Weekly Health Tech Reads | 6/12/22

This week's newsletter is sponsored by Wheel.

Wheel, a platform that enables companies to deliver virtual care, shared an article on how virtual care delivery companies can leverage outsourced clinical staffing to help manage cash burn and navigate the current market climate. It includes some helpful insights on the economic trade offs of different approaches, how to evaluate partners for outsourced clinical staff, and a case study of how a leading digital health organization navigated this decision effectively. It’s a worthwhile resource for anyone navigating these questions currently. Link.

News:

• Oracle closed its $28 billion of acquisition of Cerner this week and marked the occasion with Larry Ellison sharing some wonderful nonsense about how Oracle will now create a national health records database.  Link / Slack (h/t/ Jordan Hansen)

• Apple's WWDC event included a few new health feature announcements, including a new self-service medication tracker in the iPhone health app. While these features continue to be a nice half step in the right direction, it feels like Apple is still a ways off from building a meaningful healthcare product. There's certainly a role to play here for Apple leveraging the watch for things like sleep (also part of the announcement), and fertility (rumored to be upcoming), but it seems like they're trying to do a lot at the moment. If Apple wants to have an impact on things like medication adherence, it feels like there's a lot more work that needs to be done beyond giving folks the ability to track meds in iPhone health. Link / Slack (h/t Martin Cech)

• Included Health, the new brand for Grand Rounds and Doctor on Demand, is entering the race to help employers aggregate all of the different point solutions they are offering to employees. Included is partnering with a number of companies - Carrum Health, Employer Direct Healthcare, Hinge Health, SWORD Health, and Virta Health are the first. It's a logical move given the need employers have in navigating the various digital health offerings. It seems that in creating offerings like this, navigators are more or less starting to recreate the concept of provider "networks" for employers, just focused on digital-first offerings and specific segments of the employee populations. In order to be successful, it seems that these networks will need to demonstrate they can move beyond the typical low engagement rates of digital health solutions with employees, and also actually make an impact on overall healthcare spending for employers. It's an ambitious goal, and one that seems to require a well thought out plan for building a more complete network, including in-person care and likely TPA capabilities. Link / Slack (h/t Joe Connolly)

• Cerebral's tailspin continues this week, with a Forbes report out that Aetna has canceled its in-network contract with Cerebral and a WSJ report digging into the growth of the business and how the desire to scale led it to make a number of decisions that appear very questionable in terms of patient impact. Cerebral had approximately 1,000 patients with serious mental illness who were Aetna members, and it is not hard to envision other payors follow suit after seeing Aetna make this move. The WSJ article includes the astonishing fact that between January and May 2022, Cerebral spent $13 million on TikTok advertising, the third largest advertiser behind HBO and Amazon. It is hard for me to imagine a world where it is a desired state to have healthcare providers among the highest advertisers on social media platforms.  Link (Forbes) / Link (WSJ) / Slack (h/t Anuj Patel)

• Blue Cross of California was fined $1.1 million by the California Department of Managed Health, which includes a $360k fine for not sending EOBs to ~363,000 members in 2019. Link

• Oak Street announced its planned expansion for 2022, including that it is entering its 21st state, Colorado. Link

Funding:

• Bain Capital purchased a majority stake in LeanTaas, a platform that helps hospitals more efficiently utilize key fixed resources, including operating rooms, infusion chairs, and hospital beds. It's currently in use at 12 of the top 20 health systems in the US, and it's not hard to imagine why given the financial pressures hospitals are under. It's a really straight forward use case for process automation within hospitals, regardless of whether or not "AI" is actually driving the platform. Link

• CareBridge, a value-based care provider that is providing home-and-community services for Medicaid and Duals, raised $140 million and reached unicorn status. CareBridge, which has grown from 1,000 patients to 19,000 patients, has quite the star studded roster involved here. Brad Smith is the exec chair and Oak HC/FT led the round, which also had participation from Anthem, Optum Ventures, CVS Ventures, and HLM Ventures (representing Centene). Those four organizations represent four of the five largest Medicaid MCOs in the country, which seems like a bit of an unfair advantage for CareBridge.  Link / Slack 

• Aledade raised $123 million, noting in the press release that it was EBITDA positive in 2021 for the second straight year on revenue of $300+ million. Aledade is using the funding primarily to grow in the Medicare Advantage market and also to expand clinical services it is offering (similar to its acquisition of advanced care planning tool Iris). It's notable to see Aledade focusing so heavily on Medicare Advantage growth, expanding it's focused beyond the MSSP program where it has traditionally played. Seems quite indicative of the broader market trends across these programs. Link / Slack (h/t Eshan Tewari)

• Vanta raised $110 million for its compliance platform that helps companies with compliance requirements like HIPAA and SOC 2.  Link / Slack (h/t Anuj Patel)

• Ever/Body raised $55 million to scale its model cosmetic dermatology model. Link / Slack (h/t Zona Liu)

• Bicycle Health raised $50 million to scale its virtual opioid use disorder model nationwide. Bicycle has served 15,000 patients to date. Link / Slack (h/t Eshan Tewari)

• Nava Benefits, a benefits brokerage helping small / medium sized business access health benefits similar to F500 companies, raised $40 million. Seems like there is a large opportunity here to take all of the navigation concepts that companies are bringing to large employers and open them up to the rest of the employer market. Link

• BoulderCare raised $36 million to scale its virtual treatment model for substance use disorder.  Link

• H1, a data platform that sells provider information to life sciences companies, added $20 million to its recent Series C.  Link 

Opinions:

• Here's a good New Yorker article looking at the rise of fertility coaches and how those coaches are both serving a gap in health care for people trying to conceive, but can also exploit that and price gouge. It's a worthwhile read as we think about the impact of rising consumer influences in healthcare. The fertility space provides a unique lens into how complicated it can be when an empowered consumer hires a "coach" who questions the decisions of the provider, and how hard that can be on the patient who is now stuck between their coach and a provider when they disagree. While it certainly generally seems like a good thing that coaches are available to support people in this manner, it also isn't without its complexity (and potential for exploitation by bad actors). Link 

• Oscar published a solid read on how they used storyboarding to understand the needs of their members as they built out a virtual primary care offering. It's interesting to see some of the details of how they went about this journey leveraging Figma to build out a patient journey. It's also worth noting the watch-out they call out early on in the blog that is relevant for many digital health experiences - that focusing on the digital experience only, while helpful to launch quickly, ignores all of the interactions a patient has with the healthcare system between digital interactions. Link

• In the latest salvo of the Medicare Advantage Risk Adjustment debate, Rick Gilfillan and Don Berwick share their response to recent critiques of their original piece on the Money Machine. It provides for an effective, data-driven, rebuttal of the various points made against the original argument. Link / Slack

• Modern Healthcare this week featured a piece about how investors can attempt to hold portfolio companies accountable during this digital health gold rush. The suggested ways to do so are a bit underwhelming as they're general truisms - invest in good people and perform diligence on clinical impact. Uh, yeah. So while we don't find it all that insightful to hear from General Catalyst investors that you should invest in people like Glen Tullman (it's about as helpful as being told that you should have invested all your money in UHG stock back in 2010), we do think it is interesting to see the broader tone shift here, with the unstated but obvious driver being the the recent Cerebral experience. It will be interesting to see if anything tangible emerges from the mounting criticism of early Cerebral investors for seemingly turning a blind eye to potential patient harm in the pursuit of a solid IRR. It certainly feels like we're starting to see a groundswell around the importance of clinical evidence, which has been missing from the space over the last few years. Link 

Data:

• Spring Health released a peer-reviewed study in JAMA this week suggesting that employers using mental health programs like Spring will generate more than $7,000 in savings per participant in the first six months. Spring deserves credit for publishing a peer-reviewed article about its model, and it is helpful to read through how they think about generating ROI for employers. As discussed on Slack, it seems like there's a lot to unpack when Spring's 1,132 participants in the study represent only 5.2% of employees who enrolled in Spring's program (20,351) and only 0.4% of employees eligible for Spring's program (282,960). The chart below seems a bit generous in showing engagement rates ranging from 0.4% - 20% given those results above. While I don't doubt Spring showed an ROI across those 1,132 patients, I'd be curious to know Spring's financial impact in aggregate across all 282,960 employees. Link / Slack (h/t Rik Renard)

• Epic released data on the nurse staffing topic, finding that median nursing tenure fell by almost 20% between March 2021 and March 2022. The chart below highlights how average nurse tenure fell from 3.6 years to 2.8 years. I'd love to know what this chart looked like going back further in time, but it seems like a striking decline. Link

• This study suggests that if you integrate prescription drug monitoring data directly into the EHR, it increased queries from PCPs by 60% versus when it isn't integrated into the EHR. Another reminder that workflows are really important when attempting to drive physician adoption. Link

• Here's an interesting survey suggesting that patient-self scheduling is still in its early stages at health systems with very few appointments actually self-scheduled by patients. The discussion notes that one of the key challenges with implementing these systems is cultural pushback from physicians. Link / Slack