chronic disease. I think we are realizing that even if we double the number of primary care doctors it wouldn’t actually help because the way we treat disease with two-to-four doctor visits a year doesn’t work,” Altchek tells Forbes.
Cadence’s clinical AI agents are hooked into devices like blood pressure cuffs and blood sugar monitors, which monitor patient vitals remotely. It combines this data with information from patients’ electronic health records to recommend if someone should adjust their medication, or change their lifestyle. That enables Cadence’s system, which is supervised by physicians, to alert a clinician when a patient is deteriorating before a stroke or heart attack, for example.
Cadence touts data, published in peer-reviewed journals, that shows its model works: a 27% decrease in in-patient hospital admissions, a 230% increase in heart failure patients using recommended therapy, and a 70% increase in blood pressure control for hypertension patients. On the cost side, it showed a $1,300 per patient annual reduction in the total cost of care. The company says it saves Medicare roughly $2.7 million per week.
Today, Cadence treats more than 100,000 patients at 21 health systems, ranging from academic medical centers like Duke Health to Texas Health Resources, a faith-based non-profit with 24 hospitals around Dallas-Fort Worth. Its annualized revenue is on track to reach $140 million by the end of this year, more than double last year’s $62 million and nearly seven times higher than the $21 million it reached in 2024. (A target of $140 million in annualized revenue is the equivalent of bringing in $11.7 million in monthly revenue by the end of the year.)
Now the startup tells Forbes that it has raised an additional $100 million in a round led by Spark Capital, the VC firm best known for being an early backer of Anthropic. The new money brings its total funding to $241 million at a valuation of $1.2 billion, up from $1 billion at December 2021.
“The way we treat disease with two-to-four doctor visits a year doesn’t work.”
“Health systems are under immense financial pressure, and they are underequipped to manage more patients. You pair that with an ever-increasing number of chronic care patients and it is an untenable situation. The only way to solve it is through technology,” says Will Reed, a general partner at Spark Capital, which also invested in Abridge, the $5.3 billion (valuation) AI scribing company that’s rolling out AI-powered clinical intelligence.
The challenge of providing better care for the more than 68 million people on Medicare–most of whom have at least one chronic disease–hasn’t been a big area of focus for entrepreneurs and investors in the past. It’s a daunting task because primary care appointments are too short and infrequent to cover the complexities of chronic diseases, and there’s an increasing shortage of general practitioners nationwide. But AI has the potential to help fill some of the gaps.
Health systems sign up for Cadence and can enroll those with chronic diseases in its programs. Medicare covers the cost, either as fee-for-service or as part of a value-based arrangement that ties payments to the results the program achieves for patients. Cadence splits that revenue with the hospitals it works with. About 20% of Cadence’s patients have an insurance copay.
Cadence’s AI makes recommendations to a health system customer’s doctors, who have oversight, but does not automatically make changes to prescriptions (the startup employs nurse practitioners and clinical navigators who work in combination with the technology). Having autonomous agents make those decisions would likely cross the line into being an AI doctor, and require FDA approval.
At a recent meeting in New York, Altchek pulled up successful interventions from the company’s “Mission Wins” Slack channel. In one case, Cadence’s alert system called a patient with low blood pressure of just 69/47 and connected them with a nurse who recommended they go to the emergency room.
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Altchek, 38, grew up in suburban New York in a family of doctors. Both his father, a renowned surgeon at the Hospital for Special Surgery and the New York Mets’ longtime medical director, and his grandfather were orthopedists. His sister is an ob/gyn.
He didn’t start out in healthcare though. In 2011, he cofounded new media company Mic with a high school friend. They had big ambitions for Mic to serve up easy-to-consume stories on politics and culture online. Altchek was named to the Forbes 30 Under 30 list in Media in 2014, and the VC-backed business reached a valuation of $100 million in 2017. But in 2018, Mic laid off the majority of its staff and sold to Bustle for a reported $5 million. “It grew fast and then had a spectacular implosion,” Altchek recalls. “It was very memorable, and we learned a lot through that experience.”
Then, in the early days of the Covid-19, Altchek was listening to his wife, Dr. Kasey Grewe, a cardiac anesthesiologist, talk about what she was seeing in the ICU. “She was taking care of heart failure patients at UCLA, and noticed that none of the patients were on the right drugs….They wouldn’t have been there if they had been on the right drugs,” he says. In fact, just 2.5% of patients nationally with heart failure get the right treatment for it, even though heart disease is the leading cause of death in the United States.
That inspired Altchek to start Cadence with Thrive Capital general partner Kareem Zaki in August 2021. They envisioned a new model where machine learning could monitor chronic diseases in between doctor visits to keep patients healthier and lower healthcare costs. The company soon enrolled its first patient, a man in his 80s who had been in and out of the hospital for three years with heart failure, and adjusted his meds so that he could play golf again for the first time in years. Over time, as AI has gotten better at understanding messy and unstructured clinical conversations, Cadence has been able to move more quickly with personalized recommendations.
New Jersey health system Hackensack Meridien Health signed on with Cadence last October, and has since rolled it out to nearly 5,000 patients with chronic ailments, most of whom are seen by its primary care doctors. Health systems run on razor-thin profit margins, and Cadence showed Hackensack how both the hospital and the company could get paid by Medicare for keeping people healthier. “Those are all new revenue streams that CMS [the Centers for Medicare & Medicaid Services] is creating to improve population health,” says Hackensack Meridien Health’s chief physician executive Dr. Daniel Varga.
Cadence currently covers 14 chronic conditions. With the new funds, Cadence plans to expand to additional health systems, and to build out AI agents for additional ones such as cirrhosis and cognitive care. It also plans to roll out devices for ailments such as kidney disease that don’t currently include remote monitoring. Altchek has big goals for Cadence: to reach 1 million patients, a 10-fold increase from today, with 100 hospital systems signed on—“hopefully in three years,” he says.
That’s extremely aggressive, given how slowly things move in healthcare. But Altchek says that over the past few years the company has shown that its AI monitoring works across all kinds of hospitals: rural and urban, academic and community health focused.. “We thought we could do it,” he says. “Now we are confident we can replicate it.”
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