UnitedHealth Group CEO Andrew Witty

Digital Health

Innovation for Underserved Groups

Venture firm Rock Health recently published an interesting deep dive on the digital health adoption patterns of marginalized user groups that have carried a disproportionate amount of access disparities. The analysis was based on survey results from Rock Health’s latest Digital Health Consumer Adoption Survey of 7,980 US adults, which shed light on where digital health solutions are gaining traction, and where gaps still remain.

Rural households have one of the most persistent adoption gaps among all demographics, with rural respondents reporting lower rates of live video telemedicine use, wearable ownership, and digital tracking of health metrics… and not by a small margin. Rock Health found that rural residents trust health information from a doctor (88%) far more than from a website (52%), highlighting a need to invest in tools that empower rural providers.

• Startups working to solve these problems include Main Street Health, which pairs rural MA beneficiaries with local health navigators to coordinate chronic care needs, and Homeward Health, which designed its RPM platform to function on cellular networks to bypass the need for a broadband connection.

Medicaid’s 80M beneficiaries account for over $650B in annual health expenditure, and the fact that they use digital health tools at similar levels to the survey average seems to bust the myth that people with low incomes or disabilities won’t use health technologies. 

• Recent raises from startups like Waymark ($45M) and Clinify Health ($3.1M) have helped support Medicaid care hubs like Federally Qualified Health Centers, and Rock Health expects more innovation to be targeted at these community-based networks.

Women of color reported significantly lower satisfaction with digital health tools than women who identified as white, despite their strong adoption across all modalities. Although the survey didn’t explore the “why” behind the satisfaction levels, Rock Health believes that they may relate to disconnects between product design and the communities using the solutions.

• Several startups have begun co-designing solutions with their communities to mitigate these satisfaction breakdowns, including Radical Health (online peer support for navigating healthcare journeys) and Grapevine Health (community-created health content that’s then distributed at scale).

LGBQA+ and transgender patients report some of the highest levels of discrimination in health settings, and their sky-high digital health utilization serves as a proxy for lack of trust in traditional care. Rock Health found that 85% of transgender respondents and 33% of LGBQA+ respondents delayed medical care in 2021, and several solutions are entering the market to ensure that care gap doesn’t persist.

• Startups supporting queer and transgender patients raised a record $311M in 2021, including Folx, which raised $25M to expand its virtual clinical services, and Plume, which raised $14M to help deliver holistic gender-affirming care to anyone who needs it.

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• Homethrive Funding: Homethrive completed a $20M Series B round (total funding now $43M) to scale its Dari platform that equips caregivers with resources for topics such as Alzheimer’s and Medicare, as well as live one-on-one support from dedicated care guides. The startup reports that employees who engage with its platform reduce their intent to resign by 80%, which sounds like a solid value proposition for employers considering the implementation of this type of program.

• Impact of Word Choice: New research from the University of Arkansas found that stakeholders often have different definitions for key digital health terms such as telehealth and telemedicine. While the study found that legislators use “telehealth” and “telemedicine” interchangeably, it also revealed that academic researchers have distinct meanings for the terms 60% of the time. On top of this, healthcare organizations had distinct meanings for the terms 76% of the time, and the author’s are quick to point out that addressing these differences will be key to effectively advocating for any new telehealth legislation.

• Mayo Clinic Financials: Mayo Clinic ended the first quarter of 2022 with an operating income of $142M, bucking the trend of many US health systems currently facing negative operating margins. Although Mayo Clinic saw a 7% lift in total revenue to $3.9B, operating expenses also climbed to $3.8B, and when $369M in non-operating expenses were incorporated into the equation the health system tallied a hefty net loss of $227M. Non-operating expenses include items such as taxes, interest, and last but certainly not least in 2022: investment losses.

• Hospital Market Power: A RAND study found that private health plans paid 224% of Medicare rates in 2020, with wide variation among individual states. In some states (Hawaii, Arkansas, and Washington) private rates were 175% below Medicare, while others (Florida, West Virginia, and South Carolina) were 310% above Medicare. RAND indicated that very little of the variation was explained by each hospital’s share of patients covered by Medicare or Medicaid, but was driven instead by hospital market power.

• Tufts Medicine + AWS: Tufts Medicine became the first health system to successfully launch its digital health ecosystem in the cloud after working with Amazon Web Services to migrate its Epic EHR and 3M accounts to an AWS-hosted environment. The $2B health system also migrated over 40 applications, with plans to repeat the process with 300 other apps in the coming months. Provider organizations considering a similar move will be keeping a close eye on the results, with Tufts expecting the migration to save the system between $2-5M annually while decreasing the time spent on some workflows from months to hours.

• Telehealth Use for Children: A CDC study of National Health Interview Survey data found that children with chronic conditions were more likely to use telehealth during the pandemic than those without. Over 23% of children with asthma used telehealth during the pandemic (compared to 13.6% of those without), but the largest difference was seen in children with developmental conditions, who used telehealth at a rate of 32.5% (compared to 11.1% of those without).

• UNH Digital Medicine: UnitedHealth Group CEO Andrew Witty took to the stage at the Wall Street Journal’s Future of Everything Festival to share how his company is leaning into telehealth to reduce costs and meet the chronic need for more behavioral health providers. UnitedHealth currently offers a plan to employers with lower premiums that requires patients to seek a virtual visit before pursuing in-person treatment, and while Witty admits that “not everybody will like the idea of a gatekeeper,” he believes that telehealth services will only continue to expand following the pandemic.

• Teletherapy for OCD Symptoms: An NOCD teletherapy program was found to reduce symptoms of obsessive-compulsive disorder by 43.4%, according to a study published in JMIR (n = 3,500 patients). The three-week treatment included twice-weekly video appointments with exposure and response prevention therapy along with quarterly check-ins over the following year. On top of the reduction in OCD symptoms, the study also reduced symptoms of depression (44.2%) and stress (37.3%), notable results given that the complete intervention took less than 11 therapist hours per patient.

• Cayaba Care Raises $12M: Maternal health startup Cayaba Care raised $12M in Series A funding that the company will use to invest in their technology, hire more staff, and expand into new markets beyond Philadelphia and New Jersey. Cayaba works with local providers and obstetricians to offer virtual support to pregnant patients, connecting them to a care navigator to bridge the gap to maternal care in the US where lack of access can lead to worse outcomes for mothers.

• Data Sharing Survey: More data continues to come out indicating that Americans are willing to share health data, but only for certain use cases. Q-Centrix’s Health Care Data Sharing Survey of 1.2k US adults found that 71% are open to sharing de-identified health data to improve their own healthcare or to advance health equity, however most are either very concerned (42%) or somewhat concerned (45%) about how that data is shared. Despite these hesitations, only one-in-five believe that sharing health data is not important when done responsibly.

• Humana Primary Care: Humana is expanding its joint venture with private equity firm Welsh, Carson, Anderson & Stowe to open over 100 new value-based primary care clinics for Medicare patients by 2025, adding to the 67 clinics already in the works. The move comes as traditional health plans compete for lucrative Medicare Advantage members that benefit payors that can keep costs down while caring for seniors, and should help reverse Humana’s slowing growth among this high-value population.