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Category: WTF Health

The Medicaid Plan of the Future: Sean Lane on Building Circulo on Top of Olive’s AI Platform

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By JESSICA DaMASSA, WTF HEALTH

What’s better than being the CEO of one blazing-hot disruptive health tech company that’s raised $450M to build “the internet of healthcare”? How about becoming the CEO of a second company – a new managed Medicaid health plan company – that’s to be built on top of your first company’s machine learning platform, which is chock-full of hospital data and learning how to automate healthcare admin expertise? So is the fate of Sean Lane, CEO of Olive and now, also CEO of Circulo.

What does a built-from-scratch, tech-first Medicaid plan look like? Sean talks through the strategy behind the new health insurance co, which is aiming to use Olive’s tech to automate every aspect of the way a payer functions in effort to 1) strip away health plan admin costs and 2) create a never-before-seen relationship between patient, payer, and provider. On this latter point, it’s the fresh approach to payer-provider relations that seems to really have Sean excited. With Olive already built into hundreds of health systems, and conveniently located on the desktops of those providers, Sean says Circulo will be poised to take advantage of that network’s data and distribution to forever alter the healthcare payment model. Submitting claims goes away. Denials go away. Costs drop. Care improves.

Backed by a fresh $50M from Olive’s investors (Drive Capital and General Catalyst led Circulo’s Series A with participation from Oak HC/FT and SVB Capital) the new plan is currently building team and tech and aiming “to cover one life, bring on one provider, and earn one dollar of revenue by the end of the year.” It’s early days, but we dive into the details behind the strategy and also explore how this fits into the “health assurance thesis” that’s lurking behind General Catalyst’s latest investments, particularly those spearheaded by Hemant Taneja, who literally co-wrote the book on the subject with Jefferson Health’s Steve Klasko, and is the CEO of the Health Assurance Acquisition Corporation ($HAACU) SPAC that’s just out there waiting to take a health tech business public.

Meet Rightway: The Little-Known $1.1B Care Navigator PBM Startup That Just Scored $100M

By JESSICA DaMASSA, WTF HEALTH

Despite nearly 900 employer clients (including big brands like Burger King, Kroger, and DoorDash), a net promoter score of 84, and a new pharmacy benefits management (PBM) program launched mid-pandemic, healthcare navigator startup, Rightway, seems to have come out of left field with its $100M Series C fundraise and $1.1B valuation. CEO Jordan Feldman introduces us to the company he’s built and its pretty impressive ability to achieve double-digit decreases in the cost of healthcare for mid- and large self-insured employers.

We walk through the business model, talk about the well-funded competition in both the care navigation and PBM spaces, and get acquainted with Rightway’s plans for scaling up and attracting new clients. An added little point of intrigue? As Rightway looks to gain a foothold working with health plans, Jordan mentions some interesting ties via its Series C investors. While the round was led by Khosla Ventures, with participation by Tiger Global and existing investors, it’s Thrive Capital, also an investor in the health insurance startup Oscar Health, that sounds like it might help Rightway make its way into the payer market.

Glen Tullman’s Return to Digital Health: In-Depth Chat on New CEO Role at Transcarent

By JESSICA DaMASSA, WTF HEALTH

As if one consumer digital health company with an $18.5B exit wasn’t enough, Livongo founder Glen Tullman has decided to give the transformation of healthcare another go – this time as Executive Chairman & CEO of Transcarent. Matthew Holt and I sit down with Glen to hear about the “new kind of experience” that Transcarent is offering self-insured employers and their employees: one focused on providing unbiased information, guidance for accessing high-value healthcare, and an at-risk model that promises to share back the financial benefits associated with better healthcare decision-making.

Could you consider Transcarent an aggregator, a healthcare navigator-PLUS, or is it more like a next-gen health plan that does everything but process claims? Glen talks about how his team was “asked” to jump into providing a better experience for this kind of healthcare service, details what the company needs next, and explains the role of Bridge Health, which merged with Transcarent in October 2020 when the company closed its $44M Series A. Familiar investors, General Catalyst and Glen’s own 7Wire Ventures, have led the funding for Transcarent and we find out if there will be any additional support from the Health Assurance Acquisition Corporation (the SPAC that Glen launched in partnership with General Catalyst’s Hemant Taneja and others) that could potentially provide a vehicle for taking the business public. And, what about Teladoc Health? With a seat on TDOC’s Board, does Transcarent’s commitment to offering “unbiased” direction to the best possible healthcare put Glen into a conflict of interest? This is one catch-up chat you’re not going to want to miss!

Buoy Health Wins Over Three Health Plans, Turns Symptom Checking into Patient Decision-Making

By JESSICA DaMASSA, WTF HEALTH

Symptom checker startup Buoy Health’s $37.5M Series C caught a lot of attention among health tech market watchers because of the collaborative support the funding round garnered from health plans. THREE payor orgs – UnitedHealth’s Optum, Humana, and Cigna – participated in the round, and co-founder and CEO Andrew Le is here to tell us why.

What’s interesting is how the health tech startup’s model has evolved past “symptom checking” and into patient decision-making to better solve the underlying uncertainty that typically causes a patient to “shotgun into care” that’s often a poor fit clinically AND financially. “If you don’t solve the clinical uncertainty first,” says Andrew, “then nothing else matters.” Health plans, though, are likely also seeing the potential of making sure that their members are routed to the right kind of “covered” care. And Buoy’s big plan is to help that along with a full-on marketplace of curated solutions – think telehealth, digital health apps, digital therapeutics, and so on – that round out the benefit design of a traditional health plan. Suddenly, symptom checking seems a means to a very different end…

The Habit Change Provider? Newtopia & the Case for a New Category of Healthcare Provider

By JESSICA DaMASSA, WTF HEALTH

Chronic disease prevention is often lumped into chronic disease management – but should it be? Aren’t there different nuances to preventing diseases than to treat them? Making the case that healthcare’s “primary prevention” businesses deserve their own category is the CEO of Newtopia, Jeff Ruby. Newtopia’s just announced the creation of a new category of healthcare provider, the Habit Change Provider, in effort to more accurately describe the role of companies working to change the way people behave in their everyday lives. What they eat, whether or not they exercise, how they deal with stress and anxiety – in short, this is the business of influencing the many micro-decisions that, cumulatively, add up to our overall health and whether or not we’ll be impacted by “lifestyle diseases” like diabetes, obesity, heart disease, mental health issues, and more.

Newtopia’s been in this business for over a decade, starting its path to commercialization with Aetna and a three-year randomized control trial of more than 2,800 Aetna employees that proved the power of prevention: physical risk reduction, clinical cost savings, and the “holy grail” of any population health model, in-year ROI. So confident is Newtopia in their approach that the company goes at-risk on outcomes, a compelling enough value proposition to attract clients like Accenture, JP Morgan Chase (and it’s now defunct joint-venture with Amazon and Berkshire Hathaway, Haven) and the whole of CVS Health (which acquired Aetna.)

Is this starting to sound different than those chronic condition management companies yet? Listen in to hear more about the details behind Newtopia’s approach, which even leverages genetic testing to “remove blocks for habit change” by helping people identify what they’ve inherited from their parents (slow metabolism, difficulty processing fats, body’s ability to handle stress signals) so they can get past blaming themselves and start developing healthy lifestyle improvements.

Teladoc Health Integration Update: Former Livongo & InTouch Health Execs Weigh-In

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By JESSICA DaMASSA, WTF HEALTH

Just 45 days after Teladoc Health closed its $600 million acquisition of hospital telehealth provider InTouch last year, it turned around and announced a surprise $18B acquisition of Livongo, extending its reach into patients’ homes via the digital health startup’s remote monitoring platform for diabetes, hypertension, and more. Now, four months past the signing of that deal, and at the start of yet-another pandemic year expected to be big for virtual care, the two big questions healthcare market watchers have for Teladoc Health are: 1) how’s that double integration going? and 2) just how much pushback are you getting from health system clients that look at this “hospital-to-home” virtual care pathway as a little too close to their own business models? Jess DaMassa gets the latest from InTouch Health’s former CEO, now Teladoc Health’s President of Hospital and Health Systems, Joe DeVivo and Livongo’s former Chief Medical Officer, Dr. Bimal Shah, who’s now Teladoc Health’s Chief Medical Officer for Product and Analytics.

What’s the integration been like for our old friends from the InTouch and Livongo teams? What areas of the “hospital-to-home” digital infrastructure are priority for 2021? And, what about data integration? With more than 1-billion data elements from Livongo, 10.5 million visits on Teladoc’s platform, and 3.5-million Teladoc-enabled visits via hospital clients, it sounds like interoperability to provide “intelligence, not data” is paramount to the company’s strategy for driving growth. As Joe says, “Teladoc has just positioned itself to be “THE” partner to institutionalize virtual care for healthcare systems. Excellence around the delivery of care will always sit in the health system, but to the extent that we can improve the consumer experience in the onboarding into the healthcare system and to prop up our health system customers, all the better.” For lots more on winning over hospitals, outflanking the competition, and fully leveraging the AI-plus-AI engine Livongo built, tune in now.

And, for the die-hards… to catch a bit more on Teladoc Health’s vision for the future of virtual care, watch Dr. Bimal Shah and Joe DeVivo here: https://perspectives.teladochealth.com/

UpHealth’s Exec Leadership Team on the Digital Health Super-Company’s Plans for Market Growth

By JESSICA DaMASSA, WTF HEALTH

The executive leadership team of UpHealth, the self-described “global digital health super-company” that’s headed toward the public market via a SPAC that’s brought together six companies, 10-years of health tech innovation, and a war chest of $285M dollars, stops by to talk about growth plans and grabbing market share. UpHealth’s Chairman & Founder, Dr. Chirinjeev Kathuria, Co-CEO & President Dr. Al Gatmaitan, and future COO Jamey Edwards talk through what Jamey says is “really a revenue story” about the fastest growth areas of digital health. Global telehealth, integrated care management, digital pharmacy, and behavioral health will be UpHealth’s sweet spots. The newco is positioning itself as a “one-stop shop” for the digital healthcare infrastructure that will support a local healthcare organization in rolling out digital care services and integrating them with their in-person care continuums. This is different than, say, a Teladoc or an Amwell, which in addition to providing infrastructure also have their own tech-enabled medical groups, which can sometimes be viewed as competitive to their customers. The global nature of UpHealth is another differentiator, particularly in how it hopes to ultimately make it possible for highly specialized care from the US to be “exported” to countries abroad AND for lower cost care for lower acuity issues to be “imported” in. With $190M in revenue projected for 2021 – and that’s NOT dependent on integrating the six companies – we talk through areas for potential growth, that aforementioned competitive landscape, and whether or not UpHealth is feeling the pressure to hurry their integration.

One-Price, 30-Day Warranty, Payment at Discharge: Carrum Health’s CEO on Changing How We Buy Surgery

By JESSICA DaMASSA, WTF HEALTH

No copays. No coinsurance. No surprise out-of-network anesthesiologist fees or pre-op imaging bills. Just one, single price (that you see in advance) tells you EXACTLY what you’ll be paying for your surgical care on Carrum Health. Backed by the recent close of a $40M Series A funding round, the health tech startup’s CEO Sach Jain talks through all the ways his company is looking to disrupt how we buy surgical care. Standardized bundle pricing is just the beginning. Carrum requires its Centers of Excellence (and each of their docs) to pass a proprietary 50-point inspection before they can join the platform, AND every surgery must be backed by a 30-day Warranty! How have they convinced providers to jump through these kinds of hoops? With a growing client-base of self-insured employers (Sach says they have several Fortune 100 and Fortune 500 clients) and payment-in-full made to providers upon discharge, the case for additional revenue and zero A/R days is pretty compelling to a health system. And what about the other side of the business model? Tune in to find out why Sach believes Carrum Health’s “marketplace” approach will appeal to the growing base of “activist” employers whose HR benefits administrators are becoming more and more adept at building-their-own healthcare networks.

The Evernorth Digital Health Formulary & the Disruption of the Digital Health Payment Model

By JESSICA DaMASSA, WTF HEALTH

Last December, Express Scripts — now a part of Evernorth — became the first PBM to go to market with a digital health formulary. Basically, adapting the vetting, organizing, and pricing functions of a traditional medication formulary to the digital (health) age. Mark Bini, Chief Patient Experience Officer, spearheaded the effort, meant to alleviate the burden faced by Evernorth’s clientbase of 4,000 employers and health plans, who’s HR benefits teams want to make digital health solutions available to the 100+ million members of their health plans, but don’t have a frictionless, repeatable way to do so. As Mark puts it, “if you’ve seen one digital health startup, you’ve seen one.” And, for an HR benefits administrator whose inbox is inundated by digital health companies, the challenge of dealing with different levels of clinical validation, different data needs, different contracts, and, probably, most frustrating, different payment models that are often separated from their health benefit and pharmacy benefits, Evernorth’s Digital Health Formulary eases a real burden. So, a year in… how’s it going? Have Evernorth’s clients bought into more digital health solutions as a result of the formulary? What’s uptake been like among the populations they manage? And, how has this been working out for digital health startups? Mark gives us an update, talks through the details of the selection process, AND reveals what he’s got planned next. Spoiler: The evolution of the Formulary means adding more cohorts of digital health solutions more frequently, increasing the number of digital health solutions covered under drug benefits, getting a beat on longitudinal digital health engagement, and working out how to help consumers navigate all the various health tech options that are available to them.

Michelin Star Medicine: Food Start-Up Epicured Delivers Meals for GI & Chronic Condition Care

By JESSICA DaMASSA, WTF HEALTH

Food-as-Medicine startup, Epicured, looks and acts a lot like the consumer meal delivery startups booming during this pandemic (think Freshly, which was just acquired by Nestle for $1.5B) but with one important difference: all the meals are based on diets that have been clinically validated as treatments for chronic disease. The three year old company got its start in GI disorders, turning complex Low FODMAP diets, gluten-free diets, etc. into home-delivered, ready-to-eat dishes that patients with Crohn’s disease, Colitis, IBS, IBD, celiac, or other gastro conditions could actually integrate into their daily lives. (Just Google the list of restrictions on a Low FODMAP diet and imagine the lack of adherence over a 6-8 week period while trying to calm an IBS flare-up…)

Richard Bennett, Epicured’s CEO & co-founder, stops by to talk about why he believes this more convenient, yummy, and easy solution will not only continue to win the hearts of healthcare consumers, but why, ultimately, healthcare payors will look to invest more into innovation around nutrition, particularly as its proven to help with other, more common and costly conditions like diabetes, renal disease, and cancer. Backed in part by Mount Sinai (which not only invested in their seed round, but also lent their GI team to the co-design a special IBS menu), Rich let’s us know a bit about some yet-to-be-released clinical study results AND how Epicured has taken a page out of the “digital therapeutics playbook” by partnering with AbbVie to wrap their solution around one of the pharma co’s drugs as a way to improve medication adherence. Chicken Cacciatore wins over companion app any day!