Weekly Health Tech Reads | 2/13/22

This newsletter is sponsored by Columbia Business School.

Columbia Business School will be hosting its annual healthcare conference virtually on February 24th/25th with in-person networking after the event for those in NY. The focus is quite timely on how to advance a more equitable and sustainable healthcare ecosystem. The conference features keynotes from individuals at a number of different organizations, including Apple, Northwell Health, Walgreens Boots Alliance, and more. Register for the conference here!

News:

• CVS's earnings call featured an analyst Q&A session that focused heavily on CVS's growth in providing health services. CVS mentioned they'll be growing both through internal initiatives and M&A, and in response to an analyst question they said services that extend the care continuum for Medicare patients would be high on the list (i.e. home health). Given CVS's investor day comments about wanting to expand into providing more MSO-like services for primary care, I also would imagine the companies playing in the primary care MSO space would be high on the list as well. Things would get really interesting if they made a big move there.  Link / Slack.

• Oscar also posted earnings, sharing some insights into their growth. Lots of discussion of the +Oscar platform and the growth they're driving there in addition to the insurance business growth, but there's still very little insight into what that actually means. They mention that they see a lot Medicare Advantage growth opportunity via the +Oscar platform, which would make sense, particularly if they're partnering with local health systems that have deep patient relationships in local communities. And given the slow organic growth they've seen in Medicare Advantage (they are still at <4,000 members at the end of 2021), it makes sense that they'd look to grow via partnership. Oscar's investor day is coming up in March, and it'll be interesting to see what they have to share on the +Oscar pipeline. Link.

• Amazon Care announced it will be expanding in-person care delivery services to over 20 new cities in 2022. Amazon Care announced three new employer clients, with the big name being Whole Foods, which just so happens to be owned by Amazon. Lots of discussion in multiple Slack threads as to what exactly Amazon is up to here and whether they're only going after employer clients or a broader population. Link / Slack 1 / Slack 2 (h/t Frederik Mueller & Bo Bergstrom)

• Doximity acquired Amion, a physician scheduling platform, for $82.5 million. The article shares that clinician jobs posted on Doximity increased 4x this year as hospitals are looking for staff. It makes a lot of sense then that Doximity would acquire Amion, which manages the schedules for nearly 200,000 phyisicans. Doximity continues to build a really solid business.  Link / Slack (h/t Matt Sakumoto)

• Carbon Health shared an investor update on its progress in 2021, which by all accounts appears to have been a very good year for an organization that aims to be the "the greatest modern healthcare company in the world". Carbon hit $220 million of revenue in 2021, up from $7 million only two years ago, with 95 clinics at the end of 2021. Carbon is making more of those clinics into primary care clinics, which will be an interesting transformation to keep an eye on. It's a reminder that a lot of Carbon's business is likely driven by COVID testing, as discussed in Slack. Currently Carbon has 28 clinics in California that sound like primary care clinics. The investor update articulates how it aims to achieve its vision, articulating the key pillars of the business, which in large part are what you'd expect. It appears Carbon is prepping for an eventual IPO, and this will be a fun S-1 to read. Check out the Slack link for some additional analysis on this one, as well as the next article below for some more Carbon news! Link / Slack. 

• Carbon Health also announced a new partnership with Stanford as Stanford is joining Carbon Health Connect, Carbon's partnership ecosystem. I still don't understand what that phrase actually means, or what the nature of the business relationship is between Carbon and Stanford is here. Carbon seems to want to provide more integrated care via Carbon Health Connect, which is certainly a laudable goal. But the primary challenges standing in the way of providing integrated care delivery across large organizations have generally stemmed from financial incentives, and good luck deciphering the financial incentives from this partnership, or how it compares to Carbon's partnership with John Muir Health. You've got one partnership (John Muir) that includes joint clinic development, and you've got one (Stanford) that appears focused on remote patient monitoring... they seem like vastly different relationships. While I'm generally long on Carbon, this initiative makes zero sense to me (and just in case this needs to be said, the idea of more integrated, less siloed care is great). Link / Slack. 

• D2C telehealth platform Thirty Madison is acquiring Nurx, which provides access to birth control via telehealth. The combined company will serve 750,000 customers and is expected to do $300 million of revenue. It's interesting to see Thirty Madison attempting to argue it doesn't compete with Ro or Hims, which I can't quite make sense of. Of course, they all seem to be following the same playbook of growth via acquisition into new markets. I can't imagine this is the last of these deals as the D2C players fight to scale their platform.   Link / Slack / Slack 1 (h/t Frederik Mueller & Ben Lee)

• Signify Health acquired Caravan Health, which helps FQHCs and health systems succeed in managing ACO arrangements, for $250 million with a $50 million earn out. Caravan, mind you, has 200 health systems and 100 FQHCs - over 10,000 PCPs who manage 500,000 patients - in ACO arrangements. Given the general frothiness of the market and excitement around Medicaid innovation, it's a curious price point for Caravan to exit at, potentially indicating some challenges with driving growth (you'd think that if there was a clear growth path for Caravan it'd have VCs begging to put money in at that valuation).Link / Slack (h/t Lois Drapin)

• Community Health Systems partnered with Cadence to roll out a remote patient monitoring and virtual care platform. You can see a lot of value for both sides in a partnership like this, so long as they can drive enough patients into the program to make it meaningful, particularly for Community Health Systems. Link / Slack (h/t Justin Venneri)

• Walmart is now selling a UTI telehealth kit on its shelves. While the packaging seems a bit silly, it gives the patient something tangible to work with that's better than going to urgent care, as Raihan pointed out in the Slack. It's a reminder that while this newsletter's readership is attuned to the various virtual care options, the majority of the population probably has no idea many of these virtual options exist. Putting a telehealth visit on shelves is an interesting way to drive more awareness, particularly for the telehealth vendor (Physician 360). Link / Slack (h/t Jenine John & Raihan Faroqui)

• Anthem is rolling out a virtual plan to fully-insured and ASO employer clients in 11 states via Anthem's Sydney Health app. Link.

• Epic's shared it will be launching a new CRM, called Cheers, at HIMSS. Some interesting dialogue in Slack about how digital health companies are starting to leverage Epic. Link / Slack (h/t Brendan Keeler)

• Medable and CVS are partnering to expand access to clinical trials using Medable's platform. Link / Slack (h/t Casey Rhode)

Funding:

• AndHealth, a new digital health startup creating "virtual centers of excellence" to reverse migraines and autoimmune diseases, raised $57 million. AndHealth was founded by the CoverMyMeds team, which sold to McKesson for $1.4 billion in 2017. Link / Slack (h/t Chris Hogg)

• Ada Health, an AI chatbot that has partnered with organizations like Sutter Health and Bayer, raised $30 million. Link.

• Expressable, a virtual speech therapy startup, raised $15 million. Link.

• Curve Health, a telehealth platform for skilled nursing facilities, raised $12 million. Curve is based on the technology from Call9. Link.

• VisuWell, a virtual care platform, raised $10 million. Link.

• Koda Health, a palliative care startup, raised $3.5 million. Link.

Opinions:

• This is a good summary of corporate interests getting involved in the primary care market. If you've been following the space you'll probably find yourself nodding along to things you know, but if you're newer to it or looking for a good refresher, this provides a really good grounding on topics like what CVS is up to, what's happening to physician employment, public primary care startups, etc.  Link.

• Here's an interesting look at competition in the Medicare Advantage insurance market, highlighting Humana's recent earnings comments about issues with member retention. It also highlights SCAN's membership growth in California, which it attributes to offering $0 premium plans and $125 monthly rebate checks for members. Yes, giving people $125/mo for signing up for your insurance product does indeed seem to be a good marketing strategy. Competition is certainly booming in the MA market, with seniors now averaging 39 plans they need to choose from, which generally seems good for consumers (and the new wave of brokers helping people navigate all of those choices). Link.

• The Aledade leadership team shared some perspective on why they've launched Aledade Care Solutions. It provides some interesting insight into how they view augmenting primary care practices, providing additional support services for complex patients. As the article notes, a 1% increase in savings can generate an additional $100 million of revenue across Aledade's ACOs, which creates some nice ROI opportunities for programs that drive savings.Link.

• This article provides a good look at the various dimensions health systems evaluate when deciding which digital health solution to implement. Link / Slack (h/t Erin Cole)

• Jan-Felix Schneider shared a post looking at digital health startups attempting to build the "Shopify for digital health". It includes a good market map and some thinking about how the space evolves.  Link

Data:

• NEJM study looking at costs across sites of care for low acuity injuries. They go through process flows for an ankle sprain at each of the four sites of care (virtual, urgent care, primary care, ED) and do time-based activity costing based off that to come up with costs. The chart below is interesting to look at - it's not surprising that the ED costs the most, and that virtual care is the cheapest, at least for things that can be addressed virtually. If you have a sprained ankle, the in-person evaluation component actually makes virtual care a more expensive route than primary care. Of course, all of this is just the cost to deliver care, which as we find out time and time again in healthcare has little to do with what a patient might pay for things.Link / Slack (h/t Rik Renard)

• This is an interesting look at how telehealth reduced racial inequities in post-discharge follow-up visits with a primary care provider. Link.