Brightside Raises $33M for Medicaid Expansion

Last week’s funding-heavy news cycle was punctuated by Brightside Health’s $33M Series C round, which added more momentum to the telemental healthcare provider’s recent expansion efforts.

Brightside provides full-range care for patients with mood disorders spanning anywhere from mild anxiety to severe depression. The “precision psychiatry” platform is built on a technology backbone that includes:

  • ActiveSupervision – a real-time care management solution that tracks patient progress and identifies situations that might require risk escalation.
  • PrecisionRx – AI clinical decision support that recommends medication and dose combinations most likely to be effective (resulting in a 70% response rate to the first treatment cycle, twice the industry standard).
  • Crisis Care – a national telehealth program for individuals with elevated suicide risk.

In the two years since its last raise, Brightside has scaled those solutions to the point where it can now provide in-network care to over 100 million covered lives, and it’s published close to a dozen peer-reviewed papers supporting its approach. 

  • A study from November showed that the Crisis Care program was effective at eliminating suicidal ideation in an average of six sessions.
  • Another study in the March 2023 issue of Psychotherapy Research found that supplementing teletherapy with video lessons helps address depression and anxiety.

Put all that together, and Brightside is uniquely positioned to serve not only the highest-acuity patients, but also the populations that often have the hardest time finding effective care.

  • The fresh capital will help it do just that, advancing its expansion into Medicare and Medicaid through recent payor partnerships with CareOregon, Blue Shield of California, BCBS of Texas, and Centene.
  • The Series C also put Brightside on a “comfortable path to profitability” in the next few quarters, with former Optum Behavioral Health Solutions CEO Trip Hofer joining the board to help oversee the next leg of that journey.

The Takeaway

Few telemental health companies have been brave enough to target the patients with the most severe symptoms, let alone those in the markets with the greatest need. Even fewer have been open to publishing their results. Brightside’s willingness to check all of those boxes makes it a must-watch in this space, especially considering that it’s tackling that checklist with soon-to-be positive margins.

Digital Diabetes Management in the Hot Seat

Digital diabetes management tools found themselves in the hot seat after a blistering study from the Peterson Health Technology Institute suggested that several leading solutions don’t provide significant clinical benefit, especially relative to their cost.

That conclusion naturally had many digital health advocates sharpening their pitchforks, but first let’s start by unpacking PHTI’s research and findings.

The analysis had two main endpoints: clinical effectiveness and economic impact. PHTI reviewed 1,100+ articles, including 120 submitted by the companies being evaluated, then offered ratings across three categories – remote patient monitoring, behavior / lifestyle modification, and nutritional ketosis. This chart summarizes the results beautifully.

  • On the clinical side, PHTI found that these tools deliver small reductions in HbA1c (0.23 to 0.60 percentage points) compared to usual care, as well as limited long term durability of the improvements.
  • On the economic side, PHTI concluded that each of the three product categories led to a net increase in spending, with total reimbursement and program investment exceeding any cost reduction from avoided care (the ketosis category carried an asterisk for its potential to cut costs over the long term).

Those findings led to plenty of blowback, including an excellent rebuttal from the Digital Therapeutics Alliance and a flurry of press releases from the companies in the report.

The DTx Alliance’s rebuttal centered around three primary issues:

  • The limited selection of solutions overlooks a large portion of the diabetes tools on the market, and that it’s misleading to give generalized conclusions based on a small sample when many products can demonstrably improve clinical and economic outcomes.
  • The report’s reliance on predictive models rather than actual cost studies overlooks real-world evidence, particularly concerning products like Dario, which has independent studies demonstrating reductions in both costs and hospitalizations.
  • It might have made sense for PHTI to list any of the nation’s 9,000 endocrinologists (diabetes experts) as authors or advisors. It’s tough to beat their pointed suggestion: “Had there been expertise in this evaluation, they may have considered the broader scope of diabetes management like reductions in hypo- and hyperglycemic events, in addition to the reduction of A1C levels.”

The Takeaway

Embracing debate is essential if the industry wants to improve, and even if there was room for improvement in PHTI’s methodology, it definitely succeeded in its goal of refocusing attention on the clinical and economic impact of digital innovations.

Virtual Care is Table-Stakes, Now What?

There’s no catalyst like a pandemic to transform virtual care from a niche offering to a must-have service, at least according to the 8,000 people who responded to Rock Health’s latest Consumer Adoption Survey.

Virtual care has become table-stakes for both patients and providers, with a majority of respondents using it within the past year (63%).

  • A mature market doesn’t mean virtual care is for everyone. Almost a quarter of respondents still have never used it, citing preferences for in-person care (56%), quality concerns (18%), and lack of awareness (13%).
  • Rock Health doesn’t expect adoption to ever reach 100%, and anticipates always needing a spectrum of omnichannel offerings – traditional, virtual, and retail – to meet consumers’ preferences and capabilities.

There’s a growing share of respondents that prefer virtual care over in-person care for use cases like prescription refills (69%, up 8pp) and mental health services (41%, up 3pp). [Chart]

  • That isn’t too surprising given that refills are transactional care encounters, making them well-suited to low-touch virtual channels like app or portal messaging.
  • Virtual mental health on the other hand reflects a changing status quo, where consumers want to choose from a wider range of providers with different identities or treatment approaches (especially relevant in mental healthcare), and can conveniently access them for regularly scheduled visits.

Consumers are drawn to convenience, but virtual care innovators will need to invest in additional value drivers like data security and user-friendliness to stay competitive.

  • While convenience helped drive virtual care’s popularity, it also attracted competition from retailers, grocers, and CarePods that have the advantage of bundling healthcare with other routines like grocery shopping.
  • For virtual care players, continuing to compete on convenience involves considering both when and where virtual is really more convenient than the best in-person offering, and when it makes sense to partner with retailers as opposed to competing on other differentiators.

The Takeaway

Rock Health’s survey makes it clear that we’re in a new era of virtual care, one that brings its own set of market pressures. Those looking to succeed will have to navigate new value propositions (what defines the best virtual care), alternatives (virtual care doesn’t have a monopoly on convenience or access), and as always, the regulatory/reimbursement landscape.

Hippocratic Raises $53M, Showcases AI Staff Marketplace

Less than a year after emerging from stealth with little more than a vague mission to transform healthcare through the power of “safety-focused” generative AI, Hippocratic AI took the stage at NVIDIA’s GTC conference to announce the close of its $53M Series A round.

When Hippocratic debuted last May, it hadn’t yet decided on its first use case, despite closing more seed funding than any company we’d ever covered ($50M). 

  • In July, it raised an additional $15M and partnered with 10 healthcare providers for model evaluation, including Cincinnati Children’s, HonorHealth, and SonderMind.
  • Now, Hippocratic found its use case, as well as a $500M valuation.

The first product Hippocratic is rolling out for phase 3 safety testing: a staffing marketplace where healthcare orgs can “hire” generative AI agents that complete low-risk, non-diagnostic, patient-facing tasks.

  • Initial roles for the AI agents include chronic care management, post-discharge follow-up for specific conditions (congestive heart failure, kidney disease), as well as SDOH surveys, health risk assessments, and pre-operative outreach.
  • The agents won’t be allowed to speak with patients unsupervised until phase three testing is completed, which involves its 40+ partners and 5,500 licensed clinicians interfacing with the agents as if they were patients.

Shareholder hero and NVIDIA CEO Jensen Huang demonstrated a care manager agent named “Diana” on stage at GTC, and this video of the demo will tell you everything you need to know about the look and feel of Hippocratic’s first product. 

  • NVIDIA also announced that it’ll be working alongside Hippocratic to develop “super-low-latency conversational interactions,” which will reportedly cost about $9/hr to run on the company’s hardware.

Critics are hard to avoid when you hit a half-billion valuation before launching a product and start throwing around terms like “Health General Intelligence (HGI).” Most critics seem concerned about medical device classifications, venture capital mania, and some past lawsuits, but time will tell which critiques (if any) can stop Hippocratic’s momentum.

The Takeaway

Despite all the talk about whether a general purpose healthcare AI is possible or safe, Hippocratic has an elite roster of VCs and provider partners that are willing to help it find out. Hippocratic definitely has the talking points nailed, now we’ll have to wait and see whether it has the operational chops to back them up.

Innovaccer Acquires Pharmacy Quality Solutions

It’s already shaping up to be a big year for Innovaccer, which just announced its second acquisition in three months after picking up pharmacy-payor performance company Pharmacy Quality Solutions (PQS).

PQS connects payors and providers to standardized tracking of medication quality measures, plus value-based reimbursement programs focused on adherence, outcomes, and safety.

  • The PQS platform is designed to optimize medication management for Medicare, Medicaid, and commercial populations, covering 95% of all community pharmacies, the top 10 pharmacy chains by store count, and over 60 million lives.
  • The acquisition not only accelerates Innovaccer’s VBC roadmap, but also adds a treasure trove of pharmacy data to Innovaccer’s existing ecosystem of payors and providers – not to mention the potential to cross-promote services to complementary payors and pharmacies.

The talk on the show floor at HIMSS was the we could see as many as four more acquisitions from Innovaccer before the end of the year, targeting data-oriented teams that can propel Innovaccer’s three-pronged forward strategy:

  • Value – transitioning from fee-for-service to value-based care (Health Cloud and PQS)
  • Productivity – shifting from burnout to AI-driven productivity (upcoming AI Copilot)
  • Experience – moving from encounter-based care to experience-driven care (Cured acquisition)

While last year failed to produce a much-anticipated spike in M&A fueled by attractive valuations, startups’ increasingly depleted war chests have set up the current market to be even more favorable for potential acquirers.

  • Startups working with enterprise customers could start leaning toward mutually beneficial acquisitions from their partners, which helps founders find a path forward while allowing enterprises to sustain their work with valuable clients. 
  • Others like Innovaccer will be looking to M&A to bolt-on complementary features or capture market share in adjacent categories. While running out of runway might not guarantee more M&A activity, it certainly tips the scales in that direction.

The Takeaway

Innovaccer is quickly delivering on its ecosystem approach to integrating payors, providers, and pharmacies through a connected AI-enabled data infrastructure. Although an acquisition’s success is determined as much by the hard work put in post-announcement as it is by the target, Innovaccer so-far appears to have its playbook dialed.

HIMSS 2024 Recap and Major Announcements

It’s the final day of HIMSS 2024, and although most exhibitors are still either valiantly stationed at their booths or playing hooky at Disney World, the giant wave of announcements has already crashed and it’s time to round up some of the biggest stories from the show.

The topics du jour among the ~35,000 attendees weren’t entirely unexpected. Generative AI was definitely the main course, but with an especially heavy portion of HIMSS’ signature interoperability sauce poured over it following the TEFCA go-live. Cybersecurity was also an even more popular side dish than usual (anyone’s guess as to why).

HIMSS24 major announcements, launches, and partnerships:

  • Abridge added UCI Health to its quickly growing roster of health system deployments, and the system-wide ambient AI roll out sounds like it’s already helping out significantlywith “pajama time.” The expansion hits less than a month after Abridge closed its $150M Series C.
  • Altera Digital Health showcased Paragon Denali, its cloud-native EHR built on Microsoft Azure that’s designed for rural, critical access, and community hospitals. Paragon Denali’s SaaS model gives smaller hospitals a single platform for managing clinical and financial data without having to do the heavy lifting of on-premises implementations and upgrades.
  • Ambience Healthcare is now fully integrated with Oracle’s Cerner Millennium EHR, enabling clinicians to seamlessly interface with Ambience’s medical scribe, coding assistant, and full suite of generative AI products within their standard workflows.
  • Caregility presented its new class of adaptive telehealth edge devices that support multiple audio and video streams at the bedside, enabling providers to deploy advanced hybrid care delivery models at scale.
  • emtelligent unveiled the next generation of its medical AI platform dubbed emtelliPro+, which uses a custom medical LLM to produce hallucination-resilient outputs that can be used to make safe determinations in even the most complex use cases.
  • Google Cloud launched Vertex AI Search for Healthcare, a genAI tool that allows providers, payors, and life science orgs to make better use of their clinical data. Users can search for information across clinical notes, scanned documents, and other data sources to find natural language answers to their questions (e.g. patient medical history).
  • Hyro announced a long-term strategic partnership with healthtech consulting firm Disruptive Innovations that’ll see Hyro’s Responsible AI platform and voice assistants help DI’s clients address key challenges such as agent burnout, patient access, and operational efficiency.
  • Innovaccer previewed its upcoming provider AI copilot, a portable tablet designed to deliver multi-solution clinical support at the point-of-care. Not to outshine its foray into the hardware game, Innovaccer also announced its acquisition of Pharmacy Quality Solutions to accelerate VBC in pharmacy settings. Stay tuned for a deeper dive on this next week.
  • Intermountain Health became the first organization in the world to attain Stage 7 validation of the HIMSS Infrastructure Adoption Model (INFRAM), which basically means it’s the bee’s knees across all corners of care delivery, including clinical outcomes, adoption, sustainability, performance, and cybersecurity. We’ll unpack the newly modernized INFRAM framework in an upcoming issue, and want to give a major congratulations to Dr. Farukh Usmani and team.
  • Juno Health demonstrated a range of new features within its modular EHR that enhance its user experience through personalization, including a Clinical Content Builder, Care Planning tool, and Treatment Plan solution.
  • Linus Health introduced two huge upgrades to its cognitive impairment detection platform, including Hearing Screener tests to identify signs of MCI and a new Digital Trail Making Test Part B (an FDA Class II medical device designed to capture more data than traditional paper-based exams). The cherry on top? Linus also acquired speech analytics vendor Aural Analytics.
  • Microsoft is spearheading the Trustworthy & Responsible AI Network (TRAIN), a consortium of top tier organizations aimed at operationalizing responsible AI principles in healthcare. The packed announcement also casually included three major deployments for Nuance’s DAX Copilot at Stanford Medicine, WellSpan Health, and Providence.
  • Nabla announced that Children’s Hospital Los Angeles (the largest pediatric multi-specialty medical group in the US) has selected Nabla Copilot to streamline clinical documentation after collaborating closely throughout the pilot to tailor specific capabilities for the unique requirements of pediatrics in a hospital setting.
  • Philips expanded its partnership with AWS to combine its expertise in digitization and pathology with AWS’ scalable cloud solutions to help pathology labs store, manage, and analyze growing volumes of digital pathology data.
  • Salesforce debuted Einstein Copilot: Health Actions, a new solution geared toward letting healthcare workers submit natural language prompts to summarize information, update patient and member data, and automate manual outreach.
  • Surescripts put out a gem of a report on health intelligence sharing in the US, highlighting the fact that its network saw a mindblowing 24 billion exchanges of clinical and benefit information in 2023. The report is filled with insights that make it a must-read, including the fact that last year saw 10% growth in e-prescribing among non-PCPs (29% among pharmacists), and a 49% increase in electronic processing of prior auths.
  • symplr took the lid off symplrAI, the culmination of its enterprise-level approach to AI/ML integration for accelerating productivity gains in healthcare. symplrAI will leverage genAI services from AWS, including Amazon Bedrock and Amazon Q, to bolster both established and new AI capabilities within symplr’s SaaS portfolio.
  • Talkdesk introduced Talkdesk Autopilot for Healthcare, a generative AI solution built to deliver EHR-integrated self-service experiences to resolve complex needs without burdening human contact center agents.
  • Wolters Kluwer Health unveiled its newly unified UpToDate portfolio of Clinical Decision, Drug Referential, and Patient Engagement solutions to improve interoperability and care coordination. On top of that, WK announced that its AI Labs solution now has access to the complete set of UpToDate’s evidence-based clinical content and graded recommendations across over 25 specialties. 

For the first HIMSS meeting since the conference changed hands to Informa ownership, the upbeat show floor still seemed right at home in the Florida sunshine. We hope that everyone had an awesome time if you made it out in-person, and welcome all of our new readers that we met at the show!

Medicare Advantage Lacking In Home Care

A study in JAMA Health Forum stirred the pot ahead of a busy HIMSS week by suggesting that Medicare Advantage patients are getting skimped on home care.

Researchers conducted a cross-sectional study of 178k traditional Medicare and 107k Medicare Advantage patients, analyzing those who had care between 2019 and 2022.

Compared to their Medicare counterparts, MA patients:

  • Saw shorter home health lengths of stay (-1.62 days)
  • Saw fewer nursing, therapy, and aide visits (social work was the only exception)
  • Had 3% lower odds of improving mobility
  • Had 4% lower odds of improving self-care metrics
  • Were 5% more likely to be discharged to the community

While home health isn’t a massive focus for most MA plans, it’s an important resource for keeping patients out of nursing facilities or other long-term care.

  • MA beneficiaries are also more likely to live alone and without a large support network, so the fact that they’re getting discharged to the community more frequently – combined with less mobility improvement – isn’t a great recipe for success.

The study doesn’t dive into the cause behind the discrepancies, but whether the differences are due to the administrative burden or cost-limiting incentives of MA plans, the negative implications for patients are clear. Less functional independence, and more caregiver burden.

The Takeaway

With over half of Medicare beneficiaries now enrolled in MA plans, there’s a growing concern over how the plans are operated, and whether the fences they set up around coverage are limiting access to treatment. All-in-all, this study seems to validate that concern, and reinforces the need for keeping a close eye on outcomes as MA enrollment continues its upward trajectory.

Think Twice Before Targeting Employers?

Second Opinion published an absolute opus on why digital health startups starting out today should think twice before targeting employers, with a few notable exceptions included for the brave founders among us.

Self-funded employers have long been a fan-favorite of digital health startups. They’re often faster moving than payors, with not only their own large populations and healthcare budgets, but also an added incentive to pick up exciting new benefits to attract the best talent.

Why wouldn’t you target them? OMERS Ventures Principal Christina Farr and Big Health Co-Founder Peter Hames make the case that the tried-and-true playbook of signing a critical mass of employers before leveraging it to get into health plans doesn’t work like it used to.

  • The competition is intense. A decade ago, you could count the number of solutions in any given space on your fingers, and benefits leaders had the bandwidth to interface with startups directly. Over $100B has since poured into digital health startups, and middlemen groups like EHIR have popped up to filter vendors before they reach employers. It’s hard to break out from all that noise (but not impossible).
  • Vendors are now expected to share risk. The days of fixed “per employee, per month” contracts are behind us, and most vendors are now expected to bring some form of performance guarantee. Although this trend is great for vendors that can deliver, it isn’t ideal for new entrants that now need more overhead to track outcomes and have less visibility into forward business.
  • Point solution fatigue. An abundance of point solutions has caused employers to narrow their focus toward platforms with broad offerings that focus on high cost, high prevalence problem areas. Again, not great for companies getting their start with a specialized offering. Potential exceptions include startups focusing on areas that receive a sudden boost in public attention, such as weight loss or menopause.
  • The market now has mature incumbents. Even if you’re addressing a real need, the likelihood that an employer already has an established solution is far higher. That doesn’t mean you can’t compete, but the bar is definitely higher.

When should you target them? There’s a whole section dedicated to this question that’s worth checking out if you’re playing in this sandbox, but the overarching message is clear: “the solution itself – and the impact it delivers – need to be articulated as powerfully and simply as possible.”

The Takeaway

Employers have kickstarted plenty of success stories over the years, including names that are easy to look up to like Omada, Hinge Health, and Maven Clinic. Just because top tier articles are now getting published on why you shouldn’t target employers, doesn’t mean it isn’t still a good strategy. It’s just more important than ever to make sure you’re asking yourself the right questions before going down that path.

b.well Closes $40M Series C to Unify Patient Data

Patient data unification startup b.well Connected Health cut through last week’s tradeshow noise with $40M in Series C funding to advance its mission to solve healthcare’s fragmentation problem.

b.well was founded in 2015 by a former UnitedHealthcare exec whose daughter suffered a near-fatal medical error when two EHRs weren’t connected, and has since raised just under $100M to make sure patients have one-stop mobile access to their data.

b.well’s FHIR-based platform unifies health data, solutions, and services into a single solution, enabling healthcare organizations to offer customizable experiences powered by longitudinal health records and proactive insights.

  • The white-labeled solution integrates data across healthcare providers, payors, labs, and devices, which lets its clients create personalized user flows while allowing patients to access all of their health data within a single interface.
  • b.well then provides tailored content that guides patients to specific actions, using behavioral nudges and plain language explanations to engage them.

The Series C arrives on the heels of a partnership between b.well and Samsung, which gave Galaxy smartphone users control over their longitudinal records and easy access to care from a provider network that includes Walgreens, ThedaCare, and Rise Health.

  • The partnership could also open up a huge market for b.well, considering that Samsung Health recorded 64M monthly users in 2023.
  • As a kicker, Samsung’s former Head of Digital Health joined b.well’s board of directors through the investment, after playing a key role throughout the integration.

The Takeaway

For all of the healthcare industry’s talk about meeting people where they are, it’s still rare that patients know what services are available, let alone how to access them. b.well now has $40M to help it unify health data in a way that makes these experiences possible, while also empowering organizations to stand out in a market where value is increasingly defined by choice and transparency.

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