Weekly Health Tech Reads | 1/23/22

News:

• UHG posted earnings, and as always its worth reading as a pulse of what's going on in the industry. One of the more notable data points shared is that Optum Health's revenue per consumer increased by 33% year-over-year as a result of both value-based contracts and new services. Mind you that Optum Health served 100 million people at year end 2021. Not surprisingly, lots of analyst questions about MA membership growth and the interplay between Optum Care and UHC. UHG shared that it spent $100 million in 2021 on preparing markets for value-based contracts. That spend is going to three main work streams: 1. clinician training, 2. technology / data, 3. network coordination. Given that level of investment, it's hard not to envision Optum Health continuing to experience massive growth over the next few years. Optum Ventures' portfolio also apparently had a very good year, as it was called out in the announcement specifically for driving growth in revenue from investment income. UHG certainly feels like a freight train that is just continuing to pick up speed - it's not clear that there's anything on the horizon that is going to stop UHG's growth flywheel. Link (call transcript) / Link (announcement).

• Speaking of UHG's growth flywheel, Optum also announced this week a new back-office partnership with MarinHealth. It appears similar to other deals where Optum is going to employ part of MarinHealth's staff and provide back revenue cycle management and other services to MarinHealth. Link / Slack (h/t Frederik Mueller).

• IBM sold off IBM Watson to private equity firm Francisco Partners. IBM was looking for a sale price of $1 billion and apparently got something in that ball park - but keep in mind that IBM made $4 billion worth of acquisitions as it stitched together IBM Watson. Not a great outcome, but not surprising after all the challenges Watson has had getting into the healthcare market. Will be interesting to watch what Francisco Partners does with what remains of the assets. Link / Slack (h/t Brendan Keeler).

• MVP Healthcare announced a partnership with Galileo to provide a virtual primary care offering to MVP's Medicaid members. I'm not sure of any other Medicaid plans that have gone the virtual primary care route yet, so it will be interesting to see if we see more Medicaid plans moving in this direction. It's also worth watching how Galileo executes on its multiple paths forward - while its great to talk about a model that serves all payor types and can flex between in-person and virtual-only offerings, it seems like a pretty complicated operational undertaking for a relatively young company. Link / Slack.

• Mark Cuban is formally launching a CostPlus, an online pharmacy cutting out "the middleman" essentially by combining and becoming the middlemen - the PBM and pharmacy. It claims lower prices on over 100 commonly prescribed drugs using a small markup on directly negotiated prices. This seems like a really cool approach that could help a lot of people from someone who doesn't need a profit maximizing machine. While you might expect that cash pay only (no insurance) might cause issues for consumers, it already helps solve part of that problem by removing guesswork for an individual by showing, guess what, on the site? Actual prices! Link / Slack (h/t Chris Vossler).

• Babylon made another acquisition, this time of DayToDay Health, a care management startup that helps patients pre/post surgery.  As Babylon looks to successfully manage value-based contracts, it makes sense that they'd look to add this capability. Link / Slack (h/t Elie Goldfarb).

• UCSF is apparently starting to bill for email responses from providers. You can understand why providers are frustrated by the amount of time they spend responding to messages without getting paid, but this also seems like a really poor marketing strategy on UCSF's part. There are countless virtual primary care startups selling a version of this service (messaging with a provider) for a monthly fee, but they're focusing on the consumer need (accessibility) versus the provider need (time mgmt). Link / Slack (h/t Frederik Mueller).

• ONC launched a new interoperability framework this week, the Trusted Exchange Framework and Common Agreement (TEFCA). Link / Slack (h/t Lisa Bari). 

• Quest Diagnostics acquired a patient engagement startup, Pack Health. Link / Slack (h/t Raihan Faroqui).

• DaVita acquired MedSleuth, a transplant software company. Link / Slack (h/t Martin Cech).

• Chamath Palihapitiya's latest SPAC has merged with ProKidney, a biotech company treating kidney disease. Link / Slack (h/t Agata Kowalski)

Funding:

• Mental health provider Lyra Health raised $235 million and acquired employee assistance program ICAS World. Lyra, which has now raised $900 million (!), is looking at international expansion, with ICAS giving it a footprint of 10 million members in 155 countries. Link / Slack (h/t Chris Hogg).

• Iterative Scopes, an AI platform for gastroenterology, raised $150 million. Link / Slack (h/t Zona Liu).

• Wheel raised $150 million to continue expanding its platform powering virtual care delivery. According to the post, Wheel did 1.3 million patient visits in 2021, and grew its clinician network by 60% with a 90% retention rate. Link / Slack.

• Big Health, a startup developing two prescription digital therapeutics for mental health, raised $75 million. Link / Slack (h/t Joe Connolly).

• Smart toilet seat startup Casana raised $30 million from some big name investors, because who hasn't secretly always wanted a smart toilet at home, right? Link.

• Nurse staffing company Gale Healthcare Solutions raised $60 million of growth equity. Link.

• Mantra Health raised $22 million for a digital mental health clinic for young adults. Link.

• Topography Health, a platform helping community physicians run clinical trials, raised $21.5 million. Link.

• Faeth Therapeutics raised $20 million and wins this week's award for coolest startup idea - they're building a precision nutrition platform for cancer. Currently the treatment, which sounds like you eat a specifically designed bowl of pad thai (seriously) in addition to chemo, is in clinical trials to treat pancreatic cancer and colon cancer. Absolutely wild. Link / Slack.

• Amplify, a new life insurance platform, raised $12 million. Link.

• Yuvo Health, a tech platform for FQHCs, raised $7.3 million. See below in Opinions for more on FQHCs and the massive opportunity here. Link / Slack (h/t Kevin Wang).

• Earable raised $6.6 million for a wearable headset that helps improve sleep. Link.

• STEPN, an NFT gaming startup that rewards users for exercising, raised $5 million. Link / (HTN Slack h/t Nick Helgeson).

Opinions:

• The Commonwealth Fund featured a great read on Federally Qualified Health Centers (FQHCs) and the path towards more risk-based contracts. As we hear more and more interest in supporting innovation in the Medicaid space, I have a feeling we'll be hearing a lot more about supporting FQHCs in 2022. This article does a good job highlighting some of the practical considerations for FQHCs in taking on risk, with helpful real world examples. The dynamic described in the article where FQHCs can't take on VBC contracts because they lack the resources to perform in them seems like a very straightforward opportunity for VCs to throw a ton of money at. Link / Slack.

• Here's an interesting read from Teladoc on the benefits of virtual-first plan designs. The article covers quickly a number of points why virtual-first plans are better. It highlights that virtual-first doesn't mean virtual-only, and that virtual-first plans need to seamlessly integrate non-virtual elements. It'll be curious to watch how Teladoc seeks to accomplish this over time, as it seems like a massive challenge to overcome. Of course, the most straightforward way to do this would be to acquire in-person assets. Link.

• Apparently the New York governor is proposing to re-procure its Medicaid managed care program. This article does a great job articulating why this is such a big deal for the state and national insurance landscape - in 2019 Centene paid $3.75 billion for Fidelis, New York's largest Medicaid managed care plan. Check out the article's "pros" section for re-procuring Medicaid. It sounds like manna from heaven for VCs, including: "jet fuel" for value-based contracts, new care models, new payor entrants, etc. You can see why there's so much excitement around Medicaid innovation these days. Link.

• William Besterman's Substack featured a guest post from George Lundberg, former editor-in-chief of JAMA, about how the medical establishment is broken and the need to support the "mavericks" in medicine. It's simultaneously pretty remarkable and also not all that surprising to see the open questioning of the "alphabet soup" of the mainstream medical establishment. Seems very worth keeping a pulse on this sentiment from clinicians. Link.

• Wah Yan penned a good piece on B2C versus B2B go to market strategies. It's an insightful piece on how the pendulum will inevitably swing back from B2C to B2B growth strategies. He identifies consumer trust in healthcare brands as a key element of these strategies - and given the Cerebral read below, it's easy to imagine how consumer trust could quickly erode in B2C digital health startups, opening the door for more B2B strategies. Link / Slack (h/t Chris Hogg).

• Jan-Felix Schneider wrote an article looking at the companies that are working with virtual care delivery providers to deliver in-person services, including in-home care and remote monitoring. Link / Slack. (h/t Jan-Felix Schneider).

• Cerebral unfortunately continues to serve as the poster child for digital health growth gone awry. This Forbes piece covers how Instagram has pulled Cerebral's ads for ADHD meds for violating Instagram's policies around imagery promoting eating disorders. From the outside, this seems like a classic example of a dumb mistake by a company growing too fast without anyone asking whether a specific ad is a really stupid idea. These sorts of growth-related mistakes are ok in consumer tech world, but feel higher stakes when you're promoting ads encouraging eating disorders to peddle ADHD meds. We should all strive to do better. Link / Slack (h/t Ryan Gallagher)

• Halle Tecco and Julia Cheek shared a good article defining women's health. Link.

• This article calls for health equity to be added as a fifth aim under a new "Quintuple Aim" framework. Link.

Data:

• CBO released a report on the price of commercial insurance compared to Medicare. It's a good, albeit a bit dense, read explaining the various factors that lead employers to pay more for insurance than Medicare. Link.

• This is a good read on the state of value-based care payments across different payor lines of business (Medicaid, Medicare, and Commercial). Link / Slack (ht Sachin Gangupantula).

• Cigna shared a white paper suggesting that virtual care does indeed reduce spending for employers. Although, if you peruse the report, none of the data actually appears to show employers spend less with virtual care, although there are some interesting data points about MDLive (which Cigna acquired via its Evernorth unit). Link.

• Medicare Advantage enrollment data came out last week, and this is a helpful analysis of the changes. While folks in startup land get really excited about Devoted, Clover, Bright, etc - it's a reminder that they are barely a blip on the radar. United, Humana, CVS, Anthem, and Centene each grew membership by double (or 4x in the case of UHG) what the aggregate of the startups grew by. Link.

• This is a fascinating article on health equity issues, as researchers found racial bias in EHR notes. Black patients were 2.5x as likely to have a negative descriptor in their health record as White patients. Data like these are a good reminder why so many people have massive trust problems with our healthcare infrastructure. Link.