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.
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.
The thing to do in health tech this week? Trademark infringement. Today on Health in 2 Point 00, we try to make sense of all the lawsuits right now with Teladoc suing Amwell, Allscripts suing CarePortMD, and whose side are we on for Zocdoc suing Zocdoc? On Episode 160, Jess asks me to make sense of Augmedix’s faux IPO in a reverse merger and publicly traded company Newtopia arising $7 million. Twentyeight Health raises $5.1 million in a Series C and TestCard raises $5.8 million for at-home mobile urine testing.—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
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
“I never anticipated — and no one did — the level of uptake and the level of scale.”
It says a lot that Joe DeVivo, CEO of Intouch Health, who’s worked with hospitals and health systems on standing up B2B-focused telehealth programs for years (and whose company was acquired by Teladoc Health for $600-million dollars in January) is surprised about the uptake of virtual care during the COVID-19 pandemic.
“Historically, I look at virtual care as a bell curve,” says Joe. “On one side of that small tail of the bell curve are the virtual care companies. Teladoc dominates that space for D2C. There’s millions of consultations a year, and we’re seeing a subset of that. On the opposite side of the bell curve is high-acuity, and what InTouch has been doing for critical care.”
“This crisis, and the changes in reimbursement, have opened up the middle of that bell curve. The core, everyday transaction of healthcare is now being impacted by virtual care. And the big question that everyone has is, “is this going to stick? Is this a crisis management tool and we’re going to go back to the ways of the past, or is that genie out of the bottle?”
We put Joe on-the-spot with his own question, find out what he thinks it will take to enable the permanent shift to virtual care at-scale, and dig in on how demand for telehealth within hospitals has changed as a result of the pandemic, where its not only being used to expand access to specialists, but has also been adapted into a PPE-hack to help frontline hospital workers distance themselves from infected patients.
And what of working with Teladoc? While waiting for the paperwork to finalize (all on-schedule for the end of Q2 as originally announced), the two have organized a co-selling agreement to be able to “hit the market fast” and bring their “hospital-to-home” end-to-end virtual care offering to those who need it now.
The shift in thinking required to go to a “virtual first” healthcare system may not be as unique to the health industry as we think. Teladoc Health’s new Chief Engagement Officer, Stephany Verstraete, got her start at Match.com — and explains the parallels she sees between the mainstream adoption of telehealth and what she experienced introducing online dating to the masses. Think about it: overcoming skepticism, addressing privacy concerns, and what Stephany says is most important, changing an ingrained behavior — are all challenges currently being faced by virtual care co’s. It’s not a bad idea to flirt with as we talk bigger trends in telehealth engagement.
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020.
It was a seminal moment in virtual care as Teladoc Health acquired Intouch Health for $600 million, effectively taking its mostly direct-to-consumer telehealth platform directly into more than 2,500 care providers — or, as they say, “from hospital to home.” We caught up with InTouch Health’s CEO, Joe DeVivo, to hear his thoughts on the deal, including what it means for the further advancement of virtual care and for the digital health industry at-large.
Filmed at J.P. Morgan Healthcare Conference in San Francisco, January 2020
According to healthcare leader Toby Cosgrove, THIS is “the year of telehealth.” Although Teladoc CEO Jason Gorevic would rather use the phrase ‘virtual care’ to describe the space, he’s pretty much on board with the idea that more consumers than ever will jump onto the virtual care bandwagon this year. How will Teladoc’s partnership with CVS play a role? Any other acquisitions on the horizon? Gorevic gets real about what’s impacting utilization rates and whether or not he’s worried about Teladoc competing with Apple, Google, and Amazon. (Hint: He’s not.)
Filmed at JP Morgan Healthcare 2019 in San Francisco, January 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
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