Oak Street Acquires Specialty Care Provider RubiconMD

Value-based primary care network Oak Street Health acquired RubiconMD for $130m, adding virtual specialty care to its existing services focused on seniors in the Medicare Advantage population.

  • Oak Street operates by initiating full-risk contracts with Medicare Advantage plans, taking on complete economic responsibility for patients in exchange for per-member, per-month compensation. Oak Street Health currently operates over 100 centers across 18 states and is the only primary care provider endorsed by the AARP. 
  • RubiconMD’s network contains over 230 specialists across all major specialties, with a virtual platform that provides clinical insights on specific patient cases and allows primary care providers to directly manage more of a patient’s care needs.
  • Integrating specialty care into Oak Street’s value-based model will enable it to improve coordination between PCPs and specialists while streamlining operations, an important component to successfully managing a full-risk model.

The Takeaway

RubiconMD was built to support the exact type of health centers managed by Oak Street, and the acquisition provides Oak Street with a proven platform and a large specialist network instead of having to develop both from scratch.

Although Oak Street was an early entrant in the value-based care segment, the RubiconMD acquisition highlights the scale needed to compete for contracts with a limited pool of employers and payors, likely foreshadowing more consolidation on the horizon.

B2C2B as a Digital Health Go-To-Market Strategy

In a recent editorial at MobiHealthNews, Marley Medical CEO Chris Hogg laid out the case for why business-to-consumer-to-business (B2C2B) could be the best future go-to-market strategy for virtual care.

After serving as the CCO of Propeller Health (acquired by ResMed in 2018), Hogg went on to found Marley Medical in August of this year, aiming to help people manage common chronic conditions by taking a new approach to the market.

  • Early digital health companies faced problems fitting innovative products into a lagging reimbursement framework, finding themselves misaligned with existing code descriptors. Without a standard classification, most companies began working directly with payors and employers, offering them services that they could then market to their members (B2B2C).
  • The B2B2C model allows digital health vendors to be compensated by payors in a variety of ways, usually tied to enrollment or engagement. After finalizing the contract with the payor, the vendors begin overcoming implementation challenges and marketing for new members, hurdles that often lead to slow enrollment and limited revenue.
  • Virtual care’s emergence as an effective care delivery method shifts the landscape, allowing digital health startups to classify their products as “traditional clinical services” qualifying for reimbursement. It also allows them to work with and market to individuals while unlocking the ability for payors to compensate them for providing services to their own user base (B2C2B).
  • The B2C2B model gives companies control over user acquisition while enabling their offerings to be subsidized by payors – a compelling go-to-market strategy. The need to directly acquire users causes companies to focus on specific populations and build people-centric products with tangible impacts, as opposed to ones that are easy to market to payors or employers.

The Marley Medical Strategy

In a telehealth playing field that seems to be getting more crowded every day, Marley Medical is looking to set itself apart by focusing its virtual primary care offering on specific populations with chronic disease, engaging directly with patients before working with payors as an in-network provider. With Hogg at the helm and a fresh go-to-market blueprint on its side, Marley Medical is in a good position to show how effective B2C2B can be.

Unsatisfied Patients Turn to the Internet

According to a new study from the AHIMA Foundation and Kelton Global, there is a large disconnect between the information shared by doctors and their patients’ understanding of it.

This communication breakdown leaves patients confused about how to proceed, prompting many to turn to other resources to feel more in control of their health.

  • The survey was distributed to a nationally representative sample of US adults in August 2021 (n=1,059), finding that 76% of Americans “do not leave their doctor’s office on a positive note,” due in part to lacking clear answers to questions (24%) or not having the chance to ask any questions (17%). 
  • After these visits, 62% of Americans are “not extremely confident” in their understanding of information discussed with their doctor, while 15% admit feeling more confused about their health than they did before their appointment.
  • As a result, 80% of Americans research medical recommendations online following an appointment, reporting that they are confident the information on the internet is credible (86%) and that it allows them to feel more confident in their doctor’s recommendations (35%).

The Solution

The researchers conclude that having access to a complete picture of your own health, whether through a doctor’s visit or internet research, is the key to seeing better health outcomes. Most Americans seem to agree, with 81% of survey respondents saying that if they had access to all their health information, such as medical records and test results, they’d see at least one improvement in their health management.

Equum Medical Expands Decentralized Provider Network

Acute care telehealth and tele-ICU provider Equum Medical has been busy. After raising $20m in funding this August, the company has been actively hiring and broadening the reach of its multispecialty clinician teams.

The timing of the moves is not a coincidence. As the pandemic continues to pressure hospital bandwidth and cause burnout among healthcare workers, Equum’s services could be a part of the solution.

  • Equum’s unique approach to care delivery supports health systems with telehealth-enabled physicians working in close proximity to patients. These clinical “pods” allow physicians to build durable relationships with local patients.
  • The company’s goal is to create a critical mass of local physicians and intensivists to provide uninterrupted care for partners, with the nationwide network available as a safeguard during local surges in demand.
  • This allows health systems to fill coverage gaps, reduce the labor load of on-site clinicians, and extend patient care in specialty areas. Equum’s modular services also allow partners to right-size coverage options while keeping their existing tech platforms.

The Takeaway

Unlike in other industries where specialization reigns supreme, health systems have yet to outsource a wide range of functions. With a growing number of “prosumers” taking an active role in their care and demanding more from providers, many hospitals are having difficulty meeting rising expectations.

Equum’s decentralized care framework aims to solve this challenge, not with the standard telehealth playbook, but by bringing its services closer to the people that it serves.

Teladoc Virtual Primary Care Expands Nationwide

Teladoc Health is using its scale to reach the 80% of adults that “do not have a strong relationship with a primary care physician” by making its Primary360 solution available to US commercial health plans, employers, and other benefits sponsors.

Primary360 is a virtual primary care service that Teladoc has been piloting for the past two years. It is already being used by several large companies and will be available to Aetna members early next year.

  • Primary360 allows members to select a primary care provider and develop longitudinal relationships with physician-led care teams. Members receive personalized health plans through Teladoc’s virtual care offerings, and can get help navigating to in-person providers.
  • Data from the pilot shows that two-thirds of members previously lacked traditional primary care and that Primary360 helped members detect undiagnosed chronic diseases. One in four chronic conditions identified for members of the pilot were new diagnoses of common disorders such as diabetes and hypertension.
  • Half of Primary360 members enrolled in the pilot take advantage of at least one other Teladoc product, while nearly 30% use two additional connected services.

The Takeaway

Although Teladoc is positioning Primary360 mainly as a way to make primary care more accessible, it also serves as a way to bring in new business following slowing membership growth as the pandemic wanes. Teladoc is establishing Primary360 as a hub for its full suite of virtual solutions, giving more patients the ability to receive primary care while widening the patient funnel for its other offerings.

GoodRx Launches Online Health Resource

Digital pharmacy tool GoodRx recently launched an expansive online resource called GoodRx Health to provide research-based answers to popular health questions.

GoodRx Health takes a different approach than other consumer health destinations, offering actionable insights through GoodRx Answers and a Health Wizard for navigating difficult decisions.

  • GoodRx’s current services include app-based prescription tracking and a telehealth platform called GoodRx Care, which provides virtual primary care services.
  • GoodRx Help adds new ways for users to explore the company’s library of Video Explainers and editorial content, a large strategy shift that pushes the company beyond its current role as a comparison tool.
  • GoodRx’s new strategy targets every stage of a consumer’s healthcare journey, uniting the company’s platforms by directing diagnosis-seeking consumers from GoodRx Health to its GoodRx Care telehealth service for treatment.

The Takeaway

GoodRx Health is far from a small content play to drive more traffic to a website. GoodRx is doing everything in its power to leverage the 20m monthly users already visiting its site, from hiring a 50 person editorial team helmed by the former executive editor of WIRED, Thomas Goetz, to acquiring health video company HealthiNation for $75m in April.

WebMD and symplr announced a similar partnership in August, which allows WebMD users to go from a health information search to scheduling a telehealth appointment in three clicks. GoodRx’s vertical integration of these services could position it as a leader among companies operating in the overlap between health information and treatment.

Amazon Announces Healthcare Accelerator Finalists

Amazon Announces Healthcare Accelerator Finalists

Digital health startups were in the spotlight this week as Amazon announced the ten finalists for its first ever AWS Healthcare Accelerator.

The companies were selected from 427 applications and 31 countries around the world, although each finalist is US-based. The finalists were chosen by a panel from Amazon Web Services (AWS) and KidsX, an accelerator for companies focusing on pediatric care. Each startup has a validated solution along with existing revenue and customers.

The AWS Healthcare Accelerator is a four week program that pairs finalists with technical and business mentorship from experts from AWS and KidsX, then offers collaboration opportunities with members of the AWS Partner Network looking for healthcare solutions.

AWS Healthcare Accelerator finalists include:

  1. AIVA is a voice-powered care assistant for hospital patient rooms and senior living communities with a mission to be the voice operating system for better care. 
  1. b.well offers an integrated solution for consumer engagement, holistic health management, and cost containment. They use longitudinal aggregated data to paint a picture of health for each consumer and aggregate data to show population health.
  1. Ejenta automates remote monitoring and remote care delivery using AI exclusively licensed from NASA. Their “intelligent agents” learn from connected devices and EHR data to monitor patients, predict health, and connect care teams.
  1. Giblib creates an educational content streaming experience for healthcare providers. It allows for on demand streaming of surgical videos and medical lectures from subject matter experts along with the ability to receive continuing education credits.
  1. Gyant is a virtual assistant and digital front door solution designed to optimize patient journeys. It navigates patients to the right care setting and resources while providing simple appointment scheduling.
  1. Kaizen Health is a healthcare logistics platform that connects healthcare and transportation to reduce access barriers.
  1. Medical Informatics Corp offers an FDA-cleared Sickbay virtual care platform that helps hospitals improve operational efficiencies by enabling the rapid scaling of remote patient monitoring across any inpatient setting.
  1. Neuro Rehab VR is reinventing training exercises for physical and cognitive therapy by leveraging VR and neuroplasticity for recovery. It allows providers to track their patients in real time and has shown increased patient engagement.
  1. OneRecord provides an app that helps patients build a consolidated health record of their entire medical history in a single place.
  1. Pieces uses AI to connect patients and health systems with solutions that address social determinants of health. They connect care providers to actionable data, people to services, and caseworkers to information.

Industry Impact

Amazon’s multi-pronged strategy for entering the healthcare market goes beyond its hands-on approach with Amazon Care. By providing companies such as these finalists with AWS solutions, Amazon is establishing itself as the cloud-based foundation for a new cohort of healthcare disruptors.

Xealth Makes Digital Health Usable

The booming digital health sector has seen such rapid expansion that it is beginning to enter the next level of its industry life cycle: the stage where solutions have solutions.

Digital health integration platform Xealth recently closed $24m in Series B funding, bringing the Providence St. Joseph Health spinoff’s total funding to $52.6m.

Xealth aggregates and organizes digital health tools within the EHR, enabling not only easier reporting, but also centralized distribution, enrollment, and patient monitoring.

The Xealth platform has three interdependent modules:

  • Xealth Clinical Interface – Solutions are ordered, delivered, and tracked from within the EHR, with clinical decision support matching patients to relevant solutions.
  • Xealth Digital Command Center – Provides customized reporting of patient and provider engagement, which is aggregated to match demographics to solutions.
  • Xealth Integration Layer – Supports deployment of multiple solutions through a single integration with the EHR, allowing health systems to save IT resources by avoiding independent vendor integration.

The Takeaway

As health systems pursue innovation, they’re presented with an abundance of disjointed products with specialized use cases, creating the need for a platform that allows physicians to prescribe and monitor these solutions within a single cohesive workflow.

Xealth’s services are already available to over 100k physicians, and the company states that care teams are seeing improved patient engagement metrics as a result of measuring outcomes across a health system’s entire virtual solution ecosystem.

Aggregators that improve usability of existing solutions have emerged as success stories in other industries such as business collaboration software, and Xealth is looking to replicate this success within the digital health landscape.

Under the Radar Healthcare Disruptors

Digital health venture fund and advisory team Rock Health recently published an excellent blog post outlining what they call healthcare’s “middle children,” defined as large-but-not-huge companies that should be eyeing expansion into healthcare.

The authors argue that these middle children have distinct competitive advantages over the cohort of technology giants that have recently been pursuing the healthcare space, which include the likes of Amazon, Alphabet, and Apple.

  • Middle children with market capitalizations between $10b and $350b are large enough to make an impact in healthcare, but small enough to avoid the scrutiny of massive players. They are often consumer-facing, with business lines that could pivot towards a healthcare use case (picture Lululemon’s acquisition of Mirror).
  • Larger middle children have deep pockets and talents pools (Salesforce, Nike), with the capabilities to pursue large healthcare goals.
  • Smaller middle children have more specialized capabilities (Garmin, Airbnb), that could help with solving more focused problems.

Middle Children Advantages

  • Smaller healthcare goals are big enough for middle children to pursue for growth, whereas much larger companies need loftier projects to warrant market expansion.
  • Loyal customer bases can be activated by middle children to establish initial users while avoiding the regulatory attention quickly drawn by larger competitors.
  • Specialized assets from middle children, such as logistics expertise or data analytics, can provide a competitive edge in healthcare. 

Potential Middle Children Plays

  • Blizzard could passively monitor behavioral health conditions for children playing its games
  • Paypal could integrate Health Savings Accounts to help users manage healthcare spending
  • Hello Fresh could offer health insights and recommend food products for delivery

The Takeaway

Gaining share within the $3.5t US healthcare market is a powerful motivator for any company looking to pursue a strategy shift, but even consumer-favorite brands will need humility to navigate the complex and quickly evolving environment.

Although middle children don’t specialize in the sector, Rock Health makes a solid case that they might be some of the best-positioned companies for healthcare disruption, and I wouldn’t be surprised if we’re reading about some of the plays listed in this blog post in next year’s business news.

Spring Health is the Latest Mental Health Unicorn

Digital behavioral health startup Spring Health recently raised a $190m Series C round ($300m total funding), raising its valuation to over $2b and making CEO April Koh the youngest woman to helm a multibillion-dollar company.

The Spring Health investment is the latest movement in an especially active third quarter for the virtual behavioral therapy sector, which has already seen major announcements from companies like K Health and Headspace.

  • Spring Health offers mental health benefits to employers, which include online therapy, coaching, and a guided-exercise app. Its services are marketed as either supplements to employee assistance programs or total replacements in many cases.
  • The company’s differentiator is that it caters to employers with a wide range of health needs and financial capabilities, as opposed to focusing exclusively on large businesses.
  • The new funds will be used to launch “the first cohesive mental health experience for families,” leveraging a single centralized platform to support both employees and their households. The extra capital will also aid in global expansion, adding to the list of over 200 countries that Spring Health currently operates in.

Industry Impact

Spring Health’s Series C round solidifies its position among the ranks of well-capitalized digital health leaders, a list that also includes competitors such as the rapidly growing Lyra Health ($680m funding at a $4.2 valuation).

While Lyra Health widened its strategy with recent expansion into new specialized care areas, Spring Health is instead focusing on depth over breadth by integrating its family health solutions into a single cohesive platform.

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