Congruity Health tackles healthcare costs

Healthcare is big business in the United States. Americans are projected to spend $4.9 trillion on healthcare in 2024. For many, health insurance acts as a safety net to offset the cost of medical services.  In 2023, the average annual premium for health insurance in the United States was $8,435 for individuals and $23,968 for families, and those numbers continue to rise.

Often, employers cover at least part of the cost of the insurance policy. Increasingly, companies are looking for ways to cut insurance costs without cutting employee benefits.

Kenosha-based startup Congruity Health was launched to help employers combat these soaring costs.

“We’re a health plan product. We serve employers with self-funded health plans. We reduce risk and cost for high-risk cardiometabolic patients within those health plans,” co-founder and CEO Justin Davis said.

“Healthcare is way too expensive. We help reduce the risk and cost and improve the health of those with cardiometabolic chronic conditions by helping them get them on evidence-based protocols that drive better financial outcomes for the plan …and better health outcomes for the members,” he continued.

Common cardiometabolic diseases include cardiovascular disease, diabetes, chronic kidney disease and nonalcoholic liver diseases. These diseases are expensive to treat, and they are becoming progressively more common as obesity rates climb.

“We aren’t the health plan; we work with the health plans to offer this product. We’re a data technology company,” he continued.

When an employer becomes a client of Congruity Health, the company reviews past medical claims to determine risk. Once patients with cardiometabolic chronic conditions are identified, the company reviews the patient treatment protocols to ensure that it aligns with best practices to treat those illnesses.

“The software identifies the people, understands the risk, then sorts risks and stratifies the population for the employer to know where that is. We do all the data and analytics behind that. Once we find them (cardiometabolic patients), we have a team of nurses that proactively reach out to help people understand the programs …and coach them through it,” Davis explained.

Davis explains that the process is not intrusive.

“Everything is HIPAA-secure and compliant. What’s important to understand is that the employer doesn’t know (about employee medical history). They don’t get back that data. We get that data from a third-party administrator. They manage the data and the payments for the insurance company. The employer does not get this information about the employee and doesn’t even know who we’re reaching out to. We manage this in a vacuum for the members. It is highly secure and compartmentalized,” he said.

To make this process work, the company has developed an AI tool that not only identifies patients but also determines if they are currently being treated using accepted best practice protocols.

“We use AI to find the gaps in protocols,” he said. “These answers come from a very discreet database. It’s vetted, evidence based, and it’s got 30 plus years of research and data …with outcomes approved by American College of Cardiology.”

The venture-backed business launched with a $1.5 million seed funding round from Aviv Growth Partners in 2024. In January 2024, the company completed a funding round with California-based BambuVentures for an undisclosed sum. Davis said the company is considering a third funding round to support its rapid growth. Growth plans include bringing outsourced nursing talent in-house and expanding the company focus beyond cost-saving measures for treating chronic cardiometabolic disease patients.

“We’re going to go beyond the cardiometabolic space. The musculoskeletal pain space is a hugely expensive and messy place where there’s a lot of money spent– too much money spent on surgeries that don’t need to be surgeries, protocols that are all over the place, and there’s a lack of consistency and outcomes in that space. For us to grow and scale we are going to (move) beyond the cardiometabolic space,” he said.

“We are also creating AI tools that deliver health education to consumers to help them make better decisions off the bat… AI can help people make better decisions faster. AI will not replace people. It will help people do 10 or 100 times the work (they currently can do),” he continued.

To learn more about this technology company tackling rising healthcare costs with data-driven solutions, connect with Congruity Health here.