Key Takeaways
- 90-day wind-down: Thoughtful AI has told customers its stand-alone services are being discontinued in roughly 90 days.
- PE roll-up context: New Mountain Capital combined Thoughtful.ai with Access Healthcare and SmarterDx in May 2025 to form Smarter Technologies, a hospital-focused platform.
- Customer mismatch: Thoughtful AI’s small-and-mid-market behavioral health book does not fit Smarter Technologies’ enterprise hospital strategy.
- Diligence lesson: The wind-down reflects portfolio strategy, not product failure, and sharpens investor-fit questions for behavioral health AI buyers.
Thoughtful AI, the Austin-based AI revenue cycle automation platform that built a following among applied behavior analysis providers, dental groups, and pediatric therapy operators, has told customers it is discontinuing its stand-alone services, according to a customer who received the notification. The notification gave providers roughly 90 days to transition off the platform. People familiar with the communication said it reached customers across segments, including organizations still in pilot.
The phrasing matters. Thoughtful AI is not disappearing as a brand or a technology, at least not according to the framing in its customer communication. What is going away is the product as a stand-alone offering that providers can contract for directly. Whether and how those capabilities continue to exist inside Smarter Technologies, the New Mountain Capital platform under which Thoughtful AI now sits, has not been publicly detailed.
The decision has left clinical and finance teams across the behavioral health sector rushing to stand up replacements for a tool many had woven deeply into day-to-day operations. In the company’s own marketing, Thoughtful AI’s automation agents handled work across eligibility verification, prior authorization, claims scrubbing, denial management, and payment posting. Providers that had handed those workflows over to the platform are now confronting the prospect of rebuilding them, in some cases reassigning staff to tasks the software had been performing around the clock.
One longtime Thoughtful AI customer, who asked not to be named to preserve a working relationship during the transition, said the notice caught the organization off guard. The customer described the vendor relationship as productive up through the notification, and said leadership across the provider community has been trying to understand what prompted the wind-down given the trajectory of the product. That question, the customer said, is top of mind for every operator who bought in heavily.
Neither Thoughtful AI nor Smarter Technologies has issued a public statement on the discontinuation of stand-alone services or on a formal migration path for affected customers. The Thoughtful AI website remains live, and Smarter Technologies continues to list Thoughtful AI as one of its product lines on its current public website.
From Thoughtful AI’s Series A to the Smarter Technologies Roll-Up
Thoughtful AI, formally Thoughtful Automation Inc., was founded in 2020 by Alex Zekoff and Dan Parsons. The company initially positioned itself as a horizontal automation provider before focusing on healthcare revenue cycle management, where it developed a suite of named AI agents marketed under internal personas such as EVA for eligibility, PAULA for prior authorization, and PHIL for payment posting.
In July 2024, Drive Capital led a $20 million Series A round. The company subsequently reported 350% year-over-year revenue growth in 2024, processing what it said were more than two million healthcare transactions across its customer base. Case studies featured names familiar across the behavioral health sector, including Behavioral Health Works, Hopebridge, Butterfly Effects, Ally Pediatric, People’s Care, Trumpet Behavioral Health, and Easterseals, alongside dental, mobile health, and vision groups.
The company’s trajectory changed in the spring of 2025. In May, New Mountain Capital, the New York-based growth-oriented investment firm that had more than $55 billion in assets under management at the time (now approximately $60 billion), announced it was combining three portfolio companies into a new healthcare platform called Smarter Technologies. The three companies were Access Healthcare, a global revenue cycle operations and services provider; SmarterDx, a clinical AI company focused on documentation integrity for hospitals; and Thoughtful.ai. Jeremy Delinsky, the former chief technology officer of athenahealth and founding chief operating officer of Devoted Health, was named chief executive officer of the new entity. The combined company, according to Healthcare Dive coverage at the time, was positioned to serve more than 60 hospitals and health systems at launch. Delinsky stepped down as chief executive in December 2025 following a medical issue, and was succeeded by Michael Gao, MD, the founder of SmarterDx who had been serving as president of the combined company.
Drive Capital, Thoughtful AI’s Series A lead, treated the transaction as a major exit. Drive co-founder and managing partner Chris Olsen publicly described the outcome as “near fund-returning” in comments reported by Yahoo Finance, even as it came in below a $1 billion valuation. Drive returned $500 million to its investors in a single week in May 2025, with the Thoughtful exit a key component. Zekoff, Thoughtful AI’s co-founder and chief executive, has since shifted much of his public activity toward teaching and industry commentary, including co-teaching an AI entrepreneurship course at the University of California, Berkeley Haas School of Business. Parsons now lists Smarter Technologies as his employer on LinkedIn, with the title chief product officer, while retaining his Thoughtful AI co-founder credit.
Operational Fallout for ABA and Behavioral Health Providers in 90 Days
For the behavioral health providers on the receiving end of the notice, the operational exposure is real. ABA providers in particular operate in one of the most administratively intensive corners of healthcare, with 15-minute time-based billing units, layered BCBA and RBT supervision codes, prior authorization requirements that vary by payer and state, and payer policy changes that arrive with little warning. The operators most affected are the small and mid-sized clinics that built AI automation into their back office precisely because their in-house teams could not keep pace with the administrative load.
Providers that handed eligibility checks, authorization submissions, and claim scrubbing to Thoughtful AI agents now face three practical options inside a 90-day window. They can rebuild the workflows in-house, which requires hiring or retraining staff and, in many cases, rehiring for roles that were previously eliminated. They can migrate to another automation platform, a process that typically takes longer than 90 days when implementation and integration with an EHR and practice management system are included. Or they can move the work to an outsourced RCM services provider, which offers faster onboarding but shifts the cost structure.
Across the affected customer base, the transition is forcing a quick canvass of alternatives. Practice management platforms with embedded RCM capabilities, such as Ensora Health, CentralReach, Rethink Behavioral Health, and Noteable, are familiar points of reference in the ABA and community-based behavioral health segment. Acuity has reported on newer AI-native entrants in the category, including Camber, which has built its own book with ABA providers, and Boost, which is pitching an automation-first platform aimed at scheduling, billing, and intake for ABA clinics. Outsourced billing firms with behavioral health experience represent a third path.
The transition also surfaces a question that has become increasingly relevant as AI-native vendors proliferate in behavioral health: what happens to the data, logic, and configuration that customers have invested in training a vendor’s system on. Thoughtful AI’s platform learned from each customer’s workflows over time, a selling point the company used in its own marketing. Providers shifting to a new vendor will not carry that institutional memory with them. Acuity has previously reported on the questions providers should be asking about AI in behavioral health as the category matures.
What the Thoughtful AI Wind-Down Signals for Behavioral Health AI Diligence
Thoughtful AI’s trajectory, from $20 million Series A to private equity roll-up to stand-alone service discontinuation in less than two years, is not a straightforward cautionary tale about AI in revenue cycle management. The underlying product, by most public measures and by its customers’ own accounts, was working. The wind-down appears to reflect portfolio strategy rather than product failure.
It does, however, carry a lesson for behavioral health operators evaluating AI vendors going forward. When a venture-backed startup is acquired by a private equity platform whose center of gravity sits elsewhere, the economics of serving the original customer base can change quickly, regardless of how the product is performing. The Thoughtful wind-down joins a smaller but growing set of segment exits that have left behavioral health operators scrambling to maintain continuity of care, including the UNIFI Autism Care wind-down announced earlier this year. Operators who built operational dependencies on Thoughtful AI are now, in the words of one affected customer, scrambling.
That lesson applies as behavioral health providers weigh a growing field of specialized AI tools, from intake automation to clinical co-pilots. Diligence on vendor financial structure, investor base, and strategic fit has become as important as diligence on feature set and accuracy. Acuity has covered the operational readiness questions operators often overlook when buying into new technology, and the common mistakes operators make when adopting AI before the platform itself has matured. A product that works is not the same as a product that will be supported three years from now.
Thoughtful AI’s behavioral health customers will spend much of the next 90 days finding that out.
