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Cricket + Fresenius Health Partners + InterWell Health CEO on New Biz & “Take Out Merger” Chatter

BY JESSICA DaMASSA, WTF HEALTH

Matthew Holt categorized the triple-merger between Cricket Health, Fresenius Health Partners, and InterWell Health as a “take out merger” — proposing that Fresenius orchestrated the deal to “take out” rising-star kidney care startup, Cricket Health. Well, Cricket Health’s CEO Bobby Sepucha (who will also be CEO of the newly combined entity) “takes issue” with the health tech curmudgeon’s “take out” call and we find out the reasons why.

Listening to Bobby’s explanation, it sounds like the shrewd move Fresenius might be making here in giving up its value-based care arm, Fresenius Health Partners, and its joint-venture with 600 nephrologists in InterWell Health is one that better positions their core dialysis business for the value-based care future that is headed straight toward specialty medicine.

As Bobby puts it, “when you deliver a healthier patient to kidney failure, you don’t obviate the need for dialysis.” Instead, he says, you open up options for other treatments like transplant or home dialysis along the way, as well as the kinds of patient quality outcomes that satisfy the clinical accountability of providers in value-based arrangements.

The other gain is a move upstream for Fresenius. While there are 600,000 dialysis patients each year, the population of Americans with late-stage kidney disease who remain “wildly unmanaged” is 36 MILLION. And they represent $170 Billion in healthcare costs. If InterWell works the way it’s supposed to – with the first value-based care-designed model for late-stage kidney disease management – the potential to impact that patient population is what this merger is all about. Tune in and tell us what you think!

THCB Gang Episode 86, Thursday March 24th, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang on March 24 for an hour of topical and sometime combative conversation on what’s happening in health care and beyond were fierce patient activist Casey Quinlan (@MightyCasey); patient safety expert and all around wit Michael Millenson (@MLMillenson); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and back from his travels in Mexico and medical historian Mike Magee (@drmikemagee).

Special guest this week was population health and primary care expert Ines Vigil, who developed that program at Johns Hopkins but now hangs her hat at Clarify Health &is the author of Population Health Analytics. We dived deep into what populations health means. What we need to do to make it work and whether it’s real or not!

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.

Livongo’s Former CEO Zane Burke on New Gig Leading Healthcare Navigator Biz Quantum Health

By JESS DAMASSA

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.

THCB Gang Episode 85, Thursday March 17th, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang 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: double trouble futurists Ian Morrison (@seccurve) & Jeff Goldsmith; consultant focusing on platform business models and strategy Vince Kuraitis (@VinceKuraitis), & back after a long while analyst and Principal of Worksite Health Advisors Brian Klepper (@bklepper1).

Today there will be more discussion than usual about platforms and whether health care is ready for them!

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

Where Health Care Value Can Lead

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By BRIAN KLEPPER

It seems inevitable that, in the near future, an innovative health care organization – Let’s call it The Platform – is going to seize the market opportunity of broader value. It will cobble together the pieces, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than previously has been available.

To manage risk and drive performance, The Platform will embrace the best healthcare management lessons of the past decades: risk identification through data monitoring and analytics, driving the right care, quality management, care navigation and coordination, patient engagement, shared decision-making, and other mission-critical health care management approaches. It will practice care that is grounded in data and science, and is outcomes-accountable.

But The Platform will also appreciate that a few specialty vendors have developed deep expertise in dealing with clinical or financial risk in high value niches – where health care’s money is – like management of musculoskeletal care, chronic disease, maternity, surgeries, high performing providers, or specialty drugs. It will understand that it often makes sense to partner with experts who can prove and guarantee high performance rather than trying to learn to achieve high performance within each niche. The Platform also will realize that simplicity is a virtue, and that bundling specialized services under one organizational umbrella is easier for health plan sponsors to manage and for patients to negotiate than an array of individual arrangements.

Continue reading…

Past the Talking Points: Glen Tullman on Affordable Insulin, Payment Model Reform & Transcarent

By JESSICA DaMASSA, WTF HEALTH

Turns out, that if you’re lucky enough to catch Glen Tullman in an impromptu chat just off the main stage at ViVE 2022, he’s warmed up enough (we could maybe even call it ‘fired up’ enough) to kick it into overdrive, roar past the usual talking points, and tell us what he REALLY thinks about what’s happening in the healthcare market today.

Things are changing. And, if you listen to this chat from start-to-finish, one of the key, overarching themes is payment model reform. From the news about Civica RX’s commitment to $30-dollars-or-less insulin (an initiative Glen helped lead and fund via his family foundation) to the 10X growth of virtual care coming out of the pandemic and the rise of “Big Customer” (aka Walmart and Amazon) in healthcare, the bottom line is that we’re no longer talking about fixing the way care is paid for – it’s actually starting to happen.

What is Transcarent’s role in all this? For those who might still be confused, tune in. This IS confusing, but I think the candor of our situation here may have given rise to one of the best descriptions of the business yet. Glen goes point-by-point on the way Transcarent is attempting to shift the paradigm for cost-and-quality across five (5!!!) different aspects of care at one time, using different strategies, novel technologies, cross-industry partnerships, and never-before-seen relationships with health systems to deliver what “20 years working with payers and 5 years working navigators didn’t deliver” for self-insured employers and their employees.

Will ‘DoorDash for Lab Draws’ Startup Sprinter Health Be What Speeds Up Virtual Care’s Growth?

By JESSICA DaMASSA, WTF HEALTH

Sprinter Health bills itself as “the “DoorDash for lab draws” – sending nurses and phlebotomists out to patients’ homes to collect blood samples and urine samples, check vitals, and even perform Covid tests. Their model has been received with some skepticism (most notably by my Health Tech Deals co-host and legendary health care curmudgeon Matthew Holt) so we get down to the bottom of what’s REALLY going on with CEO Max Cohen.

The long-term play is NOT to just rove the streets like some nomadic Quest Diagnostics; it’s to support the emerging market of virtual care and telehealth-based next-gen healthcare companies that will, ultimately, be limited in their abilities to diagnose-and-treat unless they can easily – and inexpensively – get patients lab tests.

Sprinter hopes to be that logistics company, extending the ‘value of virtual’ so it can live up to its promise of providing less expensive, more convenient care to patients. Max says only 15-20% of their business is made up of consumer-directed concierge calls; instead, the focus is on having a provider – think home health providers, specialty labs, virtual-first primary care clinics – dispatch Sprinter instead. Their pricing is built to attract these kinds of providers, giving Sprinter an advantage over, say the kind of medical transport services that are typically engaged to bring home health patients to the lab instead of the other way around.

Less than one-year old, Sprinter has already raised more than $37 million and counts health-tech-famous funds like Andreesen Horowitz, General Catalyst, Accel, Google Ventures – and even the real DoorDash’s co-founder and CEO Tony Xu – as investors. So, what’s ahead in the short-term to expand services out of LA, San Francisco, and Sacramento? We talk geographic expansion (hello, Texas and Georgia) and how Max is planning to continue to expand the utility and value of virtual care without increasing cost.

Mental Health Care & Medicaid State-of-Play: Circulo Health, Brave Health Execs Weigh-In

By JESS DaMASSA, WTF HEALTH

Two experts in mental health care for the Medicaid market stop by to help us get smart on the challenges facing patients and providers alike in this critical area of care. It’s not just the payment model that is different; stigma is different, patients are more racially and culturally diverse than those in commercial plans, support systems vary, and even the normalization of seeking mental health care manifests itself differently when it’s individually-driven as opposed to part of an “employer group.”

Anna Lindow, CEO of digital-first mental health startup Brave Health, and Vik Bakhru, Chief Health Officer of new managed Medicaid plan Circulo (the one built on Olive’s health tech platform) share what they know about this patient population, including what they are learning via the partnership they share to provide Brave Health’s services to Circulo’s members in Columbus, Ohio and Albany, New York.

The top of this conversation starts with the trend-talk and identification of the key issues facing Medicaid mental health care, then we get into some updates from Brave and Circulo, including how Circulo is examining “what it means to be a payer of care” and looking to innovate just one-year after launch.

Matthew’s health care tidbits: The Stupidity Vaccine

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 think we need a new vaccine. We need one that prevents stupidity.

Look I get that some people don’t think the flu vaccine is effective and don’t think the effects are too bad, so they don’t get one every year. Many people don’t get a vaccine for shingles. But as someone who had shingles long before the recommended age for the vaccine, let me tell you, you’ll wish you had the vaccine should you get it. And even sensible liberal Maggie Mahar a long while back was pretty suspicious of Merck’s Gardasil vaccine for cervical cancer–although since then it’s been replaced both by a more effective updated version and by Cervarix and the long term results are really good.

But since COVID-19 appeared the cultural and ideological identification among most Republicans has been that only wussy liberals take the COVID vaccine. This is stupid and indefensible. Even Donald Trump thinks so! But when he told his cult members that, they booed him! And so the US is stuck on not enough people vaccinated to repel variants or stop ICUs filling up. There are now hundreds of thousands of unnecessary deaths among the unvaccinated with no end in sight.

But this isn’t stupid enough. Now we are seeing senior political leaders attacking vaccines for diseases we’ve had under control for ages. We’ve already seen outbreaks of measles in recent years, including one at Disneyland. Last month 17 Georgia state senators proposed banning school mandates for all vaccines including MMR, chickenpox, DtAP, Hep B, Polio and more. It’s amazing that these people don’t believe in science, yet they are probably happy to use a smartphone or get in an airplane.

Sadly there appears to be no vaccine for stupidity on the horizon

THCB Gang Episode 84, Thursday March 3rd, 1pm PT 4pm ET

Joining Matthew Holt (@boltyboy) on #THCBGang 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:  fierce patient activist Casey Quinlan (@MightyCasey); patient safety expert and all around wit Michael Millenson (@MLMillenson); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); and policy consultant/author Rosemarie Day (@Rosemarie_Day1).

The video will be below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels