Tag: digital health

Astrana Joins Forces With Awell to Bring CareOps to VBC

Posted on by Jason Barry

Astrana Health ranks among the rare breed of publicly traded digital health players that can actually turn a profit, so it’s worth paying attention to when they join forces with a company like Awell to push their advantage even further.

Astrana gives physicians the keys to value-based care by supplying the technologies and administrative services needed to succeed in risk-based arrangements.

  • Once upon a time, Astrana got its start as “ApolloMed” and established itself as an innovator in the VBC-enablement space, particularly within Medicare Advantage.
  • These days, Astrana is taking on financial risk for patient outcomes and creating a “constellation of quality care” to help providers meet quality metrics and manage cost of care. 

Awell’s CareOps platform is a low-code editor that lets clinical and ops teams build workflows that embed into their existing tech stack, without requiring IT or engineering resources.

  • Picture drag-and-drop building blocks tied together with if-this-then-that logic that you can use to create your ideal workflow. Oversimplification, but you get the gist.
  • That allows orgs like Astrana to design and implement automated processes in a matter of days, giving them a unique advantage from an operational efficiency standpoint.

Scaling CareOps across Astrana’s extensive network will not only allow it to eliminate manual workflows and improve the experience of its providers and patients, but it will also accelerate the pace of future improvements by enabling it to adopt an agile development framework.

  • Similar to the DevOps transformation that redefined the software industry, CareOps trades fragmented teams and lengthy deployment cycles for integrated dev/care teams and quicker software releases. (Here’s CareOps 101 for the uninitiated.)
  • By breaking down the silos between clinicians and engineers, Awell empowers more of Astrana’s best and brightest to participate in the creation of the care processes that should ultimately deliver better patient outcomes.

The Takeaway

Healthcare is changing faster than ever before, and anyone looking to keep up is going to need a tech stack that’s as flexible as the challenges heading their way. Astrana and Awell are all-in on using CareOps to make that possible, and it’ll be exciting to keep an eye on their results as the partnership gets up to speed.

CoachCare Locks Growth Capital for RPM Expansion

Posted on by Jason Barry

CoachCare locked in a $48M growth investment to advance its mission of becoming the go-to virtual care management platform for providers, and it has a clear blueprint for how it plans to get there.

After digging into CoachCare for the funding coverage, one of the things that jumped out the most was how well the company seems to be executing on the M&A front:

  • January 2017: CoachCare got its start as a virtual coaching platform for weight and lifestyle management programs.
  • January 2020: The pandemic era emergence of new RPM and CCM reimbursement pathways prompts CoachCare to lean in on commercializing the technologies it built to use internally, with a platform combining connected devices and outreach / monitoring services to give providers everything needed to spin up their own virtual care programs.
  • January 2023: CoachCare kicks off its acquisition spree with NVOLVE, a remote patient monitoring startup focused on MSK, pain management, and orthopedics.
  • April 2023: CoachCare scoops up Carbon Health’s cardiology and nephrology-focused healthcare platform – Alertive.
  • September 2023: WebCareHealth gets brought on to add new RPM, video conferencing, and real-time messaging expertise to the CoachCare platform.
  • December 2023: Verustat joins the portfolio to bolster CoachCare’s presence in primary care and cardiology.
  • June 2024: CoachCare also closed on another soon-to-be-announced acquisition just last month, which saw Dedica Health round out the solution suite with one-to-one care management and navigation.

The end result of all that M&A is that CoachCare now has a platform that can deliver specialized RPM and virtual health services for everything from hypertension and behavioral disorders to stroke recovery and high-risk pregnancies.

  • Along with $48M in newly raised capital, CoachCare just took a step up to the RPM big leagues, and will now be competing for many of the same customers as the established leaders in the space.

The Takeaway

CoachCare is pedal to the metal with its M&A playbook, and an extra $48M pretty much guarantees that more acquisitions are right around the corner. As long as CoachCare continues finding attractive targets for reasonable costs, its next arc of growth will be defined by its ability to execute, hire, and integrate new capabilities into a cohesive offering.

Epic, Mayo, Abridge Tackle Nursing Workflows

Posted on by Jason Barry

The power trio of Mayo Clinic, Epic, and Abridge are joining forces to bring the magic of generative AI to the “scaffolding of the healthcare system” – nurses.

The new solution will work similar to Abridge’s core ambient documentation tools for physicians, but optimized specifically for the unique complexity of nursing workflows.

  • Whereas physician conversations usually involve capturing the medical history and patient’s story, nurses are also performing and documenting tasks like vitals collection or turning patients to avoid bed sores.
  • This data all ends up in different places within the EHR, and requires a new user experience to work backwards from.

Mayo Clinic nurses are at the center of the collaboration.

  • The development team is engaging with them directly to ensure the new solution meets the needs of all nursing and patient care workflows along with regulatory requirements for ambient solutions.
  • Nurses will also help prioritize the workflows where the tool will have the highest impact, and will be “instrumental” in designing and testing the overall solution.

Epic’s involvement will allow the tool to integrate seamlessly into its EHR and inpatient nursing workflows, another sign that the company is all-in on quickly advancing its GenAI roadmap.

  • It also represents one of the most significant efforts to stem from the Epic Workshop program announced last year, which features third-party vendors co-developing technology with Epic. 

The combination of Abridge’s AI stack, Epic’s development, and Mayo Clinic’s nursing expertise should help accelerate the development cycle, and the health system is looking to get the tool in the hands of nurses before the end of the year.

The Takeaway

Nurses perform a massive breadth of activities in fast-paced environments, and they’re grappling with the same documentation-driven burnout as the rest of the industry. Toggling between patient duties, documentation, and staff communication is a demanding use case for ambient AI, but this team appears to have all the pieces it needs to make it happen.

Rock Health: H1 Funding Comeback

Posted on by Jason Barry

There’s a comeback brewing for digital health, with Rock Health’s latest funding report showing that the sector is officially on track to beat last year’s investment total.   

US digital health startups raised $5.7 billion across 266 rounds in the first half of 2024, setting a pace that could surpass 2023’s full-year total of $10.7 billion.

Most of the excitement came from early-stage startups. Seed, Series A, and Series B raises accounted for 84% of labeled rounds in H1. The median size of a Series A was $15M (up $3M from last year), driven by big showings from companies like Hippocratic AI and Fabric. 

  • Rock Health pointed out that larger Series As have helped AI startups manage costs for training models and acquiring datasets, while also helping others make well-timed M&A (Ex. Fabric’s acquisition of MeMD from Walmart).

Unlabeled rounds started to wane as fewer companies pushed off a valuation haircut or delayed a labeled raise due to not meeting necessary benchmarks. Just 33% of Q2 2024 rounds were unlabeled, down from 47% in Q1 and 55% in Q4 2023.

  • This could mark the beginning of a return to a more normal cadence of labeled raises, which Rock Health predicted would be in the cards for 2024.

The most funded value proposition in H1 went to “treatment of disease,” thanks in part to Foodsmart’s $200M raise feeding the $1.1B total. 

  • Mental health retained its usual position as the most funded clinical indication, raising $700M as companies like Talkiatry and Brightside managed to attract more investor attention than the surging weight management segment ($300M).

The first half saw three public exits for digital health companies, ending a 21 month drought with stock market debuts for Nuvo (remote fetal monitoring), Tempus AI (precision diagnostics), and Waystar (revenue cycle management).

  • Among players still gearing up for an IPO, fewer companies were rounding out their offerings by acquiring the missing pieces, which was chalked up to companies wanting to be conservative with their runway. H1 2024 clocked in at 34 digital health acquisitions, well below half of 2023’s full-year total (83).  

The Takeaway

Resilience seems to be leading to brilliance for digital health founders, with overall funding momentum and fewer transition measures (AKA unlabeled rounds) suggesting the “new normal” is upon us. Although a presidential election and decisions around telehealth flexibilities will have a huge impact on the rest of the year, most signs are pointing toward H2 playing out just as well as the first half.

Foodsmart Loads Its Plate With $200M

Posted on by Jason Barry

The headliner of this week’s funding-heavy news lineup was Foodsmart, which loaded its plate with over $200 million to expand the reach of its virtual nutrition services.

Foodsmart supports patients facing chronic disease and food insecurity by partnering with health plans and providers to improve access to personalized healthy eating options.

  • The FoodSMART telenutrition platform delivers virtual nutrition counseling from the largest standalone network of Registered Dietitians in the US, with integrated benefits management to help with things like applying for SNAP/EBT benefits.
  • The FoodsMART marketplace then bridges the gap between the visit and the table, allowing patients to order quality food and have it delivered to their doorstep.

The combination of Foodsmart’s dietitian network and food marketplace sets it apart from most of its competitors, which either focus on supporting specific conditions or avoid tackling the logistics of grocery delivery.

  • That versatility has led to Foodsmart serving over 2.2M members, as well as numerous peer-reviewed studies highlighting the cost reductions and health improvements resulting from the approach.

The food-as-medicine movement has provided fertile ground for startups since the pandemic, with shifting consumer behaviors and regulatory changes planting the seeds for growth.

  • Investors are taking notice, and Foodsmart’s mega-round follows close behind other raises from Season Health ($7M), Fay ($25M), and Nourish ($35M).

The Takeaway

At a time when weight management medications are getting all the attention, Foodsmart is paving its own non-pharmacological path to preventing diet-related issues. If an ounce of prevention is worth a pound of cure, then $200M should be heavy enough to help Foodsmart improve the lives of plenty of patients.

Telehealth Struggles to Live Up to Expectations

Posted on by Jason Barry

Telehealth demand hasn’t exactly lived up to expectations, but that might have more to do with manic forecasting than real-world performance when a 6,000x utilization increase isn’t enough to satisfy the naysayers.

There’s nothing like forced adoption to kickstart a market, and the combination of in-person office closures and pandemic-era legal flexibilities caused telehealth utilization to vault from less than a million visits in Q4 2019 to over 60 million visits by Q2 2020.

(Overly) enthusiastic forecasts quickly followed the early data, but Trilliant Health’s latest telehealth tracker shows that demand has only headed downhill since the initial spike. 

  • As of Q3 2023, sustained declines have left telehealth volumes 54.7% below their peak, and the trendline doesn’t appear to have found a bottom.

Recent high-profile retreats from players Optum and Walmart have sparked solid viewpoints from pessimists and optimists alike, although the general consensus is that patients don’t view telehealth as a substitute for in-person care for most conditions.

  • Since 2019, behavioral health has represented a consistently increasing share of overall telehealth utilization, and accounted for a substantial majority (67%) of all virtual visits in Q3 2023.

E-prescribing increases closely mirrored the telehealth growth, and now represent a significant share of prescriptions for many drug classes:

  • 30.3% of antidepressants, 38.9% of stimulants, and 5.4% of opioids. It’ll be interesting to see the GLP-1 data when it catches up.

The Takeaway

Event-driven demand shocks don’t last forever, and the telehealth slowdown showed that reality is usually more nuanced than an overnight paradigm shift. New modalities don’t magically create better businesses, but they can be the tools that founders use to build them.

Physician Compensation Rebounds

Posted on by Jason Barry

The numbers are in. Doximity’s always-anticipated Physician Compensation Report showed that overall compensation grew 5.9% last year – a welcome rebound after the 2.4% dip in 2022. 

Survey responses from 33k doctors brought more good news than that, with medicine’s gender wage gap narrowing to 23%, down from 26% in 2022.

  • Decent improvement, but women physicians are still taking home an average of $102k less than men after controlling for specialty, location, and experience.

Neurosurgeons continued to top the charts at $764k, nearly 4X the annual compensation of their pediatric endocrinologist peers at the bottom of the totem pole ($217k).

Other interesting highlights from the report included the fact that 81% of physicians reported feeling overworked, causing many to consider an employment change (59%) or early retirement (30%).

  • 88% of physicians also said that their practice has been impacted by the physician shortage, three-quarters of which described the impact as “moderate” or “severe.”
  • Funnily enough, the physician shortage wasn’t even the leading contributor to burnout, which 70% of respondents pinned squarely on administrative burden.

Despite recording a slight increase, total physician compensation has dropped 26% since 2001 when accounting for inflation. As it currently stands, only 40% of physicians are happy with their compensation, and more of these disgruntled doctors are unfortunately eyeing the exit.

The Takeaway

Physicians are still overworked and the wage gap is barely moving in the right direction, but at least they can rest easy knowing inflation is barely eating into their total compensation…

A Delicious Primer on Food-as-Medicine

Posted on by Jason Barry

Rock Health dished up a fantastic primer on the food-as-medicine market, serving as a helpful cheatsheet of which trends will stay fresh the longest, and which ones are already stale.

Fertile grounds for new FaM models have been created by shifting consumer behaviors around diet and wellness, with 20% of US adults saying the pandemic prompted healthier choices. [Graphic: Three eras of food-as-medicine]

  • Payors are also grappling with the rising costs of treating the nearly 50% of Americans with diet-related illness, and FaM offers an avenue to reign these in without pricey medications like GLP-1s.
  • Policy changes have also planted the seeds for growth, with new initiatives helping scale FaM programs like medically tailored meals. One wild stat is that FaM partnership volume in the last 18 months has surpassed that of the prior seven years combined.

As the FaM market begins to sprout, startups are facing an increasingly complicated menu of funding sources and potential partners

Value chain segment #1: Food access

  • Food and supply chain – Providers of healthy groceries, prepared meals, or digital marketplaces for third-party products, including delivery partners and food “farmacies” that fill clinician’s produce prescriptions. Examples: Mom’s Meals, Uber Health
  • Service navigation – Services that refer consumers to food access programs and support enrollment, often through community orgs like FQHCs. Examples: Findhelp, Unite Us

Value chain segment #2: Nutrition care

  • Medical nutrition counseling – Virtual or in-person nutrition counseling with dietitians to provide tailored nutrition plans and resources. Examples: Foodsmart, Season Health
  • Behavior change support – Tools for tracking diet and outcomes, educational content, and recommendations. Includes non-digital services like nutrition and cooking classes. Examples: Heali, SeekingSimple

Value chain segment #3: Program enablers

  • Fintech – Targeted tools and vouchers (category-restricted to healthy products) that enable consumers to use food benefits provided by their health plan. Examples: Solutran, Soda Health
  • Data and food benefits management – Data on consumer behavior or food products to help payors optimize benefit design, measure program impact, and inform engagement strategies. Examples: DietID, NourishedRx

The Takeaway

The food-as-medicine market is turning into a “cornucopia of innovation,” but founders looking to take advantage of new funding mechanisms now have to separate the wheat from the chaff when it comes to business models and potential partners.

Cross-Market Mergers Aren’t For the Patients

Posted on by Jason Barry

Make sure you’re sitting down for this one, because new research suggests that cross-market hospital mergers aren’t doing patient wallets any favors.

To investigate the impact of cross-market mergers on both prices and quality, researchers rounded up 214 hospitals that acquired hospitals further than 50 miles away, then compared them to 955 control hospitals without any merger activity during the study period. This was also the first study to use claims data to back its findings.

Six years after acquisition, acquirers had increased their prices for patients by an average of 12.9% relative to control hospitals, yet saw no discernible impact on mortality or readmissions.

  • The impact was even higher among serial acquirers with at least four separate acquisitions, which increased prices by a steep 16.3%. This wasn’t a small subset either, representing 45% of the M&A hospital group.
  • On top of that, there was a 21.8% price increase when the target’s market share was greater than the acquirer’s (vs. 9.7% when the opposite was true), which makes sense as smaller acquirers have more to gain from acquiring an entity with more market power.

There have been a couple of other studies examining the impact of cross-market mergers, but this was the first to use claims data to untangle some of the factors driving the price effects (serial acquisitions, target size) while showing no significant impact on quality.

Although the mechanisms behind the price effects weren’t within scope, there are a few potential reasons that likely contributed.

  • Common customers – If the target and acquirer hospitals both share the same customer, having a larger operational footprint improves bargaining power (e.g. employers need provider networks that span multiple patient markets if they have employees in multiple markets).
  • Tying – A health system with a strong position in one market could tie its services to a second market (e.g. a cutthroat system could operate at a loss in a second market to drive out competitors while staying afloat using margin from its primary market).
  • Change in control – Acquirer hospitals are able to increase prices at the target because it wasn’t maximizing profit for whatever reason. Given the increases this study shows at the acquirers themselves (which by definition didn’t change control), this one is probably ruled out.

The Takeaway

All-in-all, the evidence is mounting that competing hospitals don’t make massive acquisitions for altruistic reasons (earth-shattering, we know). If the scale wasn’t already tipped toward needing more antitrust scrutiny of cross-market mergers, this study seems to get us past the usual conclusion of “more research is needed.”

How Walmart F—– Around and Found Out

Posted on by Jason Barry

White flags are flying left and right, with Walmart announcing its retreat from care delivery less than a full week after Optum made a similar surrender.

Walmart’s five-year foray into primary care is ending with the closure of 51 health centers, the shuttering of its telehealth service, and the cancellation of any active ambitions in the space.

  • The press release chalked up the “difficult decision” to a challenging reimbursement environment and high operating costs, which ultimately made the business unsustainable.

The abrupt finale arrives shortly after Walmart laid out plans to nearly double its footprint to 75+ health centers by the end of 2024, as well as several other marquee announcements.

  • As recently as November, Walmart was inking health system partnerships with the likes of Orlando Health, and Bloomberg was even reporting on a potential acquisition of ChenMed that would have opened the doors to the Medicare Advantage market.

So what happened, and why couldn’t the nation’s largest retailer succeed in delivering care to the millions of underserved patients where it already has a presence? Mainly because retail clinics aren’t set up to succeed.

  • Scaling brick-and-mortar clinics is simply a low margin endeavor. Reimbursement is low, provider costs are high, and the telehealth piece looks more commoditized every day.
  • Even with Walmart’s economies of scale and armies of foot traffic, the system it was operating in doesn’t incentivize preventative care, but rather expensive procedures that it didn’t offer in-house.

The perfect storm of inflating costs and shiny technology that fails to actually reduce those costs is proving too much for retailers and telehealth companies alike. The only ones succeeding seem to have an edge that makes it possible:

  • They have access to better rates (One Medical’s health system relationships)
  • They have boosted margins from marking up generics (Hims & Hers)
  • They control premium through value-based care arrangements
  • They have some form of subscription revenue

The Takeaway

The moral of Walmart’s story is that even if you have all the best ingredients, the meal is still only going to be as good as the recipe. Having groceries and doctors under one roof doesn’t lead to more health visits if people don’t want to see a doctor where they get their groceries.

Get the top digital health stories right in your inbox

You might also like..

Select All

You're signed up!

It's great to have you as a reader. Check your inbox for a welcome email.

-- The Digital Health Wire team

You're all set!