An overview of Carbon Heatlh, CareMax's acquisition of Steward's VBC business, & more!
Three things this week:
Carbon Health Deep Dive. Carbon Health obviously made headlines this week unfortunately for laying off 250 employees as it makes strategic adjustments. Given changing market conditions, it shouldn't come entirely as a surprise that a company with the growth ambitions of Carbon is facing some tough strategic choices. We began diving in a few weeks back writing a research report on Carbon's current state business, and published our "initiation of coverage" style report yesterday. Carbon is certainly an interesting case study and there is a lot to learn from its approach. It looks a lot like a private-equity style rollup of small urgent care practices that benefitted significantly last year from COVID volumes, but is perhaps a bit over its skis in selling a huge vision about changing the way we access healthcare. As Carbon shifts to focus on profitability, we think it is going to look a lot like other urgent care plays, like CityMD. As CityMD and others have demonstrated, that can still generate a nice exit, even though the $3.3 billion valuation Carbon hit recently feels like a thing of the past. Link (paywalled) / Slack
CareMax's Acquisition of Steward's VBC Business. We took a look at what we learned in this acquisition as CareMax has acquired Steward's 171,000 VBC lives and will act as the MSO to Steward moving forward. It's a really interesting example of capital efficient growth for CareMax, as it now has access to nearly 400k Steward MA FFS patients that it can attempt to flip to global cap contracts. We dig more into this and a number of other takeaways in the article below. Link (paywalled).
HTN Survey on Market Sentiments. Clearly the shifting investment market tides is changing the way digital health startups are behaving. In a joint effort with Christina Farr, we're surveying both digital health company leaders (involved in fundraising and overall strategy) and investors to get a sense of how the changing markets are impacting decision making. If you're in either of those categories (digital health leader or investor) we'd appreciate it if you took ~3 minutes to fill out the survey below. We'll compile results and share out findings! Survey Link
Rural care delivery startup Homeward has partnered with Rite Aid to provide care at rural Rite Aid locations. The partnership will initially launch in Michigan, where Homeward will park mobile care units in Rite Aid parking lots. The operational logistics are interesting here - it sounds like Rite Aid pharmacists will be responsible for driving awareness of Homeward's services. Seems like a big win for Homeward to sign up a relationship like this as a relatively early stage startup, and it sounds like they're going to seek to grow via similar partnerships with organizations in rural markets that are already interacting with consumers daily. It makes a lot of sense, obviously with the key question being how well these partnerships are operationalized. Link / Slack
Accrete Health Partners, which was spun out by Bon Secours Mercy Health, has acquired longtime Epic consulting shop Nordic Consulting Partners. Epic consulting shops have been really nice businesses, as Nordic has over 1,900 employees and google would suggest it's doing over $100 million revenue annually. Will be curious to watch what Bon Secours Mercy does with Accrete / Nordic over time. Link / Slack (h/t Brendan Keeler)
Optum is acquiring another Texas provider group, this time its a Dallas-based group called Healthcare Associates for a reported $300 million, an EBITDA multiple in the "high teens" according to the article. UHG just continues to to run circles around the rest of the industry and it doesn't seem like there's much anyone can do about it other than watch in awe, and wait until either regulators step in or cracks start to emerge over time as it inevitably struggles integrating these assets in a meaningful way. Link / Slack (h/t Michael Ceballos)
Cerebral and Carbon Health both announced large layoffs this week, and we're fairly certain they won't be the last growth stage company that will need to lay off staff given market conditions as companies realize that valuations are coming back down to earth and investors are looking at cash flow. Carbon's post in particular provided some nice insight into how the business has changed very quickly, especially around COVID-19. Link (Cerebral) Link (Carbon)
As layoff announcements become more common for growth stage employees, we'd love to support those impacted by the layoffs find their next gig at awesome companies within the HTN community. If you're one of the folks who was laid off and are looking for what's next, fill out this form and we'll share your details with the HTN community in our #talent-for-hire channel on Slack. And if you have other thoughts on how we can help support those individuals, we're all ears.
PE firm Francisco Partners is selling specialty pharmacy firm Trellis Rx to CPS Solutions. Link
European virtual fertility clinic Apricity is acquiring a period tracking app, Woom. Link / Slack (h/t Rik Renard)
Hint Health, a platform enabling Direct Primary Care practices, raised $45 million. DPC is one of those concepts that has been around in healthcare for a while now, and seems really solid, although it's just never caught on in the mainstream. Hopefully organizations like Hint can help more providers practice leveraging this sort of model. Link / Slack
Moxe Health, an interoperability platform, raised $30 million. Link / Slack (h/t Brendan Keeler)
Culina Health raised $4.75 million for a food-as-medicine platform. Link / Slack
Visana, a Minneapolis (!!!!) based startup building a virtual platform for women's health, raised $2.6 million. Link / Slack
This is a good read on how Medi-Cal is providing medically tailored meals to Medicaid recipients in the state as part of a broader attempt to curtail spending. The article focuses on Inland Health Empire, a health plan with 1.5 million Medicaid members that has ~11,000 eligible members for this program, with 720 people having been approved for the benefit since January. Link / Slack (h/t Martin Cech)
If you want to better understand the challenges created by state-based provider licensing, this is a great blog from Crossover Health's CEO Scott Shreeve. It describes his attempt as a physician to get licensed in the state of Colorado, how they denied his license because as CEO they didn't think he'd practice enough, and how Crossover had to spend ~2 years in a legal fight with Colorado's state medical board to eventually get him licensed to practice there, so that Crossover could enter the state. These are the sorts of things that make innovating in healthcare so hard - mundane, illogical regulatory requirements that most people who haven't been through it before assume don't exist. And yet here we are reading articles like this. Link / Slack
This is an interesting market map from the Andreessen team on the unbundling of the payvidor landscape. As with virtually all market maps, the more I look at it the more confused I get by it, but it provides a helpful lens on where startups are picking off pieces of the core insurance product offering with good examples of companies working on each piece. If you're interested in startups playing in the insurance landscape, this is a really good starting point. Link / Slack (h/t Jon Wang)
For those interested in a history of health insurance in this country, this is a good Substack piece by James Leckie running through the last 100 years of evolving health insurance policy in this country and how we got to this point. Link
Pearl Health shared an interesting analysis looking at how much FFS revenue can be replaced by ACO Reach for providers. Link
Cleveland Clinic, the non-profit academic health system, is hiring an Executive Director Access Transformation. Link.
Optum's Home & Community team is hiring a Director of Operations Transformation. Link.
Privia Health, a physician enablement company, is hiring a Director, Digital Strategy and Operations. Link.
Homethrive, a startup building an aging-in-place platform, is hiring a Principal Product Designer. Link.
The University of Texas at Dallas, is hiring a Health IT Program Manager to collaborate across UT System’s Health Related Institutions (HRI’s). 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.
For access to exclusive content, join the community