Weekly Health Tech Reads | 5/9/21

News:

• Walmart made some waves this week by acquiring a telehealth company called MeMD, which I am not ashamed to admit I had never heard of until I saw news of this acquisition. Interesting that they chose to go the buy route here after going the build route for the clinics in Walmart stores - makes me wonder what asset they think they had to acquire here. I’d have to imagine it’s primarily the clinicians MeMD employs, although I haven’t found a ton of detail on that. Either way, it appears Walmart is continuing down the path that Amazon and others are going down in providing virtual primary care services. Walmart, despite its recent internal struggles, seems particularly well-suited to succeed in this space given its breadth of physical locations across the country. But as the article notes, Walmart has been slower to move in this space than some of the other players including CVS and Walgreens. Will be interesting to watch whether Walmart attempts to attract more employers with this offering - I’d presume MeMD already has employer contracts for its services - or reorients the approach to focusing only on Walmart shoppers. Link.

• A handful of S-1 filings / updates caught my eye this week:

  • Flywire’s S-1 was made public this week after they confidentially filed. Flywire is a payments platform that serves a number of industries, including healthcare. They count 80 health systems as customers, including four of the top 10 hospitals in the US by size. Flywire acquired Simplee back in Feb 2020 for a price of $86 million, while Simplee drove $10.2 million of revenue in Q1 2021. Seems like a bargain for Flywire given everything that has unfolded since February last year. Most of the S-1 isn’t healthcare specific, but if you’re interested in the payments space generally it might be worth checking out. Link.

  • FIGS, a company that sells nice scrubs, filed its S-1 this week. It appears to have built a really impressive DTC business. I’ve linked to a tweetstorm here that does a great job going through some of the more impressive details of the business - revenue has exploded, they have grown revenue per customer and have solid customer retention, CAC has shrunk from $101 to $39 from 2018 to 2020, oh, and they’re profitable. Link (Tweetstorm). Link (S-1).

  • ShareCare filed an updated prospectus related to its SPAC. This MedCity article does a nice job covering some of the details. Anthem’s previously undisclosed investment in ShareCare is $50 million. ShareCare’s revenue has been declining each year since 2018, although they are projecting significant growth moving forward after rightsizing the business acquired via the Healthways Population Health division. There’s a lot going on with this company, and I personally remain in the wait-and-see camp on the growth they’re projecting over the next few years. Link.

• Accolade hosted its earnings call this week. The PlushCare acquisition was a topic of conversation, with Accolade’s CEO highlighting how PlushCare’s virtual primary care offering opens the door for a much deeper relationship with Accolade’s employer customers. PlushCare is currently doing $35 million a year of revenue, about the same size as Accolade’s other recent acquisition of 2nd.MD, and has an EBITDA margin close to negative 20%. Interesting to see the WSJ article on HR teams digital health fatigue (see below in Opinions section) brought up as a question in this earnings call, which of course plays nicely into Accolade’s strategy of being an employer’s partner in managing health benefits. Link.

• R1 RCM, a revenue cycle management company, acquired VisitPay, a patient payment platform, for $300 million. It’s wild to note the valuation difference between VisitPay and Cedar, two companies providing very similar offerings to health systems. Cedar of course in its recent massive funding round was valued at $3.2 billion. A 10x valuation difference between those two companies seems a bit much - but I suppose highlights the value of being the perceived best-in-class asset in this funding environment. Link.

• A private equity group acquired a majority interest in Icario, a member engagement platform for health plans. Icario is the entity created out of two Minneapolis (!!!) startups that merged recently, Revel and NovuHealth. Link.

• HHS shared that almost 1 million people have signed up for ACA health insurance via healthcare.gov during the recent Special Enrollment Period. That is significant growth for the exchanges, which have already been experiencing a resurgence of interest from the payor community recently. Seems like a safe bet to say we’ll continue to see that interest grow over the coming years. Link.

• Connect America has agreed to acquire the Aging and Caregiving business from Philips, which offers a PERS device and support model. Link.

• UHG is launching a new post-discharge home health program for group retiree MA members. The creatively titled Healthy at Home program offers food and transportation benefits, with UHG covering 2 meals a day for two weeks in addition to 12 rides for care. Link.

Funding:

• Collective Health, a health benefits management platform for self-insured employers, raised $280 million at a $1.5 billion valuation. Notably, the round was led by HCSC, the large Blues plan. Collective has partnered with HCSC to roll out Collective’s platform to HCSC’s customer base, with HCSC customers being able to opt into the Collective platform. It’ll be an interesting partnership to watch. You can imagine HCSC looking at Collective as an acquisition target assuming it goes well. Link.

• Vida, a virtual care platform for a number of conditions, raised $110 million to expand its virtual provider network and invest in its technology platform. Vida is seeing some interesting adoption across customer types as this article notes - in addition to employer customers, Centene has rolled out Vida across its ACA plans in 20 markets.

• Oura Health, makers of a fitness ring, raised $100 million. Oura, which has targeted the sleep market as its first use case, has now sold over 500,000 rings. Link.

• Florence raised $80 million for decentralized clinical trials. Link.

• Headway, a startup building a mental health provider network, raised $70 million. I’m really intrigued by the approach they’re taking to increase in-network access to more mental health professionals - providing free software to mental health professionals that helps them submit insurance claims (and then as I understand charging the insurers for the increased access). They’ve grown revenue 9x over the last year and now have 3,000 mental health professionals accepting insurance via the platform. Link.

• Groups, an opioid addiction treatment model, raised $60 million. They’re using the funding to expand from 12 states to 17 states and have grown membership 45% over the last year to ~8,000 members currently. Groups takes a hybrid in-person / virtual approach but it sounds like is heavily focused on scaling the virtual approach going forward. Link.

• Vim, a platform helping payers and providers work together to achieve success in value-based settings, raised $60 million. Walgreens and Anthem were among the lead investors in this round, which will make for interesting Board meetings moving forward as now Anthem and Optum have Board seats at Vim. Link.

• Vori Health, a new virtual-first clinical model for MSK, raised $45 million. Link.

• ZOE Health, a personal nutrition startup, raised $20 million. Link.

• Alife, a fertility startup, raised $9.5 million. Link.

• Little Otter raised $4.2 million in the pediatric mental health space. Link.

Opinions:

• Virta’s CEO shared a good article on the challenges of starting a health tech company - needing significant capital, long B2B sales cycles, etc. I particularly appreciated how Inkinen raised the point on ‘meritocracy vs relationships’ - noting that it’s often not the company with the best data or product that wins. Instead it has a lot to do with who is involved from an advisor, Board, and investor standpoint. With so many companies going after a finite set of ideas in digital health at the moment, these relationships are everything. Link.

• On a somewhat related topic, this article (behind the Wall Street Journal paywall) suggests that corporate HR teams are overwhelmed by the digital health startup onslaught. While this isn’t exactly a new sentiment for HR teams to express, it is a good reminder that as this space continues to grow hotter and hotter, it is going to increasingly become a challenge for many of the early stage startups raising money these days to get through to HR teams. And again, you can imagine the companies it’s going to work out well for are the ones that have well-connected advisors, Boards, and investors. For everyone else, at some point this party is going to come to an end. Of course, this is why everyone is now racing to be the ‘one-stop shop’ partner for HR teams. Link.

• This is a good article on Direct Contracting (behind the Business Insider paywall), highlighting why many of the Medicare Advantage primary care startups (Iora, Oak, etc) are excited about the program. Essentially, it creates an opportunity for significant revenue growth by opening up the Medicare FFS population to MA-like primary care economics. Analysts are estimating Oak Street could see a $90 million increase in annual revenue from the program. The article also does a good job highlighting the challenges these startups might have in managing expenses in the direct contracting model as CMMI is attempting to set a tougher benchmark to calculate savings off of. Link.

• This looks like an interesting read on primary care during COVID. While I can’t claim to have read all 300 pages of this report yet, it does look like it covers off on a number of interesting topics related to primary care. Link.

• This is a rather freaky Wired article about how a popular European mental health startup that ran the largest network of private mental health providers in Finland had its data hacked and people were finding their personal stories posted online. Link.

Data:

• Here’s an interesting survey on consumer preferences for in-person versus virtual care as we hopefully return to some normalcy post COVID vaccine rollout. In person care remains the preferred option of most consumers, although 40% of people said they’d switch to a doctor who also offers virtual visits. I’m a bit surprised to see this chart below with the “combination of in-person and virtual” option so low. When you’re picking between in person, virtual, or both - why not pick both? Link.

• The CareJourney team shared an analysis on the characteristics of organizations that perform well in MSSP. This chart below highlights how, perhaps not surprisingly, the best performing ACOs have: 1. been in MSSP the longest; 2. are generally Low Revenue (which I think generally means there aren’t hospitals in the ACO); and 3. are moving more towards two-sided risk. Link.

• This Health Affairs study looks at the effects of provider consolidation by examining whether hospital ownership of physician practices impacts diagnostic imaging and labs. Both categories had increases in hospital settings - bigger than the decreases in non-hospital settings - after vertical integration, of course with the result being increased spending. Link.

• Speaking of provider consolidation, 2020 marked the first year that less than half of physicians worked in private practice, according to this AMA survey. Link.