Weekly Health Tech Reads | 10/31/21

News:

• Teladoc's Q3 earnings call highlighted the breadth of their business at this point as it jumps around between their new Primary360 offering, mental health, Livongo, other chronic conditions, and platform for providers. Lots of questions asked on the Primary360 offering, which is gaining traction via partnerships with Aetna (for self-insured employers) and Centene (for the exchanges). Teladoc clearly sees a lot of potential for the offering, with plans to get into risk-based contracts, as well as  opening up the offering to health system customers. Interesting to see Teladoc reference the opportunity that exists around virtual-first plan designs, as RFP activity with health plans looking to launch virtual first products has increased significantly. Seems like this model is picking up steam. Link.

• FemTec Health launched out of stealth, announcing it acquired BirchBox for $45 million and Mira AI for $28 million. FemTec itself has raised $38 million at a $380 million valuation. Confused by how that math works? So am I. Regardless, it'll be an interesting play to watch unfold. It sounds like they're going to use Mira AI to deliver personalized recommendations for wellness products that'll be delivered to women via BirchBox. This leads into a broader play called Awesome Women, a telehealth platform for a variety of women's health topics. FemTec will be building it's own set of branded wellness products as well. Will be worth watching to see if FemTec can successfully build trusted, lasting relationships with women - if so it could easily spur a wave of companies taking this approach blending health & wellness together. Link.

• UnitedHealth filed a lawsuit against Team Health, claiming that Team Health systematically upcoded ER bills, causing UHG to overpay Team Health around $100 million over the last decade. The chili dog example is quite memorable - a guy goes to a Team Health ED with heartburn after eating a chili dog, is given Maalox and told to go home. UHG is billed at the highest severity level CPT code for this visit. The lawsuit itself is interesting if you're looking to understand how upcoding words, and how challenging it is to prove it's happening. I wonder how many Team Health providers understand the extent of the financial shenanigans happening in their organization, let alone where those profits are going. Link.

• Amazon is launching an offering to bring Alexa into senior living facilities and hospitals. I know folks are worried about privacy and such with Amazon moving into hospitals, which certainly isn't unwarranted. At the same time, 24% of the population already chooses to have these things in their homes and the voice/communication technology in the hospital is due for an upgrade with those hospital bed TV/alert remotes. This seems like it has the potential to take off quickly. Link.

• TransUnion sold its healthcare business to nThrive for $1.7 billion. TransUnion will generate $190 million of revenue this year from its revenue cycle management business that serves 1,850 hospitals. Rev cycle management continues to be a very hot space. Link.

• Northwell and venture studio Aegis Ventures are creating a new AI-venture, committing to investing $100 million into seed stage ideas around AI. Will be interesting to see what they choose to invest in. Link.

Funding:

• Hinge raised $600 million at a $6.2 billion valuation from Coatue and Tiger Global. Hinge now has ~575 enterprise customers, doubling its customer base year-over-year. It would seem as though we're nearing an S-1 filing from Hinge, and it'll be interesting to see how they articulate growth strategy from here. $6.2 billion is a massive valuation to go to public market investors with if the play is continuing to go deep in MSK - I would imagine we'll see them articulate plans to branch out. I'd be willing to wager that they use some of this funding to make an acquisition outside of the MSK space pre-IPO as a proof point for future growth. Link.

• Medable raised $304 million for its decentralized clinical trial platform. Link.

• Digital health infrastructure startup Truepill raised $142 million at a $1.6 billion valuation. It's quite interesting to see the lead investor in this round as undisclosed, while at the same time Optum is not mentioned as an investor in the round. Optum Ventures co-led Truepill's last funding round (a $75 million round last September). Since then, Optum rolled out its Optum Store, which is powered by Truepill. The Optum Store, which has been mentioned on UHG earnings calls already, is the type of strategically important asset where it's odd for Optum to not continue investing in Truepill. Link.

• Patina Health announced its raised $57 million across a Seed and Series A round for a new virtual / at-home senior care delivery model. The pandemic seems to have opened the door for an opportunity like this, as all the MA startups pivoted to a model like when physical locations were closed. So it makes sense that you'd leverage that proof point, hire one of Iora's original clinical leaders, and go big in this space. Build a more scalable, convenient, and financially attractive (i.e. fewer physical assets) version of those companies. The major risk here seems to be in broader questions around the MA program and whether the financial dynamics change around how much insurers are paying PCP groups. Link.

• Workforce management platform ShiftMed raised $45 million. Link.

• Sana, an insurance startup targeting small businesses, raised $20 million. Link.

• Anomaly raised $17 million to tackle the $300 billion(!!!!!!) problem of wasteful medical spending due to the complexity of medical billing. I mean what investor can say no to a $300 billion TAM. Link.

• Brave Health, a mental health startup for the Medicaid population, raised $10 million. It is quite refreshing to be including news on a mental health startup not going after employers. Link.

• Vitable Health, a startup providing in-home primary / urgent care targeting hourly workers, raised $7.2 million. I like the general approach, but the low cost language in the press coverage is confusing at best. Vitable is charging $50/mo for its service according to the article below - although the website says $89/mo, - and suggests it costs 10x less than traditional health insurance: “We’re able to deliver our concierge premium experience at a substantially lower price. That’s part of why we’re about 10 times more affordable than traditional health insurances.” This seems misleading - it's 10x more affordable than health insurance because it is not health insurance, not because they deliver their experience at a lower price. At $50/mo, it's 2.5x more expensive than most primary care (which for an employer population general costs $20 PMPM). It's also more expensive than other startups in this space (Nice, for instance, is at $30 - $36 per month). Vitable seems like a cool model, and kudos to them for targeting an underserved market. But the cost language is confusing. Link. 

• Clearwave, a digital patient engagement platform, announced an undisclosed investment from Great Hill Partners. Link.

Opinions:

• This is a fascinating deep dive in the New Yorker on Hims and how it built a brand hyper-targeted at "The Hims Man" who "could could order sildenafil while waiting in line for Sweetgreen, changing in the Equinox locker room, obtaining knitwear on Mr Porter." It highlights how Hims got its start - in venture studio Atomic, which saw an opportunity at the intersection of: 1. regulatory changes around telehealth and 2. viagra and rogaine going off patent. The launched a landing page around the idea, and saw massive interest. Hims CEO articulates a broad vision for the company - one where Hims is used for everything but emergencies. It's worth reading if you're interested in the D2C space and curious how it will all play out. Link.

• Ro was in the news this week, as TechCrunch highlighted the issues of some former employees with company culture. For anyone who has worked at a high-growth company before, the problems described will seem relatively similar - it sounds like a hair-on-fire environment that is as messy as you'd expect. Link. Ro's CEO penned a thoughtful response to the criticism. Link. As highlighted well in the Hims article above, transitioning from a brand selling ED meds to a serious healthcare entity is going to be a massive undertaking, and it shouldn't be surprising that there are going to be stops and starts along the way. Perhaps more interesting to me this week was a talk Ro's CMO did at HLTH, discussing how they are starting to think of themselves as a digital hospital. The CMO also discussed the potential of a B2B employer sales strategy. While employer sales is not on the roadmap currently, it is something worth watching - she could have shut that conversation down but instead went into some detail on how they'd think about it. Link. 

• If you're curious the real world impact of the type of upcoding mentioned in the Team Health article above, check out the latest KHN Bill of the Month, which features a $2,755 charge for level 5 emergency department services - the highest level - when a woman simply entered the hospital through the ED because it was the only open entrance. Link.

Data:

• UCSF ambulatory clinicians are struggling dealing with the 2x increase of MyChart messages since 2019, according to this Bob Wachter tweet. I have a hard time thinking that patients asking more questions of their clinicians via MyChart message is a bad thing, but I can appreciate that it is hard on clinicians who aren't paid to respond to MyChart messages. Link. 

• Maven did a survey of 500 pregnant people to understand why so few are getting vaccinated, finding that 61% of people didn't know the CDC recommends vaccines during pregnancy. Link.