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ATA’s CEO Ann Mond Johnson Takes on the “Telehealth Cliff”

By JESSICA DaMASSA, WTF HEALTH

The BIG takeaway from ATA’s Annual Meeting is best bottom-lined by ATA’s big boss, CEO Ann Mond Johnson, in this interview: “From an overall perspective, we just don’t want to go over that ‘telehealth cliff.’”

ATA, the re-branded American Telemedicine Association, has not only evolved along with virtual care through the pandemic, but has also been critical in redefining telehealth as modality for healthcare and re-framing access to it as a bipartisan issue that everyone in DC can get behind.

Ann talks through the high-level changes she’s witnessed for telehealth adoption over the past two years and gives us her predictions for what’s going to happen next – particularly when it comes to the business of virtual care, consumer demand, and, most importantly, regulations and reimbursement. Lots happening thanks to ATA’s new affiliated trade organization, ATA Action, which is lobbying to ensure that the waivers that enabled the acceleration of telehealth during the Covid-19 public health emergency become permanent. The time is NOW for health tech co’s to get involved! Tune in to find out how.

Digital & Tech Are Changing Pfizer: Pharma Co’s Chief Digital & Technology Officer Takes Us Inside

By JESSICA DaMASSA, WTF HEALTH

What does digital transformation look like at a global healthcare giant like Pfizer? Lidia Fonseca, Pfizer’s Chief Digital & Technology Officer, shares her strategy for building the life sciences company’s digital data and technology solutions, including her thinking about digital therapeutics, digital diagnostics, and digital biomarkers. As Lidia puts it, this is not about trying to simply implement a “digital strategy,” but is, instead, about building a “business strategy for digital world.”

There’s probably no better story that illustrates how that “business strategy for a digital world” is playing out than the fascinating example of how Pfizer’s Digital team helped accelerate the development of the Covid19 vaccine and oral treatment. Lidia takes us inside and talks through how her team used tech to safely speed-up everything from development timelines to clinical trials and even go-to-market in areas around the globe that were experiencing outbreaks.

Beyond the tech team’s ability to effectively wield data that changed the game when it came to Covid, Lidia also shares what’s next for the pharma co when it comes to digital health and digital medicines. Beyond the pill? Around the pill? Instead of the pill? What’s Pfizer’s position on digital therapeutics as it continues to work to bring new breakthrough medicines to patients? We get into all the ways digital and technology are manifesting themselves within an organization like Pfizer AND get Lidia’s best advice for other healthcare organizations who are redefining their businesses with technology.

Vida Health Starts Prescribing: Meds, Labs, Devices, & More for Mental Health & Diabetes

By JESSICA DaMASSA, WTF HEALTH

Big news coming out of Vida Health today as the chronic condition care startup announces that it will now be able to prescribe meds, med devices, lab tests, and more to its members. This puts Vida Health among the first of the digital health chronic care companies to evolve its offerings beyond apps-and-coaching, leading on this trend to take digital health chronic care into a more full expression of virtual care.

Vida Health’s Chief Medical Officer, Dr. Patrick Carroll, introduces us to the new offering which he tipped us off about when we met him a few months ago, new to his role at Vida and coming in hot from Hims & Hers where he built similar services as he took that company public as CMO.

The new prescribing services will cover both sides of Vida Health’s integrated model: mental health and cardiometabolic health, but in different ways. On the mental health side, Pat says members will be able to receive prescription meds for anxiety and depression ONLY at this time; on the cardiometabolic side, members working with Vida Health will NOT be able to get prescription drugs to help with diabetes or heart health, but would instead be able to get continuous glucose monitors (CGMs) prescribed, specialized diets, and labs, like A1C testing, that require a script.

Do these prescribing services begin to turn Vida Health into a primary care provider? If not, how do these new prescribing and medication management roles integrate with whatever other primary care offering is in place through a member’s plan or employer without adding cost or confusion to the patient experience? We talk through the evolution of both care model and business model as Vida Health adds another layer to its full-stack chronic condition management platform.

The Next Next-Gen PBM? Healthcare Navigation Biz Rightway On Making The Pivot

BY JESS DaMASSA, WTF HEALTH

More traction in Pharmacy Benefits Management (PBM) innovation, this time coming out of care-navigation-plus-PBM startup Rightway. CEO Jordan Feldman and Chief Pharmacy Officer Scott Musial (who Jordan calls the “Godfather of PBMs”) drop in to talk about their 1500 employer client base and how the business is now even winning over health plans who are tired of working with the ‘Big Three PBMs.’

The NextGen PBM story is the headliner here, with Rightway customers saving an average 18% in their first year with the “new-to-the-world PBM” the company has built.

What’s different? Two big things. First, the PBM’s payment structure for the employer. Jordan shares how these are usually rebates-driven or based on spread pricing; Rightway is actually innovative in offering the PBM benefit on a per-member-per-month basis instead.

That leads to the second twist, which is based on gaining cost savings for the employer by pairing the PBM with navigation. According to Scott, this changes the conversation from one that’s solely focused on managing the price of the drugs to managing how employees are utilizing the formulary instead – creating opportunities for lower-priced generics or alternatives that Rightway is happy to point to because it’s not dealing with rebates or dispensing.

So, who is Rightway competing with? Navigators like Accolade, Inc. or Included Health? PBMs like CVS/Caremark, Optum or Express Scripts? Or other emerging ‘combo’ businesses like Transcarent?

We get into the competitive landscape, more about PBMs than you might have ever wanted to know, and what Jordan and Scott are hearing from hard-hit employers looking to recruit and retain employees in the face of the Great Resignation.

“There Isn’t One Health Plan to Save Them All”: Flume Health’s CEO on New Build-A-Plan Biz

By JESSICA DaMASSA, WTF HEALTH

Two of the most notable payer venture funds, Optum Ventures and Cigna Ventures, just headed up a $30 million dollar Series A funding round for Flume Health, a startup that basically builds “challenger” health plans. How did this go down? Cédric Kovacs-Johnson CEO & Founder of Flume introduces us to his company which offers providers, digital health co’s, brokers, reinsurers, and just about any other healthcare org a tech stack for creating their own hyper-niche, super personalized health plans.

The suite of services to “build-a-plan” includes things like claim processing, payments, enrollment management, digital health point solutions integration, and other API functionality – replacing the traditional TPA with tech and the one-size-fits-all plan with a new opportunity for nichey-ness that can customize coverage for patient populations based on health conditions, location, employer, and so on.

Cédric talks us through the benefit to his target client – the care provider – who, while taking on more risk anyway, may consider building their own plan to capture more premium dollars and gain better control over the end-to-end patient experience. Wait a minute – is all this “Challenger Health Plan” talk just a re-brand of value-based care? I ask point-blank and get a new buzz phrase in return; welcome to the lexicon, “Commercial Advantage.” Lots to unpack in this one including Flume’s rev-gen model and plans for growth – they’re already onboarding one new challenger plan per month!

Clarify Health Solutions’ CEO on Data Analytics Startup’s Next Trick: Value-Based Payments Tech

By JESSICA DaMASSA, WTF HEALTH

Turns out, the Clarify Health Solutions story is about a lot more than data and analytics these days. Value-based payments? Acquisition of provider-focused, behavioral science startup Embedded Healthcare? Opportunities in real-world evidence??

Good thing founder & CEO Jean Drouin and I caught up at ViVE 2022. Not only do we get into the backstory of the business, which has built a self-service analytics platform for payers, providers, and life science co’s on top of “one of the largest-ever patient datasets” in the industry, but we also talk about the strategy that’s driving Clarify into the world of value-based contracting and how Embedded Healthcare’s tech will be used to augment and refine that new offering.

Jean talks in detail about his client mix, business model, and the two “healthcare golden rules” Clarify lives by as it scales up its business: 1) figure out how the payment method is going to work and 2) don’t mess with the work-flow.

Komodo Health: Chan Zuckerberg Initiative Partnership, Rare Disease Patients, and… IPO Rumors?

By JESSICA DaMASSA, WTF HEALTH

Komodo Health has been catching lots of buzz lately thanks to a recently announced partnership with the Chan Zuckerberg Initiative’s Rare as One Network AND some chatter about a possible upcoming IPO that seems to have come from its own CEO Arif Nathoo. To check what’s true and what’s false, we sat down with Komodo’s President, Web Sun.

What did we learn? Well… a lot. The core of both the CZI partnership and the future of Komodo’s business is their Healthcare Map, which Web says draws together the data of more patients (300M+), across a longer period of time (as long as 6-years for some cohorts) than anyone else in the industry. But, this comprehensive, longitudinal view of the patient journey is only part of Komodo’s usefulness – the other part is how they use that dataset to surface insights.

As Web talks about how all this will manifest itself in the context of rare diseases to benefit the patients who belong to the 60 different advocacy organizations that will now have access to Komodo thanks to the CZI partnership, it’s not only easy to understand how comprehensive data can help rare disease patients, but how this is a metaphor for helping all patients across all manner of healthcare. Shortening the diagnostic journey, better understanding symptom patterns and comorbidities, matching patients to specialists highly experienced and adept at managing their conditions, quickly bridging connections to novel therapies and clinical trial opportunities… how beautiful that this will be offered to patients who need it most. The market potential, however, lies in how it will be scaled-up-and-out to the rest of us – which brings us back to those exit rumors! Tune in to hear what Web has to say about his co-founder’s comments, and how he believes Komodo is differentiated from other big data businesses in the analytics space.

Headspace Health Merger Update: First Look at How Ginger-Headspace Combo is Really Going to Market

By JESSICA DaMASSA, WTF HEALTH

Headspace Health CEO Russell Glass says the merger-of-equals between on-demand mental health care provider, Ginger, and consumer meditation app, Headspace, is starting its upward trajectory on the “merger J-curve” and this monster 30-minute chat gets into the how-and-why.

We start out talking about the company’s recent acquisition of chatbot-based self-care app Sayana, but quickly turn to the integration of Headspace and Ginger and where things stand in terms of bringing those offerings together after three months of operationalizing. A combined vision and set of values have been launched with all 900 employees, and Russ says its enterprise clients (there are now 3,500 of those) are just weeks away from getting a fully-integrated platform that proves reporting for both Headspace and Ginger, allows launch from a single eligibility file, and offers communication that spans both service lines.

What’s “extra” in all this – and gives us a real glimpse of where Headspace Health is headed in terms of positioning itself to health plans and employers as standout from the Lyra Health / Quartet Health / Modern Health pack – comes out when Russ is describing the company’s partnership with Blue Shield of California at the 15:25-minute mark. The plan’s members can now access Headspace Health’s full-spectrum of services (meditation to therapy) via Blue Shield of California’s Wellvolution platform, which provides intelligent intake, smart patient routing, ongoing measurement and adjustment of services, and the ultimate ability to help prove-out mental health care’s connection to the reduction of downstream healthcare costs over time. As Russ says, “All of this is part of a long-term vision for what this could mean to a broader population, not just those who may need acute care, but to think about the entire population and how you pull the cost out of healthcare by managing behavioral health in a smart way.”

The big finish to this BIG conversation is Russ’s take on what’s ahead for both Headspace Health AND the digital mental health care market in 2022. Tune-in around the 20-minute mark to start this segment off with the IPO question that I never get answered, then lots of detail on where Headspace Health is looking to acquire and expand, what he thinks the headline story will be when it comes to the business of mental healthcare this year, and which patient population will rise to the top in terms of mental healthcare need.

Futurecasting with Amy Abernethy: Verily, Real-World Data, Clinical Trials & Health Policy in 2022

By JESSICA DaMASSA, WTF HEALTH

Insight on what’s ahead for the future of clinical research, real-world evidence, and personalized healthcare from none other than former FDA Principal Deputy Commissioner and current President of Verily Life Sciences’ Clinical Research Platforms, Amy Abernethy.

Amy testified before Congress a few weeks ago to answer their questions about some of the buzziest tech and new virtual models emerging to re-shape the way clinical data is collected for regulatory approval of medical devices, drugs, and digital health applications. We get the inside scoop here on what they asked, how they reacted to her answers, and what she thinks is ahead in terms of the investments they might make and the policies they are likely to explore in order to use more technology and decentralized clinical trials to bring greater equity, diversity and safety to the development of new medical products and prescription drugs. And that’s not all! We also get into a little chat about 21st Century Cures 2.0 and how the FDA is thinking about leveraging real-world data and real-world evidence for high-level regulatory questions. Hot space to watch, and Amy is excited!

Beyond this “fresh off the Beltway” analysis of what’s ahead in health tech policy, Amy talks too about what’s next for Verily. Sounds like the business might have an acquisition in its future…

Lyn Health Out of Stealth: A Niche Healthcare Navigator for Polychronic Patients

By JESSICA DaMASSA, WTF HEALTH

Straight out of stealth and launching today! Lyn Health is out to provide specific, personalized care for patients with three or more chronic conditions in a way that’s meant to compete with healthcare navigator-advocators like Accolade, Transcarent, and Included Health INSTEAD of the crowd of digital health chronic condition management platforms like Teladoc’s Livongo, Vida Health, One Drop, Omada Health, etc. etc.

With employers and health plans getting increasingly burnt-out on point solutions for chronic care – leading many of those businesses to “platform out” themselves in recent years – will a niche-market navigator really stand-out? Is effective care for polychronic patient populations so specialized that it merits adding a specific, targeted service on top of the more general navigator, primary care provider, or chronic care platform solution that an employer or plan might already have in place?

Lyn Health’s CEO Rick Abbott stops by to introduce us to this seed-funded startup, which has raised $10M (backed by Summer VC) and has already attracted some yet-to-be-named health plan and Fortune 500 employer clients. Rick explains that market need that Lyn Health is aiming to satisfy, and how he’s leveraged what he’s learned about the cost of polychronic care from his past life at Premera Blue Cross into an approach that he believes will work to help employers both reduce spend and improve the day-to-day patient experience of managing multiple chronic conditions. Lyn Health is set-up to deliver care with its own physicians and social workers, connecting with patients in a digital-plus-bricks-and-mortar format. And, as for that business model, we get into the big question: at-risk or not?

Excited to meet this startup on the day of its official launch!

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