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THCB Gang Episode 78, Jan 13

On #THCBGang I hosted the double trouble of vaunted futurists Ian Morrison (@seccurve) & Jeff Goldsmith, and medical historian Mike Magee (@drmikemagee) for an hour of conversation and banter about the health care system, the world in politics, and whether “Don’t Look Up” is a spoof or a documentary. Really good stuff, especially from Jeff on whether Medicare pays enough to keep hospitals alive. (Spoiler alter–he doesn’t think so!)

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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…

#HealthTechDeals Episode 1: Transcarent, Medically Home, Vera Whole Health, Stryker, and more!

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.

-By Matthew Holt

What a Waste of a Healthcare System

By KIM BELLARD

An essay in Aeon had me at the title: The Waste Age.  The title was so evocative of the world we live in that I almost didn’t need to read further, but I’m glad I did, and I encourage you to do the same.  Because if we don’t learn to deal with waste – and, as the author urges, design for it – our future looks pretty grim.

Healthcare included.

Continue reading…

Transcarent’s Valuation Soars Past $1B. Hear Why Glen Tullman Says It’s More Than Worth It.

By JESSICA DaMASSA, WTF HEALTH

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!

Medicare Advantage Is a Superior Program (Part one)

By GEORGE HALVORSON

Former Kaiser Permanente CEO George Halvorson has written on THCB on and off over the years, most notably with his proposal for Medicare Advantage for All post-COVID. He wrote a piece in Health Affairs last week arguing with the stance of Medicare Advantage of Don Berwick and Rick Gilfillan (Here’s their piece pt1, pt2). Here’s a longer exposition of his argument. We are publishing part one today with part two coming soon – Matthew Holt

The evidence for Medicare Advantage being a superior program compared to standard fee-for-service Medicare is so overwhelming that anyone who cares about actual Medicare Patients or who cares about the financial future of Medicare should be strongly supporting having as many people as possible enrolled in that program as soon as we can effectively make that happen.

Compared to fee-for-service Medicare, Medicare Advantage has better benefits.

Compared to fee-for-service Medicare, Medicare Advantage has a better tool kit at multiple levels.

Medicare Advantage has team care, connected care, and electronically supported care processes — and we know beyond any debate or dispute that those advantages exist for Medicare Advantage over standard fee-for-service Medicare because fee-for-service Medicare does not pay for those sets of services and literally labels it billing fraud if a caregiver who provides team care in a patients home to prevent a congestive heart failure crisis or to keep a life threatening and function impairing asthma attack from happening sends a bill to standard Medicare for those services.

The superiority of Medicare Advantage is beyond question.

Standard fee-for-service Medicare has no quality care processes, no quality reports and no quality standards or expectations at all. Standard Medicare actually has absolutely no quality data and does not hold any provider accountable for the quality of the care they deliver.

Medicare Advantage has an extensive quality agenda and tracks more than 40 categories of quality and service at the plan level. Medicare Advantage plans build continuously improving programs around those Five-Star priorities and measures, and we know from our current reporting that even during Covid, the percentage of Medicare Advantage patients with cardiovascular disease who are currently on statin therapy went up from 80.86% of patients a year ago to 83.36% this year.

The ratings by the Medicare Advantage members for customer service by their plans went from 90.56% a year ago to 90.87% this year.

That is not a big improvement but having satisfaction numbers that start out that high actually go up during Covid days is an accomplishment and it is one of the reasons why we should be encouraging people to join the plans and its why fee-for-service Medicare is a measurably inferior approach for so many people.

Standard Medicare does not have a clue about who is getting their statin Medications and they officially don’t care.

In fact, some of the fee-for-service Medicare doctors and care sites who are paid only by the piece for care from the standard Medicare program actually often make more money when care fails, because when a patient has a major asthma crisis or a congestive heart failure crisis, that negative outcome for a patient can generate multiple medical fees and it can too often trigger a $10,000–$20,000 total additional cash flow to the caregivers whose care sites failed that patient by not helping improve the health of the patient before the crisis was triggered.

Why is Medicare Advantage’s purchasing system better?

Medicare Advantage plans are paid by Medicare by the month for each patient and they are not by the piece for each item of care.

Because Medicare Advantage plans are paid by the month for each patient, and must, by contract, provide complete care to each patient, it makes extremely good sense for the plans to help patients in ways that prevent asthma attacks and that prevent congestive heart failure crisis, and that avoid and help reduce the levels of blindness and amputations for their diabetic patients that can too easily happen to those patients if you don’t manage and guide that care.

The Medicare Advantage approach for all of those categories of care is obviously far better for the patients than the fee-for-service Medicare inadequacies in care.

Continue reading…

Health in Two Point 00 – The LAST Episode (247)

It’s the very last episode of Health in Two Point 00! (We’re not going away just changing the name next week). Six deals in 2 minutes! Embold Health gets $20m; Brainomix gets $21m; $25m for Zing Health; Quartet buys Innova Tel; Prolucent Health gets $11m; and Mightier gets $17m. And now we are done with 2021! And to announce the new name, we are wearing evening dress! – Matthew Holt

THCB Gang Episode 77, Jan 6 1pm PT – 4pm ET

After our Christmas break THCB Gang is back! Joining Matthew Holt (@boltyboy) on #THCBGang at 1pm PT 4pm ET Thursday for an hour of topical and sometime combative conversation on what’s happening in health care and beyond will be THCB regular writer Kim Bellard (@kimbbellard);  fierce patient activist Casey Quinlan (@MightyCasey);  futurist Ian Morrison (@seccurve) & patient safety expert and all around wit Michael Millenson (@MLMillenson)

You can see the video below live at 1pm/4pm or it’s kept here for posterity. If you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels

Nate Maslak, CEO of Ribbon Health

Nate Maslak, CEO of Ribbon Health talked with me late last year (2021) after his $40m round from General Catalyst and Andreesen Horowitz. We dug into the really thorny problem of information about physicians. This has so many facets and ramifications but most people only see it when their doctor somehow isn’t in their health plan’s network. But it’s much, much more than that. Nate joined me in nerding out on this topic and explaining how Ribbon is working to fix it — Matthew Holt

#Healthin2Point00, Episode 246| Healthcare.com, Found, Well, Gamer Health, Belong Health

HAPPY NEW YEAR!!! Let’s break Jess’s New Year’s Resolutions a tiny bit and look at some 2021 healthcare deal holdovers. Healthcare.com raises $180 million, bringing their total to $212 million; Found raises $100 million, bringing their total to 132 million; Well raises $70 million, bringing their total to 135 million, and Garner Health raises $45 million, bringing their total to $70 million.

-Matthew Holt

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