Nomad Raises $105M to Expand Staffing Marketplace

Big problems require big solutions, and with worker shortages still topping the list of issues at almost every major health system, it’s no surprise that staffing marketplaces like Nomad Health are continuing to haul in 9-figure funding rounds.

Nomad Health recently secured $105M in “mostly equity” financing as it looks to grow beyond its roots in travel nursing by expanding to new clinical specialties.

Nomad’s staffing platform allows candidates to search for and apply to temporary positions that usually last around 13 weeks. It takes care of sourcing candidates, filtering qualifications, and matching credentials to available roles. 

  • To differentiate itself from similar solutions, candidates who accept a role on the marketplace are hired by Nomad as W-2 employees rather than contract workers, giving them access to health benefits, malpractice coverage, and even a 401(k) for the duration of the gig.
  • Nomad attributes its seven-fold revenue growth since the beginning of the pandemic to its candidate-centric approach. The marketplace is now used by over 4k healthcare facilities and 250k healthcare workers, with Nomad expecting to generate a profit on $700M in revenue for 2022. 

After peaking in 2021, research firm Staffing Industry Analysts is projecting demand for travel nurses to decline nearly 14% by the end of the year before stabilizing at a level still substantially above its pre-pandemic baseline. 

  • To get ahead of the cooling demand, Nomad will use its new funding to expand its platform to allied health professionals outside of nurses, specifically laboratory technicians, physical therapists, and ultrasound technicians.
  • While the front-end service will look nearly identical for the new roles, Nomad said that the expansion will require a significant buildout to add more credentialing features and extend the service to other facilities besides hospitals.

The Takeaway

Staffing solutions have been an investor-favorite throughout the pandemic, with connectRN, Trusted Health, IntelyCare, and plenty of others raising capital to help fill shifts while giving healthcare workers more flexibility. Now, as demand for temporary healthcare workers begins to ebb alongside the pandemic, it’s likely that we’ll continue to see companies like Nomad turn to new clinical specialties, service lines, and permanent position placements to set themselves apart in a crowded market.

Patients and Providers Report Different Telehealth Experiences

Patients are more likely to report a positive telehealth experience than providers, at least according to Zocdoc’s new Healthcare Experience Report that broke down many of the highs and lows of delivering virtual care over the past two years.

Zocdoc analyzed the trends from its appointment booking platform between May 2020 and May 2022, then conducted patient and provider surveys to uncover insights into how care experiences evolved throughout the pandemic. The final report got pretty granular with different specialties and care types, but delivered a few overarching themes worth taking a look at.

If you’re more of a visual learner, Zocdoc also put together an infographic that does a good job summarizing the main findings.

Differing perspectives between patients and providers are common. Just over 30% of patients surveyed indicated it was easier to build a relationship with their provider via telehealth due to less formality and more relatability in the interactions. Only 7% of providers felt the same way.

  • Similar discrepancies were seen with tech difficulties. While 58% of providers indicated they or their patient has had tech issues during an appointment, just 30% of patients said they’d ever experienced a problem.

Mental health is the only specialty where virtual care remains dominant. No surprise here, but it was interesting to see how virtual mental health appointments have continued to overtake in-person visits over the last couple of years.

  • Virtual appointments comprised 74% of mental health bookings in May 2020, 85% in May 2021, and now account for 87% of appointments. Survey respondents cited convenience and the benefits of at-home comforts as reasons they appreciate virtual mental health visits.

Telehealth is a supplement, not a substitute. In May 2020, one-third of all appointments booked via Zocdoc were telehealth visits. By May 2022, that number had declined to 17%, and it dwindled to just 9% if you exclude mental health appointments.

  • Although telehealth is well above its 1% pre-pandemic numbers, 77% of patients reported that they’re still leaning towards a combination of in-person / hybrid care. This is easily seen in the rebooking trends, where over half of virtual visits with a new OB-GYN, eye doctor, or dentist resulted in an in-person follow-up. 

The Takeaway

We’ve seen many of the themes from Zocdoc’s report before, but it’s nice to wrap some numbers around them from an appointment booking perspective as opposed to the usual claim lines or anecdotes. The discrepancies between patient and provider views on telehealth were also good additions that get studied less frequently, as were other hidden gems like the fact that 36% of providers have seen a patient’s pet during a video appointment.

Improving Risk Scores With Machine Learning

Risk scores are used to help predict everything from hospital readmissions to medication adherence, but more-often-than-not these valuable metrics are still generated by adding up a few key predictors in a simple model. That makes the difficult task of selecting the right variables extremely important, which is why researchers out of Duke-NUS Medical School in Singapore developed a machine learning system to help optimize the process.

Most current risk scores are generated from regression models that are popular for their simplicity and predictive power. The widely-used LACE index predicts unplanned hospital readmissions using only four components: inpatient length of stay, acute admission, number of ED visits in the past 6 months, and comorbidities.

There have been several efforts to improve risk scores using advances in AI, but these models are usually “black boxes,” making it notoriously difficult to interpret variable selection and importance.

The Duke-NUS researchers proposed an AutoScore-ShapleyVIC machine learning model for improving risk score variable selection while maintaining interpretability, then compared it to the LACE index for predicting 30-day readmissions of patients who visited the ED of Singapore General Hospital between 2009 and 2017.

We’ll leave the model development details to the AI experts, but here’s a look at how AutoScore-ShapleyVIC performed against the LACE index:

  • AUC: 0.756 (AutoScore-ShapleyVIC) vs.0.733 (LACE)
  • Accuracy: 71% vs. 64%
  • Sensitivity: 66% vs. 74%
  • Specificity: 72% vs. 62%

The final AutoScore-ShapleyVIC model significantly outperformed the LACE index, but didn’t sacrifice interpretability to achieve its results. Although it was able to narrow 41 candidate variables down to just 6 for the final model (number of ED visits in past 6 months, metastatic cancer, age, sodium, renal disease, and ED triage), the logic behind the variable selection can still be visualized to help with interpretation.

The Takeaway 

Although we don’t usually cover AI studies, this research helped illustrate that machine learning models have a lot of potential to improve existing care paths without sacrificing interpretability. The authors emphasized how this particular approach is not limited to any specific clinical application, suggesting that machine learning algorithms are still in the early stages of improving risk scores in other areas such as ED triage or cardiac arrest survival.

Sesame Secures $27M for Healthcare Marketplace

Direct-to-consumer healthcare has attracted a lot of investor attention over the past few months, and Sesame recently continued the trend by raising $27M in Series B funding to help it become the “Expedia for medical care.”

Sesame is a two-sided marketplace for providers and patients. It allows users to quickly compare physicians with an interface that’s fine-tuned to make booking an appointment as frictionless as possible. Here’s a look at the layout.

  • There are over 2.5k providers on the marketplace offering primary care, chronic condition management, and over 40 specialties – with an average visit cost of under $40. Sesame claims that it is able to lower the cost of care by cutting out the bureaucracy that comes with working with payors.
  • Providers can leverage the platform to offer dynamic pricing based on peak windows, then patients can filter the list to match their needs. Since launching in mid-2020, more than 150k patients have used the platform, and Sesame reports that its revenue has grown nearly 500% year-over-year.

The Series B round brings Sesame’s total raise to $75M and will fund the commercial launch of its Sesame Plus membership product, which has been in beta since November 2021.

  • For $99 per year, Sesame Plus members get $20 off all telehealth / primary care visits and $30 off in-person specialist appointments, as well as other benefits geared toward supporting the 40% of Sesame patients not covered by a health plan.
  • Unlike most other subscription telehealth services, Sesame does not require a membership to book appointments, but the Sesame Plus incentives led to beta members booking 33% more appointments than other patients.

The Takeaway
Sesame isn’t the only company offering affordable direct-to-consumer healthcare (K Health and Teladoc both play in this space), but the marketplace’s dynamic pricing and wide variety of specialists are important differentiators that will only help more as the company scales. Transparency, affordability, and usability also seem like solid pillars to build a marketplace around, and Sesame’s recent growth suggests that the strategy is resonating with users.

Digital Health Primed for Consolidation

The market hasn’t been kind to digital health companies this year. The stock charts of most of these companies look like red lines in a race to the bottom-right corner, and at this point it’s safe to say that many founders are buckling down for a bumpy second half of the year.

The public market struggles are quickly carrying over to the private markets. Woodside Capital Partners counted 44 health tech funding rounds above $10M in Q1 2022, nearly half the total recorded during Q4 2021 (86). The investment bank’s latest market report calls out several main drivers for the slowdown, but the biggest one probably sounds familiar: 

  • Investors are looking for companies generating a profit, and staying far away from those piling on losses to reach meaningful scale.

On the flip side of the coin, the same public market volatility that’s hammering many high-flyers is creating bargains for M&A teams. 

  • The first quarter saw 63 health tech M&A transactions combine for a total value of $48B (an increase over the $41B seen in Q4 2021), which seems to indicate that the declining valuations have already begun translating to more M&A activity.
  • Many public companies have become solid M&A targets due to declines in their shares (Vera Whole Health’s acquisition of Castlight, Oracle’s acquisition of Cerner), while private companies have started rounding out their services by acquiring the missing pieces (Aledade’s acquisition of Iris Telehealth, Lightbeam’s acquisition of Jvion).

The companies most poised for consolidation are those offering point solutions or catering to a specific end market.

  • So many of these have popped up since the beginning of the pandemic that it’s made funding scarce at a time when other exit options are drying up.
  • This likely makes an acquisition look like one of the best paths forward, particularly as larger companies look to capitalize on the moment by expanding their platforms and pushing into new markets.

The Takeaway

It’s usually easier to acquire an established solution than to build one from scratch, and the ongoing market selloff has narrowed the exit options for many startups while also making their valuations more attractive to potential acquirers. These same conditions have made other startups begin looking for ways to bolster their strategies by merging into more comprehensive solutions, which could mean that the real consolidation is just getting started.

Oracle Announces Plans for a Unified National Health Record

Fresh off the close of its $28.3B acquisition of Cerner, Oracle hosted a virtual event to outline its healthcare roadmap, which ended up being more ambitious than most analysts expected after the company announced plans to build a “unified national health records database.”

Oracle co-founder and CTO Larry Ellison said that the national database aims to replace the hospital-centric approach of current EHRs with a more patient-centric model, pulling data from thousands of separate hospital databases to create a unified view of patient health.

  • The goal of the database is to ensure that providers have access to a patient’s up-to-date medical data regardless of their location or past points of care. It will also incorporate real-time updates from provider EHRs to let public health officials monitor trends as they unfold.
  • Ellison stressed that data privacy will be a top priority for the buildout. Providers will only be able to access identifiable information with patient authorization, while other researchers and public health officials will be limited to a de-identified view.

While a unified patient record looks like a worthwhile pursuit on the surface, the health IT community was quick to express skepticism towards Oracle’s announcement, citing concerns over everything from data security to a complicated regulatory landscape.

  • Successfully building the database would also presumably involve cooperation from Cerner’s EHR competitors, but details were vague on its strategy to accomplish this. Epic’s Cosmos solution houses over 122M patient records and could easily be viewed as a competing product, which makes information sharing seem like an uphill battle.
  • Oracle’s presentation was light on information regarding the database’s timeline, cost, and outside access, but Ellison did acknowledge that it’s a “lofty vision” that will likely take a while to execute.

The Takeaway

Establishing a unified national health record has the potential to be a gold mine for Oracle, which mentioned the data’s ability to greatly accelerate life science research and new product development. That said, having the nation’s health data consolidated in a single database operated by a public company is understandably raising some concern, and Oracle has a long road ahead to gain the trust of both the patients it intends to serve and the competitors that will need to cooperate to make its vision a reality.

Aledade Raises $123M to Fuel MA Growth

Medicare Advantage. Value-based care. Positive earnings. Aledade is hitting all the right themes with the announcement for the close of its $123M Series E funding round.

The raise lifted the value-based care enabler’s private valuation to $3.1B, and it intends to push its advantage at a time when many health tech startups are cutting back due to frothy-at-best market conditions.

Aledade partners with independent practices and health centers to establish tech-enabled accountable care organizations. It uses data analytics and guided workflows to help better manage high risk patients, then shares in the success of its partners’ value-based contracts.

  • The company currently works with over 1k independent primary care practices to generate more than $300M in annual revenue, and it ranks among the coveted digital health startups consistently turning a profit.
  • Aledade’s nearly 150 value-based care contracts collectively cover over 1.7M lives, including 220k Medicare Advantage patients. At this scale, Aledade says that a 1% increase in the savings rate attained by its risk-bearing partners would generate an additional $100M in revenue.

The fresh funding will help Aledade expand deeper into the Medicare Advantage market, while also enabling it to deliver more services directly to patients under its new Aledade Care Solutions branch formed during the January acquisition of Iris Healthcare. 

  • Aledade Care Solutions provides wraparound services like Iris’ advanced care planning solutions to Aledade’s partner practices. 
  • The business unit lets Aledade leverage its existing data platform to identify and deliver care to the patients that would benefit the most from additional services, and Aledade CEO Dr. Farzad Mostashari lists kidney care and behavioral health as possible expansion areas.

The Takeaway

Aledade’s software-led model for enabling risk-based arrangements is highly scalable, allowing it to be more capital efficient than competitors focused on building value-based primary care clinics from the ground up. Although these efficiencies have led to two years of positive earnings that probably indicate Aledade could have held off on a funding round, the difficult conditions of the current market have created the perfect moment for Aledade to take on new capital and gain ground in key areas like Medicare Advantage while its competitors are on their heels.

Hint Health Raises $45M for Direct Primary Care

Direct primary care startup Hint Health closed $45M in Series B funding to support its ambitious mission of giving providers a way to get off the fee-for-service “hamster wheel” through an end-to-end platform for opening membership-based direct care practices.

Direct primary care (DPC) is a membership model where patients are charged a monthly rate (usually between $50 and $75) in exchange for a predetermined list of services from their primary care physician, aligning incentives similarly to value-based structures but without any third party payor involvement.

  • DPC allows physicians to work for patients as opposed to the healthcare system, which results in shorter waits for appointments and more time spent in each visit (45min avg, compared to 18min for FFS models).
  • According to Hint’s in-depth overview of the market, DPC membership has increased 241% since 2017, but has yet to break into the mainstream. The 300k patients enrolled across 1.6k DPC practices still represent less than 1% of total US primary care.
  • Critics argue that DPC could worsen physician shortages because doctors see fewer patients under the model, but considering how frequently we cover stories related to burnout and early retirements, lower volumes might not be as bad as it sounds. 

Hint is leading the charge of driving DPC adoption with its HintOS platform that reduces the administrative burden of opening a direct care practice by automating enrollment, membership management, and billing.

  • HintOS supports the direct-to-employer contracting frequently used by DPC practices by managing eligibility and other aspects of the relationship that typically rely on a FFS infrastructure.
  • Hint also operates a national DPC network called Hint Connect that connects providers to potential employer partners, and the new funding will be used to expand this network while continuing to build out HintOS.

The Takeaway

Getting physicians to abandon the payor revenue that’s traditionally served as the foundation of their business sounds like a tough pitch, but Hint’s DPC operating system probably makes the conversation a lot more interesting. Until recently, there hasn’t been a turnkey solution to enable the creation of a DPC practice, and if Hint can use its new funding to become that solution, it will make the model a viable path for plenty of other physicians looking to cut out the payor middleman and spend more time working with patients.

Lightbeam Acquires Jvion to Address SDOH

Population health management extends far beyond the moments of care delivery, which is why Lightbeam Health Solutions is acquiring Jvion to move from “predictive to prescriptive” intelligence, while bringing new health equity offerings to millions of patients.

Lightbeam helps payors and providers manage risk by generating patient cohorts for over 42M lives to provide proactive insights that ensure care is delivered when it can have the largest impact on a patient’s trajectory.

  • Jvion incorporates clinical, socioeconomic, and behavioral data to identify hidden patient risk factors across various diseases, then recommends appropriate clinical interventions taking into account these SDOH influences.
  • The acquisition will integrate Jvion’s AI-enabled prescriptive analytics and social determinants of health solutions with Lightbeam’s existing population health management services, allowing Lightbeam to incorporate more risk factors into its patient cohorts.  

Jvion’s SDOH solutions are well-aligned with Lightbeam’s other offerings, building an impactful health equity component into the “Deviceless RPM” services added through last year’s acquisition of CareSignal.

  • CareSignal’s Deviceless RPM service uses a combination of automated text messages and IVR calls to gather self-reported patient data, enabling value-based organizations to sustainably scale care teams without sacrificing engagement.
  • With Jvion and CareSignal both integrated into its portfolio, Lightbeam now provides a complimentary suite of services that optimizes risk profiles, suggests interventions based on SDoH factors, and continuously monitors patient progress.

The Takeaway

Integrating Jvion’s prescriptive analytics into Lightbeam’s core population health offering improves the cohort creation at the center of the service while allowing more SDoH data to feed into its insights. The combination of these health equity enhancements and CareSignal’s remote patient monitoring capabilities position Lightbeam as a highly scalable solution for end-to-end population health management, which seems like a solid value proposition at a time when labor shortages are the single biggest concern for most providers.

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-- The Digital Health Wire team