Weekly Health Tech Reads | 5/30/21

News:

• Doximity filed its S-1 this week. This seems like a relatively under-the-radar yet very nice business based on the S-1. Doximity counts 1.8 million medical professionals as members of its platform, including more than 80% of physicians in all 50 states, as well as over 50% of NPs and PAs, and 90% of graduating medical school students. It seems as though Doximity has built an incredibly powerful community of clinicians and is now able to leverage that for launching new products into the community. For proof look no further than its recent launch of video visits during the pandemic. Last quarter, Doximity had over 300,000 providers actively using its video visit platform, and it did over 63 million visits in FY2021. And on top of that, in a shocking development for digital health company IPOs these days, Doximity has been generating meaningful net income the past two years!! $29.7 million in FY2020 and $50.2 million in FY2021. Seems like they’ve built a really solid business here. A few more notes below. Link.

  • Doximity has seen significant growth over the last few years after launching a decade ago in 2011. It hit $200+ million in revenue in FY2021 after doing $116 million in FY2020. It has gross margins around 85%, and managed to grow its EBITDA margin from 23% in FY2020 to 31% in FY2021. Whew.

  • Doximity’s revenue primarily comes from subscriptions paid by health systems, pharma, and medical recruiting firms for marketing, hiring, and now telehealth solutions. 93% of revenue in FY2021 was from these subscriptions. Doximity has 600 subscription customers, with 200 paying over $100k per year, and 29 paying over $1 million per year. The number of subscribers paying over $100k per year has increased from 113 in FY2019, to 141 in FY2020, to 200 in FY2021. Their revenue retention rates have been over 130% each of the past three years, so it seems like they have some very sticky relationships with health systems and pharma. The value prop seems pretty clear - what pharma company wouldn’t want to market to 80% of docs in this country?? Although I’m still not sure as consumers of healthcare that is the best thing for all of us, but what can you do.

  • As mentioned above, Doximity launched its telehealth service for free to health systems in Q1 FY2021 (their fiscal year ends in March so this would correspond to Apr - Jun 2020). The most impressive part of this launch? Doximity still managed to be EBITDA positive that quarter, generating an 11% EBITDA margin during that quarter. It’s wild to me that they can launch a new telehealth product - for free - and still remain EBITDA positive when looking at how much other telehealth platforms are losing. Points to the power of the network Doximity has built over the last decade.

• Optum announced a strategic partnership with Bassett Healthcare Network, a system with 6 hospitals in upstate New York, to provide Bassett with outsourced rev cycle management, analytics, and IT capabilities. Bassett will transition 500 employees to Optum as part of the deal. Optum has been quiet on these partnerships since the John Muir relationship was announced back in mid-2019. Obviously COVID likely made 2020 a challenging year to ink these sorts of deals with health systems, but it will be curious to see if the pace picks up here at all in 2021. Link.

• The National Association of ACOs sent CMS a letter late last week expressing it’s disappointment at CMS’s decision not to extend the NextGen ACO model beyond the end of 2021. Like most things in healthcare, the cost savings associated with the NextGen model appears to be questionable, as the MedCity report highlights. ACOs of course claim it saves costs, but an independent analysis claims it does not save costs. It is interesting to think about this move in the context of CMS pausing Direct Contracting as well - two data points of course don’t make a trend, but it sure starts to feel like CMS is looking at the number of programs it has out there and how to chart one more unified path forward. Will be worth watching from here. Link (NAACO letter). Link (MedCity report).

• Grand Rounds / Doctor On Demand is purchasing LGBTQ+ telehealth startup Included Health. It seems like the rate of acquisitions is picking up in this space as the employer platform plays (Grand Rounds, Teladoc, Accolade, etc) seek to round out their offerings by gobbling up point solutions in specific niches where their offerings are lacking today. Link.

• Truepill is adding two product lines to its white labeled platform for digital health: virtual primary care and in-home diagnostic testing. They’re selling the virtual primary care offering to employers and payers, which seems to indicate it is moving away from its roots supporting direct-to-consumer digital health companies and instead competing to meet the needs of payors and employers. I’m sure they’re seeing a lot of demand from those groups Link.

• HCA and Google announced they’re partnering to leverage HCA’s data and Google’s tech to build algorithms to support clinicians with decision support tools. Sounds cool and big names obviously but I’ll be more excited about this when they share something a bit more tangible about what this actually is. Link.

Funding:

• Noom raised $540 million to transform its digital product beyond its current offering targeting weight loss into a platform addressing a number of common digital health target areas - diabetes, mental health, and hypertension, among others. I’d have to assume they’ll start looking at rolling up some of the point solutions in these various spaces with this funding, in addition to going after the employer market as they mention in the press release. Link.

• Akili Interactive, a digital therapeutic company that has received FDA clearance for a few of its video game medicines for things like ADHD, raised $160 million. Link.

• AI-chatbot startup Ada Health raised $90 million. Link.

• Digital cardiology startup Hello Heart $45 million. Link.

• Clearing, a new virtual platform helping chronic pain patients, raised $20 million. Link.

• Digital pharmacy Pack4U raised $20 million. Link.

• Curebase, a startup working on decentralized clinical trials, raised $15 million. Link.

• Flume raised $10 million to build a modern TPA. Link.

• AcuityMD raised $7 million to build a data platform for medical devices. Link.

Opinions:

• The Weekly Gist included a really interesting anecdote from a health system exec looking to standardize the telehealth experience among primary care docs in their health system. Of course as health systems have learned over the years, it is really challenging to standardize basic things like appointment scheduling across various providers that have been acquired over time. As the health system exec notes, this is driven in part by financial incentives - some PCPs in their health system are making $700k versus the average of $250k, because they are more “entrepreneurial”. I’m quite interested to see how the digital-first players deal with these sorts of issues as they go down the path of provider acquisitions. It’s a tough nut to crack because at the end of the day so much of it just comes down to $$$. Link.

• Bloomberg wrote a good piece on investor excitement around digital health. This chart below showing the rising number of digital health companies raising multiple rounds of funding in a year is striking to me. I wonder how we’re going to look back on this period five years from now - if nothing else it strikes me as an incredibly inefficient market at the moment when you have so many companies raising multiple rounds of funding in a year at wildly higher valuations (presumably). Is the intrinsic value of these companies really changing that much in such a short period of time? I doubt it. Link.

• Here’s an article on mental health innovation, with six execs in different parts of the ecosystem providing their perspective on whats happening in the space. It provides an interesting lens into what different types of organizations - payors, providers, etc - are seeing and doing in the space. Link.

• Behind the Business Insider paywall, this a good piece on the rise of physician enablement companies, focusing on Privia and Agilon. Both of those companies recently went public and have been well received by Wall Street thus far. Analysts are betting that independent primary care groups need these models to help them perform well in value-based care contracts that are too complicated to manage on their own. Link.

• Behind the Modern Healthcare paywall, this is a quite interesting read on the impact COVID-19 may have on payor / provider negotiations. It provides some interesting insight into how these negotiations happen, both privately and publicly - with the example of the Greater New York Hospital Association taking out full page ads in multiple newspapers arguing that insurance companies are bullying hospitals. Andddd around and around we go. Link.

Data:

• For those of you who read the Bright article last time and were curious whether other readers were bullish or bearish on Bright - here are the results. 61% of folks who responded were bullish vs 39% of folks who were bearish. We included some of the more interesting responses in the tweets below:

• NORC released some interesting survey data suggesting consumers have lost trust in the healthcare system during the pandemic, but not their individual providers. The age breakdown in particular caught my attention - only 59% of people aged 18-19 trust their primary doctor, versus 90% of people 60+. I’m not sure what exactly to take away from that, but either way it seems to indicate that the disruption happening in healthcare isn’t going away for some time. Link.

• Here’s some interesting data from Trilliant highlighting who is using telehealth services pre / during / post pandemic. Link.