This week's newsletter sponsored by: Elation Health

​Elation Health, whose primary care EHR and billing solution supports companies including Crossover Health and Firefly Health, is committed to supporting and advancing the interests of primary care organizations.

Recently, Elation was among the coalition of companies advocating for G2211, Medicare’s new billing code that ensures PCPs are adequately compensated for their investment in longitudinal care for patients.

Elation’s commitment to advancing primary care is also reflected in their purpose-built technology, which is why they are trusted by both large prominent digital health innovators and thousands of small independent practices.

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News
​Teladoc's stock plummeted as growth grinds to a halt

Teladoc stock dropped over 30% after its earnings call highlighted that growth in Teladoc's core business has ground to a halt. Teladoc, which has contracts with ~90 million Americans for general medical services, shared that they now view this market as saturated, and that growth moving forward will come from taking share from other competitors.

Teladoc set expectations that it will see low single digit revenue growth moving forward in its core US virtual care product. The scale does provide for a cross-sell opportunity of Teladoc's chronic care products, which now has about 16% penetration, up from 12% penetration two years ago. Between this cross-sell opportunity and an opportunity Teladoc sees in growing internationally, it expects mid-single digit revenue for the entire integrated care segment of the business.

The BetterHelp business appears to have a somewhat similar if not slightly worse narrative. Revenue growth over the next few years will be low single digits, with more of a focus on international growth.

Across both lines of business Teladoc emphasized the opportunity for margin improvement moving forward, as well as productivity. But even in that category it's not exactly a great narrative Teladoc has at the moment. Teladoc's profitability efforts will help margin expansion, but you can see an analyst ask about why that margin expansion isn't showing up. And that's because Teladoc's gross margin is going to be pressured in 2024 because of the launch of Primary360.

On the bright side, Teladoc currently has almost $2 billion of cash on its balance sheet, and generated almost $200 million of cash in 2023. The first priority with this balance sheet strength is to pursue M&A opportunities that make strategic and financial sense.

Relevant links:

• ​Teladoc Q4 2023 Earnings Transcript​
• ​Teladoc Q4 2023 Press Release​
• ​Teladoc Q4 2023 Earnings Deck​

News
​Evolent stock jumps after strong quarter and expected growth ahead

While membership declined quarter over quarter for Evolent because of Medicaid redeterminations, just about everything else seems to be going right. The broader payor market upheaval appears to have Evolent well positioned for growth by supporting payors in managing increased specialty spend.

This quote from the Evolent earnings call seems particularly insightful regarding current market dynamics: "health plans and risk-bearing physician groups are increasingly turning to us to help manage the cost and quality of specialty care. We have found that many plans have increased their focus on specialty care management over the past 6 months, some citing the V-28 risk adjustment changes and others because of general utilization pressures. We're seeing organizations placing particular importance on engaging partners that can help manage these costs and we to improve patient experience and at the same time, will not increase friction with providers."

Later in the call, Evolent also noted that v28 is causing plans to rethink plan designs, hinting that the market shift to PPOs from HMOs has played a role in all this. Evolent also shared that for oncology specifically, costs have grown by 10%+ annually for plans, driven by new drugs including Keytruda. Evolent walked through how they're partnering with oncologists to make sure that needed companion diagnostic tests are completed to ensure the therapy is effective for the patient. You can see why plans would be quickly looking for partners like Evolent to manage this spend - and as they noted in Q&A they're seeing a new type of growth opportunity from plans looking to close a near term gap in medical spend, which has drastically shortened historical sales cycles for Evolent.

Relevant links:

• ​Evolent Q4 2023 Earnings Transcript​
• ​Evolent Q4 2023 Earnings Presentation​
• ​Evolent Q4 2023 Earnings Release​

Outlining best practices for DTC prescribing of GLP-1 medications

A new article from the New England Journal of Medicine explores the concerns and potential opportunities for emerging direct-to-consumer GLP-1 offerings from companies like WeightWatchers, Noom, Eli Lilly, and other wellness centers. The authors provide best practices for DTC prescribing of the anti-obesity medications, along the patient journey - from diagnosis to evaluation & counseling to prescribing, and monitoring & maintenance procedures.

A visual of projected 2024 MLRs for major payors

​This was a nice visualization from Rebecca Pifer at Healthcare Dive highlighting the trend in MLR for major payors and the projected increases that almost all major payors are seeing in 2024. It's not new data from what's already been discussed on earnings calls, but a helpful graphic and discussion of why this is happening.

Healthcare org leaders' 2024 strategic initiatives

Health Enterprise Partners and L.E.K. Consulting published a report that unpacks the results of a survey of 115 leaders of healthcare organizations on their pain points, investment priorities, and strategic objectives heading into 2024. The chart above is a good summary of the findings across several major themes, including cost reduction & revenue enhancement, labor challenges, VBC enablement, patient acquisition & engagement, care setting optimization, and more.

Walgreens announced this week that it is closing 50 VillageMD clinics in Florida. It's a sign of the strategic shift that is underway in the organization away from scaling an employed physician model via Village clinics to a partnered model. Given the importance of the Florida market it'll be interesting to watch how / if Walgreens backfills its presence in this market with a more partnered approach as its emphasized in recent months with its Pearl Health and Hartford Healthcare partnerships.
​Link / Slack (h/t Brett Jansen)

On Wednesday, Change Healthcare was hacked, leaving some pharmacies unable to fill prescriptions.
​Link / Slack (h/t Ryan Kuhn)

YCombinator released its latest Request for Startups last week, which highlights the ideas that YCombinator wants to see made real. The list includes twenty categories, four of which are healthcare focused. The healthcare categories were: 100x MRI scans to end cancer, foundational models for biological symptoms, MSOs for every provider vertical, and eliminating middlemen in healthcare. That first category is sure to elicit some strong reactions from healthcare folk. There is also some irony in seeing the third and fourth categories next to each other given the middleman-y nature of MSOs.
​Link / Slack

DarioHealth announced it will acquire Twill, a mental health digital therapeutics startup, for $10 million in cash plus stock worth over $20 million. The deal aims to help DarioHealth expand into mental health, beyond its existing capabilities in diabetes, MSK, and weight management.
​Link / Slack (h/t Conor Green)

Aptar Digital Health, a SaMD company, announced its acquisition of Healint, a digital health company that offers a virtual clinical trial platform and suite of mobile apps supporting neurological and immunological conditions.
​Link

Abridge, an AI scribe company, raised $150 million in Series C funding. Along with the fresh capital, the company announced a new enterprise agreement Yale New Haven Health System giving thousands of clinicians access to Abridge's tech.
​Link / Slack (h/t Rik Renard)

Fabric, a care enablement platform built on the acquisitions of Zipnosis and GYANT, raised $60 million in Series A funding to scale its digital patient front door.
​Link / Slack (h/t Rik Renard)

Oula, a maternity care clinic, raised $28 million in Series B financing.
​Link / Slack (h/t Shani Bocian)

HealthSnap, a chronic care RPM platform, closed $25 million in Series B funding to accelerate its product roadmap.
​Link

Blackbird Health, a virtual & in-person youth mental health provider, raised $17 million in Series A funding. The company leverages its proprietary computational models to diagnose mental health issues in kids.
​Link / Slack

AZmed, an AI computer-aided diagnostic platform, secured $16.2 million in Series A financing.
​Link

Power, a clinical trial platform, raised $11.9 million in Series A financing to enhance its platform and support further research. The company offers a patient recruitment platform that aims to expand trial access to more diverse populations.
​Link

9amHealth, a virtual cardiometabolic provider, secured $9.5 million in Series A extension funding to accelerate its growth strategy and product roadmap and expand its clinical team.
​Link / Slack (h/t Shelbi Svoboda)

Siftwell Analytics, a population health analytics platform, raised $5.8 million in funding. The company is focused on serving community health plans and currently operates in four states.
​Link / Slack

Axle Health, a software platform for home health, raised $4.2 million.
​Link​

ISHI Health raised $4 million for a new heart failure remote monitoring platform leveraging an AI-driven approach and partnership with Mayo Clinic.
​Link​

UnityAI, a hospital workflow platform, raised $4 million in Seed funding. The company's AI-enabled solution helps hospitals improve bed management, resource allocation, and overall patient care.
​Link

Elektra Health, a menopause care startup, secured $3.3 million in funding to expands its care delivery platform across payers and self-insured employers.
​Link / Slack

​The Alabama IVF ruling uses faux scientific language to justify a religious position by David Sable

This article provides good perspective on the recent legal ruling in Alabama that now has led Alabama's largest hospital to stop IVF treatments.​

​Deep Dive into Modern Eligibility & Benefits Verification by Ezzy Sriram

This was as nice explainer on the role of eligibility and benefits verification in the broader patient onboarding process. It unpacks the fundamentals of E&B verification, workflow best practices, vendors in the space, and more.

​Primary Care: The Mother of all APIs by Paulius Mui, MD and David Nichols, MD

This article unpacks the numerous types of API calls made by primary care docs - from prescriptions to labs to referrals to imaging, and beyond. The authors make the case for how PCPs are increasingly taking on what used to be the responsibilities of specialty care clinicians and are getting help from leveraging clinical decision support tools.

​So what can we do about health care costs? by Matthew Holt

Matt Holt tackles the big question: "So what can we do about health care costs?" in his recent article. The piece digs into four ways to cut health care costs - cutting prices, reducing overall usage, cut unnecessary services, and placing higher priced services with lower ones - and provides examples of each happening across the system today.

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Director, Navigation Training at American Cancer Society, a non-profit organization aimed at eliminating cancer. Link​

Provider Operations, Process Management Associate at Oscar Health, a healthcare insurtech company. Link​

Growth & Business Development at Amae Health, a mental health clinic focused on severe mental illnesses. Link​

Senior Product Manager, Activation at Virta Health, a virtual diabetes care provider. Link​

Social Media and Community Manager at Hey Jane, a virtual reproductive and sexual health clinic. Link.

​Contact us to feature roles in our newsletter.

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