Weekly Health Tech Reads | 9/25/22

BCBA MA works with Firefly and Carbon, good podcasts on CalAIM and CAA, and more!

News of the Week:

  • Blue Cross Blue Shield Massachusetts announced an interesting new deal to offer both Carbon Health and Firefly Health as virtual primary care offerings within BCBS MA's commercial plan offerings. There's a lot to unpack within this press release, including the slight pivots here for both Carbon Health, which appears to be launching a virtual primary care service, and Firefly Health, which is moving away from its health plan offering back to a virtual PCP offering. For both parties, it makes sense as a potential way to acquire patient volume to match the capacity of virtual PCPs they're likely staffing internally. One of the most interesting parts of this partnership is how Carbon and Firefly will compete to acquire patients. Here's a fun thought experiment: if your friend was on a BCBS MA plan, wanted a virtual PCP, and is deciding between Carbon and Firefly, how would you advise them? I'm guessing the tech / experience is a scenario where it's six of one, half dozen of the other. So then it seems like it comes back to the age old question of - which doctors / care teams do you like better? If you're a virtual care delivery company I think you should be thinking about how you're going to compete in a scenario like this, because it's not just coming sooner or later, it's here. Link / Slack (h/t David Han)

  • MA primary care company Cano Health is up for sale, with the WSJ reporting that Humana and CVS are among interested buyers. As we shared in the Slack discussion, given what we learned about at Humana's investor day last week we think it's unlikely that Humana will be the eventual acquirer here. Link (WSJ Paywalled) / Slack (h/t Seth Neu)

Other Announcements:

  • UHG is expanding its Peloton partnership. As was discussed in Slack, it seems like a nice relationship for both sides - Peloton gets new members and UHC gets a nice perk to entice benefits managers.  Link / Slack (h/t Rohit Kabra)

  • Also in UHG news, it looks like the Change Healthcare deal is in the clear after a judge ruled against the DOJ's attempt to block the deal. Change will have to sell its ClaimsXten business, a move that was already planned. Optum keeps expanding its reach into every corner of healthcare.  Link

  • Moody's downgraded Envision Healthcare's corporate debt, suggesting Envision, the physician staffing service and ASC operator, is at risk of going bankrupt over the next 12-18 months. Link / Slack (h/t Igor Radovitskiy)

  • Flume has partnered with a DPC provider in Texas to launch a new health plan. Cool to see a DPC provider with 5 practices able to launch their own plan, will be interesting to see if they can pick up traction with it. Link / Slack (h/t Grant Parker)

  • Cityblock partnered with MDwise, a Medicare / Medicaid insurer serving 410,000 people in Indiana to provide support services for 10,000 people. Link

  • Zocalo Health, a community health worker model for the Latino community, raised $5 million. Link / Slack (h/t Michael Ceballos)

  • Nodal raised $4.7 million to be the bumble of surrogacy. Link / Slack

  • Bicycle Health, a virtual opioid use disorder provider, added another $5 million investment onto its $68 million Series B. Link

  • Pattern Health, a no-code platform for health system employees to build digital health tools, raised $3.3 million. Link

  • Tuned raised $2.5 million for a new hearing care model selling via employers. Link

Opinions:

  • This Lumeris post on the various vertical integration strategies of UHC, Optum, and Amazon provides for a nice framework of thinking about the various capabilities that each are building when compared to health systems. Link / Slack

  • Tradeoffs dug into California's new Medicaid initiative, CalAIM, and specifically how it is addressing housing among other health needs. It's a nice look at how a program like that can make a huge positive impact via housing, and also the questions that naturally get raised in terms of scalability and ROI of these programs. It's obviously a complex topic for a lot of reasons, but good to see progress being made. Link / Slack

  • The NY Times featured a couple really well done articles looking at charity care in hospitals and how hospitals are putting profit over patients. In particular , they focus on two pretty egregious initiatives, one by Providence to collect bills from low income patients and send them to debt collectors if needed and the other by Bon Secours leveraging a hospital to make a killing off 340B payments. It's yet another stark reminder of how non-profit healthcare delivery is something of a quaint notion from times past that has been replaced by giant organizations seeking to maximize profits however possible. And as always, who is left in the lurch? Patients, and in particular, low income patients. It's really disappointing to see these organizations continue to espouse religious mission statements about how they're supporting their communities in the face of articles like this. Link (Providence - NYT Paywall) / Link (Bon Secours - NYT Paywall) / Slack (h/t Geoff Matous & Lisa Bari)

  • The latest Relentless Health Value podcast is a great one, diving into a recent regulatory change requiring benefits brokers share their compensation with employers who request it. Perhaps unsurprisingly, this is bringing to light how many brokers are receiving (demanding?) under-the-table payments from vendors. It highlights a lawsuit ongoing in Florida where a local school district is suing its broker, Gallagher, for hiding millions of dollars in payments from the school district. Hopefully, the compensation disclosure aspect of the Consolidation Appropriations Act will change this type of behavior by brokers. The CAA puts a lot of onus on employer plan sponsors to request the disclosure from brokers, which may slow progress here, given how much employers already have on their plates. Link / Slack (h/t Kate Wolin)

  • The AMA released a blog this week about how telehealth is going to be a part of ongoing care delivery for health systems, which seems pretty straightforward at this point. What's more interesting is how it highlighted the experience of Baptist Health in adopting telehealth in response to COVID-19 - telehealth went from 0.1% of visits to 58% of visits, and it was able to launch the service in a matter of days, versus typical projects that take 12+ months. Seems like a good reminder for everyone who suggests incumbents are unable to innovate quickly. Generally it's not actually that they're unable to, as this example shows, the problem is that there's no urgency to do so.   Link

  • This was an interesting blog post about the tech stack for digital health and various companies working on that, featuring the market map below. Link 

Data:

  • The Health Populi blog featured some interesting perspective on a recent Innovaccer / Morning Consult survey looking at how health system leaders are thinking about value-based care. It highlights the disconnect in conversations about the adoption of VBC that happens all too often, that we don't define it the same way. While health system execs may say that only 4% of their revenue is tied to FFS, if the majority of the other 96% is in deals that are FFS deals with some small link to quality / value performance, it still seems like we have a long way to go in implementing VBC. Meanwhile, population-based payments will only be growing 1% according to this data, from 15% to 16% over the next few years.  Link (Health Populi) / Link (report) / Slack 

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