Rock Health Q1 2024 Funding Recap

If Rock Health’s Q1 2024 Digital Health Funding Report makes one thing clear, it’s that the times of transition are behind us, and we’re now fully entrenched in a new digital health funding cycle.

The first quarter saw $2.7B in digital health venture funding across 133 rounds, marking the lowest quarterly total seen since 2019. It’s not as bad as it sounds.

  • Although total funding wasn’t trending in the right direction, the pace of the funding was actually healthy, and the 133 rounds was the highest in the last six quarters.

The average transaction size of $20.3M mostly tells the tale of growth-stage companies having to justify their valuations based on clinical outcomes rather than fancy storytelling.

  • Crowded markets are pushing enterprise customers to seek out outcomes data as a way to differentiate players and evaluate value-for-investment.
  • As outcomes data becomes a moat and a customer draw-in, investors are seeking out companies that can demonstrate efficacy early – making outcomes data more central to fundraising conversations… and at earlier stages.

AI drove a record share of funding. While not exactly too surprising, AI-enabled companies captured 40% of Q1’s funding total ($1.1B across 45 deals), compared to 33% of 2023’s funding pot and 29% of 2022’s.

  • As AI energizes the sector, it isn’t too hard to follow the funding to the areas with the most perceived promise: scribing, precision medicine, and care enablement.
  • Abridge raised a colossal $150M Series C, AI precision health company Zephyr AI landed a $111M Series A, and a suite of high flying startups landed huge rounds, including Ambience Healthcare ($70M), Fabric ($60M), and Codametrix ($40M).

The last theme is familiar: creative fundraising continues to be a crowd favorite, especially as public market delistings cause investors to rethink their exit potential.

  • Nearly half (48%) of Q1’s funding rounds were unlabeled, compared to 44% of all transactions in 2023.
  • Founders are going above and beyond to entice investors with more upside in the event of an exit, as seen with Transcarent structuring its $125M Series D to offer funders 2.5x their investment should the company M&A or IPO. 

The Takeaway

Expectations have been reset for digital health startups, causing them to evolve their strategies and reorient around different metrics of success (strong outcomes / margins vs. high projected growth). These expectations are undoubtedly higher than they were during the pandemic era of loose capital, but that’s probably not a bad thing for a sector that’s still striving for maturity.

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.

2023 Digital Health Startup Benchmarks

Rock Health’s industry analysis is a frequent feature in our top stories, but it’s tough to stay away with reports as consistently solid as last week’s 2023 Digital Health Startup Benchmarking Survey.

The survey broke down responses from 87 early-stage digital health startups to provide performance benchmarks for customer acquisition cost, lifetime value, expenses, and more [Chart: Company Breakdown by Stage / Segment].

Series B is a tipping point for growth, but not (yet) margins.

  • [Chart: Revenue by Funding Stage] While Series A startups are generally building an MVP and testing product-market fit, no Series B respondents were still pre-revenue (vs. 25% of Series A). That revenue is going straight to growth, with just 12% of Series B startups reporting positive margins (a small increase from 9% of Series A).

CAC and LTV calculations are challenging for early-stage startups.

  • [Chart: CAC by Customer Segment][Chart: LTV by Customer Segment] Both CAC and LTV vary widely by customer type, but both charts illustrate that “you get out what you put in.” It cost respondents an average of $58k to sign a payor, but the average lifetime value was $5.1M. That compares to a CAC of $170 and an LTV of $1.7k for consumers.

Engagement metrics are the first step to robust outcomes.

  • On average, each company reported tracking two engagement outcome metrics, two clinical outcome metrics, and one economic outcome metric. “For startups balancing speed-to-outcomes and quality-of-outcomes, an ‘engagement first, clinical/economic later’ approach might help to toe the line.”

Navigating product versus marketing costs is a balancing act.

  • [Chart: Company Product vs. Marketing Costs] The amount of revenue the startups devote to product versus business development and marketing evolves alongside scale. Pre-seed respondents allocated 75% of revenue to product and 11% to marketing, while Series B respondents allocated 36% of revenue to product and 22% to marketing.

The Takeaway

We’re lucky to be in a golden age of startup transparency, and between this Rock Health survey and the latest State of CareOps report, there’s no shortage of great information out there for founders to use as guideposts in their pursuit of scale.

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.

Rock Health H1 2023 Funding Recap

Rock Health’s H1 2023 digital health funding report confirmed the writing on the wall. We’re in a new market cycle, so it’s time to buckle up for fewer rounds, lower check sizes, and a smaller cohort of sector investors.

Here’s the first half of the year by the numbers:

  • US digital health funding totaled $6.1B across 244 rounds ($24.8M average)
  • Q2 contributed only $2.5B across 113 rounds (Q1 saw $3.6B across 131 rounds)
  • Unprecedented 41% of H1 rounds weren’t tagged with a series or round label
  • 12 mega-rounds over $100M accounted for 37% total funding 

If the funding trend makes one thing clear, it’s that H1 2023 began to separate the best from the rest in Startup Land. (Chart: Funding Trend)

  • We’re now on pace for the lowest funding year since 2019, and the fact that only 555 investors participated in digital health fundraises in H1 2023 (down from 775 in H1 2022) is another confirmation that we’re in the beginning of a new cycle.

Despite the slowdown, H1 counted 12 mega-rounds comprising 37% of total funding, and the $185M average check size rivaled the $188M seen during 2021’s peak mania (Chart: Mega-Rounds). Investors are now competing to crown the next class of household-name startups, particularly in three transformation areas: 

  • VBC enablement (Strive Health $166M, Arcadia $125M, Vytalize Health $100M)
  • Non-clinical workflows – bonus points for “Shift” in name (Shiftkey $300M, ShiftMed $200M, MedShift $108M)
  • At-home care (Author Health $115M, Monogram Health $375M)

The other major story from H1 was the staggering 41% of digital health rounds that were “unlabeled,” the highest share since 2011 (Chart: Unlabeled Raises). Most founders raise unlabeled capital for one of two reasons, both surefire signs of the times:

  • To delay haircuts to previously-established valuations
  • To avoid bad PR associated with a down round or a smaller-than-expected lettered raise

The Takeaway

The new funding cycle naturally brings growing pains, and the stopgap cure for those pains has been the unlabeled rounds that Rock Health referred to as “a battlefield tactic, not a long-term strategy.” When we eventually see the return of lettered funding rounds, Rock Health makes the case that founders should reset their valuations to match truly sustainable profitability and growth targets, which would ultimately position them for better long-term success.

Rock Health Q1 2023 Funding Recap

Rock Health’s Q1 2023 digital health funding report is out and its title couldn’t have put it any better: we’re investing like it’s 2019 again.

Here are the numbers in a nutshell:

  • US digital health funding totaled $3.4B across 132 rounds ($25.9M average)
  • Trend: $2.2B (Q3 2022) -> $2.7B (Q4 2022) -> $3.4B (Q1 2023)
  • Q1 2023: 28 Series A rounds, 10 Series B, 3 Series C, 7 Series D+
  • 6 mega-rounds over $100M accounted for 40% total funding 

Looking at the past decade (Chart: Funding Trend), it’s clear that the pandemic funding environment was an outlier capped by absolute mania in 2021. The funding uptrend seen in the last few quarters is also a far cry from a true bull run.

  • If funding for the rest of the year matched the average funding of the past three quarters, 2023 would still see the lowest funding total since 2019.
  • Although January and February brought cooling inflation and some real signs of hope, March stepped on any blooming momentum with the collapse of Silicon Valley Bank.

Something that Rock Health gave a lot of attention to – and for good reason – is that 40% of last quarter’s funding was from six mega-rounds (Chart: Mega-Round Breakdown) : 

  • Monograph Health – $375M Series C (at-home dialysis)
  • ShiftKey – $300M PE Round (staffing marketplace)
  • Paradigm – $203M Series A (clinical trial platform – largest digital health Series A ever)
  • ShiftMed – $200M Venture Round (staffing and workforce solutions)
  • Gravie – $179M PE Round (insurtech)
  • Vytalize Health – $100M Series C (Medicare ACO)

The other 126 startups split the remaining $2B slice of pie, with an average round size of $16M (vs. $25.9M with the mega-rounds). It makes a big impact, but if you remember back to 2021, we’re currently looking more sane than 88 mega-rounds combining for 56% of total funding.

The Takeaway

Outside of a positive funding trend over the last few quarters, it’s hard to interpret Rock Health’s report as great news for digital health startups. We have a regional banking crisis that might be in its early innings, the IPO market’s been barren since the 2021 SPAC craze, and the end of PHE isn’t exactly a tailwind for many business models. 
That said, it isn’t all doom and gloom. Rock Health is optimistic about the permanent expansion of some telehealth flexibilities and the improving guardrails for data privacy. “Those that make it to daybreak (though we can’t predict exactly when that’ll be) will come out with patched up ships and resilient mindsets.”

Consumer Adoption of Digital Health in 2022

The latest report from Rock Health and the Stanford Center for Digital Health showed that not even the end of the public health emergency or a looming recession could put a dent in the adoption of new health tech. All eyes are now on consumers’ wavering trust in the healthcare system to see if it’ll end the party early.

The headline stat from the 8,014 person survey was that 80% of consumers have now accessed care via telemedicine, with the largest surge in adoption coming from historically underserved groups. 

  • For the first time ever, telemedicine was also the preferred channel for prescription refills and minor illnesses, which could have major implications for virtual refill programs like Amazon’s new $5/mo RxPass. [Care Preferences]
  • On top of that, audio-only and asynchronous telemedicine beat out point-to-point video chats as the most used modalities, and Rock Health expects typical care journeys to start including multiple modalities to leverage the strengths of each.

The second pillar of the report was that 46% of consumers now own a wearable device, a steady continuation upward from 2021 (45%) and 2020 (43%). The vast majority of those owners purchased the device themselves (85%), signaling that there’s still a ton of work to be done integrating wearables into clinical pathways for chronic condition management.  

  • 74% of younger respondents with higher income and higher education reported owning a wearable (down from 80% in 2020), while only 21% of older, lower income, and lower education respondents owned one (up from 17% in 2020). [Wearable Ownership]
  • Those adoption stats are par for the course with any new tech and seem to be a healthy sign that wearables are continuing their shift along the technology adoption curve – from early adoption to majority acceptance. 

The final highlight was an overview of consumers’ trust – or lack thereof – in the healthcare system. “Health data sharing only moves at the speed of trust, and right now it’s slow-going.”

  • Consumers have grown far less willing to share health data since the start of the pandemic, with only a slim portion willing to share with research orgs (20%, 15pp decrease), tech companies (7%, 4pp decrease), and the government (8%, 4pp decrease). That’s a pretty steep drop off. [Willingness to Share Health Data]
  • Not a single one of the 10 healthcare stakeholders in the survey was spared from the decline in trust, although doctors’ 70% trust rating still led the pack by a wide margin (family ranked 2nd with 51%).

Rock Health 2022 Full-Year Funding Recap

Every quarter, Rock Health gives us the gift of tallying, analyzing, and adding a bit of spin to the biggest trends in digital health funding – and their 2022 recap might be their best gift yet.

As Rock Health describes it, 2022 was a “downhill ride,” with $15.3B in total US digital health funding signaling the tail end of a three year cycle centered around a pandemic investment frenzy that peaked in 2021 ($29.1B total raise).

That $15.3B figure breaks down to 572 investments at an average of $27M, and we weren’t exactly picking up steam toward the end of the year. (Chart: 10-year trend)

  • Q4’s $2.7B total was less than half of Q4 2021’s $7.4B raise, and it now looks like the market is winding down from its mania to find a more sustainable long term growth rate. (Chart: quarterly totals)
  • Investors’ reluctance to go after late-stage companies and founders’ fears of raising a down round led to only 35 startups raising $100M or more throughout the year. By all means a lot of capital, but well shy of the mega-rounds seen in 2021 (88) and 2020 (43). (Chart: mega-rounds)
  • As investors battled over early-stage prospects, median Series A rounds climbed to an all-time high of $15M in 2022, while check sizes shrunk across all later stages. (Chart: round sizes)
  • Although “on-demand” care companies led the pack with $2.4B in funding (props to DispatchHealth and Homeward), providers’ front-and-center focus on efficiency kept nonclinical workflow startups close behind with $2.2B raised. (Chart: top value props)
  • One of the best charts of the report was tucked away toward the end, highlighting how D2C startups took the biggest hit of any cohort due to rising customer acquisition costs, capital lifelines drying up, and a weakening consumer. (Chart: customer segment focus)

The Takeaway

It’s hard to tell whether we’ve reached the end of this cycle, or if we’re now entering the recession that’ll bring the real pain. Rock Health points to a couple of signals that suggest we might have already seen the worst of it: investors have dry powder stockpiled, and a difficult exit climate could bring late-stage companies back to the fundraising table.

Regardless of when investment starts ramping back up, Rock Health predicts that it’ll be “built up on slow, steady, and maybe even boring strategies.” Sounds like a reasonable prediction, and if 2023 is anywhere near as hectic as many analysts think it will be, “boring” might not be such a bad thing.

2022 Digital Health M&A Trends

One of the best reads of last week was Rock Health’s deep dive into the digital health M&A trends that have defined 2022 as the funding bubble lets some air out.

While big ticket acquisitions have taken up most of the spotlight, Rock Health makes the case that declining valuations, customer overwhelm, and an unfriendly IPO market are setting us up for a widespread upswing in M&A activity.

This year’s 144 M&A moves have been shaped in part by supply-side dynamics (harsh fundraising conditions make M&A look more appealing than a down round or shaky IPO), but the report lays out four acquirer archetypes that are likely to drive the next wave.

  • Consolidation for inorganic growth – Lets startups grow their customer base while building confidence from investors looking for growth. This approach is particularly useful as purse strings tighten and customer acquisition costs climb.
  • Enhancing core operations – These acquisitions ideally offset their cost with the internal efficiencies gained in areas such as data integration or analytics. Provider orgs are leaning into this approach, logging 11 transactions Q1-Q3 2022 (3x 2021’s total).
  • Buy-and-build – Acquiring complementary features that enable the acquirer to move along the care delivery value chain or into adjacent categories. Examples include Quest Diagnostics’ acquisition of Pack Health (pushed Quest beyond lab testing into patient engagement / condition management) and Advocate Aurora’s acquisition of MobileHelp (propelled the health system into in-home care).
  • Disruptive innovation – Transforms an acquirer’s existing services and positions them to create a new business model or drastically differentiate in the market (Ex. Amazon acquiring One Medical). Rock Health predicts that the most likely targets will have strong clinical evidence and user bases, but may be struggling with their business model.

The Takeaway

Rock Health makes a pretty convincing argument that digital health M&A is poised for an active year ahead, but also wraps up the report with a warning that acquisition announcements are rarely the end of the story.

“Successful M&A approaches are determined by important choices (e.g. how best to integrate tech stacks as well as cultures and operations, what to keep and where to cut bait, workforce strategy, etc.)… but assessing these frameworks alongside financial, cultural, and operational aspects of M&A is necessary to help organizations—both acquirer and target—maximize impact.”

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