Kevin's Weekly Health Tech Reads 9/27

Some pretty incredible deep dives this week including CHQPR detailing rural hospital finances and a look into Sutter's antitrust case; Bright Health raises $500m; & more!

For access to exclusive content, join the community

News:

  • Bright Health, the Minneapolis-based (!!!) health insurer, raised another $500 million, bringing it to $1.5 billion in capital raised since its start in 2016. They currently provide coverage to 200,000 members across 13 states, and I would assume at least some of this capital will be used to fund more acquisitions similar to their purchase of Brand New Day that closed earlier this year. Link.
  • Illumina acquired GRAIL, the cancer detection startup that just filed its S-1, for $8 billion. Keep in mind GRAIL spun out of Illumina in 2016 and Illumina still had a 14.5% ownership stake in GRAIL. Link.
  • Sams Club is now selling a subscription telehealth model to its members in partnership with 98point6, expanding upon the success they had in a pilot in a handful of states. The press release is mum about what that success looked like - would be really interested to know how many people signed up for this program. Link.
  • HIMS is nearing a SPAC deal to go public that would value it at $1.6 billion. Link.
  • 1-800-CONTACTS traded private equity owners again this week, with KKR buying it this time around for over $3 billion. Link.
  • Papa, the startup creating a ‘grandkid’ rental service for seniors, raised $18 million to expand to all 50 states. Pretty wild that according to this article Papa is seeing 20,000 applicants per month for the ‘pal’ role (i.e. the grandkid). Link.
  • The President released an executive order on healthcare this week, which… gah I dunno. Check out Nicholas Bagley’s tweet storm if you want a thoughtful analysis of what appears to be a pretty thoughtless document. Link.
  • Microsoft Teams is integrating its video platform directly into EMRs, starting with Epic. A number of big systems are already using Teams including Providence, Northwell, Allina, and the NHS. Link.
  • Osso VR raised $14 million to leverage virtual reality for surgical training. Link.

Opinions:

  • This is a great read on the backstory behind Sutter Health’s negotiating practices and the $575 million settlement it reached in its antitrust case. It provides some really interesting insight into how a dominant health system can use its leverage in payer negotiations in the local market - the gag clauses in contracts on prices and the all or nothing approach to pricing. When you take an all or nothing approach to pricing and you’re the biggest game in town delivering some key services (i.e. maternity), it providers for significant leverage over payers. A pretty worrying piece when you think about the trend of hospital consolidation at large. Link.
  • Here’s a deep dive on Bind, the Minneapolis(!!!!) health insurance startup that everyone loves and nobody understands. Bind is adding a fully insured product for 50+ employee groups, in addition to the self insured large company market it originally targeted. This move, which means Bind is becoming an insurer rather than just a TPA for customers, opens the door for it to expand into the individual market as well, which it sounds like it is looking to do. Super cool - and I still have no idea how it works. Link.
  • Here’s a quick interview with the former head of Walmart Health. I found it interesting for his comments about how they decided to build out health centers as a cash pay only business and cutting insurance out of the equation in order to reduce costs of operating the clinic by 45%. Link.
  • This is a solid blog post on how the reimbursement model is working for Viz.ai’s AI algorithm (which it recently announced is being reimbursed by CMS at up to $1,000 per case). Link.
  • Here’s a fascinating read on Epic’s backstory and corporate culture, asking some interesting questions about what happens after Judy is no longer with the company. It provides a good look at how Epic has traditionally recruited talent to its campus outside of Madison, and some of the issues they’ve faced during COVID-19 with the organizations insistence that everyone works in person. Check out the chart below on employee satisfaction ratings… woof. Link.
Epicchart2
  • HHS shared this opinion this week encouraging Medicare Advantage providers to not game the risk adjustment system, after releasing a report suggesting that Medicare is paying out $2.6 billion in risk adjustment payments for “diagnoses that are unrelated to any clinical services”. I think that’s another word for fraud? Anyways, the article is a good read on the risk adjustment process. Link.

Data:

  • If anyone knows Harold Miller at the Center for Healthcare Quality and Payment Reform please pass along my gratitude for the most incredibly thorough and awesome analysis of the financial state of rural hospitals in this country. Seriously - this report is 178(!!!!) pages of sheer goodness. It goes into so many awesome details that I’m not even sure how to begin describing it here. Want to understand why some rural hospitals are facing losses in the first place? Check out Section II! It turns out that some small rural hospitals lose money on private pay patients, and not surprisingly when you lose money on private pay you lose money on the whole. Want to understand how much it costs to run a rural ED, inpatient facility, primary care clinic, etc? Check out Section 3! It provides an incredibly in depth look at the costs associated with each, illustrating very well the challenges with operating / staffing clinics when you have low patient volumes. Want to understand the Medicare cost-based payment approach? Check out Section 4! Want to understand how alternative payment models might work for rural hospitals? Check out Sections 5 & 6. Seriously this thing is an absolute gem. Link.