Cracking the code: Lessons from 15 years of digital health IPOs for the era of AI

Introduction: As digital health evolves, identifying factors that drive success is crucial. This study examines how reimbursement billing codes affect the long-term financial performance of digital health companies on U.S. stock markets, addressing the question: What separates the winners from the rest? Methods: We analyzed digital health companies that went public on U.S. stock exchanges between 2010 and 2021, offering products or services aimed at improving personal health or disease management within the U.S. market. A search using Google and existing IPO lists identified eligible companies. They were categorized based on the presence or absence of billing codes at the time of their initial public offering (IPO). Key performance indicators, including Compound Annual Growth Rate (CAGR), relative performance to benchmark indices, and market capitalization change, were compared using Mann-Whitney U and Fisher's Exact tests. Results: Of the 33 companies analyzed, 15 (45.5%) had billing codes at IPO. The median IPO price was $17.00, with no significant difference between groups. Those with billing codes were 25.5 times more likely to achieve a positive CAGR. Their median market capitalization increased 56.3%, compared to a median decline of 80.1% for those without billing codes. All five top performers, in terms of CAGR, had billing codes at IPO, whereas nine of the ten worst performers lacked them. Companies without billing codes were 16 times more likely to experience a drop in market capitalization by the study's end. Conclusion: Founders, investors, developers and analysts may have overestimated consumers' willingness to pay out-of-pocket or underestimated reimbursement complexities. As the sector evolves, especially with AI-driven solutions, stakeholders should prioritize billing codes to ensure sustainable growth, financial stability, and maximized investor returns.