What’s the bigger news coming out of Capital Rx: that the next-gen PBM just closed a $106 million dollar Series C? Or, that the health tech startup’s business model has expanded significantly over the past 18 months, from PBM-only to PBM-plus-PBA, meaning that instead of just servicing the pharmacy benefits management needs of employer groups directly, that now they’re also adding to their business by selling THEIR TECH to other carriers and health systems so they can use it to administrate their benefits plans??
Capital Rx’s CEO AJ Loiacono takes those questions in stride, lets us in on which “side” of the business fueled their 200% year-over-year growth in 2021, and gives us the details on that tech that his business developed and why its standout compared to the inefficient infrastructure that currently exists to administrate and process pharmacy claims.
The big deal here is that AJ and team are tackling one of the biggest friction points in the cost of pharmacy benefits: the cost to administer a plan. They reduce that cost, and the “net cost” of every drug is reduced. AJ says its in this way that Capital Rx operates at one-seventh the cost of his competitors, the “Big Three PBMs” (CVS’s Caremark, Express Scripts, and UnitedHealth’s OptumRx) and saves its customers an average 27% on their prescription drug spend.
Now that Capital Rx has their slick enterprise software, will the business continue to operate a dual PBM-plus-PBA model, or will they double-down on the PBA side? AJ lets us know what’s next and (spoiler alert) it sounds like things might go in a surprising direction. If Capital Rx’s software is so effective at doing all the things it takes to manage pharmacy claims — underwriting sequences, implementation management and onboarding, communication, patient portals, network management, reimbursement networks, eligibility checks, etc. – what stops Capital Rx from processing other kinds of healthcare claims? Is a step into the medical claims processing side of the healthcare world on the roadmap? Tune in and find out!
How will the reversal of Roe v. Wade impact virtual care and digital health companies from a health data privacy standpoint, particularly as States crack down on the use of telehealth as a mechanism for obtaining abortions and begin to look at digital health data as potential evidence in criminal cases where abortions are illegal?
Health data privacy expert and rightfully-so-self-proclaimed HIPAA Scholar, Deven McGraw, who spent three years as Deputy Director of the Health Information Privacy Office at HHS and currently leads Data Sharing and Stewardship at Invitae, gives us her hot take on what’s happened from a health data privacy standpoint and how it will impact health tech businesses and healthcare consumers in the short and long terms.
Deven’s take: “We’ve really jumped the shark in terms of what the consequences are of health data falling into the hands of people who intend to use it in order to pursue a criminal case either against a woman (or a man) seeking a service, or the provider that performed the service…” So, what does that mean for those who are dealing with digital health data? What are the limitations as far as what HIPAA can protect for patients and what it can’t? What loopholes have Deven worried about the privacy law’s ability to stand-up to the challenges now posed by the Dobbs decision? And, what does all this mean for the telehealth-based businesses that are providing services to these patients?
We have a sweeping conversation about the shifting health data privacy landscape in the wake of Roe’s reversal in this latest episode of our special monthly Virtual Care Regulatory Round-up Series, sponsored by the health tech company powering the virtual care industry, Wheel.
“Being an unpaid caregiver is the epicenter of Life Sucks Disease,” says Alexandra Drane, Co-Founder & CEO of ARCHANGELS, “but it’s also one of the most glorious, one of the most magnificent jobs we’ll ever have.” So, what’s the trick to managing the “sucky” side of caregiving? Data.
Alex’s company ARCHANGELS has invented the Caregiver Intensity Index, which she describes as a “two-and-a-half minute Cosmo quiz” that helps caregivers quantify the intensity of their caregiving experience and identify the top two things driving that intensity and the top two things alleviating it. The score coming out of this helps caregivers validate the intensity of their experience, offers a framework for communicating about it, and, as Alex puts it, delivers “data that gives them permission to believe” that the stress they are feeling is real. ARCHANGELS then uses the info to crosswalk caregivers to existing resources that can help them manage those intensity-driving challenges – whether they be related to financial stress, workplace stress, relationship stress or otherwise.
Knowing that health plans and employers are starting to “see the light” when it comes to caregiving and its impact on their workforce, Alex and I talk about just how much payers are really willing to contribute to supporting the resources needed to support caregivers and how the data ARCHANGELS is providing is helping demonstrate need and connection to health and well-being. Lots of interesting data points on caregiving in this one – particularly when it comes to mental health and how things have changed through the pandemic. Watch now!
What BIG thing is Avaneer Health building with its $50 million SEED round backed by not-just-investors-but-also-partners CVS Health, Aetna, Anthem, Cleveland Clinic, HCSC, PNC Bank, Sentara Healthcare and IBM Watson Health? CEO Stuart Hanson stops by to clear-up the mystery that IS Avaneer Health, and how the massive data exchange platform it’s building is meant to connect the data coming out of the biggest payers and biggest providers in healthcare, directly and in real-time.
Hang on – is this the blockchain-based data exchange healthcare has been talking about for more than a decade?? It sure is trying to be. And what Stuart says is different about Avaneer’s effort is, indeed, the fact that it’s backed by some of the biggest brands in the business and that they see the business case in being able to more effectively share their data with one another. As he explains it, “this problem of data interoperability and data fluidity is bigger than any competitive business model that they need to worry about…”
Stuart is careful to explain what Avaneer IS and what it IS NOT, and this is critical to the company’s growth plans and revenue model. Avaneer is NOT a data intermediary; it’s not about aggregating data, normalizing it, de-identifying it, or applying any fancy machine learning algorithms to it to deliver “insights” on it. Avaneer is strictly a platform for secure, compliant data exchange, so, for example, Anthem can connect to Cleveland Clinic in real-time and verify insurance coverage. The revenue model is currently built around access to the network and will one-day-soon also take in fees from ‘Solutions Innovators’ (aka data-aggregating, algorithm-loving, insights-dropping health tech companies) that will offer their services as add-on’s to Avaneer’s customers who are plugged into the network.
What’s ahead for this stealthy start-up as it scales? Could they REALLY be looking to raise a follow-on seed round?? Find out what kind of investors they’re looking for and what’s ahead on their product roadmap in this in-depth chat.
What’s Lee Shapiro’s take on the health tech market’s state-of-play? 7wireVenture’s Co-Founder and Managing Partner stops by to talk early-stage investment, what’s hot and what’s not post-pandemic, and how he views the digital health funding frenzy of the past couple years which, one could argue, was kicked into high-gear by portfolio-company-slash-previous-employer Livongo.
Lee says there’s “enough broken business processes in healthcare to last a lifetime,” which means a lot of opportunity for consumer-minded health tech startups to change things, but does the recent slowdown in venture funding and pummeling of public market health tech stocks indicate that the category is in trouble before it even gets a chance to make a real impact? We get Lee’s opinion on whether or not the market is cooling, what he thinks will happen next with valuations, and what he views as the best way to scale a healthcare startup – particularly as we watch Glen Tullman run the ‘Livongo playbook’ at new business Transcarent. And, speaking of Glen… did Lee really teach him everything he knows?? We’re starting some trouble in this one!
Just as HHS extends the Covid-19 public health emergency waivers until July, we kick-off a brand-new monthly interview series about the state-of-play for all things telehealth and digital care policy and reimbursement. Called the WTF Health Virtual Care Regulatory Round-up, we’re partnering with our friends at Wheel to feature health policy experts, lobbyists, health plan folks, and other virtual care experts and insiders who can keep us updated on the changing regulations and what they will mean to those health tech co’s whose businesses rely on virtual care.
Attorney-to-the-stars-of-telehealth, Nathaniel Lacktman, who chairs the Telemedicine & Digital Health Industry Team at Foley & Lardner and is a Board member of the American Telemedicine Association (ATA), kicks the series off for us with an update on those public health waivers and how he is coaching health tech businesses in preparing for the inevitable transition of care that will come when they come to an end.
What will happen to patients who live across state lines from their virtual care providers? What business decisions need to be made to avoid abandoning patients and maintaining continuity of care? Nate’s not bullish on a federal national license, but there are some cases where cross-state patient-provider relationships can continue to exist – they just might not work for everyone’s business model.
And, on the subject of telehealth business models, Nate gives us his take on where he thinks reimbursement will be headed, how policy around virtual prescribing will be impacted post-pandemic (particularly around controlled substances), and whether or not Medicare’s originating site requirement will be put back in place. We also get Nate’s perspective on which virtual care business models seem to be working best among health tech startups and what legal risk those more ‘reckless’ players might be creating for the rest of the field without even realizing it. Great education on virtual care and what’s happening in the space RIGHT NOW. Watch!
Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at wheel.com.
The BIG takeaway from ATA’s Annual Meeting is best bottom-lined by ATA’s big boss, CEO Ann Mond Johnson, in this interview: “From an overall perspective, we just don’t want to go over that ‘telehealth cliff.’”
ATA, the re-branded American Telemedicine Association, has not only evolved along with virtual care through the pandemic, but has also been critical in redefining telehealth as modality for healthcare and re-framing access to it as a bipartisan issue that everyone in DC can get behind.
Ann talks through the high-level changes she’s witnessed for telehealth adoption over the past two years and gives us her predictions for what’s going to happen next – particularly when it comes to the business of virtual care, consumer demand, and, most importantly, regulations and reimbursement. Lots happening thanks to ATA’s new affiliated trade organization, ATA Action, which is lobbying to ensure that the waivers that enabled the acceleration of telehealth during the Covid-19 public health emergency become permanent. The time is NOW for health tech co’s to get involved! Tune in to find out how.
Big news coming out of Vida Health today as the chronic condition care startup announces that it will now be able to prescribe meds, med devices, lab tests, and more to its members. This puts Vida Health among the first of the digital health chronic care companies to evolve its offerings beyond apps-and-coaching, leading on this trend to take digital health chronic care into a more full expression of virtual care.
Vida Health’s Chief Medical Officer, Dr. Patrick Carroll, introduces us to the new offering which he tipped us off about when we met him a few months ago, new to his role at Vida and coming in hot from Hims & Hers where he built similar services as he took that company public as CMO.
The new prescribing services will cover both sides of Vida Health’s integrated model: mental health and cardiometabolic health, but in different ways. On the mental health side, Pat says members will be able to receive prescription meds for anxiety and depression ONLY at this time; on the cardiometabolic side, members working with Vida Health will NOT be able to get prescription drugs to help with diabetes or heart health, but would instead be able to get continuous glucose monitors (CGMs) prescribed, specialized diets, and labs, like A1C testing, that require a script.
Do these prescribing services begin to turn Vida Health into a primary care provider? If not, how do these new prescribing and medication management roles integrate with whatever other primary care offering is in place through a member’s plan or employer without adding cost or confusion to the patient experience? We talk through the evolution of both care model and business model as Vida Health adds another layer to its full-stack chronic condition management platform.
Amwell’s ($AMWL) President & co-CEO Roy Schoenberg called it early when he predicted pre-Covid that there would be a paradigm shift for telehealth that would take the technology from “healthcare product” to “healthcare infrastructure.” Now he’s back as (in my opinion) the best kind of market analyst to give us a new high-level take on where telehealth is headed next, how its customers’ demands have changed, and how the public market’s understanding of this technology and its utility in healthcare is starting to evolve.
The bottom line: Telehealth as infrastructure is just the tip of the iceberg. As Roy puts it, “The organizations that we work with now understand that distributing healthcare over technology is part of their future.” And whether it’s payers, health systems, private practices, or even Medicare, the seismic shift Roy sees now is that instead of looking at telehealth as a way to do their old business using new channels, the new channels are being looked at as an opportunity for healthcare organizations to completely remake their old business models. “Technology,” he says, “is being considered a change agent for how healthcare is actually arriving at the hands of its patients.”
So much more ground covered in this big telehealth trends conversation – it’s the PERFECT watch for the week before the American Telemedicine Association’s Annual conference. In addition to an update on the roll-out of Amwell’s new platform Converge (2/3 of the way there) and the integration of its latest acquisitions SilverCloud Health and Conversa Health, you’re going to want to listen in to our little gossip sess about telehealth policy and reimbursement at 17:45 AND our talk about the health tech investment market of privately and publicly traded companies that starts at the 20-minute mark.
Livongo Alumni Updates from ViVE 2022 continue! Former CEO Zane Burke drops in to talk about his new gig as CEO of Quantum Health, the “original” healthcare navigator biz, and how he’s bullish on the notion that navigators aren’t going anywhere any time soon.
Now, for those who’ve followed Livongo’s founder Glen Tullman as he’s launched his new business Transcarent – and a whole lot of “navigators aren’t working” rhetoric to position it – one might find it very interesting to hear Zane’s take, particularly how what he learned at Livongo has led him to adopt a viewpoint so opposite Glen’s.
Is the market large enough for both approaches to employer benefits optimization – and all the other permutations with and without primary care in between – to win? And for those of you who remember when Zane and Glen ran opposing EMR companies…is this Cerner versus Allscripts all over again?? And speaking of, I get a GREAT candid take on what IS happening in the EMR market today and whether or not Zane thinks challenger tech co’s will finally be able to win over health systems and unseat the EMR incumbents.