Weekly Health Tech Reads | 5/22/22

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News:

• The Colorado Supreme Court ruled this week in favor of a patient who was being sued by Centura Health for a back surgery that happened in 2014. The case is a good read and reminder of the lengths health systems are willing to go to get paid by patients. Centura misread her insurance card pre-surgery and informed her that she would owe ~$1,300 (and her employer would owe $57k) for the procedure. Centura then realized after the procedure that she was out-of-network and attempt to charge her the full chargemaster rate for the surgery, which was ~$229k, and the patient refused to pay. A jury sided with the patient, Centura won an appeal, but now - eight years later mind you - the Colorado Supreme Court ultimately ruled in favor of the patient. I hope someone on the Centura leadership team / Board is asking the question whether it is worth spending eight years of legal resources trying to force a patient to pay a $230k bill even while admitting you told her the cost would be $1,300. It certainly doesn't strike me as consistent with the vision / mission of a not-for-profit health system. Link / Slack 

• Vermont has received initial rate increases from payors for 2023, and not surprisingly there are some significant increases, with BCBS Vermont at 12.5% and MVP Healthcare at 16.6%. These aren't final, but do give some indication of what 2023 might look like for the exchanges, as hospitals increase prices to account for labor costs and payors increase prices to account for hospitals.  Link / Slack

• Humana and Welsh Carson are forming a second JV that will deploy up to $1.2 billion to build 100 new senior-focused primary care clinics between 2023 and 2025. The previous JV these two created is launching 67 clinics by early 2023. It seems like a very symbiotic relationship between the two parties - Welsh Carson gets to invest in a substantially de-risked opportunity with Humana as a JV partner that can supply patients to these clinics, while Humana avoids the need to invest $1.2 billion in these clinics itself, and also gets management fees for managing these clinics. Seems like a win-win for both parties. Link / Slack

• Mass General Brigham filed its performance improvement plan with the Massachusetts Health Policy Commission. It's an interesting look into how a health system thinks about removing healthcare costs when it is forced to by a regulator - not surprisingly it sounds a lot like all the value based models we see in startup and payor land regularly (+ just reducing rates). MGB is doing things like expanding enrollment in care management programs, reducing SNF utilization, reducing high cost imaging, and implementing hospital-at-home and virtual care. Should serve as a reminder that when given financial incentives to do so, hospitals can implement these programs pretty quickly.  Link

• Cerebral was unfortunately in the news a bunch again this week, first for halting the prescription of controlled substances to new and existing patients, and second for the Board firing the CEO. Both seem like needed changes at this point given the myriad challenges Cerebral faces, although per usual in healthcare the only people really hurt by this change are patients who are left in the lurch. At least these moves will give Cerebral a chance to remake itself under new CEO, clinical leader David Mou. Hopefully they can successfully hit the reset button and get to work moving towards the vision Mou has articulated for Cerebral. Certainly adding Thomas Insel to the Board seems like a good first step. Link (halting scripts - paywalled) / Link (CEO change)

  • More broadly, this whole Cerebral episode should invite more conversation about the role and responsibilities of VCs in balancing the conflicting incentives of protecting patient interests and generating financial returns. While we weren't privy to Cerebral's Board conversations, it seems clear something went off the rails here in terms of Board governance, particularly given longtime healthcare investor Oak HC/FT took the unusual step of quietly distancing itself from Cerebral after leading its Series A less than two years ago. It would be helpful for Cerebral’s VCs to share publicly where things went awry here, so that the industry as a whole can learn from this experience and Founders / Boards can avoid these sorts of outcomes in the future.

• Spring Health acquired Weldon to expand its mental health content for working parents.  Link / Slack (h/t Krish Maypole)

Funding:

• Homethrive raised $20 million to scale its platform for caregivers, with most the funding going to beefing up its sales and marketing capabilities for employers and other payors. Apparently 80% of employees who use the Homethrive service reported a reduced intent to resign, which seems like a pretty meaningful statistic for employers considering an offering like this. Link / Slack

• Cayaba Care, an in-home / virtual model for maternity care, raised $12 million. Link

• Greater Good Health raised $10 million to continue building its platform for nurse practitioners. It makes all the sense in the world that states would continue to allow NPs the ability to practice independently, and as that happens, a platform like Greater Good seems positioned to do quite well. It'll be interesting to watch this evolve over time - you could imagine a path where it is similar to what Alma is doing for mental health practitioners - building an MSO-like platform to help them operate independently and then constructing a network of these providers to go negotiate with payors on their behalf. Link / Slack

• ThoroughCare, a care coordination platform, raised $3 million to expand its platform into more value based care providers.  Link

• Jukebox Health, a home modification company supporting aging in place, raised funding. Interesting to see venture funding going after the home modification space, which feels much more like a PE-style cash flow business versus venture scale model.  Link / Slack

• Peer Collective raised funding to leverage peer support in mental health. Link / Slack

Opinions:

• Here's an interesting read on the rise of hospital-at-home models and the burden these models are placing on unpaid caregivers. It includes some interesting data on how most caregivers initially are supportive of hospital-a-home, but with more information a number would change their minds. The article suggests ways to better include caregivers in the process, which feels like it is going to inevitably be a major topic in healthcare over the next several years. As rising healthcare costs continue to push healthcare delivery towards lower cost care providers ("practicing at top of license") and lower cost settings (i.e. hospital at home), it seems like an inevitability that unpaid caregivers are going play more and more of a role in care delivery in this country moving forward, and organizations of all types should be thinking about how they can better support these individuals.  Link

• Glen Tullman was interviewed by Inc talking about the vision for Transcarent to help consumers with transparent information about their healthcare. It's interesting to note that Transcarent is willing to share some high level data in the article, like the fact that they have 100 large employer customers and expect to generate $50 million of revenue in 2022, but yet there's very little detail provided on how the model is working beyond that. For instance, if Transcarent's revenue comes entirely from shared savings, you'd think there would be more details on both the clinical and financial impact Transcarent had on those 100 large employers that is generating that revenue. It's worth noting that BridgeHealth's Center of Excellence model generated $16 million of revenue in 2017, $11.7 million 2016, and $7.2 million in 2015. We don't know what exactly happened to BridgeHealth's business over the last few years, but it gives some context for Transcarent getting back to $50 million of revenue in 2022. Tullman attempts to differentiate Transcarent from the many other companies providing navigation services to employers by suggesting it is uniquely trying to fix the system, rather than navigating people through it. It's certainly a nice concept, although not entirely convincing when its revenue appears to be essentially a center of excellence play. Link / Slack (h/t Kevin DeLury)

• This is a nice quick blog post on the challenges insurers on the exchanges may face with upcoming changes to network adequacy requirements - this analysis shows that 80% of existing plans will be out of compliance. Link / Slack (h/t Theo Soulages)

• Milliman released a report looking at how data can be used by Medicaid agencies to support health equity and SDOH. Link / Slack (h/t Deana Bell)

Data:

• This Rand study found that private insurance paid 224% of Medicare rates on average in 2020, with wide variation between states. On the low end some states were at 175% above Medicare, while others were 310% above Medicare. The report indicates that the variation is driven by hospital market power, rather than the percent of patients on Medicare / Medicaid. Link

• The Lown Institute released data finding US hospitals did over 100,000 unnecessary surgeries between March and December 2020, including over 45,000 stents placed. Link

• This is an interesting study looking at how machine learning can be used to predict mental health crises using EHR data. Link / Slack (h/t Rik Renard)