Optum acquires EMIS in UK, Circulo pivots away from Medicaid plan, & more!
This week's newsletter is sponsored by Ribbon.
Ribbon shared a helpful Q&A with virtual payor/provider startup Firefly Health about how is leveraging Ribbon's provider directory data. The article provides some interesting insight into the importance of having accurate and enriched provider data for both the payor and provider elements of Firefly's model, and why they chose to partner rather than build this capability. It's a critical piece for any organization trying to effectively navigate patients to high quality, cost-effective care. Link
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In the latest news about Healthcare Sharing Ministries acting in shady ways, Orlando Health is suing a HCSM, Liberty, over $1.1 million of unpaid claims. What is odd here is that Liberty seems to have set this whole thing in motion by sending Orlando Health a letter saying they hadn't paid the $1.1 million in claims. Because Liberty encourages members to say they are uninsured and use cash pay rates, Orlando Health had no idea it had seen any Liberty members before that letter. Seems like a massive screw-up on Liberty's part to have sent that letter. Either way, it provides some interesting insight into the behaviors of HCSMs. Link / Slack
Optum is acquiring EMIS Group, a UK-based software provider for clinicians, for $1.5 billion. EMIS group has a huge footprint in the UK, and represents another really intriguing acquisition for Optum as it gets a massive footprint in the UK working with NHS. In FY2021, EMIS generated £168 million in revenue and £36.1 million in profit before tax, fitting with UHG's general approach of buying profitable heath care businesses. It's not hard to imagine their corporate development teams looking long and hard at practice management platforms here in the US. Link / Slack (h/t Ivan Beckley)
It was a bummer to see that Circulo not only joined the list of digital health startups doing mass layoffs, but it is also pivoting away entirely from being a Medicaid insurance plan. It will instead focus on moving forward on providing at-home care for individuals with intellectual and developmental disabilities. Given Circulo's backers in its initial $50 million raise just over a year ago (Drive Capital, General Catalyst, Oak HC/FT, etc) and Circulo's close ties to Olive, this seems like a bad signal both for Olive's general business trajectory as well as the viability of a Medicaid insurance startup in today's market. Link
Bardavon acquired PeerWell in the MSK space. Bardavon has a network of 21,000 physical and occupational therapists, working to improve workers compensation experience. Interesting to see more integration between physical and digital assets, something we expect to see more of moving forward. Seems like a natural landing spot for a solution like PeerWell. Link
AmWell apparently put in a bid to acquire Talkspace that has been rejected, but it sounds like we should expect Talkspace to be acquired sometime soon. Link / Slack
Private equity firm Hg Capital is selling Medifox Dan to ResMed for $1 billion. Medifox Dan provides a tech platform for nursing homes, home health agencies, and outpatient therapy. It's used by 70,000 patients and 1,110 customers daily in Germany. Link
The topic of patient data and how it's being shared / sold came up in a number of ways this week. Senator Elizabeth Warren is proposing legislation to prevent the sale of location health data in anticipated response to Roe v Wade being overturned. The Washington Post also reported on how Phreesia is getting consent to use patient data in ways that patients may not realize it, and Stat reported on how many leading hospitals have Meta pixel trackers on their website, giving Meta access to sensitive patient information. It will be curious to watch how this space evolves. Phreesia: Link / Slack (h/t Martin Cech) Meta: Link / Slack (h/t Aaron Maguregai) Warren legislation: Link / Slack (h/t Nitin Karandikar)
Epic announced that it plans to join the new interoperability framework TEFCA as a QHIN. If you're curious what TEFCA is, check out our conversation from earlier this year with Lisa Bari and Brendan Keeler. Link / Slack (h/t Brendan Keeler)
SCOTUS sided with hospitals in a case on 340B, finding that the Department of Health and Human Services used an illegal methodology to determine average drug prices and cut reimbursement rates, driving $1.6 billion in savings. Link / Slack (h/t Suzy Goldenkranz)
Aidoc, an AI platform for health systems, raised $110 million. The company has been operating in the imaging space and looks to be investing in building out its platform into clinical workflows in the hopes of addressing workforce supply issues by freeing up doc time to see more patients. Link
Capital Rx raised $106 million to build a more transparent PBM for employers. Obviously the PBM space has a lot of room for more transparency - will be fun to see if Capital Rx can garner some serious traction here and create pressure on existing PBMs to become more transparent. Currently it has 150 customers with 1+ million members. Link / Slack (h/t Justin Venneri)
Proximie raised $80 million for its virtual surgery platform. Link
Sana, a startup selling insurance to SMBs (small & medium businesses), raised $60 million. Sana currently has ~20,000 members, and is focused on providing a lower cost option for SMBs by focusing on primary care access (i.e. free visits, partnerships with telehealth startups, etc) and using reference-based pricing instead of a network. Interesting to see that Sana has opened up its first primary care clinic that is free to members and plans to continue expanding clinics. Sana suggests it will get to profitability with this round of funding, which highlights how much the market has turned recently. Link / Slack
Oma Fertility raised $29 million, to build a technology/AI platform for IVF. Its technology identifies the most promising sperm to pair with an egg. Link
Abacus Insight, a data platform for payors, raised $28 million in a round led by MultiPlan, the SPAC'd provider network for insurers that was the subject of a short report back in 2020. You can see the potential synergy for both parties, presuming the short report hasn't materialized (it predicted MultiPlan would lose its biggest client, UHG, by end of 2022). Link.
Sesame raised $27 million for its cash pay care delivery marketplace. The average price paid for a visit on the marketplace is $40, with some as low as $25. Sesame is rolling out a membership based product for $99/yr - would be really curious to know how the financial flows work out on that. Given it doesn't appear Sesame is employing providers itself, I'd assume Sesame is paying providers the same rate, which means they're essentially taking financial risk on patients not utilizing the marketplace, which seems like an odd incentive for Sesame. Not quite sure I understand it unless they're moving away from a pure marketplace approach. Link / Slack
Berlin-based Cara Care raised $7 million for a digital therapeutic for gut health. Link / Slack (h/t Rik Renard)
The New York Times featured a really good piece looking at how Medicaid can address homelessness. It spends a good amount of time on the policy side - i.e. whether Medicaid should be the agency that solves for housing needs - and also provides some good examples of interesting activity here in Philadelphia and Arizona. The article provides some good thought provoking points about how Medicaid can step in and help here, even if it isn't necessarily the way an optimal system would be designed. Link / Slack (h/t Frederik Mueller)
This Second Opinion piece featuring Sean Duffy from Omada exploring how much care can be moved virtual is quite interesting. Omada looked at all CPT codes to determine which may be feasible for virtual care, finding that roughly 30% of care can be delivered virtually. Regardless of whether you think that percentage is correct, it should serve as another reminder that all virtual-first or virtual-only care companies are going to need to figure out how they integrate with the physical care ecosystem in the relatively near future. Link / Slack (h/t Rik Renard)
This is an interesting deep dive on how AARP profits off its trusted relationship with seniors, by getting paid to sell seniors services from organizations like Oak Street Health and UHG. AARP apparently brings in over $1 billion a year in revenue from royalties related to these types of licenses (it only brings in $300 million a year in member dues). The UHG deal sounds like it brings AARP at least a few hundred million via a fixed marketing fee for use of its brand name and then essentially a ~5% commission for each plan sold. It's not hard to imagine the Oak Street deal has similar mechanics, and while we'd guess the Oak Street deal isn't that consequential yet for AARP, we can imagine that both parties would like it to be. It's a very shrewd business move for all parties here, although a bit more transparency would certainly be welcome. Link
KHN featured another cautionary tale of a rural hospital taking private equity money. It's a sad state of affairs when groups like Noble Health are the only willing buyers of rural hospitals. It seems to be a story that happens on repeat - a questionable buyer emerges telling a story about how they can save a hospital, said buyer saddles it with additional management fees, cost cutting measures don't work, and the buyer shuts the hospital down. It's depressing in how inevitable this cycle seems - which also seems like a massive opportunity for a new model to break through here. Link / Slack
Here's a good perspective in HBR from Spencer Dorn on how to think about unbundling the various services that specialty care provides. Building off the challenges that rural hospitals are facing articulated in the article above, it seems like there is an opportunity to apply this sort of thinking to come up with new approaches to addressing rural healthcare needs in this country. I am quite curious to see when we see models like India's Narayana Health emerge here in the US. Link / Slack (h/t Spencer Dorn)
This eHealth survey of 2,800 Medicare Advantage enrollees suggests that 88% of people are satisfied with their plans and 86% would recommend Medicare Advantage to a friend. The biggest dis-satisfier for MA is lack of access to providers, which is something to keep an eye on if providers start playing hardball with plans more regularly as we've started to see a few cases of recently. Either way, it's not hard to see why MA is growing so well at the moment (regardless of whether its increasing overall costs or not), both in the survey result itself, along with the fact that a broker is conducting / releasing it. Link
West Health and Gallup released a poll that suggests that seniors are struggling with healthcare costs and foregoing care. 37% of seniors over 65 are concerned about affording healthcare in the next year, with roughly six million people foregoing care due to cost and six million skipping medications. While this data doesn't call out MA vs FFS Medicare, it is interesting to read this article and the one above and think about what is happening from a coverage perspective, especially across different patient segments. Link
KFF & NPR also published some rather depressing data suggesting that 100 million people in the US have medical debt. It's a sobering reminder how unaffordable healthcare in this country is generally. The article also finds that one in seven people with medical debt have been denied access to care because of the debt (and about two thirds have avoided care). Link / Slack (h/t Kevin DeLury)
This is a very nerdy article looking at how network adequacy is measured across states in Medicaid, finding that there is very little consistency. Almost all states use some drive time / distance standards, but there is wide variation beyond that - 37% have standards for SUD treatment, 25% have a "provider choice" standard (meaning more than one provider), ~33% have provider:enrollee ratios. If you're interested in network adequacy requirements, it's a good read. Link
Frame Fertility, a virtual fertility platform, is hiring a Chief of Staff to the CEO. Link.
Graphite Health, a not-for-profit building a healthcare data platform, is hiring a Director of Engineering - Interoperability Platform. Link.
Homeward Health, a hybrid primary and speciality care startup for rural communities, is hiring a Senior Product Manager, Core Experience. Link.
Tia, a tech enabled women’s health clinic startup, is hiring a Vice President, Experience Design. Link.
Turquoise Health, a startup building a price transparency platform, is hiring a Head of Marketing. Link.
Access the HTN Jobs Board for the full list of job postings. If you're interested in a career profile (e.g. Ribbon recording), please reach out here.
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