Month: September 2024

Providence Spin-Out Praia Brings Flywheels to Healthcare

Posted on by Jason Barry

The ink is officially dry on Providence-spinout Praia Health’s $20M Series A fundraise, and we couldn’t have asked for a better frame up of the startup’s potential impact than SignalFire’s investment memo on why it co-led the round.

Praia Health is helping hospitals avoid the commoditized care caravan by enabling the creation of consumer profiles that extend beyond the medical record, allowing them to recreate the “digital flywheels” enjoyed by other industries.

  • These flywheels have been hindered by healthcare’s reliance on the legacy architectures and closed-system constraints of the EHR, which fails to incorporate the behaviors happening outside of medical encounters that drive a lion’s share of health outcomes. 

Here’s how Praia enters the picture:

  • The first step is a “lift and shift” to Praia’s Secure Patient Identity Service that enables a single sign-on for all of a system’s digital experiences (branded apps, portals, etc.).
  • Praia’s PersonStore then marries those patient profiles with consumer data, synchronizing the EHR to connect-the-dots between outside data and outcomes. 
  • The SPI and PersonStore capabilities lay the groundwork to link Praia’s growing partner ecosystem into ecommerce-like experiences that emphasize patient satisfaction and loyalty – critical priorities for C-suites grappling with margin pressure and patient attrition.

SignalFire’s history on the patient engagement evolution highlights the leap in Praia’s approach:

  • Gen 1: Unidirectional patient notifications primarily focused on scheduling marked the first step in delivering healthcare info through more accessible channels like SMS.
  • Gen 2: Bidirectional communication transformed medical interactions by giving patients the ability to respond to provider messages.
  • Gen 3: Omnichannel engagement with tech-enabled interactions and seamless integrations let patients perform tasks like rescheduling appointments with options pulled from the provider’s practice management software.
  • Gen 4: Praia Health’s breakthrough – an AI-powered patient engagement suite and automated actions driven by deep EHR integration to connect all data sources and orchestrate the end-to-end patient experience.

The Takeaway

The healthcare industry is at a well-traveled crossroads, facing the same challenges as the banking sector encountered with the rise of online services. Just as fintech companies disrupted banking with fine tuned experiences and lower costs, digital health startups are going after health systems’ lowest hanging service lines with the same promises. Praia gives providers a way to fight back with the tried-and-true digital flywheels that have so-far been out of reach.

Sync Fast and Solve Things

Posted on by Jason Barry

The “move fast and break things” motto might work wonders with consumer products, but a new editorial in npj Digital Medicine makes a compelling case that healthcare needs to flip that paradigm on its head and co-create with clinicians to “sync fast and solve things.”

The editorial argues that healthcare practitioners (HCPs) should play an active role in driving digital health innovation, as opposed to being passively “consulted” so that developers can tout the fact that their product is backed by clinicians.

  • The breakneck pace of digital innovation in the wake of the pandemic has outpaced the inclusion of HCPs in the co-creation of new solutions, leading to a fight-or-flight response where clinicians are reluctant to adopt said solutions to defend their traditional responsibilities. Separate research seems to back that up.
  • If new tools lack product insight and buy-in from HCPs, they’re significantly more likely to be doomed to clinical irrelevance, as showcased by a recent analysis that found 44% of digital health companies have a clinical robustness score of 0 out of 10.

Although it isn’t an earth-shattering revelation that HCPs have a solid grasp on the exact workflows needed to inform clinically relevant solutions, the authors offer three considerations for shifting from “passive” to “active” co-creation.

  • First, financial incentives alone aren’t enough to ensure busy clinicians can engage in meaningful co-creation. The most important incentive that companies can offer clinicians is time, particularly by delivering a product that can optimize workflow efficiency or help deliver quicker treatments.
  • Second, the article stresses a need to embed digital health technologies in clinical curricula so that HCPs can learn about not just using these new tools, but also translating their experience into better-informed products.
  • Lastly, the authors lay out why there’s a role for regulators to mandate that HCPs participate in digital health innovation, and suggest that payors and legislators consider augmenting their approval processes by requiring HCPs be involved in the development of new solutions to serve as a proxy for their clinical safety and efficacy.

The Takeaway

Healthcare clearly isn’t the best sandbox to “move fast and break things,” but this article is an important reminder that “sync fast and solve things” shouldn’t mean trading clinician input for speed. While passive co-creation might help with the marketing materials, giving clinicians an active role in product development is the only way to ensure their experience is reflected in digital innovation.

MedArrive Shifts Gears to ClinOps Orchestration

Posted on by Jason Barry

The best path forward isn’t always the same one you started down, which is why MedArrive is pivoting from delivering in-home care to “ClinOps orchestration for healthcare@home.”

MedArrive got its start at Redesign Health in 2020, powering care-at-home programs for payors and managed care groups by integrating physician-led telemedicine with in-home care from EMS professionals.

  • Although MedArrive saw great results reducing ED usage and hospitalizations among the Medicaid populations that it worked with, the lackluster reimbursement meant that it would be a rough road to building a sustainable business.
  • Instead of ignoring that economic reality and fueling visits with its $40M of VC funding, MedArrive decided to chart a new course where it could leverage its lived experience to enable other in-home providers to deliver better care.

To meet the needs of its own providers, MedArrive developed a comprehensive platform that handles:

  • Patient and Labor Capacity Planning – models patient engagement and staffing needs
  • Resource and Shift Management – ensures optimal labor use for anticipated visit volume
  • Scheduling and Routing Optimization – maximizes utilization by minimizing driving
  • Care Coordination – EHR-integration informs care planning and supports documentation
  • Monitoring and Analytics – highlights critical efficiency, ROI, and clinical outcome levers

MedArrive is now focused on fine-tuning the tech infrastructure that it built for its own providers to meet the needs of other organizations looking to deliver high-quality in-home care.

  • That’ll start by teaming up with other providers to co-develop new features and integrations to translate MedArrive’s own success to more partners, with full commercialization planned at some point over the next year.

The Takeaway

One of the best ways to get close to the problems of your end users is to spend time in their shoes, and it’s hard to get closer than MedArrive has by actually delivering in-home care. That experience should give MedArrive a leg up on competing platforms if it can help replicate its results with new partners.

Fabric Leans In On Virtual Care With TeamHealth

Posted on by Jason Barry

Fabric is back at it again with another acquisition, this time scooping up the virtual care business of physician practice juggernaut TeamHealth.

Here’s the updated timeline leading up to Fabric’s fourth acquisition in 18 months:

  • March 2023 – Florence launches with $20M to tackle ER capacity constraints
  • May 2023 – Florence nabs Zipnosis from Bright Health 
  • Jan 2024 – Fabric rebranding and GYANT acquisition
  • Feb 2024 – Fabric closes $20M Series A led by General Catalyst
  • June 2024 – Fabric acquires MeMD from Walmart
  • Sept 2024 – Fabric picks up TeamHealth VirtualCare

That’s an unusually hot start for a startup still looking forward to its second birthday, but Fabric CEO Aniq Rahman walked Business Insider through the method behind the madness.

  • After bringing a consumer mobile experience to the ER, Fabric acquired Zipnosis to add asynchronous telehealth capabilities and accelerate its roadmap to new sites of care.
  • That apparently worked like a charm, so Fabric picked up GYANT’s conversational AI to serve as a patient entry point to its other offerings, then followed that up by grabbing MeMD and its 30k corporate/payor partners.

The latest move with TeamHealth VirtualCare officially gives Fabric access to over 100M lives in managed care contracts with payers, as well as a 50-state network of clinicians.

  • TeamHealth also broadened Fabric’s medical group with multi-specialty experience, including cardiology, sports medicine, OB/GYN, and family medicine.
  • On top of that, the health systems working with TeamHealth VirtualCare will transition to Fabric, providing plenty of surface area to start cross-promoting other services.

Put it all together, and Fabric’s strategy of acquiring both capabilities and customers has led to it having a rare amount of each for such a young company – not to mention an eight-figure ARR (reported during the GYANT acquisition) that’s probably well on its way to adding another digit.

The Takeaway

Fabric is leaning in on virtual care at a time when massive players are bowing out completely, creating an ecosystem of solutions that pushes the telehealth economics in a positive direction that’s hard to achieve with narrower strategies. That M&A playbook isn’t a secret, and given where we’re at in the investment cycle, Fabric probably has quite a few companies knocking on its door looking to be the next solution in its portfolio.

Patients Ready For GenAI, But Not For Everything

Posted on by Jason Barry

Bain & Company’s US Frontline of Consumer Healthcare Survey turned up the surprising result that patients are more comfortable with generative AI “analyzing their radiology scan and making a diagnosis than answering the phone at their doctor’s office.”

That’s quite the headline, but the authors were quick to point out that it’s probably less of a measure of confidence in GenAI’s medical expertise than a sign that patients aren’t yet comfortable interacting with the technology directly.

Here’s the breakdown of patient comfort with different GenAI use cases:

While it does appear that patients are more prepared to have GenAI supporting their doctor than engaging with it themselves, it’s just as notable that less than half reported feeling comfortable with even a single GenAI application in healthcare.

  • No “comfortable” response was above 37%, and after adding in the “neutral” votes, there was still only one application that broke 50%: note taking during appointments.
  • The fact that only 19% felt comfortable with GenAI answering calls for providers or payors could also just be a sign that patients would far rather talk to a human in either situation, regardless of the tech’s capabilities.

The next chart looks at GenAI perceptions among healthcare workers: 

Physicians and administrators are feeling a similar mix of excitement and apprehension, sharing a generally positive view of GenAI’s potential to alleviate admin burdens and clinician workloads, as well as a concern that it could undermine the patient-provider relationship.

  • Worries over new technology threatening the relationship of patients and providers aren’t new, and we just witnessed them play out at an accelerated pace with telehealth.
  • Despite initial fears, the value of the relationship prevailed, which Bain backed up with the fact that 61% of patients who use telehealth only do so with their own provider.

Whether you’re measuring by patient or provider comfort, GenAI’s progress will be closely tied to trust in the technology on an application-by-application basis. Trust takes time to build and first impressions are key, so this survey underscores the importance of nailing the user experience early on.

The Takeaway
The story of generative AI in healthcare is just getting started, and as we saw with telehealth, the first few pages could take some serious willpower to get through. New technologies mean new workflows, revenue models, and countless other barriers to overcome, but trust will only keep building every step of the way. Plus, the next chapter looks pretty dang good.

Value-Based Care Quality Measure Overkill

Posted on by Jason Barry

Value-based care has worked better on paper than in practice, and a new research letter in JAMA Health Forum offers a possible explanation for the disparity: administrative overkill.

The first-of-its-kind analysis tracked 890 primary care physicians in value-based care contracts from 2020 to 2022, finding that:

  • PCPs tracked an average of 57 quality measures.
  • The average VBC contract contained an average of 10.2 quality measures.
  • The average number of VBC contracts held went from 9.4 in 2020 to 12.3 in 2022.
  • This chart has the full breakdown.

The first bullet alone shocked the authors of the study, as well as most industry onlookers who  

expected payors to have some form of quality measure coordination.

  • The fact that the PCPs held an average of 11 VBC contracts with 10 quality measures each, and still managed to have 57 different quality measures shows how little coordination (if any) actually takes place.
  • Extrapolate that administrative burden to an average panel size of 1,309 patients, and it’s no surprise that more providers aren’t lining up to jump on the VBC bandwagon.

What would help the situation? Although out of scope for this study, a well-timed Commonwealth Fund focus group with 29 PCPs explored answers to that exact question.

  • The PCPs were concerned that many utilization and cost measures unfairly penalized them for outcomes beyond their control (ex. acute hospitalizations and total Medicare expenditures are also affected by other providers and specialists), and felt these measures should only apply to health systems or ACOs rather than small practices.
  • The PCPs thought measures of access (ex. appointment availability, wait times) and continuous care (ex. repeat visits with the same doctor, communication) would better reflect true high-quality care.
  • The lack of alignment across models and payors caused PCPs to use more time “meeting the requirements of payors than meeting needs of patients,” and they urged the government/employers to encourage consistent measures and reporting requirements.

The Takeaway

If value-based contracting is intended to promote high-quality care, does having doctors try to optimize for 50 different quality measures really accomplish that? An uncoordinated approach is not only unsustainable, but also counterproductive. Quality measures that amount to visit distractions and provider burnout aren’t a recipe for long-term success, and this study makes it clear that better coordination is a missing ingredient.

Spotlight on Employers, Thatch and Sounder

Posted on by Jason Barry

Help is on the way for employers grappling with rising healthcare costs after two separate startups closed funding to tailor benefits to the needs of employees.

Thatch raised a $38M Series A to dislodge health coverage from employment by providing individual coverage health reimbursement arrangements (ICHRA) that let employees choose their own benefit plans.

  • By blending fin-tech and health-tech tools, Thatch gives employers a way to “abstract away the complexity” of the ICHRA law that passed in 2020, which enabled them to provide a budget to employees for selecting health benefits based on their needs.
  • The Thatch platform streamlines budget setting, plan selection, and lowers costs through pooled purchasing power. If employees spend less than their budget, they receive a Thatch debit card to use for things like prescriptions, copays, and therapy.

Sounder Benefits hatched from the Redesign Health incubator with $7.5M to take a more hands-on approach to benefit design using AI-driven insights and strategic advisory services.

  • Sounder helps employers with <1k employees create a three-year benefit roadmap then guides their transition to level-funded and self-funded plans, providing HR teams with white-glove support and collecting revenue on a per member per month basis.
  • Using employee health data, Sounder identifies when employers have enough of a particular health need (like cancer support), then contracts with companies to provide access to solutions (like Jasper Health).

The back-to-back boost for benefits businesses arrives as employer healthcare costs are expected to spike 9% in 2025, surpassing $16k per employee.

  • Employers continue to bear the brunt of rising costs, and are looking for more ways to avoid passing expenses onto employees in a tight labor market.

The Takeaway

Most current health benefits solutions were designed for a workforce that stayed with a single company for most of their careers, and have had a tough time keeping up with today’s dynamic labor market. Thatch and Sounder Benefits are among a new pack of startups building the infrastructure for a modern benefits experience, and it seems like both employers and employees have a lot to look forward to.

Shrinkflation Hits Healthcare

Posted on by Jason Barry

Shrinkflation is hitting healthcare, and patients aren’t too happy about longer waits for shorter visits.

NYC Health and Hospitals rocked the boat last week after telling its primary care physicians to slash appointment times in half to 20 minutes, so they could squeeze in more patients.

  • The public health system is grappling with 50,000 new primary care patients since 2021, which caused wait times to double to an average of 22 days.
  • It’s a rough situation, and the physicians are understandably worried that shorter appointments will only hurt care quality and contribute to even more burnout as NYC HH was already struggling to compete with its private counterparts for clinical staff.

Nearly 1 in 5 patients now have to wait over a month before seeing a physician, with 43% reporting longer waits since the pandemic.

  • Rising patient volumes and pent-up demand were the stars of the show during health systems’ Q2 investor calls, but the supply of providers has struggled to keep up.
  • Ramping up physician training and recruitment hasn’t put much of a dent in the issue, and desperate systems are turning to shrinkflation to (temporarily) balance the equation. 

A vicious cycle gets created when the escalating needs of an aging population get answered with less care for individual patients. Worse care only causes demand to grow faster, which is why new solutions are needed to break the cycle.

  • Sutter Health told Axios that it’s investing in scheduling and referral tools to speed up wait times and streamline administrative workflows. Sounds better than 20 min visits.
  • Providence said that it’s been leaning in on capacity optimization software to identify scheduling gaps and ensure that its surgical suites are operating with limited downtime.

While not every health system has the same resources as Sutter or Providence, most could probably avoid some costly headaches by incorporating lessons from the success of their peers, like not trading short-term solutions – shrinkflation – for bigger problems down the road. 

The Takeaway

Times are tough, but shrinkflation is a brittle crutch.

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