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THCB Gang Episode 71, Nov 4

Joining Matthew Holt (@boltyboy) on THCBGang Thursday were fierce patient activist Casey Quinlan (@MightyCasey); cardiologist & provocateur Anish Koka (@anish_koka); patient activist, author & entrepreneur Robin Farmanfarmaian (@Robinff3); and THCB regular writer Kim Bellard (@kimbbellard).

We got into the “what are parents thinking about schools and what happens to politics as a result”, and then into the children’s COVID-19 vaccine, then how remote patient and now remote therapeutics monitoring, and ending with where we thought AI was going! Quite the conversation!

You can see the video below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

#Healthin2Point00, Episode 240|Tebra, Notable, Wellinks, Aktiia, and Enlace Health

Today on Health in 2 Point 00, Jess and I talk briefly about Frontiers Health – frontiers.health – a digital health company with a deep therapeutics focus. Kareo and Patient Pop merge to form Tebra and get $65 million dollars from a PE firm. A notable raise from Notable, $100 million in a Series B brings to total up to $119 million. Wellinks gets $25 million in a Series C in the COPD space. Constant Blood Pressure monitoring company Aktiia gets $17.5 million, bringing their total up to $28 million. Aver Inc. rebrands, becoming Enlace Health, and raises 58 million dollars bringing their total up to $111 million. Investment efforts in Enlace were led by Cox Inc., and the relationship between Cox and Enlace seems very tight. -Matthew Holt

Matthew Holt

WTF Health: Included Health’s CEO Owen Tripp on Grand Rounds, Doctor-on-Demand Merger & New Name

By JESSICA DaMASSA, WTF Health

A sign of effective ‘merging-and-acquiring’ among innovative healthcare companies? How about a new brand-name? The company known as “Grand Rounds Health and Doctor on Demand,” which merged in March 2021 and quickly acquired LGBTQ+ virtual care company, Included Health, announced that the company would be moving forward as Included Health from here on out. We get into the strategy behind that name-change – and, more importantly, how the integration of the three companies is going – from CEO Owen Tripp.

This quick update covers how the navigation-plus-virtual-care co is prioritizing integration at-scale for millions of members – unlike other growing healthcare companies who Owen says have, “acquired companies, but haven’t put them together.” From member experience, clinician experience, and the business model backing all of this, we get a state-of-play on Included Health, including Owen’s take on the rising popularity of at-risk models among competitors Accolade Health and Transcarent, the legacy relationship the company has with Walmart, and how small/mid-sized employers are increasing area of focus for growth.

#Healthin2Point 00, Episode 236 | HLTH 2021, Oak Street, 23andMe, Babylon Health, and Everlywell

Today on Health in 2 Point 00, Jess and I catch up after HLTH 2021. Some massive deals in Episode 356: Oak Street acquires Rubicon MD for 190 million, 130 in cash; 23andMe acquires Lemonade (a virtual care and drug delivery company) for 400 million – 300 million in stocks and 100 million in cash; Babylon Health’s SPAC deal, 4.2 billion in market cap now; Everlywell acquires Natalist – their third acquisition in 6 months. – Matthew Holt

Matthew’s health care tidbits

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

In this week’s health care tidbits, a little bit of light was shone on two of the dirty tricks health insurers play. First San Diego is suing Molina, Centene (owner of Healthnet) & Kaiser for misleading patients about which providers are in their networks. Apparently Healthnet & Kaiser’s directories were 35% inaccurate and Molina 80%! Now this may be incompetence, but it is not only false advertising, it’s also a way of weeding out high cost patients who may leave when they can’t find a specialist that will take them–and of course avoiding a high cost patient is a nice earner for health plans.

The next trick is double billing. In this lawsuit unearthed by Bob Herman of Axios, Aetna which was being paid to manage an employer’s health network subbed out PT care to an Optum network. Optum then also charged an admin fee. Meaning the provider got less and the patient had to pay more. So while Aetna and United Healthgroup may appear to be fierce competitors, they’re happy to cooperate when it comes to ripping off their clients.

More bad behavior by health plans and I didn’t even mention them cheating on Medicare Advantage RAFs! But the CEO of Chenmed did.

If we are going to let health insurers profit from handling employer and taxpayer business, we should see those arrangements in the clear light of day. Time for some heavy handed Federal regulation, methinks.

THCB Gang Episode 56 – Thurs June 3

Episode 56 of “The THCB Gang” was recorded live on Thursday, June 3. Matthew Holt (@boltyboy) was joined by regulars: medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) and health futurist Jeff Goldsmith; WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa) snuck in later after she finished up at the Going Digital: Behavioral Health Conference across the virtual street.

We really got into it on two issues — the Wuhan lab “leak” issue and Babylon Health’s IPO — lots of fun and no little disagreement!

Then video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on Fridays on our iTunes  & Spotify channels.

Matthew’s health care tidbits

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

In this week’s health care tidbits, we’re discussing hedge funds. Not those small private equity funds that are defunding small safety net hospitals and being exposed by Propublica & PBS Frontline. (Did you catch #TCHBGangster Jeff Goldsmith on the latter?). No, I’m talking about big non-profit hedge funds that also provide some health care services. This week two of them reported results.

Famed regional hedge fund Mayo Clinic’s health services business reported $243m profit on $3.7bn revenue for Q1 2021. Not exactly Apple margins, but a respectable 6.5%. While catholic national hedge fund Ascension eeked a $700m profit on $20bn of revenue in the nine months June 2020 to March 2021. The good news is that Mayo has $15bn in its main trading account while in those nine months Ascension made $4.3 Billion on Wall Street bringing its balance to a healthy $25.6 Bn.

And if you were concerned that these hedge funds were in trouble because of the pandemic, well not only do they avoid property, income tax and more they also got plenty of help from the taxpayer. CMS prepaid $2billion of Medicare payments to Ascension; presumably they made a tad more playing the markets with that. Then there’s the non-refundable CARES Act grants. Yes Ascension has been paid $900m since June 2020 ($1.1billion in all) and Mayo received $356m, although they were nice enough to pay $138m back.

I’m sure those Americans who lost their jobs, their houses and waited for months for government help are glad that–despite the pandemic–these hedge funds weren’t having to dip into their main reserves to keep their health services subsidiaries going…..

THCB Gang Live, Episode 41–Thurs 1pm PT – 4pm ET

THCB Gang will be held live on Thurs Feb 4 at 1pm PT -4pm ET.

Joining me, Matthew Holt (@boltyboy), will be consultant/author Rosemarie Day @Rosemarie_Day1), patient advocate/entrepreneur/author Robin Farmanfarmaian (@Robinff3), Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune), health futurist Jeff Goldsmith (@JeffcGoldsmith), Digital health futurist Fard Johnmar (@fardj).

The Biden Administration is now getting into the grist of governing. What happens next?

You can see the video below live and it’ll be on our podcast channel (Apple/Spotify) from Friday

Rehash: The Health Assurance SPAC

Not so long ago (August) Jessica DaMassa and I ran a THCB Bookclub interview with Hemant Teneja & Stephen Klasko about their new book UnHealthcare. And, just because, their friend Glen Tullman sat in…..

Fast forward to this week and the three of them plus a cast of characters from General Catalyst & Livongo (Jenny Schneider, Lee Shapiro) have put $500m of their Livongo winnings into a SPAC. The book is based on the idea of Health Assurance and so is the SPAC. So if you are interested in figuring out what they are up to and what they might do or buy, here’s the interview–Matthew Holt

Escaping COVID-19

By RAGHAV GUPTA, MD

“In seeking absolute truth, we aim at the unattainable and must be content with broken portions.”

William Osler

A colleague shared an experience with me about testing one of his patients for the novel coronavirus and it left me a bit puzzled.  An elderly gentleman with past medical history of severe COPD (chronic obstructive pulmonary disease) and heart failure came to the ER with shortness of breath, edema and fatigue.  Chest x-day suggested pulmonary edema.  He wanted to test him for SARS-CoV2 but hesitated.  Eventually he was able to order it after discussions with various staff administrators.  Dialogue included sentences like “why do we need testing? He has Congestive Heart Failure (CHF), not COVID-19” and “it could create panic amongst staff taking care of him”. I applauded his persistence as eventually the test was done.  To not test is counter-intuitive and more like an escape from diagnosing the virus rather than escaping the virus itself. 

One – the mere fact that we might hesitate before testing for a virus which is a cause of a (ongoing) pandemic should ring all the bells of concern about lack of an optimal strategy.  Inadequate testing has remained the Achilles heel of our stand against COVID-19 because to have a lasting stand, we must know where to take the stand.  

Two – the concern of CHF raised above is clinical and valid, but it is of grave importance to understand that CHF and COVID-19 are not mutually exclusive.  We now know that even the infamous flu and COVID-19 are not mutually exclusive.  Common protocols from a few months ago to test for flu in sick outpatients and not test for COVID-19 if flu was positive was like the prey closing its eyes and hoping the predator does not see it.  It did defer the use of an already scarce resource at the time, testing.  SARS-CoV2 is a virus and the disease caused by it is called COVID-19.  Virus can be ubiquitous; disease does not have to be.  A patient with CHF exacerbation can be an asymptomatic carrier of SARS-CoV2 but may not phenotypically express the disease manifestations of COVID-19.  Or may be his COPD or CHF exacerbation has happened due to a milder COVID-19 inflammatory response?  What we know about COVID-19 is that we don’t know enough about it and therefore we cannot rule out its presence.  Especially while we are in the middle of a growing pandemic.  

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