Joining Matthew Holt (@boltyboy) for the 101st #THCBGang on Thursday August 18 are medical historian Mike Magee (@drmikemagee); patient safety expert and all around wit Michael Millenson (@mlmillenson); delivery & platform expert Vince Kuraitis (@VinceKuraitis); THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard);
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.
by JESSICA DAMASSA
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!
BY JESSICA DaMASSA
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.
Manav Sevak is the (young and very smart) CEO of Memora Health. I must admit to thinking that their service was just a patient chatbot, but it’s a lot more than that. It’s digitizing care workflows that touch both patients and of course the clinical care teams that support them–especially outside the walls of the hospital. They also collect a lot of patient data, and then guide their patients through their complex journey. Manav dives deep into the product and shows us a tad of the secret sauce behind the relatively simple front end of the product. Memora raised $40m earlier this year ($50m total) with Transformation, A16z, Frist Cressey & more in the cap table. If you want to understand how technology is changing clinical workflows in health care, this is a fascinating session–Matthew Holt
Joining Matthew Holt (@boltyboy) for the 100th #THCBGang on Thursday August 4 were Suntra Modern Recovery CEO JL Neptune (@JeanLucNeptune); Consumer advocate & CEO of AdaRose, Lygeia Ricciardi (@Lygeia); and the Light Collective’s Andrea Downing (@bravebosom). Sadly fierce patient activist Casey Quinlan (@MightyCasey) had a Mets party flare up and couldn’t join at the last minute. There was a lot of chat about data and privacy, and even some ideas about what a future where patients data flowed but patients rights were respected might look like!
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.
By ELIZABETH BROWN, CATALYST @ HEALTH 2.0
INTRODUCTION: THE REGIONAL WORKSHOP PANELISTS AND BACKGROUND OF THE PANEL
For the past three years, Catalyst has been involved in the IDIH Project, which has recently concluded (you can read more about the overall project findings here). IDIH (International Digital Health Cooperation for Preventive, Integrated, Independent and Inclusive Living) – funded under the European Union Horizon 2020 Research and Innovation Program – was aimed at fostering cooperation in the field of Digital Health for Active and Healthy Aging (AHA) between the European Union and five Strategic Partner Countries (Canada, China, Japan, South Korea, and USA), especially focusing on four key areas that embrace common priorities of all countries/regions involved: Preventive Care, Integrated Care, Inclusive Living, and Independent and Connected Living.
Following an expert-driven approach, experienced and renowned experts, executives, and advocacy groups from the six regions (Europe, China, Canada, Japan, South Korea and USA) were brought together by IDIH in a Digital Health Transformation Forum working to define more specific priorities in Digital Health and Ageing, and identifying opportunities for mutual benefit and priorities for international cooperation.
During IDIH Week 2022, Catalyst ran a Regional Workshop aiming to explore the impacts of COVID-19 on AHA.
Continue reading…BY JESSICA DaMASSA, WTF HEALTH
Home-based healthcare is the stuff of tomorrow – literally. Tomorrow Health just closed a $60M Series B to grow their tech infrastructure biz into what CEO Vijay Kedar hopes will ultimately streamline and optimize how home health is ordered, delivered and paid for. This is the software that *could* be the thing that not only gets patients into home-based set-ups faster (vastly improving upon the up-to-90-minutes it currently takes providers to set-up home care for patients) but also creates a system for all stakeholders to track and monitor patient outcomes with an aim at the much larger, long-term opportunity: to realign incentives on value instead of fee-for-service.
Vijay came out of Oscar Health, meaning there is definitely a payer slant to the way this software is designed and deployed. Payers are Tomorrow Health’s clients, and it offers them a way to organize (or completely create, in some cases) home care networks out of the hundreds of different small, local market suppliers and providers that get medical equipment, skilled and unskilled services, and other in-home care elements to the doorsteps of the patients who need them. For a Geisinger Health Plan or Aetna – two of Tomorrow Health’s marquee clients – the software alleviates the pain of scaling this concept in every market while also providing a way to track what’s happening with the patient and build a “bridge” back into the health system that’s leading the patient care team.
With so many other players working in the home-health space – everyone from retail players like Walgreens/CareCentrix and Best Buy/Current Health to upstarts like Signify Health, Honor, and more – how will this tech stack approach play out against others that are one-stop-shops with frontline care and coordination layered on top? Will these ultimately be Tomorrow’s next clients?? Tune in to find out.
Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday July 21 were futurist Ian Morrison (@seccurve); medical historian Mike Magee (@drmikemagee); and fierce patient activist Casey Quinlan (@MightyCasey)
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.
I was at the AHIP conference in Vegas late last month and caught up with a number of CEOs & execs for some quick bite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am dribbling them out –Matthew Holt
Next up is Meghan Gaffney, CEO, Veda.
I was at the AHIP conference in Vegas late last month and caught up with a number of CEOs & execs for some quick bite interviews — around 5 mins getting (I hope) to the gist of what they & their companies are up to. I am dribbling them out–Matthew Holt
Next up is Sudheen Kumar, CEO, Health Chain.
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