Palantir Healthcare Lead Jeremy David

Home Care

7wireVentures: Home is Where the Health Is

Although in-home care has made some major strides over the last few years, a recent 7wireVentures perspective piece laid out why we’re likely still in the “nascent stages” of a shift that has a long way to go before reaching its potential.

7wireVentures sets the stage by defining four distinct segments of home health consumers: 

• Chronic Care – Seeks ongoing virtual care tailored to their needs, often with an in-depth treatment plan and frequent support for symptom and medication management.
• Preventative Care – Seeks routine virtual wellness appointments with a primary care physician, often desires convenient access to lab testing.
• Recently Discharged – Seeks consistent access to virtual care for support when issues arise, often related to new medications or health problems following in-patient care.
• Hospice Care – Seeks continuous in-person care to treat symptoms from the comfort of their own home, often facing a terminal illness.

The landscape of companies addressing those needs varies widely, but this market map does an excellent job grouping them across five primary categories: Preventative Care, Urgent Care, Chronic Care, Hospital at Home, Hospice and Palliative Care.

Using the above framework, 7wireVentures offers a trio of home health predictions:

Prediction 1 – As the industry shifts towards more home-based care offerings that bring a lower-cost site of care compared to traditional in-person settings, demand for such solutions will grow, thus setting in motion a virtuous cycle towards value-based care.

• This would also increase the focus on synchronized care and aggregated data collection, favoring platforms that can support different clinician types / modalities and tie it all together with EHR integration.

Prediction 2 – As demand for healthcare continues to outstrip supply and access to preventative care in traditional settings remains costly, incumbent healthcare stakeholders will expand offerings into the home.

• This would create the need for more partnerships to develop sustainable solutions, similar to Memorial Hermann’s joint venture with AccentCare that established the largest provider of in-home health services in the Houston area.

Prediction 3 – Given the increased ability to collect broader sets of user data, providers will be better equipped to develop deeper insights into consumers, and thus take a whole-person approach to care delivery.

• This would push personalized care toward earlier stage interventions, reducing costs further down the line and ultimately making the promise of always-on, preventative healthcare possible.

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The Wire

• Google Publishes Med-PaLM Results: Google pulled back the curtain on the accuracy of its Med-PaLM large language model with new results published in Nature, finding that 92.6% of Med-PaLM answers “aligned with medical consensus” – on par with human clinicians. The paper goes into a ton of detail on model development and performance evaluation for the hardcore AI enthusiasts, but also includes a great discussion on both the potential of responsible AI and the challenges of building it for healthcare.

• UnitedHealth Q2 Performance: UnitedHealth Group shares are up 7% following last week’s Q2 earnings call, with revenue jumping 16% to $92.9B despite the increased utilization executives recently warned about. UHG now expects its full-year medical loss ratio to be at the high end of its forecast (82.1% to 83.1%) due to an increase in outpatient surgeries among seniors, especially for cardiac and orthopedic procedures. Optum saw an uncharacteristic 14% decrease in operating income, which UHG attributed in part to a sustained increase in behavioral health utilization.

• CarePredict Lands $29M: Senior-focused monitoring startup CarePredict landed $29M in funding from what might be the first Series A3 round we’ve ever covered, with the triple-extended funding round a sign of the times that Rock Health unpacked in last week’s H1 Funding Report. CarePredict’s Tempo wrist wearable tracks daily living activities (precise indoor location, eating, bathing, sleeping) to identify behavior changes that precede health issues, and the funding will help with the expansion from senior housing to the aging in place segment.

• 10 Drugs Dominate Medicare Costs: Ten prescription drugs accounted for nearly a quarter of Medicare’s $216B total drug costs in 2021, highlighting the potential impact of upcoming drug cost negotiations under the Inflation Reduction Act. Bristol Myers Squibb’s Eliquis blood thinner topped the list with $12.6B of Part D costs in 2021 alone, followed by multiple myeloma treatment Revlimid ($5.9B) and blood thinner Xarelto ($5.2B). Novo Nordisk’s Ozempic totaled $2.6B despite Medicare only covering it as a diabetes drug and offering no reimbursement for weight loss.

• McKinsey Medicare Advantage Overview: McKinsey put out a solid overview of the changing Medicare Advantage landscape, outlining the direct impact of demographic shifts, regulatory changes, and shifting member preferences. The report also prescribes some steps that payors can take to stay ahead of the changes, which include leaning in on digital engagement, prioritizing investment in the Stars program, and implementing true zero-based budgeting.

• Big Health Acquires Limbix: Big Health announced its acquisition of Limbix, the developer of the SparkRx prescription digital therapeutic aimed at CBT treatment of depression in young adults. Limbix last raised $15M in Series A2 funding in 2021, and the acquisition marks Big Health’s first move into the adolescent mental healthcare arena as it rolls SparkRx into its DTx portfolio that includes Daylight for anxiety and Sleepio for insomnia.

• Private-Practice Medicine Plummets: The share of physicians in private practice continues to plummet, falling 13 percentage points in the last decade and nearly 30 points over the past three decades. That’s according to a new AMA report that found the share of doctors in private practice dropped from 60.1% in 2012 to 46.7% in 2022, noting that private-practice’s share was close to 76% in the 1980s.

• The Cost of Private Equity: In seemingly related news, an American Antitrust Institute report found that the number of physician practices acquired by private equity has grown rapidly, from 75 practices in 2012 to 484 practices in 2021. The report also found that healthcare costs tend to rise when a single PE firm has more than a 30% market share in a metropolitan area, which was certainly the case in three of PE’s favorite specialties: gastroenterology (costs up 18.2%), OB/GYN (16.3%), and dermatology (13.3%).

• AccurKardia ECG Analysis Clearance: AccurKardia gained FDA 510(k) clearance for its flagship AccurECG Analysis System, a cloud-based and device-agnostic ECG interpretation platform that supports a range of monitoring metrics (e.g. beat-by-beat, heart rate, and 13 different heart rhythms). The AccurECG Analysis System will be offered to device manufacturers, cardiac monitoring companies, and telehealth providers with the goal of speeding up ECG analysis and patient treatment times.

• Affect Therapeutics Closes $16M: Affect Therapeutics closed a $16M Series A round (total funding now $26M) to build out its Affect app that delivers purpose-built treatments for specific substance use disorders, including alcohol, marijuana, and various stimulants. Affect notably incorporates financial incentives for healthy behaviors to drive durable recovery, ranging from 10 cents for completing challenges in the app to $15 for consistently passing drug tests. 

• AI Speeds Up Prior Authorization: AI is slashing the approval time for prior authorizations at Health Care Services Corporation from as long as 14 days to “nearly instantaneously.” HCSC developed its AI prior auth tool in 2021 and piloted it in specialty pharmacy and behavioral health, and has since expanded it to other areas like outpatient services. AI is now used for 93% of HCSC members for some procedure codes, and payors’ quickly growing reliance on such algorithms has some organizations calling for more regulatory oversight.

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