Cerebral, Hartford Healthcare, & Noom all have issues with members, Ro raised $150 million, & more
Lots of fun events have been popping up in the community for HTN members, including these two:
We're hosting the co-founders of Equip to discuss their model and funding (see below on that!) this Thursday at 2:45pm CST! Sign up here.
Our resident interoperability experts, Lisa Bari and Brendan Keeler, shared their wisdom on TEFCA recently. Read a summary here.
If you want to join us for events like these, sign up for the community here!
The UHG / Change Healthcare deal is on the rocks as it appears the DOJ will block the deal. It's a friendly (well, I guess unfriendly if you're at UHG or Change) reminder that the one thing that regulatory intervention is basically the one thing that can halt UHG's growth engine at the moment. Then again, UHG now has $8 billion to deploy elsewhere. Link / Slack (h/t Martin Cech)
My Family First is a startup taking a very cool approach to solving rural health challenges in India by creating "digitally-enabled smart clinics". It's planning to open 500 clinics over the next two years using a franchisee model. Each clinic has a trained paramedic staffing the clinic and a tele-consult with a provider. It's not hard to imagine a similar model popping up in the US at some point. Link / Slack.
VillageMD is buying a patient engagement platform called Healthy Interactions. Healthy Interactions appears to have programs for a number of chronic conditions - COPD, diabetes, heart failure, etc. It's not hard to see why a primary care organization looking to drive more value-based contracts would want an asset like that in house. Link / Slack
Weight loss app Noom is paying $62 million to settle a lawsuit brought by customers who claimed it was hard to cancel the services. It's a good example the conflicting incentives that our new well-financed direct-to-consumer healthcare providers have to grapple with as they seek to grow to justify their sky-high valuations. Mistakes like these are particularly unfortunate as they reflect poorly on the space as a whole. Link / Slack (h/t Lois Drapin)
Cerebral joins Noom this week in facing issues with misleading customers. Cerebral, of course, has become a lightning rod of criticism for recent behavior related to advertising and management of its clinical workforce. This latest article highlights how it is also confusing its customers and handling customer support in a really poor manner. Similar to the Noom commentary above, stories like this reflect poorly not just on Cerebral, but create challenges for every company in the space. Link / Slack
Hartford HealthCare is facing an antitrust lawsuit brought by patients against its contractual practices, which it says is without merit. I look at chart the below from the lawsuit comparing Hartford ER prices to another nearby hospital and scratch my head - 4x the price for a level 5 ED visit seems a bit outrageous. The lawsuit itself provides a good overview of hospital contracting tactics. For as much grief as some of the D2C startups above are getting for misleading consumers, this is a good reminder that it is not as though healthcare's incumbent care delivery organizations are any better. Link / Slack.
Olive's prior auth automation platform (formerly Verata) picked up a customer in GuideWell, the parent of Florida Blue.
Telehealth platform for birth control Simple Health announced it is acquiring Emme, another telehealth platform for birth control. Link / Slack (h/t Brendan Keeler)
Sirona Medical, an AI platform for radiology, acquired Nines. Link
Ro announced it has raised another $150 million. Over the past year Ro has treated 500,000 patients (although you wonder how much of that is from COVID-19 tests) and done 150,000 home visits (presumably a combo of Workpath / Kit acquisitions). That's a pretty impressive scale for the organization. It's also interesting to think about its growth ambitions and how it stays true to its vision of "...care that people want". For instance, Ro says remote monitoring is in its future - but what will that look like for Ro? What kind of remote monitoring platform fits the bill of something people actually want? Is that something like a Tytocare-ish platform for on-demand medical exams? Regardless, it's going to be very interesting to watch Ro's evolution over the next few years. They've already come a long way from selling ED meds, and it seems like the healthcare industry still very much underestimates the potential here. Link / Slack
Equip, a startup building a virtual eating disorder treatment model, raised $58 million. They're growing coverage with both commercial and Medicaid payors, seeing a 10x increase in demand. And if you want to hear more on the model you should join our community conversation with co-founders Kristina Saffran and Dr. Erin Park on Thursday! Link / Slack (h/t Julia Bernstein).
Memora Health, a care management platform that helps providers manage workflows for complex patients, raised $40 million. Link.
PriorAuthNow, a company that is streamlining the prior authorization process, raised $25 million. Link.
HerMD, a startup providing women's sexual health and menopause services, raised $10 million to expand its clinic footprint and add a virtual care offering. Link.
Here's a really good overview of the Medicare Advantage market by The Commonwealth Fund. If you're new to the space, it provides a good basic overview of how plans get paid and the risk adjustment process. For instance the image below provides a 101 of risk adjustment. Link (risk adjustment) / Link (payments).
Business Insider covered how specialty practices are getting into value based care. It's interesting to note that the examples in the article are backed by private equity organizations financing the platform for the transition. The article features a nephrology practice that is working with a Rubicon Founders nephrology startup as well as two Deerfield backed companies, the Oncology Institute and Novocardia. The Oncology Institute, which SPAC'd last year shared an investor deck that outlines the playbook really well - launch in a market with friendly providers and grow via acquisition. This will inevitably bring up the comparisons to PE activity in the 90s and whether this growth is actually sustainable, and if not, raises questions of who is going to be left holding the bag. There certainly appears to be a lot of smart money betting that growth via an Agilon-esqe playbook is sustainable. Link (Paywalled) / Slack (h/t Kevin Wang)
Sachin Jain makes a rather bold suggestion that big tech should stop messing around in healthcare and make a big splash by... acquiring a large health system! As I mentioned in Slack, it'd be pretty wild to see an organization like Amazon buy Mayo Clinic and integrate it with AmazonCare. Just imagine a world of integrated specialty referrals via Alexa! But perhaps it'd be more feasible to see a tech player buy a multi-specialty practice and go the UHG-style strategy of owning all the care delivery assets except the hospital. Lots of interesting debate in Slack! Link / Slack.
It appears that changes to the Direct Contracting program are imminent, and this Modern Healthcare piece outlines what we might expect in terms of changes. As it articulates, it doesn't seem like we're going to see CMS completely do away with the program (CMMI would have some serious credibility issues given how much some organizations have invested in launching Direct Contracting programs) but it also seems quite likely that we'll see changes to appease some of the concerns of the ACO community. Link / Slack
Business Insider got its hands on the slides Teladoc is using to pitch the Primary360 initiative. It makes for an interesting read - a lot of it sounds like what you'd expect from a virtual primary care offering. Very little data was shared in the slides, but one thing that stuck out to me: Teladoc is apparently averaging 50+ minutes per patient onboarding visit, which is shocking to me... I would assume that is roughly 50x as long as a standard Teladoc urgent care style visit with a provider. Link (Paywalled) / Slack (h/t Matt Sakumoto)
This article provides a good overview of what Season is up to in the food-as-medicine space, as well as how the market is evolving a bit more broadly. Interesting to see that Season has signed up Cricket Health, Geisinger, and CommonSpirit Health as partners. Geisinger, as the articles mentioned, has been a leader in the food-as-medicine space for some time, but has struggled sustaining its internal efforts. Will be curious to see how those relationships grow here. Link.
This is a really good read on the practical challenges patients / caregivers face in moving healthcare to the home. While we all love discussing the trend, and conceptually it makes all the sense in the world, sometimes we lose sight of just how hard these things are for patients / caregivers in the real world. Link.
A new study from Headspace shows its meditation app has a positive impact on mental health outcomes, similar to drug treatment and cognitive behavioral therapy. Link / Slack (h/t Casey Langwith)
Anthem, the large health insurer, is hiring a Director of Product Analytics and Insights. Link.
Cityblock Health, a primary care startup for Duals populations, is hiring a VP of Growth. Link.
GoodRx, the prescription discount and telehealth company, is hiring a SVP of Product Design. Link.
Reimagine Care, a startup building a in-home cancer treatment model, is hiring a Commercial Operations Manager. Link.