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State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care

By JESSICA DaMASSA, WTF HEALTH

Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.

What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.

Nomad Health’s Next Move: $63M Raise Takes On-Demand Healthcare Staffing into Workforce Management

By JESSICA DaMASSA, WTF HEALTH

Not all who wander are lost: Nomad Health lands a $63M Series D round after a year of 5X revenue growth for their tech-driven healthcare staffing marketplace that helps hospitals hire nurses on-demand. This round, led by Adams Street Partners with participation from all existing investors, brings the company’s total fundraising up to $113M. Co-founder & CEO Alexi Nazem stops by to tell us how the startup is not only planning to expand its focus from nurses to other types of healthcare providers but how the process of doing so will transform Nomad from an on-demand staffing agency to “‘THE’ workforce management platform for healthcare.”

Alexi puts it this way: “In healthcare, the product is CARE. And, who is the product team? It’s the doctors, the nurses, the allied health professionals…and the fact that there’s no intentional management of this group of people who steward $1.5 trillion dollars of cost in the US every year is beyond unbelievable.”

The problem is twofold. First, there’s the way temporary staffing is currently being handled: by 2,500 different staffing agencies that take a fragmented, predominantly people-powered approach to sourcing, vetting, and hiring candidates. The cost is high to a health system looking to shore up their nursing staff, and the experience for job-seeking nurses is very opaque, with information being revealed about a job only after a significant investment of time within the application process. If the match falls apart, all the people involved in the process are left to try again.

This leads to the second issue – that, big picture, the status-quo way of temporary staffing is leaving behind a LOT of valuable data. Data about the clinician that is useful to the management of their career, and data about the workforce that would prove valuable to a hospital looking to better manage its care delivery resources.

We journey into the details behind Nomad’s business model, which is cutting costs for hospitals while also increasing pay for the 150,000+ clinicians on its platform. AND, while we’re there, we also find out how they expect their on-demand staffing approach to playing out in the booming virtual care space.

DayTwo Scores $37M to Expand Microbiome-Based Personalized Nutrition Treatment for Diabetes

By JESSICA DaMASSA, WTF HEALTH

People with Diabetes can get ready to celebrate: “The ‘Era of Lancets’ is over.” Precision nutrition startup, DayTwo, is scaling up its microbiome-based program, which takes the guesswork (and finger pricks) out of Diabetes management by offering its members food predictions that identify how their bodies will respond to any food BEFORE they eat it. The startup just closed a fresh $37M in Series B funding (led by aMoon and Cathay Ventures) and is expanding the rollout of their fee-for-outcomes Diabetes program to health plans and large self-insured employers.

The science behind this has yielded DayTwo the largest gut microbiome dataset in the world, and years of empirical studies on exactly what happens in our bodies as our digestive systems process different foods. Josh Stevens, DayTwo’s President & Chief Commercial Officer, walks us through the research behind the offering, which uses a gut microbiome analysis to rank foods and food combinations based on how eating them will impact a person’s blood sugar – essentially revealing what foods will (or won’t) cause a member’s blood sugar to spike before they even take a bite.

Its 70,000+ members report lower A1C levels (1 point on average), sustained weight loss, and, probably most exciting, an ability to stick with the program because the app (and wrap-around telehealth support from registered dieticians) creates a completely bespoke diet that lets people learn how to eat their favorite foods and keep their blood glucose levels within range. Will this predictive approach really bring about the end of lancet-based blood glucose testing for Diabetes management? Josh says Diabetes remission is a goal made easier by this predictive approach, but how does it stack up to other food-as-medicine approaches out there? I have a gut-feeling that you’ll want to tune in and find out!

Inside 1-Year-Old Calibrate’s $100M Raise for ‘Rx + Behavior Change’ Weight Loss

By JESSICA DaMASSA, WTF HEALTH

Just ONE-year in market, and Calibrate has already closed a $100M Series B co-led by Founders Fund and Tiger Global, with participation from Optum Ventures, Forerunner Ventures, Threshold Ventures, and Redesign Health. Why is this virtual care startup getting so much attention (and funding) from so many notable health tech investors? Founder & CEO Isabelle Kenyon is here to introduce us to the telehealth-plus-prescription-drugs business she’s building to help people lose weight.

This is NOT a Noom. Calibrate’s business model is built around a class of $700-$1,300-per month, prescription weight loss drugs called GLP-1s, which it helps its members sort through for both fit AND health insurance coverage (Isabelle says 90% of Calibrate members get the drugs covered by their health plan.) Once the drug is prescribed, the Calibrate member is wrapped in a telehealth-driven, lifestyle intervention program that addresses sleep, eating, exercise, and emotional health to help support the reset of their metabolism. As a result, Calibrate members are losing an average of 14% of their body weight, a significantly better, more sustainable outcome than achieved in clinical research when the drugs were prescribed without support.

There are lots of compelling aspects to the Calibrate story here, and we get through all of them: the 175M-person total addressable market of Americans diagnosed with obesity… the recent FDA-approval of Novo Nordisk’s new GLP-1 drug called Wegovy… and how Calibrate will use its fresh funding to build-out an Enterprise program aimed at meeting the shifting thinking employers, Medicare Advantage plans, and other health insurers have about obesity treatment as “preventative care” against more costly chronic diseases.

What else could this “behavior change + drug” framework – and its unique de-coupled payment model – be applied to? Diabetes, cholesterol, and hypertension sound like they’re all on the table, but how defensible is this? What stops a pharma company from doing this themselves? Isn’t this digital therapeutics?? A VERY interesting discussion about the often-taboo subject of weight loss, pharma, and the disruption of the healthcare delivery system behind both.

Ginger and Headspace Merge: CEOs Let Us In On What’s Next for Digital Mental Health Super Company

By JESSICA DaMASSA, WTF HEALTH

The thinking behind the merger-of-equals between on-demand mental health company, Ginger, and mindfulness and meditation company, Headspace, is revealed in this in-depth chat with Headspace CEO CeCe Morken and Ginger CEO Russell Glass. The combined entity will be known as Headspace Health, with CeCe as its President and Russell as its CEO, and we’re chatting with both of them about go-to-market, strategic direction, and whether or not the next stop is an IPO.

“Low-cost, quality mental healthcare” is where these two minds seem to meet – playing on both Ginger’s reputation for being among the lowest cost providers of on-demand coaching and mental health therapy for the employer market, and Headspace’s budget-friendly, tech-first approach to mental wellness education and training for the masses. This is a critical point of differentiation, especially on the clinical side, where the cost of therapy is oftentimes a barrier for access to it.

Headspace will be rolled out to Ginger’s enterprise clients immediately (playing what sounds like a preventative medicine / early-detection role), but what might be even more exciting are plans to integrate Ginger’s therapy and coaching services into the direct-to-consumer product that has made Headspace a household name.

Is this the move before the BIG MOVE into the public markets? How will the integration work on the data side? And, for you long-time health tech followers and lovers of the digital therapeutics space, I ask about V1 of the Headspace Health brand, which, you might remember, announced bold plans to build the first-ever FDA-approved mindfulness DTx. The new combined entity is not only taking the name – it might one-day get back into the development of mental health digital therapeutics.

Lots to hear in this one as this Headspace Health positions itself to win in both DTC and Enterprise markets, starting Day 1 with 100M lives and 2700 enterprise clients around the world.

Cityblock Health & The ‘At-Risk’ Disruption of Medicaid Care

By JESSICA DaMASSA, WTF HEALTH

Innovation in Medicaid is HAPPENING – and not only is it capable of creating better, less expensive healthcare for Medicaid members, but Cityblock Health is proving that it can also be the underpinning of a business worth over $1B dollars.

Dr. Toyin Ajayi, Cityblock’s co-founder & President, walks through the company’s novel business model, which goes AT-RISK to take care of some of the highest risk patients in all of healthcare. Here’s how it works: the startup contracts with health plans that provide Managed Medicaid services, helps them identify groups of patients that are of highest risk or rising risk, then takes over the financial and clinical accountability for that group. Cityblock then envelopes those members in a suite of highly personalized services that address both their healthcare needs and the social care challenges that are connected to them. In short…Cityblock is a medical practice built at the bustling intersection of value-based care and social determinants of health.

Toyin talks through some examples of the unique challenges facing the 75,000+ members Cityblock works with, particularly what they are learning about what it takes to “earn the right” to provide this population with care. But, is the high-touch, tech-infused core of their model defensible? What stops a huge national Managed Medicaid health plan like Centene or Molina from simply replicating this within their own multi-billion-dollar enterprises? Competition, expansion, funding, and outcomes – we get into it all, and hear Toyin’s near-term vision for Cityblock as it puts the nearly $500M its received in venture funding to work on “transforming the healthcare ecosystem for those who need it most.”

Trendspotting with Optum’s Direct-to-Consumer VP: Behavior Change Science in Healthcare

By JESSICA DaMASSA, WTF HEALTH

It’s interesting enough that Optum’s Vice President for Direct-to-Consumer is not only a serial digital health entrepreneur, but she’s also a behavior change scientist. Dr. Kate Wolin stops by to share some background on behavior change science, and how healthcare companies large and small are looking to drive health and wellness outcomes by integrating its principles and techniques into product design strategy.

Behavior change science appears to be having a “moment” here in healthcare, peppering conversations about everything from business models and consumer engagement strategies to product design, particularly in the chronic care and mental health spaces. Optum obviously has an interest in the discipline, with Kate in such a critical leadership role. And, our friends at life sciences giant, Bayer, also seem keen on exploring the approach, as it’s both the focus of one of the sessions of Bayer G4A’s free digital health forum, Health for All, on September 9, AND the reason Kate’s here to provide a deep-dive into the subject as a special prequel to the event.

So, what are the key takeaways? Well, it turns out there are a lot of misconceptions about behavior change science. Kate sets us straight, explains why she’s NOT a fan of the term “nudges,” and talks about what digital health companies usually get wrong (and right) about incorporating behavior change techniques into their products and services. Does behavior change require human intervention in order to make it sticky? Or, can technology be just as effective in achieving the right levels of personalization needed to make an ongoing impact on a person’s behavior? We get smart on this trending approach, and Kate gives us her prediction for how healthcare will be looking to increasingly incorporate this science into its future.

Special Note: To hear more from Kate and a host of other healthcare experts during Bayer G4A’s special global event “Health for All – A Digital Health Forum” on September 9, 2021, register at www.g4a.health.

Behind-the-Scenes Look at New Multidisciplinary Healthcare Conference LIFEITSELF

By JESSICA DaMASSA, WTF HEALTH

From Bill Gates to Goldie Hawn, Dr. Fauci and Rochelle Walensky to Astronaut Scott Kelly, and magician Penn Jillette to digital health’s own Dr. Daniel Kraft, new conference LIFE ITSELF (Sept 28-Oct 1) promises an eclectic mix of big thinkers from across tech, business, government, entertainment, and healthcare and a truly unique look at 10 big topics shaping the future of health and wellness.

Created, curated and co-hosted by Marc Hodosh (former owner and creator of TEDMED) and CNN’s chief medical correspondent, Dr. Sanjay Gupta, the four-day discussion is intended to be a mind-expanding, multidisciplinary discourse on healthcare topics that range from cost of care to human longevity. We’ve got Marc here to dish about the agenda as it’s being developed, and we’re lucky he’s willing to share a little bit about some of the surprises he and his team have planned.

Quick word to the wise if you’re interested in attending this one: check it out quick and register ASAP. The event is designed to be intimate to facilitate mixing-and-mingling among speakers and attendees within the iconic Hotel del Coronado and that means space is limited. Tune in to hear more and check out all the details at www.lifeitself.health.

One Drop’s Minimally-Invasive Biosensor Is Coming (!) & It Nestles Into an Expansive Data Platform

By JESSICA DaMASSA, WTF HEALTH

There’s been a steady drip of announcements coming out of One Drop in recent months about their data capabilities (28 billion biometric data points to be exact), the predictive power of their platform (remember blood glucose predictions and blood pressure insights) and NOW a partnership deal with top-of-the-line smart device manufacturer, Withings. What is this all adding up to? How about some HUGE NEWS?! Rachel Yap Martens, One Drop’s SVP of Commercial Strategy, stops by with a big reveal about the cohesive strategy behind these moves, and how they are all leading to One Drop’s launch of a first-of-its-kind, minimally invasive BIOSENSOR that will bring “continuous health sensing” to the market in the next year or so.

Health tech die-hards will remember One Drop’s acquisition of Sano Intelligence’s sensor technology in April 2020, but that was only the beginning. That sensor tech has been evolved, adapted, and refined, and works by detecting analytes in the body’s interstitial fluid, which – if you look it up – holds important things like glucose, salt, fatty acids, calcium, potassium, magnesium and more. Jump ahead to the 15-minute mark in this interview if all you want to hear about is this, BUT word to the wise: the really compelling part of the sensor is how it will plug right into all the other biometric data collection points in the One Drop ecosystem. Says Rachel, the goal is to help One Drop members “to know what is happening with their bodies right now, to know what is going to happen to their bodies next, and to know how to take action.” Exciting interview!!

The Rise of the Health Coach: YourCoach.Health on Market Opportunity Between Healthcare & Wellness

By JESSICA DaMASSA, WTF HEALTH

According to the team at YourCoach.Health, health coaching is “the ‘glue’ that’s connecting the $4-trillion wellness economy with the $8-trillion healthcare economy.” And by learning about the growing number of nearly 2,000 health coaches who are engaged in their practice management solution – and the small and mid-sized employers who want to tap into it to provide health coaching to their workforces – its seems like they might be right.

YourCoach’s CEO Marina Borukhovich and COO Eugene Borukhovich walk through the work they are doing to build a platform that both helps health coaches do their jobs better AND find clients within the SMB health benefits market. While “coaching” might often get wrapped around everything from remote monitoring devices and digital therapeutics to care plans for chronic conditions and long-term illnesses, “health coaching” as a credentialed discipline is different.

Marina and Eugene de-mystify the terminology for us, along with the certifications required to be a health coach, the current reimbursement climate for the health service, and where they think the discipline is headed as demand for “human-led, compassion-driven” healthcare booms among both healthcare consumers AND practitioners. A couple little scoops in this one too as we learn about some soon-to-be-released tech features on their platform AND the seed-funded startup’s plans to raise a Series A.

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