This week's newsletter sponsored by: Elation Health

Elation, a unified EHR and billing software system designed to support value-based primary care, in a recent study with the American Academy of Family Physicians (AAFP), found that family physicians with value-based payment models experience less burnout, but making the transition is no joke. When poorly implemented, the study indicated that VBC models have the potential to make physician burnout worse, requiring adequate infrastructure to enable success.

Whether you’re a small independent practice or large digital health company, this emphasizes the importance of finding the right partner in your value-based journey, such as Elation, whose platform is focused on the unique needs of primary care.

​Learn More About Elation​

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Happy Holidays! This will be the last regularly scheduled newsletter from us for the 2023 year as we take some time to celebrate the holidays and New Year! Looking forward to hitting the ground running in January as folks gear up for the trek out to the JPMorgan conference.

NEWS OF THE WEEK Sharing our perspective on the news, opinions, and data that made us think the most this week​ ​

News
​Centene's Investor Day highlights the advantages of a pure play insurance approach​

Centene’s Investor Day this week provided for a fascinating foil to the in vogue approach of insurers becoming more vertically integrated. The session was refreshing in its focus and simplicity - Centene sees a big opportunity for itself operating as a pure play managed care insurance company across the individual exchanges, Medicaid, and Medicare.

Centene focused the conversation on what it articulated as its key competitive advantages - the power of incumbency, a local approach, and partnerships. The local approach in particular was pretty compelling to listen to. Centene had an entire section on regulatory affairs and the current state of healthcare policy across its products, and the presentation included a number of examples articulating how Centene has very close relationships with leaders in the markets it operates, across the political spectrum. It gave a number of examples of how it is either partnering with states or state officials are reaching out to Centene leaders to inform policy decisions. You can see why this is an advantageous spot to be in as an insurance business. A few other observations from the day:

• ICHRA growth. Centene leadership highlighted repeatedly the growth opportunity that it sees with ICHRA in terms of moving lives from the employer market into the exchanges, noting that it thinks 45% of the employer market could be disrupted by ICHRA moving those lives to the exchanges long term. In analyst Q&A they added that “the data points that we’ve seen evolve out of the market over the last twelve months tell us that this is increasingly a thing on multiple vectors.” Centene noted it is already seeing 5 - 20 employee small group migrating into the marketplace as employers with low-wage employees are kicking people into the exchanges already. Currently Centene covers 13,000 ICHRA members via the exchanges. Their hypothesis is that this trend will continue and move into the 50 - 150 small business group. There were some interesting dynamics with the broker market discussed in terms of driving adoption.
• Startup partnerships / VBC. Speaking of ICHRA, Centene shared during the session that it is partnering with Take Command Health in the ICHRA market. On the care delivery front, Centene also highlighted relationships with Hazel Health to bring telehealth services into schools as well as Wayspring to support substance use disorder treatment. Centene noted both Hazel and Wayspring as examples of how it is implementing value-based care beyond PCP relationships for patients where a PCP isn't the provider best suited for that members care. Centene also shared that 40% of Medicaid members are in VBC contracts, with over half of those in downside-risk contracts. That overall number is similar to Medicare, but more Medicare members are in downside-risk contracts.
• Addressing Provider Workforce Needs. Centene brought up a number of examples of its work in Georgia throughout the session. One of the most interesting to me was how it has attempted to strengthen the physician pipeline by partnering with the Medical College of Georgia to create a accelerated path to graduation and pay for medical education when providers commit to practicing in rural or underserved areas of Georgia for six years.
• Red v blue turning to rural v urban. One particularly interesting comment regarding political support for Medicaid and the exchanges is that support is increasingly bi-partisan and that they're seeing states break down more across "urban" and "rural" than "red" and "blue" politically. .

Definitely a session worth listening to if you're interested in learning about managed care strategies or attempting to build in the Medicaid market.

CHART(S) OF THE WEEK Sharing a visual or two from the week that made us think

ZocDoc data highlights patient scheduling preferences

ZocDoc released some interesting data about how patients engaged with its platform in 2023. It should be of high interest for providers given the platform is 80% commercial patients. Perhaps not surprisingly, speed to care was an important factor, with 50% of appointments booked within four days. Providers who offered virtual and in-person visits saw 51% more bookings than those who offered in-person only, and 217% more than those who offered virtual only. Virtual visits only made up 18% of the visits offered on ZocDoc, with 10% of total visits being for virtual mental health.

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JAMA Network article finds senior physicians are less likely to treat Medicaid patients than junior physicians

​An observational analysis of athenahealth and Medicare data found that senior physicians treat fewer Medicaid patients than junior physicians, noting that the gap between senior and junior physicians doesn't exist for specialties that don't have scheduled visits.

OTHER NEWS A round-up of other newsworthy items we noticed during the week

A week after reporting talks were happening, the WSJ reported Cigna has called off merger talks with Humana after getting tripped up on valuations. Cigna is apparently opting instead to focus on buying back an additional $10 billion in stock.
​Link / Slack

Kroger partnered with Better Health Group to launch a VBC model for seniors within Kroger's retail clinic model, The Little Clinic. Better Health Group will operate as an MSO providing the infrastructure / support for the 225 Kroger retail clinics in taking on risk with Medicare members. It's an interesting strategic move for both parties and will invite reasonable questions about whether a retail clinic can successfully manage risk. Will be curious to watch how this evolves.
​Link / Slack​

GLP-1s were again in the news this week as Oprah shared in an interview with People that she is using a a weight loss drug. Axios reported that the interview drove a 30% increase in bookings on ZocDoc among patients seeking semaglutide on Wednesday (link). Oprah's news also seemed timed to coincide with WeightWatchers launch of a new membership model for GLP-1s on Thursday. With some headlines referring to Weight Watchers as "Ozempic-as-a-platform" it seems like we're destined to be talking even more about this space in 2024.
​Link / Slack (h/t Katie Chlada & Casey Langwith)

Moody's cut Walgreens credit rating to junk status after trouble with healthcare strategy. It's worth reading the Moody’s report to see how they dissect the concerns - essentially they're worried about Walgreens Debt / EBITDA and the financial risk that Walgreens has in successfully integrating its recent healthcare acquisitions.
​Link / Slack (h/t Manas Kaushik)

This is an interesting lawsuit brought by the family of a pediatric cancer patient in New Jersey against the President of the New Jersey Medical Board for rolling back access to telehealth visits, effectively denying the child access to needed follow-up care from out-of-state providers. The complaint argues this is unconstitutional, and it makes for a fascinating read on telehealth law.
​Link / Slack (h/t Neel Shah)

Privia Health Gulf Coast Texas, Privia's medical group in eastern Texas, partnered with Iron Health to provide weight management support for Privia Wellness patients in the region. It will be interesting to see how Privia corporate leadership articulates this move as part of their broader strategic narrative. Is this an example of the organization as a whole testing new models that are intended to expand across geographies, or a local market deciding it wants to do something on its own? The press release certainly doesn't read like the former (the fact that it is Privia Health Gulf Coast Texas and not Privia Health mentioned everywhere indicates as much). If it's the latter, it seems like a crack in the MSO narrative about the level of support providers are looking for from these platforms. It’s something to pay attention to not just for Privia but all the MSO models as they scale.
​Link / Slack​

Healthcare analytics platform Cotiviti is changing private equity owners as KKR is rumored to be buying a 50% stake from Veritas Capital at a valuation around $11 billion.
​Link / Slack (h/t Michael Ceballos)

The troubles related to naviHealth's post acute care algorithm continue this week as Humana is now facing a class action lawsuit for denying needed care. The lawsuit was brought by two individuals who feel they were wrongly denied care by Humana as a result of this algorithm.
​Link / Slack (h/t Samir Unni)

SmileDirectClub has shut down after filing for bankruptcy back in September.
​Link / Slack (h/t Khang Vuong)

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FUNDING A collection of notable startup financing rounds across the industry

Twin Health, a metabolic management company, secured $50 million in Series D financing.
​Link / Slack (h/t Kevin Wang)

Medefy Health, a health benefits navigation platform, raised $10 million in Series A funding.
​Link / Slack

Season Health, a food-as-medicine company, raised $7 million.
​Link / Slack (h/t Kevin Wang)

Binkey raised $3.3 million to help individuals optimize their HSA / FSA accounts.
​Link​

WRITERS GUILD A round-up of posts from the broader healthcare community this week that made us think

​HCA’S Grand Plan: Breaking Down Their 2023 Investor Day by Blake Madden

This is a good read on HCA's strategy discussed during their investor day, including their approach to building density in local markets. ​‎

​Digital health at the turn of 2024: Tracking developments along the innovation maturity curve by Irene Golden, Mihir Somaiya, and Sari Kaganoff

Some of the Rock Health team took a look at where a few of the buzzworthy digital health spaces from 2023 are on the adoption cycle - among other spaces its talks about Food as Medicine, digital obesity care, and caregiver solutions as nascent / emerging markets.

​Venturing in Senior Care: Observations and Predictions for 2024 and Beyond by Daniel Kaplan

An interesting perspective on the senior care market, both looking at the current state of the landscape and some change that might be on the horizon in 2024.

JOBS OF THE WEEK Featured job postings from the HTN Jobs Board this week

CaringBridge, a nonprofit health platform that supports family caregivers, is hiring a Product Manager (Hybrid). Link.

Devoted Health, a Medicare Advantage insurance + care delivery startup, is hiring a Sr Mgr of Clinical Operations, Behavioral Health. Link​

GEHA Health, a nonprofit that helps federal employees with medical and dental benefits, is hiring a Director - Customer Experience & Member Engagement. Link.

​​RockHealth.org, a not-for-profit that works alongside Rock Health Advisory and Rock Health Capital to advance health equity in digital health, is hiring a Chief of Staff. Link.

Wellinks, a virtual COPD company, is hiring a Director, Growth & Business Development. Link.

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