Kevins Weekly Health Tech Reads 10/4

Walmart enters Medicare Advantage insurance market; Molina acquires another Medicaid plan; UHG acquires DivvyDose; PE-backed hospitals behaving badly; & more!

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News:

  • Walmart announced that it has partnered with Clover Health to launch a co-branded Medicare Advantage plan starting in Georgia. While it makes a ton of sense to me that Walmart is moving in this direction (Walmart, of course, had its famous dalliance with Humana a few years back), it is a bit confusing to me that they chose Clover as the partner given Clover’s somewhat checkered history, versus some of the other potential partners in the space (see this CNBC article for example A). It seems like Walmart either needed to have A. gotten a good deal with Clover, B. decided it likes the tech platform Clover has built, or C. both. I’d be quite curious to know what conversations are happening behind the scenes here regarding Walmart’s expansion plans / general strategy in the space, both with Clover and with Oak Street too. If Walmart likes Clover’s tech over the other MA plans, it’d make a lot of sense for them to buy Clover and roll it out across the country using its clinics as an entry point to enroll members. Link.
  • As mentioned previously, Hims has signed a deal to go public via a SPAC merger, valuing it at $1.6 billion. Malay Gandhi had a good tweet storm this week interpreting the overview slide deck Hims filed as part of the transaction. Is it too much to ask for an S-1, Hims folks? Link. Link.
  • Molina paid $380 million to acquire Affinity Health Plan, a managed Medicaid plan in the state of New York. Affinity currently has 284,000 members with revenue of $1.2 billion for the last twelve months. It highlights the wild valuation differences between sleepy old regional health plans and the new venture backed startups - Molina paid $1,338 per member for Affinity in this case. Now, assuming Oscar trades at something like 10x - 20x 2020 revenue at IPO it’ll be worth between $20 - $40 billion with ~400,000 members. For reference see the Hims comp set in the slide deck linked above which is trading at 21.7x 2021 revenue, with One Medical the lowest at 9.6x. **Kevin does math** That implies a valuation of $50,000 - $100,000 per member. I know I know different insurance markets and such, but still. If you’re Oscar and you have access to capital at these valuations, why not start making some acquisitions as a way to drive additional growth and as an arbitrage play on the difference in valuations? Link.
  • Speaking of Oscar, it’s partnered with MercyOne to enter the Iowa market. Link.
  • UnitedHealth Group acquired DivvyDose, a Pillpack copy-cat, in a deal rumored to be worth just over $300 million. It’s curious that UHG paid $300 million for this company - it strikes me as the type of company they’d look at and decide it could build on its own. It’s a really nice outcome for a startup that hasn’t taken any VC funding. Link.
  • Advocate Aurora and Beaumont Health scrapped merger plans due to the physician upheaval at Beaumont. Link.
  • Revel and NovuHealth, two Minneapolis(!!!) startups with member engagement platforms for health plans, have decided to merge. Link.
  • Telehealth coverage is changing this week, as UHG and several other major insurers are no longer waiving co-pays for telehealth visits. Link.
  • Amwell and TytoCare are expanding their partnership to more fully integrate Tytocare’s at home devices with the Amwell platform. Would make a lot of sense to see Amwell acquire TytoCare one day. Link.
  • Doc.ai has signed a $100 million, 5-year contract with Anthem for what sounds like a back to work app. Anthem is also an investor in Doc.ai. Lots of excitement over the back to work space! Link.
  • Tend raised $37 million for its dental offices where you can watch Netflix while you’re getting your teeth cleaned. Link.
  • Hazel Health, a telehealth service for students and schools, raised $33.5 million. Certainly seems like the right timing for this idea, eh? Link.
  • Koneksa Health raised $16 million for its real world clinical data platform. Link.
  • ScriptDrop raised $15 million for its pharmacy delivery platform. Link.
  • Noyo, a startup building an API platform for insurers to manage member enrollment data, raised $12.5 million. Link.
  • Siren raised another $9 million for smart socks for diabetics. Link.
  • Temp Pal raised $2.4 million for a smart thermometer. Link.

Opinions:

  • Wired has a good read on the challenges that AI algorithms can present when attempting to integrate them into clinical workflow. It feels a lot like the conversations around alert fatigue from clinical decision support tools that were en vogue 5-10 years ago. For AI developers: if your algorithm is notifying a clinician who needs to take an action but doesn’t understand why they’re being notified or what action they’re expected to take… you have a major issue. Link.
  • For anyone who suffered through the shouting match between three seventy year old dudes on Tuesday night, you may have noticed that Cleveland Clinic was the host. Bloomberg this week highlighted some of the inequality issues that Cleveland Clinic has been facing in its own back yard - as the predominantly black communities surrounding the Cleveland Clinic campus have struggled. Seems relevant to some of the economic and healthcare themes of the shouting match. Link.
  • Also on the topic of hospitals (not) doing right by the communities they’re located in, check out this wild story from ProPublica on a private-equity backed hospital chain called Prospect Medical Holdings. The private equity owner made over $400 million in the hospital chain and two senior execs made over $200 million, meanwhile the quality of care sounds… horrific. On ten occasions over the past decade, government inspectors have deemed Prospect hospitals as posing “immediate jeopardy” to their patients. Woof. Link.
  • AmWells’s CEO was interviewed on current state adoption of telehealth and had some really interesting comments about how current telehealth reimbursement is a ‘bandaid’, but that clinicians will default back to in person visits. He makes some good points about how physician adoption and willingness to conduct video visits will be key to driving long term adoption. Link.
  • This Medium series is a good (very long) read on how Oscar, Cedar, Capsule, Maven, Ro, and TrialSpark have found success in their models. Link.
  • Here’s a good rundown of payer activity in the Medicare Advantage market for 2021 - everyone is expanding markets. Link.

Data:

  • CMS released a fact sheet on Accountable Health Communities program - a super cool program designed to screen populations for Social Determinants of Health needs. In the first 750,000 screenings completed, 33% identified a health related social need, which were broken down in the chart below. 76% of individuals with SDoH needs accepted the navigation services, and 76% of those folks who accepted assistance were on Medicaid. Seems like pretty meaningful results - here’s hoping that health systems will be able to sustain them financially once the CMS funding runs out! Link.
  • This is a good read in Health Affairs on primary care practices financials, looking at the impact of COVID-19 on financials across a number of different practice types - rural, urban with commercial populations, urban with lower income populations, and FQHCs. Link.
  • Mayo data suggests that only 11.4% of patients who show up to the doctor with symptoms from their Apple Watch actually needed to have a visit. Cool data, although I have a hunch that most health systems feelings on whether these visits are really “unnecessary” will have a high correlation with the amount of reimbursement they receive for those visits. Link.
  • Remember how easy I’ve been saying Cedar, Olive and similar companies pitches should be to health systems in the RCM / RPA spaces? Well, here’s some data from a survey of health system CFOs suggesting as much - 37% of CFOs are looking at vendor partnerships, in addition to the 32% looking to outsource. Also worth noting in this is that ~70% of CFOs are expecting increased in self-pay (and Medicaid) patients. Link.
  • Collaboration with external entities, including vendor partnerships (37%) and outsourcing (32%), were the most often cited strategies for decreasing revenue cycle costs and increasing economies of scale, according to the survey. In addition, 27% of executives cited using advanced health IT, including robotic process automation.
  • RWJF looked at on-exchange enrollments by metal level. Link.