A tweet from Scott Shreeve, MD, on Walmart’s new Epic partnership.

Digital Health

Digital Health Funding Tops $21B in 2021

With three months left in 2021, digital health funding has reached a staggering total of $21.3b across 541 deals.

To put that number into perspective, last year was the first year that total digital health funding surpassed $10b, and 2019’s total was a small-by-comparison $7.9b.

These figures are from Rock Health’s Q3 2021 Digital Health Funding Report, which analyzed how 2021’s financing boom is shifting market expectations and creating a landscape that’s ripe for consolidation.

Funding themes remained similar to prior years, with investors focusing on value propositions such as R&D software and clinical indications like mental health. R&D funding was lifted by mega rounds from XtalPi ($400m) and Reify Health ($220m), while mental health services saw an influx of capital at Spring Health ($190m) and SonderMind ($150m).

Most funded value propositions:

1. R&D catalysts ($4.7b)
2. On-demand healthcare ($3.4b)
3. Treatment of disease ($3.1b)
4. Fitness & wellness ($2.9b)
5. Non-clinical workflow ($2.1b)
6. Consumer health information ($2.0b)

Most funded clinical indications:

1. Mental health ($3.1b)
2. Cardiovascular disease ($1.4b)
3. Diabetes ($1.4b)
4. Primary care ($1.4b)
5. Oncology ($1.2b)
6. Substance use disorder ($793m)

Industry Impact

This year’s unprecedented funding signals that investors are betting on a continued surge in healthcare innovation, but the wave of new entrants is creating a clutter of digital health options for patients and providers. As the market begins to call for more unified offerings, companies are turning to M&A for the answer.

The 216 digital health M&A deals through the first three quarters of the year have already eclipsed the 146 deals in 2020. Companies like Headspace and Ginger have combined to vertically integrate their solutions to provide their user base with a deeper well of resources. Other deals, like K Health’s recent Trusst acquisition, are focusing on horizontal integration to serve multiple channels with a single tech interface.

Regardless of the strategy, the rate of the dealmaking is causing many to wonder if company valuations can continue rising at the same pace for much longer, but for now it seems like we could be in the early innings of another record breaking Q4.

Digital Health

Graphite Health Announces Open Marketplace

Piloting new digital health tools will soon be as easy as downloading a smartphone app, at least if Graphite Health has anything to say about it.

Intermountain Healthcare, Presbyterian Healthcare Services, and SSM Health recently announced the launch of Graphite Health, a member-led nonprofit aiming to create an interoperable data platform that will allow health systems to adopt new technologies “as easily as anyone can download an app from an app store to a smartphone.” 

Graphite Health is modeled on another Intermountain-owned venture called CivicaRx, which works to make generic medications broadly accessible, and is seeking to build an open marketplace for digital health tools.

• Graphite Health Platform – To support the development of plug-and-play applications, Graphite Health is creating a common data language (built on the FHIR framework) that will allow providers to implement tools without unique customizations.

• Graphite Health Marketplace – The marketplace will serve as a single location for innovators to distribute their solutions at scale, while giving providers a way to save months (if not years) of security and integration reviews when piloting a new tool.

In addition to the founding health systems, Graphite Health is planning on bringing additional organizations into the coalition over the coming months, with a target of reaching over 40m lives covered.

Industry Impact

Unlike current health marketplaces such as Epic’s App Orchard, Graphite Health’s nonprofit structure allows its marketplace to function as a “health utility,” serving members without the additional provisions of alternatives. If the company succeeds in its vision of streamlining interoperability, an elusive goal for many that have attempted, it will help facilitate the adoption of new tools while bringing operational efficiency to health systems.

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The Wire

• Apple Health Backlash: Business Insider recently painted a less-than-rosy picture of Apple’s healthcare division, revealing several situations where leaders suppressed concerns or misled executives. According to 11 current and former employees, Apple prefers “telling good stories over accurately representing the data,” and is having difficulty blending its hardware-oriented culture with its medical business. The Apple Watch’s features have historically been introduced by engineers, not clinical staff, and are often designed for consumers rather than patients seeking medical care.

• Incentivizing Medicine Adherence: A new study published in JAMA Network Open randomized 764 statin users and compared a control to groups with financial incentives for daily statin adherence ($1.40/day), quarterly improvement in LDL-C level ($126/10mg/dL decrease), or a combination of both. The study tested an important contrast in the delivery of financial incentives (process-based vs outcome-based), but found no evidence that financial incentives of either kind improved LDL-C levels. The researchers recommend that future studies combine incentives with interventions such as motivational interviewing.

• Home Care x3: Henry Ford Health System is partnering with home care provider Contessa to launch hospital-at-home, skilled-nursing-facility-at-home, and palliative-care-at-home programs for its patients. According to HFHS, Contessa programs reduce readmissions by 44%, decrease mean hospital stay length by 35% and have a 90% patient satisfaction rating. Earlier this year, Contessa’s patient-centered approach to bringing high-acuity care directly to the home drew the attention of Amedisys, which acquired the company for $250m.

• Hospital Turnover: Nearly 1 in 5 healthcare workers have quit their jobs since February 2020, according to a September survey from Morning Consult. Among healthcare workers that did not quit, 31% have considered leaving, citing the pandemic, monetary concerns, and burnout as the top reasons. Hospitals have been leaning heavily on staff to work overtime, with 79% of healthcare workers saying that the medical professional shortage has impacted their place of work, sometimes leading to “rushed or subpar care for patients.”

• Firefly Benefits: Virtual-first care delivery company Firefly Health announced the launch of a health plan for employers, making it one of the few companies expanding from care to coverage rather than the other way around. Firefly’s model drives savings through proactive telehealth visits and lower admin expenses, coupling its virtual care services with an in-person provider network. The company’s close relationship with patients (it reportedly interacts with 25% of members on a weekly basis) could give it an advantage while aligning care and coverage under one roof.

• Pediatric Health Literacy: Researchers from Lurie Children’s Hospital of Chicago studied a group of 200 teenagers with spina bifida to determine whether health literacy (HL) is associated with pediatric to adult-care transition readiness. Using a transition of care readiness scale (TRAQ) and an HL screening tool, the study found that patients with at least adequate HL had TRAQ scores 10% higher than those without. Many pediatricians use an age cut-off to determine when to begin transitions of care, but these findings suggest that HL may be a valuable component of the readiness assessment.

• Stellar Funding: Stellar Health, an analytics platform for independent primary care groups, recently raised a $60m Series B ($75m total funding), which it will use to grow its team and expand into new markets. Stellar helps providers deliver value-based care through its point-of-care platform, which integrates patient data with existing physician workflows to deliver insights while also rewarding providers that generate a strong ROI for health plans.

• MedTech Startup Trends: Deloitte and digital health accelerator MedTech Innovator (MTI) recently analyzed MTI’s database of 1k company applicants from 2021, finding that startups are expanding beyond episodic care by adding solutions to address the full patient journey. Nearly half (46%) of MTI applicants are focusing on prevention / diagnosis / wellness, and only 19% are focusing on treatment. Applicants are also choosing less burdensome regulatory paths, with a majority planning to enter the market with 510(k) (47%) or unregulated (29%) products.

• New Name, New Model: Wayspring, formerly known as axialHealthcare, recently raised $75m as it seeks to develop its value-based care model for substance use disorder (SUD). Wayspring is straying away from its roots as a software platform for providers as it evolves into a full-risk medical home, which delivers community-based peer support, behavioral health services, and primary care. If Wayspring can successfully drive savings through lower readmissions and ED visits, then the new model will align incentives to better serve both the company and patients.

• What Causes Provider Switching?: Huron Consulting Group published a survey this week that looked into the things that cause patients to switch providers, finding that “trust and respect” was the number one reason. Despite the fact that 75% of consumers are satisfied with their care, HCG found that 60% would switch providers for more trust and respect, surpassing both lower cost (46%) and closer location (44%). Patient loyalty was also driven by virtual care, and 15% more consumers are viewing telehealth as a primary care option in 2021 than in 2019.

• Telehealth Mandate: New York Governor Kathy Hochul signed an executive order that allows providers to use telehealth to address staffing shortages amplified by an August mandate requiring all healthcare workers to be vaccinated. The order enables: 1) out-of-state providers to treat patients in New York via telehealth 2) virtual visits in nursing homes 3) use of remote platforms by EMTs to care for patients in alternative locations.

• RecoverX Debut: AI-enabled CDS company RecoverX recently spun out from the AMA’s innovation subsidiary. RecoverX aims to address the system-level challenges posed by “a body of medical knowledge growing so fast that it’s humanly impossible to keep up with,” giving providers a list of insights and next-best actions to identify the most likely diagnoses. The RecoverX platform is designed to support physicians by augmenting their existing workflows to be more efficient.