Kevin's Weekly Health Tech Reads 7/5

Perspectives on new models of care delivery - hospital at home, drive through clinics, 'primary health', business model changes, etc; a cool data viz of North Carolina costs; & lots more!

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News:

  • In a win this week for healthcare coverage for Americans, Oklahoma decided to expand Medicaid despite opposition from its Governor and Republican state leaders who expressed concerns about the costs of the program. Link.
  • Some of you might be wondering, what’s the big deal if states don’t expand Medicaid? Does it really matter all that much? This New Yorker piece does a great job highlighting how it can quite literally be matter of life and death for some individuals. The article looks at Alabama, a state that has not chosen to expand Medicaid, highlighting some of the real world impacts the decision not to expand has had on people in the state. It focuses on high rates of cervical cancer, particularly among black women. I’ll leave you with this quote from the article: “Cervical cancer is almost entirely preventable and yet in Alabama there are areas where women are dying at a rate similar to that of developing nations.” Link.
  • Accolade priced it’s IPO above the expected range, and the price jumped 59% on the first day of trading this week, putting its market cap at $1.4 billion. Nice to see another digital health IPO out the door! Link.
  • Lululemon purchased Mirror, the Peleton-like at-home fitness membership with a mirror, for $500 million. I know it’s a bit tangential to this space, but I include it because the dynamic of Lululemon moving into the wellness/content space is interesting. It seems like there’s an opportunity for health care delivery brands (i.e. primary care docs!) to learn from this space as well. Could a traditional healthcare brand follow the same train of thought as Lululemon here and leverage ongoing content to create more longitudinal relationships between individuals and their brand? Ok, end random musings for the week. Link.
  • Lifesprk, an under-the-radar but cool Minneapolis(!!!) startup announced a partnership with North Memorial to implement a hospital-at-home program that intends to help North Memorial handle surges in volume due to COVID-19. Glad to see more incumbent care delivery orgs embracing the notion of hospital-at-home (see the Gist blog linked in the Opinions section for more on this). Link.
  • Evidation, a digital health research platform, raised $45 million. I’m not entirely sure what I mean by a digital health research platform, either, but folks on the Twitter seem really excited about this company so I probably should be too. Link.
  • NexHealth raised $15 million to simplify the appointment booking process for small doctors offices. Link.
  • Genome Medical, an interesting company in the genomics telehealth space, added $14 million to its previously announced Series B. Link.

Opinions:

  • Scott Shreeve, the CEO of Crossover Health, one of the more interesting primary care model startups, penned a few blog posts this week attempting to coin a new term of ‘primary health’ to describe how their approach is different from more traditional telehealth models. I can imagine that it’s hard to get HR groups at employers to understand the difference between what the telehealth companies are offering and what digital-first primary care companies are offering (Shreeve also hinted at this on Twitter this week). From my perspective, this represents one of the fundamental challenges with selling primary care (and care delivery services, generally) through employers - employee benefits teams aren’t particularly well-equipped to understand the nuances here. Shreeve makes a interesting point contrary to this in his most recent blog, though, that COVID-19 presents a good opportunity for these digital-first primary care models to demonstrate their value to employers. Perhaps this creates an opening for these models to gain more traction? One can hope! Link.
  • In the event you didn’t read the entire 474 page CMS document on interoperability rules earlier this year, Nikita Singareddy did for you and wrote a summary of the document here. She does a nice job of summarizing some interesting portions of the document and relevant startups positioned to do well as a result. Thanks, Nikita! Link.
  • Here’s a good podcast with Kate Ryder, the CEO of Maven. Lots of interesting updates on the company - the most interesting of which is that they’ve seen a 10x increase in the number of applications they’ve received from physicians to work for Maven. I also gotta say I really appreciate the Wharton team that transcribes these podcasts into a blog post - podcasters, more of y’all should do this please! Link.
  • Speaking of Maven, ‘femtech’ continues to be a very hot space for investment dollars at the moment. This piece explores how some investors are thinking about the opportunity. Link.
  • The folks over at Gist put together a really nice analysis on the hospital-at-home space this week. The survey of consumers of when they’ll seek care in a hospital again is interesting, with 24% of people saying it’ll be over twelve months. They also touch on what seems to be the biggest challenge with many of these programs: “New hospital at home programs are lucky to admit a dozen patients in their first two months of operation—suffice it to say it’s not an investment with an immediate return.” It’s hard for health systems to justify the organizational change when the volumes for programs like this are that low. Link.
  • Deloitte wrote a solid piece on what the hospital of the future might look like, focused on how they’re going to have to change their business model to survive. Really interesting to see the three types of models they think will exist - focused factories, health hubs, or virtual hospitals. Link.
  • McKinsey shared some thoughts around the challenges facing value based care in the era of COVID-19. They suggest two potential routes forward - adding additional safeguards in value-based arrangements to ensure providers are paid, or putting those arrangements on pause. Link.
  • Walmart’s healthcare lead Sean Slovenski was interviewed on their plans in the healthcare space. It’s hard not to like their approach here - and interesting to see the comments about aiming to get the core model right over the next few years before potentially expanding into certain specialties. Link.
  • Here’s an interesting piece on what’s happened to healthcare costs / outcomes in this country over the past 40 years, looking back to Reaganomics / the neoliberal approach as a foundational issue. As for profit entities increasingly play a role in care delivery today - whether that’s Private Equity / Venture Capital groups, Optum, or employers generally - it’s interesting to ponder what outcome this will lead to (and why this time around is any different than it was when folks were writing about for profit entities improving healthcare back in the 1980s). Link.
  • HBR featured a skeptical opinion on the rise of telehealth, which is helpful to read if for nothing else to see a contrarian perspective on the telehealth hype train. I do think the piece overstates the importance of a face-to-face visit, particularly with the real world constraints imposed by a FFS system - weeks of wait times, a handful of minutes per visit, etc - but there is something to the element of trust in all of this that I’d agree will be harder to digitize. Also missing from the piece is a discussion of financial incentives for providers. Which, let’s be honest, has everything to do with how sustainable telehealth adoption is. Link.
  • COVID-19 is causing increased financial stresses among rural hospitals that were already significantly stressed. This Health Affairs piece suggests a handful of policy actions that could help rural hospitals survive the times. Link.
  • Two people get the same COVID-19 test at the same emergency room in Texas. One paid with insurance, the other with cash. For the individual paying cash, they received a bill of $199 for the test. The individual paying through insurance? $6,408 (of which the insurance plan ended up paying $1,128 and the individual had to pay $928). In what world does this make sense? Link.
  • Are drive through clinics going to become more commonplace as we become accustomed to a new normal? It’s an interesting thought - this article explores how it might look. Link.

Data:

  • In what has taken the lead for my imaginary yet also very important award for most impactful data viz of the year, a group of folks released a report analyzing healthcare spending in North Carolina. Its a cool look at spending by county and payor type, breaking down the differences in costs across Medicare FFS, Medicare Advantage, employer insurance, and Medicaid. Link.
  • CMS released a detailed report on the first year of BPCI Advanced, Medicare’s bundled payment model. This article does a nice job summarizing the report and some of the key findings, which to me basically read like providers gamed the system so we can’t draw any conclusions as to whether BPCI Advanced reduced costs (i.e. providers only signed up for episodes where they stood to gain the most). Lovely. Link.
  • StartUp Health released a report on 1H 2020 digital health funding, which hit $9.1 billion, up from $7.7 billion in the first half of 2019. Link.
  • According to an AHA survey of hospital leaders in June, hospitals are going to face another $120 billion of losses this year due to COVID-19. 60%+ of hospitals don’t think they’ll get to baseline volumes before the end of the year. Link.
  • Meanwhile, the latest data from Commonwealth Fund and Phreesia suggests outpatient practices have already rebounded to only be 11% down from baseline as of mid-June. Particularly interesting is the chart I pasted below on telehealth utilization, which is continuing to fall. Link.