Femtech Breaks Ceiling, Cash-Pay Health Insurance, Women Physicians Burning Out-The HSB Blog 2/2/21
Femtech Shatters Glass Ceiling Over Addressing Unique Needs of Women
Our Take: Despite the fact that women now make up a majority of the U.S. workforce and U.S. population, healthcare that caters to their needs, often called Femtech remains in its infancy. With leading medical groups endorsing telemedicine to bolster healthcare for women’s lives, (reproductive health, post-partum, lactation assistance, post-menopausal, etc.) women’s access to resources has begun to expand and could be the next hyper-growth market in digital health.
Description: According to Pitchbook, “Femtech'' refers to the range of health software and tech-enabled products that cater to female biological needs and attempts to highlight the historical and systemic exclusion of women’s health needs in the healthcare industry. These services range from general women’s health diagnostic tests to screening for disease management and fertility solutions. With the growing need for more digital solutions and telemedicine options during the COVID crisis, this industry has become a key asset in the healthcare realm. Moreover, according to an article by Frost & Sullivan, driven by the rise in female purchasing power and the increasing (though still lagging) numbers of influential women in healthcare, Femtech has the potential to be a $25 billion business by 2025 by addressing women’s healthcare needs that often go unmet. For example, according to a 2017 women’s health survey from the Kaiser Family Foundation (KFF), many women, particularly low-income women, delay or forgo necessary healthcare. According to the report, this is primarily due to issues in obtaining transportation or childcare, underscoring the potential benefit telemedicine could have for females in low-income, urban populations. The unmet healthcare needs of low-income women along with the fact that over 4 in 10 babies born in the U.S. are covered by Medicaid has led Congress to look for high-quality, low-cost, patient-centered solutions such as digital tools for prenatal care and post-birth support. For example, in September Congress introduced the Maximizing Outcomes for Moms through Medicaid and Enhancement of Services Act (MOMMIES), which focused specifically on improving the health of women covered by Medicaid. Similarly, there has been an increase in the roll-out of virtual care options, tackling postpartum depression screenings, lactation assistance, contraception consultations, sexually transmitted infection (STI) care, and various other pivotal women’s health issues. With the additional funding and support of telehealth and virtual care programs through the passage of the CARES Act, struggles with out-of-pocket costs and lack of coverage have diminished in many states, creating better access to care for women.
Implications: With the constant innovations created for women in the Femtech industry and the increase in telehealth platforms, women are continuously gaining improved access to healthcare resources. This has been especially important in increasing accessibility and decreasing emergency room (ER) visits for Black and Hispanic women who have previously had the highest rates of ER visits among both racial groups. Some researchers speculate that increased telehealth visits for women of color may help reduce providers’ biases due to the standardization in policies and procedures for these visits. As the pandemic presses on, it is likely that services for all women will continue to expand allowing more personalized and tailored treatment going forward particularly if states expand Medicaid to help broaden coverage. However, the road to more access and tailored care will not be without bumps, particularly in the areas of privacy and data security. As the recent settlement agreement between the Federal Trade Commission (FTC) and Flo Health demonstrates, providers will have to take adequate precautions to protect the privacy of women using these apps. Despite this, the future for women’s health continues to look bright, even beyond the pandemic, as access to resources continues to expand and providers focus on addressing the unique needs of women patients.
Sidecar Health’s Low-cost, Cash-pay Health Insurance Service Now Valued at $1 Billion
Event: TechCrunch recently reported that L.A. based Sidecar Health had raised $125 million in additional funding bringing its new valuation to over $1 billion. Unlike traditional healthcare insurance where providers are paid via a third party, like the government or managed care company, Sidebar members pay for care directly with a Sidebar card (like a debit card). Sidebar uses the card to pay for clinician care, prescriptions and consultations directly, eliminating the paperwork in exchange for discounts.This gives patients the ability to pay directly for care at steep discounts, often at the same prices they would be charged under traditional insurance plans. They are growing in popularity, and are projected to end the year with 30,000 members.
Description: Sidecar issues its users a debit card to pay for necessary services. The balance comes from the company’s claims accounts eliminating the need for practitioners and providers to collect co-pays, track deductibles, file claims or adjudicate any disputes.The typical Sidecar Health member pays a $240 monthly premium for a plan Sidecar which argues offers more flexibility for millions of uninsured US adults. The plans are designed to allow customers to shop around to find the best providers using pricing information available on their app and pay directly for care. The app provides live geotagged information on the pricing of medical services, procedures, and pharmaceuticals and allows users to shop where they can get the best deal. While Sidecar members currently skew younger than average MCO populations, the average age of the company’s members is 33 years old with an annual income of between $45,000 and $75,000 annually. The company is hoping to broaden its membership beyond the uninsured to government-funded and employer-sponsored plans as well.
Implications: The future of health care financing and coverage in the United States is nebulous. As a result there is room for tremendous innovation. The appeal of Sidecar Health is its simple, direct payment structure that eliminates a significant amount of friction and inefficiencies. Not only could this create a large opportunity for Sidecar and others like them seeking to reduce the burden of administrative paperwork on the industry, success of the model could spur other insurers to adapt their models to expand their reach (ex: entry level direct pay plans). In addition, the technological appeal of getting healthcare insurance through an app and debit card with limited paperwork like Sidecar has intuitive appeal for a Millennial customer base, those tech-savvy young people who are generally healthy and may view health insurance as a burdensome responsibility. Over time we would see models shifting in a similar direction as this simplifies administrative interactions, provides immediate price transparency and increases choice.
Women, Critical Care Physicians Report Highest Level of Burnout
Event: On January 26th, Healthcare IT News reported that female critical care physicians report the highest level of burnout due to working long hours, engaging in administrative tasks, increasing computerization of practice, and insufficient compensation according to the Medscape National Physician Burnout & Suicide Report 2021. The article also highlighted a number of comparisons of physician stress, burnout and psychological well-being both pre and post-Pandemic.
Description: Medscape surveys 12,000 physicians across 29 specialties between August 30th and November 5th, 2020. While in general providers noted that the stress of treating COVID patients did not substantially increase burnout, it did exacerbate already existing issues. For purposes of the study burnout was described as long-term, unresolved job-related stress that leads to exhaustion, cynicism, detachment, and a lack of a sense of personal accomplishment. Along those lines, only about half of physicians reported that they were happy with their work life in 2020, down from over two-thirds prior to the pandemic. In addition, nearly three-quarters of physicians aged 25-54 and two-thirds of physicians between 55-73 reported that burnout has strained personal relationships with friends and family. As noted by Medscape senior director Leslie Kane, “the incidence of burnout and depression among physicians has been a concern for years and the pandemic only made a bad situation worse”. She went on to note that burnout was most severe for female physicians who have faced the brunt of at-home schooling and other disruptions. For example, over half of female physicians said they were burned out, compared to just over one-third of men.
Implications: Even before the onset of the COVID pandemic, the incidence of burnout and depression among physicians was on the rise. Medscapes Ms. Kane noted that post-pandemic, healthcare organizations and the medical community have an opportunity to rethink how best to support physicians in order to see reductions in burnout, depression, and suicide rates moving forward. While physicians cited exercise, talking with family members or close friends, isolation, and sleep as popular methods of dealing with stress currently, more needs to be done. Among suggested solutions were increased compensation, easier and more intuitive EHR workflows, technologies that reduce the administrative burden and returning clinicians to a greater focus on patient care.
Compliance with ONC and CMS Rules Could Offer Growth Opportunity
Event: Healthcare IT News reported that new ONC rules on hospital price transparency from the Centers for Medicare & Medicaid Services (CMS) which took effect January 1st, and new rules around information blocking and patient access from the Office of the National Coordinator for Health Information Technology (ONC) taking effect in April could actually provide growth opportunities for providers.
Description: Based on a recent report from Deloitte, the article noted that the new rules are anticipated to drive improved care coordination and quality of care because consumers and clinicians will now have easier access to information for diagnosis and treatment decisions. The article also surmised that this could create a more consumer-centered care market, increasing competition among providers . The Deloitte report also advocated using these regulatory programs as part of their broader competitive, financial and and digital strategies. Executives surveyed in the report recognized this and expressed plans to boost consumer participation in care, with 70% saying they plan to develop new online scheduling capabilities, 53% new cost estimation apps, and 53% new payment financing options.
Implications: Health systems should prepare for a changing ecosystem as a result of these new rules. Deloitte noted several actions as a result of the new rules including: 1) that plans should include market analyses to help drive strategic decisions; 2) developing new consumer engagement strategies and product designs; 3) learning how to work with new technology platforms; 4) developing new platforms for tracking and monitoring consumer inquiries; and, 5) finding more innovative collaborations with payer organizations. The researchers also found that measures to comply with price transparency can be leveraged to increase trust between consumers and providers. While clearly there is potential to benefit the population health goals that the new rules from ONC and CMS target, compliance with these rules presents an opportunity to engage their patient populations more deeply.
Eli Raises $1.5 Million (USD) in Seed Funding to Develop At-Home Hormone Monitoring Tech
Event: An article in BetaKit (a publication covering Canadian startup news and tech innovation) reported that Eli Science Inc., a fertility app, has raised a $1.5 million (USD) seed round to target the historically underserved women’s healthtech market. Eli has a saliva-based daily hormone tracking technology whose goal is to give women a no-compromise option to own their fertility and contraception decisions. According to the company, Eli aims to provide a non-invasive, hormone-free alternative to traditional contraception and fertility monitoring options through its personal hormone monitoring device and accompanying mobile app.
Description: Eli gives women their hormone information to let them take control of their health. It can act as a guide for couples seeking to conceive and a contraceptive alternative to other more invasive or hormone-based options. To measure their hormones, users place the Eli cartridge in their mouth to give a saliva sample. They then remove it and place it inside Eli’s portable measuring device, which records daily hormone fluctuations. This data is then given to the startup’s learning algorithm-powered mobile app for interpretation. The app then gives users tailored information, including their hormonal profile and precise fertile days. The data is configured into an app to provide personalized insights. With this information, users know their precise fertile and non-fertile days. For couples who want to conceive, this data increases their chances significantly. For women who want a safe contraceptive method that’s hormone-free and non-invasive, Eli finally brings a no-compromise option. The proprietary consumables are recharged with a subscription. This unique approach was designed to engage users and provide increased effectiveness.
Implications: The lack of data in women's health has led to it being poorly understood and addressed and the pandemic is amplifying those widespread unmet needs. Eli's technology has been engineered to overcome this and tackle major unmet needs at all stages of women’s lives. In addition, Eli can help eliminate the unwanted side effects of hormonal birth control including side-effects and headaches. Eli joins a burgeoning market for so-called “Femtech” products and fertility apps such as Clue Ovia, Glow, Natural Cycles, and Flo. Research indicates that 1 in 6 couples in North America experience difficulties in conceiving. Moreover as Millennials put off forming families and having children, more couples are trying to conceive in their early 30s rather than their 20s, leading to a decrease in the chances of conception. By monitoring hormones and selecting the most fertile days, Eli will help older couples maximize their efforts to conceive at a time comfortable for them.
Telehealth Fraud: Tampa Pharmacy Owner Faces 10 Years for $931M Conspiracy
Event: A recent article in Healthcare IT News reported that four people and one company have pleaded guilty in a telemedicine pharmacy healthcare-fraud conspiracy that allegedly lasted for years.
Description: Tampa-based pharmacy owner Larry Everett Smith conspired with several individuals and telemedicine marketing companies (HealthRight and Sterling-Knight) to defraud pharmacy benefit managers into paying for fraudulent prescriptions. The group was charged with a conspiracy to defraud pharmacy benefit managers out of $174,202,105 by submitting $931,356,936 in fraudulent prescriptions. From 2015 to 2018, the scheme solicited insurance coverage and prescription information from consumers across the country. After soliciting patient information, marketing companies obtained approvals through contracted telemedicine prescribers, then sold the costly prescriptions to pharmacies in exchange for kickbacks. A press release from the Justice Department states that doctors approved the prescriptions without knowing that the defendants were massively marking up the prices of invalidly prescribed drugs. All of these drugs were then billed to private insurance carriers. All defendants have plead guilty and will have to pay restitution and face prison time of up to 10 years.
Implications: As highlighted in the article telehealth fraud is a significant threat to consumers, providers and government and commercial insurance programs' integrity. The dramatic rate of increase in telemedicine usage has exponentially multiplied the opportunities for hackers to steal patient data (either directly from consumers themselves or indirectly through provider and payer systems). As a result the entire healthcare system needs to be on the lookout for social engineering schemes which enable ransomware and other forms of targeting digital tools. Even though consumers think that they are dealing with trustworthy entities such as pharmacies or doctor's offices, unscrupulous actors can easily obtain sensitive information that enables billing fraud. With the mass adoption of telehealth technology, payers and providers in particular have to ensure a more significant focus on cybersecurity through such means as improving endpoint controls, patching critical security tools, security audits and identity and access controls. (Please see our 9/22/20 blog post covering the following two articles, “Targeted Cyberattacks on Telehealth Vendors Skyrocketed Along with Adoption & Report Finds & Fewer than Half of Healthcare Institutions Met National Cybersecurity Standards Last Year”, Link Here ).