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Spotlight on Employers | PCP Evolution
September 9, 2024
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Together with
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“In healthcare, the question is simply—should I throw more bodies and fax machines at the problem, or should I jump to adopt AI without the baggage of last-generation workflow apps getting in my way?”
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a16z General Partner Julie Yoo
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Help is on the way for employers grappling with rising healthcare costs after two separate startups closed funding to tailor benefits to the needs of employees.
Thatch raised a $38M Series A to dislodge health coverage from employment by providing individual coverage health reimbursement arrangements (ICHRA) that let employees choose their own benefit plans.
- By blending fin-tech and health-tech tools, Thatch gives employers a way to “abstract away the complexity” of the ICHRA law that passed in 2020, which enabled them to provide a budget to employees for selecting health benefits based on their needs.
- The Thatch platform streamlines budget setting, plan selection, and lowers costs through pooled purchasing power. If employees spend less than their budget, they receive a Thatch debit card to use for things like prescriptions, copays, and therapy.
Sounder Benefits hatched from the Redesign Health incubator with $7.5M to take a more hands-on approach to benefit design using AI-driven insights and strategic advisory services.
- Sounder helps employers with <1k employees create a three-year benefit roadmap then guides their transition to level-funded and self-funded plans, providing HR teams with white-glove support and collecting revenue on a per member per month basis.
- Using employee health data, Sounder identifies when employers have enough of a particular health need (like cancer support), then contracts with companies to provide access to solutions (like Jasper Health).
The back-to-back boost for benefits businesses arrives as employer healthcare costs are expected to spike 9% in 2025, surpassing $16k per employee.
- Employers continue to bear the brunt of rising costs, and are looking for more ways to avoid passing expenses onto employees in a tight labor market.
The Takeaway
Most current health benefits solutions were designed for a workforce that stayed with a single company for most of their careers, and have had a tough time keeping up with today’s dynamic labor market. Thatch and Sounder Benefits are among a new pack of startups building the infrastructure for a modern benefits experience, and it seems like both employers and employees have a lot to look forward to.
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RPM Made Easy with a User-Friendly Platform
Seamlessly integrate Withings RPM with your existing EHR system and empower your care team to focus on what matters most – patient care.
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Navigate the Future of Healthcare AI at Elevate
Join Medallion at Elevate on October 30th and experience the top minds in healthcare coming together to share bold ideas and connect in an informal, down-to-business setting. This was hands-down the best virtual conference we attended last year, and the lineup for 2024 is packed with execs from orgs like from VillageMD, Multiplan, and Community Health Systems. Take advantage of Elevate by registering here.
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Join the Nabla Team!
Nabla is expanding its team, and it’s on the lookout for an exceptional VP of Sales to bring aboard. This role will be instrumental in shaping the go-to-market efforts of a company dedicated to bringing joy back to the practice of medicine. Learn more and apply here.
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- The Evolving Primary Care Workforce: Dr. Paulius Mui at XPC read the tea leaves (and data) to share some fantastic insight into why the “the primary care workforce is undergoing a major transition that is poised to disrupt the status quo.” The article explores the factors behind the outflow of PCPs to other specialties over the last decade, which resulted in the rise of mid-level providers like NPs and PAs to fill the workforce gap. We’re seeing many approaches to staffing care teams, although the jury’s still out on which model works best.
- Physician Telehealth Use: A study in Health Affairs analyzed Medicare claims data from 2022 to identify which physicians stand to be most-impacted by the looming telehealth flexibility deadline. Although virtual care is often cited as a saving grace for rural patients, physicians in metropolitan areas provided 8.3% of visits through telehealth, versus 5.3% for rural physicians. There were also differences between genders (9% telehealth visits for female physicians, 6% for male) and specialties (23% of psychiatrists had nearly all telehealth visits, vs. <1% of every other speciality).
- Risant Commits Cone Investment: Financial documents filed by Kaiser Permanente revealed that Risant is committing at least $1B over five years to support Cone Health “facilities, health equity, and other capital projects.” The Cone acquisition was first announced in June and is still awaiting regulatory approval, but once that happens Risant will also commit up to $400M to integrate Cone into its network and another $300M for future growth.
- Fewer Cancers Diagnosed During COVID: Nearly 150k cancers may have gone undiagnosed in 2020 and 2021 due to the pandemic. New research in JAMA Network Open found that cancer incidence was 9.4% lower than expected in 2020 and 2.7% lower in 2021, adding up to 149.6k potentially undiagnosed cases. Only female breast cancer diagnoses rebounded in 2021 (exceeding expectations by 2.5%), while remaining lower for lung cancer (-9.1%) and cervical cancer (-4.5%) There was unsurprisingly also a decline in early-stage diagnoses.
- Nabla Now Supports 35 Languages: Nabla’s ambient AI assistant is now available in 31 new languages on top of its existing support for English (U.S./U.K.), French, and Spanish. Medical errors due to language barriers cost the U.S. healthcare system an estimated $60B to $80B every year, and Nabla’s addition of languages ranging from Mandarin to Tagalog will help advance culturally responsive care while breaking down communication walls between physicians and their patients.
- Labor Shortage Predictions: A new report from Mercer predicts that a lagging labor market and the care needs of an aging population will leave us with a shortage of over 100k critical healthcare workers by 2028. Mercer expects certain states and specialties to bear most of the burden: New York is projected to be short 61k healthcare workers (a 4% gap between supply and demand), while nearly every state will likely face a shortage of nurse practitioners (despite NP employment growing faster than nearly all other jobs). One of the only bright spots was that the U.S. is expected to have a surplus of 30k RNs by then.
- Vesta Series C: Vesta Healthcare closed $65M in Series C funding to leverage in-home caregivers as a way to “bridge the gap between healthcare and home care.” The Vesta platform spans from home-based primary care to passive monitoring, combining RPM with an all-hours call center to support seniors aging at home and relay caregiver insights to the rest of the care team. Providers work with Vesta to monitor patients between visits, while payors use them to improve member satisfaction and quality metrics.
- Mobile Phones & Heart Issues: Compulsive mobile phone usage might be associated with future cardiovascular issues. That’s the takeaway from a widely-covered study that analyzed 12-year outcomes from 444k mobile phone users, finding that regular mobile phone users had a higher risk of incident CVD (HR: 1.04) and increased carotid artery wall thickness (odds ratio: 1.11). Although phones don’t technically cause CVD, high phone usage was associated with disrupted sleep, psychological distress, and neuroticism.
- Ochsner’s RPM Success: New Orleans-based Ochsner Health told the American Medical Association that it’s seen a 3-to-1 return on investment in remote patient monitoring for value-based care patients. A key success driver was the expansion of Oschner’s Connected Health program for cardiometabolic patients, which creates dashboards using data from connected BP cuffs and glucometers and feeds algorithms to control blood pressure and blood sugar. The system reportedly cut $2,200 in annual costs for patients in risk-based contracts.
- Hospitals Find Steady Footing: The latest Strata data showed that hospitals saw higher revenue, operating margins, and patient volumes in July, despite the fact that expenses continue to climb. Hospital year-to-date operating margins rose to 6.5% in July (up from 4.9% in June), driven by both outpatient visits (up 13.2% YoY) and inpatient admissions (up 8.2% YoY). The margin improvements were achieved in the face of big expense jumps for drugs (17.3%), supplies (16.4%), and labor (5.7%).
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A First Principles Approach to Responsible AI
Playback Health has over 15 years of experience breaking down complicated technology problems into basic elements then reassembling new solutions from the ground up, and just published a short-and-sweet guide to help others take a “first principles approach” to responsible AI.
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K Health’s First-of-its-Kind AI Knowledge Agent
K Health’s AI Knowledge Agent is a first-of-its-kind GenAI system purpose-built for the clinical setting, with a familiar feel hiding some major innovation under the hood. Discover how the AI Knowledge Agent is bringing new levels of personalization to answering patient medical questions and changing what it means to have a “digital front door” in the process.
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Bridging Care Gaps for Underserved Populations
Is your health system, rural health clinic, or federally qualified health center struggling to reach patients with obstacles to receiving in-person care? This Clear Arch Health whitepaper explores how combining RPM with VBC can help facilitate proactive interventions, address social determinants of health, and get the most out of new CMS reimbursement pathways.
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