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Is Care Navigation Healthcare’s Next ‘Gold Mine’? Quantum Health’s Move to Win Over Larger Employers

BY JESSICA DaMASSA, WTF HEALTH

One-to-watch as a potential health tech IPO this year is care navigator Quantum Health, and I’m talking to CEO Zane Burke about both their breaking new product launch AND the key differences between Quantum and the increasingly competitive field of other employer benefits advocacy-based businesses like Accolade, Rightway, and Transcarent.

Private equity backed, two-decades old, and EBITA positive, Zane says Quantum Health is delivering an ROI of “over two-and-a-half to one” to its client roster of 450 top large, self-insured employers and saving more than 14% on all healthcare costs over time. The new product – Quantum Health Access – is a streamlined, more flexible version of the soup-to-nuts Complete Care offering capable of yielding these results, and it’s being offered to give the largest of employers (those big enough to be working with multiple health plans, for example) a way to start out with Quantum’s data-driven navigation tools without a total overhaul of their current benefits situation.

Zane explains Quantum’s “real-time intercept tool” and how it not only helps engage high-utilizers in an employer’s plan (aka those who spend more than $10,000 in claims), but how 85% of the time it catches them on their care journey before they’ve spent a thousand dollars – creating an early opportunity to provide better routing and, ultimately, reduce overall costs. The upside for Quantum? “Employers have long thought of the carriers as this is their responsibility, but the carriers are really maximizing around their siloed system to pay a claim, do the disease management, get you off the phone and into somebody else’s queue,” explains Zane. “Our model is, ‘hey…every single one of those interactions is a gold mine.’”

We get further into the details around the new Quantum Health Access product, and, more importantly, what Zane sees as Quantum’s key point of differentiation against Accolade, Rightway, Transcarent, and the rest. Tune in around the 20-minute mark to hear this bit and to find out what Quantum’s doing with provider data that makes “everybody else that talks that game” look like they are just playing “Pick Up Sticks.”

Patient Journey or Customer Journey? How Salesforce’s CRM Aims to Reposition the EHR

BY JESSICA DaMASSA, WTF HEALTH

While at Dreamforce 2022, one of most thought-provoking things I heard was that, in order to really meet the needs of the healthcare consumer, we in healthcare need to once-and-for-all let go of the idea that there will be “one tech system to rule them all” and adopt an “and both” approach that integrates both the EHR and a CRM. The EHR is how we’ll “know the patient” and the CRM is how we’ll “know the customer.”

Dr. Geeta Nayyar, Salesforce’s SVP & Chief Medical Officer and Amit Khanna, SVP & GM of Salesforce’s Health & Life Sciences business join me to unpack this “and both” approach to infrastructure technology and talk all-things healthcare consumer. The paradigm shift that comes with this duality – we are at times “patients”, we are at times “customers” – is a big one. Especially in healthcare.

Dr. G speaks to the strategy that Salesforce is operating under to take its tech further into the healthcare and life sciences space, while Amit introduces us to some of the new Healthcare 360 product features launched at Dreamforce that fully show-off Salesforce’s expertise at integrating different technology solutions (Slack, MuleSoft, telehealth) and making perfect sense of massive amounts of real-time data (longitudinal record, health scoring).

As Salesforce advances further into the health market with more care-forward features in its CRM and a strategic focus on healthcare-important issues like improving equity and access to care, will our traditional view of the importance of the EHR change? What if the replacement tech comes with ‘self-service at-scale’ and more ‘seamless experiences?’ Could we head away from “and both” and choose CRM “instead of?” Tune in – the EHR IT infrastructure may have finally met its match!

Future of Big Data in Health? LexisNexis® Risk Solutions Says Next-Gen Tokenization & Health Equity

BY JESSICA DaMASSA, WTF HEALTH

Data-juggernaut LexisNexis® Risk Solutions is making a big data play in healthcare, launching a new capability that allows for unprecedented accuracy in the kind of de-identified data that payers, providers, and pharma are clamoring to use for everything from cutting admin expenses to improving patient outcomes and health equity.

Jeff Diamond, President & General Manager of The Health Care Business of LexisNexis® Risk Solutions and Andrea Green, Director of Healthcare Strategy, SDoH, drop in for a chat about all things VERY big data, including this concept of “next-gen tokenization” which leverages LexisNexis’s massive amount of consumer data as a way to connect data “personas” to create a much more accurate, actionable, and longitudinal view of a patient.

The thing to understand is just how much health data LexisNexis® Risk Solutions is working with and who they are working with it for: 90% of commercial payers in the US; 8 of the Top 10 pharma manufacturers; 10 of the Top 10 retail pharmacies; and hundreds of hospital systems.

So, how is this data “turned” into insightful and actionable information that appeals to this top-tier clientele? Jeff and Andrea walk through use case after use case that demonstrate the ‘business of healthcare’ applications of the LexisNexis data processing platform (think patient safety, risk stratification, claims analytics, provider directory, etc.) with special emphasis on how their new analytics suite, focused on Social Determinants of Health data, is helping with such clinical initiatives as improving diversity in clinical trials and providing predictive insights about patients who might need mental healthcare support. The data comes to life in this one. Watch now!

Salesforce for SDOH: Health Equity is Taking Center Stage in Salesforce’s Real-Time Health Data Play

By JESSICA DaMASSA, WTF HEALTH

At Dreamforce 2022, Salesforce’s big annual user conference, “real-time data” was THE topic of conversation as the tech company launched a brand-new platform across its lines of business to help make this type of data integration-plus-analytics “magically” easy. I caught up with Salesforce’s EVP & CRO of Global Health & Life Sciences, LaShonda Anderson-Williams, just after her division’s keynote to find out more about how the new platform (called Customer 360 for Health) is intended to impact what we can do with health data, particularly in the realm of improving health equity and access to care.

Never mind the actual new product features – telehealth integration, health scoring, longitudinal patient records, marketing integrations, etc. – the sum-total of their potential impact is intended to not only improve the way healthcare understands its patients as health consumers, but to also enable it to better meet their nuanced needs with more personalized “seamless” experiences.

LaShonda and I chat about how this type of work is already happening at CVS Health and Moderna – the two marquee customer stories shared during the keynote – as well as how other healthcare organizations can benefit from “putting data at the center” of their health equity initiatives. Her best advice for health and life sciences businesses as they work on improving health access for all? Tune in to find out!

Deep-Dive Into Availity’s Acquisition of Diameter Health

by JESSICA DAMASSA

“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.

Jenny Schneider on Homeward’s $50M Series B, 30K-Patient Partnership with Priority Health

By JESSICA DaMASSA, WTF HEALTH

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!

The Tech Layer for Home-Based Care? Tomorrow Health Hopes To Network-ize Home Health

BY JESSICA DaMASSA, WTF HEALTH

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.

How Happify Health Became Twill: Inside the New Biz Model & What’s Next

By JESSICA DaMASSA, WTF HEALTH

Mental health digital therapeutics startup Happify Health has spent the past 5 years quietly ‘self-actualizing’ into a brand-new, tech platform company that just launched this week: Twill. This is a big pivot – not just a brand change – and we’ve got co-founder & President Ofer Leidner and newly-hired Chief Operating Officer Megan Callahan (who formerly ran Lyft Health) here to tell us how it all went down AND what will happen to the old Happify app.

Wellness-app-no-more, Twill has emerged as a health tech infrastructure company. Its core product (called Sequences) is the open architecture, digital back-end that ties together a health plan, employer, or pharma co’s various digital point solutions – wellness apps, digital therapeutics, virtual coaching, peer support groups, telehealth platforms, etc. etc. – to create one neat-and-tidy, hyper-personalized, automagically-navigated patient care journey based on condition or patient population.

Big brands like Elevance Health (Anthem), Biogen, and Almirall have already bought-in, with products already in market for conditions as diverse as maternal health, multiple scleroses, and psoriasis. Not forgetting its mental health roots, Twill is bringing in its own vast resources from the ole Happify days to run digital mental health support under each of these disease-specific point solutions. Ofer and Megan say that Sequences can be developed for ANY condition or to target specific populations of patients and they plan to launch 2-3 new Sequences each year.

What else is ahead for Twill now that it’s revealed from its stealthy start? Happify Health had raised $73 million in March 2021 in a big round lead by Deerfield Management Company – what should we expect next? Tune in for all the details on the transformation, the new products, and how other digital health companies can expect to work with Twill in the future.

Inside Vida Health’s Move Into Musculoskeletal Care

By JESSICA DaMASSA, WTF HEALTH

In the ‘point solution versus platform’ debate, mark another score for integration as Vida Health jumps into the musculoskeletal (MSK) care space. This is a move we’ve seen before among the digital health chronic condition management set (remember when Omada acquired Physera, Dario Health acquired Upright, and everyone was waiting to see if Livongo would make a play for Sword or Hinge?) so why is Vida just jumping in now?

Dr. Patrick Carroll, Vida Health’s Chief Medical Officer, lets us in on the strategy behind the startup’s move into the MSK space and what it signals about how employers (and their employees) are starting to view digital health and virtual care within the larger scope of available care options out there.

As for Vida’s MSK program, it’s different than what you might expect. According to Pat, the program is strictly focused on lower back pain and helping members quickly find the physical therapy and, if needed, mental health care that can make a real difference to their overall health in a manner of weeks. If something more complex is discovered, Pat says Vida is working with partners – including those digital-first MSK clinics – to refer out. Is this the long-term play or will Vida eventually build out or buy its way further into MSK? We find out what’s ahead for the cardiometabolic care company as it launches yet another new offering to improve access to care.

Quantifying Caregiving: ARCHANGELS CEO Alexandra Drane on The Caregiver Intensity Index

By JESSICA DaMASSA, WTF HEALTH

“Being an unpaid caregiver is the epicenter of Life Sucks Disease,” says Alexandra Drane, Co-Founder & CEO of ARCHANGELS, “but it’s also one of the most glorious, one of the most magnificent jobs we’ll ever have.” So, what’s the trick to managing the “sucky” side of caregiving? Data.

Alex’s company ARCHANGELS has invented the Caregiver Intensity Index, which she describes as a “two-and-a-half minute Cosmo quiz” that helps caregivers quantify the intensity of their caregiving experience and identify the top two things driving that intensity and the top two things alleviating it. The score coming out of this helps caregivers validate the intensity of their experience, offers a framework for communicating about it, and, as Alex puts it, delivers “data that gives them permission to believe” that the stress they are feeling is real. ARCHANGELS then uses the info to crosswalk caregivers to existing resources that can help them manage those intensity-driving challenges – whether they be related to financial stress, workplace stress, relationship stress or otherwise.

Knowing that health plans and employers are starting to “see the light” when it comes to caregiving and its impact on their workforce, Alex and I talk about just how much payers are really willing to contribute to supporting the resources needed to support caregivers and how the data ARCHANGELS is providing is helping demonstrate need and connection to health and well-being. Lots of interesting data points on caregiving in this one – particularly when it comes to mental health and how things have changed through the pandemic. Watch now!

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