Kevin's Weekly Health Tech Reads 11/1

Intermountain & Sanford merge, interesting tidbits from Q3 earnings calls, lots of funding rounds, Verma rips CMMI, & more

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News:

  • In rather big health system consolidation news, Intermountain and Sanford announced their intent to merge and create a $12.5 billion revenue health system. This article includes a quote from Sanford’s CEO regarding why its doing the merger now - its about the insurance plans. Sanford has struggled to grow its insurance plan, while Intermountain’s plan has almost 1 million members (with 75% in global risk arrangements). Certainly interesting to see that cited as the primary rationale. Intermountain’s CEO also noted on the call that they are looking at other hospital acquisitions across the ‘interior West’ that are in the #1 or #2 spot in a market, and obviously Sanford has had its eye on expansion as well (it tried and ultimately failed to acquire UnityPoint in Iowa last year). Will be quite interesting to watch how aggressively these entities look to expand from here. Link.
  • Q3 earnings season was in full swing this week. Here are some notable results:
  • Teladoc reported record revenue with 90% organic growth over last year, along with bigger losses than expected. They saw 500%+ growth in mental health. Lots of excitement around international growth and the Livongo acquisition. They also briefly mention that they’re in discussions with employers / insurers on creating virtual plan designs around Teladoc - will be interesting to watch what materializes there. Link.
  • Hims, which is describing itself as a ‘multi-specialty telehealth platform’, posted its Q3 results as part of its SPAC process. Hims announced it partnered with Privia Health, a physician group with 2,600 docs, to provide access to to in-person and virtual primary care services via Privia providers. That is a super interesting partnership. The financial results also look good - 91% YoY revenue growth, gross margins up to 76%, and average order value increasing 16%. Seems like they’re doing very well, although the Bloomberg article linked below in the Opinions section is enough to give some pause. Link.
  • Anthem posted lower net income than a year ago, but beat Wall Street estimates. Operating revenue increased, driven largely by growth in Medicare and Medicaid. Non-COVID-19 utilization is essentially back to normal, at 95% of historical baselines. Interesting to see Anthem’s focus on supporting community needs in the opening comments - a partnership with SDoH startup Aunt Bertha is called out among other activities. Link.
  • Molina shared some interesting notes on the impact of COVID-19 in its call. They’ve seen disproportionate impacts in places like Texas and California, as well as the exchanges more generally. Specifically, they’ve struggled with their Bronze product on the exchanges, where they haven’t been able to manage utilization or capture appropriate risk scores and are seeing significant churn. They’ve also attracted 300,000 new Medicaid members, which are showing lower acuity than the general Medicaid population. Link.
  • HCA’s revenue was up 5% from last year, beating Wall Street estimates. Volumes were down across the board, with a particularly large drop in Emergency Department utilization (down over 20%), which was offset by a 14% increase revenue per admission. That’s a big increase in revenue per admission. Interesting to see their comments about 66% of the decline in ED volume being from Medicaid and uninsured patients. Link.
  • UHS posted a similar quarter to HCA - volume declines across the board with ED hit the hardest, but it saw an overall revenue increase of 3% due to sicker patients coming in. Average revenue per admission went up 26% - an even bigger increase than HCA. Link.
  • Two more SPACs were launched this week:
  • The folks behind Livongo launched a SPAC, saying “we want to create the conditions for 1,000 Livongos to bloom”. This SPAC seems like a no brainer to me given the track record here - will be quite interesting to see who they end up acquiring. Link.
  • Lux Capital launched a SPAC that’ll likely be focused on acquiring a med tech company given the thesis they published a few weeks ago. Link.
  • UnderArmour is selling MyFitnessPal to private equity firm Francisco Partners for $345 million, five years after acquiring it for $475 million. Link.
  • Honor raised $140 million to expand markets across the country. It appears Honor’s pivot has gone well for them - if you’ll remember they originally raised $100+ million to build the next generation of home health agency, but found that was challenging to scale, so they pivoted to become the infrastructure platform for existing home health agencies. They’ve currently partnered with 40 home care agencies across 1,000 communities - seems like they’ve found a more workable model here. Link.
  • Fitness band manufacturer Whoop raised $100 million at a $1.2 billion valuation as quantified self enthusiasts everywhere emerge from their 5 year slumber. I’m super pumped for the day five years from now when Whoop has tapped out growth in the D2C market and it launches a healthcare division to sell population health data & insights to insurers (cf. Fitbit). Link.
  • Intuitive Surgical has started a $100 million venture fund, Intuitive Ventures, designed to invest in minimally invasive technologies. Link.
  • Sidekick raised $20 million to build its digital therapeutic health platform that leverages gamification techniques. Link.
  • HumanAPI raised $20 million to continue building its platform that aggregates health information. Link.
  • HomeThrive raised $18 million to build its platform that supports caregivers of seniors in the aging at home process. Cool idea hitting on the aging in place theme - although I’m curious to see how willing the employer market is to pay for this for employees caring for their parents. Link.
  • KelaHealth, a tech platform supporting patient risk stratification / interventions around surgeries, raised $12.9 million. Link.
  • Curve Health, a startup building a tech platform for skilled nursing facilities, raised $6 million. Curve was founded by the founder of Call9, a startup that had a similar model but shut down after raising $40 million and struggling to find a viable financial model. Link.
  • Upswing is a cool brand new fund focused on adolescent mental health. It’s being helmed by the awesome Solome Tibebu, with backing from Melinda Gates’s fund, Pivotal Ventures. Link.
  • This is an interesting read on Ilara, a Kenyan maternal care startup that received a $1.1 million grant from the Bill & Melinda Gates Foundation. Link.
  • BCBS NC is partnering with a startup called Caravan Health to bring BCBS NC’s value based care program to rural providers in the state. It appears that this partnership is focused on rural hospitals, complementing BCBS NC’s efforts with Aledade in the primary care space. Link.
  • In somewhat terrifying news this week, the FBI and DHS are warning hospitals of an imminent threat of ransomware attacks at over 400 US hospitals. Link.

Opinions:

  • In this week’s installment of reads that will make you feel gross about the healthcare industry, check out this KHN article about how hospital lobbyists are mobilizing against North Carolina’s Treasurer. What did he do to deserve such punishment, you ask? He tried to force a reference-based pricing structure down hospital throats, which of course would have resulted in decreased profits for hospitals, some of which are charging upwards of 300% of Medicare rates. This example, as well as Colorado’s failed attempt to implement a public option earlier this year, provides for some really good insight into the significant political opposition from hospitals that these sorts of proposals face. Link.
  • Hims was featured in a Bloomberg article this week that took a critical look at its prescribing policies. The sections talking about how providers are viewed as salespeople, seeing 200 - 300 patients a week and being encouraged to always prescribe medications are tough to read. Particularly when you juxtapose that with Hims interest in getting into more traditional primary care services. As the article notes, this appears to be a byproduct of consumerism - consumers who want a need met will find someone who can. But is that ultimately a good or bad thing? Link.
  • This is a solid report on challenges and potential tech solutions for Dual Eligible populations. It articulates four key challenges in the population - complex care coordination, data collection and sharing, home and community based services, and enrollment / engagement, with examples of startups playing in each space. Link.
  • Seema Verma wrote an article in Modern Healthcare this week slamming the efforts of CMMI to implement innovative alternative payment models. She writes that of the 54 models that have been implemented, only 5 have demonstrated statistically significant savings, and only three have met criteria for national expansion. She also offers some thoughts on how to turn it around - more downside risk for providers, more regulatory flexibility, better benchmarks, and more timely access to data / analytics. Link.

Data:

  • Deloitte published a report on how Medicare Advantage plans are leveraging digital technologies. It provides a nice review of how plans are thinking about the digital space and why they’re adopting digital tools - provider engagement, member stickiness, improved health outcomes, and reduced costs. Link (Summary). Link (Deloitte Report).
  • KFF shared some data showing that only 43% of MA enrollees compare their plan options each year. Highlights why it is so hard for new plans to drive enrollment (also why retention is so high for existing plans). Link.

Jobs:

Here’s a rundown of jobs posted on the Slack channel this week. (If you’re not on the Slack channel yet but want to join you can do so here).

  • Bright.md, a telehealth startup, is hiring for a bunch of different roles. Link.
  • Covera, a startup building a data platform to help employers direct employees to high quality radiologists, is hiring for a general manager and head of provider success. Link.
  • Firefly, a digital primary care clinic, is hiring a claims analyst. Link.
  • Maven, a digital womens health clinic, is hiring for some clinical, marketing, and BD roles. Link.
  • NeuroFlow, a behavioral health platform, is hiring for a bunch of roles. Link.
  • Stellar Health, a value based care platform that just rolled out in Minnesota(!!!) , is hiring for a bunch of roles on the ops and product side. Link.
  • Phosphorous, a computational genomics company, is hiring a couple business roles. Link.