Joining Matthew Holt (@boltyboy) on #THCBGang on April 28 for an hour of topical and sometime combative conversation on what’s happening in health care were: THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson) & Principal of Worksite Health Advisors Brian Klepper (@bklepper1). Matthew had COVID so didn’t do much & Kim ran the show. Lots of discussion on telehealth, primary care, private equity and much more…
You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
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.
You may have thought the days of huge digital health rounds were over. Not quite yet! CEO Kuldeep Singh Rajput talks with Matthew Holt about Biofourmis’ $300m Series D raise. They’re in the business of sensors, digital therapeutics and chronic specialty care (cardiology/oncology) and hospital at home. And as if that wasn’t enough, they have a solid plan for both organic & “inorganic” growth!
Joining Matthew Holt (@boltyboy) on #THCBGang on April 21 for an hour of topical and sometime combative conversation on what’s happening in health care are: patient safety expert and all around wit Michael Millenson (@MLMillenson); digital health guru Fard Johnmar (@fardj); delivery & platform expert Vince Kuraitis (@VinceKuraitis); and a special guest – Alexandra Drane (@adrane) the queen of caregivers everywhere.
You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
Virgin Pulse has been a big name in workplace wellness for a long time – working with health plans and employers (including 25% of the Fortune 500) to provide care navigation, well-being services, health coaching and access to digital health point solutions for years. Yet, it raised some eyebrows at the end of last year when it announced its acquisition of data-driven wellness company, Welltok. So, what happens when one of the biggest names in worker wellbeing suddenly has access to a dataset of 250M healthcare consumers? Virgin Pulse’s CEO Chris Michalak stops by to talk about the value of that data, which he believes will not only turbo-charge Virgin Pulse’s engagement rates, but also provide new ways for the business to serve as a “full-on navigation capability” for employers, plans, and health systems.
As Chris puts it, Virgin Pulse has always been an “engagement company” but the addition of Welltok’s data turns it into an “activation company.” As Virgin Pulse continues to partner up with digital health point solutions, bring digital therapeutics into the fold, and build-out primary care relationships as a lead stream, the platform Chris describes starts to sound more and more like a navigation business that competes with the likes of Accolade or Included Health. Will Virgin Pulse one-day dip into primary care themselves and add their own virtual care providers? Will they build their own digital therapeutics with data derived from that rich Welltok database? We get into the ‘what’s next’ for the business as it integrates its latest acquisition and seeks to win more C-suite attention from employers seeking to better manage their employees’ access to healthcare benefits.
Joining Matthew Holt (@boltyboy) on #THCBGang on April 14 for an hour of topical conversation on what’s happening in health care and beyond were fierce patient activist Casey Quinlan (@MightyCasey); futurists Ian Morrison (@seccurve) & Jeff Goldsmith; Jennifer Benz (@Jenbenz); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).
Lots of chat about McKinsey and conflicts of interest, what’s next with COVID, where employers are now, and Casey has a unique idea about how to profit from data brokers.
You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.
More traction in Pharmacy Benefits Management (PBM) innovation, this time coming out of care-navigation-plus-PBM startup Rightway. CEO Jordan Feldman and Chief Pharmacy Officer Scott Musial (who Jordan calls the “Godfather of PBMs”) drop in to talk about their 1500 employer client base and how the business is now even winning over health plans who are tired of working with the ‘Big Three PBMs.’
The NextGen PBM story is the headliner here, with Rightway customers saving an average 18% in their first year with the “new-to-the-world PBM” the company has built.
What’s different? Two big things. First, the PBM’s payment structure for the employer. Jordan shares how these are usually rebates-driven or based on spread pricing; Rightway is actually innovative in offering the PBM benefit on a per-member-per-month basis instead.
That leads to the second twist, which is based on gaining cost savings for the employer by pairing the PBM with navigation. According to Scott, this changes the conversation from one that’s solely focused on managing the price of the drugs to managing how employees are utilizing the formulary instead – creating opportunities for lower-priced generics or alternatives that Rightway is happy to point to because it’s not dealing with rebates or dispensing.
So, who is Rightway competing with? Navigators like Accolade, Inc. or Included Health? PBMs like CVS/Caremark, Optum or Express Scripts? Or other emerging ‘combo’ businesses like Transcarent?
We get into the competitive landscape, more about PBMs than you might have ever wanted to know, and what Jordan and Scott are hearing from hard-hit employers looking to recruit and retain employees in the face of the Great Resignation.
Well Health is flying under-the-radar as a white-label patient communications platform that lets more than 400 healthcare providers text message their patients via their hospital’s EMR. In the “is it a feature or is it a company?” debate that often surrounds digital front door startups, I ask CEO Guillaume de Zwirek why Well Health has decided to go out as an infrastructure play rather than own the patient relationship itself. How does he see this strategy lending itself to long-term growth?
One of the best-funded startups that I’ve never heard of (they’ve quietly raised $97 million from the likes of Dragoneer, Lead Edge Capital, Twilio Ventures and others) we get into the details behind the business model, the tech that’s supporting their patient comms platform, and why I haven’t heard about these big fundraises.
The health care industry is rapidly embracing new technologies. Covid-19 changed the way many industries operate, and healthcare is one industry that was particularly affected by the pandemic. Many health care organizations were already undergoing digital transformations, but Covid exponentially sped up those processes. Health care providers and health-tech companies were forced to adapt to the new normal and change the way they operate. Here are 3 major ways health care has changed in recent times.
1. Increased popularity of telehealth services:
Covid made telehealth appointments a necessity, but even in a post-Covid world virtual visits are likely to remain a core component of modern healthcare. According to McKinsey, telehealth utilization was 78 times higher in April 2020 than in February 2020. It remained nearly 40 times as popular in 2021 as compared to pre-pandemic levels.
Research shows that both patients and physicians are fans of telehealth. Many patients prefer the convenience of being able to speak to their doctor from home and physicians feel that offering telemedicine allows them to operate more efficiently. Phone and video-based medical appointments became mainstream in 2020, and they are unlikely to go away anytime soon.
2. More wearable medical devices with connected ecosystems:
The number of wearable medical devices in use has skyrocketed over the past 5 years. The wearable medical device market is expected to reach $23 million in 2023, a major increase from $8 million in 2017. Gadgets like heart rate sensors, oxygen meters, and exercise trackers are all becoming increasingly popular. Many popular consumer products such as cell phones and smartwatches ship with built-in medical tracking technology.
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, the controversy about Medicare Advantage is getting louder and louder. There’s no question that it results in lower out of pocket payments for its members than traditional FFS Medicare. Medicare Advantage members use fewer services, and their care appears to be better “managed” –then again FFS Medicare’s “members” are barely managed at all.
But the big question is, Does Medicare Advantage save the government money? Critics (notably ex CMS veterans Berwick & Gilfillan) claim that risk adjustment games played by the private plans who run Medicare Advantage have cost up to $200bn over 10 years. Medpac (the independent body that advises Congress) estimates that “Medicare spends 4 percent more for MA enrollees than it would have spent if those enrollees remained in FFS Medicare” and go on to say “In aggregate, for the entire duration of their Medicare participation, private plans have never produced savings for Medicare”. However data from the Medicare Trustees and other research from ACHP & the trade group Better Medicare Alliance suggests that Medpac’s analysis is incorrect and that Medicare Advantage saves the government about 9% per enrollee.
THCB ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year, and a related one from current Permanente Federation CEO Richard Isaacs. But it’s much more nuanced than that. J Michael McWilliams has long piece on Health Affairs Forefront trying to capture the various strands of the argument. His conclusion? “The substantial subsidies MA receives are largely responsible for the extra benefits and have more than offset savings from any efficiencies, posing a net cost to Medicare and complicating assessments of MA’s added value.”
Meanwhile CMS has just changed the most controversial aspect of risk adjustment (which is the most controversial part of Medicare Advantage) by banning the plans from doing it, and only allowing providers to be involved.
Whether any of this is going to change CMS regulations or wider government policy regarding MA payments is less certain. CMS is currently dealing with its replacement for the even more controversial Direct Contracting (now called ACO REACH). But Medicare Advantage is the most profitable part of private health insurance and has many knock on effects for care services and technology. So I’ll be watching this space and you should too!
