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.
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.
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!
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 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 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.
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…
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!
Acorai is an early-stage medical device startup working with Bayer to improve the way we manage the world’s 65 million patients living with heart failure by using their own smart phones. CEO Filip Peters shows the Acorai device, which is basically an extended smart phone case packed with four different kinds of sensor technologies that work together to measure the pressure inside a patient’s heart, by simply holding their phone against their chest. Of course, the real magic is the algorithm that turns these readings into early detection of a potential incident. How does this stack up against the status-quo way we’re currently caring for these types of patients? Filip says that, right now, the alternative for such monitoring is an IMPLANTED sensor, which many patients aren’t even able to get. As a result, most of the early warning signs of impending heart failure are missed; Acorai’s tech has the potential to be truly revolutionary as it’s able to detect the signs that lead to heart failure hospitalizations up to 30 days in advance.
Acorai has been selected as one of four “Growth Track” companies in Bayer G4A’s Digital Health Partnerships Program, and Filip talks to us about the potential Bayer sees in the daily data stream of information Acorai’s device makes available to cardiologists. A fascinating look at the future of cardiac care!
Healthcare navigator Accolade (NASDAQ:ACCD) is on the move. Not only are they now cruising in care delivery territory with two new primary care/mental healthcare offerings that let them personally guide their 9M members further into the healthcare system, BUT they’re also starting to talk more and more about their tech infrastructure and the “operating system” they’ve built to power that healthcare GPS with shared data and access.
CEO Rajeev Singh stops by to walk us through the strategy behind both sides of this (especially interesting when you consider his tech startup background in the context of those “operating system” statements) and why Accolade launched its own new category (personalized healthcare) as a framework for talking about the new course they’re charting.
We get into the September debut of Accolade Care, which bundles primary care and mental health in a per-employee-per-month model, and Accolade One, which wraps the full Accolade ecosystem around the Care product in a value-based model. At-risk models seem to be rising in popularity these days, and I get Rajeev’s perspective on why Accolade chose to go-to-market with one of those…and one that falls into the usual PEPM structure.
More interesting to me, however, is this whole “operating system” thing and how it’s playing out behind-the-scenes to strengthen integration across the businesses Accolade has acquired (Health Reveal being the most recent) and point solutions its partnering with like Virta, Headspace Health, Sword Health, RxSavings Solutions, and Carrot Fertility. The “purpose-built” architecture Rajeev describes sounds like it’s not only giving Accolade what it needs to better manage population health outcomes within its own offerings but that it, in and of itself, could be a new offering for partners who don’t want to build a tech platform themselves.
New directions explored…next moves discussed…AND Raj’s six-year CEO Anniversary celebrated! Watch now.
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