Categories

Category: Health Tech

Health in 2 Point 00, Episode 243|Quartet, Ribbon, Lyn Health, Medallion & Safely You

I cough my way through this episode of Health in 2 Point 00 in his original interview sweater. There’s $60m for Quartet (mental health), Ribbon Health gets $43.5m to fix provider lists, Lyn Health reinvents the medical group with $10m (sort of), Medallion gets $30m to fix cross-state line provider credentialing & Safely You gets $30m to use AI to prevent falls in nursing homes. -Matthew Holt

Matthew’s health care tidbits: Athenahealth & Private Equity

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 delve into the private equity firms’ buying and selling of Athenahealth. That’s of course the practice management/EMR firm bought by private equity companies led by Elliot Capital Management–they of the Israeli spy agency dirty tricks division–for roughly $6.5bn in 2018. Many (including me) have wondered how, given it was already doing about $1bn a year in revenue then, Athenahealth could be sold for $17bn three years later. After all it’s hardly likely to have tripled its revenue in a mature market! This comment by “Debtor 23” on @histalk is very instructive:

“Elliott did quite a bit better than 3x on its investment. The original deal was funded with about $4.8B of debt and $1B of equity from the hedge fund sponsors. Add in the acquisition cost of Centricity (call it $500M of equity, $500M of debt) and the equity investors are all-in with $1.5B of equity and $5.3B of debt. They sold off some assets for a total of ~$600M in cash, so net equity in play is $900M. They turned that equity into $11.7B (assuming no interim debt pay down), which is a 13x return. 13x feels ridiculous….but….if you’d invested that same levered-up $6.8B in the Nasdaq (QQQ) on the same timeline (Elliott began buying ATHN in spring 2017)…you could sell today for $18.1B. Absurd as this whole deal sounds, it has actually underperformed the market. This story is more about tech multiple expansion/bubble broadly than it is about improving management or running the business.”

So much like Renaissance and other hedge funds that rely on leverage, essentially Elliott leveraged Athenahealth up with debt to the tune of 80% of its value. So after slashing and burning R&D, selling assets (like the HQ which they apparently got $500m for) they probably got costs down & profits way up. When it was public under CEO Jonathan Bush, Athenahealth never tried to be that profitable. It was always fixated on the next big thing (the last one was building the future state inpatient EMR with Toledo & using the BIDMC tech it bought from John Halamka). That’s one reason its PE ratio was 100+.

So if Elliott can get some sucker to pay up and manages to turn $1bn into $13bn, how do the next greater fools–H&F and Bain Capital–do it? Well they need to layer Athenahealth up with even more debt (as money is currently so cheap) and keep generating enough cash to pay the debt. Of course at that price and with this mature a market it’s going to be super hard to grow the company enough to justify another leap in sales price, but it might be doable to service or even pay down some of the debt and take it for an IPO for a couple of billion more if the market stays nutso. So if H&F and Bain Capital basically shrink their equity portion down to $1-2 billion, and get it to IPO in a year or so for say $20Bn, they will at least double or triple their money. Not quite 13 x but not terrible.

And if it all goes wrong and Athenahealth can’t service the debt? Well the beauty of leverage and debt is that it attaches to the company – not to the PE fund that put it in that position. So all the new owners will have at stake is a reasonably small amount of equity. Of course if the shit hits the fan and Athenahealth goes bankrupt the employees and customers may not be so happy, but who cares about them? (Apart from that hasbeen CEO who got kicked out!)

DNA Storage in a Yottabyte Era

By KIM BELLARD

Did you know we are living in the Zettabyte Era? Honestly, did you even know what a zettabyte is? Kilobytes, gigabytes, maybe even terabytes, sure, but zettabytes? Well, if you ran data centers you’d know, and you’d care because demand for data storage is skyrocketing (all those TikTok videos and Netflix shows add up). Believe it or not, pretty much all of that data is still stored on magnetic tapes, which have served us well for the past sixty some years but at some point, there won’t be enough tapes or enough places to store them to keep up with the data storage needs.

That’s why people are so keen on DNA storage – including me.

A zettabyte, for the record, is one sextillion bytes. A kilobyte is 1000 bytes; a zettabyte is 10007. Between gigabytes and zettabytes, by powers of 1000, come terabytes, petabytes, and exabytes; after zettabyte comes yottabytes. Back in 2016, Cisco announced we were in the Zettabyte Era, with global internet traffic reaching 1.2 zettabytes. We’ll be in the Yottabyte Era before the decade is out.

Continue reading…

Lyn Health Out of Stealth: A Niche Healthcare Navigator for Polychronic Patients

By JESSICA DaMASSA, WTF HEALTH

Straight out of stealth and launching today! Lyn Health is out to provide specific, personalized care for patients with three or more chronic conditions in a way that’s meant to compete with healthcare navigator-advocators like Accolade, Transcarent, and Included Health INSTEAD of the crowd of digital health chronic condition management platforms like Teladoc’s Livongo, Vida Health, One Drop, Omada Health, etc. etc.

With employers and health plans getting increasingly burnt-out on point solutions for chronic care – leading many of those businesses to “platform out” themselves in recent years – will a niche-market navigator really stand-out? Is effective care for polychronic patient populations so specialized that it merits adding a specific, targeted service on top of the more general navigator, primary care provider, or chronic care platform solution that an employer or plan might already have in place?

Lyn Health’s CEO Rick Abbott stops by to introduce us to this seed-funded startup, which has raised $10M (backed by Summer VC) and has already attracted some yet-to-be-named health plan and Fortune 500 employer clients. Rick explains that market need that Lyn Health is aiming to satisfy, and how he’s leveraged what he’s learned about the cost of polychronic care from his past life at Premera Blue Cross into an approach that he believes will work to help employers both reduce spend and improve the day-to-day patient experience of managing multiple chronic conditions. Lyn Health is set-up to deliver care with its own physicians and social workers, connecting with patients in a digital-plus-bricks-and-mortar format. And, as for that business model, we get into the big question: at-risk or not?

Excited to meet this startup on the day of its official launch!

WTF Health: Early-Stage Med Device Startup Acorai is Turning Smart Phones into Heart Failure Monitoring Devices

By JESSICA DaMASSA, WTF HEALTH

Acorai is an early-stage medical device startup working with Bayer to improve the way we manage the world’s 65 million patients living with heart failure by using their own smart phones. CEO Filip Peters shows the Acorai device, which is basically an extended smart phone case packed with four different kinds of sensor technologies that work together to measure the pressure inside a patient’s heart, by simply holding their phone against their chest. Of course, the real magic is the algorithm that turns these readings into early detection of a potential incident. How does this stack up against the status-quo way we’re currently caring for these types of patients? Filip says that, right now, the alternative for such monitoring is an IMPLANTED sensor, which many patients aren’t even able to get. As a result, most of the early warning signs of impending heart failure are missed; Acorai’s tech has the potential to be truly revolutionary as it’s able to detect the signs that lead to heart failure hospitalizations up to 30 days in advance.

Acorai has been selected as one of four “Growth Track” companies in Bayer G4A’s Digital Health Partnerships Program, and Filip talks to us about the potential Bayer sees in the daily data stream of information Acorai’s device makes available to cardiologists. A fascinating look at the future of cardiac care!

Inside FarmboxRx’s Groundbreaking Work in SNAP/EBT Benefits to “Eradicate Food Deserts Overnight”

By JESSICA DaMASSA, WTF HEALTH

HUGE news on the “food-as-medicine” front for Medicaid/Medicare Advantage beneficiaries! Now, they can get fresh fruits and veggies delivered directly to their doorsteps and they can pay for them using their SNAP/EBT benefits. FarmboxRx is behind this first-of-its-kind partnership with the U.S. Department of Agriculture, and here to talk through EXACTLY why this is groundbreaking (and what precedent it could set for the food-as-medicine movement in terms of payor support) is founder and CEO, Ashley Tyrner.

As Ashley explains it, FarmboxRx’s produce deliveries have been previously covered by Medicare Advantage and Medicaid, but only under the limited ‘over-the-counter’ healthy foods benefits those plans provide. In some states, this nets to just $20-$25 per month for a family of one. With the addition of SNAP/EBT funding, the budget available for spending on these farm-to-table deliveries expands to $164-$230 per month. A potential game-changer.

We unpack Farmbox further and get into how they’re differentiated from Amazon and Walmart, which also take food stamps online, but don’t deliver produce nationally like Farmbox does. This is a move Ashley describes as having the ability to “eradicate food deserts overnight.” There’s so much more about food insecurity, the way FarmboxRx is working with health plans to use food as member engagement and trust-building tool, and, of course, the backstory behind the business which is basically BOOTSTRAPPED (there’s some venture debt) and raising a Series A.

THCB Gang Episode 73, Dec 2 1pm PT – 4pm ET

#THCBGang is back from its Turkey day snooze! Joining Matthew Holt (@boltyboy) at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be patient activist, author & entrepreneur Robin Farmanfarmaian (@Robinff3);  Queen of all employer benefits related issues Jennifer Benz (@Jenbenz); medical historian Mike Magee (@drmikemagee); and patient safety expert and all around wit Michael Millenson (@MLMillenson)

You can see the video below live at 1pm/4pm or it’s kept here for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

WTF Health: Accolade Navigates Itself into New Territory: CEO on Personalized Healthcare & Tech Infrastructure

By JESSICA DaMASSA, WTF HEALTH

Healthcare navigator Accolade (NASDAQ:ACCD) is on the move. Not only are they now cruising in care delivery territory with two new primary care/mental healthcare offerings that let them personally guide their 9M members further into the healthcare system, BUT they’re also starting to talk more and more about their tech infrastructure and the “operating system” they’ve built to power that healthcare GPS with shared data and access.

CEO Rajeev Singh stops by to walk us through the strategy behind both sides of this (especially interesting when you consider his tech startup background in the context of those “operating system” statements) and why Accolade launched its own new category (personalized healthcare) as a framework for talking about the new course they’re charting.

We get into the September debut of Accolade Care, which bundles primary care and mental health in a per-employee-per-month model, and Accolade One, which wraps the full Accolade ecosystem around the Care product in a value-based model. At-risk models seem to be rising in popularity these days, and I get Rajeev’s perspective on why Accolade chose to go-to-market with one of those…and one that falls into the usual PEPM structure.

More interesting to me, however, is this whole “operating system” thing and how it’s playing out behind-the-scenes to strengthen integration across the businesses Accolade has acquired (Health Reveal being the most recent) and point solutions its partnering with like Virta, Headspace Health, Sword Health, RxSavings Solutions, and Carrot Fertility. The “purpose-built” architecture Rajeev describes sounds like it’s not only giving Accolade what it needs to better manage population health outcomes within its own offerings but that it, in and of itself, could be a new offering for partners who don’t want to build a tech platform themselves.

New directions explored…next moves discussed…AND Raj’s six-year CEO Anniversary celebrated! Watch now.

Health in 2 Point 00, Episode 242|Owlet, EasyHealth, Luma Health, Calal Health, and more

Today on Health in 2 Point 00, Jess and I talk about the FDA informing Owlet, whose CEO Jess interviewed about their products and business model, that they can no longer sell their socks. EasyHealth, a medicare advantage broker, gets 35 million plus 100 million credit. Luma Health gets 130 million, bringing their total up to 170 million. Calal Health gets 77 million dollars, led by Ascension Ventures. Evercore buys Dr. Chrono. -Matthew Holt

Matthew’s health care tidbits: Drug prices

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, I am going to talk drug pricing. Anyone who gets basically any health policy newsletter has seen some of the cash PhRMA has splashed trying to make it seem as though the American public is terrified of drug price controls. But as Michael Millenson on a recent THCB Gang pointed out, when Kaiser Health News asked the question in a rational way, those PhRMA supported numbers don’t hold. 85% of Americans want the government to intervene to reduce drug prices.

Big pharma whines about innovation and how they need high prices to justify R&D spending but health care insiders know two things. First, for ever Big Pharma has spent about twice as much on sales and marketing as it’s spent on R&D. This was true when I first started in health care thirty years ago and it’s still true today. Second, the “R” done by big pharma is resulting in fewer breakthrough drugs per $$ spent now compared to past decades. Which means that they should be increasing that share spent on R&D and need to improve the “R” process. But that’s not happening.

Finally, pharma is very good at increasing prices of branded products and extending their patent protection. Lots of dirty games go on here. Look into it and you can expect a lot of discussion about insulin pricing or discover how Humira is still raking in $16bn a year in the US, despite the fact its original patent expired in 2018. With 85% of the American public in favor, you’d think then that a Democratic Congress would leap at the change to pass a bill that might save the taxpayer $50bn a year in drug costs. But of course that’s not going to happen. There is about $30bn a year in savings in the House version of Build Back Better that passed last week, but there’s little chance of much of that being in the Senate version given Joe Manchin’s daughter’s role running a drug company, and Krysten Sinema being a recent recipient of PhRMA’s largesse. And that’s assuming any version of #BBB gets through the Senate.

Instead hope something small happens to help desperate patients, and wonder how we ended up in a political system that apparently disregards what 85% of the public wants.

Registration

Forgotten Password?