Weekly Health Tech Reads | 10/25/20

Reads for the week of 10/18 - 10/24

Note - I’ve included a section on jobs at the bottom… there have been a lot of people posting jobs in the Slack channel over the past week so I thought I’d amplify them here. As always if you want to join the Slack conversation you can do so here.

News:

• Bind, the Minneapolis(!!!) on demand health insurance startup, raised $105 million to drive its expansion into the fully-insured market, putting it at $250 million in total capital raised. The article indicates Ascension and UHG are still the investors here. Given how consistently Wichmann references Bind on quarterly earnings calls at this point as a UHC product, its worth watching how that relationship between UHC and Bind evolves over time. Link.

• Doctor on Demand partnered with Carelinx, a company that provides in-home caregiver support, partnered in what seems like a very interesting partnership bridging the realms of physical and digital offerings. Carelinx caregivers can now offer their customers video visits through Doctor on Demand. Link.

• Clover filed an S-4 related to its SPAC deal this week, which feels a lot like the traditional S-1 document (the meat of it starts on page 235). Given the recent deep dive over on Medium, I’m not going to rehash too much of that here, as the S-4 doesn’t change much. Still lots and lots and lots of questions to be asked about this one. I will highlight a few of the more interesting points below. Link (S-4).

  • 2020 Financial Performance. Losses have dropped dramatically thus far in 2020, due to both drops in SG&A costs as well as MLR. MLRs fell to 79% for 1H 2020 after being at 97% last year - it will be worth watching when Q3 and Q4 numbers come out how much of that is associated with COVID-19 utilization declines in Q2. If Clover can sustain that lower MLR over time and point to the model working, it obviously would help the story a lot. Clover also slashed its SG&A costs - salaries went from 29% of revenue in 2018, to 20% in 2019, to 12% in 1H 2020; while G&A went from 35% to 20% to 15%. While that’s obviously helpful from a profitability perspective it seems a bit odd when you try to reconcile that with the market growth and product development needs they have. (pg 285)

  • Clover Assistant (CA). It’s clear in the S-4 that CA software platform is the core piece of differentiation for Clover. The S-4 is helpful in clarifying a few items around adoption of CA - 2,100 PCPs are using it as of June 30, 2020 (500% growth since 1/1/2019), and ‘on-boarded’ providers are using it in 92% of Clover patient visits. Almost 35,000 Clover members are assigned to a PCP using CA. Clover is paying PCPs an enhanced fee of 2x normal rates to drive adoption. Still feels like lots more questions to be asked on this piece. More on this in the Opinions section below. (pg 252, 269)

  • Go to Market. Clover describes it’s go-to-market strategy as: 1. pick a market; 2. get providers on the CA platform; 3. deploy insurance plans; 4. grow! Easy peasy! It is interesting to see that their first step opening a new market is selling providers on the CA platform - highlighting the B2B nature of their growth as opposed to the B2C approach of many other insurance startups. (pg 250)

• BridgeHealth and Transcarent are merging with a $40 million capital infusion from a handful of VCs - 7wire, General Catalyst, and Alta. It looks like they’re going to scale BridgeHealth’s play of creating a Center of Excellence network for employers, leveraging Transcarent’s tech platform (although it’s not clear if that’s real yet - Transcarent has two employees on LinkedIn). It’s worth noting some of the VCs involved here: 7wire’s partners include the founder of Livongo, while General Catalyst was the early backer of Livongo. Seems like some folks who know what they’re doing in the employer market. Link.

• Sami raised $15.5 million to take Oscar’s playbook and apply it to the Brazil insurance market. Seems like a pretty smart move by the Sami folks - take a playbook that’s worked in the US but not scaled internationally and run it in another market. Link.

• Cricket Health, one of the crop of startups working on reinventing kidney care, raised $15 million in debt financing and switched CEOs. Link.

• eVisit raised $14 million to build on its telehealth platform. Link.

• Cohere Health raised $10 million as well as a partnership with Humana to improve the prior auth process for musculoskeletal conditions. Seems like a smart way to approach the prior auth problem by bringing in a payor partner early that can help scale. Link (funding). Link (Humana partnership).

• Nice Healthcare, a Minneapolis(!!!!) startup building an in-home urgent care model, raised $5 million. Nice is targeting an interesting subset of the employer market, going after small businesses. Nice charges $30 - $36/mo to employers, and has signed up ~30,000 members across 200 companies. Nice! Link.

• Oula raised $3.2 million for a cool approach to birthing centers. They’ll be opening up their first center in NYC in 2021. Link.

• Verifiable raised $3 million for a provider credentialing API. Link.

• Mira raised $2.7 million for a D2C membership model providing individuals with access to urgent care, wellness programs, and prescriptions starting in NYC. Seems like a interesting program that will appeal the healthy millennial population and could do really well as a result, although I have my reservations about people thinking this is an alternative to insurance. Link.

• Vitable Health, a startup building an in-home urgent care model, raised $1.5 million from Softbank. Vitable it looks like is taking a similar approach to Nice of targeting smaller employers. They charge a $15/mo fee for access to the service, and are up to 2,000 monthly subscribers. Link.

• BCBS NC partnered with Carrot and Virta to offer no-cost smoking cessation and type 2 diabetes programs for members in its fully-insured and individual products. Link.

Opinions:

• I am loving this world of super smart folks writing awesome free content on Substack… there were a bunch of great articles to check out from this week:

  • Olivia Webb on Clover’s tech platform and whether there’s anything all that different in the Clover Assistant versus a run of the mill EMR technology. Webb’s comments on flu shots were particularly interesting - she notes Clover’s flu shot compliance is only 67%, putting it at 2 on that Star Rating measure, or in the bottom 20% of all MA plans. Why is that so interesting, you ask? In the S-4 Clover highlights flu shots as one of only three examples of how the Clover Assistant is able to improve Star Ratings (along with cancer screenings and med adherence reminders - see pg 273 of the S-4). If that’s the shining example of success, this thing is in serious trouble. Link.

  • Steve Hardgrove wrote on the cash pay market versus the insurance market. The section looking at the needs of the cash pay market and some of the companies that are starting to meet those needs (Sesame, MDSave, Walmart, GoodRx, Surgery Center of Oklahoma, etc). I have a feeling we’re going to see a lot more activity in these spaces over the coming years. Link.

  • Nikhil Krishnan wrote a piece on price transparency, and specifically up-front pricing for services, which touches on many similar themes as Hardgrove’s piece on the rise of patient cash pay models. I have a feeling we’re going to see a lot more activity in these spaces over the coming years (yes I’m aware I copy + pasted that sentence again). Link.

  • Nikita Singareddy shared her thoughts on Surescripts, the e-prescribing platform behind virtually all pharma in the US. Link.

• KHN featured a cringe-inducing piece about how Virginia-based health systems UVA Health and VCU Health have been collecting on patient medical bills by placing liens on patient’s home equity. VCU Health at least promised to stop seizing home equity earlier this year and is in the process of releasing those liens. For context as to the size of the issue, VCU Health had over 80,000 cases of property liens filed against patients that they are in the process of unwinding. UVA’s total number is unknown, but hopefully they decide to follow VCU’s suit. Link.

• Tradeoffs featured an interesting podcast on telehealth utilization. The story about the older patient who didn’t want telehealth services because the eight hour drive to the doctors office was an excuse to spend the day with their kids is particularly interesting to me. We have an ever increasing senior population dealing with isolation and loneliness, for whom a trip to the doctor can be a big part of their social life. Worth pondering what the right role of telehealth is in these sorts of scenarios. Link.

Data:

• Willis Towers Watson released a survey on what employers are thinking about to manage costs of care. It’s a good read if you’re selling to employers or trying to understand how they view the world. The reports highlights some key trends and opportunities across Centers of Excellence, narrow networks, steerage, condition management, virtual care, and patient navigation. Link.

• This is a good review by Jane Sarasohn-Kahn of a survey on consumer expectations in healthcare. It’s interesting looking at results like the chart below in the times of COVID (the survey was done in September and compared to a version from March) - costs dominate the conversation. It’s also worth checking out the Wordle of phrases people associate with good vs bad healthcare experiences - as Sarasohn-Kahn notes, people seem to be looking primarily for empathy and understanding. Link.

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