Turning Regulatory Compliance into an Operating Backbone with Readily

Why we're investing in Readily

We are excited to lead Readily's $11M Series A fundraise, alongside YC and the California HealthCare Foundation (CHCF). Readily is building the operating backbone for government healthcare businesses - health plans, states agencies, delegates - starting with regulatory compliance as the wedge. Its AI-native platform helps healthcare organizations manage regulatory processes and business operations, with the ability to give leaders a consolidated, real-time view of their organization that has not existed before.

The company supports dozens of regional and national healthcare organizations that collectively serve over 25 million Americans across 46 states. In less than two years in California alone, they already reach over 60% of Medicaid lives. Customers are already seeing real results: regulatory analysis that once took three weeks now takes two hours, and audits that consumed compliance teams for nine months now take three.

The Challenge

More than 160 million Americans get their health coverage through Medicare and Medicaid. Behind every one of those member experiences sits a dense layer of rules: how quickly a call must be answered, how a claim must be adjudicated, how an appeal must be handled, what a delegated provider must report back. These rules exist to protect members and make sure they get the care they are entitled to. But what was meant to safeguard members has instead created significant administrative overhead for the enterprises that have to comply.

The volume of those rules has outgrown any manual way of keeping up with them, and the burden of meeting them has fallen on payers. CMS issues hundreds of final rules and guidance documents a year, and every state adds its own layer for Medicaid. The rules touch nearly every part of a health plan's operations, from call centers to claims to utilization management. Compliance, operations, and clinical teams scramble to aggregate the data, but the information they need to see the whole organization is too disparate. As a result, senior leaders are forced to be reactive when an audit surfaces, which can cost plans up to tens of millions.

This process not only affects health plans themselves, but also the organizations that sit up and downstream of their operations. Health plans pass these obligations down to their contracted providers, who have their own processes and reporting cycles. Reporting and accountability across these delegates is more complex than managing their own internal processes. Similarly, state and federal agencies that oversee plans lack the capacity to review all the reports and data they receive, let alone act on them in real time. Regulators receive reports that are out of date when they arrive, resulting in systemic gaps in care, hefty fines, and dissatisfied members.

Regulatory compliance is a compelling use case for AI. Regulatory texts are notoriously dense and unstructured, and large language models can distill the key insights and impacts from these documents and translate them into practice, which until recently required armies of consultants and manual crosswalks.

Payers are investing in AI. With margins tight and compliance headcount no longer scalable, they are prioritizing spend on AI. Our recent AI in Healthcare report found that the share of payers significantly increasing their AI budgets jumped from 6% of respondents in 2024 to 31% this year.

The Solution

Readily is stepping into this AI opportunity with payers. Readily gives health plans a live, shared picture of their obligations and how they are performing against them. Its AI reads new regulations, plan letters, and state guidance as they are published, connects them to the plan's own policies and workflows, and turns them into specific action items for the leaders who own each function. The output is a living map of the organization rather than a one-time manually produced memo. That changes what a plan can see, and therefore what it can do.

Because the same problem repeats at every link of the reporting chain, from regulators down through payers and their delegated providers, Readily is already in conversations with organizations in this ecosystem across the country. Readily becomes a connector in the ecosystem: each new participant makes the shared picture more valuable to everyone connected to it.

Across these customers, Readily's impact shows up in three ways:

1. Reduced administrative cost. Compliance has traditionally meant heavy spend on outside resources to support compliance work and audits. One customer cut annual external compliance spend by over 90% by reducing its reliance on those resources.
2. Better quality and faster time to insight. New requirements reach the right owners as they are published, so teams act while there is still time to act. Teams have also expanded their capacity for more rigorous internal audits by 6x, which reduces compliance risk.
3. Leaders move from reactive to proactive. Instead of reconstructing the state of the organization during an audit, executives get a live view of compliance and operational health across call centers, claims, utilization management, and delegates. Seeing the trends allows leaders to act. For example, health plan leaders have used Readily's data from grievances and appeals and utilization management to identify trends and systemic gaps in care in real time, so they can make real changes to improve member experiences.

Looking ahead, we believe Readily becomes the AI native, operational backbone for heavily regulated healthcare organizations. Because compliance touches every function, Readily has access to the data that shows how a healthcare organization actually runs. That makes transparency possible in a way it never was before: a consolidated, real-time, and proactive view into compliance and operations across the organization. With that view, leaders can decide where and how to deploy resources most effectively to meet their biggest operational goals. Plans spend less resources on administrative work and more on delivering the programs these policies were written to protect.

Why Readily, Why This Team?

Why Readily. Compliance software exists today, but it is largely built around static checklists and document repositories that leave the interpretation to people. Readily is AI-native from the ground up and built for the specific workflows of health plans, with deep attention to Medicaid and government plans, where state-by-state variation, delegation, and federal oversight make the problem hardest.

Why this team. This is a unique founding and leadership team to tackle this problem. The company was founded by Edward Tiong, a former ML engineer from Microsoft and Akasa, where he built enterprise AI products both outside and inside healthcare. He founded Readily to reduce the administrative burden for healthcare organizations working with government payers, while still upholding the quality of the programming these policies intend for members and patients. Chief Compliance and Product Officer Elysse Tarabola brings deep industry expertise from the health plan compliance market, having spent 10 years at LA Care.

"Health plan compliance is hard to build for because almost nobody outside a plan understands how it actually works. From our first conversation with Define, it was clear they did, and that they could get us into rooms we couldn't reach on our own. That's the partner you want when you're building the compliance layer for healthcare," said Edward Tiong, CEO of Readily

We are excited to work with Edward and the entire Readily team as they help health plans move from flying blind to running with clarity.

To learn more about Readily, visit https://readily.ai/

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