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Inside Wheel’s $150M Series C: CEO Talks “Long Game” for Stealthy Virtual Care Infrastructure Biz

By JESSICA DaMASSA, WTF HEALTH

Wheel’s CEO Michelle Davey says the white-label virtual care startup’s $150M Series C – led by notable health tech mega-funders Lightspeed Venture Partners & Tiger Global – is “really about the long-game.” We get into the details of this purposeful funding round and what it means for the future of Wheel, as well as the play-by-play analysis of what happened over the past 9 months, since the company closed its $50M Series B. (FYI: Wheel’s total funding is at $216 million to-date.)

Wheel is currently running behind-the-scenes for an undisclosed client list of brands, facilitating 1.6 million virtual visits a year for digital health companies, digital pharmacies, retailers, and, now, even traditional healthcare providers. That number is expected to triple by the end of 2022, and we get into what’s fueling that growth and whether or not Michelle believes that this institutional push toward online care will persist as the pandemic wans and the world continues re-opening.

Armed with this fresh funding, how will three-year-old Wheel continue to differentiate its offering from legacy telehealth infrastructure providers like Amwell and Teladoc? How will it win against their legacy relationships with legacy healthcare providers? Or, is Wheel’s big bet on the continued scaling of what Michelle calls “next generation healthcare”? Wheel has added A LOT of tech to its own infrastructure recently, providing asynchronous options, better clinician matching, more triaging and navigating, and, with this funding, are is now talking about adding “diagnostic services” to round out their service line. What, exactly are we talking about here in terms of business model evolution? Tune in and find out what this stealthy startup is up to!

THCB Gang Episode 80, Thursday Jan 27

Joining Matthew Holt (@boltyboy) on #THCBGang for an hour of conversation on the happenings in health care and beyond were regulars medical historian Mike Magee  (@drmikemagee) and writer Kim Bellard (@kimbbellard), and TWO special guests.

Shantanu Nundy @DrNundy  is Chief Medical Officer of Accolade and last year we had him on to talk about his book Care After Covid. This week, with Lisa Cooper and Kedar Mate he wrote in Jama adding “advancing health equity” as a new part of the “quintuple aim.”

Our second guest was Janae Sharp @CoherenceMed from the Sharp Index, which is dedicated to increasing awareness of and reducing physician suicide and burnout through support and data science

Were we ever going to be able to cover everything about physician burnout and health equity in just one hour? Yes, it was unlikely but we gave it our best shot!

The video is preserved below. If you’d rather listen to the episode, the audio is available from Friday as a weekly podcast available on our  iTunes & Spotify channels. 

Infermedica raises a big round and demos new product

Infermedica is a company that started by creating symptom checking and chatbot functionality in Poland back in 2012. It’s spread to delivering that patient-facing diagnosis functionality via API and now as preparation for a physician visit. Today they announce a $30m series B and demo their new product which helps prepare a visit, and integrates into the clinician workflow. I spoke with CEO Piotr Orzechowski and Chief Product Officer Tim Price–Matthew Holt.

Interview & Deep Dive into Summus Global

Summus Global is company with a very interesting model that gives a glimpse about the future of virtual care. It delivers online specialty care and much more to employers. You might think that means it is in the second opinion space, or in the care navigation space. And you’d be right, but not completely right. Julian Flannery the CEO tells me that it’s much more than that and has greater ambitions too. I took really deep dive into Summus with conversation with Julian and a thorough demo of the service from Dennis Purcell the COO–Matthew Holt

Medicare Advantage Is a Superior Program (Part two)

By GEORGE HALVORSON

Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably with his proposal for Medicare Advantage for All post-COVID. He wrote a piece in Health Affairs last week arguing with the stance of Medicare Advantage of Don Berwick and Rick Gilfillan (Here’s their piece pt1, pt2). Here’s a longer exposition of his argument. We published part one last week so please read that first. This is part two – Matthew Holt

Medicare Advantage is better for the underserved

The African American and Hispanic communities who were particularly hard hit by those conditions and by the Covid death rates have been enrolling in significant numbers in Medicare Advantage plans.

The sets of people who were most damaged by Covid have chosen in disproportional numbers to be Medicare Advantage members. Currently 51 percent of the African Americans on Medicare are in Medicare Advantage plans and more than 60 percent of the Hispanic Medicare members will be on Medicare Advantage this year.

That disproportionate enrollment in Medicare Advantage surprises some people, but it really should not surprise anyone because the Plans have made special,  direct, and inclusive efforts to be attractive to people with those sets of care needs and have delivered better care and service than many of the new enrollees have ever had in their lives. 

The Medicare Advantage plans have language proficiency support competencies, and language requirements and capabilities that clearly do not exist anywhere for fee-for-service Medicare care sites. A combination of team care,  language proficiency, and significantly lower direct health care costs for each member has encouraged that pattern of enrollment as well.

The $1600 savings per person has been a highly relevant factor as more than twice as many of the lowest income Medicare members — people who make less than $30,000 a year — are now enrolled in Medicare Advantage plans.

Medicare Advantage’s critics tend to explicitly avoid discussing those enrollment patterns, and some of the most basic critics actually shamelessly say, with what must be at least unconscious malicious intent in various publications and settings, that the Medicare Advantage demographics for both ethnicity and income levels are a clone for standard Medicare membership. Those critics have said that  there is nothing for us to learn or see from any enrollment patterns or care practices based on those sets of issues.

Many people who discuss Medicare Advantage in media and policy settings generally do not focus on or even mention the people in our population who most need Medicare Advantage — the 4 million people who are now enrolled in the Special Needs Plans.

Special Needs Plans for Dual Eligibles

The Special Needs Plans take care of low-income people who have problematic levels of care needs and who very much need better care.

Continue reading…

Medicare Advantage Is a Superior Program (Part one)

By GEORGE HALVORSON

Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably with his proposal for Medicare Advantage for All post-COVID. He wrote a piece in Health Affairs last week arguing with the stance of Medicare Advantage of Don Berwick and Rick Gilfillan (Here’s their piece pt1, pt2). Here’s a longer exposition of his argument. We are publishing part one today with part two coming soon – Matthew Holt

The evidence for Medicare Advantage being a superior program compared to standard fee-for-service Medicare is so overwhelming that anyone who cares about actual Medicare Patients or who cares about the financial future of Medicare should be strongly supporting having as many people as possible enrolled in that program as soon as we can effectively make that happen.

Compared to fee-for-service Medicare, Medicare Advantage has better benefits.

Compared to fee-for-service Medicare, Medicare Advantage has a better tool kit at multiple levels.

Medicare Advantage has team care, connected care, and electronically supported care processes — and we know beyond any debate or dispute that those advantages exist for Medicare Advantage over standard fee-for-service Medicare because fee-for-service Medicare does not pay for those sets of services and literally labels it billing fraud if a caregiver who provides team care in a patients home to prevent a congestive heart failure crisis or to keep a life threatening and function impairing asthma attack from happening sends a bill to standard Medicare for those services.

The superiority of Medicare Advantage is beyond question.

Standard fee-for-service Medicare has no quality care processes, no quality reports and no quality standards or expectations at all. Standard Medicare actually has absolutely no quality data and does not hold any provider accountable for the quality of the care they deliver.

Medicare Advantage has an extensive quality agenda and tracks more than 40 categories of quality and service at the plan level. Medicare Advantage plans build continuously improving programs around those Five-Star priorities and measures, and we know from our current reporting that even during Covid, the percentage of Medicare Advantage patients with cardiovascular disease who are currently on statin therapy went up from 80.86% of patients a year ago to 83.36% this year.

The ratings by the Medicare Advantage members for customer service by their plans went from 90.56% a year ago to 90.87% this year.

That is not a big improvement but having satisfaction numbers that start out that high actually go up during Covid days is an accomplishment and it is one of the reasons why we should be encouraging people to join the plans and its why fee-for-service Medicare is a measurably inferior approach for so many people.

Standard Medicare does not have a clue about who is getting their statin Medications and they officially don’t care.

In fact, some of the fee-for-service Medicare doctors and care sites who are paid only by the piece for care from the standard Medicare program actually often make more money when care fails, because when a patient has a major asthma crisis or a congestive heart failure crisis, that negative outcome for a patient can generate multiple medical fees and it can too often trigger a $10,000–$20,000 total additional cash flow to the caregivers whose care sites failed that patient by not helping improve the health of the patient before the crisis was triggered.

Why is Medicare Advantage’s purchasing system better?

Medicare Advantage plans are paid by Medicare by the month for each patient and they are not by the piece for each item of care.

Because Medicare Advantage plans are paid by the month for each patient, and must, by contract, provide complete care to each patient, it makes extremely good sense for the plans to help patients in ways that prevent asthma attacks and that prevent congestive heart failure crisis, and that avoid and help reduce the levels of blindness and amputations for their diabetic patients that can too easily happen to those patients if you don’t manage and guide that care.

The Medicare Advantage approach for all of those categories of care is obviously far better for the patients than the fee-for-service Medicare inadequacies in care.

Continue reading…

Health in Two Point 00 – The LAST Episode (247)

It’s the very last episode of Health in Two Point 00! (We’re not going away just changing the name next week). Six deals in 2 minutes! Embold Health gets $20m; Brainomix gets $21m; $25m for Zing Health; Quartet buys Innova Tel; Prolucent Health gets $11m; and Mightier gets $17m. And now we are done with 2021! And to announce the new name, we are wearing evening dress! – Matthew Holt

Nate Maslak, CEO of Ribbon Health

Nate Maslak, CEO of Ribbon Health talked with me late last year (2021) after his $40m round from General Catalyst and Andreesen Horowitz. We dug into the really thorny problem of information about physicians. This has so many facets and ramifications but most people only see it when their doctor somehow isn’t in their health plan’s network. But it’s much, much more than that. Nate joined me in nerding out on this topic and explaining how Ribbon is working to fix it — Matthew Holt

Simple Bills are Not So Simple

By MATTHEW HOLT

I went for an annual physical with my doctor at One Medical in December. OK it wasn’t actually annual as the last time I went was 2 & 1/2 years ago, but it was covered under the ACA, and my doc Andrew Diamond was bugging me because I’m old & fat. So in I went.

I had a general exam and great chat for about 45 minutes. Then I had blood work & labs (cholesterol, A1C, etc) and a TDAP vaccination as it had been more than 10 years since I’d had one.

Today, about one month later, I got an email asking me to pay One Medical. So being a difficult human, I thought I would go through the process and see how much a consumer can be expected to understand about what they should pay.

Here’s the email from One Medical saying, “you owe us money.”

Continue reading…

Matthew’s health care tidbits: #DigitalHealth valuations

Each week I’ve been adding a brief tidbits section to the THCB Reader, our weekly newsletter that summarizes the best of THCB that week (Sign up here!). Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt

For my health care tidbits this week, it’s time to bring up the disconnect between the continual collapse of #DigitalHealth stock prices and the continued increase in private sector investment and valuation in the same sector.

All of nine months ago, way way back in March 2021 market leader Teladoc hit a stock price of $308. Last week it hit a low of just under $90. Meanwhile several companies have IPOed or SPACed this year and almost all of them have seen their stock fall dramatically. For example, pioneer online mental health company Talkspace is now at a market cap of under $300m. This week a different mental health company Cerebral which was only founded in January 2020 raised $300m at a private valuation of over $4 billion. Yes they could have bought out Talkspace for that amount! In October Medicare Advantage plan Devoted Health raised money at a $12 billion valuation which exceeded the market cap of rivals Clover, Bright Health and Oscar–each of which has more members.

So what’s going on? Part of this is the wash of money still going into venture funds. Interest rates are historically low, while inflation is picking up, so that money has to go somewhere. Additionally some of the companies that SPACed out were probably unable to get such a good valuation in a private round. But it can’t be that all the 50 or so public companies are lower quality than the private ones. That indicates that either the private valuations aren’t real (because there are so many protections built into the deal for investors), or that the private and public valuations are going to get closer together. There is of course one more possibility–some of the private companies may pursue M&A and buy out some of the public ones. But in any event, this current arbitrage cannot last forever.

It’s not unlikely the public stocks may pick up. But we’ve seen private and public market bubbles before and the aftermath isn’t usually pretty.

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