Each time I send out the THCB Reader, our newsletter that summarizes the best of THCB (Sign up here!) I include a brief tidbits section. Then I had the brainwave to add them to the blog. They’re short and usually not too sweet! –Matthew Holt
I had a little scare the other night. I was driving home from a weekend in the mountains and I asked my wife if she saw that flashing light. No it wasn’t the cops, and no she hadn’t seen it. Turns out that I had a bright flash if I moved my eye a certain way. Oh, well I assumed I was tired and a good night’s sleep would fix it.
Next morning the flash was still there when I looked quickly to the left and a few weird floaters had appeared. I headed to the Mayo Clinic website and it looked to me like I had a detaching retina. I got on the urgent visit video with One Medical. The NP who answered said it sounded like I might have retina problems and I should get it checked by my ophthalmologist. But my eyesight has always been great (other than me needing reading glasses in my old age) and I haven’t got one. So who, I asked, do you recommend?
Here we fall into the crux of the problem. One Medical is an excellent primary care service. So good that Amazon bought it for $3bn. But it’s not a multi-specialty group nor is it a system like Kaiser. The answer was, “we don’t really recommend anyone–that’s not how it works.” The NP ended up looking up ophthalmologists near me & sent me a name as a referral in their app. But that’s not a link to anything and it wasn’t one chosen through some analytical process of seeking quality excellence.
I looked up MarinHealth (my local hospital)’s website and searched ophthalmology. That referred name was on it. I called. The doctor was out this week. They gave me another name. That doctor’s office gave me another name and that third office could see me that same day. I felt some pressure to see them right away as in the case of a detached retina Mayo says “ Contacting an eye specialist (ophthalmologist) right away can help save your vision”. The good news is having spent a couple of hours at the ophthalmologist’s my retina needs watchful waiting not surgery.
But the bad news is that for me, like 90% of Americans, there’s no easy way to get referred into a trustworthy system for specialty care. This can be even worse. My friend Sarah McDonald explains in her book The Cancer Channel how, after being diagnosed with a rare incurable cancer by a head & neck surgeon, the all encompassing support she received was to be given the number of a specialist at UCSF who couldn’t even talk to her for 3 weeks.
Mike Magee talks about the role of the health care system being to reduce patients’ “fear and worry”. Our lack of a specialty care referral system, especially when potentially serious and urgent care is on the line, is a big reason why there is so much fear and worry. I wish I had a concierge advocacy system like Included Health or Transcarent which could get me to the right place and work with me through the experience. But like most Americans at the time I need reassurance the most I’m calling a list of phone numbers hoping someone can see me.
We have primary care, we have specialty care. But we don’t have a system that cares.
Lesson learned: Don’t bet against Glen Tullman. Transcarent’s CEO brings his legendary “paper schedule packet” to our interview to prove the point that he carries Livongo’s first growth chart around with him everyday as a reminder of the number of overnights it takes to build a “overnight success” of a business. As Glen puts it, “When you’re building these companies, everybody remembers where you ended…they don’t remember where you started.”
So, how in the world did we get to this public prove-you-wrong? Catch the conversation that led us there as we talk about Transcarent’s growth two-years in and address the elephant in the room about why there have been so few customer announcements from the employer-focused health and care company. We get a few name-drops here, and also assurance that publicity around some new Fortune 50 and Fortune 100 clients is imminent. Lots of other interesting “build-mode” talk about what else is starting to come together at Transcarent including the “first independent provider network in the country” and more details on the recent Prescryptive partnership which is aiming to rewrite the script on how employers source pharmacy benefits.
What’s this? A new show? Sort of: Health in 2 Point 00 is now called Health Tech Deals! In our first episode, Jess and I reminisce a bit on our previous 247 episodes, and talk about new huge deals in health tech: Transcarent raises $200 million, bringing their total to $298 million and bringing their valuation to over $1 Billion, more than their competitor Accolade; Medically Home raise $110 million, bringing their total to $274 million; Vera Whole Health buys Castlight for $370 million; Stryker buys Vocera for $2.97 billion.
Transcarent raises a whopping $200 million Series C funding round that values the year-ish old business at over $1.6 billion – valuing the up-start higher than quasi-competitor, Accolade, which is sitting on the NASDAQ with a $1.3 billion dollar market cap. Executive Chairman & CEO Glen Tullman shares some very revealing details about the round, why he’s deliberately added leading hospital systems onto his cap table, and what he’s got to say to the doubters who might question whether not Transcarent is a billion-dollar business just yet. (Spoiler alert: Glen says Transcarent didn’t even take the highest valuation they were offered…)
The investors are interesting for all those who want to read into the strategic messaging there: late-stage Livongo investor Kinnevik led the round alongside Human Capital and Ally Bridge Group, existing investors came back in, and, probably most surprising, are hospital systems Northwell Health, Intermountain Healthcare, and Rush University Medical Center. Apparently, other hospitals wanted in too but missed the chance thanks to a tight timeline. Glen explains his rush and why the capital is essential to further build out Transcarent’s offering in light of the market opportunity he’s seeing among employers.
This is a payment model innovation play, folks, that is basically arming those large, self-insured employers with the bargaining power and healthcare ingenuity of Glen Tullman, and what he says is the best executive leadership team he’s ever assembled. The pieces are certainly starting to come together, and it looks a lot like a new age payer to me. Transcarent’s basically got the prescription drug pricing power of a PBM in its relationship with Walmart… a national network of top-end health systems who are either partners or have skin in the game thanks to this funding round… the centers of excellence business it bought with BridgeHealth… AND some ‘coming soon’ care-at-home, cancer care, and behavioral health offerings Glen teases us about here. All that is offered to employers at full risk to Transcarent, which takes no copays or coinsurance from members, doesn’t charge any per-employee-per-month fees to their employers, and is keeping providers happy with payment up-front. If it’s not a payer because it’s better than our current definition of a payer, that might be the only reason why!
Still, Glen tells us that partnerships with some of the market’s “most innovative” payers are coming soon, along with new customer announcements. And, what will he spend this $200 million on to further build-out Transcarent’s offering? I’m not afraid to ask if there’s a chronic condition management co he’s got his eye on acquiring!
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.
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!
For those keeping score at home, Glen Tullman is scaling up Transcarent faster than he did Livongo. The startup just closed a $58M Series B, bringing its total funding just shy of $100M. In less than 8 months. What’s the hurry? Have we ordered the balloons for the IPO yet? Glen says he’s out to fix the core problem first, and, in this interview, we get into the details about what that problem statement is all about and you might be surprised.
This is more of a payment model story than anyone may have all initially realized. And, while we may keep trying to put Transcarent into the “healthcare navigator” box or call it a “second opinion service” or a “centers of excellence play,” the truth is that those are all means to achieve a much larger end, which is about redefining the healthcare experience and its payment model for self-insured employers. Remember when Livongo created its own category of care (applied health signals) because they didn’t fit in with what a ‘chronic condition management’ company meant to the market? Well, I think Glen just used this interview to soft-launch a new category of healthcare company here again with Transcarent…
“People always try to put us in a category,” says Glen. “Are you a navigator? No, we’re not a navigator. We do navigation. Are you a health management company? No, we’re not. Are you a supplier? No, we’re not. Are you a PBM? No, we’re not. But we do all of those things to create an experience and that’s why, when you think about it, we’re a health experience company and that’s a new category that no one has.”
I get Glen to talk specifics about what this really means — directly managing healthcare spend for employers in a ‘category-creating’ completely at-risk way – and the examples really do help bring it to life. So does hearing about how he sees Transcarent as completely different than Accolade or Grand Rounds, which are often listed as competitors.
What other trouble do we get into in this 30-minute mega chat? OF COURSE I get his take on this year’s record-breaking investment into health tech, whether or not he thinks we’re in a bubble, and how Amazon, Walmart, and other non-traditional players are going to impact healthcare moving forward. Lots of insights in this one!
Amazon Cares already has customers, Clover has become a meme stock, Transcarent has got a Series B that they closed already, and OneDrop has hit 25 billion biometric data points – what the hell is going on in digital health? Today on Health in 2 Point 00, we still have lots of deals to cover. Monogram, an end-stage kidney disease company, raises $160 million. LetsGetChecked raises $150 million in a Series D – all of these at-home testing companies are getting a push because of COVID. Next, Lenus raises €50M in a Series A, making it the biggest ever single A round in Denmark. Transcarent gets $58 million in a Series B already, and Ada Health raises $90 million for their symptom assessment chatbot. —Matthew Holt
Today on Health in 2 Point 00, we’re back with more deals as promised for our post St-Patty’s episode. On Episode 192, Jess and I have lots to chat about because Glen Tullman is back—he becomes the CEO of Transcarent, a new company which is going direct to employers and doing navigation and telehealth and centers of excellence. Despite the crowded space (especially after this week’s Doctor on Demand and Grand Rounds merger), Glen says there is huge demand from employers. Catch our interview with him on WTF Health. Next, Happify Health gets $75 million, bringing their total up to $123 million. I had an interview with their President Ofer Leidner on THCB Spotlight yesterday, so tune in there to find out about this mental health company delivering automated, self-service care. Finally, two remote patient monitoring companies get funding – 100Plus gets $25 million in a Series A, and Health Recovery Solutions gets $70 million in a C. How are these different and why is there all this money in RPM now? —Matthew Holt
As if one consumer digital health company with an $18.5B exit wasn’t enough, Livongo founder Glen Tullman has decided to give the transformation of healthcare another go – this time as Executive Chairman & CEO of Transcarent. Matthew Holt and I sit down with Glen to hear about the “new kind of experience” that Transcarent is offering self-insured employers and their employees: one focused on providing unbiased information, guidance for accessing high-value healthcare, and an at-risk model that promises to share back the financial benefits associated with better healthcare decision-making.
Could you consider Transcarent an aggregator, a healthcare navigator-PLUS, or is it more like a next-gen health plan that does everything but process claims? Glen talks about how his team was “asked” to jump into providing a better experience for this kind of healthcare service, details what the company needs next, and explains the role of Bridge Health, which merged with Transcarent in October 2020 when the company closed its $44M Series A. Familiar investors, General Catalyst and Glen’s own 7Wire Ventures, have led the funding for Transcarent and we find out if there will be any additional support from the Health Assurance Acquisition Corporation (the SPAC that Glen launched in partnership with General Catalyst’s Hemant Taneja and others) that could potentially provide a vehicle for taking the business public. And, what about Teladoc Health? With a seat on TDOC’s Board, does Transcarent’s commitment to offering “unbiased” direction to the best possible healthcare put Glen into a conflict of interest? This is one catch-up chat you’re not going to want to miss!
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