Today on Health in 2 Point 00, I’m getting my shots soon! On Episode 197, General Catalyst is throwing more money around – $101 million goes to BrightInsight for its digital health insights management platform. SteadyMD raises $25 million bringing its total to $31 million, and CirrusMD raises $20 million in a Series C bringing its total to $47 million. Is there room for more telehealth companies? Finally, fertility benefits company Cleo gets $40 million, bringing its total up to $80 million – this was a hot space last year, what’s going on now? —Matthew Holt
Firefly Health’s CEO & Exec Chairman on $40M Raise & Becoming a “Bloat-less Kaiser”
By JESSICA DaMASSA, WTF HEALTH
Virtual-first primary care company Firefly Health is becoming a health plan! Backed by a $40M Series B, CEO Fay Rotenberg and Executive Chairman Jonathan Bush stop by to explain how they’re providing “half-price healthcare that’s twice as good.” (Or, as only Jonathan can put it: “we’re a bloat-less Kaiser.”) All kidding aside, some big-name health innovation investors are not only behind this raise (Andreessen Horowitz led, F-Prime Capital and Oak HC/FT dipped back in), but also this idea to wrap a benefit around Firefly’s digitally-driven comprehensive care model. Already in-market, the new benefit-plus-care product is aimed squarely at mid-sized/small, fully-insured employers – shops with 50-500 employees which, right now, have limited options for dramatically changing their healthcare spend or being able to build out their own benefits the same way large self-insured employers can.
Fay and Jonathan get into the details about how they’re extending their “Marie Kondo-ing” of healthcare delivery – which has thus far netted some pretty impressive health outcomes, cost savings, and a 92 Net Promoter Score – into healthcare financing.
BONUS: Tune in around 25:30 and stick around for a few minutes as Jonathan weighs in on the health tech funding boom, how it compares to the EMR arms race days of ole, and whether or not he thinks he can beat Glen Tullman’s $14.5B valuation if/when Firefly goes public. HA!
The Art of the Chart: Documenting the Timeline
By HANS DUVEFELT
The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions is necessary to document and review when following a patient through their treatment.
In the old paper charts, particularly when they were handwritten, office notes, phone calls, refills and many other things were displayed in the order they happened (usually reverse chronological order). This made following the treatment of a case effortless, for example:
3/1 OFFICE VISIT: ?UTI (where ciprofloxacin was prescribed and culture sent off)
3/3 Clinical note that the culture came back, bacteria resistant and treatment changed to sulfonamide.
3/5 Phone call: Patient developed a rash, quick handwritten addition on left side of chart folder, sulfa allergy. New prescription for nitrofurantoin.
3/8 Phone call: Now has yeast infection, prescribed fluconazole.
Each of these notes took virtually no time to create and you could see them all in one glance.
Continue reading…Time to Reboot “Medicare-For-All”
By MIKE MAGEE
In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why.
The January 6th insurrection, followed by the past weeks two mass shootings, have served to remind our citizens that we must address a range of issues while continuing to confront the pandemic threat.
Modern civilized societies rely on a double-armed approach to maintain order, peace and security. The first arm is laws. But laws are of little value without even and unbiased enforcement.
The second guardrail of civility is culture. MIT professor Edgar Schein described it this way: “Culture has three layers: the artifacts of a culture — our symbols and signs; its espoused values — the things we say we believe; and, most important, its underlying assumptions — the way things really are.”
In the Senate chamber this week, and in Republican controlled state houses across the nation, Americans witnessed a colossal collision of reality and ideals in the form of new Jim Crow laws to suppress minority voting rights, and refusal to address gun violence. In the wake of a constant stream of racial animus and mass shootings, this lethal epidemic demands a response as well.
Were these the only flashing alerts signaling danger ahead, that would be enough to cause sleepless nights. But unenforced or unevenly enforced laws, and value dissonance in America, do not occur in isolation, but are supported by an even more erosive underpinning – greed-induced economic inequality.
Continue reading…Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
By HANS DUVEFELT
The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed is not on our formulary or the dose is exceeding our limits.”
Well, which is it? Nine times out of ten, the fax doesn’t say. They don’t explain what their dosage limits are. And if it isn’t a covered drug, the covered alternatives are usually not listed.
So the insurance company is hoping for one of a few possible reactions to their fax: The patient gives up, the doctor tries but fails in getting approval, or the doctor doesn’t even try. In either case, the insurance company doesn’t pay for the drug, keeps their premium and pays their CEO a bigger bonus.
First problem: This may be in regards to a medication that costs less than a medium sized pizza. And the pharmacy generally doesn’t even bother telling the patient what the cash price is.
Second problem: A primary care physician’s time is worth $7 per minute (we need to generate $300-400/hour). We could spend half an hour or all day on a prior authorization and there is absolutely zero reimbursement for it.
Continue reading…#Healthin2Point00, Episode 196 | Rightway, AKASA, Viz.ai, AppliedVR, & Harmonize
We’ve only got one $100 million deal today on Health in 2 Point 00 — has the bubble burst? On Episode 196, Jess and I talk about care navigator Rightway raising $100 million – there’s a lot going on with this space, does it make sense to do this right now with Transcarent? AKASA, formerly known as Alpha, raises $60 million bringing its total to $85 million for revenue cycle management. Viz.ai gets $71 million, bringing its total to $150 million, for its stroke diagnostic AI software, AppliedVR raises $29 million bringing its total to $35, and Harmonize Health raises $10 million working on remote patient monitoring. —Matthew Holt
#Healthin2Point00, Episode 195 | Cityblock, Crossover, Redesign Health & Vesta
Today on Health in 2 Point 00, I’ve been banned from talking about the Suez Canal by Jess. On Episode 195, we cover Cityblock raising $192 million in a C extension, adding to their $160 million Series C in from December. Crossover Health raises $168 million in a proper D round, Redesign Health raises $100 million adding to their capital of $250 million for their digital health studio, and Vesta, formerly called Hometeam, raises $20 million which has flopped from working to get caregivers into the home to helping care agencies do telehealth at home. —Matthew Holt
“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
By HANS DUVEFELT
The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies to the life of a doctor, too.
Personally, I have to do Windows, the default computer system of corporate America, even though I despise it. But in my personal life I use iOS on my iPad and iPhone and very rarely use even my slick looking MacBook Pro. I use “tech” and machines as little as possible and I prefer that they work invisibly and intuitively.
In medicine, even in what used to be called “general practice”, you can’t very reasonably do everything for everybody. Setting those limits requires introspection, honesty and diplomacy.
In my case, I have always stayed away from dealing with machine treatments of disease. But I do much more than just prescribe medication. Since the beginning of my career, and more and more the longer I practice, I teach and counsel more than I prescribe.
I have decided not to be involved with treatment of sleep apnea, for example. It may sound crass, but I don’t find this condition very interesting: The prospect of reviewing downloads and manipulating machine settings is too far removed from my idea of country medicine.
Worse than CPAP machines are noninvasive respiratory assist devises. I won’t go near those.
Continue reading…#Healthin2Point00, Episode 194 | Ro, Appriss, Everlywell & Ginger
We’re swimming in a pool of money, health tech! Today on Health in 2 Point 00, we have over $1 billion and 3 acquisitions in this episode alone. First up is Ro, which just raised $500 million – they’re building quite the big healthcare company; their valuation is roughly double what Hims is trading and their revenue is a little bit more. Next, Appriss Health acquires PatientPing for $500 million and Everlywell acquires both PWNHealth and Home Access Health Corporation. Finally, our friends over at Ginger close another $100 million round. Be sure to tune into Jess’s interview with the CEO Russ Glass for the scoop. —Matthew Holt
Inside Ginger’s $100M Funding & Plans to Scale Value-Based Digital Mental Health Care
By JESSICA DaMASSA, WTF HEALTH
Digital mental health startup Ginger just closed a $100M funding round on the heels of its biggest growth year yet: tripling revenue in 2020, bringing its employer-client count to 500, and expanding to offer its services to more than 30 integrated health systems and health plans. CEO Russ Glass updates us on what’s next for the company now that it, too, has joined the $1-Billion-Plus club of digital mental health startups.
In a space where competitors are well-capitalized and poised to scale (Don’t forget: Talkspace awaits it’s SPAC IPO, Lyra Health has raised a whopping $475M, and others like Happify Health and Modern Health have just soared past $100M in total funding) Ginger plans to stand apart with a value-based care approach that offers employers a single-priced, fixed fee that gives employees access to Ginger’s entire spectrum of care. Launched during the pandemic, more than 60% of Ginger’s new employer clients have opted for this approach in effort to improve both the quality and cost of care offered to their employees. We dig in to hear more about this model and hear Russ’s predictions for how the supply-and-demand imbalance in mental health will continue to impact us (and the digital mental health market) as the pandemic wans.
