Kevin's Weekly Health Tech Reads 1/31

Lots of funding rounds: Equality Health, Sidecar, Lyra, Dario & more; a handful of acquisitions: Doc.ai, Discovery Health Partners, Docent Health, & Upright Health; and lots more!

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News:

  • In rather interesting yet under the radar news this week, Oscar Health announced it is providing its tech platform to another insurance plan, Health First Health Plans, supporting Medicare Advantage and Individual members in Florida. It’s worth keeping an eye on whether this becomes a one-off experiment for Oscar or a central part of their strategy moving forward. It is easy to imagine a narrative where Oscar sees this as the latter - after all, it would appear their core competency lies in building a modern tech stack to power health insurance. Why limit that offering to just their own insurance product when you could be the Intel Inside powering insurance plans across the country? For many of the small regional insurers trying to compete for consumers, they have a build vs buy decision to make with these consumer experience and care navigation capabilities, and as long as the pricing is right, it seems like an easy decision to buy Oscar’s offering. Seems like a good long term growth play for Oscar to lean in here. And from a public markets positioning perspective, this sort of product expansion sets Oscar up to pitch itself as more of a SaaS tech company in the health insurance space, rather than a health insurance company. Gotta keep an eye on those multiples, naturally. Link.
  • There were three rumored SPACS this week (which, combined with all the GameStop craziness of the week, makes me a little uneasy about the current state of the markets generally), all at around $4 billion valuations:
  • 23andMe is in talks for a SPAC, despite some sales challenges in 2020 that led to them laying off 100 staff. Note 23andMe raised $82.5 million in December 2020, and was rumored to be valued at $2.5 billion in 2020 (and also in 2018 as well). I’ll be curious to see in the investor deck what’s happened in the last few months to justify a valuation bump to $4 billion with that context. Link.
  • Ro, a DTC telehealth company is considering following in the footsteps of competitor Hims and exploring a SPAC. Link.
  • Sharecare, a healthcare company that does a potpourri of things for employers, payers, and others, is in talks to do a SPAC. This article says that Sharecare will first acquire doc.ai and then the SPAC will acquire both companies. Which certainly makes the next bullet make sense! Link.
  • Sharecare announced the acquisition of doc.ai, an enterprise AI platform for healthcare. You may remember doc.ai was in the news a few months back for having signed up a $100 million deal with Anthem to support Anthem in building new digital products leveraging doc.ai’s AI platform. I struggle to understand the businesses of both Sharecare and doc.ai individually, so combining them makes it even more confusing to me. Hopefully the investor presentation with the impending SPAC will help clarify the various businesses under this umbrella. Link.
  • Multiplan, the recently SPAC-ed provider network rental for insurers, acquired Discovery Health Partners, an analytics firm helping insurance plans improve revenue and payment processes, for $155 million. Link.
  • Equality Health raised funding from PE firm General Atlantic, among others. Equality is a rather cool sounding company building a network of primary care docs to help implement value based care for Medicaid patients. Equality currently works with over 1,600 PCPs serving 300,000 beneficiaries via 20+ managed care sponsors. Equality is also buying an actuarial firm as part of the transaction, I would assume in an effort to help them build capabilities around taking and managing global risk. Smart. Seems like a rising tide in Medicaid innovation these days, which generally seems like a good thing. Link.
  • Aware Recovery Care, a company providing an in-home care model for addiction treatment, raised funding from Health Enterprise Partners. Their data suggests the Aware program is showing 60 - 70% of individuals who complete the year long program are abstain from alcohol / drugs, versus 10% of those who attend residential programs after a year. The funding will grow the model from five states currently to scale it. Sounds cool. Link.
  • Mental health company Lyra officially raised $187 million at a $2.3 billion valuation. This marks their third funding round in the last twelve months - they raised $40 million back in March 2020 and then another $110 million in August. Link.
  • Sidecar Health, a health “insurance” startup for millennials, enters unicorn land as it raised $125 million at a $1 billion valuation. I put insurance in quotes there as Sidecar doesn’t actually appear to be an insurance product at the moment - although they will be adding a product for the ACA exchanges in 2022 - and so the branding here feels a bit… inaccurate. From my vantage point, Sidecar is missing some core elements of what an insurance product generally includes (i.e. with insurance, a bad thing happens to you and the insurer covers everything above $X dollar amount. Sidecar appears to be the opposite - they’ll pay up to $Y predefined amount, and then you are on the hook for everything after that). On the one hand, the healthcare person in me worries for the individual who signs up for a cheap coverage option, then incurs some major medical expense they weren’t expecting, and then is personally on the hook for everything Sidecar doesn’t pay (hello, Christian Sharing Ministry horror stories). On the other hand, clearly Sidecar is meeting the needs of a generally healthy millennial population looking for a cheaper health coverage option - they expect to hit 30,000 members at the end of the year paying $240 per member per month (which will put them at ~$86 million of revenue a year). The average age of a member is 33, and annual income is between $45k - $75k. The member stories page on their website articulates really well why Sidecar is appealing to the people it is. All in all it seems like a cool product for a specific population of folks, even if it’s not a insurance product yet. Will be interesting to watch how they choose to expand from here. Link.
  • DarioHealth, a public company that is selling diabetes / mental health platforms to employers, announced it raised $70 million and acquired Upright Health, an MSK startup that has a device that helps with posture, for $31 million. Now they’ve hit the trifecta of conditions for employers - diabetes, mental health, and MSK - which one do they go after next?! Link.
  • GetWellNetwork acquired Docent Health for an undisclosed amount. Docent will add to GetWellNetwork’s capabilities in the patient engagement space for health systems. Seems like a smart landing spot for Docent and a good new product for GetWellNetwork to add to the portfolio. Link.
  • TimelyMD raised $60 million for mental telehealth for college students, now serving 80 college campuses across the country, 10x growth from this time last year. Link.
  • Calibrate, a telehealth startup building a year long program focused on metabolic health to drive weight loss, raised $22.5 million. Link.
  • Concert Health raises $14 million to build a platform that integrates mental health into primary care. I’m interested to watch if the Collaborative Care Management model helps this idea gain traction with providers. Link.
  • Vessel raised $8 million for a home health testing platform. Link.
  • Hurdle raises $5 million to provide digital mental health for Black communities. Link.
  • Kevala raised $4 million for a tech platform for long term care. Link.
  • Aavia, a fertility startup focused on hormones, raised $2.5 million. Link.
  • Echo Health Ventures is creating an investing alliance with USAble Corporation, a strategic investing arm for Arkansas BCBS. Link.
  • VillageMD acquired a primary care practice in Chicago, its first Village Medical clinic in Chicago and 45th clinic overall. Link.

Opinions:

  • Part 2 and 3 of Karan Singh’s piece is out on Ginger, and it is well worth a read for any founder of a digital health startup, or anyone trying to understand what it’s like to be a founder. There are a lot of hard-earned lessons shared in here, particularly around how to leverage your Board and also how to take care of yourself during the journey. It seems to be a struggle for everyone going through it, yet one that many feel like they need to go through individually. I’m quite grateful for folks like Karan sharing and normalizing the experience. Link (part 2). Link (part 3).
  • This is quite a good read from Steve Hardgrove on the employer care coordination space, focused specifically on Accolade. It does a very nice job walking through Accolade’s business - explaining the problem they’re solving, how the solution works, why they made the 2nd.MD acquisition recently, and the idea of these solutions as platforms rather than point solutions. He raises some good questions around Accolade’s efforts to bundle third party point solutions and whether Accolade should be charging those third parties. Worth checking out. Link.
  • Welcome to this weeks excursion into insane hospital pricing, where a San Diego hospital billed a patient $77,000 for a three hour outpatient sinus surgery (oh yeah, and that is in addition to the $5k the patient was charged separately by the surgeon and anesthesiologist, because ya know they gotta get paid too and $77 thousand dollars surely can’t cover all of the expenses, just the facility fees naturally). The $77k bill represents a 1,200% markup from what Medicare thinks the procedure should be reimbursed at - just under $6,000. The LA Times does a nice job digging into and explaining the craziness at hand in a relatively approachable manner. It’s a good reminder of how crazy the pricing and billing process for healthcare is in this country. Link.
  • Speaking of hospital pricing, Kaiser Health News took a look this week at hospital consolidation, focusing on the story of a publicly-owned hospital in North Carolina that has had to sell itself to Novant Health, a big local health system. The article provides a really interesting look into the various dynamics of hospital consolidation and all of the various opinions different constituents have on it. This is a fascinating quote in the article from the North Carolina Treasurer (who has taken political heat for opposing health systems) on the deal: “I’m their largest customer. I know we should expect quality to go down, access to go down, prices to go up. And when that happens, public service workers get hit the worst.” Of course, Novant disagrees with that assessment, but it’s not exactly a good look when that’s what your largest customer believes. Link.
  • This is quite an interesting read from Brian Dolan on how he thinks the Livongo / General Catalyst SPAC crew will choose to acquire Color, a population health / genomics startup that just raised an $167 million round led by… General Catalyst. And in addition, they’ll look to merge it with Commure and Tendo Systems, two startup companies created in the past few years by… General Catalyst. Anyone else sense a theme here? Will be curious to watch whether this materializes, and if it indeed does how they handle all the various conflict of interest questions at hand. Link.
  • Humana shared some growth plans on its Partners in Primary Care initiative, its joint venture with PE firm Welsh Carson. Humana is planning on adding 20 centers this year after opening 15 in 2020. It’s now treating 57,000 Medicare Advantage members across 15 different payers with 40 clinics in 7 markets. You have to wonder what it means for the MA focused provider companies who rely so heavily on Humana’s members for revenue as this entity continues to grow over the next several years. Presumably there are geographic restrictions on where Humana can build these centers which will limit the near term impact, but it’s clearly in Humana’s long term interest to move those patients away from the MA startups and to this business, right? Will those startups be able to diversify their payer mix away from Humana faster than Humana grows this? Will be fun to watch who wins this space. It’s also wild to me that Partners in Primary Care saw 87% of patients in person in their clinics in 2020, an increase from 75% of patients in 2019. I would not have expected a number that high given the pandemic and all. Link.
  • This is a good read from the Flare Capital team on opioid use disorder and the landscape of startups trying to help provide more effective treatments. Link.

Data:

  • Minnesota awesomeness alert! Medical Alley posted a review of 2020 activity in this wonderful snowy place, highlighting the $1.4 billion raised by Minnesota healthcare startups in 2020, led by big rounds from health insurers Bright and Bind. Link.

Jobs:

  • Calibrate, the telehealth startup mentioned above focusing on metabolic health, is hiring a director of product management. Link.
  • Covera, a clinical analytics and AI company working to eliminate clinical misdiagnosis, is hiring Chief of Staff & Process Improvement roles. Link.
  • Impilo, a startup building an API for remote monitoring, is hiring a founding engineer / CTO. Link.
  • Rewind, a startup trying to tackle diabetes reversal, is looking for a product lead to be part of the founding team. Link.
  • Ribbon Health, a startup building APIs to manage provider data, is hiring a Enterprise Sales lead. Link.
  • TrialSpark, a platform for managing clinical trials, is hiring a bunch of roles. Link.
  • The University of Minnesota, home of the best college football in the country at least once a decade - row the boat! - is hiring a part-time Senior Lecturer for its quite awesome MHA program. Link.