Kevin's Weekly Health Tech Reads 5/17

UHC makes its exchange re-entry official, One Medical has their Q1 earnings call, more conversation on hospital finances, Haven is back in the news, & more!

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News:

  • One Medical had their Q1 earnings call, ending the quarter with 455,000 members but facing some financial headwinds due to COVID-19. Their CEO mentions that even though virtual visits are reimbursed at the same rate as in person, they’re still seeing lower FFS reimbursements per virtual visit because they’re doing fewer services per visit (i.e. no vaccines / reproductive care). Overall utilization is down 45%, which is a bit surprising to me given the heavy digital emphasis. There was some discussion of One Medical’s health system partnership strategy given the financial challenges facing health systems, but that portion was a bit of a let down for me. Just some comments about how systems might want to restructure some of their payments but nothing too detailed. Link.
  • As UHG hinted during its previous earnings call, it is officially re-entering the exchanges in at least one state starting in 2021, as Maryland came out this week and shared the news. Will be interesting to watch how big of a re-entrance UHC makes into the exchange business. Link.
  • Doctor on Demand became the first nationwide telehealth provider to make its services available to the 33 million Medicare Part B beneficiaries. As this article states, the move indicates a significant investment in the space with credentialing providers and other backend infrastructure. I’m assuming this means Doctor on Demand has received some assurances that the changes to telehealth reimbursement guidelines are here to stay. Link.
  • Kaiser’s headline this week was that they lost $1.1 billion in Q1. But if you dig down a bit there’s an interesting dichotomy in their performance - operating revenue was up from last year, and operating income was positive $1.25 billion. Their losses were driven from their investment portfolio - which was the primary driver behind a loss of $2.4 billion for the quarter. It’s a useful reminder of how large the investment portfolios of some of these health care delivery institutions are. Link.
  • Folx Health launched a digital telehealth platform for the LGBTQ community this week, providing a good example of the ‘unbundling’ of care delivery concept. I’m curious to see how far the demographic segmentation of healthcare delivery goes - what characteristics of a population of individuals will lead them to gravitate their own specific care model and create enough demand to support care delivery concepts tailored specifically to that population? Link.
  • Premera Blue Cross launched a virtual primary care plan with 98point6 for employers in Washington, following in the footsteps of other insurance early adopters launching a digital-first primary care products. It makes sense that Premera (and other plans) would put a plan design like this out there as an option to see what happens. But the big question seems to remain: how many individuals actually sign up for these digital-first plans? Link.
  • Carbon Health, a digital first primary care model with bricks and mortar clinics, raised an additional $28 million to scale its virtual model to all 50 states by this summer. Will be curious to watch how (if?) they choose to scale the bricks and mortar business from here given the state of the world. Link.
  • Nanit raised $21 million for a smart baby monitor thingy, because, ya know, there are lots of babies out there and parents obviously need more smart baby monitor thingys. Link.
  • Stellar Health raised $10 million for its software platform that helps providers get paid for closing gaps in care in value based contracts. Link.
  • Meru Health raised $8 million for a mental health telehealth program that connects therapists with patients. The article linked here goes into some good detail on this one: Meru currently has treated 700 patients with 20 therapists on the platform. They think they can scale a therapist from treating 20 patients on average normally to 120 patients using telehealth. The round values Meru at $30 - $40 million. Link.
  • Lucid Lane raised $4 million for its substance use disorder telehealth program. Link.
  • Ophelia raised $2.7 million for its substance use disorder telehealth program. Link.

Opinions:

  • This is a good read from the Healthbox folks on changes COVID-19 might have on healthcare over the long term - shifting consumer expectations, emboldened new entrants, hospital financial challenges, social determinants go mainstream, & more. Link.
  • Brian Dolan wrote about the potential consolidation of the musculoskeletal digital health space, looking at how Hinge Health is on a trajectory to be competing with Livongo and Omada sooner rather than later. It provides some solid perspective on which companies Livongo and Omada might look at acquiring to get into the space, and also ends with some interesting questions about Hinge. How quickly does it try to compete as a platform instead of just offering an MSK? Link.
  • Speaking of selling digital health tools to employers, Nikhil Krishnan continued his series poking holes in common digital health business models, this time focusing on the employer space. It raises some good points on the size distribution of employers and the role that big benefits managers play in distribution. Link.
  • Sarah Kliff wrote a piece that provides a good overview of health system financials and the challenges COVID-19 is presenting, with a heavy focus on Mayo Clinic. Mayo, which expects to lose $900 million in 2020 - has historically had 60% of revenue come from commercial patients while only 3% comes from Medicaid patients. This is significantly lower than a system like Johns Hopkins, which has 25% Medicaid, or New York Presbyterian, which has 16% Medicaid. Link.
  • It kind of felt like Haven was journeying off quietly into the night, until the news of Atul Gawande’s departure as CEO has brought it back into the spotlight for a brief moment. This article takes a look at how Haven could still disrupt the employer insurance market - direct contracting with providers, increased access to primary care, pharmacy costs something something - and makes some worthwhile points as to various approaches in each space. Even assuming Haven does continue its journey off into the night, it’s still worthwhile to read this piece as it applies more generally to disruption in the employer market. Link.

Data:

  • Jefferies surveyed 40 high volume orthopedic surgeons to get their thoughts on procedure volumes. Apparently these surgeons have seen a 90% drop in their weekly volumes, but are hopeful that within three months their volumes will only be down 5% - 7%. Link.
  • KFF suggests that 27 million people could become uninsured due to losing their employer sponsored insurance. Link.
  • This dynamic adds to the issues facing health system finances these days due to the pricing difference between commercial and government rates, as Sarah Kliff explains well in this Tweetstorm. Link.