Weekly Health Tech Reads | 5/16/21

News:

• Cedar, a startup helping health systems successfully collect payments from patients, announced it is buying Ooda for $425 million. Ooda, which is also in the payments space, is more oriented towards real-time claims processing between payors and providers. Ooda made waves a few years back launching a partnership with Blue Shield of California and Dignity, but has been relatively quiet beyond that partnership. Ooda has a prior auth automation product, which makes this feel very similar to Olive’s recent acquisition of Verata to get into the prior auth space. This shift will be interesting to watch for Cedar. It certainly seems to have nailed the growth story with health systems… after all, pitching a solution that only takes a portion of the upside and gets up to 30% increased collections rates for health systems seems like a slam dunk financially. Can it successfully navigate the territory between payors and providers? Ooda’s website articulates the value prop on both sides really clearly, so I’d assume that Cedar + Ooda will continue to find success pitching both. Now, whether this is all a good thing for healthcare costs in this country is another question entirely. Link.

• Oak Street hosted its earnings call, and not surprisingly the Direct Contracting program was center stage. It enrolled 6,500 members in Q1 (versus 75,000 members in its traditional MA model), and those members are seeing better per-patient economics than Oak Street had previously estimated. Oak Street indicated it isn’t concerned with CMS pausing the program for new applicants, and doesn’t seem to think it impacts them at all given they can still grow within the program. Also, interesting to note the question about whether Oak thinks it might expand into any other specialties in its clinic and it appears they’re thinking deeply about cardiology. Their partnership with Rubicon to do specialty e-consults gets some nice air time. Link.

• Oscar reported its first quarter earnings and shared some interesting insights and reported solid growth. Lots to unpack in this one, some bullets below: Link.

  • Oscar announced that it plans to end its annual tradition of lighting money on fire by 2023, at which point it expects to be profitable. This is a noticeable change in strategy for them, and I suspect the lukewarm reaction from the public markets thus far has had a major impact on their views towards cash burn moving forward.

  • Oscar highlighted a number of interesting stats about its virtual primary care offering: members who use it are 10% more likely to stay with Oscar and 45% of members reported not having a PCP before signing up for virtual primary care. Oscar’s medical group is now the third largest PCP for their members in markets where the service is offered. Oscar also noted that the virtual visits platform saved 22 basis points by diverting ER utilization. While that sounds nice, it’s also a reminder that diverting ER utilization doesn’t actually save all that much off premiums - 0.22% isn’t exactly transformational change. For comparison, Oscar cites that risk adjustment tech saved 70 basis points, and Oscar’s internal claims platform saved 90 basis points.

  • Lots of questions from analysts on the +Oscar platform, and they are equally vague on many of the answers. When asked specifically about the pipeline for the +Oscar platform, a vague answer was given that there is a pipeline and potential clients at all stages of it. Ok… They do state that the value prop is three-fold: 1. provider-sponsored plans are seeing a 10 - 15% reduction in PMPM administrative expenses, 2. better medical cost management, and 3. improved retention. It’s a value prop that makes sense, will be curious to see what that pipeline starts to shape up like.

• One Medical also reported earnings this week. Interesting to see them pivot their growth strategy slightly, as they announced a partnership with ParetoHealth, an organization that helps small and medium-sized employers manage self-insurance benefits for employees. As part of that partnership, it appears One Medical is taking over ParetoHealth clinics in Kansas City and Alabama. It is not entirely surprising to see One Medical look for new paths for growth beyond health systems in new markets. The financial value prop to a health system is much clearer once One Medical already has members in a market, and this move seems indicative of that challenge. It may very well solve the challenge of how they enter new markets, but it isn’t exactly confidence inspiring in terms of their ability to sign up new health systems. Link.

• Four members of congress wrote a letter this week to HHS Secretary Becerra and CMS Administrator Richter asking them to freeze the entire Direct Contracting program. They’re concerned with both how the program will be implemented and its potential to increase healthcare costs. This is a pretty rough couple of sentences (for both Direct Contracting and Medicare Advantage generally: “We are also concerned that the insurer DCE model creates additional risk for beneficiaries without adding any value. This model has less accountability than Medicare Advantage plans, which have been overpaid $143 billion between 2008 and 2020 according to MedPAC. The insurer DCE model offers a similar opportunity to maximize reimbursement through inflated Hierarchical Condition Category (HCC) codes.” Link.

• Minneapolis-based (!!!!) home health startup LifeSprk made an interesting move this week acquiring Tealwood, a group of 35 senior living communities in Minnesota and Wisconsin. LifeSprk will bring its in-home primary care model to residents of those communities, and presumably it will be able to get to global risk arrangements on those populations. This integration of housing + primary care is an interesting trend to watch. Link.

• GoodRx made another tuck-in acquisition, this time acquiring RxSaver for $50 million. Link.

• Decentralized clinical trial platform Science 37 is going public via SPAC. Link.

Funding:

• Diagnostic testing startup Cue Health raised $235 million. Currently, their main product is a rapid COVID-19 test that’s being used by groups like the NBA to perform COVID-19 testing. Link.

• Huma raised $130 million to build its remote monitoring platform while also serving as a decentralized clinical trial platform for life sciences. Link.

• Aetion, a data platform providing real world evidence for life sciences and payors, raised $110 million. Link.

• Hospital-at-home startup Medically Home raised $100 million from Mayo Clinic and Kaiser Permanente, hopefully serving as a sign that the hospital-at-home market is finally hitting the mainstream. This is one of those no-brainer concepts in healthcare to me that should have taken off years ago, but has struggled to do so because of misaligned financial incentives for providers. Link.

• DrFirst, a startup doing a confusing array of things that it calls “Uniting the Healthiverse”, raised $50 million. Link.

• Heartbeat Health, a virtual cardiology platform, raised $20 million. Link.

• Memora Health, a startup building a new operating system for care delivery orgs, $10.5 million. Link.

• Jasper, a cancer navigation startup, raised $6.75 million. Link.

Opinions:

• The Substack Healthcare Writers Guild is back in action with some good stuff:

  • Scott Alexander takes a look at the mental health digital therapeutics world, specifically looking at apps for sleep / the Pear Therapeutics Somryst app. He expresses some anger towards the current state of the industry and the fact that an app costs $899. Link.

  • Olivia Webb looks at how digital health can be used to help manage chronic conditions and specifically whether it can take on the mess that is dialysis. Link.

• This is an interesting interview with the CEO of Pair Team, a startup working on a tech platform for primary care clinics serving Medicaid populations. The stat that a typical provider at an FQHC is seeing 50 - 70 patients a day (7 minutes per visit) is crazy. Lots of interesting learnings in this one if you’re interested in primary care for Medicaid. Link.

• This Business Insider article (behind paywall) on Humana’s investment strategy in care delivery assets is a fascinating read. Link.

Data:

• KFF released data on insurance margins and it looks like 2020 was a pretty good year across the board for insurers relative to 2019. Curious if this is a trend or a one time bump due to COVID. Link.

• CMS released data on how individuals on Medicaid and CHIP used healthcare services during the pandemic. It includes a bunch of interesting data, including telehealth utilization, but this chart in particular caught my eye. Check out the decline in mental health services among children last year versus previous years - it was down 34% in October 2020 from the previous year. Link.