# rev.health — Executive Summary

**The ambient-AI-native EMR with revenue cycle built in, for independent primary care (1–5 clinicians).** Seed round: **$4M** · founders@rev.health

## The problem
Independent primary-care clinicians spend 2–3 hours every evening finishing notes, while fragmented billing workflows leak 5–10% of revenue and hold AR at 30–60 days. The cloud RCM suites (athenahealth, eClinicalWorks, NextGen) have outgrown this buyer on price and complexity; lower-tier EMRs ship weak interoperability and aging UX. It is the largest underserved segment in ambulatory health IT.

## Why now
The 2026–2027 regulatory wave — HTI-1 enforcement (Mar 2026), USCDI v3, CMS-0057-F payer/prior-auth APIs (Jan 2027), TEFCA live with 11 QHINs — forces every incumbent to retrofit. A new entrant gets to be FHIR-native, AI-native, and TEFCA-connected from day one. This window opens roughly once a decade.

## The product
One platform spanning EHR, practice management, and RCM, with two promises: the note is done before the clinician leaves the room (structure-first ambient scribe that writes back to coded fields — problems, A/P, orders — with audio-linked evidence), and the practice is paid correctly the first time (native charge capture → 10K+ rule scrubbing → auto-posting → AI denial triage; target ≥98% first-pass clean claims, ≤32 days AR). Differentiators no incumbent ships: minute-level resource-graph scheduling, turn-key integrated RCM, and a patients-as-users data model where the record is portable and every read is audited — a compounding network moat.

## Competition (from our recorded 2026 vendor demos)
athenahealth charges 4–7% of collections yet still requires the practice to hire its own billing coordinator. eClinicalWorks carries a $155M DOJ False Claims settlement and failed AI demos live. NextGen had 1.05M patient records exfiltrated in 2023 ($19.4M settlement) and couldn't produce breach-indemnity language. Elation is closest in spirit but has no integrated RCM. **rev.health: $399/provider/mo + 3.5% of collections — transparent and turn-key.**

## Business model & plan
~$26K revenue per provider per year (~$65K ACV per practice at 2.5 providers), 77% blended gross margin. Path: 5 design partners (2027) → ONC-certified GA (2028) → 850 practices and ~$34M revenue / $46M exit ARR by 2031, EBITDA-positive. High-collections specialties (ortho, cardio, GI) are a pure ACV expansion lever after the primary-care beachhead.

## Status
De-risked before production code: a validated 10-module PRD (44 documents), full regulatory matrix across 15 frameworks, working UI prototypes, and a competitive teardown built on recorded incumbent demos. Next 90 days: close seed, sign 3–5 design-partner LOIs, first 4 engineering hires, kick off Drummond ONC + Surescripts EPCS certification (the 9–12-month critical path).

## The ask
$4M seed: 55% engineering & product, 15% regulatory & certification, 12% design partners & GTM, 8% G&A, 10% contingency. Carries the company to certified general availability and ~$2M ARR run-rate entering 2028 — the Series A milestone set.