With 61% of American adults reporting a negative behavior change – troubled sleep, changes in diet, increased alcohol consumption, more time on screens, etc. – as a result of the pandemic, AND healthcare payers looking at 2022 cost increases in the range of 8-10%, one has to wonder just how bad our collective health has become thanks to the past two years.
Jeff Ruby, CEO of tech-enabled habit change provider, Newtopia, shares some startling stats about our population’s health, particularly when it comes to those lifestyle-related metabolic disorders that his company is trying to prevent. And, thus, we get into a fiery conversation about condition prevention versus condition management… at-risk payment models versus per-member-per-month models… behavior change versus prescription drugs… and whether or not a biz like Newtopia (running at-risk on goals related to prevention) is better placed or worse off as a result of this population that, though sicker and riskier than before, is showing up in greater numbers to try their program.
It’s clear where Jeff stands with his genetics-plus-behavioral-psychology-based platform, but questions about how to best handle our population’s health as the pandemic wans are still very much up for debate. Even on the public markets – Newtopia was one of the first digital health companies to go public during the pandemic, hitting the Canadian TSX as $NEWUF in March 2020 – investors’ sentiment for virtual care just isn’t what it used to be. Maybe we can apply some behavior change psychology there too? (wink, wink) Though Jeff talks about “uncertainty about how US healthcare works” in the context of the market, it seems like that “uncertainty” is also pervasive in our approach to spending for chronic care – especially now. Are dollars toward prevention dollars that are better spent? A compelling case is made…
Amwell’s ($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.
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.
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!
Two of the most notable payer venture funds, Optum Ventures and Cigna Ventures, just headed up a $30 million dollar Series A funding round for Flume Health, a startup that basically builds “challenger” health plans. How did this go down? Cédric Kovacs-Johnson CEO & Founder of Flume introduces us to his company which offers providers, digital health co’s, brokers, reinsurers, and just about any other healthcare org a tech stack for creating their own hyper-niche, super personalized health plans.
The suite of services to “build-a-plan” includes things like claim processing, payments, enrollment management, digital health point solutions integration, and other API functionality – replacing the traditional TPA with tech and the one-size-fits-all plan with a new opportunity for nichey-ness that can customize coverage for patient populations based on health conditions, location, employer, and so on.
Cédric talks us through the benefit to his target client – the care provider – who, while taking on more risk anyway, may consider building their own plan to capture more premium dollars and gain better control over the end-to-end patient experience. Wait a minute – is all this “Challenger Health Plan” talk just a re-brand of value-based care? I ask point-blank and get a new buzz phrase in return; welcome to the lexicon, “Commercial Advantage.” Lots to unpack in this one including Flume’s rev-gen model and plans for growth – they’re already onboarding one new challenger plan per month!
Turns out, the Clarify Health Solutions story is about a lot more than data and analytics these days. Value-based payments? Acquisition of provider-focused, behavioral science startup Embedded Healthcare? Opportunities in real-world evidence??
Good thing founder & CEO Jean Drouin and I caught up at ViVE 2022. Not only do we get into the backstory of the business, which has built a self-service analytics platform for payers, providers, and life science co’s on top of “one of the largest-ever patient datasets” in the industry, but we also talk about the strategy that’s driving Clarify into the world of value-based contracting and how Embedded Healthcare’s tech will be used to augment and refine that new offering.
Jean talks in detail about his client mix, business model, and the two “healthcare golden rules” Clarify lives by as it scales up its business: 1) figure out how the payment method is going to work and 2) don’t mess with the work-flow.
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.
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.
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.
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