Weekly Health Tech Reads | 6/26/22

This week's newsletter is sponsored by Medallion.

Medallion, a provider data management platform that just announced its $35 million Series C (see below in Funding), is hosting a free, two-day virtual conference in July, focused on the future of healthcare operations.

Sessions will cover a wide range of timely topics, from what it takes to stand out for health tech funding to overcoming provider burnout to winning on provider retention. Keynote speakers John Prince (President & COO at Optum) and Ann Mond Johnson (CEO at ATA) are joined by leaders from orgs like Ro, Cedar, Equip, and Alma, among others. Register now to save your spot! Link

News:

• The big news of the week of course was Friday's Supreme Court ruling overturning Roe v Wade, as the US joins Poland, El Salvador, and Nicaragua as the only countries to roll back abortion rights over the last 30 years. Personally, I found it hard to read the majority opinion, which by my read is primarily about how strictly we interpret the Constitution, the role of the Court, and what people in the 1700 and 1800s might have thought about abortion, leaving it for the dissent to discuss the practical implications that this decision will have for women across the country. It felt like the majority decision journeyed back in time to both curtail the rights of women and also open the door for the reversal of many other rights granted to people in this country that weren't explicitly recognized hundreds of years ago. Regardless of your views on the moral and ethical considerations at hand, it seems clear the ruling is already having major practical implications for healthcare in this country, forcing providers to evaluate the legality of their actions, employers to choose how they will support employees impacted by this, and upheaval for patients who live in states where there is now significant uncertainty around what care they can and can't receive. We found that this NEJM article interviewing clinicians and patients in Texas provides good insights on the challenges ahead and impossible decisions we are making patients make in these uncertain times. In a country that already has some of the worst maternal health outcomes among developed countries, it seems like we are heading in the wrong direction from a public health perspective. Here are a few links we've been reading: SCOTUS opinions. Link NEJM article interviewing Texas providers / patients. Link Modern Healthcare on ramifications for healthcare providers. Link

• The Supreme Court also released a ruling against DaVita this week, finding that an employer can reduce its reimbursement coverage of outpatient dialysis (i.e. move all dialysis providers out of network) for all employees uniformly because the employer isn't differentiating between employees who do or don't have ESRD / Medicare coverage. I find the dissenting opinion to be much more persuasive here - that a limit on outpatient dialysis coverage functionally is differentiating a benefit for ESRD patients and this isn't what the statute intended. The decision ultimately impacts the Medicare Second Payer statute, as Medicare will now be covering the costs of outpatient dialysis, and it's not hard to imagine more employers following this path to offload dialysis costs.  Link / Link (court decision)

• SteadyMD, a virtual clinician staffing platform, is acquiring Bloc Health, a provider credentialing company. It's an interesting move for SteadyMD, as it seems to indicate SteadyMD is looking to support a wider range of needs across the lifecycle of its virtual care customers - not only will it provide outsourced staff, but it will also help its customers build out their own workforce. It seems like a smart move as virtual care providers mature and inevitably realize owning a clinician workforce is the core asset of any care delivery company, whether virtual-first or not.  Link / Slack

• Ribbon and Turquoise Health announced a partnership to embed Turquoise's price transparency data into Ribbon's platform. A relationship like this seems to make sense for both parties - Ribbon has another relevant selling point for its customers as including both cost and quality data presumably makes Ribbon's platform more actionable. Meanwhile, Turquoise gets a channel partner that helps expand its reach. As the race to build the new scaled infrastructure platform for care delivery heats up, we wouldn't be surprised to see an increasing number of partnership and/or acquisition deals like this and the SteadyMD deal above in the coming months. Link / Slack (h/t Krish Maypole)

• Convey Health Solutions, a company that provides a tech platform and advisory services supporting Medicare insurers, is being taken private by PE giant TPG at a valuation of $1.1 billion, which represents a 143% premium over the stock price. TPG owned Convey prior to taking it public only a year ago, after purchasing Convey from New Mountain Capital in 2019. This move seems to indicate pretty clearly how TPG feels about the public market valuation of Convey, suggesting it will be able to grow the business better as a private entity for the foreseeable future. It's not hard to imagine that we're going to see more healthcare companies moving off rather than entering the public markets this year (at least for the rare birds that are generating enough cash flow to attract the interest of private equity bidders).  Link / Slack (h/t Blake Madden)

• The FTC made waves this week as it ordered a PE firm to divest veterinary clinics in California and Texas, the first such antitrust action under current FTC leadership attempting to quell anticompetitive behavior in healthcare. Given the increasing for-profit investment in US healthcare – whether PE, VC, or corporate – it will be interesting to see whether regulators start pushing back harder against this trend moving forward. It seems like one of the few levers remaining that could reverse the consolidation trend in healthcare today, if regulators are willing to do so. Link (WSJ paywall)

• Ro joined the list of growth stage health tech companies conducting layoffs, as it announced it is laying off ~18% of its 750 employees. Link (BI - paywalled) / Link (Techcrunch)

Funding:

• Medallion, a provider data management platform, announced $35 million in funding this week. Medallion is going to use the funding for product development, go-to-market, and strategic partnerships. Similar to the SteadyMD and Ribbon news above, it's another indicator that the race to be the administrative platform partner for the next generation of digital health companies is heating up. Link

• Belgium based Lynx Care raised €20 million to structure clinical data for research leveraging real-world data. Link / Slack (h/t Rik Renard)

• AiVF, an AI platform aimed at supporting IVF clinics, raised $25 million. Link / Slack (h/t Thiv Paramsothy)

• Nibble Health, a buy-now-pay-later startup targeting employers to help employees manage out of pocket costs, raised $8.5 million. As the healthcare industry continues to shift cost to patients (in this case via high deductible plans offered by employers), models like this seem inevitable in order for patients to help pay for care they otherwise can't afford. Of course, if this increases access for people to needed care, that's great, even if I'd love to see more companies working to encourage less cost shifting to patients, rather than more.  Link / Slack (h/t Neil Sanghavi)

• Physical therapy platform Kins raised $7.2 million. Link

• Enara, a virtual weight loss clinic, raised $6 million. Link 

• Live Chair Health raised $3.5 million. This is another awesome community-based concept that takes local and personalized care to a new level by partnering with local barbershops to support African American men in their health leveraging the already established trusted relationships.  Link

Opinions:

• Medi-Cal passed a new plan that will cover doulas at over twice the rate initially proposed, which sounds like a huge increase until you see that it was from $450 per birth to $1,154 per birth, which if a typical doula does 3 births a month, the new rate equates to $41,544 in annual pay for a doula. As the article covers, that rate is higher than most states that cover doula services for Medicaid, as average rates are between $770 and $900. At these rates, doulas will cost Medi-Cal $10.8 million annually, which represents 0.04% of Medi-Cal's budget estimate of $26.8 billion from this year. It is odd to me that it is so hard to convince the healthcare system to fund doulas at livable wages despite evidence suggesting that doulas are associated with improved birth outcomes, particularly when Medicaid birth outcomes are so dismal in this country. Link

• There were two articles this week on the topic of provider licensing across state lines. One article in NBC News talked about how patients are losing access to telehealth options as states are reimposing rules about providers practicing across state lines. It provides a nice overview of where we're at and what might happen moving forward. Another article in Healthcare Dive, though, cited new data suggesting that out-of-state virtual visits actually declined as a percentage of total virtual visits during the pandemic, decreasing from 8% to 5%. Granted, this is Medicare data only so perhaps it isn't representative of commercial or Medicaid populations, but it would be interesting to see what that data looks like as well. It certainly invites some interesting questions as to whether the bump in telehealth use was from the national virtual-first models or local health systems getting their act together and offering virtual care. Link (Healthcare Dive) / Link (NBC News) / Link (Slack)

• This is an interesting read in Bloomberg about how the New Jersey state employee health plan apparently wants a $34 million payment back from Horizon Blue Cross Blue Shield. That payment was for Horizon to provide enhanced care navigation services that apparently were non-existent. Ultimately, the New Jersey's governors office intervened on Horizon's behalf, halting the employee health plan's effort to claw back the payment. It's a good case study for all the startups working in the care navigation space (and health tech more generally) that sometimes it doesn't matter how good your product actually is, it's all about having the right relationships. Link (Bloomberg paywall)

• Weill Cornell apparently has been sending out a letter to expectant mothers for the last few years suggesting that they shouldn't have birth plans because Weill Cornell OBs felt birth plans are detrimental to the care they want to deliver. Weill's OB/GYN department chair had never seen the letter before and was "disgusted" by it, and Weill is now in process of developing a template birth plan for patients (side note: that template is apparently going to take close to a year to create which is insane even by health system standards). It's a reminder that for all the issues that digital health companies can have with clinical quality and standard operational processes, the existing care delivery infrastructure in this country has its own set of warts.  Link / Slack

• The 7wireVentures team posted an article on the landscape of startups working to address health equity, featuring the market map below. The article provides some helpful examples of the approaches various companies are taking, including cool early stage models like Live Chair, Violet, Alkeme, Reema, and others. Link

Data:

• Trilliant Health claims data suggests there was a significant uptick in adderall prescriptions for the 22 - 44 age group over the past few years. There's a good discussion in Slack about whether this increase is something we should expect given increasing mental health awareness and pandemic challenges or if it's driven by D2C companies driving market demand. Link / Slack

• Rock Health folks published an interesting study looking at the clinical evidence of 244 digital health startups, finding that digital health startups generally lack clinical evidence as defined by regulatory filings, clinical trials, or other data shared publicly online. While it's not exactly surprising news, it'd be interesting to see the list of the 13 companies with the best "clinical robustness score" of >10. Link / Slack

• This study finds that if Medicare purchased generic drugs from Mark Cuban's pharmacy, it would generate over $36 billion in Medicare Part D savings. Lots of interesting dialogue in Slack on the topic. Link (WSJ paywall) / Slack (h/t Josh Heurung)

• A new survey suggests almost 80% of people paying for insulin have financial difficulties, with average credit card debt of $9,000 to pay for those costs. Link