Weekly Health Tech Reads | 5/1

Teladoc and Accolade shares tank after earnings, Cerebral faces a lawsuit, our look at Devoted Health, and more

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Our Stuff:

As we continue writing more exclusive content for HTN members, we'll call out some of the articles we've been writing here for folks. If you want access to these articles, sign up here.

  • Devoted Health Deep Dive. A community member asked us for an update on Devoted Health, so we did a deep dive on what we know about the state of the business - our version of a private company initiation of coverage. Its MLR performance in 2021 seems a lot like many of the other insurance startups, and it'll be interesting to watch if the private markets are willing to subsidize losses moving forward after watching the performance of Bright, Oscar, and Clover on the public markets.
    Link.
  • Earnings Call Discussion. It was an eventful earnings week as digital health companies Accolade and Teladoc took nose dives while incumbent insurers Humana and Centene raised outlook for the year. We provided our perspectives on each earnings call here.
    Link.
  • A look at MA Onboarding. McKinsey recently shared an interesting survey looking at member onboarding processes for Medicare Advantage plans recently, finding that members didn't think they were getting many basic elements of their plan. We took at look at Devoted's onboarding process to show what a good experience can look like (Devoted appears to have a very nice onboarding flow).
    Link.

News:

  • Teladoc's stock plummeted 40% as its earnings announcement underwhelmed, with Teladoc revising its 2022 guidance downwards. The D2C mental health market and challenging employer sales cycles were the primary culprits here. As we discuss for HTN members, the D2C mental health market appears to have turned very quickly for Teladoc.
    Link (transcript) / Link (HTN) / Slack
  • Accolade's stock plummeted 50% as its earnings announcement underwhelmed, with Accolade announcing that its largest customer, Comcast, is ending their contract as of December 2022. Accolade also saw a general softening of the employer market and not surprisingly is shifting its focus toward profitability vs growth.
    Link (call) / Link (HTN) / Slack
  • Humana raised guidance for the year after a strong Q1. Humana spent a good portion of the earnings call providing insights into their healthcare services business and how they're moving it to value, laying out a three step strategy to do so.
    Link (transcript) / Link (HTN)
  • Centene also raised guidance for 2022 after a strong start to the year, as well as an assumption that redeterminations will start in August, which is pushed back three months from its previous assumption. Centene spent a lot of time talking about value creation / operating efficiency during the call.
    Link (transcript) / Link (HTN)
  • This is an interesting read out of South Florida about how Medicare Advantage members with Humana PPO plans are in the middle of a contract dispute between Humana and a local health system. It's an look into payor / provider contracting dynamics currently. Seems like over the next year we're going to see systems push back hard and fight for rate increases (particularly given the rising input costs - see the AHA article in the Data section below).
    Link (paywalled) / Slack
  • Speaking of MA market dynamics, a federal report found that MA plans are using prior authorizations to inappropriately deny care for patients.
    Link / Slack
  • BCBS Michigan is launching a joint venture with Honest Medical Group to help independent PCPs take risk with Medicare patients (both MA and ACO REACH). It's interesting to see Honest partner with a payor in Michigan after forming a JV with a IPA in Buffalo (this is a good read on the model in Buffalo). Will be curious to see if this is an A/B test of go-to-market or an intentional strategy to form JVs with either payors or providers in different markets. Either way, the underlying thesis seems smart in an agilon-esqe way - form a relationship with a scaled player in a mid-sized market, facilitate moving it from FFS to global cap, and take a cut of the global cap payments for PCPs. It should be a win-win-win.  
    Link / Slack
  • Cerebral again finds itself in hot water this week, this time as a former VP makes some serious allegations against the company. In addition to the issues we've heard raised previously about leadership valuing growth over all else, this alleges that Cerebral did nothing about a data breach for tens of thousands of patients and knew about thousands of duplicate mailing addresses, a sign of prescription fraud. At the very least, something seems fundamentally broken within the culture of this company. Even investors appear to be distancing themselves here - as discussed in Slack, Oak HC/FT, a noted healthcare investor that led Cerebral's Series A round in late 2020, has removed Cerebral from its list of active investments on its website in the past few months (it was listed as an active investment as recently as January 2022).
    Link / Link (case) / Slack (h/t Ryan Gallagher)
  • The WSJ reports that Walmart, CVS, Walgreens, and Capsule pharmacies are denying adderall prescriptions from Done (which is the primary focus of the article) and Cerebral over concerns relating to excessive prescribing practices. What a mess.
    Link (paywalled) / Slack

Funding:

  • Remote monitoring company Biofourmis raised $300 million at a $1.3 billion valuation. They've got two lines of business within the company, one helping pharmaceutical companies monitor patients and develop digital therapeutics. The other is a hospital-at-home model. It's a friendly reminder of how similar many of the underlying core competencies can be across seemingly distinct segments of care delivery innovation.
    Link / Slack (h/t Raihan Faroqui)
  • Yet another staffing platform raised a significant round, as Vivian Health raised $60 million. Vivian is a bit unique from other startups in that it is a division of IAC. The press release includes some interesting data points - 700,000 clinicians are registered on Vivian, and they've facilitated over 3 million job applications. Seems like a pretty sizable business.
    Link / Slack
  • Concert Health raised $42 million to help integrate behavioral health into primary care. It's currently partnering with 54 groups across 11 states, which include health systems, independent medical groups, FQHCs, and more.
    Link / Slack
  • Syllable, a tech platform that helps make health system call centers more efficient, raised $40 million.
    Link
  • Waltz Health raised $35 million playing in a similar space as GoodRx to help consumers save on their prescriptions.
    Link / Slack (h/t Matthew Holt)
  • Frame Fertility, a fertility startup selling into employers, raised a $2.8 million seed round.
    Link / Slack
  • Ruth Health, a telehealth model for prenatal and postpartum care, raised $2.4 million.
    Link

Opinions:

  • Buzzfeed did an in-depth report on home and community-based health provider BrightSpring. It provides a sobering view on the challenges the organization has faced since being acquired by KKR in 2019. It's a reminder of how glamorous companies can sound in investor filings (check out the narrative of their recent S-1) versus the reality of what patients are going through. I think it's worth going through both the S-1 and this article asking the question: is this a company that is putting profits over patients? Or is this just a challenge the entire industry faces where staffing is a massive challenge?
    Link / Slack
  • Halle Tecco penned a good piece looking at how broken fertility care is in this country, in terms of access, cost, and quality for patients. It is hard to see how terrible the experience is for patients, yet meanwhile, investors are doing quite nicely rolling up fertility clinics across the country. It's a stark reminder of how flawed the system is for patients, but also that the system isn't actually designed for patients at all. It's designed around the entrenched interests making a lot of money in those fertility clinics.
    Link / Slack
  • Blake Madden takes a look at the future of the independent physician practice and the current boom in physician practice management models, predicting that practice management models will run out of steam over the next few years and new models enabling independent practices will emerge. Will certainly be interesting to watch.
    Link / Slack (h/t Matthew Conboy)
  • This is a good look from Jacob Effron on approaches that startups are taking to value-based care including the market landscape overview below. It gets into some helpful nuance like how Aledade and Stellar approach getting into provider workflows differently.
    Link / Slack (h/t Jacob Effron)

Data:

  • The American Hospital Association released a report articulating how rising costs are causing financial challenges for hospitals. Among other things, it is interesting to see them pick a fight with staffing agencies, calling out the exorbitant prices and skyrocketing margins for staffing agencies. You'd think that if this data is true this market will normalize pretty quickly - if I'm an RN working for a staffing agency that is generating a 62% profit margin off my time, I'm going to go work with another agency makes 15% margin and pays me the remaining 47% margin.
    Link / Slack
  • This is an interesting study in JAMA looking at the impact of telehealth on utilization patterns. It finds that for commercially insured patients with acute conditions, an initial telehealth visit had higher odds for follow-up in-person care than an initial in-person visit. Yet for chronic condition management, it had lower odds.
    Link (summary) / Link (study) / Slack (h/t Kevin Wang)

Featured Jobs:

  • Human API, a startup building a real-time health data network for consumers, is hiring a Marketing Leader. Link.
  • Initiate Studios, a healthcare focused startup studio that partners with founders to co-create companies, is hiring a Principal, New Ventures. Link.
  • Truepill, an API-connected healthcare infrastructure startup, is hiring a Chief Operating Officer. Link.
  • Welkin Health, a startup building a care management platform, is hiring an Operations Analyst. Link.

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