Kevin's Weekly Health Tech Reads 11/15

SPACs - Cano Health is acquired & a scathing report on Multiplan, Oak Street is excited about Direct Contracting, AmWell might buy Omada, & more!

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News:

  • This week’s SPAC updates:
  • Barry Sternlicht’s SPAC is acquiring Cano Health at a $4.4 billion valuation. Cano is an under-the-radar Medicare Advantage primary care startup that looks like a mix of Oak Street and VillageMD in that it both has its own PCPs and also serves as an MSO to other PCPs. Cano estimates it will hit $1.5 billion of revenue in 2021 with 102,747 members, while being EBITDA positive. This compares favorably to Oak Street, which Cano estimates will have 89,500 members, $1.2 billion of revenue, and will be EBITDA negative. Yet Oak Street currently has a market cap over $10 billion, which makes Cano look like a steal. The concentration of revenue mix is interesting to check out here - Humana is 54%, Anthem is 15%, FL Blue is 10%, United is 5%, and Other is 15%. Humana is also supporting Cano by funding 50 clinics over the next few years. It’s crazy to think about the role that Humana has played in starting the MA primary care space over the past several years - they’ve been the major supporter of Oak Street, Iora, and Cano in addition to its Welsh Carson JV. Link (Investor slides). Link (Investor call).
  • Muddy Waters Research, a well-known short seller, released a scathing report on the Multiplan SPAC. It is centered around the UHC’s development of Naviguard, a company in the UHG Ventures portfolio that is billed as a cheaper and better competitor to Multiplan. Muddy Waters estimates that this development will cost Multiplan 35% of revenue in 2022. The report paints a picture of a company that has traded private equity owners multiple times over the past few years, with the most recent PE owner viewing the SPAC as a money grab. Link.
  • This week’s earnings call tidbits:
  • Oak Street’s earnings call is an absolute goldmine for anyone interested in Direct Contracting (DC). It is almost entirely focused on the nuances of how Oak Street views and is implementing Direct Contracting after it started enrolling patients in the program in October. Oak Street’s CEO appears quite excited about the opportunity, which has the potential to convert loss-generating Medicare Fee for Service patients into profitable patients similar to Medicare Advantage (MA). That means 5k patients converted to DC would be $50 million in revenue for Oak Street, and Oak Street has 30,000 FFS patients that could be converted. That is a nice tailwind if it materializes for Oak Street (and others in the space, too). The call also provides a very pragmatic view into questions like how Oak Street is enrolling patients in DC vs MA. Oak Street also provided an updated investor presentation with a handful of slides (23 - 27) walking through how they expect mechanics of the program to work, which also provides a really good summary of the Direct Contracting program for those interested. Link (transcript). Link (investor deck).
  • AmWell hosted its first earnings call as a public company. Visits were down by 30% since the previous quarter during the initial COVID peak, dropping from 2 million to 1.4 million. Gross margins dropped significantly, from 45.1% last year to 32.7% this year, a result of shifting revenue mix - visit revenue is significantly higher this year and has lower margins. They spent a lot of time in the call discussing the number of health system providers using AmWell’s platform, which has gone up quite significantly this year, and is where AmWell sees its future. Link.
  • One Medical reported a strong quarter, ending the quarter with 511,00 members. The conference call didn’t include anything earth shattering, although it is interesting to note that they’re seeing a lot of membership growth with schools - including middle schools and high schools. Link.
  • Evolent Health hosted its earnings call, and again you see another organization talking about the interesting opportunity that is Direct Contracting, although Evolent appears to be taking more of a wait and see approach. Link.
  • Brian Dolan reported that AmWell is in talks to acquire Omada Health. It would be quite a logical move for AmWell to make in the wake of the Teladoc / Livongo deal as the arms race to be the pre-eminent digital health system continues. I have to imagine Omada is a very hot commodity at the moment for a number of organizations that are looking to keep up with Teladoc. Link.
  • Centene acquired Apixio, a data analytics platform that has raised over $50 million. Apixio’s platform analyzes data in EHRs to help with clinical guidance, quality, and also risk adjustment. Link.
  • Carbon Health raised $100 million to grow its in person + virtual primary care model to 150 clinics in 2021 and 1,500 clinics by 2025. One Medical, mind you, has around 100 clinics and it has taken over a decade to get to that point. It appears that Carbon expects to be able to drive this growth in part by focusing on pop-up clinics, as it is planning to open 100 COVID-19 testing pop-up clinics. Will be interesting to watch this grow. Link.
  • Eko, a startup building a digital stethoscope, raised $65 million to expand in the telehealth world, both in clinics and at home. Link.
  • Medically Home, a hospital at home startup that partners with health systems including Mayo Clinic, raised $40 million according to this recent SEC Filing. Link.
  • Buoy raised $37.5 million for its AI chatbot platform at a valuation just under $200 million. Interestingly Buoy managed to get venture dollars from three separate payer orgs in this round - Cigna Ventures, Humana, and Optum Ventures. Link.
  • Solv Health raised $27 million for its online booking platform for patient visits. It appears Solv has seen some huge growth in 2020 - 6.3 million monthly visitors in October 2020 vs 1.1 million in October 2019. Link.
  • SpringTide, a startup building a new care model for kids with autism, raised $18.1 million from Deerfield and Optum Ventures. Link.
  • Cota raised $10 million for its oncology data platform. Link.
  • Caption Health received a $4.95 million grant from the Bill & Melinda Gates Foundation to develop AI that helps untrained medical personnel interpret lung ultrasounds. Link.
  • Spora Health, whose team is currently hanging out in Minneapolis(!!!) as part of the UHG / Techstars accelerator, raised a $1.2 million round and launched its virtual-first primary care platform for people of color. Link.
  • BCBS Michigan has partnered with Premise Health to offer on-site health clinics for BCBS Michigan employer clients. Link.
  • Amazon Alexa is getting into aging at home marketplace, launching a new feature called Care Hub. Link.
  • Direct primary care provider Paladina changed its name to Everside Health. Link.

Opinions:

  • This is a interesting look at CAPABLE, an aging-in-place model developed at Johns Hopkins that combines nursing, occupational therapy, and handyman services. As the article notes, demand is at an all-time high, and it seems like there are a number of regulatory tailwinds in this space - note the section discussing Azar asking CMMI to look into the CAPABLE model, as well as PTAC voting that CMS should test it on a larger scale. Also interesting to note that VillageMD is partnering with CAPABLE to launch the offering in the Houston market. Link.

Data:

  • Ivor Horn and Rock Health released their report on diversity in digital health, showing, among other things, the differences in how founders across different races, genders, and ethnicities have funded their companies. Link (summary). Link (report).
  • Dispatch Health released new data suggesting its hospital at home program didn’t cause any patient safety issues. Interesting to see Dispatch migrating into the hospital at home market. Link.
  • Aon data suggests employer health costs are decreasing by 5% per employee due to COVID-19 in 2020, although they expect employer costs to grow by 2% above normal trend in 2021 due to deferred care. Link.
  • Avalere suggests COVID-19 could reduce Medicare Advantage revenue by 4-6% in 2021 due to declining risk scores. This is the result of fewer medical claims during the initial COVID-19 peak - the number of MA enrollees with a medical claim in April 2020 dropped 47% from the prior year. Link.

Jobs:

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  • Covera, a startup building a data platform to help employers direct employees to high quality radiologists, is hiring for a couple different operations roles. Link.
  • Dispatch Health, an in-home urgent care startup, is hiring a data analyst. Link.
  • Eleanor Health, an addiction treatment startup, is hiring Operations Directors in Massachusetts and Ohio. Link.
  • Grand Rounds, a second opinion startup that’s expanding to navigation services, is hiring a product role, as well as many others. Link.
  • Kyruus, a provider search, scheduling, and data management startup, is hiring for a bunch of different roles. Link.