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
It took a while–those public companies stock prices started falling from their heights 14 months ago–but in the last month the venture capital scene has gone quiet. The days of sub $20m ARR companies getting mutli-hundred million dollar valuations are over for now. They will be back at some point in the future, as that’s how Silicon Valley has always worked, but it’ll be a while and in the meantime everyone is going to have to figure out what to do in the new world.
The “What to do?” question is getting harder as the data starts to come in, and it’s getting ugly. On the one hand the two fastest growing digital health companies ever have both had their comeuppance. Livongo was a tremendous exit for its investors and ended up trading at 20 times future revenue before it got acquired by Teladoc for $18bn mostly in stock. This quarter Teladoc wrote off much of its investment in Livongo and the whole company is now only worth $5bn. Clearly those “synergies” between telehealth and chronic care management didn’t work. The other rocket ship was Cerebral, which went from nothing in Jan 2020 to by Jan 2022 having over 100,000 patients and thousands of providers on its system as it raised over $300m from Softbank et al. Its aggressive & expensive customer acquisition costs, with its controversial controlled medication prescribing patterns, brought it way too much controversy. Its young CEO is gone, and it’ll be a slow climb back with bankruptcy and collapse the likeliest of outcomes.
But the part of digital health that’s trying to replace the incumbents is not the only place showing ugliness. The technologies and services being rolled out are often not working. Exhibit A is a randomized controlled trial conducted a Univ of Pennsylvania. One set of heart patients was set up with connected blood pressure cuffs, a pillbox that tracked their Rx adherence and lots of coaching help. The others were sent home with the proverbial leaflet and told to call if they had problems. You’d assume many more deaths and hospital readmissions in the second group. You’d be wrong. There were no differences.
So digital health needs to see if it can produce services companies that move the needle on costs and outcomes. The advantage is that they are eventually competing with hospital systems whose DNA doesn’t allow them the ability to let them cross the chasm to the new world. The bad news is that those systems have huge reserves which they can use to subsidize their old world activities.
I’m hoping digital health’s impact in the next 2 years will be as big as it was in the past 2, It’s by no means dead or over, but I am pessimistic.
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!
The Teladoc Health-Livongo merger continues to expand Teladoc Health’s virtual care capabilities — this time in mental health. Dr. Julia Hoffman, Head of Mental Health Strategy for Teladoc Health, gives us the inside story on the launch of myStrength Complete, the souped-up, next-gen version of the digital mental health app that Livongo acquired in 2019 and integrated into its “AI-plus-AI whole person health” platform. So, what’s new now that all this is part of Teladoc? Think full-service mental health care, akin to what you might find in a digital mental health point solution, but with more providers… sitting on top of a gold-standard telehealth and remote monitoring infrastructure… and ready-to-move on an outsized opportunity for integration into Teladoc’s virtual primary care offering, Livongo for Diabetes, Livongo for Hypertension, and so on.
myStength Complete is now more than just a smart, cognitive behavioral therapy app; it’s the entry point into an entire mental health care continuum of services. Teladoc Health’s physicians stand ready for telehealth consults alongside a robust portfolio of coaching and self-service mental health care programs that are bolstered by the data-driven “health nudges” made famous by Livongo’s ever-improving AI-AI engine. Looking forward, the data integration strategy has a lot of potential to do a lot of good. Julia talks about how her team is already leveraging learnings from the Livongo products into a better intake process for members, helping them more quickly, easily, and accurately find the type of care they need. This is no small feat, especially when we find out that Teladoc Health consumer survey data shows that about 60% of people seeking mental health care say they have no idea where to start, or what their diagnosis would be. We get into all those survey findings (a little gold mine for those interested in consumer sentiment and digital mental health) and a full “under-the-hood” poking around of myStrength Complete in advance of its July roll-out to employers. This interview is one to watch now for the full details on how Teladoc Health is pushing further into virtual mental health care.
Today on Health in 2 Point 00, we have some hot gossip re: Glen Tullman starting his own SPAC. On Episode 161, Jess and I discuss Bind Benefits raising $105 million, BridgeHealth merging with Transcarent and raising $40 million in a Series A, and Loyal raising $12.5 million in a Series A. Jess also asks for my take on a slew of new partnerships between Lyra and Calm, Cigna and MDLive, and Doctor on Demand and CareLinx.—Matthew Holt
On Episode 144 of Health in 2 Point 00, Matthew has gingerly emerged from his office and gone into a Magical Forest! Jess asks me about Healthline media acquiring PsychCentral, the first-ever online psychiatry support group and I explain the history of how it has been passed around from Corporates to PE firms, Bridge Connector getting 25.5M for its interoperability platform, Cecelia Health raising $13M for its chronic condition management service, and Reify closing $30M to help pharma companies run clinical trials from home. Also, we had our first book club discussion with authors Hemant Teneja (VC at General Catalyst) & Stephen Klasko (CEO at Jefferson Health System) on their book “UnHealthcare: A Manifesto for Health Assurance”. Glen Tullman also made a special guest appearance during the discussion. The episode will be released soon! – Matthew Holt
On Episode 143 of Health in 2 Point 00, we have all the alphabets in the raising series represented ;)! Jess asks me about Lumeon raising a $30M Series D for their care orchestration centers, Nurx raising a $22M Series C to develop out its online pharmacy presence, Thirty Madison getting $47M and Johnson & Johnson is an investor this round, Bodyport closing an $11.2 M Series A for their weighing scale platform that can detect early cardiovascular disease, and Kumanu raising a $3M Series A to grow out its platform that helps people figure out their lives’ purpose.
Be sure to check out our talk from the 7 competitor CEOs to Teledoc & Livongo who weigh in about the $19B merger. If you want to join our book club, we are reading UnHealthcare: A Manifesto for Health Assurance, which is a how-to for creating a platform for a revolutionary future for healthcare, by Hemant Teneja (VC at General Catalyst) and Stephen Klasko (CEO at Jefferson Health System). We will have a video on our discussion with the authors which will be published on the 3rd Wednesday of every month! —Matthew Holt
Six competitor CEOs and one ex-CMO discuss the biggest-ever digital health merger
By JESS DAMASSA & MATTHEW HOLT
It was the news that stunned the world of health tech. And us! So we had seven of Teladoc and Livongo’s biggest competitors weigh-in on what the merger means for telehealth, digital health, the future of health care delivery–and their businesses! You’ll hear from the CEOs of Omada, Ginger, One Drop, Vida, Lark & Cloudbreak, with some spicy commentary from Lyle Berkowitz who was, until recently, CMO at MD Live. From reaction to the merger to speculation about how this will impact the future of digital health funding, fasten your seat belts for some impactful and fun infotainment about all the implications of the deal.
Today, a special Health in 2 Point 00. Jessica DaMassa asks me about the biggest news in public digital health companies ever: this morning’s merger of Teladoc and Livongo. We discuss the deal, the implications for digital health, what’s next for Continuous Clinics, whether our T-Shirts will become a collectors item, and of course what about our book club on August 19! —Matthew Holt
Even before Covid19, virtual care for chronic conditions was a hot and competitive area, with the heat turned up by Livongo Health’s IPO last year and big funding rounds for companies like Omada Health, Virta Health, and One Drop. Another contender in the space, Vida Health, has been best known for taking a “platform” approach to chronic condition management before “platforming out” became the-move-to-make for scaling health tech companies. Their digital health biz actually started out with a “whole health approach” to helping patients manage all their conditions at once, integrating care for diabetes, hypertension, COPD, high cholesterol, mental health conditions, and more from the get-go. Contrast that to some of their biggest competitors, who have adapted to that approach by adding on treatments for co-morbidities as their core businesses evolved.
Is there a benefit to starting out with a holistic care model that those who build it along the way can’t capture? We caught up with Vida Health’s founder & CEO, Stephanie Tilenius, to find out what advantage starting out as a platform play has brought to her business, which just closed a $25M funding round in April and is now available to more than 1.5 million people through employers and health plans.
How will the company scale from here? How will they remain competitive in such a crowded space? Stephanie talks through some of Vida Health’s post-pandemic plans AND how lessons learned from her “previous life” as an exec in Big Tech during that industry’s growth era of the 2000s & 2010s has shaped her thinking about the uptake of technology in healthcare. Not only did Stephanie work at eBay, PayPal, and Google during the birth of the online payment era, BUT she also helped take an online pharmacy company (Planet Rx) public during the dotcom boom.
Health tech deals are just back to back this week! On Episode 139 of Health In 2 Point 00, Jess asks me about Withings getting $60M in a new round to develop their connected devices & apps products, Neurovalens raising €5.5M to grow their headset technology that helps with obesity, insomnia, diabetes, & more, Pocket Health raising $6.5M to build out their image sharing platform within in EHRs, and Sidecar Health raises $20M for their price transparency direct pay option. I also talks about Livongo’s new DPP program which provides users with diet tips & coaching sessions to offset diabetes in high-risk populations —Matthew Holt
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