We loved meeting many of you in Atlanta and at Money 20/20 a couple weeks ago. We'll be off the road for a bit, which is good timing as we let the air traffic system reset after the long government shutdown. We've decided to add HIMSS back to our event calendar in the first half of next year, along with Fintech Meetup, ETA's TRANSACT show, and HFMA's annual conference. If you're planning to attend any of these let us know - we always prefer to say hello in person!
This issue we share data on healthcare market share among top payments companies. We also bring in some thoughts on business payments in healthcare with a look at the shift from virtual card to advanced ACH models. Plus the usual - healthcare payments deals, AI, and other reading.
Remember to download our Demystifying Healthcare Payments white paper here. And reach out here to schedule time if you'd like to take a deeper dive.
DEAL NEWS
Rev cycle company R1 to acquire Phare Health
Murray, UT-based R1 announced in October that it is acquiring Phare Health, a leader in building AI-native solutions for inpatient coding and clinical documentation improvement (CDI). Terms were not disclosed. Phare Health, founded in 2023 by a team with experience from Google DeepMind and prominent AI research institutions, was funded by General Catalyst, Bertelsmann Healthcare Investments and Meridian Health Ventures.
We had so many announcements after Labor Day that we completely missed this big one! Atlanta-based Rainforest, growing quickly as a challenger to Stripe, Adyen and other embedded payments companies, closed on a $29 million Series B round in early September. While Rainforest serves multiple verticals, healthcare is a big focus. (Founder Joshua Silver, whom we profiled last year, was a co-founder of Patientco which sold to Waystar in 2021.) The round was led by existing investors Matrix Partners and Infinity Ventures, with participation from Accel and Tech Square Ventures.
Hippocratic AI raises $126M to expand across healthcare
While agentic AI in healthcare has occasionally been pointed at payments via call center support, it still bears watching as all AI-based patient engagement can eventually (and should) handle patient financial responsibility. With that in mind we include Palo Alto-based Hippocratic AI's recent Series C raise of $126 million. Investors include Avenir Growth (lead), with participation from CapitalG (Google), General Catalyst, Andreessen Horowitz (a16z), Kleiner Perkins, and several large healthcare organizations.
The company's growth is impressive - in the 1+ years since commercial launch, it has partnered with more than 50 health systems, payors, and pharma clients in 6 countries, and completed over 115 million clinical patient interactions with no safety issues (it has big focus on clinical safety in its current go-to-market approach).
Business Insider reports that Warburg Pincus and Berkshire Partners, the PE owners of Cincinnati, OH-based revenue cycle company Ensemble Health, are pursuing a dual-track approach to sell the company. They have apparently hired JPMorgan to pursue a sale and Goldman Sachs to explore an IPO. No bids are being solicited until Q1 2026. The investors are reportedly looking for a $13 billion valuation for Ensemble, which according to Business Insider has annual EBITDA of $700 million.
RCM technology company MedEvolve sold to Emergence
Little Rock, AR-based MedEvolve - which recently divested its services business - has just been acquired by Emergence. Emergence is a long-term equity partner backed by The Pritzker Organization. MedEvolve's technology "integrates workflow automation, analytics, benchmarks and generative AI" and "captures millions of workflow actions across the revenue cycle creating a proprietary dataset combined with advanced algorithms that power a new generation of industry benchmarks". This will be supported by Emergence's "long-term orientation and deep software expertise". Terms were not disclosed.
A quiet transition is underway in healthcare payments as “enhanced ACH” products – marketed under names like ACH+, PayLogic, and other variants – are displacing virtual credit card volume as a way for payers to reimburse medical and dental providers.
The shift addresses a fundamental pain point for providers. Despite faster payment, improved cash flow, reduced administrative burden, and improved payment security, virtual credit cards (aka virtual cards) impose average processing fees of 3-4% and as high as 5% on providers who are receiving them as payment for medical and dental claims. For a $10,000 reimbursement, the traditional overnight ACH payment would cost 34 cents based on federal regulation imposed to cap healthcare ACH fees in 2014. The virtual card payment would cost upwards of $300.
The growth of virtual cards across healthcare and other B2B verticals also generated a new set of financial intermediaries. Companies like Boost Payment Solutions emerged to help suppliers and providers manage the inflow of virtual card payments. Boost’s Virtual Healthcare Lockbox, for example, intercepts virtual card payments, processes them automatically, and deposits funds directly into providers’ bank accounts while eliminating their exposure to sensitive card data.
Pushback against virtual cards has been growing for years, fueled by increased payer use of virtual cards, and increased provider awareness of the less expensive ACH option. (ACH healthcare claim payments reached 510 million in 2024, a 4.6% increase from 2023 and a 2,556% increase since 2013!). The federal regulation in effect in 2014 made it possible for providers to refuse virtual cards and required insurers to make ACH payments available upon request.
Ten states have enacted some type of easy opt-out legislation aimed at dentists. At least seven states have enacted or are pushing new laws in 2025 to address fee caps, opt-out rights, transparency, and fee prohibition for excessive surcharges, including California, Maine, Oklahoma, Utah, Virginia, Washington, and Wyoming.
In response to this pressure, banks and fintechs have introduced less-costly ACH products that carry fees of 1.5-2.0%. Zelis’ ACH+ platform processes more than $220 billion in annual provider payments. ACH+ consolidates payments and remittance data from 550+ payers into a single portal. This platform lowers fees compared to virtual cards and delivers electronic remittance advice (835 files) directly to clearinghouses and EHR systems. (Traditional ACH simply transmits funds, with no remittance data.)
ECHO Health is one of the largest healthcare payment facilitators, with a network of 1.6 million provider and vendor connections. The company offers virtual card, ACH, digital checks, and paper check options on its platform. As recently as March 2025, ECHO was emphasizing the advantages of virtual cards to simplify payments. But it too is accommodating the growing provider demand for less costly reimbursement options. The ACH option in ECHO’s PayLogic solution includes electronic remittance advice and richer data, and better payment controls and fraud protection, than traditional ACH. Its platform offers an easy EFT/ ERA enrollment process.
Over the next 2-3 years, expect this momentum to accelerate. State legislative action continues to strengthen provider protections against virtual card fees. Healthcare organizations have become savvier about their choices, and are enrolling in ACH options on platforms offering single-portal access to multiple payers’ remittance information. The question is not whether enhanced ACH will replace virtual cards for healthcare claim payments, but how quickly providers will complete the transition.
PAYMENT DATA
Relative position of payments companies in healthcare
FinMed Partners recently took a look at the competitive positions of payments in the healthcare vertical. Including the dental and veterinary markets as well as medical electives such as cosmetic surgery, our analysis showed Global Payments with Worldpay as the clear leader with over one-third of total volume and 55 platform integrations. Stripe is in second place, also with 55 integrations but half of Global/ Worldpay's payment volume. Newcomer Adyen has a smaller share (3-4%) but is quickly adding new partners.
Please email us if you'd like more information about our methodology and a deeper look at these results.
EMR NEWS
New report outlines challenging situation for Oracle's EMR
Healthcare Dive recently summarized an August 2025 KLAS report reviewing Oracle's EMR performance since acquiring the former Cerner in 2022. Here are some of the article's key takeaways:
Negatives:
Oracle has lost 57 acute care customers in the past three years, 12 of which are large health systems with 1,000+ beds (including Intermountain Health, UPMC, Henry Ford Health, Adventist Health and ChristianaCare)
Half of customers interviewed would not purchase the (now Oracle) EMR again in 2024
Only 47% of customers viewed Oracle as a "long-term partner" compared to 67% three years earlier in 2022
Positives:
Oracle clients reported improved code quality in new releases
Excitement among clients about new and updated technologies such as Oracle's Clinical AI Agent
Oracle launched its new AI-based EMR to ambulatory providers in August
U.S. payments growth may have peaked. Payments revenue growth is projected to slow over the next four years, with cash-to-card migration largely in the rearview. (Payments Dive)
Worldpay teams with Affirm on Embedded Payments for SaaS Firms. Worldpay, a leader in acquiring and processing for healthcare payments, is adding Affirm financing to its platform offering; Affirm has already expanded into cosmetic financing with integrations such as RepeatMD. (PYMNTS)
Conference List. Rolling twelve month look ahead at conferences and other events covering healthcare payments, revenue cycle, fintech and related areas. Updated through November 2026.
FMP Blog. Thoughts from healthcare payments CEOs and investors on their right to win and goals for the year ahead, as well as data and perspectives on healthcare payments.
Newsletter Archive. News, trends, and insights from the healthcare payments industry compiled in our bi-weekly newsletter. Last six months of newsletters.
Epic MyChart. Excel sheet with full listing of all Epic MyChart instances as of May 2024, categorized by state, provider type and specialty.
All of these resources can also be accessed at the FinMed Partners Insights page.
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FinMed Partners is a management consulting and advisory business focusing at the intersection of payments/ fintech and healthcare. Our founders have developed deep expertise from decades of experience with health IT companies, healthcare providers and many players within the payments ecosystem. Investors, boards and executive teams work with us to maximize business value through strategic input and tactical execution.
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