Weekly Health Tech Reads | 6/16/24

Other Headlines

• The Justice Department and FTC filed an amended complaint against former Cerebral executives, alleging that Cerebral and its former executives violated the FTC Act, the Opioid Act, and the Restore Online Shoppers’ Confidence Act (ROSCA). Cerebral has already settled the claim, but the Justice Department will continue pursuing Cerebral’s former CEO, Kyle Robertson, and his more recent telehealth company.

• Two executives from ADHD startup Done were arrested and charged with fraud. The case argues Done made $100+ million in revenue by targeting drug seekers with deceptive social media ads.

• CMMI came under fire on the hill this week as Elizabeth Fowler, the Director of CMMI, was questioned by the House Energy and Commerce subcommittee. HealthcareDive did a nice job summarizing the various lines of probing from congresspeople here. Fowler’s written testimony discusses a number of programs CMMI is currently prioritizing.

• CalPERS approved two new plan contracts with Blue Shield of California and Included Health. Blue Shield of California and Included will serve ~400,000 CalPERS members, all individuals in self-insured CalPERS PPO plans. The other 1.1 million CalPERS members are covered through other fully insured HMOs. Blue and Included are putting $464 million at risk based on medical cost trends and quality — initially targeting a 5.5% trend in 2025 that is lowered annually until it hits 3% in 2029. Blue and Included will replace Anthem Blue Cross, which has managed the PPO book for CalPERS for over two decades.

• CityMD will pay $12 million to settle allegations that it fraudulently billed the government for COVID-19 testing services by submitting false claims showing that people were uninsured when CityMD knew those people had insurance.

• Telemental health provider Brightside Health entered the virtual substance use disorder treatment space this week, acquiring Lionbird Recovery.

• Tempus AI successfully raised $410 million in its IPO offering, pricing at the top end of the range, valuing the business at $6.1 billion.

• Asset managers at JP Morgan have launched a $500 million fund to

Funding Announcements

• Anterior, an AI-based automation platform for clinicians, raised $20 million.

• Better Health, a platform for medical supplies, raised $14 million.

• Canary Speech, a vocal biomarker technology, raised $13 million.

• Grayce, a caregiver support platform, raised $10.4 million.

• Auxilius, a startup that helps biotech companies manage clinical trial finances, raised $10 million.

• Koda Health raised seed funding for advanced care planning.

Good Reads from the Community

Value-based care in nephrology by a Humana team
Humana shared a report on their efforts in the VBC nephrology market, including work with Evergreen Nephrology, Interwell, Monogram Health and Strive Health. It provides a good overview of how and why Humana is attempting to move the specialty care market to VBC, but stops short of sharing much Humana data on results thus far. Read more.

The Role of Design in US Health Systems by a Equitable Healthcare Lab team at the Institute of Design at Illinois Tech
This is an excellent report if you’re interested in how health systems structure design and innovation teams. It surveys 27 big-name health systems and shares many learnings and lessons from how these teams have been built. Read more.

Telehealth Demand: An Update Four Years After the Onset of the COVID-19 Pandemic by Sanjula Jain
A helpful look at the latest telehealth claims data, showing that telehealth visits continue on a downward trajectory. In Q3 2023 there were ~27 million telehealth visits, down from ~60 million in Q2 2020. It’s still a significant increase from pre-pandemic — in Q4 2019 there was ~1 million telelehatlh visits. Read more.

Overcoming Our Misplaced Nostalgia For Traditional Medicare by Sachin Jain
Jain, SCAN Health Plan’s CEO, shared a perspective advocating for a “major reboot” of the Medicare program. His suggestions include: doing away with fee-for-service, eliminating annual enrollment cycles, changing the benefit design process, and reducing utilization management. It’ll be interesting to see how the conversation about Medicare unfolds in this political cycle. Read more.

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