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HLTH 2022: Health Gorilla & Interoperability’s New TEFCA-Fueled Future

Health Gorilla is in the business of health data interoperability and the double-backflip this startup is doing to both make clinical data an easily accessible commodity – while also making sure that access to that data adheres to the privacy rules established by the US government – takes a minute to understand, but is critically important for the future of many health tech businesses.

CEO Steve Yaskin takes on the tough job giving us a brief overview of TEFCA (the Trusted Exchange Framework and Common Agreement) which is meant to establish once-and-for-all a common ground for data interoperability. Then, we get into QHINs – a specially designated group of “qualified health information networks – and how his business is applying for this certification to further build “the bridge” between the public sector and the private sector and what’s needed to achieve compliance for data exchange.

Phew! No wonder this startup has landed nearly $80 million dollars in funding! We talk about the basis for the business model – but, more importantly, the real market need – and find out what’s in store for all of us in the next chapter of data interoperability.

HLTH 2022: Thirty Madison and The Expanding Definition of Women’s Health – and Its Revenue Model!

By JESSICA DAMASSA, WTF HEALTH

The definition of women’s health keeps expanding beyond sexual and reproductive health (finally!) and among those leading the way toward more holistic health for women is virtual pharmacy startup, Thirty Madison, which acquired “Uber-for-birth control” biz, Nurx, at the beginning of this year.

Thirty Madison’s President Michelle Carnahan gives us an update on the integration of the two companies around women’s health, and talks about Thirty Madison’s brand-new mental health offering which will address “mild to moderate” mental health care needs including medication management.

More interesting for those interested in the business of health tech, however, is how Thirty Madison’s business model is starting to evolve from its direct-to-consumer beginnings. Michelle says that just a year ago, 95% of revenue was generated from their D2C efforts. Now, it’s more of a 70/30 split, with enterprise earnings coming in through a variety of mechanisms including accepting insurance on their site, partnering with PBMs, and some special partnerships with incumbents like UnitedHealthcare and CVS Health. Interesting evolution AND interesting partners there…watch to hear more!

HLTH 2022: Calibrate Launches Enterprise Product to Bring GLP1 Weight Loss Drugs to Payers/Employers

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by JESSICA DAMASSA, WTF HEALTH

Telehealth weight loss clinic Calibrate is expanding its two-year old D2C biz and taking it into the workplace with the launch of ‘Calibrate for Enterprise,’ which makes its program of GLP-1 weight loss drugs and behavior change coaching now available to payers and self-insured employers as a packaged employee health benefit. CEO Isabelle Kenyon shares the news here and reveals that the enterprise offering actually launched in stealth-mode a little more than a month ago with three clients and already has signed up more members in one month than it had its entire first six months D2C. How does the math work on ‘Calibrate for Enterprise,’ when GLP-1 drugs are $700-$1,300 per month? Isabelle explains how they’re making the total cost of care equation work for payers and employers AND addresses common concerns about what happens to all that successful weight loss when employees eventually come off their meds.

HLTH 2022: Wheel Adds More Telehealth Tech Infrastructure with Acquisition of GoodRx’s Care Software

by JESSICA DAMASSA, WTF HEALTH

Health tech infrastructure startups remain HOT and, given the industry-wide rise of the “omnichannel care” strategy, none might be hotter than telehealth infra biz, Wheel. CEO Michelle Davey talks about providing white label virtual care services that will now not only include telehealth and EMR technology, clinical care, and end-to-end lab technology, but also the back-office tech that has powered GoodRx all these years. We dive into the acquisition of GoodRx’s care engagement software, how it will enable Wheel to expand its behind-the-scenes reach into the healthcare market, and whether or not Michelle sees all this clamoring about omnichannel care as ultimately eroding Wheel’s biz…or as the force that will propel its growth long into the future.

New VC Fund Angelini Ventures Launches to Find Next Big Digital Health & Biotech Disruptors

BY JESS DaMASSA, WTF HEALTH

NEW VC Fund! Angelini Ventures just launched their $300 million dollar investment fund to support early-stage biotech and digital health startups in the US, Europe, and Israel. CEO & Managing Director Paolo Di Giorgio and Managing Director Elia Stupka explain the fund’s thesis which is different than the usual corporate investment funds because of its “very long-term” strategy and interest in supporting disruptive health innovation that doesn’t necessarily need to relate to the core businesses of its multi-national parent, Angelini Industries. Find out more – including details about where this fund has already placed some investment dollars – from this quick chat in Milan.

Is Care Navigation Healthcare’s Next ‘Gold Mine’? Quantum Health’s Move to Win Over Larger Employers

BY JESSICA DaMASSA, WTF HEALTH

One-to-watch as a potential health tech IPO this year is care navigator Quantum Health, and I’m talking to CEO Zane Burke about both their breaking new product launch AND the key differences between Quantum and the increasingly competitive field of other employer benefits advocacy-based businesses like Accolade, Rightway, and Transcarent.

Private equity backed, two-decades old, and EBITA positive, Zane says Quantum Health is delivering an ROI of “over two-and-a-half to one” to its client roster of 450 top large, self-insured employers and saving more than 14% on all healthcare costs over time. The new product – Quantum Health Access – is a streamlined, more flexible version of the soup-to-nuts Complete Care offering capable of yielding these results, and it’s being offered to give the largest of employers (those big enough to be working with multiple health plans, for example) a way to start out with Quantum’s data-driven navigation tools without a total overhaul of their current benefits situation.

Zane explains Quantum’s “real-time intercept tool” and how it not only helps engage high-utilizers in an employer’s plan (aka those who spend more than $10,000 in claims), but how 85% of the time it catches them on their care journey before they’ve spent a thousand dollars – creating an early opportunity to provide better routing and, ultimately, reduce overall costs. The upside for Quantum? “Employers have long thought of the carriers as this is their responsibility, but the carriers are really maximizing around their siloed system to pay a claim, do the disease management, get you off the phone and into somebody else’s queue,” explains Zane. “Our model is, ‘hey…every single one of those interactions is a gold mine.’”

We get further into the details around the new Quantum Health Access product, and, more importantly, what Zane sees as Quantum’s key point of differentiation against Accolade, Rightway, Transcarent, and the rest. Tune in around the 20-minute mark to hear this bit and to find out what Quantum’s doing with provider data that makes “everybody else that talks that game” look like they are just playing “Pick Up Sticks.”

Patient Journey or Customer Journey? How Salesforce’s CRM Aims to Reposition the EHR

BY JESSICA DaMASSA, WTF HEALTH

While at Dreamforce 2022, one of most thought-provoking things I heard was that, in order to really meet the needs of the healthcare consumer, we in healthcare need to once-and-for-all let go of the idea that there will be “one tech system to rule them all” and adopt an “and both” approach that integrates both the EHR and a CRM. The EHR is how we’ll “know the patient” and the CRM is how we’ll “know the customer.”

Dr. Geeta Nayyar, Salesforce’s SVP & Chief Medical Officer and Amit Khanna, SVP & GM of Salesforce’s Health & Life Sciences business join me to unpack this “and both” approach to infrastructure technology and talk all-things healthcare consumer. The paradigm shift that comes with this duality – we are at times “patients”, we are at times “customers” – is a big one. Especially in healthcare.

Dr. G speaks to the strategy that Salesforce is operating under to take its tech further into the healthcare and life sciences space, while Amit introduces us to some of the new Healthcare 360 product features launched at Dreamforce that fully show-off Salesforce’s expertise at integrating different technology solutions (Slack, MuleSoft, telehealth) and making perfect sense of massive amounts of real-time data (longitudinal record, health scoring).

As Salesforce advances further into the health market with more care-forward features in its CRM and a strategic focus on healthcare-important issues like improving equity and access to care, will our traditional view of the importance of the EHR change? What if the replacement tech comes with ‘self-service at-scale’ and more ‘seamless experiences?’ Could we head away from “and both” and choose CRM “instead of?” Tune in – the EHR IT infrastructure may have finally met its match!

Future of Big Data in Health? LexisNexis® Risk Solutions Says Next-Gen Tokenization & Health Equity

BY JESSICA DaMASSA, WTF HEALTH

Data-juggernaut LexisNexis® Risk Solutions is making a big data play in healthcare, launching a new capability that allows for unprecedented accuracy in the kind of de-identified data that payers, providers, and pharma are clamoring to use for everything from cutting admin expenses to improving patient outcomes and health equity.

Jeff Diamond, President & General Manager of The Health Care Business of LexisNexis® Risk Solutions and Andrea Green, Director of Healthcare Strategy, SDoH, drop in for a chat about all things VERY big data, including this concept of “next-gen tokenization” which leverages LexisNexis’s massive amount of consumer data as a way to connect data “personas” to create a much more accurate, actionable, and longitudinal view of a patient.

The thing to understand is just how much health data LexisNexis® Risk Solutions is working with and who they are working with it for: 90% of commercial payers in the US; 8 of the Top 10 pharma manufacturers; 10 of the Top 10 retail pharmacies; and hundreds of hospital systems.

So, how is this data “turned” into insightful and actionable information that appeals to this top-tier clientele? Jeff and Andrea walk through use case after use case that demonstrate the ‘business of healthcare’ applications of the LexisNexis data processing platform (think patient safety, risk stratification, claims analytics, provider directory, etc.) with special emphasis on how their new analytics suite, focused on Social Determinants of Health data, is helping with such clinical initiatives as improving diversity in clinical trials and providing predictive insights about patients who might need mental healthcare support. The data comes to life in this one. Watch now!

Salesforce for SDOH: Health Equity is Taking Center Stage in Salesforce’s Real-Time Health Data Play

By JESSICA DaMASSA, WTF HEALTH

At Dreamforce 2022, Salesforce’s big annual user conference, “real-time data” was THE topic of conversation as the tech company launched a brand-new platform across its lines of business to help make this type of data integration-plus-analytics “magically” easy. I caught up with Salesforce’s EVP & CRO of Global Health & Life Sciences, LaShonda Anderson-Williams, just after her division’s keynote to find out more about how the new platform (called Customer 360 for Health) is intended to impact what we can do with health data, particularly in the realm of improving health equity and access to care.

Never mind the actual new product features – telehealth integration, health scoring, longitudinal patient records, marketing integrations, etc. – the sum-total of their potential impact is intended to not only improve the way healthcare understands its patients as health consumers, but to also enable it to better meet their nuanced needs with more personalized “seamless” experiences.

LaShonda and I chat about how this type of work is already happening at CVS Health and Moderna – the two marquee customer stories shared during the keynote – as well as how other healthcare organizations can benefit from “putting data at the center” of their health equity initiatives. Her best advice for health and life sciences businesses as they work on improving health access for all? Tune in to find out!

Deep-Dive Into Availity’s Acquisition of Diameter Health

by JESSICA DAMASSA

“There’s $4-$4.5 trillion dollars of annual spend in the healthcare system. A trillion of that is administrative. And, some big chunk — some BIG number that you measure in the 100’s of billions of dollars – is waste. So, the TAM for what Availity and Diameter Health are going to do together is huge.” Russ Thomas, Availity’s CEO, is clearly excited about his company’s recent acquisition of Diameter Health and we ask him – and Diameter’s President & COO Mary Lantin – why this is such a big deal.

In the end, what this comes down to is making more sense of all the data that flows between providers and payers to automate where possible, find insights to improve business processes and workflows, and, ultimately, cut out that notorious “admin expense” that adds to healthcare cost without creating any value.

For twenty years, Availity’s been in the business of “translating” data from providers into a language health plans can understand, so payors could refine their own business processes and automate pre-auths, pay claims, etc. Diameter, on the other hand, deals in the world of clinical data and “upcycles” it into concepts and “digestible bites” that a health plan can use to automate an administrative workflow process with a provider and – get this – build a longitudinal health record that now Availity’s robust supply of claims and health plan data can fully flesh out.

How excited are Russ and Mary about the idea of this comprehensive, longitudinal, fully-integrated clinical-plus-claims patient record? Much more excited than even I anticipated! Tune in for all the details on the merger and this BIG vision for scaling up the fight against healthcare’s massive spend on administrative waste.