Kevin's Weekly Health Tech Reads 2/28

Two interesting acquisitions this week - Optum / Landmark and Cigna / MDLive; Oscar's roadshow; a look at Comcast's position in healthcare & more

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News:

  • Optum is reportedly buying Landmark Health for $3.5 billion. Assuming this deal comes to fruition, it’s another very logical asset for them in their quest to own everything in healthcare aside from the hospital. Landmark of course is one of the original success startup stories in home health - largely doing in home geriatric care for the Medicare Advantage population. Landmark is also one of the Direct Contracting Entities giving Optum / UHG a bit more exposure to that CMMI model. This is an interesting overview of Landmark from a few months back and it’s planned growth in the post-COVID environment. I would love to be a fly on the wall in Optum’s Corp Dev team meetings these days - it’s gotta be such a fascinating conversation across the healthcare landscape. Link.
  • Cigna is acquiring MDLIVE via it’s Optum-esqe services subsidiary Evernorth in another strong exit for the telehealth space. I gotta imagine we’ll see American Well and / or Doctor on Demand gobbled up this year as well as folks get worried about being the last one without a dance partner in the telehealth space with the number of targets dwindling. American Well has already been the subject of recent rumors that Optum is sniffing around, which would make a ton of sense given Optum’s recent run of acquisitions. Link.
  • HCA acquired a majority stake in a home health, hospice, and outpatient therapy business this week for $400 million from Brookdale Senior Living. Link.
  • Some interesting notes from earnings calls from the week:
  • One Medical reported earnings and it was interesting to see that they reported an average of 10 engagements per member in 2020, with two of those engagements being in person. That appears to mean their clinics were actually pretty full throughout the year (2 visits per person at around 500k average members for the year puts them at ~1 million in person visits for the year, across ~100 clinics open business days puts each clinic around 40 visits a day, or 5 visits an hour). That seems like a full clinic - I’m surprised they were still seeing so much volume in person last year. Also interesting to read about how they’re thinking about One Medical Now members (the virtual care offering) converting into full members as they expand geographies - seems like it would provide them with some really good insight on future market entry and placing future clinics. Link.
  • Teladoc also reported earnings, and spent a lot of time discussing their virtual primary care initiative. They mention that in their pilot, they’re diagnosing 25% of diabetes cases as first time diagnoses, and the opportunity that creates for Livongo to address members earlier. They have a D2C mental health brand, BetterHelp, that had $300 million of revenue in 2020. Link.
  • Business Insider is reporting that Devoted Health, a tech-forward Medicare Advantage insurer, raised another $380 million quietly during 2020. Can’t say that’s surprising given the quick growth they’ve been experiencing. Link (behind paywall).
  • Innovacer, a data analytics platform for providers, raised $105 million at a $1.3 billion valuation. Link.
  • Medication management startup Medisafe raised $30 million. Link.
  • Baby smart sock maker Nanit raised $25 million. Link.
  • January AI raised $8.8 million for it’s AI-driven diabetes management platform. Link.
  • Marani Health, a Minneapolis(!!!) based pregnancy care platform, raised $3.7 million. Link.
  • Firefly Health, a virtual primary care startup, announced a partnership with Dana Farber. This is a really interesting example of how virtual models can partner with other providers in a way that’s a win-win for both - Dana Farber isn’t going to provide Firefly-like services anytime soon and gets the referral volume; Firefly similarly isn’t going to be providing Dana Farber-like services anytime soon and gets to draft off the Dana Farber’s quality brand name. Link.
  • Mental health startup Ginger and pharmacy delivery startup Capsule announced a partnership to provide same day medication delivery for Ginger members. Seems like a very logical move for both parties. Link.
  • Maven also announced a pharmacy partnership this week, launching a new program called MavenRx for same-day / next-day fertility treatment delivery. Link.
  • The Emily Program and Veritas Collaborative, two leading eating disorder treatment programs, have merged. They have - quite wisely from my perspective - chosen to keep HQ in Minnesota moving forward, although Durham is cool too to be fair. Link.
  • The AmWell / Cleveland Clinic Joint Venture is getting into the second opinions market. Link.

Opinions:

  • Oscar’s roadshow presentation is available for folks to check out online. It’s a really well done presentation, although it doesn’t share much more data than the S-1. They do include the data point that they are the lowest priced plan in less than 10% of the markets they’re in (24:54), seemingly to address some of the concerns about them pricing their product low to buy membership at a loss. The product demo in particular is worth checking out for anyone in the space - their ‘campaigns’ functionality for population health management at the end of the demo is super cool, among other features. Link.
  • The general consensus I’ve been seeing on Oscar seems to be settling towards the bear case centered on the financials being very problematic. There have been a number of good articles pointing out the financial challenges that are hard to argue with (Ari Gottleib wrote good pieces here and here looking at the challenges of the model). But as I’ve been pondering that issue a bit this week - I keep coming back to one question / thought: if all of us see this as such an obvious issue, presumably the Oscar leadership team has been aware of it for a while, too. Assuming that’s correct, are they not able to fix it (i.e. get at least closer to profitability) because they can’t get there, or because they are choosing not to get there - i.e. is this a ‘can’t’ or a ‘won’t’ issue? I personally don’t think it’s a “can’t” issue - and rather think that Oscar is placing a massive bet that they can continue to access enough cash to fund their losses and get to more meaningful scale to eventually get there. This is the chicken / egg challenge of starting an insurer - scale is the name of the game (good luck building a network with no patient volume), but how do you get there starting from scratch? My hunch is that Oscar has actively chosen this route to try to get there, under the presumption that they can solve for a 80% MLR and a 15% admin ratio at a later date. And I personally am a believer they should be able to do that eventually. Obviously the financials don’t give much assurance of this to date, though. Whatever the outcome, it sure is going to be a fun story to watch unfold over the next few years!
  • This is a good read on telemedicine in the pandemic and how some providers have adjusted to the changes. The last portion of the article around remote patient monitoring is really interesting, including this quote:
  • "The same tipping point that's coming for video visits is coming for remote patient monitoring," Testa said. "There's no putting this genie back in the bottle."
  • I imagine we’re going to be seeing a lot of activity in the remote monitoring space this year along this general thesis. Link.
  • The Tradeoffs podcast took a look at the new federal ban on surprise medical bills and the likelihood of that ban working. It provides a nice explanation of how a similar piece of legislation worked in New York, resulting in 88% drop in emergency department visits that were out of network. Link.
  • Business Insider continues its streak of pumping out interesting content, this time looking at how Comcast is getting out of the ventures business. For those who haven’t dug into Comcast’s role in the healthcare innovation space, it provides for a really interesting case study. This serves as another reminder for me that successes like these are often due to a handful of individuals pushing really hard inside of those organizations, and that as soon as those individuals are no longer there to push the initiatives it becomes hard to sustain. Link.

Data:

  • I liked this graphic from the Weekly Gist this week looking at how health systems are being dwarfed by other industry giants in terms of annual revenue. Health systems are in quite a tough spot strategically in this landscape - it’s easy to see why many health system execs view consolidation as an ‘easy button’ strategy. Link.
  • NYC Health Business Leaders released a report providing a good overview of digital health startup activity in NYC. It’s obviously no Minneapolis but there is a lot of cool stuff happening out there, and this does a nice job summarizing the companies behind it. Link.

Jobs:

  • Allara, a startup building a digital care platform for PCOS, is hiring a head of product and a head of clinical ops. Link.
  • Brightline, a cognitive behavioral therapy platform for kids, is hiring for product and engineering roles. Link.
  • Hospital for Special Surgery, a leading orthopedic hospital based in NYC, is hiring a director of business development to build it’s MSK offerings for employers nationally. Link.
  • Uno Health, a startup helping Medicare members connect to available financial assistance programs, is hiring an operations manager. Link.