Weekly Health Tech Reads | 7/10/22

This week's newsletter is sponsored by Tegus.

Tegus, a research platform that facilitates calls between investors and Key Opinion Leaders, posted a white paper with a few transcripts of Tegus calls between KOLs and investors exploring AI use cases for hospitals and various vendors (both startups and incumbents, including 3M, Aidoc, Epic, Nym Health, and PathAI).

The interviews are interesting to read through if you’re curious about how hospitals evaluate solutions for radiology, clinical coding, and pathology. You can pretty quickly see why interviews like these are really valuable to investors. Link

News:

• Signify Health announced that it is exiting the Bundled Payments for Care Improvement (BPCI) program "in light of the newly released CMS retrospective trend calculations that lowered target prices for episodes, thereby reducing the opportunity for savings". It's worth recognizing that only a few years ago, Signify merged with Remedy Partners, one of the biggest bundled payments conveners. When Signify subsequently went public last year, the first competitive strength listed in its S-1 was that it is the largest participant in BPCI-A, and it was driving 20% - 25% of Signify's revenue. That said, as the first analyst comment on the call mentioned "I don't know if congratulations is the right word [...] but I'm happy to see you guys exit this segment." It's a stark reminder of how  quickly success can turn into disaster in VBC programs because of contractual dynamics. Of course, Signify still sees strong growth moving forward and that this will improve profitability for the organization. Link 

• Optum and Red Ventures have formed a new joint venture called RVO Health. Per RVO Health's LinkedIn page, it brings together a bunch of assets including: Healthline Media (Healthline, Medical News Today, Psych Central, Greatist and Bezzy), Healthgrades, FindCare and PlateJoy; Optum Perks, Optum Store and the virtual coaching platforms Real Appeal, Wellness Coaching, and QuitForLifee. Obviously Optum Store is an interesting asset to see included in this JV, given at UHG's last investor day, Witty was on stage talking about how in the future consumers would "meet" UHG via the Optum Store rather than UHC insurance products. I would imagine the learning curve for Optum building a trusted resource that consumers will turn to to shop for healthcare goods is quite high, and that a JV like this recognizes that those competencies might lie outside the current Optum organization.  Link / Slack (h/t Ed Manzi)

• One Medical's stock jumped this week as Bloomberg reported on rumors that it is considering its strategic options after receiving initial interest from CVS Health in an acquisition. Lots of discussion in the Slack channel on this one - it's not clear to me how many other logical buyers for One Medical there would be at the moment. Optum seems like it'll get thrown out as another potential acquirer, but I outlined a few reasons why I think that's unlikely in this case in Slack. The combination of significant losses and intermixing of VBC / FFS businesses make it a challenging fit with a number of different acquirers. Will be curious to see what happens next here, but our hunch is that there isn't much acquisition interest for One Medical at the moment.   Link / Slack (h/t David Han)

• Cano Health stock also jumped this week as its rumored to be in acquisition talks with Humana. Unlike One Medical, it's a bit easier to see the strategic rationale for Cano and Humana (or other Medicare Advantage players), with Cano focused on the Medicare Advantage population primarily in South Florida. The density it is building in Florida and other key markets should make it an attractive asset for a player like Humana looking to grow its MA market share. Link / Slack (h/t Paul K)

• The Medicare 2023 Physician Fee Schedule was released, with some major updates for the MSSP program. Check out the Slack threads for some good links to tweet storms on the topic. Link / Slack (h/t Lisa Bari)

• Enhabit Home Health & Hospice completed its spin-off from Encompass Health. If you're interested in the home health / hospice space, its worth checking out Enhabit's slide deck linked here, which provides a nice overview of the business and how it has grown over time. Link (Slides)

• Banner Health launched a new Direct Primary Care insurance plan in partnership with two startups, Hue and Flume. Hue will manage the DPC offering, Flume will manage the insurance product, while Banner will be the anchor clinical partner, including offering primary care.  Link / Slack (h/t Grant Parker) 

• Cedar, Forward, and Ro join the latest growth stage healthcare companies to lay off portions of their workforce. Cedar laid off 24% of staff, Forward laid off 5%, while Ro cut 18% of staff, including the entire Workpath team. I'd be curious to understand the rationale behind shutting down Workpath less than two years after acquiring it - it seems much more labor-intensive than Ro's other businesses, so perhaps Ro didn't want to fund the staff costs, instead looking to models like Kit to provide home health tests without the same staffing needed. Link (Cedar) / Link (Forward) / Link (Ro)

• Physicians Immediate Care was acquired by WellNow Urgent Care, a portfolio company of The Aspen Group (TAG), a private-equity backed conglomerate that provides back office support services for a number of clinics. The combined urgent care entity will have 183 centers across six states. Link

• Teladoc announced that its Primary360 virtual primary care product will integrate with Capsule for same-day medication delivery and Scarlet Health for in-home labs. Additionally it launched a new virtual first plan with Priority Health, an insurer in Michigan.  Link / Slack

Funding:

• Nomad Health, a nurse staffing marketplace, raised $105 million. Link

• Tomorrow Health raised $60 million for its platform providing DME for in-home care. It's interesting to note how the language has shifted between the Series A announcement to the Series B announcement below. The Series A was much more focused on DME specifically, while the Series B seems to hint at broader ambitions to coordinate home healthcare services, both DME and potentially beyond. Link / Slack (h/t Ben Lee)

• PicnicHealth raised $60 million to build real world data sets. Link / Slack (h/t Niko Fotopoulos)

• Faeth Therapeutics announced it has raised another $47 million. Seems like a good sign for one of the more ambitious ideas that we've seen recently - that using diet to control metabolism can fight cancer. Will be very interesting to watch this company evolve. Link

• Matter Health, not to be confused with the Chicago-based community MATTER, raised $35 million to build primary care clinics in affordable housing developments for dual eligible patients. Matter currently operates four clinics in Tennessee, has contracts to open 23 more clinics this year, and intends to open 70-100 new clinics by 2024. Link

• Socially Determined, an SDoH analytics startup, raised $26 million. Link

• CareConnectMD raised $25 million. Link / Slack

• Ria Health, a telehealth model for alcohol use disorder, raised $18 million. Link

• Regard, formerly HealthTensor, raised $15.3 million for its clinical decision support tool. Link

• Ursa Health, a value-based data analytics platform, partnered with Valtruis, Welsh Carson's value-based care investment arm. Ursa is working with Valtruis's companies, including Cricket and Wayspring. Valtruis is taking an interesting approach here - will be worth watching what other services they add into the portfolio. Link / Slack 

Opinions:

• This is an interesting addition to the Medicare Risk Adjustment debate, suggesting that rather than overcoding in MA there's undercoding in Traditional Medicare, and that CMS should introduce disease based risk adjustment in Traditional Medicare. It's a nice addition to the debate, although it stops short of actually including numbers on the financial impact of this, which would be helpful to see (similar to Berwick & Gilfillan's original piece walking through various financial scenarios). Link

• As you probably heard, as of July 1st payors are required to post prices online. Here's a good perspective from Niall Brennan on the "fatal flaw" of price transparency and how hospitals are viewing the price transparency mandate. It argues there's too much leeway in the definition of what it means to be compliant with the legislation. Link

• The Society of Actuaries released a report looking at factors driving 2023 premiums in the individual and small group markets. It does a nice job walking through a number of key factors in the market, including how the individual market risk pool might change in 2023 due to the expiration of APRA, the resumption of Medicaid redeterminations, fixing the family glitch, and more. Link

• A good look at the Diagnostics-as-a-service space from Marissa Moore, with the helpful market map included below. Link / Slack (h/t Marissa Moore)

Data:

• Mercer released its survey data on employer's health benefit strategies for 2023. While last year's survey had behavioral health firmly atop the employer priority list along with more virtual care enablement, this year's survey indicates employers are now trying to figure out how to make those behavioral offerings actually work, with over 67% of employers are looking to provide enhanced EAP services and 62% adding online resources. On the virtual care front, while more employers are continuing to add virtual care delivery elements, there is still a lot of work to do in driving home the virtual first health plan value prop, as the chart below indicates. Lots of interesting stats in here across different cohorts. Link

• KFF data found that 18% of in-network claims are getting denied by insurers on the exchanges, with a crazy range going from 1% to 80% depending on the insurer. 28 of 144 insurers reported in-network denial rates above 30%. Oscar is one of a handful of plans that denied over one-third of in-network claims, and it did so across seven states. Regardless of how good your digital experience is, when you're denying 33%+ of in-network claims, it's hard to imagine a good customer experience. Link / Slack (h/t Khang Vuong)

• The folks at SCAN Health published a brief article supporting "street medicine" to treat patients experiencing homelessness. The article includes some interesting data on the care model and population - average patient panels range from 70 - 200, mean annual cost of care for 40 dual eligible SCAN members experiencing homelessness was $69,000, of which 87% of costs were for ED, hospital, and SNF visits.  Link / Slack (h/t John Prendergrass)

• Interesting study looking at "phantom" provider listings in Medicaid provider directories in Oregon. 58% of network directory listings didn't actually see Medicaid patients. Link