Kaigo Health

What do they actually do

Kaigo Health provides a cloud platform with an AI agent (“Ambi”) that performs routine outpatient outreach to older adults by phone and SMS, collects answers and vitals (via integrated RPM devices), runs triage protocols, and returns concise summaries and flags to human care teams. It includes voice check‑ins, protocol‑based triage (e.g., Schmitt‑Thompson), transcription/summaries, dashboards, and options to integrate with EMRs/CRMs Kaigo site, Launch YC.

The product is aimed at providers managing Medicare/senior populations (value‑based primary care groups, ACOs, hospital/post‑discharge teams) and is positioned for pilots and deployments with HIPAA compliance and enterprise integrations. Outcome improvements listed on the site (e.g., reduced readmissions, increased CPT/HCC capture) are company claims rather than independently published studies Kaigo site, YC company page.

Who are their target customer(s)

• Value‑based primary care groups and ACOs managing Medicare seniors: Need to scale routine outreach and monitoring without adding nursing headcount; struggle to capture complete documentation and risk‑adjustment/billing codes in a timely, structured way.
• Hospital discharge and transitional care teams: Overloaded with manual post‑discharge calls and miss early warning signs that lead to readmissions, creating regulatory and financial risk.
• Remote patient monitoring (RPM) program managers and home health agencies: Low engagement with device programs, high logistics overhead for supplying/collecting vitals, and difficulty turning data into billable services and actionable workflows.
• Medicare Advantage care management teams: Pressure to hit quality metrics and prevent costly inpatient care, but limited staff capacity for proactive, frequent check‑ins at scale.
• Small primary care clinics/community practices serving older adults: Clinicians spend time on repetitive follow‑ups that contribute to burnout, and results from outreach are hard to push cleanly into the EHR.

How would they acquire their first 10, 50, and 100 customers

• First 10: Run tightly scoped pilots with value‑based primary care groups, ACOs, and hospital discharge teams via founder/YC intros, including EMR connection and device provisioning plus a clear measurement plan for readmissions and documentation capture Kaigo site, YC company page.
• First 50: Convert pilot proof into a repeatable playbook: dedicate an enterprise AE and clinical onboarding lead, standardize SOWs and EHR integrations for fast deployments, and scale targeted outbound with customer referrals and on‑site demos Kaigo site.
• First 100: Add partner channels and productized offers: bundle with EHR/CRM integrators, home‑health vendors, and device suppliers; launch a lower‑touch tier for small clinics; standardize clinical/billing templates and use performance‑based pilots for larger accounts Kaigo site, YC company page.

What is the rough total addressable market

Top-down context:

The core market is U.S. Medicare seniors. CMS reports roughly 69 million total Medicare beneficiaries in 2025 CMS enrollment. Within that, about 32.8 million people were enrolled in Medicare Advantage in 2024 KFF MA 2024.

Bottom-up calculation:

Focus on value‑based seniors across MA and MSSP ACOs (~33M MA in 2024 and ~10.8M aligned to MSSP ACOs in 2025; little overlap since MSSP is FFS) KFF MA 2024, KFF Medicare 101. If 15 million seniors are targetable for continuous outreach/RPM and average pricing is ~$12 PMPM over 12 months, TAM ≈ 15M × $12 × 12 ≈ $2.2B per year.

Assumptions:

• Pricing averages ~$12 PMPM for AI‑led outreach/triage with EMR/RPM integrations.
• Serviceable population approximated at 15M seniors in value‑based programs likely to enroll in chronic care, post‑discharge, or RPM workflows (U.S. only).
• Minimal overlap between MA and MSSP counts; 12 months of engagement per member per year.

Who are some of their notable competitors

• Conversa Health: Automated clinical conversations and virtual‑care pathways for health systems (post‑discharge, chronic disease, RPM integration) with EHR write‑backs; overlaps with Kaigo’s automated check‑ins and triage for enterprise health systems source.
• Luma Health: Broad patient‑engagement platform for outreach, scheduling, reminders, and messaging; competes where Kaigo sells automated outreach and follow‑ups but is positioned as a patient access/communications layer rather than an autonomous care agent source.
• Twistle by Health Catalyst: Automated post‑discharge monitoring and care pathways with multi‑channel outreach and routing; competes on readmission reduction and scaling follow‑up for hospitals/ACOs, often bundled with analytics/quality suites source.
• CareMessage: Text/IVR engagement for safety‑net and community clinics (FQHCs); overlaps on automated chronic‑care journeys for vulnerable populations but emphasizes text/coach workflows and health‑equity use cases over voice‑first agents source.
• Gyant / Fabric: Conversational triage and asynchronous care used by health systems for symptom checking and routing; strong in intake and EHR‑integrated virtual care pipelines, less focused on long‑running RPM/voice outreach to seniors at home source.