Optura

Optura develops an enterprise healthcare platform built around ROAI™ (return on AI investment), a trademarked methodology for selecting, executing and measuring AI initiatives. The platform integrates with an organization's operational systems, combines live data with healthcare regulatory knowledge and industry-trained large language models, and constructs an organization-specific ontology that grounds subsequent AI decisions. From that foundation, standardized workflows can be automated with prebuilt or custom agents, applications and SOPs can be converted into agent-enabled capabilities, and cost, performance and returns are tracked continuously.

The product is organized into four stages and named components. The Librarian connects enterprise data, regulations and institutional knowledge into a single intelligence layer. The Analyst collects and details candidate use cases by cost, feasibility and organizational readiness, scoring them against executive-approved criteria to produce a Value and Viability Matrix. The Generator creates AI agents from workflows and SOPs, and the Agency deploys prebuilt or custom agents across the enterprise, using the Model Context Protocol to anchor agentic workflows. The Operator supervises deployed agents, tracking actions and outcomes in real time and reconciling actual results against projected costs and returns. At launch in 2025 the company described the product as an AI Enterprise Operating System (AIEOS) with an Intent Engine, Operator and Librarian.

Stated healthcare applications include claims, utilization management, prior authorization, risk stratification, rebate automation and formulary management. The company reports work with health plans, providers and tech-enabled healthcare service companies.

Founding story

Optura was co-founded by Andy Fanning, previously VP of AI/Automation at Cigna, and Michael Hollis, formerly President and CGO of Emids and a current board advisor there. The founders framed the company around what they describe as "AI paralysis" in healthcare — disconnected pilots without governance or demonstrable ROI. Hollis has described the underlying obstacle to adoption as a trust problem rather than a technological one.

Business model

Optura sells enterprise contracts for its healthcare AI orchestration platform, combining software with an advisory methodology delivered through executive work sessions and forward-deployed engineering. Coverage cites annual recurring revenue and a sales pipeline, indicating recurring enterprise subscriptions.

Enterprise platform contracts with health plans, providers and tech-enabled healthcare service companies; reported ARR of over $3.7 million with a pipeline of more than $18 million.

Traction

The company reports more than $2.1 billion of AI initiatives managed in the platform (as of 3 January 2026), 8,000 unique platform users, over 250 use cases, more than $120 million in tracked value, measured ROAI of 500–700% on in-flight initiatives, over $3.7 million ARR and an $18 million-plus pipeline. Named enterprise customers include Independence Blue Cross, Prime Therapeutics and Ardent Health. An early implementation with a national pharmacy benefit manager identified $50 million in potential annual value from prior authorization, rebate automation and formulary management improvements.

Latest developments

In May 2026 Optura announced a $17.5 million Series A led by Salesforce Ventures with participation from Echo Health Ventures and existing investors Susa Ventures, Matrix Partners and HC9 Ventures, to be used for expanding platform AI capabilities, growing platform development teams and scaling LLM partnerships. The company states $25 million raised to date. Recent senior hires include SVP Jon Hilton (previously LBMC and EY) and VP Katy Feldner (previously Elevance Health).