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“There Isn’t One Health Plan to Save Them All”: Flume Health’s CEO on New Build-A-Plan Biz

By JESSICA DaMASSA, WTF HEALTH

Two of the most notable payer venture funds, Optum Ventures and Cigna Ventures, just headed up a $30 million dollar Series A funding round for Flume Health, a startup that basically builds “challenger” health plans. How did this go down? Cédric Kovacs-Johnson CEO & Founder of Flume introduces us to his company which offers providers, digital health co’s, brokers, reinsurers, and just about any other healthcare org a tech stack for creating their own hyper-niche, super personalized health plans.

The suite of services to “build-a-plan” includes things like claim processing, payments, enrollment management, digital health point solutions integration, and other API functionality – replacing the traditional TPA with tech and the one-size-fits-all plan with a new opportunity for nichey-ness that can customize coverage for patient populations based on health conditions, location, employer, and so on.

Cédric talks us through the benefit to his target client – the care provider – who, while taking on more risk anyway, may consider building their own plan to capture more premium dollars and gain better control over the end-to-end patient experience. Wait a minute – is all this “Challenger Health Plan” talk just a re-brand of value-based care? I ask point-blank and get a new buzz phrase in return; welcome to the lexicon, “Commercial Advantage.” Lots to unpack in this one including Flume’s rev-gen model and plans for growth – they’re already onboarding one new challenger plan per month!

Clarify Health Solutions’ CEO on Data Analytics Startup’s Next Trick: Value-Based Payments Tech

By JESSICA DaMASSA, WTF HEALTH

Turns out, the Clarify Health Solutions story is about a lot more than data and analytics these days. Value-based payments? Acquisition of provider-focused, behavioral science startup Embedded Healthcare? Opportunities in real-world evidence??

Good thing founder & CEO Jean Drouin and I caught up at ViVE 2022. Not only do we get into the backstory of the business, which has built a self-service analytics platform for payers, providers, and life science co’s on top of “one of the largest-ever patient datasets” in the industry, but we also talk about the strategy that’s driving Clarify into the world of value-based contracting and how Embedded Healthcare’s tech will be used to augment and refine that new offering.

Jean talks in detail about his client mix, business model, and the two “healthcare golden rules” Clarify lives by as it scales up its business: 1) figure out how the payment method is going to work and 2) don’t mess with the work-flow.

Will ‘DoorDash for Lab Draws’ Startup Sprinter Health Be What Speeds Up Virtual Care’s Growth?

By JESSICA DaMASSA, WTF HEALTH

Sprinter Health bills itself as “the “DoorDash for lab draws” – sending nurses and phlebotomists out to patients’ homes to collect blood samples and urine samples, check vitals, and even perform Covid tests. Their model has been received with some skepticism (most notably by my Health Tech Deals co-host and legendary health care curmudgeon Matthew Holt) so we get down to the bottom of what’s REALLY going on with CEO Max Cohen.

The long-term play is NOT to just rove the streets like some nomadic Quest Diagnostics; it’s to support the emerging market of virtual care and telehealth-based next-gen healthcare companies that will, ultimately, be limited in their abilities to diagnose-and-treat unless they can easily – and inexpensively – get patients lab tests.

Sprinter hopes to be that logistics company, extending the ‘value of virtual’ so it can live up to its promise of providing less expensive, more convenient care to patients. Max says only 15-20% of their business is made up of consumer-directed concierge calls; instead, the focus is on having a provider – think home health providers, specialty labs, virtual-first primary care clinics – dispatch Sprinter instead. Their pricing is built to attract these kinds of providers, giving Sprinter an advantage over, say the kind of medical transport services that are typically engaged to bring home health patients to the lab instead of the other way around.

Less than one-year old, Sprinter has already raised more than $37 million and counts health-tech-famous funds like Andreesen Horowitz, General Catalyst, Accel, Google Ventures – and even the real DoorDash’s co-founder and CEO Tony Xu – as investors. So, what’s ahead in the short-term to expand services out of LA, San Francisco, and Sacramento? We talk geographic expansion (hello, Texas and Georgia) and how Max is planning to continue to expand the utility and value of virtual care without increasing cost.

Mental Health Care & Medicaid State-of-Play: Circulo Health, Brave Health Execs Weigh-In

By JESS DaMASSA, WTF HEALTH

Two experts in mental health care for the Medicaid market stop by to help us get smart on the challenges facing patients and providers alike in this critical area of care. It’s not just the payment model that is different; stigma is different, patients are more racially and culturally diverse than those in commercial plans, support systems vary, and even the normalization of seeking mental health care manifests itself differently when it’s individually-driven as opposed to part of an “employer group.”

Anna Lindow, CEO of digital-first mental health startup Brave Health, and Vik Bakhru, Chief Health Officer of new managed Medicaid plan Circulo (the one built on Olive’s health tech platform) share what they know about this patient population, including what they are learning via the partnership they share to provide Brave Health’s services to Circulo’s members in Columbus, Ohio and Albany, New York.

The top of this conversation starts with the trend-talk and identification of the key issues facing Medicaid mental health care, then we get into some updates from Brave and Circulo, including how Circulo is examining “what it means to be a payer of care” and looking to innovate just one-year after launch.

Lyn Health Out of Stealth: A Niche Healthcare Navigator for Polychronic Patients

By JESSICA DaMASSA, WTF HEALTH

Straight out of stealth and launching today! Lyn Health is out to provide specific, personalized care for patients with three or more chronic conditions in a way that’s meant to compete with healthcare navigator-advocators like Accolade, Transcarent, and Included Health INSTEAD of the crowd of digital health chronic condition management platforms like Teladoc’s Livongo, Vida Health, One Drop, Omada Health, etc. etc.

With employers and health plans getting increasingly burnt-out on point solutions for chronic care – leading many of those businesses to “platform out” themselves in recent years – will a niche-market navigator really stand-out? Is effective care for polychronic patient populations so specialized that it merits adding a specific, targeted service on top of the more general navigator, primary care provider, or chronic care platform solution that an employer or plan might already have in place?

Lyn Health’s CEO Rick Abbott stops by to introduce us to this seed-funded startup, which has raised $10M (backed by Summer VC) and has already attracted some yet-to-be-named health plan and Fortune 500 employer clients. Rick explains that market need that Lyn Health is aiming to satisfy, and how he’s leveraged what he’s learned about the cost of polychronic care from his past life at Premera Blue Cross into an approach that he believes will work to help employers both reduce spend and improve the day-to-day patient experience of managing multiple chronic conditions. Lyn Health is set-up to deliver care with its own physicians and social workers, connecting with patients in a digital-plus-bricks-and-mortar format. And, as for that business model, we get into the big question: at-risk or not?

Excited to meet this startup on the day of its official launch!

#Healthin2Point00, Episode 228 | Mahana, Vera, Cadence, Commure & Ovia

#HealthIn2Point00 is still catching up on back deals from my HIMSS “vacation” when Jess lost track of me. Mahana Therapeutics gets $61m for its IBS related CBT DTx. Not everyone is happy! Vera Whole Health Clinic gets $50mm even if they don’t love Jess! Cadence gets $41m for RPM. Commure buys PatientKeeper from HCA, and LabCorp buys femtech co Ovia Health–Matthew Holt

THCB Gang, Episode 36, Dec 17

Today’s #THCBGang was an End of Year special. It’ll was a full “Hollywood Squares/Brady Bunch” with nine of us. Michael Millenson @MLMillenson, Deven McGraw @HealthPrivacy, Jessica DaMassa @jessdamassa, Maggi Cary @margaretcaryMD, Robin Farmanfarmaian @Robinff3, Mike Magee @drmikemagee, Rosemarie Day @Rosemarie_Day1, & Marcus Whitney @marcuswhitney all got on to talk about the vaccines, the future of investing in health tech, a little bit about HIPAA, the future of vaccine passports, and more.

Yup we rounded off the year talking about the good, the bad and the very ugly of 2020. And giving our forecasts for 2021. And then a bunch more of the Gang came on at the 50 minute mark to give their hopes for 2021

You can see the video below and it’ll be on our podcast channel (Apple/Spotify) from Friday

— Matthew Holt