Weekly Health Tech Reads | 5/29/22

CVS launches virtual primary care, Babylon's investor day (& Bright Health partnership), Advocate Aurora lawsuit, & more

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Ribbon Health, an API data platform, shared a blog post this week articulating the need for comprehensive and reliable provider directories to create high quality digital front door for patients / consumers. Given the rapidly changing provider landscape, automating provider directory updates to ensure real-time information on providers seems like a needed building block for any digital experience.

Check out the post here and reach out to Ribbon Health if you’re looking for a partner in revolutionizing the accuracy, access to, and enrichment of provider directory data.

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Our Stuff:

  • We watched the recording of the Babylon Health investor day on Monday this week and put our thoughts in this document for HTN members. The session was a good exercise in storytelling about the impact a virtual care delivery model can potentially have in managing value-based care contracts. The challenge, however, is that Babylon appears to still be building out key parts of the technology and clinical model, which seems like a major concern for a public company aiming to hit $1 billion in revenue this year. Link

News:

  • CVS announced it is launching a virtual primary care platform starting Jan 1 2023 for eligible Aetna members. The press release doesn't include many details on how CVS is standing this program, but it is interesting to take a look at this job posting for a virtual primary care provider by CVS - the job posting indicates they're hiring two PCPs to cover the central region of the US, which covers 17 states. If that is accurate, it doesn't seem like they're staffing for significant volumes coming through the platform at the moment. Either way, seems like a very logical product extension for CVS to add to its portfolio as it steps further and further into care delivery.  Link / Slack (h/t Michael Graham)

  • In addition to its investor day covered above, Babylon Health announced this week that it is participating in the Direct Contracting program via a partnership with... Bright Health? Yes, it appears that Babylon is participating in the program leveraging NeueHealth's CMS contract, and that Neue and Babylon have negotiated a percent of premium deal where Babylon is still taking on risk. It's a somewhat odd move for both parties who are each trying to tell a story of the value of their respective platforms in managing VBC contracts, yet a partnership like this would seem to indicate it doesn't really matter all that much. Link / Slack

  • A self-insured pharmacy has filed a class action lawsuit against Advocate Aurora, alleging that Advocate is leveraging its market power in an anti-competitive manner. The lawsuit is a good read on the various negotiating tactics health systems use to get better deals - anti-tiering / steering, all or nothing contract language, as well as various relationships with provider groups. It's particularly interesting to note in the lawsuit that one of the complaints is that Advocate is refusing to work with TPAs in Wisconsin that use reference-based pricing in order to thwart innovative plan designs in the area (note Centivo has been in the news recently gaining marketshare in the Milwaukee area). Advocate is apparently refusing payments from any of these plans, "consciously forgoing profit in the short term to achieve its long-term goal of suppressing competition." It highlights one of the many challenges with healthcare innovation - i.e. as soon as your innovative model is big enough to start threatening cash flow for incumbents, they fight back hard.  Link (article) / Link (lawsuit)

  • SCAN continues to redefine what it means for a regional insurer to be innovative, this week announcing the acquisition of The Residentialist Group, an in-home care delivery model for frail and vulnerable seniors. SCAN will be combining it with SCAN's current in-home care delivery model and rebranding both of those as Homebase Medical. SCAN health plan members will be one of Homebase Medical's first customers it appears. Given all of the news about incumbent organizations in healthcare using market power to thwart innovation, like Advocate above, it is refreshing to see an incumbent using its market power to build new models. Link / Slack

  • GoHealth, an urgent care model that forms JVs with health systems, is partnering with Henry Ford Health System to launch 15 urgent care clinics in the Detroit metro. GoHealth provides a good example of how companies can effectively work with health systems to create win-win scenarios, and the article summarizes nicely why this approach works well in urgent care (basically that health systems typically lose money on it so they're happy to have a partner operate it at a profit and still get what they want, the downstream volume). Link / Slack

  • The American Hospital Association sent a letter to the DOJ encouraging that the DOJ launch a Medicare Advantage fraud task force to look into MA insurers who are denying care for patients based on the recent OIG report. Another sign that the political battle here is slowly escalating.  Link / Slack

Funding:

  • Friday Health Plans, an ACA insurance startup, announced it raised $70 million in equity and another $50 million in debt. Per Ari Gottlieb's post, Friday apparently is seeing quite strong member growth, from 75k members in 2021 to 300k members currently, although it lost $100 million in 2021 and appears on track to lose more in 2022. It's going to be interesting to watch how Friday continues to finance those losses moving forward, and at what valuation. Link / Slack

  • Parallel Learning raised $20 million to provide pyschoeducational services for students with learning disabilities. Seems like an interesting model that has both a B2B (selling to school districts) and B2C (selling to parents) component. Link

  • nilo.health, a German-based startup building a mental health platform for employees, raised €7.49 million. Link / Slack (h/t Rik Renard) 

  • Miga Health, a consumer-facing heart health app, raised $12 million. They're offering a free blood pressure app to consumers, and then connecting them with providers via the app.   Link / Slack (h/t Saumitra Thakur)

  • KAID Health, a platform that analyzes medical charts for coding purposes, raised $4.25 million. Link

  • Auxa Health raised seed funding for a SDOH analytics platform.  Link / Slack

Opinions:

  • The Christensen Institute released a report looking at the business models required to effectively support SDoH interventions (while suggesting that instead of SDoH, we should use the term DOH, Drivers of Health). It's a good read highlighting a number of ways that organizations are attempting to meet DOH needs of patients, and provides a helpful map of types of organizations (included below). Link.

  • This is a good read on a pitch deck from PE-backed emergency department staffing firm American Physician Partners detailing how it intends to make up for the financial hit from surprise billing bans by slashing workforce costs. It will be able to do so, in part, because of the growing number of emergency department residency programs, which will create an oversupply of emergency department doctors in the US by 2030 - APP projects there will be 59,000 doctors, an oversupply of almost 10,000 beyond what is needed. Perhaps unsurprisingly, HCA is cited in the article as one of the largest drivers of this change. It's an interesting look into supply and demand dynamics in care delivery and the impacts of increasing supply. Link / Slack (h/t Matthew Holt)

  • Here's a solid post on UnitedHealth Group's growth over the last decade, describing how the various businesses within UHC and Optum have grown, the acquisitions both have made over time, and the implications for future strategy of the org.  Link / Slack

  • Adam Fine provides an informative breakdown of the challenges GoodRx is facing with Kroger. Pharmacy is one of the more opaque spaces within healthcare, and we won't pretend to fully grasp all the dynamics at play here, but when you read a post like this it helps illuminate what is happening with Discount Card models like GoodRx and why it might be in for some major issues moving forward. Link

  • Morgan Cheatham and Suhas Gondi shared a helpful perspective on how digital health startups can demonstrate clinical outcomes for payors. It's interesting reading this piece and pondering how many startups selling to employers have actually done any of this, which is perhaps a sign of the times of how the industry is changing to ask for results (which ultimately is a good thing, from our perspective). Link / Slack (h/t Rik Renard)

  • This is a good look into how private equity is getting into the colonoscopy market, and the general playbook for doing so. Link

Data:

  • Milliman released the Milliman Medical Index, which shows that a family of four with an employer sponsored insurance plan (PPO) pays on average $30,260 per year for health insurance, up from $25,561 in 2020. Link / Slack (h/t Deana Bell)

  • RWJF and the Urban Institute released a report this week suggesting that if ACA subsidies are allowed to expire it will reduce healthcare spending by $11.4 billion as more people would become uninsured. Link

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