Weekly Health Tech Reads | 8/20/23

Epic launches a new program, BSBC drops CVS, AdventHealth lawsuits, and more!

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Amanda DiTrolio & Kevin O'Leary
August 20, 2023

Welcome to this week’s free weekly newsletter, where we share our perspectives on some of the key healthcare related news of the week.

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NEWS OF THE WEEK

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Sharing the news, opinions, and data that caught our attention this week

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Blue Cross Blue Shield of California announced it will be dropping CVS Caremark as its PBM and will replace it with a collection of alternative partners, including Amazon pharmacy, Mark Cuban's Cost Plus Drugs Company, and Abarca. The insurer shared that the program is on track to launch next year and projects it will generate $500 million in annual savings.
​Link / Slack

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Epic is launching a "Partners and Pals" program designed to collaborate with third parties. The initial partners are Nuance and Press Gainey, and Abridge is the initial "pal", which is specifically targeting relationships with early stage startups. There's some interesting back and forth in the Slack about what exactly it means to be a "pal" of Epic.
​Link / Slack (h/t Samir Unni)

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A Propublica report detailed how CMS seems to have been influenced by a former-staffer-turned-lobbyist to introduce a fee for providers to use electronic payments, which has turned into a very nice business for payment processors. Not a great look for CMS.
​Link / Slack (h/t Khang Vuong)

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Definitive Healthcare announced it will acquire provider analytics startup, Populi for $52 million in cash.
​Link

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Virtual cardiology startup, Heartbeat Health has partnered with MedArrive to bring in-home cardiology services to Medicaid members.
​Link

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CMS recently announced several changes to the ACO Reach program aimed at improving health equity and increasing participation. Adjustments include reducing the beneficiary alignment minimum, expanding bid criteria to incorporate more beneficiaries, adding variables to address low income and state based deprivation status. You can check out the full list of changes below.
​Link​

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MOBE and Override announced a partnership to launch a Shared Savings Program for chronic care management. The partnership will leverage MOBE’s Health Guide, pharmacist, and data science capabilities in combination with the “Override Pain Protocol” to provide neuroscience-based pain education, holistic support, medication management, and coaching.
​Link / Slack (h/t Kevin Wang)

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Verily and OneOncology are partnering to advance clinical trials in the oncology space. OneOncology plans to implement Verily's clinical trial management software platform, SignalPath, across its network of independent oncology practices.
​Link / Slack (h/t Chase Jones)

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Lindus Health raised $18 million in Series A financing to build out its next generation clinical research org. To date, the company has delivered 80+ clinical trials across various conditions, such as depression, diabetes, and insomnia.
​Link / Slack​

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Minneapolis-based (whee!!!!!) women's health startup, Visana, secured $10 million in seed funding. The company provides care for a range of conditions - including menopause, endometriosis, fibroids, PCOS, contraception, and UTIs - and is available in all 50 states.
​Link / Slack

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OHSU and Legacy Health announced they will be merging to create one integrated health system. Together, the combined system would account for 32,000+ employees, 100-plus locations, including 10 hospitals, and more than 3 million patient visits a year.
​Link / Slack (h/t Brendan Keeler)

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CHART(S) OF THE WEEK

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Sharing a visual or two from the week that made us think

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​AdventHealth filed a lawsuit last week alleging that Multiplan is leading a "cartel" of insurers who are all colluding to reduce out of network prices. The chart above is presented as evidence in the case - as you can see Multiplan has a product that is standardizing OON payments at a lower rate than providers like Advent are seeking, apparently capping those rates at 350% of Medicare. Advent presents this data as proof of collusion amongst the largest insurers in the country, who all use Multiplan's product to negotiate OON prices. The lawsuit provides some fascinating insight into the battle of political wills between two large healthcare institutions, with each ultimately trying to control a $19 billion profit pool in the form of OON payments. Here's maybe a bold suggestion: what if neither payors nor providers should capture that profit pool?

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WRITERS GUILD

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A round-up of posts from the HTN community that made us think

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This thesis provides an optimistic perspective on Software-First Care, a view that seems more rare these days given the big time public flameouts we've seen of similar models. It's an interesting look into this category of tech that aims to provide a first level of care without human intervention, including things like triaging, diagnostics, patient education, ongoing management and more.

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This is a nice deep dive into how to think about integrating bundles into ACOs, specifically diving into cost / quality metrics around hip replacements.

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As a continuation of a multi-part series digging into the intersection of AI and ADHD, Adi looks at the risks of using AI to help people with ADHD - covering topics such as diversity, social risk, and more.

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In what is likely the oldest article we've linked to in this newsletter, Matthew reposted an article he wrote from 20 years ago critiquing McKinsey's suggestion for health system strategic adjustments. It's amazing how applicable the article still feels today.

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A look at startups addressing the home and ambulatory infusion market and some of the broader market dynamics at play.

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A very deep nerdy dive on how LLMs can potentially be used to help clinicians manage messages in their inbox. Seems like there's some potential to help, but also some challenges, particularly around understanding context.

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