Weekly Health Tech Reads | 3/6/22

This newsletter is sponsored by the Yale SOM.

Yale is hosting its healthcare conference on Apr 1st, both in-person and virtually. This conference is focused on all things patients, which is very cool to see. Panels will cover topics including patient-centric payment models, precision medicine, patient / caregiver advocacy, and patients as consumers. The two keynotes, Dr. Jaewon Ryu (President & CEO of Geisinger) and Dr. Libby Rosenthal (author of "An American Sickness") should also provide some thoughtful perspective on the topic.

See the AgendaRegister Here (using code HEALTHTECHNERDS gets you 20% off!).

News:

• Bright Health had a terrible, horrible, no good, very bad quarter. Somehow it managed to lose over $800 million in Q4 alone. The news sent Bright's stock price tumbling ~30%. Bright seems to be facing some major organizational challenges that will make for a tumultuous 2022. It posted an MCR of 124% on the Bright Healthcare business and 190% on the NeueHealth business in Q4, which flies in the face of everything they've been saying about their confidence in how they've been pricing their insurance product. And the fact that there was no hint of this at investor day in January would seem to indicate these issues came out of the blue over the past month or so, which is pretty astounding. Even worse, it appears from the earnings call that this was at least partially driven by basic claims processing issues. Bright's CFO mentioned they've been manually processing claims because of operational issues with the claims platform, and they didn't properly account for claims lag. These are basic insurance functions you'd hope and expect a public insurer would know how to perform at this point. And of course, every organization has its issues, but an $800 million loss in a quarter is wild. Bright also announced this week that it appointed a longtime Cigna executive to the Board, which certainly feels related to the above. Given it doesn't appear Bright was aware of these issues in January, you have to imagine Cigna wasn't made aware of them before the investment, either. So I can see why Cigna might want some additional Board oversight to make sure they get things back on track. But this is where Bright appears to be in a sticky wicket - talk to any insurance exec and they're going to tell you Bright needs to blow this thing up. Exit markets and shed membership as fast as you can to stop the bleeding. Particularly if you didn't fix pricing for 2022 (which I'm not sure how they could have given they didn't know about the issues until January). So as bad as Q4 was, it seems that 2022 is going to be an even more challenging year for Bright. What a mess. Link / Slack. 

• Oak Street, on the other hand, had a solid quarter and its stock price jumped 20%+, even though it paired back growth expectations a bit. Oak Street shared that it now plans to build 40 clinics a year over the next four years, which invited some questions from analysts about Oak Street's JPMorgan presentation where it suggested it'd open 70 new clinics next year. Goes to show you how much the market has been turning towards profitability recently that Oak makes this move to manage losses and its stock price jumps. Oak also shared that it expects to hit profitability by 2025, which feels like a lifetime away. Oak Street again shared some helpful data on profitability of clinics - it has 10 clinics at the $8 million profitability mark, and among the 19 clinics that are six+ years old it generates $6.5 million per clinic. It also shared a perspective that the Direct Contracting changes don't change much for Oak Street's growth via that program. All in all, a good quarter for the Oak Street team. Link / Slack

• Teladoc and Amazon announced that Teladoc will be integrating into Alexa, so that patients will be able to access Teladoc visits via Alexa (it'll start with audio-only visits). Seems like a nice PR move for both organizations but I can't imagine Teladoc will be driving significant volume via this channel anytime soon. More interesting is that Amazon announced this partnership with Teladoc despite working on Amazon Care internally, which seemingly could be a substitute to Teladoc for something like this. You'd think if someone were orchestrating a grand healthcare strategy over there, this isn't a move you'd make. Link / Slack (h/t Justin Venneri)

• Ro acquired sperm testing startup Dadi at a price rumored to be around $100 million. Seems to make a ton of sense for Ro as an expansion of their platform.Link / Slack

• Sanofi and Dario Health announced a $30 million deal for Sanofi to help drive commercial adoption of Dario's digital therapeutic platform that covers multiple chronic diseases. Will be interesting to watch how much Sanofi helps drive adoption here.  Link / Slack (h/t Isabel Hines)

• Cigna is allocating $450 million to its venture fund that launched in 2018 with $250 million. Part of the slack convo was around how many other health plans have venture arms and it's interesting to see what level of patience exists, especially for the public company venture arms (e.g. UHC/Optum, Aetna/CVS, Cigna, Humana, etc), with specific portfolio companies when losses of the portfolio start to make an impact on the EPS line.  Link / Slack (h/t Katie Fisher)

• AllScripts is selling its hospital and large practice business to Constellation Software for up to $700 million. Link / Slack (h/t Martin Cech)

Funding:

• Nayya Health, a platform helping employees navigate benefits decisions, raised $55 million. Link.

• Qventus, a platform helping health systems automate patient flow processes, raised $50 million. Link

• Flume Health, a digital TPA platform that enables provider companies to build their own health plan, raised $30 million with the goal of becoming the "operating system of every health system." Link / Slack (h/t Grant Parker)

• Kintsugi raised $20 million for a vocal biomarker that detects depression. Super cool product with a straightforward opportunity helping call centers,  Link.

• Lynx raised $17.5 million for a fintech for healthcare platform that appears to be doing a bunch of things from the press release. Link

• CancerIQ, a cancer screening and detection platform for providers, raised $14 million. Link.

• XRHealth raised $10 million for something to do with "virtual reality treatment in the metaverse". Link.

• Budgie Health, a platform helping employees navigate benefits decisions, raised $3.2 million. Link.

Opinions:

• Equip's co-founders joined us for a conversation last week to discuss their recent funding announcement. They shared a lot of insight about how Equip got started, tested its clinical model early on, successfully signed up payors, and more. Lots of food for thought for founders building virtual care delivery organizations.  Link / Slack.

• For HTN Community members, we hosted a conversation the other day on Tivity Health's SilverSneakers program, and how its the "killer app" for Medicare Advantage plans. Thanks to Kevin Wang & Andrew Rosenthal for sharing their knowledge with us. Lots of interesting discussion about the importance of supplemental benefits like this one and the brand that SilverSneakers has built for itself in the senior population, making it hard for plans to move away from.Link (paywalled) / Slack.

• Speaking of healthcare brands, this survey suggests that Teladoc (#21) and Calm (#12) are two of the top 50 brands people can't go without. Jane Sarasohn-Kohn provided some interesting summary thoughts on the survey, talking about the focus on consumer health and wellness. Interesting to see Teladoc check in this high on the list - as mentioned on the Slack perhaps its suggesting that Teladoc's brand name is becoming synonmous with telehealth. Link / Slack.

Data:

• For folks who still think that increased for-profit investment in healthcare is going to reduce healthcare spending in this country, I present to you this JAMA study. It looked at anesthesiology practices and found that prices increased ~26% after a facility contracted with a private equity backed physician management company.   Link.

• This UCSF study looks at primary care practices participating in Meaningful Use, MSSP, and the Patient Centered Medical Home model and finds mixed results. The Slack dialogue breaks down nicely a lot of the nuance of the study and what's happening across those various programs. Link / Slack (h/t Benjamin Schwartz).

• This is an interesting study looking at the high cost of PCP turnover in this country, finding that a PCP leaving their job on average costs payors roughly $90,000 in higher spend in that PCPs commercial and Medicare patients. With roughly a third of the workforce expecting to turnover in many specialties, this article suggests that could cost the system almost $1 billion in excess spending due to turnover. Link.

• This Commonwealth Fund report does a nice job summarizing Massachusetts data on Health Care Sharing Ministries, showing that they are only paying out about half of claims. The data are really interesting - if you look at an MLR equivalent (amount paid out as a percent of member contributions), there is some wild variation. One HCSM is paid out 44% & 28% of what it brought in 2020 and 2021 respectively. Link (Commonwealth Fund) / Link (underlying data).