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#Healthin2Point00, Episode 222 | Funding for Availity, VisiQuate, Truveta, and Bayesian

Today on Health in 2 Point 00, Jess and I cover Availity raising $50 million bringing their total to $200 million and a valuation at over a billion. Revenue cycle management company Visiquate raises $50 million, bringing their total to $70 million. Truveta raises $95 million for its data analysis platform, and finally Bayesian gets $15 million using AI to predict sepsis. —Matthew Holt

Up, Please

By KIM BELLARD

When I think of elevator operators, I think of health care.

Now, it’s not likely that many people think about elevator operators very often, if ever.  Many have probably never seen an elevator operator.  The idea of a uniformed person standing all day in an elevator pushing buttons so that people can get to their floors seems unnecessary at best and ludicrous at worse. 

But once upon a time, they were essential, until they weren’t.  Healthcare, don’t say you haven’t been warned. 

Elevators have been around in some form for hundreds of years, and by the 19th century were using steam or electricity to give them more power, but it wasn’t until Elisha Otis debuted the safety elevator that they came into their own.  New engineering techniques such as steel frames made skyscrapers possible, but safe elevators made them feasible; no one wanted to climb stairs for 10+ stories. 

Those generations of elevators weren’t quite like the ones we’re used to.  The speed and direction had to be controlled manually, the elevator had to be carefully brought to a stop at a floor, and the doors had to be opened and closed.  Managing all this was not something that anyone wanted to entrust to passengers.  Thus the role of the elevator operator.

But, of course, technology evolved, allowing for more automation.  According to elevator engineering expert Stephen R. Nichols:

Elevator buttons were introduced in 1892, electronic signal control in 1924, automatic doors in 1948, and in 1950 the first operatorless elevator was installed at the Atlantic Refining Building in Dallas. Full automatic control and autotronic supervision and operation followed in 1962, and elevator efficiency has steadily increased in other ways.

Elevator operators gradually transitioned from being mechanical operators to concierges, helping passengers find the right floors and making them more comfortable.  A 1945 elevator operators strike in New York City had a crippling effect.  As Henry L. Greenidge, Esq. wrote on Linkedin, “The public refused to go near the controls despite having watched the operators work the levers numerous times. The thought that a layperson could operate an elevator was simply an outrageous thought.” 

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Does Newly IPO’d Privia Health’s Climbing Stock Price Prove Value-Based Care Can Scale?

By JESSICA DaMASSA, WTF HEALTH

Privia Health ($PRVA) went public a few weeks ago and the stock not only popped when it hit the market, but has continued to rise. When you look at the numbers – and hear about the business model from CEO Shawn Morris – it’s easy to get excited and see why. Privia calls itself a “physician enablement” business, which is the two-word marketing way of saying that they bring together different docs in a region and give them the systems to become part of a value-based care network while also maintaining their private practices. They’re more or less building accountable care organizations (ACOs) in a hub-and-spoke fashion, uniting docs around Privia’s common tech systems, workflow processes, value-based care strategies, and contracting power with commercial and government payers. The model is appealing to docs who want to make the switch to value-based care, but still want the autonomy of their own practices. The value prop has already attracted more than 2,700 providers in 650 different locations netting the biz $817 million in revenue in 2020 – and Shawn says they’ll only expand from here. What’s the growth plan? Value-based care models are often criticized as “un-scalable” – what does Shawn say to combat that? A great, detailed chat that pitches a hopeful end to fee-for-service healthcare and a promising future for a newly public healthcare co.

Cancer Centers Rebounding From COVID-19 Can Grow By Making the Most of New Technologies for Clinical Trials

For community cancer centers that rely on patient reimbursement to stay afloat, a smart data-driven approach to clinical trials provides a foundation for future growth.

Brenda Noggy
Dr. Tandy Tipps

By TANDY TIPPS and BRENDA NOGGY

Covid-19’s tragic, devastating impact on cancer treatment is now well documented. Cancer screenings dropped by almost 90 percent at the peak of the pandemic. Billing for some leading cancer medications dropped 30 percent last summer. Studies found a 60 percent decrease in new clinical trials for cancer drugs and biological therapies.

Cancer centers, like every part of the US health system, have a lot of ground to make up. Those community cancer centers without grants and other institutional advancement funds, experience financial and human resources as major constraints to charting a path to growth. For them, successful programs which generate revenues for expansion or break even help them maintain fiscal health. Often, unfortunately, too often their research programs lose money.

Clinical trials have not been a viable revenue source because of the difficulty in accurately predicting patient enrollment and the challenges of managing trial portfolios, a task that requires streamlined feasibility processes that include querying baseline populations for new trials and potentially eligible patients.

The hard work of patient screening and trial matching requires clinical coordinators, physician investigators and research support staff to spend between three to eight manually scouring databases of electronic medical records and unstructured files to find patients eligible for trials based on increasingly complex inclusion and exclusion criteria. This costly process does not take into consideration the pre-screening efforts in patient matching that may not be reimbursable.

Resources are also needed to implement feasibility processes to accurately predict how many patients might enroll in a trial if they are eligible. Most community-based sites do not have an accurate ability to query their current patient populations by disease cohort or mutation in real time. They often rely on physicians’ memories to estimate patient numbers for trial feasibility questionnaires, which must returned to sponsors quickly, usually before cancer centers have definitive recruitment numbers.

As a result, before COVID, an average of only 5 percent of patients had a chance of participating in trials, 50 percent of clinical trials failed to meet enrollment goals and less than 14 percent were completed on time. Cancer centers still incur the administrative and clinical resources required to maintain the protocols in the first place, however.

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Make Mine Bioresorbable

By KIM BELLARD

I learned a new word this week: bioresorbable.  It means pretty much what you might infer — materials that can be broken down and absorbed into the body, i.e., biodegradable.  It is not, as it turns out, a new concept for health care – physicians have been using bioresorbable stitches and even stents for several years.  But there are some new developments that further illustrate the potential of bioresorbable materials. 

It’s enough to make Green New Deal supporters smile.

Bioresorbable stents and stitches are all well and good – who wants to be stuck with them or, worse yet, to need them removed? – but they are essentially passive tools.  Not so with pacemakers, which have to monitor and respond.  Medicine has made great progress in making pacemakers ever smaller and longer lasting, but now we have a bioresorabable pacemaker. 

Researchers from Northwestern University and The George Washington University just published their success with “fully implantable and bioresorbable cardiac pacemakers without leads or batteries.”  What their title might lack in pithy is more than offset by the scope of what they’ve done.  Fully implantable!  No leads!  No batteries!  And bioresorbable! 

Most pacemakers are, of course, designed to be permanent, but there are situations where they are implanted on a temporary basis, such as after a heart attack or drug overdose.  Dr. Rishi Arora, co-leader of the study, noted: “The current standard of care involves inserting a wire, which stays in place for three to seven days. These have potential to become infected or dislodged.” 

Dr. Arora went on to explain:

Instead of using wires that can get infected and dislodged, we can implant this leadless biocompatible pacemaker. The circuitry is implanted directly on the surface of the heart, and we can activate it remotely. Over a period of weeks, this new type of pacemaker ‘dissolves’ or degrades on its own, thereby avoiding the need for physical removal of the pacemaker electrodes. This is potentially a major victory for post-operative patients.

The device is only 15 millimeters long, 250 microns thick and weighs less than a gram, yet still manages to deliver electric pulses to the heart as needed.  It is powered and controlled using near field communications (NFC); “You know when you try to charge a phone wirelessly? It’s exactly the same principle,” GW’s Igor Efimov, a co-leader of the study, told StatNews

It dissolves over a period of days or weeks, based on the specific composition and thickness of the materials.

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Sharecare ($SHCR) Hits NASDAQ Tomorrow, CEO Jeff Arnold on Closing the SPAC IPO

By JESSICA DaMASSA, WTF HEALTH

Sharecare ($SHCR) starts trading on the NASDAQ tomorrow and CEO Jeff Arnold has come back to catch us up on what’s happened since April when we first spoke and took a deep-dive into Sharecare’s population-health-slash-care-navigator-slash-health-security business model. That interview (watch here: https://youtu.be/P6DzFbtiLWg) digs into the $400 million/year revenue model Jeff’s built so far, and now THIS CHAT picks up where we left off — mere hours before Sharecare heads into the public market. valued at just under $4 billion dollars, with ZERO Debt and $400 million in cash to invest in scaling up.

Turns out a lot can happen while you’re waiting for your paperwork to be signed! So what’s new? How about the $50 million dollar private placement Anthem has made into business? Jeff explains how this kind of backing from the country’s second largest health insurance company is not only a win when it comes to securing a customer base, but also how it will likely impact product roadmap. The Anthem investment was closely linked to Sharecare’s January acquisition of health tech startup Doc.AI, which had been working with Anthem on some very payer-friendly tools that will likely be expanded. And speaking of expansion? Jeff’s already made more than a dozen acquisitions to build up Sharecare’s three main verticals over the years– what else could they possibly need now? Tune in for all the last-minute news and numbers before $SHCR pops tomorrow!

CareAlign, fixing that physician workflow–demo & interview

By MATTHEW HOLT

I recently interviewed Subha Airan-Javia, the CEO of CareAlign. CareAlign is a small company that is working to fix the clinician workflow by creating a tool for all those interstitial gaps that the big EMRs leave, and now get moved to and from paper by the care team. In this interview she tells me a little about the company and shows how the product works. I found it very impressive

Full transcript below

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#Healthin2Point00, Episode 219 | Health Catalyst acquires Twistle, Hims acquires Apostrophe, & more

Today on Health in 2 Point 00, Jess claims that I am to blame! But for what?? On Episode 219, Jess and I talk about home care software company AlayaCare raising $225 million CAD. Next, Health Catalyst acquires Twistle for $104 million and Hims acquires teledermatology company Apostrophe. Finally, Spiras Health raises $14 million for at-home chronic care management. —Matthew Holt

Did Glen Tullman Just Launch Another New Category? Transcarent the ‘Health Experience Company’

By JESSICA DaMASSA, WTF HEALTH

For those keeping score at home, Glen Tullman is scaling up Transcarent faster than he did Livongo. The startup just closed a $58M Series B, bringing its total funding just shy of $100M. In less than 8 months. What’s the hurry? Have we ordered the balloons for the IPO yet? Glen says he’s out to fix the core problem first, and, in this interview, we get into the details about what that problem statement is all about and you might be surprised.

This is more of a payment model story than anyone may have all initially realized. And, while we may keep trying to put Transcarent into the “healthcare navigator” box or call it a “second opinion service” or a “centers of excellence play,” the truth is that those are all means to achieve a much larger end, which is about redefining the healthcare experience and its payment model for self-insured employers. Remember when Livongo created its own category of care (applied health signals) because they didn’t fit in with what a ‘chronic condition management’ company meant to the market? Well, I think Glen just used this interview to soft-launch a new category of healthcare company here again with Transcarent…

“People always try to put us in a category,” says Glen. “Are you a navigator? No, we’re not a navigator. We do navigation. Are you a health management company? No, we’re not. Are you a supplier? No, we’re not. Are you a PBM? No, we’re not. But we do all of those things to create an experience and that’s why, when you think about it, we’re a health experience company and that’s a new category that no one has.”

I get Glen to talk specifics about what this really means — directly managing healthcare spend for employers in a ‘category-creating’ completely at-risk way – and the examples really do help bring it to life. So does hearing about how he sees Transcarent as completely different than Accolade or Grand Rounds, which are often listed as competitors.

What other trouble do we get into in this 30-minute mega chat? OF COURSE I get his take on this year’s record-breaking investment into health tech, whether or not he thinks we’re in a bubble, and how Amazon, Walmart, and other non-traditional players are going to impact healthcare moving forward. Lots of insights in this one!

#Healthin2Point00, Episode 218 | Bicycle, NexHealth, Stork Club, DrChrono & Pear Therapeutics

On Episode 218 of Health in 2 Point 00, it’s a big week in digital health for IPOs. Today Jess asks me about Bicycle Health’s $27 million Series A, bringing the substance use disorder startup’s total to $32.3 million. NexHealth, which is like Shopify for doctors, gets $31 million in a Series B, Stork Club raises $30 million in a Series A, and DrChrono raises $20 million for its EHR. Finally, Pear Therapeutics is SPAC-ing out with a $1.6 billion valuation. As we all know, DTx is my favorite category of health tech so tune in for what I have to say about this one. —Matthew Holt

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