In this episode of #healthTechDeals Jess DaMassa is hoping Matthew Holt disappears, possibly on Elon Musk’s rocket to Mars. Matthew just wants him to buy Chelsea FC. And then there’s actual funding deals for Osmind ($40m), Turquoise Health ($20), Mahmee ($9) & Simplifed which got $6m despite having Matthew help!
matthew holt
The Licensing Walls Come Tumbling Down
BY KIM BELLARD
Abortion rights continue to be one of the most heated issues in American politics, super-fueled by last week’s leak of a draft Supreme Court opinion that would overturn 1973’s Roe v. Wade and return the issue to the states to decide.
I’ll leave it to others more qualified than me – women, for example — to weigh in on abortion itself, but I want to talk about how abortion pills are going to force changes to our healthcare system that many may not be ready for.
Although the stereotype of abortions is a procedure done by a physician in an office/clinic, the majority of abortions in the U.S. are now done through the use of abortion pills. It is a two step process, and the two medications must be prescribed by a physician. Until last December, women were required to see a physician in person, but the FDA permanently lifted those requirements, following a temporary waiver during the pandemic. The pills are considered both highly effective and safe. There are startups, like Hey Jane and Just the Pill, that specialize in them.
Not surprisingly, since the leak searches for “abortion pills” have hit all-time highs.
The states that have been passing various abortion bans have not ignored the loophole that abortion pills represent. There are a variety of restrictions that have been enacted, such as requiring in-person visits to outright banning use of telehealth for them. In those states, some women have opted to travel out of state to do the telehealth visit and/or to receive the pills via the mail.
Continue reading…The Reckoning: What Happens to Digital Health After COVID?
By JEFF GOLDSMITH and ERIC LARSEN
It has been a rough year so far for digital health. After an astonishing $45 billion poured into new digital health companies in 2020 and 2021, and an early 2021 peak in market valuations of publicly-traded digital health providers, valuations and multiples have collapsed. Once high-flying Teladoc, which traded at an eye-watering 42x revenues and commanded a $45 billion market capitalization, is now trading around 2.7X at about $5.7 billion. AmWell, the next largest telehealth player, has seen its stock drop more 90% from its high.
Nor is the evaporation in market value is confined to just a few highly visible incumbents. The 29 healthtech companies to go public (either via IPO or SPAC) in 2021 were collectively trading 45% lower than their opening day price by the end of the year, according to STAT. Among the privately held firms, re-valuation of digital health is getting underway. Bearish market signals portend a sharp correction in digital health, characterized by brutal price competition, widening (and less tolerated) operating losses, layoffs, and ultimately, widespread consolidation.
However, there is also major pushback from the ‘demand side’ of the digital health equation. With the explosion of digital health players, potential customers are confused and frustrated. There is a fundamental disconnect between the exuberant (and as yet largely unsubstantiated) promises of digital health startups and the needs of the four ‘phenotypes’ of health care customers. How digital health firms respond to those customers’ needs will ultimately determine the shape and size of the digital health market.
Why is the Digital Health Market Correcting?
Let’s start with the supply side. It is not difficult to identify the source of the digital health boom: hyper liquidity in the market fueled by expansive COVID-related fiscal and monetary policy. In the heat of COVID, Congress enacted three enormous stimulus/relief packages in eighteen months. The Federal Reserve also turned deeply dovish, keeping interest rates near zero and embracing epic quantitative easing – pumping $120 billion a month into the economy and expanding its balance sheet by more than $6 trillion. Much of this newly printed cash found its way into the coffers of private investors. Private equity, growth equity, and venture capital collectively raised $733 billion in new capital across 2021. Globally, private equity firms alone invested $151 billion in healthcare in 2021.
Telehealth Ignition
The spark to ignite the digital health explosion came from the surprise growth in telehealth visits in the spring of 2020. In the wake of the spring 2020 lockdown and freeze on elective hospital care that accompanied the COVID public health emergency, telehealth visits went from less than 1% of total Medicare Part B patient visits in 2019 to nearly 13% during the spring of 2020 (and nearly 38% of all behavioral health visits), according to an analysis by DHHS’s ASPE. Private insurers saw 50-70% of behavioral health visits turn virtual.
This surge was not caused by a spontaneous surge of consumer activism but rather by hospital systems desperate to remain in touch with existing patients during the spring COVID lockdown. These systems saw plummeting visit volumes not only due to service closures but to patient reluctance to visit hospital ERs and outpatient clinics crowded with contagious COVID patients. Larger systems with extensive IT infrastructure were able to stand up far more robust telehealth offerings than smaller systems. As Bob Wachter, Chair of Medicine at University of California at San Francisco said, “We made 20 years’ worth of progress in twenty days.”
The sudden multi-thousand percent rise in telehealth volumes led to breathless estimates of future growth in telehealth volumes and revenues. In July 2020, McKinsey estimated a total addressable market (TAM) of $250 billion for telehealth services — this from a business with a revenue base McKinsey itself estimated at $3 billion in 2019-2020, and $5.5 billion in 2020-2021. This risible TAM estimate assumed that 24% of all physician and outpatient visits (a 1.8 billion visit “universe”) and 25% of Emergency Department visits would be addressed through telehealth alternatives.
However, more than 90% of telehealth visits during the spring of 2020 were with physicians patients already knew, not random, anonymous physicians signed on to cover telehealth services by vendors. And 47% of those visits were one-time users, according to a recent Trilliant analysis. Visit volume growth was also materially aided by Congressional approval of temporary Medicare coverage for telehealth visits as part of the COVID Public Health Emergency declaration.
Continue reading…#HealthTechDeals Episode 27: Levels, Waltz Health, Safety Wing & Implicity
In this episode of #HealthTechDeals, Jess is enjoying Cinqo de Mayo in an Addams Family-themed hotel where she is playing “the mummy” introducing health tech companies coming back from the dead. There’s gossip about Amazon’s pharmacy operation over supplying insulin, and there’s deals for Levels ($38m) in CGM analysis, Waltz Health ($35m) in pharmacy search, Safety Wing ($25m) for health insurance for nomads & Implicity ($23m) doing cardiac implantable monitoring in France.
#HealthTechDeals Episode 26: Hello Heart, Concert Health, Vivian Health, Curebase, Mendel.ai & Blue Spark
It’s the May the 4th be with you day! In Episode 26 of #HealthTechDeals, Jessica is huddling in Boston after the American Telehealth Association conference, and has Star Wars-related trivia. There’s gossip there, there’s more gossip about Cerebral & its ADHD med strategy. Meanwhile a lot of copy cats in deals today with Hello Heart ($70m) for hypertension, Concert Health ($40m) for mental health, Vivian Health ($60m) for nurse staffing, Curebase ($40m) for DCTs, Mendel.ai ($40m) for NLP & Blue Spark ($40m) for RPM — all joining very crowded markets.
ONC Explainer: Micky Tripathi Deep-Dive on Info Blocking, API standardization & TEFCA
By JESS DaMASSA, WTF HEALTH
Micky Tripathi the National Coordinator for Health Information Technology at HHS says this year will be a “transformative” year for Health IT as the decade-long, $40 billion dollar effort to lay an electronic foundation for healthcare delivery heads to the next level. Why is this year THE YEAR when it comes to the digital exchange of health information? Where is federal health IT strategy headed in order to provide the standards and policies health tech co’s need to be able to kick up the pace of innovation?
We get into a SWEEPING chat about the technology and business implications of all the work coming out of ONC, including implementation of those new information blocking regulations, goals for API standardization, and TEFCA (Trusted Exchange Framework & Common Agreement). Micky not only gives the background on the regulations and policies, but also provides some analysis on what they actually mean for those health technology companies trying to do business in-and-around a more digital healthcare ecosystem.
Healthcare Suffers from Patient Bias
By KIM BELLARD
If you went to business school, or perhaps did graduate work in statistics, you may have heard of survivor bias (AKA, survivorship bias or survival bias). To grossly simplify, we know about the things that we know about, the things that survived long enough for us to learn from. Failures tend to be ignored — if we are even aware of them.
This, of course, makes me think of healthcare. Not so much about the patients who survive versus those who do not, but about the people who come to the healthcare system to be patients versus those who don’t. It has a “patient bias.”
Survivor bias has a great origin story, even if it may not be entirely true and probably gives too much credit to one person. It goes back to World War II, to mathematician Abraham Wald, who was working in a high-powered classified program called the Statistical Research Group (SRG).
One of the hard questions SRG was asked was how best to armor airplanes. It’s a trade-off: the more armor, the better the protection against anti-aircraft weapons, but the more armor, slower the plane and the fewer bombs it can carry. They had reams of data about bullet holes in returning airplanes, so they (thought they) knew which parts of the airplanes were the most vulnerable.
Dr. Wald’s great insight was, wait — what about all the planes that aren’t returning? The ones whose data we’re looking at are the ones that survived long enough to make it back. The real question was: where are the “missing holes”? E.g., what was the data from the planes that did not return?
Continue reading…CEO Kuldeep Singh Rajput on Biofourmis’ huge Series D raise
You may have thought the days of huge digital health rounds were over. Not quite yet! CEO Kuldeep Singh Rajput talks with Matthew Holt about Biofourmis’ $300m Series D raise. They’re in the business of sensors, digital therapeutics and chronic specialty care (cardiology/oncology) and hospital at home. And as if that wasn’t enough, they have a solid plan for both organic & “inorganic” growth!
Dara’s “Hero Quest”: How About Embracing Universal Health Care in America?
By MIKE MAGEE
Joseph Campbell, who died in 1987 at the age 83, was a professor of literature and comparative mythology at Sarah Lawrence College. His famous 1949 book, “The Hero With a Thousand Faces” made the case that, despite varying cultures and religions, the hero’s story of departure, initiation, and return, is remarkably consistent and defines “the hero’s quest.” Bottom line: Refusing the call is a bad idea.
George Lucas was a close friend and has said that Star Wars was largely influenced by Campbell’s scholarship. On June 21, 1988, Bill Moyers interviewed Campbell and began with a clip from Star Wars where Darth Vader says to Luke, “Join me, and I will complete your training.” And Luke replies, “I’ll never join you!” Darth Vader then laments, “If you only knew the power of the dark side.”
Asked to comment, Campbell said, “He (Darth Vader) isn’t thinking, or living in terms of humanity, he’s living in terms of a system. And this is the threat to our lives; we all face it, we all operate in our society in relation to a system. Now, is the system going to eat you up and relieve you of your humanity, or are you going to be able to use the system to human purposes.”
Systems gone awry? Think Putinesque Russia, or Psycho-pernicious Trumpism, or Ultra-predatory Capitalism.
Dara Kharowshaki, the CEO at Uber, who took over the company from uber-bro, Travis Kalanick, is a fan of Campbell’s and understands the journey of a hero – departure, initiation, return. Perhaps that is why he defines “movement” as fundamental to life…adding deliberately the qualifier “movement in the right direction.” In an interview in December, 2021, with Brian Nowak, Equity Analyst, U.S. Internet Industry, for Morgan Stanley, he pushed for corporate engagement in a range of issues including “sustainability, safety, equity, and anti-racism – these are all issues that go to the core of who we are, and our identity.”
How did health care escape that list, especially considering the companies investment in “Uber Health” – a health care delivery service promoting speed, care coordination, privacy, and cost-effective and reliable transport to and from care-giving brick and mortar?
It may have something to do with the fact that Uber has fought tooth and nail to avoid providing health care as a benefit to its drivers. In 2020, the company joined Lyft, DoorDash and other gig companies in throwing $205 million into a lobbying effort in California titled “Yes on 22”.
Continue reading…Has Virgin Pulse’s Acquisition of Welltok Created a New Kind of Care Navigator?
By JESS DaMASSA, WTF HEALTH
Virgin Pulse has been a big name in workplace wellness for a long time – working with health plans and employers (including 25% of the Fortune 500) to provide care navigation, well-being services, health coaching and access to digital health point solutions for years. Yet, it raised some eyebrows at the end of last year when it announced its acquisition of data-driven wellness company, Welltok. So, what happens when one of the biggest names in worker wellbeing suddenly has access to a dataset of 250M healthcare consumers? Virgin Pulse’s CEO Chris Michalak stops by to talk about the value of that data, which he believes will not only turbo-charge Virgin Pulse’s engagement rates, but also provide new ways for the business to serve as a “full-on navigation capability” for employers, plans, and health systems.
As Chris puts it, Virgin Pulse has always been an “engagement company” but the addition of Welltok’s data turns it into an “activation company.” As Virgin Pulse continues to partner up with digital health point solutions, bring digital therapeutics into the fold, and build-out primary care relationships as a lead stream, the platform Chris describes starts to sound more and more like a navigation business that competes with the likes of Accolade or Included Health. Will Virgin Pulse one-day dip into primary care themselves and add their own virtual care providers? Will they build their own digital therapeutics with data derived from that rich Welltok database? We get into the ‘what’s next’ for the business as it integrates its latest acquisition and seeks to win more C-suite attention from employers seeking to better manage their employees’ access to healthcare benefits.
