Brightline Raises $105M for Adolescent Mental Health

Virtual mental health startup Brightline recently closed $105M in Series C funding to broaden its services as it tackles the nation’s “pediatric mental-health crisis.”

The two-year-old company is a poster child for the rise of behavioral health startups during the pandemic, with a valuation of $705M after a quick total raise of $209M.

Brightline offers adolescents and their families virtual services and educational content aimed at treating anxiety, ADHD, depression, and other behavioral issues.

  • The company staffs over 85 care providers (psychiatrists, speech-language pathologists, behavioral coaches) trained to support children with unique needs such as cyberbullying or wearing masks in the classroom.
  • The services are offered through employers and as in-network benefits with major health plans, including Blue Cross of California, Blue Cross Blue Shield Massachusetts, Aetna, and Primera.

The new funding will help Brightline triple the size of its care team by the end of the year while exploring additional ways to deliver specialized care through more modalities.

  • This includes upcoming services specifically for the caregivers of young children with Autism Spectrum Disorder and youth who identify as LGBTQ+ and/or BIPOC.
  • Brightline expects to serve over 30k children and teenagers by the end of 2022, while doubling the number of lives covered through its health plan contracts to 48M.

The Takeaway

Psychiatrists are among the most in-demand specialists, and adolescent psychiatrists aren’t exactly easier to find. Some research suggests that upwards of 75% of US counties don’t have access to a single one. If Brightline can address this supply-demand imbalance with its virtual services it could have a big impact on families affected by behavioral health challenges, and the company’s swift funding pace suggests that investors are eager to wager that they can.

Allscripts Sells Hospital EHR Segment for $700M

The quickly shifting EHR landscape saw another major move last week following Allscripts’ announcement that it is focusing its offerings by offloading its hospital EHR assets to Harris Computer, a subsidiary of Canada-based holding company Constellation Software.

Harris is set to acquire Allscripts’ Hospitals and Large Physician Practices business segment for $670M, plus an additional $30M tied to the segment’s performance in the next two years.

  • The transaction includes Allscripts’ Sunrise, Paragon, TouchWorks, STAR, Opal, HealthQuest, and dbMotion solutions, which together accounted for $928M of the company’s $1.5B total revenue in 2021, but have also been steadily losing market share.
  • The $700M valuation implies a 4.8x multiple on the hospital EHR segment’s expected earnings for this year, not particularly high given that other publicly traded EHR companies command an average multiple of over 10x, which reflects two consecutive years of shrinking revenue with another decline forecast for 2022.
  • By divesting the contracting division, Allscripts can now “maximize focus” on its healthier service lines like the Practice Fusion EHR for small practices and the Veradigm analytics solution, which has faster growth (up 4.6% to $552M in 2021) and healthier margins than the legacy EHR business.
  • Veradigm houses one of the largest EHR-linked patient databases available for research, transforming data from Allscripts’ clients into insights that help connect providers and payors to life sciences companies. The data flow won’t be affected by the hospital EHR division’s new ownership, and the platform will now serve as the core of the company’s operations moving forward.

The Takeaway

Allscripts has been committed to refining its offerings since posting a wide net loss in 2019, a process that included similar sales of its 2bPrecise genetic research arm and its CarePort patient coordination services. Offloading the business segment that generates a majority of its revenue highlights just how committed Allscripts is to focusing its portfolio on high growth areas, and the uptick in the company’s stock price following the announcement is a good indication that investors agree with that strategy.

Teladoc and Amazon Partner on Echo Voice Visits

Yesterday’s competitors are today’s collaborators, with Teladoc and Amazon inking a new partnership to bring voice-activated virtual visits to Alexa-equipped Echo devices.

  • “Alexa, I want to talk to a doctor” will now connect Echo users to a Teladoc call center to verify a patient’s medical history and health plan information ($0 if covered, or $75 direct-to-consumer). Within roughly 15 minutes, the patient will then get a call back from a Teladoc physician to treat mild needs such as colds, flus, or allergies.
  • The new service will initially be available in an audio-only format for supported devices such as the Echo Dot and Echo Show, but will add video functionality “soon” to make it easier to diagnose certain conditions.
  • The partnership greatly expands Teladoc’s consumer reach as part of its ongoing strategy to meet patients where they are. Amazon reports over 40M Alexa users in the US alone, and has delivered more than 200M Alexa-equipped devices globally.
  • This is the latest in a string of health-focused improvements to Amazon’s Alexa ecosystem, which have included capabilities for elder care coordination through Alexa Together, as well as medication management through the Care Hub… and those are happening outside of even bigger moves with Amazon Care.

Industry Impact

Despite the recent launch of Amazon’s own Amazon Care telehealth service, Teladoc’s virtual physician network is significantly larger, and this scale will be absolutely essential to keep up with what could be an insanely high call volume for the new service.

The Teladoc partnership marks Amazon’s first attempt at providing truly on-demand healthcare with Alexa devices, and if well executed, could go a long way towards breaking down barriers to care for many patients. Even though Amazon and Teladoc are now competing in the same arena, the collaboration shows that coordinated efforts are still on the table when there’s a clear benefit for both patients and the companies.

Teladoc Launches Chronic Care Complete

The big are getting bigger with the announcement that virtual care giant Teladoc Health is expanding its services with a “first-of-its kind” Chronic Care Complete solution targeted at the one in three US adults living with multiple chronic conditions.

  • Chronic Care Complete is now offered through the Teladoc Health app and provides a comprehensive experience that leverages connected monitoring devices in combination with personal coaches to help patients achieve health goals.
  • The program also provides access to physicians who can review medications or order labs as needed, as well as licensed therapists to provide mental health support for those dealing with difficult diagnoses.
  • Integrated proactive insights help Chronic Care Complete patients achieve better outcomes by applying personal health data and social determinants toward driving timely outreach.
  • According to Teladoc, chronic conditions such as diabetes, hypertension, and obesity account for 90% of all healthcare spending, driven in part by the confounding mental health challenges that are often ignored by other solutions but are a core component of Chronic Care Complete.

The Takeaway
Teladoc’s scale gives it unique positioning to address the intertwined physical and mental health challenges faced by polychronic patients. Chronic Care Complete is the latest in a string of new solutions launched following Teladoc’s 2020 merger with Livongo, each aiming to leverage this scale to provide better whole-person care, including the mental health offering MyStrength and the primary care service Primary360.

Online CBT Improves Depression Symptoms

Amid a recent flurry of reports calling into question the effectiveness of virtual cognitive behavioral therapy, a new study published in JAMA Network Open found that computer-assisted CBT (CCBT) does in fact improve depressive symptoms in primary care patients.

  • Methodology – The study included 175 adult primary care patients at the University of Louisville who had scored 10 or higher on the Patient Health Questionnaire-9 (27 point scale), indicating at least a moderate case of clinical depression. Nearly 62% of participants made less than $30k/year, while 74% did not graduate from college.
  • Interventions – Participants were randomly assigned to CCBT or treatment-as-usual groups (TAU) for 12 weeks of active treatment, as well as 3- and 6-month follow ups. CCBT included 9 online CBT lessons and weekly 20-minute teletherapy visits, in addition to TAU, which included in-office treatment at the primary care practices. 
  • Results – CCBT led to significantly greater improvement in PHQ-9 scores than TAU (mean difference: -2.5), with the positive results maintained at 3-month (-2.3) and 6-month follow-ups (-3.2). CCBT remission rates were more than double TAU at all time points.

Conclusions and Relevance

This study was particularly interesting because of the treatment’s sustained results and because its participants largely came from groups that are often underrepresented in CCBT research. Although the study had some limitations (treatment-as-usual as a control can’t compare CCBT to regular CBT), the results suggest that CCBT has the potential to be particularly valuable for patients in diverse primary care settings.

Amazon Expands Telehealth Services Nationwide

It’s never great to hear that a competitor with deep pockets and an army of engineers is pushing into your market, and this week Amazon gave companies in the employer telehealth space a lot to be nervous about.

After launching as an internal service in 2019, Amazon is now expanding its Amazon Care health offering to employers across the US amid “growing demand” for hybrid care.

Amazon Care’s hybrid model consists of two main elements:

  • Telehealth-based primary care delivered by a dedicated Care Medical doctor
  • Nurse practitioners dispatched to patient homes when medical needs can’t be resolved over video

Virtual services are now available nationwide to meet the needs of Amazon Care’s growing roster of employer clients, which now includes TrueBlue and Whole Foods Market (a fairly self-congratulatory announcement considering Amazon acquired the grocer in 2017).

In-person services are also expanding beyond the 8 existing locations (Seattle, Baltimore, Boston, Dallas, Austin, Los Angeles, Washington, DC, and Arlington), with Amazon planning to bring its nurse practitioner network to 20 additional cities by the end of the year, including San Francisco, Miami, Chicago, and New York City.

Industry Impact

The telehealth landscape is crowded with companies promising to improve outcomes with video visits, but Amazon Care’s in-person component could prove to be its biggest differentiator.

The hybrid model allows Amazon to keep patients within its ecosystem when in-person care is needed, building off the logistical expertise of its retail business to coordinate at-home and virtual care. Amazon is aiming to make ordering healthcare as seamless as ordering any other product off of Amazon.com, a patient experience that the company could be uniquely positioned to pull off.

New HHS Data Highlights Telehealth Disparities

A new report from the HHS’ Office of the Assistant Secretary for Planning and Evaluation found that although telehealth use remains drastically elevated from pre-pandemic levels, access challenges are equally persistent.

The analysis stems from the Census Bureau’s Household Pulse Survey, which had a total of 808k US adult respondents between April and October 2021.

Overall, 23.1% of respondents reported using telehealth over the past month, with use levels similar among most demographic subgroups.

  • The lowest telehealth use was among those who were uninsured (9.4%) and young adults between the age of 18 and 24 (17.6%).
  • The highest telehealth use was among those with Medicaid (29.3%), Black patients (26.8%), and those earning less than $25k (26.7%).

The most significant disparities began to emerge when examining the modality used by different subgroups.

  • The share of telehealth visits by video was highest (meaning the share by audio was lowest) among those between the ages of 18 and 24 (72.5%), college graduates (67.4%), beneficiaries of private health plans (65.9%), and white respondents (61.9%).
  • The share of telehealth visits by video was lowest among those without a high school diploma (38.1%), adults ages 65 and older (43.5%), and Latinos (50.7%).

The Takeaway

Although reports on telehealth disparities are unfortunately quite common, the HHS survey’s modality analysis highlights the need for new strategies to ensure equitable access to video visits.

Audio visits lack several advantages of video visits, including the ability for providers to pick up on nonverbal communication or check on a patient’s home environment. As a result, the authors emphasize a need to keep barriers such as device ownership, broadband access, and digital literacy at the forefront of future regulatory conversations.

Calm Acquires Ripple, Appoints New CEO

Wellness company Calm announced the acquisition of Ripple Health Group as it becomes the latest meditation app developer to set its sights on the healthcare market.

While the terms of the acquisition were not disclosed, Ripple’s CEO David Ko will now serve as Calm’s co-CEO alongside Calm co-founder Michael Smith.

  • Calm’s app provides users with audio content that helps them reduce stress, improve sleep, or strengthen their overall mental fitness. Calm’s 100M downloads make it the most popular meditation app of all time.
  • Ripple is the developer of a pair of apps that aim to reduce the burden of caregiving. Care Memo allows patients to communicate with their care teams, while LikePaper helps users organize medical information and set reminders.
  • Following the acquisition, the Ripple team will focus on building Calm Health, an upcoming employer solution designed to support employee mental health that will replace Calm for Business after its launch later this year.
  • Calm Health will include “content, community, and coaching to drive outcomes across the full spectrum of mental healthcare,” building on the lessons learned from Calm for Business, which covers over 20M lives.

The Takeaway
Unlike Headspace and Ginger’s merger from late last year, which aimed to reach the meditation app’s large user base with additional teletherapy services, Calm’s acquisition of Ripple was geared more towards obtaining talent than existing products. The Ripple team and the appointment of Ko as CEO should help to accelerate Calm’s push into the mental health space, and Calm Health is now a core focus of the company’s product roadmap.

Talkiatry Raises $37M to Fuel Nationwide Expansion

Telepsychiatry startup Talkiatry recently announced the completion of its $37M Series A funding round, which it will use to scale its strategy of offering psychiatric care as an in-network benefit with payors.

  • Talkiatry’s platform guides patients through an online survey before matching them with a staffed psychiatrist based on the results, offering continuous virtual care from diagnosis to medication and ongoing support.
  • Many psychiatrists don’t participate in private health plans due to minimal reimbursement and paperwork headaches. Only 62% of them are willing to work with payors while just a third will accept new patients using Medicaid.
  • Talkiatry’s solution to this problem is to bring psychiatrists on board as W-2 employees as opposed to contractors, offering stability while streamlining administrative tasks. Since launching in April 2020, the company has hired 190 providers and conducted over 60k visits.
  • The funding will help Talkiatry expand beyond its home state of New York and continue to aggressively hire psychiatrists to meet the needs of its payor contracts that currently cover more than 200M lives.

The Takeaway

Nearly every startup in the behavioral health space is addressing a common issue: the supply-demand imbalance for providers. Many companies have turned to recruiting therapists in place of psychiatrists, despite the fact that only psychiatrists can prescribe medication.

By avoiding the contractor model, Talkiatry is finding success in attracting these highly sought after providers, and so far the approach appears to be scalable. Over 83% of the psychiatrists in the company’s pipeline have actively applied to join the team.

eConsult Company AristaMD Acquires Preferral

Lack of availability for specialist appointments is a growing problem that’s hard to tackle by just adding video calls or improving referral systems, but AristaMD believes that a combination of both solutions will move the needle in the right direction.

eConsult company AristaMD announced the acquisition of referral management startup Preferral to help address the 20% of referrals that it reports are misdirected and the 50% of referrals that “are often unfulfilled.”

  • AristaMD’s eConsult platform allows primary care physicians to submit a case to a contracted team of over 300 specialists, who then have 24 hours to review it. The patient’s clinical history, lab results, and images are provided to allow the specialist to return a treatment pathway during the one-day window.
  • The model is able to operate due to the fact that peer-to-peer asynchronous consultation is an informational consult, meaning that the specialist does not have to be licensed in the patient’s state. AristaMD works with health plans that offer eConsults as benefits, as well as health systems that use the platform to facilitate collaboration.
  • Preferral’s solution enables PCPs to easily send a referral to a specialist and confirm receipt with both the originating practice and the patient, eliminating avoidable complications that result from busy clinics using fax machines and follow-up calls to coordinate referrals.
  • Combining AristaMD’s eConsults with the Preferral platform will create a comprehensive physician-to-specialist referral solution, complete with reviews for prior authorization, scheduling, and interim care plan support.

The Takeaway

The acquisition of Preferral greatly improves the referral management component of AristaMD’s eConsults service, reshaping it as a comprehensive platform with the ability to improve access to specialists while expediting treatments.

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