Medstar Health, a big hospital system in the Washington DC area, has been using a selection of digital health tools like Bluestream Health’s telehealth system for a while. Now they are showing to the world their implementation of b.well Connected Health‘s patient interface which as you’ll see is being used to create a digital first experience for their patients, enabling booking of virtual and physical appointments. I spoke with John Lock, Chief Digital Transformation Officer at MedStar Health & Kristen Valdes, CEO of b.well Connected Health, while Cathryna Nieves, AVP, Digital Transformation at MedStar Health gave a full demo of the experience. I don’t often head into the belly of the beast, but it’s very interesting to see how big incumbents like Medstar are working with tech vendors to react to the billions being spent by venture capitalists to create denovo virtual first health services–Matthew Holt
Summus Global is company with a very interesting model that gives a glimpse about the future of virtual care. It delivers online specialty care and much more to employers. You might think that means it is in the second opinion space, or in the care navigation space. And you’d be right, but not completely right. Julian Flannery the CEO tells me that it’s much more than that and has greater ambitions too. I took really deep dive into Summus with conversation with Julian and a thorough demo of the service from Dennis Purcell the COO–Matthew Holt
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!)
By JESSICA DaMASSA, WTF HEALTH
Walmart is looking to scale its healthcare business in a brand-new way: setting its sights on self-insured employers. Today the retail giant announced a go-to-market partnership with Transcarent that will make its “everyday low price” prescription drugs and healthcare services available to self-insured employers for the very first time. Transcarent’s Executive Chairman & CEO Glen Tullman drops in to give us the inside story on the deal with Walmart, what it means for the industry, and how it could once-and-for-all ignite the ‘disruption of the payer’ that we’ve been waiting for since JP Morgan, Berkshire Hathaway, and Amazon came together to found Haven.
Transcarent and Glen are hell-bent on re-making the healthcare payment model by eliminating as many middlemen as possible, reshaping the health and care experience along the way. So, what does this partnership with Walmart mean for that mission and for Transcarent? Is this “THE Deal” we’ll look back on as the one that catapulted Transcarent into a new phase of growth? Remember when Glen’s last company, Livongo, shot into the stratosphere after its deal with CVS Health? I ask Glen if he’s running the same play in a much bigger game and finally concede: Transcarent is NOT a healthcare navigator!
By MATTHEW HOLT
I recently interviewed Subha Airan-Javia, the CEO of CareAlign. CareAlign is a small company that is working to fix the clinician workflow by creating a tool for all those interstitial gaps that the big EMRs leave, and now get moved to and from paper by the care team. In this interview she tells me a little about the company and shows how the product works. I found it very impressive
Full transcript belowContinue reading…
By JESSICA DaMASSA, WTF HEALTH
Jonathan Bush has “More Disruption Please-d” himself and is back at it with a new company, Zus (get it…like the father of Athena) backed by a $35M Series A led by Andreessen Horowitz, F-Prime Capital, Maverick Ventures, & Rock Health.
“It’s ‘Build-A-Bear’ for EMR, patient relationship management, CRMs…” says Jonathan, and meant to help digital health startups work around incumbent EMR companies by providing a developer kit of components common to the “middle” of a health tech stack — AND a single shared record backend where all Zus clients can land and access patient data.
The intention is to help digital health startups reduce the time and cost of developing their tech by eliminating the redundant, generic aspects of building a healthcare tech stack in the same way companies like Stripe or Twilio have taken the burden out of writing code to process payments or integrate messaging. Zus intends to be the go-to for code used to make an appointment, create a patient profile, connect to a telehealth platform, etc. And the shared record on the back end? Does that make Zus a next-gen EMR company?? Find out more about Zus’s business model, current client list, and why, exactly, Jonathan believes that NOW is the time that the dream of the shared patient medical record is within reach.
An email interview with the Co-CEO’s of Evidation Health
Over the last few weeks I’ve been conducting a back & forth email interview with Christine Lemke (L) & Deb Kilpatrick (R), the co-CEOs of Evidation Health. They raised $153 million in a Series E back in March (almost a small round these days!) but I wanted to understand a bit more about what the “new” Evidation was doing—Matthew Holt
Matthew Holt: Congrats on the latest funding. Clearly Evidation has evolved since its founding, but focusing first on the clinical trial study aspect, can you explain how the Achievement panel is structured? How was it put together? What are the typical ways that your clients use it, and what is the member experience?
Deb Kilpatrick: Our Achievement platform is the largest virtual connected research cohort in the United States, with more than 4 million users across all 50 states and representing nine out of every 10 ZIP codes. Through the platform, accessible via our app or through a browser, individuals have the opportunity to contribute to ground-breaking medical research in a number of ways: they can connect smartphones, wearables, and connected devices—think Apple Watches, Fitbits, CGMs, etc—that generate heart rate, activity, sleep quality, and other health-related data; they can connect health apps like Strava and MapMyFitness; and they can participate in surveys and provide patient-reported outcomes (PROs) of many forms.
And they do so with strong privacy protections for both data collection and data use, including use-case specific consents that can be sequential over time. This goes for new Achievers and those who have used the platform for years. And Achievers always have the option to remove themselves from any research project, and/or the platform altogether, at any time.
What do we do with that data? Evidation partners with leading health care companies, including nine of the top 10 biopharma companies in the world, to understand health and disease outside the clinic walls while measuring real world product impact. We’ve conducted virtual trials for almost a decade now, totaling more than 100 real-world studies across therapeutic areas.Continue reading…
By JESSICA DaMASSA, WTF HEALTH
You know all that “magic” that machine learning is meant to bring to seemingly lackluster healthcare data and our limited understanding of it? Komodo Health’s co-founder & CEO Arif Nathoo demystifies the wizardry of one of our favorite buzz phrases, “The Algorithm,” and gives us a colorful overview of how his startup is making data useful to the way payers, health systems, and pharma co’s study populations at-scale. Komodo’s raised $314M to-date, closing a MASSIVE $220M Series E backed by Tiger Global Management, Casdin Capital, ICONIQ Growth, Andreessen Horowitz, and SVB Capital in April, and after hearing this enthusiastic explanation of what they’re working on – and the market potential for it – we understand why.
At its most simplistic, Komodo is using de-identified healthcare claims data as a base from which to learn how patients flow through the healthcare system. Other data sets are brought in and layered onto that “patient-flow, dollar-flow” claims trail in effort create a new vantage point for seeing what’s happening within the system, at a population level. That insight can then be used to predict patient behavior and provide evidenced analysis for how the system can be improved. Don’t worry: Arif provides lots of detailed examples and talks through exactly what kind of data can (and currently can’t) be pulled into the mix. If you want to get smart on the “Big Data” opportunity in healthcare and how it’s going to be impacting the future of care delivery and virtual care delivery, this is one chat you won’t want to miss!
Special Event: The Catalyst @ Health 2.0/Wipfli Survey on the State of Digital Health Results Presentation
TODAY Tuesday, May 11th at 2pm ET/11am PT — RSVP here
Back in November of last year, Catalyst @ Health 2.0, supported by professional services firm Wipfli, launched the Survey on the State of Digital Health, with the goal of creating a comprehensive analysis of the impact of COVID-19 on digital health companies and the rest of the ecosystem. Between the end of 2020 and thru March 2021 we received detailed responses from 300+ digital health aficionados including 180 digital health companies. We’re sure this is the most detailed assessment of what’s happening on the ground in digital health companies you’ll find anywhere.
Join us at 2pm ET/11am PT on Tuesday, May 11th for The Catalyst @ Health 2.0/Wipfli Survey on the State of Digital Health Results Presentation, you’ll see the full results from me & Catalyst’s Elizabeth Brown, hear from Wipfli’s Paul Johnson & Girish Ramachandra, and get reaction to the results from our guests Ryan Johnson, lawyer at Fredrikson & Byron; Sunny Kumar, investor at GSR Ventures;, and digital health CEOs Helena Plater-Zyberk, Supportiv; and Mudit Garg, Qventus.
I think the zoom is full, but you can see it livestreamed below at 11 am PT – 2pm ET – Matthew Holt
By JESSICA DaMASSA, WTF HEALTH
Sharecare, the population-health-slash-care-navigator of the stars (literally, celebrity doc Dr. Oz is a co-founder, and Oprah’s Harpo Productions, Sony Pictures Television, and Discovery Communications are partners) is about to hit the public market via a $4-Billion SPAC IPO with Falcon Capital. Jeff Arnold, co-founder, CEO, and Chairman drops in to talk about how he plans to make Sharecare even more successful than the first healthcare business he founded-and-exited, WebMD.
The Sharecare ecosystem is sprawling. The company’s been around for more than a decade, acquired about a dozen digital health point solutions and health tech businesses, and built a population health analytics platform that’s interwoven consumer, employer, provider, and health plan data for years. Now, the business is even getting into providing Health Security verifications for hotels, restaurants, and the like to prove that their facilities meet guidelines for health and hygiene protocols, cleaning standards, physical distancing and other health requirements implemented in the Covid-19 era.
So, how does Jeff anticipate meeting shareholder expectations for growth? The investor deck touts a future of recurring revenue driving sustainable 20% year-over-year growth; Jeff talks through each of Sharecare’s verticals in detail so we can learn how.