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WTF Health: Transcarent, Walmart & The “Re-making” of Healthcare Payers: Glen Tullman on the Power of Big Retail

By JESSICA DaMASSA, WTF HEALTH

Days after announcing their deal with Walmart, Transcarent’s Executive Chairman & CEO Glen Tullman and meet again (in-person!) to pick up our conversation right where it left off. For the details about the deal, see our last interview; for what the deal signifies for the disruption of the healthcare payer and the ultimate rise of the healthcare consumer, tune in now and take note.

The plot of Transcarent’s story is starting to take shape. Their conflict is with the “big middle” of healthcare where drugs are marked up, care needs pre-authorizations, and docs labeled “this is NOT a bill” are ridiculous artifacts of a payer-first healthcare experience.

“The system behind our healthcare today is working exactly as its designed: for payers. We want to re-design that,” says Glen. “It’s not, ‘how do we get through that better?’ That would be navigating. It’s ‘how do we go completely around that and re-design the experience?’”

Glen talks us through the leverage retailers like Walmart and Amazon really have to help take on non-innovative payers what role Transcarent is playing in all of this, and how startups like GoodRx, Ro, and Capsule who are successfully challenging PBMs are demonstrating that payment model innovation is possible.

And, while we wait for the next big deal to come from ‘healthcare’s best dealmaker, we’ve got some foreshadowing: a quick mention of Oscar Health that registered on my radar as interesting, along with some very specific details about how Transcarent will expand its offering next, looking at MSK, cancer care, behavioral health (particularly for teens), and bringing in more “human voices” for their members to turn to for advice.

Update from Olive: CEO Sean Lane on Putting $850M+ Funding to Work

By JESSICA DaMASSA, WTF HEALTH

There was lots of chatter at HLTH 2021 about the fact that healthcare AI unicorn, Olive, showcased its brand-bedecked touring bus on the show floor. Some expressed disdain about whether or not this was really the best use of more than $850M in funding, while others quickly (and literally) jumped on the bandwagon of the company’s quest to go door-to-door to win over hospital-after-hospital with its “Internet of Healthcare” vision. But, to hear CEO Sean Lane talk about it all – including what’s happening at Circulo, the less-than-a-year-old Medicaid plan being built on top of Olive’s infrastructure – the bus might actually be a grand metaphor for a company continuing to “move fast and fix things” despite the typical stop-and-start nature of innovating in healthcare.

Sean gets us up-to-speed on the latest at Olive: its growth (he says the company is “growing by one mid-sized company each month”)… its expanding client base which now also includes more and more payers…and its own new status as a full-service clearinghouse, thanks to its Olive Assures product that instant pays claims to hospitals and completely eliminates the cost of collection associated with these types of payments. And this is just what you can see of the road ahead from the dashboard! On the horizon, is whatever will be built on top of the Olive infrastructure, and Sean gives us insight as to what’s on the itinerary.

Olive launched “The Library” at HLTH, which is a “marketplace” where other tech companies, including competitors, can sell into Olive’s client base any technology – clinical, operational, administrative, or otherwise – that can help automate healthcare. Sean talks about how this marketplace, along with Olive’s recently launched venture fund, are just parts of what they’re doing to build healthcare’s first TRUE platform business. (You’ll have to listen in to hear how he’s defining platform…) So, what’s in store for our legacy “platforms” like EMRs in the future if/when this more open, democratic type of platform thinking takes off? And, what about the first company already being created from scratch on said platform? You can see how passionate Sean is about building Circulo as the “Medicaid Plan of the Future,” and we get into some examples of elements this new plan will offer its members: primary health sites, “Circulators” that bring telehealth into neighborhoods via tricked-out Sprinter vans for those on the other side of the digital divide, and payment model features (zero prior auths, zero denials, payment immediately) that sound a lot like what Olive is enabling in hospitals with traditional payers. There’s a lot to hear in this one!

WTF Health: Included Health’s CEO Owen Tripp on Grand Rounds, Doctor-on-Demand Merger & New Name

By JESSICA DaMASSA, WTF Health

A sign of effective ‘merging-and-acquiring’ among innovative healthcare companies? How about a new brand-name? The company known as “Grand Rounds Health and Doctor on Demand,” which merged in March 2021 and quickly acquired LGBTQ+ virtual care company, Included Health, announced that the company would be moving forward as Included Health from here on out. We get into the strategy behind that name-change – and, more importantly, how the integration of the three companies is going – from CEO Owen Tripp.

This quick update covers how the navigation-plus-virtual-care co is prioritizing integration at-scale for millions of members – unlike other growing healthcare companies who Owen says have, “acquired companies, but haven’t put them together.” From member experience, clinician experience, and the business model backing all of this, we get a state-of-play on Included Health, including Owen’s take on the rising popularity of at-risk models among competitors Accolade Health and Transcarent, the legacy relationship the company has with Walmart, and how small/mid-sized employers are increasing area of focus for growth.

WTF Health: Inside the One Drop – Bayer Collaboration: New Cardiovascular Disease Product Is Just the Beginning

By JESSICA DaMASSA, WTF Health

Bayer’s $98M co-development-plus-investment in One Drop from August 2020 has yielded its first new product: a highly-personalized, AI-powered digital program aimed at preventing cardiovascular disease. While the solution itself is impressive in terms of its predictive analytics and integration into One Drop’s chronic condition precision health platform, what’s really remarkable about this milestone is that it demonstrates what’s possible when a pharma co and health tech startup are truly aligned as businesses, from R&D to go-to-market.

Bayer Pharmaceuticals’ CIO and Head of Digital & Commercial Innovation Jeanne Kehren and One Drop’s CEO Jeff Dachis take us inside their collaboration, with a very candid conversation about how their two orgs have not only developed a new product here today but how they’ve established a solid foundation for a working relationship that’s poised to revolutionize chronic care and define a new market around precision health.

We talk strategy: for Bayer-One Drop… for what the “digital disruption” will bring to pharma… and for “putting a lab on everybody’s arm” via One Drop’s sensor that’s under development. This chat reveals how the thinking behind incumbent-disruptor partnerships has truly evolved, and what it will mean for bringing digital technologies into healthcare in a big and meaningful way. For me, hearing Jeanne say, “it all starts with pharma being ‘self-aware’” and that they need to “we stop slicing things into therapeutic areas and consider the individual” AND recognize that “not everything is going to be process-oriented and shaped like we do for drugs” is a sea-change from what we were hearing only a few years ago from pharma execs about partnering with health tech companies. Things are changing! Tune in to hear so much more.

WTF Health: Inside Scoop – Medicaid Mental Health Startup Brave Health Lands $10M

By JESSICA DaMASSA, WTF HEALTH

Healthcare startups serving the Medicaid population are FINALLY catching the attention of investors and, this time, it’s for improving access to mental health services. Brave Health’s CEO Anna Lindow and I catch up in-person at HLTH 2021 – under super-secret embargo – to talk about Brave’s $10M Series B funding which was just announced today.

We get into Brave Health’s virtual-first approach to therapy, psychiatry, and outpatient addiction services, its tech underpinnings (which Anna hopes makes her services feel like “magic” to patients and providers alike), and the best-and-most-challenging parts about working with Medicaid plans.

This funding round, which takes Brave Health’s total funding to over $20M, should help with surmounting one of Anna’s biggest challenges: the extra effort required to expand to new states and the new set of Medicaid requirements and regulations that meet her every time she crosses state lines. Still, Brave Health has already expanded into 10 states in two years and, when utilized by Medicaid case managers, providers, and plans, is making a real impact on outcomes and cost of care. We dive into the details about meeting the mental health needs of a population that has typically been misunderstood and marginalized, and talk more about the nuances of supporting innovation and investment in solutions for people with Medicaid.

State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care

By JESSICA DaMASSA, WTF HEALTH

Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.

What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.

Nomad Health’s Next Move: $63M Raise Takes On-Demand Healthcare Staffing into Workforce Management

By JESSICA DaMASSA, WTF HEALTH

Not all who wander are lost: Nomad Health lands a $63M Series D round after a year of 5X revenue growth for their tech-driven healthcare staffing marketplace that helps hospitals hire nurses on-demand. This round, led by Adams Street Partners with participation from all existing investors, brings the company’s total fundraising up to $113M. Co-founder & CEO Alexi Nazem stops by to tell us how the startup is not only planning to expand its focus from nurses to other types of healthcare providers but how the process of doing so will transform Nomad from an on-demand staffing agency to “‘THE’ workforce management platform for healthcare.”

Alexi puts it this way: “In healthcare, the product is CARE. And, who is the product team? It’s the doctors, the nurses, the allied health professionals…and the fact that there’s no intentional management of this group of people who steward $1.5 trillion dollars of cost in the US every year is beyond unbelievable.”

The problem is twofold. First, there’s the way temporary staffing is currently being handled: by 2,500 different staffing agencies that take a fragmented, predominantly people-powered approach to sourcing, vetting, and hiring candidates. The cost is high to a health system looking to shore up their nursing staff, and the experience for job-seeking nurses is very opaque, with information being revealed about a job only after a significant investment of time within the application process. If the match falls apart, all the people involved in the process are left to try again.

This leads to the second issue – that, big picture, the status-quo way of temporary staffing is leaving behind a LOT of valuable data. Data about the clinician that is useful to the management of their career, and data about the workforce that would prove valuable to a hospital looking to better manage its care delivery resources.

We journey into the details behind Nomad’s business model, which is cutting costs for hospitals while also increasing pay for the 150,000+ clinicians on its platform. AND, while we’re there, we also find out how they expect their on-demand staffing approach to playing out in the booming virtual care space.

DayTwo Scores $37M to Expand Microbiome-Based Personalized Nutrition Treatment for Diabetes

By JESSICA DaMASSA, WTF HEALTH

People with Diabetes can get ready to celebrate: “The ‘Era of Lancets’ is over.” Precision nutrition startup, DayTwo, is scaling up its microbiome-based program, which takes the guesswork (and finger pricks) out of Diabetes management by offering its members food predictions that identify how their bodies will respond to any food BEFORE they eat it. The startup just closed a fresh $37M in Series B funding (led by aMoon and Cathay Ventures) and is expanding the rollout of their fee-for-outcomes Diabetes program to health plans and large self-insured employers.

The science behind this has yielded DayTwo the largest gut microbiome dataset in the world, and years of empirical studies on exactly what happens in our bodies as our digestive systems process different foods. Josh Stevens, DayTwo’s President & Chief Commercial Officer, walks us through the research behind the offering, which uses a gut microbiome analysis to rank foods and food combinations based on how eating them will impact a person’s blood sugar – essentially revealing what foods will (or won’t) cause a member’s blood sugar to spike before they even take a bite.

Its 70,000+ members report lower A1C levels (1 point on average), sustained weight loss, and, probably most exciting, an ability to stick with the program because the app (and wrap-around telehealth support from registered dieticians) creates a completely bespoke diet that lets people learn how to eat their favorite foods and keep their blood glucose levels within range. Will this predictive approach really bring about the end of lancet-based blood glucose testing for Diabetes management? Josh says Diabetes remission is a goal made easier by this predictive approach, but how does it stack up to other food-as-medicine approaches out there? I have a gut-feeling that you’ll want to tune in and find out!

Inside 1-Year-Old Calibrate’s $100M Raise for ‘Rx + Behavior Change’ Weight Loss

By JESSICA DaMASSA, WTF HEALTH

Just ONE-year in market, and Calibrate has already closed a $100M Series B co-led by Founders Fund and Tiger Global, with participation from Optum Ventures, Forerunner Ventures, Threshold Ventures, and Redesign Health. Why is this virtual care startup getting so much attention (and funding) from so many notable health tech investors? Founder & CEO Isabelle Kenyon is here to introduce us to the telehealth-plus-prescription-drugs business she’s building to help people lose weight.

This is NOT a Noom. Calibrate’s business model is built around a class of $700-$1,300-per month, prescription weight loss drugs called GLP-1s, which it helps its members sort through for both fit AND health insurance coverage (Isabelle says 90% of Calibrate members get the drugs covered by their health plan.) Once the drug is prescribed, the Calibrate member is wrapped in a telehealth-driven, lifestyle intervention program that addresses sleep, eating, exercise, and emotional health to help support the reset of their metabolism. As a result, Calibrate members are losing an average of 14% of their body weight, a significantly better, more sustainable outcome than achieved in clinical research when the drugs were prescribed without support.

There are lots of compelling aspects to the Calibrate story here, and we get through all of them: the 175M-person total addressable market of Americans diagnosed with obesity… the recent FDA-approval of Novo Nordisk’s new GLP-1 drug called Wegovy… and how Calibrate will use its fresh funding to build-out an Enterprise program aimed at meeting the shifting thinking employers, Medicare Advantage plans, and other health insurers have about obesity treatment as “preventative care” against more costly chronic diseases.

What else could this “behavior change + drug” framework – and its unique de-coupled payment model – be applied to? Diabetes, cholesterol, and hypertension sound like they’re all on the table, but how defensible is this? What stops a pharma company from doing this themselves? Isn’t this digital therapeutics?? A VERY interesting discussion about the often-taboo subject of weight loss, pharma, and the disruption of the healthcare delivery system behind both.

Cityblock Health & The ‘At-Risk’ Disruption of Medicaid Care

By JESSICA DaMASSA, WTF HEALTH

Innovation in Medicaid is HAPPENING – and not only is it capable of creating better, less expensive healthcare for Medicaid members, but Cityblock Health is proving that it can also be the underpinning of a business worth over $1B dollars.

Dr. Toyin Ajayi, Cityblock’s co-founder & President, walks through the company’s novel business model, which goes AT-RISK to take care of some of the highest risk patients in all of healthcare. Here’s how it works: the startup contracts with health plans that provide Managed Medicaid services, helps them identify groups of patients that are of highest risk or rising risk, then takes over the financial and clinical accountability for that group. Cityblock then envelopes those members in a suite of highly personalized services that address both their healthcare needs and the social care challenges that are connected to them. In short…Cityblock is a medical practice built at the bustling intersection of value-based care and social determinants of health.

Toyin talks through some examples of the unique challenges facing the 75,000+ members Cityblock works with, particularly what they are learning about what it takes to “earn the right” to provide this population with care. But, is the high-touch, tech-infused core of their model defensible? What stops a huge national Managed Medicaid health plan like Centene or Molina from simply replicating this within their own multi-billion-dollar enterprises? Competition, expansion, funding, and outcomes – we get into it all, and hear Toyin’s near-term vision for Cityblock as it puts the nearly $500M its received in venture funding to work on “transforming the healthcare ecosystem for those who need it most.”

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