Weekly Health Tech Reads | 1/30/2022

This newsletter is sponsored by Canvas Medical.

Canvas Medical, an EMR and payments platform for digital health developers, just released a three-part series exploring how a startup’s technical infrastructure can enable the core building blocks around care modeling for success in digital care delivery. It is a helpful frame of reference from Canvas' CEO, Andrew Hines, for any company trying to figure out what sort of technical infrastructure they need and whether they should build / buy / partner. Link.

News:

• Oscar announced it hit one million members and raised $305 million. Honestly I'm not sure what to make of Oscar's prospects at the moment - on the one hand you have the bears arguing as loudly as ever that Oscar is basically on the verge of being insolvent. On the other hand, hitting one million members is no small feat for an insurer, and citing 80% - 90% member retention on the exchanges is a pretty impressive number. Oscar still is projecting a $380 - $480 million Adjusted EBITDA loss in 2022 and is also introducing a new metric, the "Adjusted Administrative Expense Ratio" as its finance teams try to figure out a way to claim it will hit profitability in 2023. Your guess is as good as mine what happens at this point - there are times when I think Oscar could still be the next big insurer, and there are other times where I wonder if they're going to end up insolvent. I'm still personally in the long camp, more out of a hope better tech and experience counts for something than anything else.  Link / Slack (h/t Noah Landesberg)

• Anthem hosted its earnings call, which featured a number of questions about Anthem's care delivery / value-based care  strategy. It certainly seems like UHG's success in moving to Optum Care to global cap contracts has caught the attention of analysts. There were a number of questions about Anthem's approach to care delivery, seemingly trying to assess Anthem's opportunity to head down a similar path. It's also interesting to note Anthem saying the individual market has become much "stickier" than it used to be in terms of membership retention. They didn't quote a specific retention number, but it seems both they and Oscar are seeing higher retention than the exchanges were known for a few years back. Link

• Brigham Mass General has found itself in a bit of hot water with the Massachusetts Health Policy Commission over costs - HPC suggests that Brigham has increased commercial spending by $293 million over the last five years. The slides provide some good data on local care delivery dynamics in Massachusetts. Not surprisingly, Brigham takes some issue with the analysis, suggesting HPC isn't properly accounting for the acuity of Brigham's patients. Link (news) / Link (slides) / Slack.  

• Wisconsin-based health system ThedaCare got in a tussle with Ascension over seven interventional radiology employees that Ascension hired from ThedaCare. ThedaCare filed a temporary injunction stopping those employees from starting work at Ascension, claiming it needed time to hire new staff so it wouldn't have to divert patients. The opening sentence of Ascension's legal response to ThedaCare says a lot about the case: “Your failure to prepare is not my personal emergency.” The back-and-forth provides some interesting insight into the business of health systems. While so much PR language is couched in patient access and safety, at the end of the day, these are (sometimes mis-managed) businesses competing for employees. Link (news) / Link (Ascension response) / Slack (h/t Josh Heurung).

• Children's Hospital Colorado apparently billed a patient an $847 facility fee for a two hour virtual visit. Lest you think this was some sort of mistake, check out Children's Hospital Colorado's response to situation that is quoted in the article. It's essentially a version of "don't hate the player, hate the game", which is really disappointing to see. This seems like a classic example of the incentive problems that plague healthcare. Hospital finance teams know that adding facility fees is a tactic they can use to increase billing. And of course, at least some hospitals are going to take full advantage of their ability to jack up prices, as Children's Hospital Colorado has done here. Why bother yourself with the fact that a patient never stepped foot in your facilities, or that your providers are doing virtual visits from their homes. Link / Slack.

• Digital therapeutics company Akili Interactive is officially doing a SPAC with SPAC-king Chamath Palihapitiya. At this point, it seems wise to be generally skeptical of SPACs, but Akili certainly is playing in an interesting market with its FDA-cleared prescription digital therapeutics. Link / Slack (h/t He Wang)

• Apollo Medical, one of the more under-the-radar public companies in the care delivery space, announced it is acquiring Orma Health. Orma is a remote patient monitoring platform and a Direct Contracting Entity, giving Apollo Medical access to Orma's 4,000 aligned Medicare beneficiaries via the program. It seems like a positive signal for the prospects of the Direct Contracting program that Apollo Med is moving in this direction.  Link.

Funding:

• Alto Pharmacy raised $200 million, stating that it now is at a $700 million annual revenue run rate. Link / Slack (h/t Frederik Mueller). 

• Eucalyptus, an Australian company building a portfolio of D2C digital health brands, raised $60 million. It seems like a sign of the times that we're starting to see  more CPG-like "house of brands" plays emerge in the digital health space. Seems like we're going to see a lot more of this over the coming years. Link.

• Atlas raised $40 million for a "patient advocacy" platform that helps hospitals collect more money by matching those patients with available financial aid. It would be nice to see "patient advocacy" startups discuss metrics in press releases about the number of patients they're helping, rather than the ROI they're driving for health systems. Link.

• Reimagine Care, a startup building a in-home cancer treatment model that takes value-based payments, raised $25 million. Link.

• DigitalOwl, a NLP technology that helps insurance companies automate medical record review, raised $20 million. Link.

• Mental health startup Talkiatry raised $17 million. It's interesting to see this press release focus so heavily on Talkiatry's ability to recruit psychiatrists. Hiring and retaining a high quality clinical staff seems like one of the more enduring competitive advantages care delivery startups can focus on, yet one that often gets ignored for the sake of quick scale. Link.

• First Dollar, a startup building a digital health wallet for insurance members with with tax-advantaged plans (HSAs, FSAs, HRAs, etc) raised $14 million. First Dollar appears to be finding success with startup insurance brands like Bright, Sidecar and others. It makes a lot of sense that insurers and TPAs would offer this to members on all of their high-deductible plans, so not surprising to see forward-thinking insurers adopting it. Link.

• Intellect, a Singapore-based mental health startup offering self-guided cognitive behavioral therapy, raised $10 million. Link

• Caribou, a startup providing financial planners with data on customers' expected medical spend to into broader retirement planning, raised $3 million. Link.

• Learn to Live, a Minneapolis-based (!!!) mental health startup focused on virtual cognitive behavioral therapy, raised growth funding. Link.

Opinions:

• This is a really good look at how Medicare Advantage insurance startups are growing. Devoted is seemingly finding much more success than the other startups, which the article attributes at least in part to providers like VillageMD and ChenMed telling their patients to sign up for Devoted. Some good discussion on the Slack channel this week as to what might be driving that. It was also curious to see one of Devoted's Board members suggest that: "Devoted's valuation is realistic and will likely grow in the coming years as the company remains private." The phrase "remains private" seems to be doing a lot of the heavy lifting in that sentence. In a world where Bright, Clover, and Oscar now have a collective market cap of ~$4 billion, you can imagine why Devoted's investors are not looking to exit at the moment (when the last disclosed valuation of Devoted was ~$11 billion). Link / Slack.

• Speaking of valuations, Ari Gottlieb penned an article highlighting how health tech startups have lost a combined $190 billion in market cap from their 2021 peaks. You look at a piece like this and have to imagine this bear mentality will trickle down to the private markets sooner or later. Winter is here y'all.  Link / Slack (h/t Tamra Lair).

• The Weekly Gist, which is always a great read on health system strategic topics, featured a segment this week on some worrisome dynamics as it relates to nurse staffing shortages and the impact of working with agencies. Link / Slack.

• McKinsey shared a good interview with Alignment Healthcare's and Humana's approach to the Medicare Advantage space. It provides some insight into how both organizations think about the space - of particular note is their answers to the question about how each organization differentiates. Alignment has a very specific answer about its clinical model, while Humana has a much more general statement about quality and customer experience.  Link / Slack (h/t James Lu)

• Here's an overview of Pine Park Health, a startup applying an Oak Street-like model to senior living communities. It sounds like it's seeing success with the model, as senior living communities are finding it valuable as an amenity to pitch to potential residents. In a world where clinician shortages are presumably not going away, I am curious whether we'll see more approaches that integrate care delivery as part of the pitch to live in a community - and not just for seniors ("hey, young family, come live in this neighborhood where HOA fees include access to this awesome pediatrician who lives/works down the street!"). Link.

• This is a great, albeit tough, read on the challenges facing rural hospitals in the Mississippi Delta. It outlines how one hospital let go of the only neurosurgeon in the Delta because of financial difficulties, as well as the challenges of turning to traveling nurses. 2,000 nurses have quit or left the state since the start of the pandemic. It's shocking to read that nearly 40% of adults in Mississippi under 65 have medical debt. You read articles like this and it makes you wonder about what its going to take to meaningfully change healthcare in this country for the better - as excited as everyone is for digital-first-this-and-that, it sure feels like a bit of a shiny object while reading this.  Link.

Data:

• A study funded by the AMA found that one in five doctors are planning to leave the profession in the next two years. Link / Slack (h/t Mark Molckovsky)