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.
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.
When your target market is growing quickly, it takes funding to keep up, which is why Vytalize Health recently closed a $53M Series B round to help bring value-based care to Medicare enrollees and their primary care physicians.
The latest funding brings Vytalize’s total raise to just over $75M as it looks to enter new partnerships within a Medicare market that’s projected to double in size over the next decade.
Vytalize got its start as a Medicare-focused primary care practice in 2014, but has since developed a vertically integrated platform that combines a risk-bearing entity with an in-home clinic model to help other practices transition to value-based care.
- As an ACO, Vytalize connects physicians and specialists to wrap care around the Medicare population, aiming to improve preventive health services while reducing avoidable hospitalizations.
- The company doubled its patient base to 130k seniors over the past year, and is now partnered with 280 primary care practices across 16 states that account for a combined $2B in annual care delivery.
To help manage high-risk populations, Vytalize equips its clients with a virtual in-home clinic that helps practices deliver better care in the white space between appointments, a task made easier due to the acquisition of patient communication company MedPilot in 2021.
- The influx of capital will help Vytalize integrate a wider network downstream from its primary care partners (hospitals, specialty networks, ancillary providers), while also establishing relationships with more Medicare Advantage and commercial plans.
The Medicare population is one of the hottest corners of the healthcare market, and many startups have sprung up to help providers transition away from volume-based reimbursement.
These companies are making big moves to gain an edge – just look at Devoted Health’s hefty $1.15B Series D round or One Medical’s acquisition of Iora Health for some recent examples – but Vytalize’s latest funding could help it carve out a niche as a novel type of ACO focused on helping strengthening patient-provider relationships through value-based primary care.
Value-based care is a common line item on the strategy whiteboards of many digital health startups, but few are executing on a real-world gameplan at the level of Clarify Health.
Less than a month after acquiring Embedded Healthcare to drive provider behavior change, Clarify is once again the top story of the week following the completion of a massive $150M Series D funding round led by Softbank Vision Fund 2.
To recap Clarify’s solutions, it builds cloud-based applications on top of its Clarify Atlas Platform, which maps over 300M patient journeys to illuminate areas that can be optimized to improve value-based performance.
- The platform links clinical performance to financial impact to boost payer-provider collaboration, while helping target behavioral nudges at the moments when they’ll be most effective.
- Clarify’s scale allows it to apply what it calls a “Moneyball-style” analytical method to healthcare, objectively assessing provider performance to identify the most efficient incentives and interventions.
Clarify’s latest investment is earmarked to accelerate the adoption of its intelligence offerings and payments technology beyond the 75 healthcare organizations it currently serves.
- Although scaling up the client roster is obviously a top priority for most companies, it’s doubly important in the value-based care space, improving the AI-driven models that allow quality care to be compensated fairly and building the provider trust that serves as the foundation of risk-based arrangements.
Clarify Health President Todd Gottula stated that the company was founded to help healthcare organizations benefit from “the big data efficiencies of the banking and consumer industries.” Clarify’s been quickly bolstering its services to make this vision a reality, and if the past year has shown us anything about the company, it’s that it won’t shy away from using its newly replenished coffers to acquire companies aligned with that goal.
Value-based analytics company Clarify Health is acquiring Embedded Healthcare to help cross what it refers to as the “last mile” of creating durable shifts in care models: behavior change.
Although the terms of the transaction were not disclosed, the acquisition comes on the heels of Clarify’s $115M Series C funding round in March 2021, which gave it plenty of capital to invest in companies like Embedded that help make insights from data platforms more actionable.
- Clarify’s cloud-based applications are built on the Clarify Atlas Platform, which maps over 300M patient journeys to illuminate areas that can be optimized to improve value-based performance. The platform links clinical performance to financial impact to boost payer-provider collaboration.
- Embedded was spun out of the UPenn’s Healthcare Transformation Institute in 2019 to apply behavioral economics principles to provider behavior change, such as selecting higher-value care sites for elective procedures. Embedded reports that targeted incentives delivered to the point of care have proven to change 10% of physicians’ decisions in under nine months.
- Combining the Clarify Atlas Platform with Embedded’s incentive framework should help with targeting behavioral nudges at the moments when they’ll be most effective, such as giving early bonuses as soon as positive performance is identified.
Five Pillars of Value Based Care
In an interesting interview with Modern Healthcare, Clarify CEO Dr. Jean Drouin laid out what the company views as the five key pillars for value-based care technology:
- Trusted baseline to assess performance of care delivery
- Digital contracts to help automate progress tracking
- Contracts well-designed to align incentives
- Clinicians are aware of incentives before they make a decision
- Predictive analytics to reduce the lag between action and incentive
Clarify’s core analytics platform centers around the first pillar, while its acquisition of Apervita’s value-based care digitization business in summer 2021 took care of the second one. Now, Embedded’s behavior change technology directly addresses the third pillar, and it doesn’t seem like too much of a stretch to say that clinician communication (pillar 4) and predictive analytics (pillar 5) are now Clarify’s top priorities as it looks to round out its product portfolio.