Weekly Health Tech Reads 6/14/20

News:

• Andreessen led / co-led two rounds announced this week as Julie Yoo continues her tear over the last several months investing in interesting health tech companies:

  • Patient Ping, which has built a platform that uses Admissions, Discharge, and Transfer (ADT) data to help care delivery organizations coordinate care, raised $60 million. The article notes that CMS is making use of these ADT feeds an interoperability requirement shortly, which provides some regulatory tailwinds that I’m guessing Patient Ping is riding to drive growth. Link.

  • Alpha Health raised $20 million to help providers automate their revenue cycle management platform. It of course sounds cool and all, but I’m a little confused so to what they’re actually doing here. Andreessen’s article makes the approaches that other robotic process automation companies are taking sound simplistic in that they’re just automating human processes, rather than coming up with better ones like Alpha is doing. That may very well be the case, but I’m not so sure health systems are going to appreciate the nuance. The challenges in rev cycle management in a health system don’t seem like an overly complicated technology challenge. Then again the folks involved in this one all seem a lot smarter than I so I’m probably wrong on that. Link.

• Kyruus raises $30 million to grow its platform that does provider search, scheduling, and a bunch of other things for providers. As health systems start taking digital more seriously coming out of COVID-19, Kyruus strikes me as particularly well positioned to win a bunch of new business. It’s not hard to envision a scenario where they make a few acquisitions to extend their capabilities and be the Health Catalyst-esqe partner for health system’s ‘digital front door’ needs. Link.

• RapidSOS, a tech platform for 4,700 public safety agencies for 911 responses, raised $21 million. It’s a really interesting company to me that has a lot of potential runway in the healthcare space. As part of this raise they, along with the American Diabetes Association and American Heart Association, are launching an Emergency Health Profile, which promises to give first responders more information about the overall health of an individual. Note also the example they give about RapidSOS about the story of an Apple Watch identifying a man having a heart attack and notifying 911 - Rapid Response was the app that actually did the 911 call, as it is integrates with Apple Watches. A really cool, relatively under the radar company. Link.

• Amazon is rolling out a COVID-19 testing plan for its employees, aiming to test most of it’s employees every two weeks. Grand Rounds seems well positioned in this approach by Amazon, as they’re serving as the telehealth partner to do medical consults for any employees showing symptoms. It strikes me that we’re in a really interesting moment for employers and their involvement in health care delivery. In order to safely reopen, employers all of a sudden are leading the way in terms of temperature screening, testing, and connecting employees with doctors if they’re not feeling well. It’s not hard to envision a scenario where a few years from now where this is commonplace, and that the services offered are significantly broader than just COVID-19 treatment. If I’m an employer-focused digital health company I’m thinking really hard about how to get myself prominently positioned in that workflow (i.e. Grand Rounds with Amazon). Link.

• Insurers are coming out with 2020 earnings guidance and it looks like they’re not going to be hurting financially this year:

  • Anthem issued an 8-K this week, reaffirmed their financial guidance for 2020. They expect 70% of their earnings this year to come in the first half of the year. Link.

  • Centene increased its earnings guidance for the year based on membership and medical utilization trends. Link.

• Medtronic has taken a $337 million investment from Blackstone to advance diabetes products. Curious to see Medtronic decide not to fund this work internally but rather seek outside funding from a PE group. Medtronic spends over $2 billion a year on research and development expenses, so it’s not like it can’t afford to fund it internally. Link.

• Headspace, the meditation app, adds another $48 million in funding. Link.

• CareAcademy, a platform for training home health workers, raised $9.5 million. Link.

Opinions:

• Another week goes by which means another scathing review of PE-backed care delivery models. This time, ProPublica used recent court filings to look behind the curtain at TeamHealth, an emergency department staffing firm owned by Blackstone, which is right in the middle of the surprise billing controversy in this country. The article does a really good job highlighting some of the issues at play, including how physicians employed by TeamHealth aren’t the ones profiting from the surprise billing practices, rather it seems that Blackstone is taking home the extra profit. Looking at some of the depositions and quotes about where profits are going, you can’t help but wonder if there’s going to be many more conversations like this ahead as PE / VC groups continue to pour money into new care delivery model companies and will naturally want to see ROI on those investments. Link.

  • For an example of a market that’s been struggling with billing practices even more than emergency department staffing, check out the air ambulance space. This article highlights how 75% of patients transported by air ambulances with commercial insurance didn’t have coverage for the air ambulance. 40% of patients are being balance billed close to $20k on average. Woof. Link.

• Here are three solid podcasts from this week:

  • Chas Rhoades of Gist Healthcare was interviewed on Healthcare is Hard providing some really solid insights on what normal looks like for health systems in a post-COVID-19 world. There’s some particularly good dialogue in here around the nature of not-for-profit system Boards and the challenges that Boards have in terms of oversight and decision making in these quickly changing times. Link.

  • Jay Parkinson, formerly founder of Sherpaa and currently at Crossover Health, was interviewed on The Exam Room. Minute twelve is where it starts to get into some really meaty topics around the nature of telehealth and primary care. Jay is one of the best thinkers on digital primary care models, and provides for some really interesting food for thought here, particularly around the notion of health care delivery as a project management concept and the questions he raises around whether problems in healthcare are technology problems or incentive problems. Link.

  • Andreessen Horowitz, which hasn’t been busy investing in startups or anything recently, released a podcast on the future of primary care featuring Julie Yoo and a few others. Link.

• This is a good read on how capitated primary care models have been performing better in era of COVID-19 than FFS primary care practices, as they get paid a monthly “subscription” fee that is not dependent on patients showing up in the office for in-person visits. So, whereas FFS practices have been furloughing employees and such, capitated approaches haven’t had a financial hit and have been able to focus on providing their patients the care they need in whatever setting is appropriate. Link.

• Here are a few pieces on telehealth from the week:

  • Seema Verma was interviewed saying she thinks that increased telehealth use is here to stay. Although interestingly, she did say that the government needs to evaluate whether virtual visits continue to be paid for at the same rate as in person visits, and she does not think that it should be paid for at the same rate as in person care. It’s going to be interesting to watch how this is paid for going forward. Link.

  • Here’s an interview with AmWell co-CEOs on the future of telehealth. Obviously they’re excited by growth in the space - AmWell’s daily visits went up from 5k per day to 45k per day as a result of COVID-19. Link.

  • Chrissy Farr wrote a piece on health system finances, looking at how digital isn’t making up for the loss of in person visits. An interesting data point: Ochsner Health in Louisiana saw 120,000 virtual visits in May after seeing only 3,000 in all of 2019. Link.

• AVIA published a nice look at what a ‘contactless’ patient journey might look like as care delivery organizations start to bring back patients. Link.

• Here’s a good, very in depth, read on Livongo’s business. Link.

Data:

• Here’s a look at the impact of potentially expanding Medicaid in the 15 states that haven’t already done so, estimating that 3.9 million Americans would gain insurance via Medicaid. This analysis was based on pre-COVID-19 data, so presumably those numbers would increase. Link.