164 items found

  • ACOs Direct Contracting Becomes REACH, Challenges Remain-The HSB Blog 2/28/22

    Our Take: On Thursday, February 24th, CMS announced it was ending the GPDC ACO program and replacing it with the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) Model effective 1/1/2023. While the new program attempts to increase the role of ACOs in helping to achieve health equity and the amount of provider ownership in ACOs a number of fundamental challenges remain the same. In addition, given the program was only extended until the end of the previous GPDC many analysts have speculated that this will not be the last in a likely series of changes to value-based care programs in Medicare’s ACO programs. Key Takeaways: Approximately 41% of Medicare ACOs are still on one-sided risk models down from approximately 80% in 2018 Under REACH providers must develop a “Health Equity Plan” “that must include identification of health disparities and specific actions intended to mitigate” them as well as a method to collect “demographic and social needs data.” The number of Medicare beneficiaries appears to have plateaued at approximately 11M in 2022 which is down slightly from a peak of 11.2M in 2020 Healthcare spending remains out of control in the U.S. and consumed almost 20% of GDP in 2020, an increase of over 7% of GDP in the past 20 years The Problem: While Accountable Care Organizations (ACOs) were originally envisioned by Dr. Elliot Fisher at the Dartmouth Institute as a way to improve quality and costs by sharing accountability for a patient’s care among all providers along the health care continuum, in practice actual implementation has been more difficult. As noted, Fisher believed accountability was the key to implementing what today we call value-based healthcare whereby providers, including hospitals and physicians, are paid based on patient health outcomes, instead of volume with a goal of reducing the dramatic growth costs while improving quality. Originally put into practice by the Pioneer ACO Model in Medicare as part of the Affordable Care Act (ACA), ACOs have gone through a number of iterations including the Medicare Shared Savings Program (MSSP) and the Next Generation ACO Model as administrations and public policy officials have tried to improve performance and address challenges that have arisen as the models have been implemented. In April 2019 the Trump Administration introduced the Direct Contracting (DC) program. According to the HHS in its announcement, the program was an attempt to get providers who had dropped out of other ACO pilots to reengage with the program as well as to get them to take on so-called two-sided risk. (Please see “The Backdrop”). In addition, the Trump administration’s goal was to incorporate elements of Medicare Advantage (MA) and other private sector initiatives into the DC model. Implementation of DC was set to begin on April 1, 2021. On April 15, 2021, CMS announced that it would stop accepting applications for January 1, 2022. Among other things many were concerned that DC would effectively force beneficiaries to enroll “Medicare beneficiaries into a managed-care like a plan”, it would give create incentives for profit-making entities (ex: MA insurers and private equity groups) to skimp on patient care, and would not adequately address the needs of the underserved. The Backdrop: As described in “Origins and Future of Accountable Care Organizations” which details the evolution of ACOs, “by moving away from strict FFS payment arrangements toward more accountable, value-based reimbursements, providers can be incentivized to more efficiently improve the cost and quality of care.” In early Medicare models such as Medicare’s MSSP, policy officials believed that providers would move through three stages of a payment continuum, taking on more financial risk (and reward) as they took on responsibility for a higher degree of care. Initially, it was believed that providers would need to gain experience by sharing risk in so-called one-sided contracts which had limited downside to learn how to manage patient populations while being shielded from the risk of loss. Eventually, it was believed as providers gained experience managing risk, they would want to capture more reward and move towards what is termed two-sided risk where they would share in any savings compared to a benchmark as well as in any loss. Finally, the theory went, as providers perfected their expertise they would want to move towards a partial or full-capitation model, where they would effectively be paid a flat fee per member per month for all of their care (at a rate that theoretically would provide savings to plans and payers like Medicare). However, while the number of Medicare beneficiaries in ACOs has increased fairly significantly from just under 5 million in 2014 to 11 million in 2022, this number is down slightly from its peak of 11.2 million in 2020. In addition, and perhaps more importantly from a cost-savings standpoint, the overall savings achieved by ACOs in Medicare and the number of providers choosing to take on the additional risk and move into two-sided risk arrangements are still relatively modest. While this is a major point of contention, studies tend to indicate that to date overall savings from Medicare ACOs have not been large (see Implications). In addition, until recently the percentage of providers that have chosen to take on downside risk was relatively low. For example, according to CMS as of 2018, only 17% were taking downside risk and while this number recently increased to 59%, as recently as 2021 it stood at only 37%. As a result of all of the concerns surrounding care being compromised by for-profit entities as well as the somewhat lackluster performance of ACOs last week, the Biden administration announced a halt to DC and a rebranding to the ACO Realizing Equity, Access, and Community Health Model (REACH). Among other things, CMS noted ACOs must have a greater focus on addressing healthcare inequalities by requiring participants to develop a “Health Equity Plan” “that must include identification of health disparities and specific actions intended to mitigate the health disparities identified” as well as “collect beneficiary-reported demographic and social needs data.” Also, CMS will allow nurse practitioners to order additional services to improve access including cardiac rehab, home infusion care, and hospice care. In order to address concerns about beneficiary care being compromised or beneficiaries being forced into plans, “participating providers generally must hold at least 75% of the governing board voting rights” and the new application process will consider whether providers have a “demonstrated strong track record of direct patient care and a record of serving historically underserved communities with…quality outcomes.” In addition, the REACH model is going to change the risk adjustment process to “mitigate potential inappropriate risk score gains” and also reduce the discount rate for global ACOs in 2024-2026 (with the lower discount rate effectively reducing costs to providers). Implications: Healthcare spending has long been out of control in the U.S. and consumed almost 20% of GDP in 2020, an increase of over 7% of GDP in the past 20 years. While value-based care and ACOs have intuitively and logically seemed to make sense, they have never really lived up to that promise in practice. For example, according to Brad Smith, former Director of the Center for Medicare and Medicaid Innovation at CMS, while CMS has launched 54 value-based payment models, only 5 of which have yielded significant savings. As a result, according to Axios, ACOs have saved Medicare only 0.5% of fee-for-service Medicare spending. The REACH rebrand is yet another attempt to tweak some of the issues that have hindered ACOs but it is unlikely to spur long-term success. First, the REACH program does not address a fundamental challenge that many ACOs had faced in prior models, lengthening the transition period from upside-only to downside risk. Many studies have shown that providers drop out of programs like Medicare’s MSSP model when required to take on downside risk. Moreover, most studies indicate better performance when beneficiaries are assigned to the same ACOs for longer time periods. In addition, an overwhelming number of studies have shown that ACOs who serve high-need and underserved populations tend to be underresourced themselves and thus tend to underperform, failing to achieve savings. This model does not do anything to provide additional resources to poorly resourced providers thereby helping them better serve patients and achieve savings. Similarly, while the REACH plan does make some changes to risk adjustment, it only modestly addresses some of the issues around risk adjustment. First, many studies of Medicare ACOs have shown that Medicare’s risk adjustment mechanisms for ACOs fail to properly adjust for the very intensive and specialized care that many in this group demand, leading to inappropriate reimbursement. In addition, while CMS did adjust the risk adjustment mechanisms from what existed in the DC model, many critics contend that the risk adjustment mechanisms need to be more finely tuned to avoid inadvertent profits. This has long been an issue in MA and something that likely will require more study and more transparency. Lastly as noted in “All-Payer Spread Of ACOs And Value-Based Payment Models In 2021: The Crossroads And Future Of Value-Based Care”, “CMS needs to take specific actions to demonstrate its continued support for value-based payment”, and although this rebrand is a step in the right direction the fact that the program will only run until 2026 will give some providers pause about CMS’ commitment and likely lead them to question whether or not to participate. Since Medicare only accounts for a portion of most payers and providers' revenues and patients will have many types of insurance over their lifetimes, “CMS needs to identify opportunities for multipayer ACO models.” More importantly, given the growth and relative size of MA compared to Medicare ACOs (MA is more than twice the size) providers need to work with payers to find ways they can incorporate value-based payment mechanisms into innovative MA plans. Related Readings: All-Payer Spread Of ACOs And Value-Based Payment Models In 2021: The Crossroads And Future Of Value-Based Care Origins and Future of Accountable Care Organizations Comparing GPDC to the ACO REACH Model comparison chart CMS All-Payer Spread Of ACOs And Value-Based Payment Models In 2021: The Crossroads And Future Of Value-Based Care” CMS Innovation Center at 10 Years — Progress and Lessons Learned

  • Scouting Rpt-Trialjectory: Connecting Cancer Patients to Clinical Trials&Advanced Treatment Options

    The Driver: Trialjectory recently raised $20M in its series A funding round bringing the total the company raised to $27.7M. The round was led by Invest Partners ( a private equity firm that invests in start-up technology and software companies) and was joined by JAL Ventures, Contour Venture Partners, TIA Ventures, Rho Ventures, and Connecticut Ventures. Trialjectory is an AI-based clinical trial matching platform that uses self-reported clinical information to facilitate the clinical trial search and enrollment by cancer patients and their physicians. The company was founded by Noem Geva and co-founder Tzvia Bader. Trialjectory works alongside all sectors of health care to improve the recruitment process. The money raised in the latest funding round will go towards upgrading the AI technology for their clinical trial matching platform. Key Takeaways: A meta-review of 310 clinical trials conducted between 2003 and 2016 found that non-Hispanic whites were more likely to be enrolled in clinical trials than African American or Hispanic and Latino participants Trialjectory's app allows patients to enter information related to their specific cancer to find the best matched clinical trials and has matched more than 50,000 patients to clinical trials. 35% of patients on Trialjectory are people from underrepresented backgrounds and of that 35%, 60% are African American, 30% are Hispanic or Latino Trialjectory anticipates working with pharma companies and trial sponsors to help recruit patients The Story: For CEO and cofounder Tzvia Bader, cancer treatment hits close to home. In December of 2013, Bader was diagnosed with Malignant Melanoma, a type of skin cancer that develops from pigment-producing cells. Bader also lost his mother to a battle with Non-Hodgkin’s Lymphoma, another type of cancer that affects white blood cells. After participating in three clinical trials, the evidence of cancer in Bader’s body was reduced. During his cancer journey, he realized that the clinical trials enrollment process was not patient-friendly, made it difficult to enroll in trials and challenging to access treatment options. With this in mind and years of developing technology companies, Bader decided to team up with Noem Geva to create an AI platform to help address this issue. The end result was the Trialjectory platform which attempts to connect patients in need of advanced cancer treatments and those running trials for cutting-edge therapeutics. The platform allows patients to input their health information, then the AI matches them to open clinical trials. Pharmaceutical companies use it to recruit patients to their own clinical trials. The collaboration between patients, physicians, and pharma companies makes clinical trials more accessible for all. The platform is free for patients, and the company anticipates its revenue stream will come from being sold to drug companies and hospitals. The Differentiators: What sets TrailJetory apart is its ability to break down the barriers to enrolling in clinical trials and to increase enrollment of the underserved. For example, as noted in the book “Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary” patients often encounter challenges such as lack of encouragement, inconvenience, fear of getting no treatment, and difficulty with eligibility criteria. By helping match patients to trials with minimum effort Trialjectory helps reduce these frictions. In addition, while data indicate the Caucasian White males were more likely to be enrolled in oncology trials than Blacks, LatinnX, or women, data supplied by the company indicate that 35% of patients on Trialjectory are people from underrepresented backgrounds, and of those 60% are African American, and 30% are Hispanic or Latino. In the words of cofounder XXXX “This unique approach continues to successfully remove the barriers and biases that historically prevented cancer patients from accessing advanced treatment options.” The Big Picture: Trialjectory is taking an automated approach to both connecting patients with clinical trials and increasing the ranks of the underserved for patients diagnosed with cancer. Their platform is furthering the use of technology in healthcare to make life easier for patients, doctors, and clinical trial sponsors. If this platform works as intended, it will potentially benefit patients and pharmaceutical companies. Patients will have better access to treatment options for their specific cancer. For the company’s holding clinical trials, the platform will increase and diversify patient enrollment helping to speed trails and increase the efficacy of trial results. In addition, as personalized medicine and therapeutically focused companies like Trialjectory create support communities, and other mechanisms to support patients in their care journey it will improve the quality and effectiveness of dialogue with clinicians. Trialjectory scores $20M to match cancer patients to clinical trials; Trialjectory on track to match 50K cancer patients with clinical trials this year: 35% are from underrepresented groups

  • We Can't Fix Inequities in Healthcare If We Don't Fix How We Measure Them-The HSB Blog 2/21/22

    Our Take: Lack of available and high-quality health data for black, indigenous, and people of color (BIPOC), as well as language barriers in healthcare settings, will make it impossible to reduce racial disparities in healthcare unless these issues are resolved. Not only is this type of data essential for ensuring quality care for everyone, but these hurdles are a reflection of system inequities and the ongoing disconnect between providers and patients of different backgrounds that desperately need to be addressed. However, while challenges surrounding accountability for improved data collection and analysis around BIPOC populations continue to persist, efforts to improve these initiatives and dismantle these disparities are on the rise as evidenced by including such efforts in quality measurement scores. This is a start, but more needs to be done. Key Takeaways: According to HEDIS data in 2019, an astounding 94% of commercial health plans reported incomplete ethnicity data The Healthcare Effectiveness Data and Information Set (HEDIS) holds plans responsible for addressing gaps in treatment and outcomes among their patient populations Blacks were almost twice as likely to have undiagnosed kidney disease as Whites according to “Racial and Ethnic Disparities of Chronic Medical Conditions in the USA” Barriers to effective and equitable healthcare can result from social, cultural, and linguistic differences between patients and clinicians The Problem: Persistent racial and ethnic disparities within our healthcare system and the inability to get solid data around the sources and impacts of these challenges have impeded our ability to understand how certain social determinants of health (SDOH) affect the quality of healthcare and health outcomes. These SDOH which the CDC defines as “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes” can have profound impacts on the health and effectiveness of certain treatment protocols. For example, according to the Robert Wood Johnson Foundation, SDOH can drive as much as 80% of health outcomes. Although acknowledgment of basic acknowledgment of these factors is increasing, the policy maker’s ability to understand specifically what created and factored into such issues is still in its nascent stages. For example, although the historic lack of effort and resources put forth to examine and address such disparities is one factor, understanding how and why specific geographic regions vary in levels of disparities in care is equally as important. For example, the efforts of many states to collect and analyze the impact of COVID on communities of color has been a meaningful step. Prior to that, there were inconsistent policies in state collection of racial and ethnic data and classifications around illnesses and diseases. Prioritizing the collection of valid and accurate data from all racial and ethnic groups will aid in understanding the missteps and limitations in the data that’s collected. Furthermore, many communities' language barriers or cultural differences often factor into the lack of data collection and analysis. For example, many racially and ethnically diverse populations are not able to participate in research that is only being undertaken in a limited number of languages, limiting their ability to understand the purpose of the research and preventing them from understanding the importance of their participation and data in the research. Reaching out in their own language, and explaining the purpose, benefits, and importance of data collections could help. Along these lines, addressing the regulations and standards governing the collection of data around racial and ethnic populations, known officially as the Standards for the Classification of Federal Data on Race and Ethnicity, is sorely needed as these standards were last updated almost 25 years ago. The Backdrop: In order to understand the differences in health outcomes for diverse populations, it is necessary to advocate for reliable and valid resources to conduct research and examine data to draw conclusions and make policy recommendations. Unfortunately, the lack of reliable, high-quality data, inadequately updated data standards, and an inability to collect culturally relevant data have led to a void of effective answers. Healthcare organizations first need to be able to identify any disparities that exist in particular populations as well as why they exist before being able to address them. For example, if the community being examined is a diverse Black or Latino population, understanding the type of barriers that exist to provide additional services and resources would improve the ability to steer resources and treatment to their needs. In addition, attitudes towards the healthcare system and sources of health information could decrease the difficulty associated with recruiting the various populations into research studies which could increase the diversity of such studies and acceptance of their conclusions. It is also important to note the impact that changes in economic conditions can have on such communities over time. Certain communities may be more sensitive to small changes in economic conditions as they often live with a much smaller safety net than other populations. For example, the Pandemic caused striking and greater shifts in financial conditions and quality of life for many in the BIPOC community as compared with white adults. According to “Disparities in Health and Health Care: 5 Key Question and Answers”, “about six in ten Hispanic adults (59%) and about half of Black adults (51%) said their household lost a job or income due to the pandemic, compared to about four in ten White adults (39%)”. In addition, diverse and underserved populations typically experience a higher prevalence of undiagnosed diseases compared to white populations. For example, in a study entitled “Racial and Ethnic Disparities of Chronic Medical Conditions in the USA”, the authors noted “all minorities were more likely to have undiagnosed diabetes compared to Whites” and “Blacks were almost twice as likely to have undiagnosed kidney disease as Whites”. Identifying and diagnosing these problems will become increasingly important as people of color become an increasing portion of the population given that people of color are forecast to make up more than half of the population by the year 2050. To better adapt healthcare resources, advocacy for and communication with these targeted populations is necessary. While historically healthcare interventions may have fallen short due to the lack of good data and the inability to effectively design strategies that would benefit these populations, as people of color grow demographically, healthcare equity needs to be the top priority for social, economic, and humanitarian reasons as untreated disease strains challenge us ethically as well as fiscally. Leveraging resources rolled out during the Pandemic like the CDC COVID Data Tracker or Emory University; COVID-19 Health Equity Interactive Dashboard to better collect and disseminate granular health data on BIPOC populations could strengthen connections and instill trust in those communities. Implications: The need for interventions to target gaps in health data and in care for minority populations is vital as is the need for sustainability of these initiatives. Quality measurement systems have been one method of encouraging health care systems to fill the information void where data on current disparities exist. For example, the National Committee for Quality Assurance (NCQA) has started “implement[ing] a stratification by race and ethnicity in its health plan quality measure set, the Healthcare Effectiveness Data and Information Set (HEDIS), to hold plans accountable for addressing disparities in care and outcomes among their patient populations.” This is due to the fact that according to HEDIS data in 2019, an astounding 94% of commercial health plans reported incomplete ethnicity data. This demonstrates how incomplete information on inequities in healthcare data is and as such how difficult it would be to address issues within this data even if they are measured. Nevertheless, when providers and health plans have been able to measure such data and take action to address it they have found success. For example, when health plan Health Net, LLC put forth efforts to combine patient-level data, provider data, and public mapping information in order to improve the rates of Mandarin-speaking Chinese members to encourage them to get their cervical cancer screenings, there was a 4% increase in the cancer screening rates. While improved data collection and analysis will help address disparities, it will take time. In the meantime policy officials, providers and plans should explore other approaches near-term. Multilevel interventions that encompass individual patients, family and friends, organizations and providers, and policy and stakeholders may be an effective method to see a shift in the healthcare system. The Centers for Population Health and Health Disparities have developed several multilevel interventions to bridge gaps in access to quality of services for cardiovascular disease and cancer. In addition, language and communication barriers also need to be addressed in order to improve the care given from provider to patient. It is critical for providers and healthcare systems to recognize that populations who are culturally and linguistically diverse need communication solutions to better the overall experience when dealing with clinicians. While delivering culturally competent care means more than just translating something written in English just implementing language translation can be a step in the right direction. For example, one study showed that the use of online translation tools such as Google Translate and MediBabble in hospitals and clinics “increased the satisfaction of both medical providers and patients…and improved the quality of healthcare delivery and patient safety.” Achieving high-quality care for diverse populations will be an effective means in treatment and satisfaction of medical providers and patients. However, it will not be complete until we measure, analyze and address care in a culturally competent manner. According to the American Hospital Association, this will require acknowledging the importance of culture, incorporating the assessment of cross-cultural relations, recognizing the potential impact of cultural differences, expanding cultural knowledge, and adapting services to meet culturally unique needs. Related Readings: A Data-Driven Approach to Addressing Racial Disparities in Health Care Outcomes Disparities in Health and Health Care: 5 Key Questions and Answers The Challenges of Collecting Data on Race and Ethnicity in a Diverse, Multiethnic State In Focus: Reducing Racial Disparities in Health Care by Confronting Racism A New Effort To Address Racial And Ethnic Disparities In Care Through Quality Measurement

  • Scouting Report-League: An Integrated Employee Benefits Platform

    The Driver: League recently raised $95 million in a series C funding round led by TDM Growth Partners with participation from Workday Ventures and other unnamed existing investors to scale its consumer-centric healthcare navigation platform. Founded in 2014, League is a medical platform technology company powering next-generation healthcare consumer experiences which has now raised a total of $205M. Through League’s platform, companies ranging from health insurance to medical organizations can create digital patient experiences. These experiences would let patients access telemedicine, personal medical records, and other services. The platform is HIPAA compliant, making it viable for medical use. According to the company, which is based in Toronto and has a presence in Chicago, the new capital will be used to scale the platform. Key Takeaways: Payers, providers, consumer health partners, and employers build on League’s platform to deliver high-engagement, personalized healthcare experiences for consumers League claims its integrated platform creates engagement loops and drives habitual behaviors with customers, resulting in a 12x industry engagement rate and over an 80%-member enrollment rate The digital transformation of the healthcare consumer experience will benefit employers by helping to ensure employees quickly get the services and support that they need. The creation of a single comprehensive, personalized health platform has the potential to result in a much smoother experience for patients hopefully promoting better engagement, improved preventative care to a reduction in costs The Story: League was founded by successful startup founder and investor, Michael Serbinis, who was most recently the CEO of digital reading company Kobo, which was sold to Rakuten. According to an interview in TechCrunch the genesis of League followed a discussion with pharmaceutical entrepreneur and billionaire, Patrick Soon-Shiong, the inventor of Abraxane. In the interview, Serbinis noted that Soon-Shiong “told him that the healthcare system needed to be fixed by someone outside of the industry who was able to take a fresh, consumer-driven approach”. Serbinis added that “most people think about healthcare through the lens of health insurance, i.e., can I do it, can I afford it...the more I learned the more I realized how broken [the system] is.” League’s platform acts as a centralized operating system for employee health benefits. League uses Google Cloud’s healthcare application programming interface to connect a patient’s health information from electronic health records, claims, and wearable devices for an all-in-one consumer healthcare platform. For Payers, League’s digital infrastructure creates an experience that improves engagement by giving members a front door to their programs and services while for Providers, it offers patients the digital experience they’ve come to expect in their everyday lives: easy, seamless, and tailored to their needs. The Differentiators: According to the company, League’s platform harnesses data from electronic health records (EHRs), claims, health and wellness devices, and third-party partners to deliver deeply personalized digital health experiences and create a cohesive, omnichannel experience for the consumer. As noted by Deloitte (and reproduced on the company’s website), “League leverages contemporary technology architectures that support rapid integration, API connectivity and interoperability across different digital point solutions.” League uses FHIR (Fast Healthcare Interoperability Resources) as the data model to support the integration of healthcare data on their platform and to model data that is generated by members as they interact with the platform as it seeks to build an integrated solution for customers and consumers and move them away from point solutions. For example, as patients complete health assessments and pulse checks within their product, their responses are directly mapped to the QuestionnaireResponse resource in FHIR. League claims its integrated platform creates engagement loops and drives habitual behaviors with customers, resulting in a 12x industry engagement rate and over an 80%-member enrollment rate. League notes that it is regularly audited to make sure it complies with security, availability, and confidentiality requirements for managing patient data. League is available to both providers and payers. While there are similar companies proactively venturing into the digitized market for healthcare, League stands firm on its belief that its engagement-focused and consumer-centric platform may be unique in its attempt to close the gaps in care and drive better outcomes all while lowering employee health costs. The Big Picture: League is seeking to move employee benefits from a series of point solutions to an integrated, easy to use, and navigate platform. As noted on their website, employee “benefits are a fragmented ecosystem of expensive point solutions that are difficult for HR leaders to manage, and close to impossible for employees to navigate.” For example, a recent article in the Wall Street Journal noted that the average employee benefits package has anywhere from 16–20-point solution apps that employees must navigate, adding to the complexity of the benefits experience and decreasing engagement. Through League’s platform, companies ranging from health insurers to consumer health companies can create seamless digital patient experiences on a single platform with a single interface. In the words of League CEO Serbinis, “League’s PaaS offering is positioned as the de facto digital infrastructure to build comprehensive healthcare consumer experiences. Providers, payers, consumer health partners, and employers use League’s platform to build unique and differentiated applications that transform healthcare from a patchwork of disparate point solutions to a cohesive experience that just works”. As the digital tools become more prevalent in healthcare and consumers take a more active role in managing their own health, employers will have to ensure that their benefits keep pace with changes in work habits (especially the move to remote work) and desires for greater convenience and navigation. Integrating new tools and technology will play a crucial role as employee benefits programs evolve to meet the needs of workers, many of whom may not actually work in the same physical office or space. League gets $95M for 'digital front door' consumer-centric healthcare platform; League raises $95M in its bid to rule the world of healthcare platforms

  • Explosion of Digital Health Empowers More Efficient Medicaid Expansion-The HSB Blog 2/14/22

    Our Take: The striking growth in demand and acceptance for digital health technology presents a way to improve the access and quality of care for the uninsured by further expanding Medicaid with lower administrative costs or expenses. Accumulating data suggests that nationwide Medicaid expansion as part of the ACA would benefit non-expansion states and their patients at lower costs than many opponents have argued. In addition, the increased adoption of healthtech has provided or strengthened the number and types of tools that Medicaid officials have at their disposal to help increase enrollment. Key Takeaways: An estimated 4.1 million individuals would gain health insurance coverage if all states adopt Medicaid expansion, according to the Urban Institute. A recent article in the Archives of Public Health found that digital nudging, similar to that used by employer benefit plans, increased Medicaid enrollment by anywhere from 10%-23%. One study in JAMA found that Medicaid expansion can have a hidden economic stimulus effect with every $100,000 of additional federal Medicaid spending creating employment for 2 workers per year. According to the Journal of Economics, there was a reduction in collection balances of approximately $1,140 for those who gain Medicaid coverage due to the ACA The Problem: According to The Commonwealth Fund Biennial Health Insurance Survey, approximately 12.5% of the U.S. population was uninsured and an additional 21.3% of the U.S. population was underinsured (please see the backdrop for how underinsured is defined). Early on in the pandemic, millions lost their jobs, and consequently, their employer-provided health insurance or their ability to afford other subsidized coverage. While many in this situation who lived in certain states became eligible for Medicaid under their state’s Medicaid expansion, many did not, why? A total of thirty-nine states have adopted Medicaid expansion that became available as part of The Affordable Care Act, however, twelve states including Texas, Florida, Wisconsin, Georgia, and Mississippi decided not to expand their Medicaid programs. As a result, approximately 4.1 million individuals currently lack coverage that they would be able to obtain if all states adopted Medicaid expansion, according to the Urban Institute. In addition, as more data has become available to assess Medicaid expansion, studies have indicated that it both improves outcomes and saves costs where it has been passed. In addition, a number of studies have indicated that digital tools can be used to effectively and efficiently increase enrollment, helping to improve the cost outcomes. For example, according to an article entitled, “Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States”, low-income populations in Medicaid non-expansions states had worse access to care, less preventative care utilization, less medical expenditures, and more out-of-pocket costs compared to those in expanding states. In addition, states like Missouri have employed integrated, online decision support systems to “help individuals purchase private insurance in the marketplace by simplifying information and graphics, developed interactive activities to assess understanding of health insurance, and provided [an] individualized report to ease the selection of a plan that met their financial and healthcare needs” In terms of costs, not only are patients in non-expanding states suffering from the lack of coverage, hospital and state budgets are being strained by costs (which are written off as “uncompensated care” by providers. For example, an article in the Journal of Economics noted that there was a reduction in collection balances of approximately $1140 among those who gain Medicaid coverage due to the ACA”. Correspondingly a JAMA insight article found that “there are spillover benefits for economic well-being” from Medicaid expansion and “for every $100,000 of additional federal Medicaid spending, 2 workers gained a year of employment.” The Backdrop: In 2010 approximately 18% of the U.S. population was uninsured and a large portion was underinsured, leading to the passage of the Affordable Care Act. Underinsurance often impacted the so-called working poor, who often made too much to qualify for Medicaid but too little to be able to pay for health insurance. Many of these were often referred to as underinsured (where their out-of-pocket costs equal 10 percent or more of household income or 5% or more of household income less than 200% of the Federal poverty level ($52,400 for a family of four) not including what they paid in premiums or deductibles. As a result, one key element of the initial design of the Affordable Care Act (ACA) was to effectively require states to increase Medicaid coverage to all U.S. residents with family income at or below 138% of the federal poverty level via the expansion of Medicaid eligibility limits. Following challenges to a significant portion of the law and a variety of lower court rulings, in 2012, the Supreme court ruled that states could not be compelled to expand Medicaid and that Medicaid expansion under the ACA must be voluntary. The Court ruled that it was within states’ rights to decline to participate in the expansion. There were a number of other aspects of the ACA that have been subject to legal challenges but the law remained largely intact. As a result, the ACA includes the private insurance expansion (in part by eliminating pre-existing condition clauses), allows for income-based tax credits for those eligible, depending on federal poverty level, and provides subsidized premiums for the purchase of insurance on state exchanges. Additionally, the dependent provision of the ACA allows children to remain on their parents’ insurance coverage until age 26. While there are multiple parts of the ACA that have contributed to the increase in access to health insurance coverage, expansion of Medicaid led to significantly increased health coverage and reduced racial and ethnic disparities in coverage and access to care for low-income individuals. Implications: Healthcare has increasingly been shown to be an essential good at an individual, local, and federal level. As the COVID-19 pandemic has made clear, individual choices can have broad impacts on the health of their local communities, which in turn can have dramatic effects on the broader economy. Increased healthcare coverage within societies has clear positive impacts on the quality, equity, and efficacy of care and subsequent health outcomes. Accumulating studies show improved access to medical care translates to better health and lower mortality, a benefit for both patients and hospitals alike. Moreover, given the striking increase in the use of telehealth and other healthtech tools during COVID, facilitating more effective and efficient Medicaid expansion goes hand-in-hand with digital health adoption. While efforts to bridge the digital divide and broadband access will have to continue full force, many lower income patients (those who would benefit most from Medicaid expansion) have been shown to embrace digital health tools. For example, two studies cited in a recent Archives of Public Health article found that nudging, similar to that used by employer benefit plans, increased Medicaid enrollment by anywhere from 10-23%. These types of digital nudges can be a very inexpensive and convenient method of outreach for Medicaid plans looking to increase enrollment, “with relatively little expense or administrative burden.” Moreover, with many potential Medicaid beneficiaries likely to be among the working poor who may have difficulty accessing transportation to clinicians or to be unable to take time off work to see providers they are more likely to attempt to avail themselves of technological tools should they be available. However, these tools should not require substantial investment or design by Medicaid authorities, as noted in one study, “simply improving the design and implementation of standard outreach efforts produced durable increases in enrollment that were sometimes even larger than the increases from these more-intensive interventions.” Related Reading: The Benefits of Medicaid Expansion The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom The Impact of Medicaid Expansion on States’ Budgets Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States

  • Scouting Report-Koneksa: Validating Biomarkers for Decentralized Clinical Trials

    The Driver: Koneksa Health recently raised $45 million series C funding bringing their total capital raised to $70.6M. As noted by the company, Koneksa Health is a healthcare data analytics company that develops end-to-end solutions for remotely collected clinical data to help produce more meaningful data in clinical research by collecting it in real-world settings. Koneksa is founded by Chris Benko, the former VP of Strategic Planning at Merck. The fundraising round was led by AyurMaya with participation from Takeda Ventures, Velocity Capital, McKesson Ventures, Merck Global Health Innovation Fund, Novartis (dRx Capital) Spring Mountain Capital, and Waterline Ventures. The funds will be used to collect more data to support their digital biomarker pipeline (ex: to validate the assessments that the app offers) and to develop a “self-service” platform to allow new users to combine data from different sources into one stored dashboard. Key Takeaways: In one study, Koneksa was able to reduce the number of patients for biomarker validation by 82% Studies show approximately half of clinical study participants drop out of trials before study completion and only 5% of patients participate in clinical trials Koneksa is working to show in-home patient data can provide clinical insight, demonstrating in one study that for every 1,000 steps walked, there was a 26% reduction in hospitalization risk faced by the patients. Koneksa Health has worked with clinical trials at 700 sites. The Story: Chris Benko was responsible for incubating Koneksa Health as part of the Merck Global Health Innovation Fund which he ran, It was his desire to help capture health-related data that can be used to find novel treatments for diseases ranging from neurological diseases to respiratory conditions. He founded Koneksa to develop healthcare software to record patient-generated health data using digital biomarkers, which Rock Health defines as “consumer-generated physiological and behavioral measures collected through connected digital tools.” As Benko noted when the company did its series B fundraising, “digital biomarkers have as much potential to transform the development of new medicines as the molecular, imaging, and fluid biomarkers of the last two decades.” With the use of the Koneksa app, information can be recorded from anywhere, even the patients’ home. The company partners with biotech and pharmaceutical companies to develop biomarkers that can be used clinically to treat patients with different diseases. At the moment, the majority of company capital comes from investors like the ones mentioned earlier. The Differentiators: Koneksa’s software gathers a variety of data through questionnaires about mood, daily activities, symptoms, and combines it with clinical evaluation like movement tests. The end goal is to develop a drug or treatment for several different kinds of health conditions. While Koneksa’s competitors like Songe use tools like vocal screening for spirometry and mental illness analysis, as noted in Tech Crunch, Koneksa is working to turn analog testing scales into digital ones. For example, as noted in Tech Crunch, when testing for Parkinson’s Disease in order to quantify a tremor, “a physician might ask a patient to stretch out an arm and flip their palm upwards and downwards as fast as they can” and watch for subtle changes in speed or shape of that movement. By contrast, “Koneksa’s approach, asks that the patient hold their phone, and perform the same motion using the phone’s accelerometer and gyroscope, record those changes and transmit data to the company’s platform”, which can then be evaluated and “scored” against others by Koneksa’s algorithm. In addition, Koneksa is also focusing on how digital biomarkers can be used to increase the amount of real-world data collected in the trial process and then using this data to help get products to market more rapidly. For example, in a study of asthma patients, Koneksa was able to demonstrate that data collected from at-home devices were comparable to clinical devices but also enabled more frequent data collection requiring fewer participants to collect the required data. That not only makes it cheaper for trial sponsors but more convenient for patients. The Big Picture: Digital biomarkers have significant potential to increase the quality and frequency of data collection for drug discovery going forward, As a result, data collection for many types of trials can go from collecting infrequent, discrete data sets to essentially continuous data sets, empowering improved data quality and even predictive analytics. There is also a positive outlook on user friendliness among patients. In addition, this type of platform may create entirely new sets of valuable health data to help speed the regulatory approval process and boost the efficiency of clinical trials. The more usage this technology gets, the more effective it should be in further research. The application of such real-world devices will also make it easier and more convenient for many groups who were not able to access the current clinical trial system to become more involved and hopefully better represented. However, challenges may arise with such platforms for those who are frail or elderly and may not be technologically literate or for those who may lack access to broadband. While near-term these issues may be addressed by devices that can store and forward the data, over time a more permanent solution will need to be developed. Koneksa’s $45 million round could help make at-home clinical trials a reality, Digital biomarker startup Koneksa scores $45M in Series C funding

  • Take These Steps To Increase Vaccine Adherence-The HSB Blog 2/7/22

    Our Take: We need to broaden the use of culturally appropriate tools, expand the use of digital tools as a source of vaccine knowledge and increase representation through broader use of digital clinical trials to improve vaccine acceptance as we move from Pandemic to endemic. While the initial COVID vaccines were developed in under a year, vaccines were not widely accepted for a number of reasons including (but not limited to) the politically infused tradeoffs between personal liberty and public health, confusing communication by public health around various mandates, historic distrust of the healthcare establishment, particularly in communities of color around the safety and efficacy of the vaccine. However, as we move forward we need to do a better job of actively taking into account the social perspectives and cultural backgrounds of underserved communities by utilizing stronger grassroots listening and education campaigns (in the place of mildly informative and effective PSAs). Embracing and changing reimbursement that allows clinicians to do a better job of 1:1 education and care for the disaffected, such as proactive telehealth extension, broader education, and recruitment through digital trials, and leveraging virtual prenatal care would help increase vaccine adoption as we move from pandemic to endemic over time. The Problem: While the first two COVID vaccines to earn emergency use authorization (EUA) in the U.S. were developed in under a year, the approval process itself was shrouded in the fog of politics and then held up as a litmus test of loyalty to political philosophy (and some would argue a political party). For example, there was tremendous pressure on the FDA to grant approval and speed up the pace of its review. In addition, once the vaccines were granted emergency authorization, distribution was plagued by delays and there were initial reports of initial adverse reactions to the shots increasing a sense of apprehension. As a result, there was clear public confusion. Public health authorities appeared to lack the ability to craft a coherent and consistent message as information was imperfect and in a flexible situation. While this persisted, the Biden Administration instituted various government mandates to increase vaccine adoption which simply fanned the flames of the philosophical debate. All the while, efforts to educate the underserved around the factors that contributed to the rapid development of the vaccine were lacking. In addition, challenges surrounding the resistance to the vaccine among many in underserved communities who were healthcare workers, teachers and, students (and thus subject to the mandates) appeared to have been shoved to the side thus creating a backlash. In addition to the mandates, public health officials also enacted incentives to increase vaccination rates which included such things as prepaid debit cards or gift cards to local attractions or establishments. Although these have been successful, they did create a sense of inequality for those who felt like they were doing their civic duty by getting their shots with nothing in it for them. As we move forward, strict regulation on compliance will be an active means of protecting oneself and others by preventing the spread of the virus and it appears there will have to be some consequences for those who choose not to get vaccinated (many European countries have successfully enforced mandates and brought about strong vaccine adherence). However, with the shortage of healthcare workers and with variants like Omicron being highly contagious some sort of COVID vaccine is likely to be with us for some time. ​​ The Background: Assessing a new health threat while keeping the public calm is an arduous and delicate task in and of itself, especially in the digital age where conspiracy theories and fake news are ever present. During this pandemic, poor communication and constant changes in rules and regulations are the main culprits. The Centers for Disease Control and Prevention (CDC) has been highly criticized for failing to be more proactive in its actions against COVID and create a more coherent and consistent plan for protecting the public. During the early phases of the Pandemic, the public received conflicting perspectives and uncoordinated government communications from both state and federal leaders. Many have argued that the CDC is not designed for this role and was poorly equipped to take it on once COVID hit. They have called for the creation of a new public health authority to be responsible for monitoring and alerting the public to risks such as COVID. This is particularly true as the access to and understanding of public health terminology and assessing personal risk is not easily definable for the general population. For example, according to an article entitled “An Analysis of Government Communication in the United States During Covid-19 Pandemic: Recommendations for Effective Government Health Risk Communication”, “conflicts within governmental agencies are key factors that often trigger social disorder, and in the United States, [these] sparked increased societal hostilities between public sectors with different political orientations…[leading to] negative health outcomes (illness, suffering, and deaths) during the COVID‐19 crisis situation.” This was further complicated by a lack of real-time, coordinated public health systems that could help collect and disseminate relevant data. As noted earlier, there is significant distrust in underserved communities based on some historical precedents. This stems from the lack of trust in governing officials, discomfort related to the lack of diversity in clinical trials, and fears of hidden agendas. According to, “The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials”, “Ethnic minority communities have 10–50% higher mortality risk compared with those of white ethnicity in the UK and USA”, yet were dramatically underrepresented in the vaccine trials as a percentage of total participants. In addition, often accompanying or compounding this vaccine hesitancy in communities of color many women of childbearing age had specific concerns around preterm birth and potential birth defects that were difficult to address early on due to the risk of running trials on pregnant women. However, once the initial safety of the vaccine was established these trials could be run to address these issues. For example, a study in the CDC’s Morbidity and Mortality Weekly Report (MMWR) “found no significant risk or association for preterm births, infants that were born small for their gestational age (SGA), or for those that received a COVID-19 vaccine dose(s) in comparison to unvaccinated pregnant women,” yet many would argue the CDC has not done a good job publicizing this information in terms that are accessible to many and significant misinformation still exists. Nevertheless, many are optimistic about recent developments and the potential for an annual single-dose COVID vaccine that would be effective against a range of variants. However, even with a so-called “single-jab” vaccine, there are likely to be many who will refuse to get even one dose of the vaccine because they question its efficacy. As a result, we have to look at new and alternative vehicles to get the message out and that more effectively combat vaccine hesitancy and misinformation. Implications: To achieve improved compliance with COVID 19 vaccination, policymakers need to take social, cultural, and political perspectives into account in order to better understand and acknowledge the fears of the vaccine hesitant. While significant resources have been poured into rebutting the fears of those anxious about getting the vaccine (and even those opposed to getting the vaccine at all) we need to do a better job of listening and acknowledging those concerns. This is where digital apps and tools which provide culturally appropriate care may play a pivotal role as these solutions cater to minority groups who may be unable to comprehend information due to a language or cultural barrier. Culturally appropriate education, support, and resources on the COVID vaccine, its benefits (and risks) should be addressed and accessible to everyone, especially underserved communities. Interventions such as these that engage with communities in a meaningful way play a key role in not only educating but in helping communities feel heard as their doubts are answered and not simply downplayed. This is where telehealth and other digital tools could play a significant role. With the dramatic increase in telehealth during the Pandemic, communicating with your doctor, typically a family’s most trusted health advisor, became significantly easier and more convenient. Yet a study by the New York University School of Global Public Health found just over ⅓ got their information about the Pandemic from doctors or medical authorities while an almost equivalent amount (29%) got their information from traditional media channels (13.6%), new media (9.8%) and (5.8%) from family, friends, or colleagues. The study noted, “In contrast, those with the lowest level of COVID knowledge preferred informal sources like social media or family and friends.” It is clear that we need to empower and reimburse clinicians to address these issues. At the very least, personal physicians are in a position to address vaccine hesitancy in the context of a patient’s personal history and are in a good position to counter any vaccine misinformation. In addition to a more proactive use of virtual care tools, actively recruiting more participants from underserved communities and enabling more convenient participation in clinical trials by using digital clinical trials would combat myths about side effects and increase the credibility of vaccines. Seeing more information about participation (and possibly even knowing a trial participant) by people who are more representative of the underserved will provide reassurance that getting vaccinated will be beneficial for the average person’s health. Moreover, successful clinical trials with significant BIPOC panel participation can demonstrate that the vaccine is not dangerous and in fact, is effective at preventing patients from contracting or suffering serious illnesses from COVID. This would give the vaccine credibility and help dispel many of the myths and misinformation currently out there. More than anything we need a transparent and thorough breakdown of vaccine-related information and clinical procedures so we can increase vaccine participation as we move from pandemic to endemic. Related Readings: No Jab, No Job? Ethical Issues in Mandatory COVID-19 Vaccination of Healthcare Personnel An Analysis of Government Communication in the United States During the COVID‐19 Pandemic: Recommendations for Effective Government Health Risk Communication The views of ethnic minority and vulnerable communities towards participation in COVID-19 vaccine trials Digital health tools can help with COVID-19 vaccine hesitancy Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information

  • Scouting Report-Well: Empowering and Incentivizing People to Engage in Their Health

    The Driver: Well Dot, Inc., or “Well”, is a healthtech company based in Chapel Hill, NC, and Newton, MA that is founded by Gary Loveman and Dave Werry with a mission to be the world's most effective partner in the advancement of individualized health. They recently raised 70 million in a Series B funding for their consumer-focused health improvement platform which combines leading-edge artificial intelligence, advanced behavioral economic techniques, and on-demand human guidance. The Series B funding was led by Valeas Capital Partners, a recently launched investor-operator firm led by Ed Woiteshek and Rob Little (former Hellman & Friedman colleagues) along with a new investor group of 12 unnamed prominent CEOs and senior managing partners at top-tier private equity firms. Existing investors General Catalyst and partners of Hellman & Friedman also participated in the round.Well plans to use the new money to expand its business with large employers and community health organizations, in addition to growing its direct-to-consumer offerings. Key Takeaways: Well is attempting to be a consumer health platform that proactively delivers a personalized health advancement scale. Live health experts are available for on-demand support to its members to assist in the navigation of health care services. The platform facilitates members’ engagement with personalized actions, incentives, and concierge services to improve their health, instead of using episodic interactions to intervene only when a problem arises. Well offers a wide range of services including preventative care, condition management, and mental health over members’ lifetime and members are given rewards for health milestones achieved. The Story: Gary Loveman (chairman & CEO) and Dave Werry (co-founder, President & COO) established Well Dot on January 2019 in Chapel Hill, North Carolina. According to Well, the company's AI-driven health engine analyzes each member’s health triggers and promotes personalized, achievable steps toward improved health. Gary was previously the EVP of Consumer Health Services at Aetna where he led their efforts in the areas of consumer, data, analytics, marketing, pharmacy, and clinical. Before Aetna, Gary was the long-time Chairman & CEO of Caesar’s Entertainment Company where he pioneered the customer loyalty and rewards program that adapted the use of analytics to influence consumer behavior in the hospitality industry. David was previously the VP of Transformation at Aetna where he oversaw the member-facing capabilities for the enterprise. These areas included Aetna’s digital assets, high-touch clinical services, as well as business units in healthcare payments, benefits enrollment, and population health management. Together, Well was founded to help every individual take control of their health, adding a layer of ease and empowerment to improve a system that’s badly broken while cutting healthcare costs for employers. After decades of healthcare and consumer experience, the founders built Well to deliver personalized, concierge-style health advancement to the masses. According to the company, “they are all-in to deliver for their members — and disrupt healthcare in the process”. In November 2019, the company picked Chapel Hill over Boston for its headquarters after being approved for an incentive package worth nearly $3.9 million. Well now has more than 90 employees across all of its locations and generates $6.38 million in sales. Well works like this: employers sign up to offer the app to employees, and each individual employee can choose whether to opt-in. If an employee opts in Well gets access to some of their health information and uses that to get a sense of what activities or tasks to push to the workers. Well now serves thousands of members across many corporate clients and says they will launch with additional jumbo employer customers in 2022. According to Well, the company is working directly with community health organizations and direct-to-consumer offerings in collaboration with leading consumer brands, providing more avenues for consumers to access Well's digital health platform. Well has not shared any revenue or membership numbers to date however, Werry said the company's next phase is adding more members. According to Ed Woiteshek, of lead investor Valeas Capital Partners, “Well has developed a differentiated and fundamentally unique offering that is proving successful at helping members make meaningful progress on their health and wellness goals”. The Differentiators: Well claims to stand apart amid a crowded marketplace by trying to improve a broken consumer experience for more than 100 million people. According to the company they want to be the first to offer proactive personalized healthcare and services at scale. Whether you want to start sleeping better, managing your health needs, or taking your medications, the app is intended to help users achieve their best health through reminders and rewards through their platform. In addition to the app, users have access to a team of live health guides and nurses who can assist them in reaching their goals as well as the potential to earn rewards for taking “healthy actions”. To help increase your participation in activities, Well utilizes your healthcare provider in an effort to find services and products within coverage of your plan while delivering daily health recommendations. Some competitors such as Unforged focus more on subgroups of the population such as Gen Z with mental health concerns while also charging a subscription fee service. One of Well’s goals is to demonstrate that the time and money that can be saved through the app can outweigh the cons of physically going to see a health professional for the same advice you may receive from one of the live experts or nurses. The Big Picture: Well’s platform and other inexpensive digital tools like it may be paving a new way towards assisting employees on focusing on their own wellness. As digital health has been making inroads into more traditional healthcare delivery during the pandemic, so too should it progress in the ways we address prevention and wellness. With its unique way of utilizing an AI-driven health engine which analyzes each member’s health triggers, it promotes personalized, achievable steps toward an improved health status all while being rewarded for it. Given our sedentary lifestyles, Well’s platform may be most useful to those who need that extra boost of encouragement or those who are confused on how to start on their journey to a healthier lifestyle. In addition, Well’s solution could be helpful for those who could use a little nurturing in making the best choices for themselves. Research has shown that such nudges by employers tend to work. For example, according to an article in Corporate Wellness magazine, “nudging creates a default for people by playing on their subconscious system by winnowing down or outright eliminating options, which in turn, prompts healthier behavior.” In addition to helping employees lead physically healthier lives, services like Well can help with employees mental health. As corporations look to reduce burnout Well is taking the initiative to create sustainable health habits among employees for better health outcomes and lower costs for self-insured employers. Today, about 1,200 people use the Well app which will allow them to drive their own health decisions. Health Improvement Platform Company Well Raises $70 Million

  • Virtual Care May Be One Answer to Healthcare’s Labor Shortages-The HSB Blog 1/31/22

    Our Take: Leveraging virtual care is one way to deal with a number of the issues that healthcare’s workforce shortages have brought to light due to the Pandemic. Following huge spikes in demand in almost every part of the country as it deals with COVID, the industry had had to deal with countless labor issues and shortages due to burnout and the overwhelming physical and mental demands placed on caregivers. While healthcare workers are experiencing elevated levels of stress, patients may also experience a different type of stress when it comes to patient quality and overall care. It is important to understand the dynamics of the overlapping crisis we currently face as healthcare professionals quit and the barriers hospitals and Healthcare systems face to catch up. As an alternative, many providers have opted to provide virtual care albeit the future of telehealth is unpredictable. However, the flexibility and convenience that virtual care provides for both the patient and the provider may be here to stay. Key Takeaways: According to the Association of American Medical Colleges (AAMC), physician shortage in the United States is anywhere from 40,800 to 104,900 physicians by 2030 A study conducted by Wheel found that clinician burnout impacts 80% of patients and 1 in 3 patients believe burnout impacts their quality of care Providers have delved into the virtual care world since the pandemic in order to allow for a more flexible and accessible environment for patients If high-value providers no longer pursue in-person care and decide to go on the route of virtual care, patients may follow (where in-person care can be supplanted) to maintain their provider relationship The Problem: The challenges of the pandemic have exacerbated and crystalized labor challenges and the preexisting labor shortages that existed in healthcare prior to the Pandemic. The relatively non-stop confrontation with the Virus and its variants has forced clinicians to work long hours donning layers of PPE often short-staffed due to illness caused by COVID itself as well as employees who refused to comply with vaccine mandates. Consequently, the stresses on clinicians such as the increased administrative burden and inability to focus on patient care have reached a breaking point. For example, issues such as the decline in the supply of nurses and doctors reflecting the retiring of practitioners from the Baby Boomer generation as well as others in the demographics requiring more care left a significant supply-demand imbalance. While demand is high many providers cite insufficient staffing models, insufficient benefits/raises, and lack of flexibility as main concerns along with burnout and the inability to de-stress. This in turn has pushed providers to take a stand as they will no longer tolerate the reduction in their overall quality of life and have chosen to leave the profession or set up virtual practices. In light of the heightened demand during COVID, issues around the healthcare labor shortages have garnered nationwide attention. For example, during the so-called “Great Resignation,” where large numbers of working-age people have simply dropped out of the labor force, approximately half a million healthcare workers have quit since February 2020 according to a recent article in Forbes. Understandably the stress of dealing with a continuous over two-plus years has taken a great toll on clinicians' emotional, and physical health leading to burnout. For many, this has left them with two options–either to step away or go digital. Many have chosen to go digital and work in telehealth or start their own virtual practics which provide flexibility and a work/life balance that many so desperately desire. The Backdrop: Healthcare is a service industry that depends on the dedication and manpower of the individual clinicians and support staff responsible for maintaining the facilities, diagnosing their illnesses, and treating them to care for the lives of patients. A key element in this equation is the hiring and support systems that go into creating a physically and emotionally safe environment for clinicians to operate in where they feel their concerns can be heard and addressed. If not, the burnout and stress associated with working long hours under severe emotional stress, such as those experienced during COVID, can negatively impact the quality of patient care. For example, while the medical profession has long been sought after for its high wages it had also enjoyed significant professional prestige which helped attract a growing labor pool. That may no longer be the case. For example, according to “Amid Rampant Provider Burnout, Marketplace Platform Companies Focus on Clinician Experience” a survey conducted by Wheel, approximately forty percent of respondents would not want their children to go into the field of medicine as it is not worth their time or investment.” In many ways, this may serve as a wake-up call for administrators and public policy officials looking at the causes of the shortage of clinicians as we look for ways to improve the quality of care and lower costs for patients. In addition to the stresses noted above, many practitioners are facing a working environment that is filled with aggression and constant abuse. According to “Nursing Shortages” approximately eight to thirty-eight percent of health care workers are at accelerated risk of facing emotional and physical abuse, which some attribute to insufficient staffing ratios. Following the explosion in digital care during COVID, digital has emerged as an option for many nurses and physicians. Going virtual is a way to create work-life balance and still practice their craft, optimizing the benefits for everyone involved. Many digital and virtual-first solutions are specifically designed to address administrative inefficiencies inherent in current electronic medical record systems (EMRs) and designed to improve information flow for patients and providers. Implications: Addressing the void between provider flexibility and patient care is the future of telehealth. While there is still room for improvement in the delivery of virtual care such as patient privacy and broadband access, virtual platforms have the potential to move healthcare to a more consumer-centric omnichannel experience and address many of the issues of burnout. As noted, newer technologies are specifically designed to address many of the challenges adding to the administrative burdens that clinicians face thereby allowing them to spend more direct time on patient care. In addition, given the number and variety of digital providers, both traditional and non-traditional, doctors and nurses will choose both the type of provider and work schedule that is customized to their needs. Moreover, virtual care will facilitate the use of value-based care by allowing more effective triage of patients into the system, better tracking of care across care settings, and improved analytics (although this will be a function of data sharing and interoperability). Treating patients holistically and funneling them to the proper sites of care should help clinicians work “at the top-of-their” licenses” and focus less on certain types of routine or chronic care which can be handled by other providers in the system or even prevented by higher quality care. Also, as some of the technical hurdles to providing these care delivery mechanisms are addressed, underserved communities and seniors can be given access and training on the technologies, so that virtual care can broaden the scope of care delivery, theoretically increasing provider satisfaction. However, it is important to note that as currently configured there are limitations that come along with virtual care, such as current levels of reimbursement which if left unaddressed following the end of the PHE may discourage the use of virtual care (assuming they revert back to the lower pre-pandemic levels). There are also the issues of patient preference and accessibility and comfort with technology as mentioned, particularly within elderly and underserved communities. Of course, there will be some patients that require “hands-on” procedures or other forms of care that are acute and/or cannot be resolved through a virtual visit. Finally, digital health has the potential not just to reinvent care delivery but many of the tools that can be used or repurposed for education and training of future practitioners which could allow practitioners more options to finish their degrees and ultimately help resolve the current labor shortages. Related Readings: Using Telehealth to Deliver Affordable, High-Quality Care Amid Rampant Provider Burnout, Marketplace Platform Companies Focus On Clinician Experience US Healthcare Labor Shortages Compounded as a Result of the Pandemic Nursing Shortages Domino Effect: Wheel Survey Finds Clinician Burnout Impacts 80 Percent of Patients

  • Scouting Report-Casana: Integrating Remote Patient Monitoring into Our Everyday Lives

    The Driver: Casana recently raised $30 million from investors in its series B fundraising round for its smart toilet seat. With this product, the Heart Seat, Casana could change the way we see home health devices. Casana was founded by Nicholas Conn in 2018 after he developed a prototype of the seat during his Ph.D. work at the Rochester Institute of Technology. The product is focused on capturing clinical grade vital signs via heart health monitoring devices that keeps them simple. The fundraising round was led by Morningside Venture Partners and included participation from Matrix Partners, General Catalyst, Outsiders Fund, and a large vertically integrated health care provider. The $30 million in funds are being used to debut the smart toilet seat capable of taking your vital signs. Key Takeaways: Casana’s innovative smart toilet seats may provide an alternative for people to monitor their health easily from the comfort of their homes. The Heart Seat is capable of measuring heart rate, blood pressure, blood oxygenation, and cardiac output. This handy toilet seat would be useful in tracking the vitals of someone with an existing heart condition. The latest fundraiser brings the total capital raised by Casana to $46 million. The Story: Casana was founded to make heart monitoring easier for the millions of people that suffer from abnormal heart conditions. According to CEO Aaron McChord, “Our goal is to be able to monitor a patient’s health more naturally at home, without interruption of their daily routine”. For example, the Heart Seat could be used for an older member of your family such as a grandparent or aunt suffering from hypertension who has memory issues and often forgets to check their blood pressure. With an unobtrusive device like this which requires little effort from the patient for remote monitoring, just having the device in their home would act as a fail-safe and enable continuous monitoring. In fact, Mintu Turakhia, director of the Stanford Center for Digital Health, believes these so-called “ambient devices” represent the next phase of products for the home-health market after wearables. Casana is focused on delivering a product that can make obtaining vitals effortless for both parties, the clinician and the patient. While CEO McChord is hoping that Medicare will agree to pay for the cost of the seat, as well as a monthly subscription for doctors to use the data that is collected, Medicare currently doesn't cover it and there is not a clear-cut payment method in place for the product. However, McChord stated “ I don’t see this being issued as part of remote patient monitoring which is reimbursed by Medicare. The Differentiators: Typically patients get their blood pressure readings when they make an appointment with a doctor or other clinician (or perhaps from a free-standing machine in a grocery or drug store). With the Heart Seat, patients and physicians are getting real-time data on vitals without having to remember anything and with literally no effort. This can potentially take home health monitoring to a new level. Although more recently with the growth in wearables and virtual care, patients can gain readings through wireless blood pressure cuffs or other devices, the patients still need to remember to wear them, charge them and often download the data. With Casana’s product, all you have to do is go to the bathroom and continue with your normal daily routine. While Olive Diagnostics has a similar product that can gather health information by enabling patients to easily gather a urine sample and applying AI insights to it, currently the Heart Seat appears to be less bulky and more natural creating greater ease of use. The Big Picture: Casana’s approach to home health monitoring has the potential to change the lives of many while seamlessly improving their care and monitoring. For example, products like this would be a good fit for older patients with cognitive issues who may forget to check their vitals or charge their devices. In fact, a 2019 study on the use of wearable activity trackers by older adults found that “research based on a general population sample has shown that nearly three-fourths of the participants discontinued using activity trackers after 100 days from the initiation date,” By contrast, with low maintenance easy to use devices like the Heart Seat, physicians will be able to monitor their patients while receiving constant updates. Despite this, one challenge the company has yet to overcome is price and potential reimbursement. Although the company is expected to submit the device to the Food and Drug Administration for approval as a class two medical device in the first half of this year, as noted earlier, it is unclear if Medicare or commercial insurance companies will cover the cost of the product. Nevertheless, products like the Heart Seat may be very useful as seniors look to remain in their homes longer and “age-in-place” or in the senior care space (ex: nursing homes or assisted living facilities). In such institutional settings, monitoring a large volume of patients can be laborious, but the Heart Seat can relieve the effort of manual vital checks from nurses and clinicians. This can improve clinicians’ efficiency, freeing them of the need for routine tasks like taking vitals and giving them more time to work with patients with greater needs. This is especially important in the current environment for healthcare workers, where clinicians are experiencing burnout from COVID and the high administrative burden. Products like these that can help ease the tension and workload by improving efficiency and convenience are sorely needed. Blood pressure monitoring toilet Casana lands $30M,Scoop: Casana nets $30 million to make smart toilet seats

  • What Sports Analytics Can Teach Us About Integrating AI Into Care-Special Issue:The HSB Blog 1/24/22

    Note: Several weeks ago, our founder, Jeff Englander presented on a panel at the AI Summit NY entitled, “Operationalizing AI in Healthcare-Bringing Analytics and AI Into the Clinical Setting”. One of the topics of the panel was how to increase clinician’s interaction with AI technologies. During the panel, he referenced an article he had written in May of 2018 on “What Steph & LeBron Can Teach Business About Analytics” and how sports demonstrates many practical ways to gain acceptance and integrate analytics into an organization. Given an incredible weekend of playoff football, sorry to all our friends in Nashville, and the number of ensuing debates about sports analytics, we thought it might be timely to reprint it here: As I sat watching the NBA conference finals last night, I began thinking about what I had learned from the MIT Sloan Sports Analytics conferences I went to over the last several years. I thought about how successful sports had been and the NBA in particular in applying sports analytics and what lessons businesses could learn to help them apply analytics to their businesses. Five basic skills stood out that sports franchises had been able to apply to their organizations that were readily transferrable to the business world: 1) intensive focus; 2) deep integration; 3) limited analytic “burden”; 4) trust in the process; and, 5) communication and alignment. 1) Intensive focus - when teams deploy sports analytics they bring incredible focus to the task. One player noted that they do not focus on how to stop LeBron, not even on how to stop LeBron from going left off the dribble, but instead how to stop LeBron from going left off the dribble coming off the pick and roll. This degree of pinpoint analysis and application of the data has contributed to the success and continued refinement of sports analytics on the court, field, rink, etc. 2) Deep integration - each of the analytics groups I spoke with attempted to informally integrate their interactions into the daily routines of players and coaches through natural interactions (the Warriors analytics guy used to rebound for Steph Curry at practice). Analytics groups worked to demystify what they were doing and make themselves approachable. The former St. Louis now L.A. Rams analytics group jokingly coined its office as the “nerds nest”. By integrating themselves into the player’s (and coach's) worlds they were able to break down stereotypes and barriers to acceptance of analytics. 3) Limited analytic “burden” - teams’ data science groups noted given the amount of data they generate it’s important to limit the number of insights they present at any one time. One group made it a rule to discuss or review no more than 3 analytical insights per week with players or coaches. This made their work more accessible, more tangible to players/coaches and helped them quantify the value to the front office. 4) Trust in the process - best illustrated by a player who told the story of working with an analytics group and coaches to design a game plan against an elite offensive player which he followed and executed to a tee. But that night the opposition player couldn’t be stopped and in the player’s words "he dropped 30 on me". The other panelists pointed out that you can’t go away from your system based on short-term results. As one coach noted ‘don’t fail the plan, let the plan fail you…Have faith in the process.” 5) Communication and Alignment - last but not least teams stressed the need to be aligned and to communicate that concept clearly all throughout the organization. As Scott Brooks, at the time the coach of the Orlando Magic noted, “we are all in this together, we have to figure this out together”. Surprisingly, at times communication was paramount even for the most successful and highly compensated athletes. For example, at last year’s conference, Chris Bosh a 5x All-Star and 2x NBA Champion, making $18M a year at the time he was referring to, lamented the grueling Miami Heat practices during their near-record 27-game winning streak in 2013, seemingly despite their success (at the time the 2nd longest winning streak in NBA history). When I asked him, what would have made it more bearable, he said communication, just better communication on what they were trying to do. Clearly, professional sports have very successfully applied analytics to their craft and there are a number of lessons that businesses can copy as they seek to gain broader and more effective adoption of analytics throughout the value chain.

  • Scouting Report-Wheel: Moving Virtual Care Forward Toward True Omnichannel Care

    The Driver: This week Wheel raised a $150M series C round bringing its total raised to $216M since the company was founded in 2018, and follows the company’s $50M series B just last May. Wheel’s fundraising round was led by Lightspeed Ventures and Tiger Global with participation from existing investors CRV, Silverton Partners, and Tusk Venture Partners. New investors Coatue and Salesforce Ventures also joined the round. According to the company, it will use the funds to continue to grow headcount, broaden its virtual care platform, particularly in diagnostics, as well as expand its onboarding and educational programs. Key Takeaways: According to the Austin Business Journal, Wheel had twice the number of patent visits in Q4 2021 as it did during all of 2020. According to Wheel internal data, standing up and scaling a virtual care service on your own costs an average of $15MM and takes approximately 15 months. The McKinsey 2020 Virtual Care Study claims that approximately $250B or ~20% of all outpatient, office, and home health spend, could potentially be virtualized. A study by Nuance and HIMSS found that 97% of doctors and 99% of nurses surveyed had experienced burnout at some point in their working life. The Story: According to Forbes, the idea for the creation of Wheel goes back to when CEO and co-founder Michelle Davey was a child and had to undergo over a decade of being “ferried between doctors for her to be diagnosed with an autoimmune condition.” After several stints working in healthcare and recruiting, Davey returned to healthcare to work at a telehealth startup to do recruiting. Thinking her previous recruiting experience would give her a leg up in her new role, she was quickly surprised to learn that it had not. In 2018 this led Davey and her co-founder Griffin Mulcahey to found a matching market for virtual healthcare providers called Enzyme which subsequently became Wheel. According to the firm’s website, Davey and Mulcahey felt that “no one was looking out for those at the center of the healthcare engine: the clinicians on the “front lines” and decided to found Wheel as “the industry’s first model for delivering high-quality virtual care at scale by empowering clinicians and providing new efficiencies for healthcare companies.” According to the company, Wheel helped facilitate 1.3M patient visits in 2021and expects that number to grow by approximately 3-fold by year-end 2022. The Differentiators: Unlike some of its competitors which offer branded virtual care services, Wheel offers a private or “white-label” platform that empowers companies to quickly and easily launch virtual care services on its own by providing them with the appropriate back-end infrastructure and software. In addition, while Wheel is helping traditional healthcare providers like hospitals and physician practices offer virtual primary care services, it is also helping non-traditional players like retailers, pharmacies, and employee benefit programs create their own virtual care programs under their own brand. Wheel claims that using their platform is much more efficient in terms of both time and money than standing up and scaling a virtual care service on your own, which their internal data shows costs an average of $15MM and takes 15 months. Moreover, as we noted in our earlier Scouting Report on Wheel (please see Scouting Report-Wheel: Moving Virtual Primary Care Forward 09/21/21) Wheel has been looking to expand the breadth of its services beyond just virtual primary care for some time and is slated to use some of the proceeds from the round to increase services in labs, and diagnostic care. Interestingly given Wheel’s roots in physician recruitment and staffing, Wheels has a strong background in some of the technical issues involved in scaling a virtual care business. As Davey noted to Forbes about founding the business, one of “the biggest sticking point[s] to scaling digital health startups was understanding the regulations across all 50 states and recruiting licensed clinicians.” Moreover, as noted in our prior article, Wheel continues to experience a strong retention rate of more than 90% even in the face of over 60% growth in its clinician network this past year. Wheel currently has approximately 150 employees (up from 120 in August) and now expects that to increase to 300 by year-end 2022. Wheel charges its customers a base fee for its software and then an additional fee per consultation. The Implications: While Wheel’s last fundraising appeared to be more about the need to keep pace with the explosive growth and market opportunity in digital care created by COVID, this round appears to be more about the transformation to virtual-first care. As CEO Davey noted to MedCity news, in order to move healthcare forward and truly deliver on virtual-first care we need the infrastructure that can deliver “anytime, anywhere” care, which they are helping to create. While the pandemic created a newfound acceptance of digital health, “companies were still struggling to meet their patient’s needs”. However, as Davey notes “the funding puts the company in a strong position to speed the transition from telehealth to virtual first care.” For example, according to the McKinsey 2020 Virtual Care Study “approximately $250B or ~20% of all Medicare, Medicaid, and Commercial outpatient, office, and home health spend, could potentially be virtualized.” Nevertheless, while a great deal of care can be virtualized, virtual first is really about creating a less expensive, more accessible triage point for entry into the system and should begin to enable a true omnichannel experience like consumers experience in most other industries. Davey states, “by leaning on technology, healthcare organizations can more easily triage a patient’s care need and determine the best care setting”. Virtual first brings healthcare much closer to other industries by bringing patient care to the patient at the time and place they desire as opposed to the other way around. Importantly in a time of labor shortages, virtual primary care also provides a mechanism to address the issue of physician burnout, where over 90% of doctors report experiencing at least one symptom of burnout in their lives. By giving them the ability to create their own virtual practice with a much lower infrastructure incidence of burnout can be reduced. While important issues like broadband access and ensuring patients receive culturally relevant care still need to be addressed, virtual first care and technology are changing the nature of healthcare delivery. Wheel Raises $150M in Quest to Move Beyond “telehealth 101” to Virtual-First Care, Wheel Raises $150 Million Series C to Power the Virtual-First Care Revolution, Behind The Screen: Meet The Startup Powering Telehealth