Ami Parekh is the Chief Health Officer of Included Health. It provides navigation services & expert medical opinions (the original Grand Rounds) and virtual care (the old Doctors on Demand) and it then bought a smaller company called Included Health. Ami explains why navigation exists (clue: health plans have been terrible at it) and how it works, and what money it saves on trend (about 2%). They’re also reaching out asking about people’s “Healthy days” and are tracking that metric, and giving people more healthy days–Matthew Holt
THCB Quickbite: Julian Flannery, CEO, Summus
Julian Flannery is CEO of Summus, which I can’t pronounce (it’s Sue-mus like lawsuit not Sum-mus like math, despite the 2 Ms!). It’s a multidimensional referral platform which combines primary and specialty virtual care for employers, a white-label service for hospitals to deliver their specialty care, and now a peer-to-peer escalation model for specialists to talk to AMC-based specialists & get 2nd opinion reviews. Around 1.4m members on the platform and it’s seen massive usage growth in last 12 months–Matthew Holt
Virtual Care Regulatory Round-Up: Ro’s Z Reitano & Virtual-First’s Power to Control the Care Journey
by JESSICA DAMASSA, WTF Health
“What happens when there is a massive shift of where the beginning of a journey occurs…that sort of affords the opportunity for everyone after that to be disintermediated.” So says Zachariah “Z” Reitano, co-founder & CEO of Ro, arguably one of the most successful OG virtual-first care companies which has been providing telehealth-plus-testing-plus-pharmacy-delivery (and now a whole lot more) via its Roman and Rory brands since 2017.
As health tech companies – and now, more and more incumbent orgs and retail health providers – evolve their own “omnichannel” strategies, we talk to Z about Ro’s direct-to-patient care model, and what we can learn from its successful operation and expansion as one of the first “digitally native” healthcare providers.
To Z, the technology is just an enabler to a larger shift in how people are ultimately gaining more control over their health. Technology can turn luxuries into commodities, he says, and, at Ro, that’s translating into a concept they’re calling “goal-oriented healthcare,” which is basically providing the “luxury” of giving a patient what they want, when they want it; easily, conveniently, and affordably.
In short, Z explains: “Patients come to us, and they say what they want to achieve: ‘I want to lose weight…I want to have a child…I want to improve my mental health…I want to improve my skin…I want to have better sex.’ And then, we help them from beginning to end in the most convenient and effective way possible.”
The role of digital in all this is critical. It allows for costs to be stripped out, for providers to be able to practice at the top of their licenses, and for data to be shared between provider and patient asynchronously (aka conveniently.) But, it sounds like what’s most exciting about ‘virtual-first’ to Z is the “first” part – having the opportunity to initialize the relationship with the patient, then “raise the standard of where we guide people afterwards, and have the opportunity to disintermediate and really heavily influence the entire patient journey.”
Oooohh – can’t hear enough about this! Tune in to find out more about how Z sees virtual-first care as changing patients’ relationships with the healthcare system AND, because we had to talk a little policy too, get his thinking on how barriers like state licensure that are often looked at as constraints to ‘virtual care at-scale’ might also be evolving to help enable that shift.
* Special thanks to our series sponsor, Wheel – the health tech company powering the virtual care industry. Wheel provides companies with everything they need to launch and scale virtual care services — including the regulatory infrastructure to deliver high quality and compliant care. Learn more at www.wheel.com.
BREAKING: Thirty Madison and Nurx Merge, CEO Steve Gutentag Takes Us Inside
By JESSICA DaMASSA, WTF HEALTH
Thirty Madison and Nurx are merging and here’s what Steve Gutentag, CEO of Thirty Madison and the soon-to-be-combined entity, is saying about the deal!
This is a merger of two well-funded, direct-to-consumer, virtual-care-plus-pharmacy startups that deliver specialty and expert care and prescription drugs to a combined 750,000 active patients, with or without insurance. To-date, Nurx has raised a total $110 million, and Thirty Madison closed a Series C in June 2021 that brought their total funding to $210 million with a then-valuation of over $1 billion.
Thirty Madison currently deals with migraines, allergies, GI issues, and men’s hair loss, while Nurx (once referred to as “the Uber of birth control”) brings a predominantly women’s health-focused portfolio of chronic condition care focusing on sexual health, contraception, STIs, and dermatology.
So, what makes sense about this combination? And, what’s the big-picture plan for differentiation against rivals like Hims&Hers or Ro’s Rory or Roman brands – OR, the myriad virtual-first primary care clinics that have popped up in-person and online and offer more traditional routes to care for these same such conditions?
Steve talks extensively about the chronic care focus of both businesses, how each is providing access to specialists and experts patients wouldn’t otherwise be able to see, and how both companies’ tech platforms are built to scale along with the addition of new conditions. Still…why bring together care for this assortment of conditions instead of, say, either Thirty Madison or Nurx looking to find a merger partner who could expand their platform into high-demand chronic care areas like diabetes management, heart health, or mental health care? Is that what’s next, after the paperwork on this merger is signed? Tune in for more on Steve’s plans for the future of the NEW Thirty Madison and how “longitudinal care models” factor into its strategy to win over more patients AND their employers and payers.
Interview & Deep Dive into Summus Global
Summus Global is company with a very interesting model that gives a glimpse about the future of virtual care. It delivers online specialty care and much more to employers. You might think that means it is in the second opinion space, or in the care navigation space. And you’d be right, but not completely right. Julian Flannery the CEO tells me that it’s much more than that and has greater ambitions too. I took really deep dive into Summus with conversation with Julian and a thorough demo of the service from Dennis Purcell the COO–Matthew Holt
Maximizing the Long Term Value of Virtual Care
By JON BLOOM
The rate of adoption for virtual care and remote monitoring solutions has skyrocketed over the last year as access to in-person appointments has been limited, but despite the uptick, we’re still drastically underutilizing their potential. These solutions often focus on treating a singular episode or chronic condition, when in fact they can open the door to more wide-ranging proactive monitoring and care that can have huge benefits in the long term.
By simply offering a touchpoint for patients to interact with the health care system through solutions like remote monitoring, providers can detect and address all sorts of problems before they escalate and require more intense, expensive interventions, even if the problem isn’t related to the primary purpose of the solution.
The downstream effects of these solutions are significant, both in terms of reducing the financial strain by eliminating unnecessary ER visits and hospitalizations, and in the long-term patient outcomes that are improved by catching problems early.
For example, a study from October we conducted with the Mid Atlantic Permanente Group found that one prevention program for patients at risk of diabetic foot complications also saw reductions in all-cause hospitalizations by 52 percent and emergency department visits by 41 percent. Despite the fact that the subject solution was originally designed specifically to help prevent diabetic foot complications, the touchpoint was able to have a profound impact on overall health and total cost of care.
This follows previous research on other condition-specific remote patient monitoring solutions that showed similar reductions in all-cause hospitalizations and mortality, further supporting the idea that these solutions can have broader impacts than just helping treat the condition they’re designed for.
These findings are especially significant considering many of these solutions, like the one studied in the October research, are often deployed to underserved populations who tend to be less likely to schedule care on their own, whether that be for a well visit or because they’ve noticed a change in their health. By putting devices in their homes and removing the burden of seeking care, we can move toward a future in which patients are able to get the care they need even if they don’t know they need it or don’t know how to get it.
Continue reading…Telehealth Reality Check: Who’s Really Going to “Win” the Race to Virtual Care Market Leadership?
By JESSICA DaMASSA, WTF HEALTH
It’s the telehealth market reality check you’ve been waiting for! “Rogue” digital health consultant Dr. Lyle Berkowitz unpacks the numbers and the market potential for virtual care from the unique vantage point of a primary-care-physician-turned-health-tech-entrepreneur with nothing to lose. Having been 1) a clinician, 2) the Director of Innovation at Northwestern Medicine, 3) the founder of a health tech startup (Health Finch) that successfully exited to Health Catalyst, and 4) the former Chief Medical Officer at one of telemedicine’s biggest players, MDLive, few can boast such a wide-reaching, deep understanding of the inner workings of both the innovation and incumbent sides of the virtual care market — AND have a willingness to talk about it all with complete candor!
This is an analyst’s perspective on the telehealth market — with a twist of insider expertise — so expect to hear some good rationale behind predictions about how much care will remain virtual once hospitals and doctor’s offices return to normal, how “real” health system enthusiasm is for building out telehealth capacity to execute on the “digital front door” idea, and whether or not all these well-funded telehealth startups will have what it takes to win market share from traditional care providers.
BONUS on Primary Care: Is this the area of medicine that’s going to be the “battleground” where digital health and virtual care companies will be going head-to-head with incumbents for market share? Lyle says 50-plus percent of primary care “can and should be automated, delegated, virtualized, etc.” and boldly predicts that in 10-20 years we won’t even have primary care physicians anymore. Tune in to find out why starting at the 8:00 minute mark, where we shout out Crossover Health, Oak Street Health, Iora Health, and more.
Telehealth die-hards, don’t think for a second I’d miss this chance to also get some input on Teladoc-Livongo, Amwell, Doctor On Demand, SOC Telemed, the impending IPOs there, digital first health plans, virtual primary care, health systems (who Lyle hopes “don’t shoot themselves in the foot” with their opportunity to jump into the space) and, ultimately, who’s really going to ”WIN” in virtual care moving forward. For this, jump in at 17:00 minutes and hold on!
Quality Virtual Care Is Within Reach – But Only If We Act Now
By JULIA HU
Though it will be impossible to overstate the devastation that the COVID-19 pandemic is leaving in its wake, we can also acknowledge that it has pushed humanity to creatively adapt to our new, socially-distanced reality—necessity is the mother of invention, as they say. Telehealth is not a new invention, but the necessity of keeping people physically apart, especially those particularly vulnerable to COVID, has suddenly put virtual health care at the center of our delivery system.
Patients and providers quickly pivoted to at-home care as in-person visits were limited for safety, and use of telehealth spiked early in the outbreak. One survey of over 500,000 clinicians showed that by April—only about two weeks after the first stay-at-home orders were issued in the U.S.—14 percent of their usual number of pre-pandemic visits were being conducted via telemedicine. For many, that involved using unfamiliar technology and a big shift in procedures for providers. Congress recognized the need to support providers through this transition and allocated $500 million for waiving restrictions on Medicare telehealth coverage as part of the emergency funding bill that passed in March.
But, as restrictions have begun to lift and hospitals and medical offices are beginning to reopen for non-emergent care, we have seen the use of telemedicine start to taper off. The same 500,000 clinicians were surveyed in June, revealing that telemedicine was used for only 8 percent of the usual pre-pandemic number of visits. Providing quality, virtual health care won’t be as easy as flipping a switch, but we currently have an unprecedented opportunity to carry forward the best version of virtual care and create a more holistic health care system. As we work toward that goal, there are three components our virtual care system needs in order to be sustainable, feasible, and manageable for both patients and providers.
Continue reading…Telehealth’s Missing Link: In the Rush to Implement Virtual Care, What Did CMS Leave Out?
By RAY COSTANTINI, MD
Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues.
This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed.
I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care.
Continue reading…Health in 2 Point 00, Episode 131 | Tele-everything! Oscar, Evidation, Lululemon, Calibrate, & more
Today on Health in 2 Point 00, Jess and I talk about Oscar raising $225 million, Evidation Health raising $45 million doing digital clinical trials, Lululemon buying fitness startup Mirror for $500 million, Calibrate raising a $5.1 million seed round bringing telehealth to weight loss and metabolic health, at-home urine analysis startup Healthy.io buying Inui Health for $9 million, and Airvet raising $14 million for veterinary telemedicine. —Matthew Holt
