ViVE 2024 Recap and Major Announcements

ViVE Los Angeles is officially a wrap, and the collaborative event between HLTH and CHIME keeps growing up right before our eyes.

The show’s third year eased up on the flashy displays and DJs that were hard to miss in Miami and Nashville in favor of a more down-to-business approach, not unlike the AI conversations happening in the expo hall.

True to form, the vendors were the stars of the show, so we’ll follow ViVE’s lead and get right into some of the biggest announcements that came out of La La Land:

  • Arcadia unveiled its next-generation data platform powered by an open lakehouse architecture. We won’t pretend to know exactly what that means, but it’ll apparently be a nice boost to Arcadia’s population health and value-based care capabilities.
  • Artera gave an update on its digital health marketplace, which now includes 50+ vendors after bringing on newcomers like Azara Healthcare, Health iPASS, and Memora Health. Artera’s Message API now receives a whopping 150 million calls each year.
  • AvaSure rolled out its Episodic virtual care solution that allows care teams to seamlessly collaborate regardless of location around admissions, discharges, rounds, and specialty consults.
  • Biofourmis is partnering with GE HealthCare to enhance continuity of care during transitions from the hospital to the home. Biofourmis’ care-at-home solutions will extend GE HealthCare’s inpatient monitoring portfolio.
  • Brightside Health announced a string of new payor partnerships to support Medicaid and Medicare after moving into the space a few months ago. The big name roster includes CareOregon, Blue Shield of California, BCBS of Texas, and Centene.
  • CancerX revealed the 16 members of its inaugural Startup Accelerator, which includes a healthy mix of up-and-comers across clinical research, diagnosis, treatment, operations, and care experience. 
  • DeepScribe is working with Amazon Web Services to scale purpose-built healthcare LLMs, and is incorporating AWS HealthScribe into its platform while also making its ambient documentation tool available to health systems through AWS Marketplace.
  • Elevance is launching a digital weight management program for employer clients of its CarelonRx PBM. Users who are prescribed GLP-1s will have access to medication management support and a digital companion module.
  • Gozio released new data showing that 86% of patients who received medical care in the last year used a mobile device when interacting with their provider. Although using a single platform to reach their provider is important to nearly all patients, 46% are still using multiple.
  • Highmark is joining forces with Epic and Google to bring more data to the point of care. Epic’s Payer Platform will enable “bidirectional” data sharing between the payor and providers, while Google Cloud will allow the tech to integrate with Highmark’s existing systems.
  • Included Health is embedding the CDC’s Healthy Days measure into its navigation service following a successful two year pilot.
  • Vale Health made its grand debut as it looks to build an online marketplace of vetted wellness offerings for consumers, and it already has sixteen health systems in its corner.
  • Veda Health is teaming up with Humana to improve the accuracy of its provider directories and ensure that seniors have real-time details about in-network providers. Love to see this come full circle after Veda got its start in a Humana hackathon back in 2016.
  • Xealth’s Digital Health Review showed how digital tools are reshaping surgery, chronic care, and preventive services. Preventive care programs are seeing the highest levels of patient engagement, while surgery preparation programs see the highest enrollment.

Huge thanks to all of our readers who were in LA and took the time to walk us through the latest and greatest. For everyone holding onto more announcements for HIMSS, we’d love to connect in Orlando. Hit reply and let’s get it on the books!

The Case For More Retailers and Health Systems to Partner

A new viewpoint in the Harvard Business Review made the case that health systems and retailers are only scratching the surface of their partnership potential.

The authors – a trio of professors out of Harvard and UNC – outline four actions they believe health systems and retailers should take to better coordinate their complementary services.

Move Beyond Convenience. Retailers like CVS and Walmart are beginning to add services such as primary care, mental health counseling, and home care, yet even more robust solutions like Amazon Clinic still fall short of integrated care. 

  • Things like cancer treatments and surgeries remain well outside the realm of retail health, yet a close partnership between a retailer and a health system could help integrate the many elements involved in treating more-serious conditions.

Move Care Into the Home. Although retail clinics are more convenient and accessible than hospitals, patient homes have them beat on both metrics. Hospitals have begun offering more care in the home, but often lack the logistical prowess to supply patients with the monitoring tech needed for larger programs.

  • Efficiently equipping patients’ homes with RPM devices is right in the retailer wheelhouse, and a partnership could fill the gap. Look no further than Best Buy and Geisinger for proof.

Leverage Data to Improve Care. The data held by retailers and health systems largely remains in separate databases, with some notable exceptions like Target-Kaiser Permanente.

  • The authors point out that better integration could help with everything from flu outbreak prediction (grocery carts filled with tissues = sick people) to food-as-medicine programs (well-timed nudges and incentives).

Change Who Delivers Care. Labor shortages are one of healthcare’s biggest immediate obstacles, and few employers have a larger workforce than retailers. The article gives the example of Walmart, which subsidizes education for its employees to train for roles like pharmacy technician and medical assistant.

  • Health systems could ensure these training programs meet quality standards and help graduates find jobs, creating a model where retailers attract more ambitious candidates and providers have a new talent pool to tap into.

The Takeaway

One way or the other, retailers are moving past the Retail Care 1.0 era, and it’s hard to argue against the case for tighter retailer-provider partnerships. Even if consumers might not jump at the idea of sharing their grocery list with their physician, the ideas outlined in this article are good food-for-thought for combining the complementary strengths of retailers and providers to improve the system as a whole.

Rock Health 2023 Full-Year Funding Recap

Rock Health’s 2023 digital health funding numbers are in, and although they’re every bit as bleak as expected, there were some silver linings that could bode well for the year ahead.

Here’s 2023 by the numbers:

  • US digital health funding totaled  $10.7B across 492 rounds ($21M average)
  • Q4 funding totaled $1.9B across 122 rounds (lowest quarterly total since Q3 2019)
  • Unlabeled rounds accounted for a record 44% of annual total
  • Surprisingly no pronounced spike in startup shutdowns

Last year’s $10.7B funding total was the lowest seen since 2019, but Rock Health points out that the real story often gets missed by the headline number. (Chart: Funding Trend)

  • Most startups tend to raise every 12-18 months, however Rock Health’s database shows that 81% of US digital health startups that raised in 2021 or earlier haven’t closed a subsequent labeled round.
  • Silent rounds (quiet raises from existing investors), Series extensions, and unlabeled rounds appear to have been the tools of choice to stay afloat.

Rock Health’s predictions for 2024 

  • Labeled raises will return – The startups that extended their runway with creative financing will need to produce proven outcomes data or showcase new products to keep investors interested. This year will separate the best from the rest, and the latter group will be looking at adjusted valuations (down rounds) or restructured cap tables.
  • M&A pace will accelerate – 2023 failed to produce the uptick in M&A that was expected to be brought on by attractive valuations, due in part to “higher for longer” interest rates and market volatility. In 2024, getting acquired will start to look like the best path for startups struggling on the fundraising front. (Chart: M&A Trend)
  • The public market cohort will recalibrate After a year without a single digital health public exit, we should see a few of the late-stage players that delayed their listing to wait out market choppiness finally take the plunge, especially those with strong financials. (Chart: Digital Health Exits)

The Takeaway

While last year definitely delivered on “financial creativity” from nimble founders, the transition period can’t last forever, and Rock Health expects some startups will have to face the music in 2024 (i.e. raise at a reduced valuation, seek an acquisition, call it quits). Those are tough decisions to make, but the silver lining is that they’re also the decisions that will strengthen the sector in the long run (i.e. smaller cohort of stronger companies, platform synergies unlocked through M&A, and a more successful IPO class).

Digital Health at the Turn of 2024

Rock Health is wrapping up the year in style by sharing the trends it believes are most likely to move the needle in 2024, based on where they stand along its “innovation maturity curve.

The top trends were plotted along the curve to reflect their funding momentum, research volume, and partnership activity, revealing insights into which innovations are ready to make the leap from hype to impact.

  • Food as Medicine (Maturity Score: Nascent) – Nutritional recommendation platforms are moving beyond their historically narrow set of use cases (“niche” support for type 2 diabetes) to a variety of conditions ranging from mental health to cancer. Keep an eye on: As legislation and reimbursement pathways continue to expand in 2024, more providers will start using food as medicine to differentiate their care delivery models.
  • Digital Obesity Care (Maturity Score: Nascent) – Although GLP-1s were one of this year’s hottest topics, weight management support services like remote monitoring and behavioral coaching are also coming along for the ride. Keep an eye on: Supply chain and accessibility challenges will continue to constrain GLP-1s, and payors could push for more precise triage to determine who gets priority for medication-based programs.
  • AI in Healthcare (Maturity Score: Developing) – AI startups were one of the only groups spared from the venture funding slowdown, raising nearly $2.8B across 101 rounds through Q3. Keep an eye on: Providers and payors will be solidifying their approach to AI governance and thoroughly assessing the tradeoffs between platform-level integrations (EHR plugins) and best-in-breed solutions (built for specific features).
  • Value-Based Care Enablement (Maturity Score: Developing) – With the most partnership growth in the analysis, VBC enablement is gaining commercial traction and moving closer to maturity. Keep an eye on: As health systems continue to consolidate, VBC solutions might be pushed toward platform-ization to address more needs, especially in areas where they’re easiest to adopt (solidified, attributable care pathways).
  • Data Interoperability (Maturity Score: Calibrating) – Interoperability infrastructure is still under construction, with the ONC only recently onboarding the first cohort of QHINs, but commercial partnerships are picking up as regulations stabilize. Keep an eye on: Data will be increasingly important as more powerful analytics tools become available, and disruptive solutions will need built-in insights capabilities as a value-driver.

The Takeaway

If 2023 was digital health’s transition year, Rock Health expects 2024 to be its recalibration year. Major innovations have begun their trek along the maturity curve, and it’s now time to build the strategies that will give them the staying power to keep progressing.

Medallion Sets Sights On Tackling Administrative Burden

Healthcare costs are climbing, burnout is at an all-time high, and new data arrives on a daily basis highlighting the heavy toll that administrative burdens are placing on the workers making care delivery possible. Each of those issues is wildly complex, which is why Medallion is setting out to automate away the cumbersome operational processes at the core of the complexity.

CMS’ just-released 2022 National Health Expenditures helps set the stage by wrapping some numbers around the size of these challenges:

  • US healthcare spending grew 4.1% last year to reach $4.5 trillion, outpacing the 3.2% increase seen in 2021. The two largest slices of that pie belong to hospital care (30% share) and physician services (20%), largely due to the massive amount of administrative and operational overhead that goes into care delivery.
  • That same administrative overhead is placing a huge weight on providers and operations teams, with CDC figures now showing that 46% of healthcare workers are struggling with burnout (up from 32% in 2018).

Medallion tackles this administrative burden with an end-to-end provider network management platform, which streamlines time consuming and repetitive tasks like credentialing, licensing, and payor contracting and enrollment.

  • The credentialing solution automatically performs primary source verifications, checks state licenses and board certifications, and provides alerts on provider eligibility changes to eliminate manual reviews and ensure regulatory compliance.
  • The licensing solution simplifies cross-state licensing and license renewals to help keep up with ever-evolving state requirements, as well as continuing education tracking in all 50 states.
  • The payor contracting and enrollment solution allows organizations to offload the payor negotiation process from start to finish, then solves the problem of getting providers in-network with enrollment services for any commercial and government payor.
  • All of that information is housed in a provider data management dashboard that serves as a centralized view of the provider network, improving oversight and slashing operations task time.

The Takeaway

The healthcare industry has its work cut out for it reigning in administrative costs and burnout, but platforms like Medallion help make sure that the work filling the plates of providers and digital health companies is actually advancing their mission instead of distracting from it. Make sure to schedule a demo here to check out Medallion in action.

How Health-Tech Founders Can Survive a Brutal 2024

Journalist-turned-VC extraordinaire Christina Farr put out a feast of insights just in time for Thanksgiving, with the latest issue of Second Opinion sharing “How Health-Tech Founders Can Survive a Brutal 2024” instead of a rosy predictions post.

Why might things get worse in 2024? In part because most companies raise funding every 18 to 24 months, and those that raised at the top of the market but had a healthy enough burn rate to sit out 2023 will have to come back to the table. Some startups won’t like what they hear when the music stops.

  1. Don’t forget that there’s no shame in letting go… Farr opens her survival guide with some heartfelt advice and a light at the end of the tunnel for the startups that don’t make it. If you end up starting over with a clean slate, you’ll have: 1) a faster path to funding because you’ll know more investors; 2) a better sense of the right hires for the early team; 3) more experience finding the right customers.
  1. Don’t be afraid of a rollup. For companies that are “features” as opposed to platforms, firms are actively looking to invest in roll-ups that keep talented teams intact as they merge with other companies to build comprehensive solutions.
  1. Practice ruthless prioritization to get to break-even. Farr recommends that founders start operating as if they won’t raise another dime. The hard decisions, like cutting a growth initiative that might not pan out, are ultimately what will get expenditures equal to income.
  1. Think through what a liquidity event looks like for your business. Not all companies will see a $1 billion exit. Now’s the time to be realistic about your company’s potential and make smart decisions around that. “If you don’t expect in your heart of hearts that your company can IPO, don’t waste cycles trying to raise a big round at a big valuation.”
  1. Get into short-term survival mode. Farr is in the camp that now probably isn’t the time to step on the gas. Rather than being forced to shut down because of lack of capital, play it tight and maintain optionality. “Sometimes, particularly in healthcare when things tend to be slower, that’s all you need.”
  1. Think carefully about a down round versus structure. When debating whether it’s better to take the hit on valuation or take a term sheet that preserves valuation but includes “structure” provisions that are less favorable, Farr’s team at OMERS Ventures mostly agreed that a down round is preferential. That said, “in 2024, take whatever you can to stay alive!”

The Takeaway

The takeaway here is simple: the frontrunner for this year’s best prediction post is a survival guide, and you should probably be tuning in to Second Opinion.

A Hospital Sector Under Siege

Flare Capital’s Michael Greeley and Dr. Gary Gottlieb published a stellar breakdown of the current challenges barraging US hospitals, unpacking how the convergence of cost pressures and workforce issues is creating a perfect storm of financial distress.

It’s a thorough overview to say the least, but most of the issues fit into a few main buckets that are worth considering when mapping out how to best partner to help tackle them:

  • The median debt-to-EBITDA ratio for US hospitals stands at approximately 3.9x (up from 2.5x in 2021), and 60 health systems have seen their debt ratings downgraded this year. The looming restructuring negotiations are going to be painful.
  • CMS hospital star ratings for 2023, which measure performance along five key areas (mortality, safety of care, readmission, patient experience, timely/effective care), showed slight declines across the board. That directly translates to worse reimbursement.
  • Over 600 of the country’s 1,800 rural hospitals are at risk of closing, and mostly in states with a large number of disenrolled Medicaid members. The upcoming spike in disenrolled patients that no longer have health coverage could be the tipping point for many of these hospitals due to increased bad debt and charity cases.

One “promising shiny penny” for avoiding hospital closures has been the broader adoption of technology to reduce clinical and administrative costs.

  • In today’s environment, hospitals need a clear ROI from their vendors. The writeup makes the case that a more patient-centric care delivery system might sound seductive, but could also actually increase a provider’s overall cost structure. That might give solutions that directly drive better star ratings an edge in the current market.

The Takeaway

Hospitals are a customer base that’s under siege from a ton of angles. It’s tough to solve these problems without first identifying their root causes, and this article is a great tool for honing in on those underlying issues.

HLTH23 Recap and Major Announcements

Another HLTH is in the rearview mirror, and this week’s exhibit hall chatter was a testament to how much things can change in a single year.

It’s hard to believe that this intro for last November’s show didn’t include a single mention of generative AI. In a few short months, nearly every exhibitor has not only thought about incorporating LLMs, but has implemented new features and shipped entire solutions centered around the technology. 

It was also refreshing to see the amount of good ol’ fashioned innovation happening outside of the AI-focused spotlight. To help keep it all straight, here’s our recap of the major announcements, launches, and partnerships from HLTH23: 

  • b.well Connected Health is integrating with Samsung Health to give millions users control of their longitudinal health record plus proactive insights from a growing network of providers, including Walgreens, ThedaCare, Lee Health, and Rise Health.
  • CirrusMD showcased its Physician-first Care & Guidance model that streamlines care journeys by building around the physician, allowing them to overcome traditional limitations of one-to-one encounters through collaborative virtual environments. 
  • Darena Solutions took the lid off its new MeldRx platform-as-a-service that enables the rapid creation of FHIR-compatible healthcare apps, taking much of the guesswork out of app development while ensuring that new tools integrate seamlessly with EHRs.
  • DrFirst unveiled its Fuzion platform that uses “clinical-grade AI” to streamline clinical workflows such as medication reconciliation, eliminating the need for manual data entry while offering analytics on drug fills, patient engagement, and improvement areas. 
  • Google Cloud announced healthcare-focused search capabilities that connect clinical data to the Vertex AI algorithm development platform, functionality that can be combined with Med-PaLM 2 to let providers surface answers to specific medical questions.
  • HATCo – AKA the Health Assurance Transformation Company – is on the M&A hunt after General Catalyst unveiled the company with the intention of acquiring a health system to serve as a proving ground for tech-enabled care. We’ll unpack this one more on Monday.
  • Health Gorilla announced that 17 healthcare organizations have committed to its QHIN once designated (on track to be before the end of the year), a list that included heavy hitters such as Evernorth and Virta Health.
  • MDLIVE, the telehealth arm of Cigna’s Evernorth, acquired the technology behind to begin offering asynchronous options for virtual care in 2024, with plans to expand to chronic condition management and wellness visits at a later time.
  • Nuance shared some impressive results from Atrium Health’s roll out of DAX Copilot, which included 92% of clinicians saying the automatic documentation solution was “easy to use” and 84% reporting an overall improved documentation experience.
  • PEP Health put out a stellar report using AI-powered natural language processing on over 25M patient comments across 8.5M unique web pages to create what might be the first national index on experience scores that doesn’t rely on survey data.
  • Solera Health launched its HALO unified benefits platform that allows payors and employers to manage all Solera and non-Solera point solutions within a single interface, including a consolidated dashboard to assess program effectiveness side by side.
  • SteadyMD is rolling out an all-in-one virtual care solution that combines 98point6’s tech backend with SteadyMD’s 50-state clinician network to help short staffed healthcare organizations lower operational costs while handling additional patient volume.
  • Talkiatry debuted its new Mindshare partner program that lets providers easily refer their patients for telepsychiatric care from Talkiatry’s network of 300 psychiatrists across 44 states, with NYU Langone, NOCD, and Transact Campus signed-on at launch.
  • Walgreens is throwing its hat into the virtual care ring as it continues its strategic pivot to healthcare services, with virtual consultations for common medical needs and prescriptions slated to begin later this month.
  • Withings Health Solutions is partnering with Validic to integrate its suite of cellular devices with the IoT platform, providing seamless access devices such as the Withings Body Pro smart scale and the Withings BPM Connect Pro blood pressure monitor.

Special thanks to everyone at HLTH who caught us up on the latest and greatest, and welcome to all of our new readers we met at the show! Stay tuned for deeper dives into many of these announcements in next week’s Digital Health Wire.

Health System Partnership Playbook

Andreessen Horowitz partner Julie Yoo and Bassett Healthcare CDO Paul Uhrig recently shared their playbook for entrepreneurs looking to partner with health systems, which included plenty of insider tips to stand out in a crowded field.

Getting in the (right) door is the first step to any pitch, but an academic medical center with a healthy mix of payor contracts will have a different lens than a rural hospital serving mostly Medicaid patients.

  • Advice: Research target health systems and make sure they align with your product’s value proposition. Make sure you’re reaching the right person, which usually involves multiple stakeholders across clinical, operational, and financial leadership. The value proposition needs to hold up to each.

Making the pitch will vary by health system (an asterisk that could probably be added to every tip), so it’s important to tailor all information and supporting data to individual priorities. This section stresses that it’s “imperative” to illustrate a positive financial impact. 

  • Advice: Don’t be afraid to ask about budget and clarify your revenue model. Even if stakeholders like the solution, it’s moot if they aren’t able to find the funds for it. 

The evaluation process can run the gamut from informal discussion to formalized diligence, but health systems aren’t usually opposed to giving visibility into the evaluation checklist.

  • Advice: Upfront qualification work is intended to de-risk the implementation process and identify potential blockers early. Be prepared with case studies and references from other customers to support the evaluation process.

Pilot programs are a health system favorite, but clearly defined success criteria and a commitment to move forward if those are met are two key ways to avoid “death by pilots.” 

  • Advice: Try not to get hung up on IT integration, and if possible steer toward an implementation scope that requires minimal integration before phasing into a full-blown integration to ramp up to your product’s full value.

The Takeaway

As Yoo and Uhrig describe it, partnering with providers is a bit like “making an emulsion from oil and water,” especially at a time when many of them are grappling with rising labor costs and slim margins. Health systems see a daily flurry of startups offering to solve these problems, and if this playbook makes one thing crystal clear, it’s that the only way to get a pitch to land is to make it hit squarely in the center of their individual needs.

Rock Health Q3 2023 Funding Recap

Another quarter’s gone in a blink, which means our friends over at Rock Health are already on deck with another recap of the biggest digital health funding trends of Q3.

Here’s Q3 by the numbers:

  • US digital health funding totaled $2.5B across 119 rounds ($21M average)
  • 4 of the past 5 quarters saw funding in the $2B range (establishing new normal)
  • Capital shifting to digital support for disease treatment (notably kidney & heart) 

Although the $2.5B raised in Q3 was the second-lowest total since 2019, it was also the fourth of the past five quarters to log funding in the $2B range – a far cry from the volatility we’ve seen since the start of the pandemic. (Chart: Funding Trend)

  • On top of that, every quarter for the last year has notched an investment count in the low hundreds, maxing out at 131 rounds in Q1 2023.
  • New norms have been established, meaning we’re finally past the shakeout and onto a fresh investment cycle. 

The other major story from Q3 was that capital is shifting away from COVID-era favorites like life science R&D catalysts (a top investment in both 2021 and 2022) toward digital health solutions that support disease treatment. (Chart: Top Value Propositions)

  • Disease treatment is now the most-funded value proposition of the year ($1.6B YTD), including recent raises from Vivante Health (virtual digestive care) and Healthmap Solutions (value-based kidney care).

Value-based care enablement was another obvious standout last quarter, and Rock Health predicts that VBC will become an increasingly important component of commercial roadmaps and enterprise partnerships.

  • This will likely be particularly true in high-cost areas like mental health, cardiology, and oncology, not-so-coincidentally three of the top clinical indications in Q3 funding.

The Takeaway

The headline for the third quarter has a familiar ring to it – overall digital health funding is slowing, but bringing more stability along with it. That predictability is much needed after years of wild market swings, and the new investment cycle is also equipping founders with a clear playbook: find a high-cost area, focus on outcomes, and build a sustainable business.

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