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The Evernorth Digital Health Formulary & the Disruption of the Digital Health Payment Model

By JESSICA DaMASSA, WTF HEALTH

Last December, Express Scripts — now a part of Evernorth — became the first PBM to go to market with a digital health formulary. Basically, adapting the vetting, organizing, and pricing functions of a traditional medication formulary to the digital (health) age. Mark Bini, Chief Patient Experience Officer, spearheaded the effort, meant to alleviate the burden faced by Evernorth’s clientbase of 4,000 employers and health plans, who’s HR benefits teams want to make digital health solutions available to the 100+ million members of their health plans, but don’t have a frictionless, repeatable way to do so. As Mark puts it, “if you’ve seen one digital health startup, you’ve seen one.” And, for an HR benefits administrator whose inbox is inundated by digital health companies, the challenge of dealing with different levels of clinical validation, different data needs, different contracts, and, probably, most frustrating, different payment models that are often separated from their health benefit and pharmacy benefits, Evernorth’s Digital Health Formulary eases a real burden. So, a year in… how’s it going? Have Evernorth’s clients bought into more digital health solutions as a result of the formulary? What’s uptake been like among the populations they manage? And, how has this been working out for digital health startups? Mark gives us an update, talks through the details of the selection process, AND reveals what he’s got planned next. Spoiler: The evolution of the Formulary means adding more cohorts of digital health solutions more frequently, increasing the number of digital health solutions covered under drug benefits, getting a beat on longitudinal digital health engagement, and working out how to help consumers navigate all the various health tech options that are available to them.

Bayer G4A Agents of Change: Watch the Panels, Meet the Co’s that Got Deals

By JESSICA DaMASSA, WTF HEALTH

Bayer G4A, the global life science company’s digital health innovation arm, held their splashy “Agents of Change” event last month to not only introduce their latest cohort of health tech partners, but to also demonstrate the pharma co’s commitment to digital transformation. The entire C-suite of Bayer’s Pharma division became a panel itself — marking the first time the full leadership team of a major pharmaceutical company appeared together to talk strategically about tech’s role in shaping the pharma business model of the future. 

The rest of the program’s agenda teased out G4A’s priorities: consumer health, health disparities, women’s health, and investing. Matthew and I both moderated “star-studded” panels with health tech greats: he tackled health tech investment, ridiculous valuations, and advice for startups with a powerhouse crew of investors, while I led my women’s health panel past the usual talk of period-tracking and into a real push for a paradigm shift in thinking about what actually constitutes women’s health data. Rounding out the program were fascinating discussions about health equity and access led by Indu Sabiaya, and a ‘who’s-interviewing-who-here’ fireside about patient-centered tech with OneDrop’s Jeff Dachis and DiabetesMine founder Amy Tenderich, both entrepreneurs with diabetes who have a lot to say about how most tech misses the mark when it comes to grappling with patient needs in everyday life.

And… if you’re curious about what Bayer G4A actually invested in and who they decided to sign partnership agreements with, check out my exclusive WTF Health interviews featuring these companies by way of the playlist below. 

Spoiler Alert: Not a single digital therapeutic. 

What else could there possibly be for a pharma co to invest in? Watch and see. But, so you know a bit about what you’ll be getting into:

  • Caria is women’s health startup focused on menopause 
  • Sweetch is using just-in-time-interventions linked to mobile data to help “outsmart” chronic diseases
  • ONCARE is a care plan content management platform that lets any healthcare provider upload a care pathway that a patient can then follow via an app on their phone
  • Decipher Biosciences is using genomic testing to disrupt the way prostate cancer is diagnosed and treated 
  • Elly is helping improve the quality of life for cancer patients and those with chronic disease by way of educational and motivational content delivered via voice technology

Michelin Star Medicine: Food Start-Up Epicured Delivers Meals for GI & Chronic Condition Care

By JESSICA DaMASSA, WTF HEALTH

Food-as-Medicine startup, Epicured, looks and acts a lot like the consumer meal delivery startups booming during this pandemic (think Freshly, which was just acquired by Nestle for $1.5B) but with one important difference: all the meals are based on diets that have been clinically validated as treatments for chronic disease. The three year old company got its start in GI disorders, turning complex Low FODMAP diets, gluten-free diets, etc. into home-delivered, ready-to-eat dishes that patients with Crohn’s disease, Colitis, IBS, IBD, celiac, or other gastro conditions could actually integrate into their daily lives. (Just Google the list of restrictions on a Low FODMAP diet and imagine the lack of adherence over a 6-8 week period while trying to calm an IBS flare-up…)

Richard Bennett, Epicured’s CEO & co-founder, stops by to talk about why he believes this more convenient, yummy, and easy solution will not only continue to win the hearts of healthcare consumers, but why, ultimately, healthcare payors will look to invest more into innovation around nutrition, particularly as its proven to help with other, more common and costly conditions like diabetes, renal disease, and cancer. Backed in part by Mount Sinai (which not only invested in their seed round, but also lent their GI team to the co-design a special IBS menu), Rich let’s us know a bit about some yet-to-be-released clinical study results AND how Epicured has taken a page out of the “digital therapeutics playbook” by partnering with AbbVie to wrap their solution around one of the pharma co’s drugs as a way to improve medication adherence. Chicken Cacciatore wins over companion app any day!

#Healthin2Point00, Episode 172 | MedArrive, PointClickCare, Consejo Sano & FOLX Health

Today on Health in 2 Point 00, we’ve got quite a diverse set of companies to cover. MedArrive, which is Dan Trigub’s company – the former CEO of Uber Health – raises $4.5 million. Jess also asks me about PointClickCare acquiring Collective Medical, connecting data from EMRs in the acute care space into their long term care solution (I interviewed both companies on THCB Spotlights here). Consejo Sano quietly raised $17.1 million for their patient engagement and communication solution for the Hispanic community, and FOLX Health raises $4.4 million to provide care to LGBTQIA+ folks. —Matthew Holt

#Healthin2Point00, Episode 171 | Massive deals & a massive IPO

Today on Health in 2 Point 00, we have a huge IPO coming up – JD Health, a Chinese company which has a valuation of $28 billion, could raise up to $4 billion in its upcoming IPO. On Episode 171, Jess asks me about Everlywell raising $175 million in a Series D for at-home testing, everyone’s favorite keto startup Virta Health raising $65 million bringing its valuation to a billion, Olive Health already putting their funding raise to good use by acquiring Verata Health, and dtx company Click Therapeutics raising $30 million. —Matthew Holt

#Healthin2Point00 Episode 170 | Olive, WithMe, Andor & more

Today on Health in 2 Point 00, Jess & I are together in Marin County before Jess sets off! On Episode 170, Jess asks me about Olive raising $225 million following a recent raise as well, WithMe Health closing a $20 million Series B, Andor Health getting an undisclosed amount in a Series A with an investment from M12, Microsoft’s venture fund, Upfront Healthcare raising $11.5 million in a Series B, and Voluntis – which is a publicly traded DTx company in France – raising $7 million. —Matthew Holt

#Healthin2Point 00, Episode 169 | They’re real and they’re SPACtacular!

Today on Health in 2 Point 00, It’s a whacky SPACy world, as a new SPAC rolls “UpHealth” and has me singing Bob Marley, meanwhile there’s $91m for remote clinical trial software player Medable, $76m more for Spring Health joining the throng of mental health companies, while K-Health gets $42m to introduce chat bot front ends to Korean pop music…or something like that. —Matthew Holt

Comcast, Independence BlueCross’s Quil: Fast-Forward Past Video Content to Home Sensors for Seniors

By JESSICA DaMASSA, WTF HEALTH

It’s not just eyeballs that Comcast NBCUniversal and Independence BlueCross’s joint venture, Quil, is after these days. Carina Edwards, Quil’s CEO, paints a compelling picture of the full-scale business model for “health-in-the-home” that her company is enacting. What started out with trusted healthcare content for surgery prep (able to be deployed across a household’s army of devices, including their TV for those 1.3M Comcast Xfinity cable subscribers) is now expanding with more tech and more services to meet the needs of seniors aging-in-place and the fifty million unpaid caregivers looking after them. Ambient, “context-aware” sensors. Voice integrations with smart speakers. And that’s nothing to say of the caregiver-focused programming that addresses everything from caregiver burnout to tackling tough conversations about a range of issues from paying for care to end-of-life wishes. Quil’s pilot of this new senior-focused offering will be rolled out with Comcast’s help this winter, with the full direct-to-consumer commercial launch expected in Q3 2021. As Carina says, “Comcast knows how to pilot technology.” And, Quil has shown its ability to impact healthcare quality measures thanks to studies around its initial surgery-prep offering. Will it be enough to take on others looking to help turn our living rooms into exam rooms? Tune-in around 17:20 to hear just how integrated Comcast and IBX are in the strategy at Quil.

#Healthin2Point 00, Episode 168 | Is Amazon taking over the world of healthcare?

Goodbye health insurance, hello Amazon Prime membership! Today on Health in 2 Point 00, we talk about all the Amazon news now that they’re moving into pharmacy via Amazon Prime. Jess and I also discuss AliveCor raising $65 million for its personal EKG technology and Talkspace acquiring Lasting, a relationship counseling app. Levels raises $12 million in a seed round, adding more fun things you can do with your CGM, and another SPAC takes a company public—Barry Sternlicht’s SPAC is acquiring Cano Health at a $4.4 billion valuation. —Matthew Holt

#Healthin2Point00, Episode 167 | Bridge Connector, Togetherall, Solv Health & more

Today on Health in 2 Point 00, the big news is about another COVID vaccine… or is it the collapse of the telehealth and digital health market as we know it? On Episode 167, Jess asks me about Bridge Connector shutting down 2 months after getting a $25.5 million raise, UK-based online mental health platform Togetherall raising $10 million, Cerner partnering with Well Health for provider-patient communication services, Solv Health—the OpenTable for healthcare—raising $27 million, and Springtide raising $18.1 million for its clinic and platform for children with autism. —Matthew Holt

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