It’s one of the greatest mysteries of the era of health data digitization: Why is provider directory still so hard to get right?? Ribbon Health’s co-founder & CEO Nate Maslak explains how Ribbon (which started out in the symptom-checker biz) pivoted to take on, once-and-for-all, the miserable state of provider data management to not only fix provider directories (which are still wrong 50% of the time!), but also referral management systems, health plan enrollment data, and now, thanks to those new price transparency rules, price lists.
“All of the different use cases we focus on around enrollment, referral management, provider data management for directory…” explains Nate, “These are actually the same problem that use different words to describe it because of the different parts of the ecosystem that we’re in.” So, as Ribbon gets the process right for provider directory by building an underlying tech platform that uses predictive analytics and network effect methodologies to work its magic to validate-and-verify that kind of healthcare data, then it can apply that framework to ANY healthcare data to the same end. And, maybe one day, layer member-facing services – like instant-booking with a doc – on top of them.
Backed by nearly $54 million from Andreesen Horowitz and General Catalyst, and we get into what makes this startup’s take on one of the oldest healthcare infrastructure issues so appealing. From platform to business model (which serves a mix of health plans, provider orgs and patient-facing solutions) to grand plans for the future (which include figuring out how “API as a platform” can further productize provider data management and power care decisions) we chat with Nate on all things Ribbon Health.
Early-stage health tech start-up Caridokol is developing technology that listens to the sound of a patient’s voice over a mobile phone, landline phone or smart speaker to detect and analyze vocal biomarkers that indicate that the patient may be suffering from disease. The voice tech co is proving its case first in detecting arrhythmias, which are often asymptomatic and usually go undetected until they’ve led to a more serious issue like a stroke.
Cardiokol’s CEO James Amihood explains the tech behind this first use case – which already has one US patent granted and is pending approval on three more – and his plans to expand the company’s base of vocal biomarkers to enter into new disease states and new markets. The company is currently raising a Series A funding round and is planning to expand from Israel and Europe to the US. How could the technology change the game for disease prevention, starting with strokes? James connects the dots to the big vision for the company’s future as he explains how Cardiokol’s tech is already providing those most at-risk of arrythmia a very cost-effective, simple-to-use way to screen and monitor their long-term heart health.
Headspace Health’s CEO Russell Glass and The Shine App’s co-Founder & co-CEO Naomi Hirabayashi give us the inside story on deal that makes The Shine App’s award-winning, inclusive self-care and mental health platform a part of the Headspace Health family.
This is Headspace Health’s second acquisition this year, and we find out why they chose to ‘buy instead of build’ when it came time to refine and enrich the inclusiveness of their meditation, self-care, and mental health care offerings.
The Shine App brings 45,000 subscribers and 90 enterprise clients to the table, but what Russ points to as ‘stand-out’ is the quality of the content that Shine is built on, and the depth of understanding that their team has realized when it comes to the unique mental health issues that are facing minorities and other traditionally underserved populations. For example? Naomi talks about “representation burnout” which is its own brand of burnout that is often-experienced-but-not-often-named by people who suffer the pressures of being the “lone representative” of a minority population in a vastly homogenous workforce. Wow.
Tune in for more on what this acquisition will mean for Headspace, what Naomi and her co-founder Marah Lidey intend to do as new Headspace employees, how Shine will help Headspace’s Leadership Training program, AND some extra surprise bonus gems. Apparently, the BIGGEST DEAL yet for the full integration of Headspace-plus-Ginger is on the horizon and, OF COURSE, I find out if Russ got a chance to meet John Legend as part of Headspace’s Super Bowl commercial shoot.
“There’s $4-$4.5 trillion dollars of annual spend in the healthcare system. A trillion of that is administrative. And, some big chunk — some BIG number that you measure in the 100’s of billions of dollars – is waste. So, the TAM for what Availity and Diameter Health are going to do together is huge.” Russ Thomas, Availity’s CEO, is clearly excited about his company’s recent acquisition of Diameter Health and we ask him – and Diameter’s President & COO Mary Lantin – why this is such a big deal.
In the end, what this comes down to is making more sense of all the data that flows between providers and payers to automate where possible, find insights to improve business processes and workflows, and, ultimately, cut out that notorious “admin expense” that adds to healthcare cost without creating any value.
For twenty years, Availity’s been in the business of “translating” data from providers into a language health plans can understand, so payors could refine their own business processes and automate pre-auths, pay claims, etc. Diameter, on the other hand, deals in the world of clinical data and “upcycles” it into concepts and “digestible bites” that a health plan can use to automate an administrative workflow process with a provider and – get this – build a longitudinal health record that now Availity’s robust supply of claims and health plan data can fully flesh out.
How excited are Russ and Mary about the idea of this comprehensive, longitudinal, fully-integrated clinical-plus-claims patient record? Much more excited than even I anticipated! Tune in for all the details on the merger and this BIG vision for scaling up the fight against healthcare’s massive spend on administrative waste.
There are surprise profits in an overfunded sector, but then there are funding deals for staffing company Incredible Health ($80m), voice recorder Abridge ($12m), meditation company Interaxxon (Muse Headband) ($9m), medication company Arine ($29) & new virtual care medical group Keycare ($24)–Matthew Holt
“If I continue to hear how difficult it is for hospitals to make money, I would like for them to see what it’s like to operate a real business. They are overstaffed…they are overpaying…they are not responsible for quality or outcomes…there are no guarantees on their services…they can block competition from entering their markets…they can buy up market share – that’s not a real business.”
Well, lesson learned. If you ask Roger Jansen, Michigan State University Health Care’s Chief Innovation & Digital Health Officer, how he think things are going in US health systems when it comes to digital transformation and the integration of technology and value-based business models in hospitals, be prepared for a blunt conversation about how US healthcare model is failing and how the lack of incentive for change is keeping us all stuck in the same-old, same-old.
From digital health and telehealth to EMR and value-based care business models, we cover a lot of health innovation ground in this chat and get a reality check on whether or not things are really evolving inside health systems – and which stakeholders Roger believes hold the key to driving that change. (Hint: He identifies them as those who are already “footing the bill for the lavish lifestyles that healthcare administrators live that are probably well out-of-balance with the value that they actually bring to their corporations.”)
Roger on digital health? There’s better adoption and receptivity when it’s combined with “a service component that doesn’t add additional burden to the clinical component.” On virtual care and telehealth?
Down 70% since the pandemic’s lockdown days and more of a “behavior change problem” at this point than anything else.
When we get to EMRs around the 19-minute mark, things get extra spicy and we take a turn into “all this gibberish about volume versus value” and how value-based care models aren’t gaining meaningful traction either. It’s a big, bold reality check on the state-of-play of health tech, virtual care, and healthcare payment model innovation in health systems… watch now and let us know what you think!
Particle Health’s CEO Troy Bannister stops by to not only talk about the API platform company’s $25M Series B, but to also explain exactly what’s going on in that patient data ‘exchange-standardize-and-aggregate’ space that, these days, looks poised to pop as the 21st Century Cures Act Information Blocking Rule stands ready to make hospitals share data like never before.
Troy calls Particle a “network of networks” and what that means is that their API pulls patient records from organizations and businesses that are already aggregating them (so aggregating the aggregators) to get all the lab data and medical data a clinician would want to in order to have a more complete picture of their patient. For clients like One Medical or Omada Health, who deliver value-based care and take on risk, having such a robust historic data set on patients – along with a more complete picture of their comorbidities – helps improve decision making and outcomes.
So, how is Particle Health working now – and what will change – as the Information Blocking Rule gets implemented? Troy’s written about this for Forbes, and explains what has him fired up here too. Turns out their model has room to accommodate a big pivot: giving patients access to their own ‘network of networks’ record. Find out what sets Particle off in this new B2B2C direction and how they will be using that Series B funding to build out deeper analytical tools to help everyone make better sense of what the data in all those records can show us.
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!
Just FIVE MONTHS after launch, rural health startup Homeward is proving its potential for growth with MORE funding – today announcing its $50 million Series B (that’s $70 million total for the folks keeping score at home) – AND a huge 30,000-patient partnership with Priority Health. Co-founder & CEO Dr. Jennifer Schneider is here to breakdown both bits of news and give us some context about what they indicate about the rural healthcare market.
There are a couple surprising facts in this one that add up to why investors like ARCH Venture Partners and Human Capital (co-leads), General Catalyst (which led the Series A), and Lee Shapiro and Glen Tullman (old buddies and former Livongo colleagues who went in on this with personal funds outside of their fund 7wireVentures) were excited to jump into a quick Series B.
Surprising Fact 1: 90% of all rural Medicare beneficiaries are covered by just 7 payers, which makes the Priority Health deal a bigger deal than even that massive 30K patient population might indicate.
Surprising Fact 2: Homeward’s market of rural Americans is actually TWICE as large as the diabetes market that spurred the investment and growth of Livongo.
For all the math, the details on how the business actually works five months in, and how Homeward is actually going to market as a ‘healthcare infrastructure’ provider rather than just a next-gen medical group, you’re going to have to give this one a watch!
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.
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