Short takes: Intuition Robotics gains $25M funding, Akili Interactive abandons digital Rx therapeutics, NextGen goes private for $1.8B, ATA’s DC advocacy ‘fly in’ + launches new tools on disparities

September 19, 2023 | by

Catching up on the catchup…

Israel-based Intuition Robotics raised $25 million. The unlettered round closed at end of August with $20 million in venture capital plus $5 million in venture debt. According to the release, the funding was led by Woven Capital, the growth fund of Toyota, with participation from Toyota Ventures, OurCrowd, Western Technology Investment, and additional investors. Intuition Robotics is the developer of ElliQ, an interactive desktop companion robot targeted to older adults and those with assistive needs, last covered in their 2.0 update last December and their involvement with New York’s Office for the Aging [TTA 25 May 22 and WSHU]. The Area Agency on Aging of Broward County, the Olympic Area Agency on Aging, and California’s Agency on Aging in Area 4 have also worked with Intuition Robotics on distributing the companion to older adults in their programs. According to the company, older adults who successfully engage with it average over 30 daily interactions with ElliQ and reduce the devastation of loneliness for 95% of users. 

Akili Interactive exits prescription digital therapeutics (PDT), pivots to consumer, drops 40% of staff. Much like Better Therapeutics and the now sliced-up Pear Therapeutics, the company realized that PDT was not a winning strategy for its interactive video game-based therapy for adults with ADHD. The EndeavorOTC version, released in June, is available via a subscription (SaaS) through the Apple App Store and the Google Play Store for $24.99 for a monthly plan or $129.00 for an annual plan. According to their release, Akili will pursue regulatory approval for over-the-counter labeling of its treatment products. Akili is yet another cracked SPAC facing a reckoning, currently trading on Nasdaq at $0.66 from its debut in August 2022 at $14 with a quick fall to $4.   HIStalk 15 Sept, Rock Health Weekly Newsletter

NextGen acquired by private equity firm Thoma Bravo for $1.8 billion, ending 41 years of public market trading. The offer price is $23.95 per share in cash, an over 46% premium to the Nasdaq share price on 22 August. NextGen Healthcare is an EHR with population health and practice management features designed primarily for specialty medical practices. NextGen went public as Quality Systems an eon ago in 1982.  Release, FierceHealthcare

And…the American Telemedicine Association (ATA) celebrates the third annual Telehealth Awareness Week (17-23 September) with a telehealth advocacy ‘fly in’ to meet with Congressional offices and Members in Washington DC on 18-19 September, plus their three tools to eliminate disparities in telehealth services developed by ATA’s Advisory Group on Using Telehealth to Eliminate Disparities and Inequities. They are a Digital Infrastructure Disparities Score and Map, an Economic and Social Value-Added Calculator, and a toolkit with all ATA and advisory group-developed resources. Releases 19 July (fly-in) and 18 Sept (disparities tools)

Rock Health’s first half funding roundup adjusts the bath temperature to tepid, the bubbles to flat

July 11, 2023 | by

The ‘new normal’ continues, as the bubbles vanish and the poor duck’s feathers are getting soggy and cold. Rock Health’s roundup of digital health funding (US only) continues the chilly flat-to-downward trend to funding. What money and fewer funders are out there which persist in their dedication to healthcare are betting cautiously, minimizing their risk on the table in lower unlabeled funding rounds and pre-vetted concepts. 

  • First half 2023 (H1) funding closed at $6.1 billion across 244 deals. Average deal size was $24.8 million, the lowest since 2019.
  • Breaking down by quarter, Q2 2023 funding hit a new low– $2.5 billion in funding across 113 deals, lower than Q4 2022’s ‘hole’ of $2.7 billion. By comparison, Q1 2023 funding totaled $3.5 billion over 131 deals, adjusted from the earlier report of 132 deals [TTA 5 Apr]. The collapse of three banks, most notably Silicon Valley Bank in March, clearly affected Q2.
  • Given the trend, Rock Health projects that 2023 funding will fall well below 2022, between 2019’s $8.1 billion and 2020’s $14.3 billion

Delving into the numbers:

  • Those ‘generalists’ who jumped into the digital health pool in 2021-22 jumped out. H1’s 555 investors had a 71% repeat rate, meaning that those who knew the water saw some opportunity or put on their wet suits. The overall total dropped from 775 in H1 2022 and 832 in H1 2021.
  • Unlabeled raises were suddenly the way to go. 101 of 244 deals–41%–had no series or round attached. This unprecedented move avoids the spectre of down rounds for companies needing to raise funds–down rounds affect valuation. Interestingly, 67% of these companies’ prior raises were in 2021 and 2022. 37 of them were Series B or lower. 
  • Mega deals inhabit a different territory. H1 had 12 mega deals, 37% of total funding dollars, and was at the 2021 norm of $185 million. Half were at Series D and growth/PE. They clustered in value-based care, non-clinical workflow, and that former mouse in the pumpkin coach, in-home and senior care. This level of funding also gravitated to the pre-vetted: incubated by VCs included Paradigm (clinical trials) and Monogram Health (kidney care).  Recently funded Author Health, long in stealth, will operate in a narrow slice of mental health funded by Medicare plans.
  • Zero IPOs, but acquisitions and shutdowns/selloffs continue. Acquisitions continued on a track of about a dozen per month, down from 2022’s average of 15. On the gloomier side, quite a few companies simply ran out of runway after raising a little or a lot of funding. These hit the lights at the end resulting in hull loss: Pear Therapeutics, SimpleHealth, The Pill Club, Hurdle, and Quil Health. If they were lucky, they had intellectual property worth something to someone–Pear to four buyers including a former founder, 98point6’s AI platform business to Transcarent–or subscriber bases worth acquiring, such as Pill Club to Nurx, SimpleHealth to TwentyEight Health. This does not count Amazon shuttering Halo and leaving subscribers in the lurch. (Nor Amazon’s dodgy approach to privacy getting Federal and private scrutiny, which this Editor explores here and here.)

To this Editor, 2023 will be a ‘grind it out and survive’ year for most health tech and digital health companies. Survivors will carefully tend their spend, their customers (who will be doing their own cutbacks), and watch their banks. The signature phrase this year was written in 1950, another uncertain time, by Joseph L. Mankiewicz and uttered with flair by Bette Davis in a classic film about the theatre, ‘All About Eve‘: “Fasten your seatbelts; it’s going to be a bumpy night.”   Rock Health Insights

Friday roundup: VA Spokane quashes staff cuts; EHR market share ex-US; Epic’s proposed UK HQ expansion; Apple watchOS 10 adds health features; Nox Health on Pear buy; GP2U Telehealth sold

June 9, 2023 | by

VA assures Mann-Grandstaff VA Medical Center staff that they won’t face cuts due to their budget deficit of about $35 million. The Northwest regional network director Teresa Boyd said to staff in a 1 June message that  the hospital had “not been asked to cut current staff or reduce services to Veterans to mitigate any effects of the deficit.” Mann-Grandstaff was The Last Straw for the Oracle Cerner implementation, and problems with the EHR and the loss of productivity (estimated at 18%) contributed significantly to the ongoing deficit. This follows on the earlier center director’s statement that Mann-Grandstaff would face at least a 15% cut to make up the shortfall [TTA 31 May]. The Spokesman-Review story goes on to recap the mound of miseries around the Oracle Cerner rollout as well as the local angle with Senator Patty Murray and Representative Cathy McMorris Rodgers, a Spokane Republican who has called for the VA to scrap the Cerner system, but who also called on VA Secretary Denis McDonough to pledge to use money Congress had already appropriated to prevent cuts to staff or services in Spokane.

Speaking of Oracle Cerner, KLAS’ 8 June report on EHR hospital market share outside of the US has Softway Medical by far the leader. Oracle Cerner has the #3 ranking while Epic, tops in the US, is #10. The top 13 are (by 2022 number of hospital beds):

1. Softway Medical: 17,805
2. Dedalus: 9,436
3. Oracle Cerner: 7,564
4. CompuGroup Medical: 6,039
5. IQVIA: 5,803
6. MV: 4,309
7. Philips: 3,486		8. InterSystems: 2,876
9. System C: 2,706
10. Epic: 2,564
11. ezCaretech: 2,376
12. Maincare Solutions: 2,222
13. Meditech: 2,027

Leading in Europe are Softway Medical, Dedalus, System C, and CGM (not on list), while in Asia/Oceania IQVIA, InterSystems, ezCaretech lead. In Latin America, MV and Philips in Brazil with NTT DATA (not on list) in Argentina. Becker’s

But Epic has plans to expand. One sign: plans to move their UK headquarters staff currently located in several buildings in Bristol to a much larger campus on the outskirts of town in nearby Long Ashton. The campus site is currently pasture fields and the village cricket club. This coincides with plans to develop a ‘garden village’ with 2,500 homes to the south that may include a rail station. The public hearing is 12 June in Long Ashton. Bristol Post

Apple debuted its latest iteration of its Watch, OS10, on Monday at its annual Worldwide Developers Conference, with new mental health, vision health, fitness, and medication tools.

  • Mental health: Mindfulness app logs emotions and daily moods, with a Digital Crown that turns to choose a shape to represent their feelings. The Health app adds depression and anxiety assessments which can be turned into a PDF that can be shared with appropriate health resources. 
  • Vision health: this allows users to track time spent outdoors, which can be good for mental and physical health, but supposedly can create nearsightedness through sun exposure (!). This Editor finds this most curious as most of us myopics were ‘that way’ by age 5 or earlier.
  • Fitness tools: a boon for cyclists with workout reminders, fall detection (unless it’s obvious), and an automatic connection to the person’s iPhone to display heart rate, elevation, race route, custom workouts, and cycling speeds. 
  • Medication: follow-up reminders to log medication sent 30 minutes after the scheduled time

Mobihealthnews, CNET video

Nox Health, which bought $3.9 million of Pear Therapeutics assets [TTA 24 May] spilled a bit to Mobihealthnews on their plans for Somryst, the Pear FDA-cleared insomnia treatment. Nox is already in the sleep health business and has several lines of business around benefits for self-insured employers and payers, plus sleep diagnostics and related technologies targeted to hospitals and health systems including the VA. Nox’s origins are in Iceland and while developing sleep diagnostics from hospital to home got to know Pear while they were developing Somryst. Their CEO also has some thoughts on why Pear got sliced up.

Down Under, GP2U Telehealth is being sold, the second change of ownership in just over two years. The seller is UK-based Doctor Care Anywhere (DCA) Group. Australia’s Connected Medical Solutions, operating as My Emergency Doctor (MED), agreed to buy GP2U for A$3 million (US $2 million): A$500,000 in cash and A$2.5 million in Connected Medical Solutions shares. DCA bought it in September 2021 for A$11 million (US$7.4 million), which is quite a haircut in any currency, but announced that the sale is to reinforce its focus on its core UK market. MED partners for telehealth services with over 40 healthcare services, including ambulances, primary health networks, residential aged care facilities, hospitals, urgent care centers, and multi-purpose centers. DCA’s current UK consults in April/May totaled 121,200, up 30%. Mobihealthnews, MarketWatch

Watch your cash burn! Now 31 months average for startups between Series A and B. Now what do you do?

June 8, 2023 | by

Yes, it’s an even longer way from Series A to B. Add some rockslides to that picture (left) and that’s what the road looks like. A thoughtful article in Crunchbase illustrates the changes over the past dozen years. We are certainly not in the palmy throw-money-at-great-ideas-devil-take-the-hindmost days of 2020-21. Their chart has both median and average time from Series A to B and both are at an all-time high: 31 months on average and 26 months for the median, sharply up from 2022’s 26 and 22 months respectively. The lowest quartile of startups took a stunning 38 months median to get to a Series B–that is over three years.

The question for most startups is how long they can hold out till the next successful fundraising. The pattern has been that once the Series A is completed, the founders put most of their time and energy into raising the next round. What they should be doing, according to the article, is cutting costs and extending runways till the time that things improve among funders. Startups should also keep in mind that investors now prefer lower-risk, slower growth, lower ongoing loss startups to the high flying (in 2020-21). high-cash burn/high-growth startups. 

There are exceptions of course in hot sectors, notably AI and generative AI, but formerly scorching mental health has distinctly frosted over. And if your startup is already profitable, that also attracts funding if the sector is appealing.

The CB conclusion is cautionary and to the point: 

Sooner or later, however, Series A companies will have to do one of five things: Get acquired, go public, become self-sustaining, raise more financing, or shutter. If enough years pass with none of the first four options happening, it becomes increasingly likely the startup will not make it.

This Editor will add that the latest shutterings have been in women’s health which never has received a lot of investment (5% according to Rock Health) and to funders is too niche: NYC-based Bunnii (fertility planning) and SimpleHealth (birth control), which sold its assets to Twentyeight Health. Both got trapped in the funding trough between promises and actual funding. Axios

What’s the way forward from the tough picture above? Well, digital therapeutics probably should be avoided as their track record from Happtique’s vetted app prescribing (failed by 2014) to Pear Therapeutics (failed 2023) has been a losing one. This Editor saved a January MedCityNews article to see if their thumbs up-and-down projections on startups raising capital held up six months later. 

  • Thumbs up: companies that serve multiple stakeholders by creating value for providers, pharma, payers, employers, and consumers; those that not only save clients money but also make them money after one year (!); labor/staff-saving systems; anything with clear ROI; concretely addressing issues with affordability, accessibility, and accuracy. 
  • Thumbs down: niche players that serve highly targeted markets; care navigation (and other-Ed.) services where ROI is hard to track; too crowded sectors like patient engagement and clinical documentation unless they can provably be the lowest cost, most efficient provider versus competition

This Editor would add as ‘thumbs up’ technologies that facilitate simple and less expensive deployments that address extreme pain points around Federal/state compliance and legal/safety cost issues such as staff safety, drug diversion, and patient/resident elopement. 

FTA: Companies are advised to diversify their funding as well: reduce dependence on private capital by looking for investments from alternative sources like the government for non-dilutive funding.

What’s your thoughts and experience?

Mid-week roundup: Pear assets fetch paltry $6M *updated*, Bright Health’s reverse stock split, Oracle Cerner loses hospital EHR share, Lifeforce health optimization scores $12M Series A

May 24, 2023 | by

From a $1.6 billion valuation to $6 million in a bankruptcy court is sad. Pear Therapeutics‘ assets were sold at a bankruptcy court auction for $6 million. Even that took four bidders slicing themselves individual pieces.

  1. Nox Health Group of Atlanta ponied up the major bid of $3.9 million for Pear’s Somryst, their FDA-cleared insomnia treatment. Nox Health offers sleep-related treatments to employers and payers.
  2. Harvest Bio anted up $2.03 million for the ISF licenses and patents, plus Pear assets related to schizophrenia, multiple sclerosis, depression, and the remaining pipeline projects. They also bought the corporate trademarks, the PearConnect commercial platform, and the rights to the FDA-cleared reSET and opioid-specific reSET-O programs. Editor’s view: with no discernable website or Crunchbase listing, Harvest’s purpose could be to buy themselves the core of a business. (See below for more)
  3. Click Therapeutics paid $70,000 for the patents that powered Pear’s platform, except Invention Science Fund (ISF) licenses and patents. Click is an NYC-based developer of digital therapeutics to treat migraine, smoking cessation, schizophrenia, depression, and more.
  4. WELT Corp. of Seoul, South Korea, put down $50,000 for Pear’s migraine-focused program. Samsung-backed WELT develops digital biomarkers tracked by smartphones and sensors to track, monitor, and predict health outcomes.

The court filing (PDF) is here. The hearing to finalize the approved bids took place yesterday (22 May) in the United States Bankruptcy Court for the District of Delaware. The $6 million is nowhere near the $32 million in debt that Pear had on the books at the time of their Chapter 11 filing [TTA 13 Apr]. The $1.6 billion was the valuation of Pear at the time of its SPAC in December 2021 and Pear had raised over $400 million previously. Mobihealthnews, STAT

Update 30 May: The mysterious Harvest Bio LLC is now a little less mysterious with the tracking down by STATNews‘ Mario Aguilar that the signatory for the purchase of over $2 million in assets from Pear is none other than Pear’s former CEO, Corey McCann. @mariojoze. Brian Dolan on LinkedIn adds the tracks of a molto stealthy Boston-based funder, T.Rx, which is using a recently set up fund (1/23) to back up McCann’s bid. Former Pear exec (head of search, evaluations, and in-licensing), independent investor, and Zus Health investor Michael Langer appears to be a co-founder and managing director of T.Rx, according to Mr. Dolan. Zus Health raised $40 million back in March and is headed by former athenahealth head Jonathan Bush.

In other implosion news, Bright Health on Monday executed its reverse stock split buying itself time on the NYSE from delisting. The board and shareholders approved a 1:80 split. It is now trading as BHG1 and closed today (Tuesday 23 May) at $14.38. Bright is in real extremis–selling its California health plans, either fined or under investigation in four states, in a lawsuit over unpaid claims with SSM Health, and needing a quick $500 million to pay off their outstanding JP Morgan credit facility. Ouch.  [TTA 7 Apr, 20 Apr, 4 May, 5 May  Mobihealthnews, Becker’s Payer Issues, Seeking Alpha    See 24 May update on their sale of Zipnosis

Oracle needs to execute a turnaround at Cerner. Stat. And it’s not just at the VA. KLAS Research in a report published today calculated EHR hospital market share by both location and hospital beds. Epic is running away with the core hospital market with a 39.5% market share while Oracle Cerner has 24.9%. The KLAS findings are access-restricted, but the publicly available toplines are that Epic is the only vendor with positive net change in hospital market share and beds, while Oracle Cerner has lost beds and gained share in small hospitals, losing large ones. Third ranked is Meditech with a 16.3% share. It’s not unthinkable to shrink out of this business. Once upon a time, GE Healthcare was a major player in this sector with Centricity–and exited back in 2015, retreating to specialty physician practices. Becker’s

In contrast, if it has some celebrity shine, money gets raised. Lifeforce closed a Series A round at what is now a strong amount–$12 million. It promises a clinically integrated approach to health optimization for longevity based on physical and psychological biomarker data, clinical expertise from doctors and health coaches, and validated interventions on a telehealth-based platform. Blood draws every three months are done by registered phlebotomists. It also markets nutriceuticals, peptides, and hormones as part of treatments to members. Co-founded by Dugal Bain-Kim, Peter Diamandis, and Tony Robbins, Lifeforce is endorsed by Serena Williams. The $12 million raise was co-led by M13 and Peterson Ventures with participation by Ridgeline Ventures, Rosecliff Ventures, and Seaside Ventures. The maintenance program starts at $349 for an initial baseline assessment and $129 per month for membership thereafter. However, when this Editor as a marketer sees claims in the release headline such as “World’s Most Effective Health Optimization Platform”, yellow flags start flying. Mobihealthnews, Lifeforce release

Mid-week roundup: Pear Therapeutics’ Chapter 11; Workit Health pinkslips 100; Outcome Health principals convicted of $1B fraud

April 13, 2023 | by

Pear Therapeutics ran out of runway and is in the drink. On Friday, CEO Corey McCann announced in a post on LinkedIn that the company filed for Chapter 11 bankruptcy and has laid off 170 employees, including him. Dr. McCann will continue on the board and as a compensated consultant, while chief operating and financial officer Christopher D.T. Guiffre will remain through the Chapter 11 process along with about 15 employees to manage the asset sale process, limited operations, and transition on behalf of the debtors.

According to their Securities & Exchange Commission (SEC) 8-K filing, terminated employees were paid through April 7, 2023, received two weeks’ salary as severance, and were asked to sign a separation agreement, which includes a general release of claims against the company resulting in a $1.2 million charge.

Only last month, Pear announced that it was exploring ‘strategic alternatives’ including a sale or being acquired. According to the release, the debtors are still seeking a sale of the whole business or to part out specific assets. Now such sales and the bidding process must be approved by the US Bankruptcy Court in Delaware. Release  The sale is anticipated for May.

Another behavioral health casualty in a model that proved unworkable. Pear developed and marketed Prescription Digital Therapeutics (PDTs) concentrated in behavioral health and substance use including opioid use disorder. While these seemed to be accepted by providers, patients, and some payers, payment didn’t materialize from the last, according to Dr. McCann’s LinkedIn post. According to Forbes, “There were more than 45,000 prescriptions written for Pear’s products in 2022, but only around half were filled and the company was able to collect payment for only 41% of those.” The other factors were price and reimbursement. Pear’s products averaged $1,195, which took them out of private payment. Only a limited number of commercial insurers and Medicaid plans would pay for them. Medicare did not. In 2022, Pear reported an operating loss of $123.4 million on $12.7 million in revenue, which doesn’t fly in 2023.

This is quite a change from the heady days of 2021, when Pear went public on Nasdaq via a SPAC in December, raising about $175 million in additional funding. A sign of trouble was that the raise was far less than the anticipated $400 million. At that time, Pear was valued at about $1.6 billion. Prior to the SPAC, they had raised about $284 million through Series D funding (Crunchbase)  Mobihealthnews, MedCityNews

Another virtual behavioral health company facing loss of business is Workit Health, This is due to the Drug Enforcement Administration’s (DEA) planned return to the in-person visit requirement for Schedule III-V non-narcotic controlled medications. Workit is a virtual therapy/treatment company for alcohol, stimulant, and opioid abuse, a crowded field. The company, rationally, is cutting 100 staff in anticipation of a drop in activity. To date, it has over $130 million in funding through a Series C, not a lot.  Behavioral Health Business  Also TTA 15 March on the DEA rule debate

Outcome Health–the other late 2010’s scandal after Theranos–had its denouement in a Federal court in Chicago yesterday (11 April). Convicted of $1 billion in fraud were:

  • Rishi Shah, 37, the co-founder and former CEO of Outcome Health: five counts of mail fraud, 10 counts of wire fraud, two counts of bank fraud, and two counts of money laundering
  • Shradha Agarwal, 37, the former president of Outcome: five counts of mail fraud, eight counts of wire fraud, and two counts of bank fraud
  • Brad Purdy, 33, former chief operating officer and chief financial officer: five counts of mail fraud, five counts of wire fraud, two counts of bank fraud, and one count of false statements to a financial institution

Each count carries specific maximums of between 10 to 30 years which are usually served concurrently. Sentencing for the three executives and for three other employees who had pleaded guilty to lesser charges will be at a date to be determined. SEC charges are pending against the executives, along with Ashik Desai, former chief growth officer, who testified against his former bosses in the criminal trial and was one of the three who pleaded guilty.

Outcome delivered patient education on screens in doctor’s offices and circa 2016 was one of the hottest companies in Chicago. During the pandemic, it merged with PatientPoint. Their problem was inflating their ad delivery numbers to their sponsors such as Pfizer, Biogen, and Sanofi. This puffery included third-party analyses of the ads’ effectiveness, e.g. for prescriptions written. This was exposed by the Wall Street Journal in October 2017. Advertiser makegoods and clawbacks from lenders in the millions resulted. TTA 29 Jan 2018   But the executive crew above plus the other three employees concealed the under-delivery problem, faked revenue numbers, and presented them for debt financing plus equity funding in 2016-17 that rewarded them richly–thus the Federal fraud charges. Mobihealthnews, FierceHealthcare, DOJ release  TTA’s coverage from that time here

Let’s hope for more cheerful news out of HIMSS next week.

Digital health’s funding time machine dialed back to 2019–before the SVB implosion: Rock Health

April 5, 2023 | by

Rock Health’s 2023 Q1 report tries to put a good face on an implosion. The good: Q1 followed their Retro Time projection; the 2020-first half 2022 bubble was over, but digital health was snapping back to 2019 funding levels. The bad: while things were snapping back, Silicon Valley Bank (SVB), the favored bank of most Silicon Valley VCs and the companies they funded, imploded due to mismanagement.  This Editor would add two corollary nervous-making bank failures on SVB’s heels: Signature Bank (some East Coast healthcare, but too many uninsured deposits and a lot in crypto, taken over by Flagstar Bank/NYCB) and Credit Suisse (pending a Swiss government shotgun marriage with UBS). Add another unnecessary Federal Reserve rate hike to kill growth and the end of the pandemic PHE regulation suspensions that fueled telemental health, plus inflation at about 8-10%…. Like that 1949 Studebaker Starlight coupe, are we coming, or going?

Sidebar: This Editor has heard from other sources (not Rock Health) that ‘dry powder’ (funds) are low for VCs and barely existent on the provider (health system) side. Their own investors, now leery, are cutting back on their exposure. Where there is dry powder, fintech and biopharma are seen as better bets. VCs sense the bottom hasn’t yet been found in digital health valuations. Payers like UHG and CVS are making big deals but not in digital health. If they are, they are small ‘pocket lint’ pickups. Private equity? Largely kicking tires. Family offices and high net worth individuals are generally staying out of the healthcare picture unless there are other compelling (usually personal) reasons to invest. (Theranos still hangs heavy over these last two funders.)

Back to Rock Health, total Q1 funding was $3.4 billion across 132 deals. Yet only six mega deals (over $100 million) accounted for 40% of the funding early in the quarter: Monogram Health (in-home care, $375M), ShiftKey (PRN nurse scheduling, $300M), Paradigm (drug trials, $203M), ShiftMed (another healthcare workforce scheduler, $200M), Gravie (broker benefit solution, $179M) and Vytalize Health (MSO for providers, $100M). To call these ‘mega deals’ is an overstatement. In 2021 or even in 2022 these would have been seen as outstanding Series A and decent Series B-D+ raises. In 2021, the top mega deals crested $500 million.

The remaining 126 sliced up the remainder ($2.043 billion) of the pie, with a median value of only $16 million per deal. Throwing in the six ‘mega deals’, the overall median increased to $25.9 million. That tracks closely with 2019/2022, allowing for some inflation. Comparisons with full year medians: 2019–$19.8 million, 2020–$31.9 million,  2021–$39.9 million, 2022–$26.7 million. 

The IPO window remains closed tight. No easy exits for investors in late-stage companies. Those that went public during the bubble, with few exceptions, have cracked. From the report: “Digital health stocks started 2023 trading almost 50% lower than they did at the start of 2021, pushing some recently-exited players like Pear Therapeutics to explore going private.” (Under $1.00 per share, Pear is currently exploring a sale in toto, in parts, or merger.) According to this chart shown by Arundhati Parmar, MedCity News’ editor-in-chief, during his VC panel at ViVE [TTA 31 Mar], only two of 17 publicly traded digital health companies that went public have share prices in excess of their IPO: Progyny (also profitable) and HealthEquity. Many are near or below the critical $1.00 mark. (This chart does not include Babylon Health which is trading around $5 and reorganizing to become a US company.) He also pointed out that only two of the 17 are profitable.

These deals now also come with strings attached: valuation adjustments and operational revamps which usually mean staff layoffs, but can also be operational in closing/selling off lines of business. Growth is not the key metric anymore–profitability or a road to it is. Recent examples are Komodo Health and Carbon Health, where their substantial fundings ($200 and $100 million respectively) were tied to jettisoning LOB and staff. 

Last but certainly not least in putting a damper on digital health funding and growth is the end of the prolonged pandemic PHE. This relaxed rules for telehealth platforms around HIPAA compliance and also in mental health prescribing without in-person visits of DEA-controlled substances in Schedule 2 and 3-V. This puts a definite halt to telemental health’s expansion, fueled by drug prescriptions and none-too-fussy signups (see: Cerebral) but also too many virtual players in one niche (Mindstrong ceasing business with remaining assets bought out by SonderMind). New telehealth platforms largely complied with HIPAA but penalties for non-compliance are returning and platforms have to secure data. FTC is an added factor with its own privacy microscope.

Even the eternally optimistic Rock Health likens 2023 in digital health to a stormy sea with “turbulent waters’ resulting in “patched up ships and resilient mindsets.” Now that is a stunning mix of metaphors. Your Editor chooses a classic phrase penned by Joseph L. Mankiewicz and uttered with flair by Bette Davis in ‘All About Eve‘: “Fasten your seatbelts; it’s going to be a bumpy night.” And it’s only Q1. Also Mobihealthnews

Mid-week corral: CVS closes Signify Health; Bertolini to lead Oscar Health; ViVE highlights from Wellvana, AWS, Everly Health; Better Therapeutics lays off 35%, CoverMyMeds 815

March 30, 2023 | by

CVS closed its acquisition of Signify Health today. This $8 billion transaction ($30.50/share) adds a network of more than 10,000 clinicians nationally, including the 170-provider Medicare ACO group originally organized by Caravan Health. It was beneficial to the major shareholder group, New Mountain Capital and their investors, which owned 60% of Signify and have a tidily profitable exit. The CVS press release stated that Signify would continue to operate as a ‘payer-agnostic’ business within CVS Health. As earlier stated, Kyle Armbrester, Signify’s CEO, will continue to lead the business. Also Healthcare Dive (updated)

The bulldog engineer of the CVS-Aetna merger, Mark Bertolini, now tapped to head Oscar Health. Bertolini, the former chairman/CEO of Aetna (center), in the past three years since his unwilling (according to him) departure from the CVS board of directors [TTA 6 Feb 2020], has not been idle. From 2022, he was co-CEO of asset management firm Bridgewater Associates, and in the last 18 months, he has been a ‘strategic advisor’ to insurtech Oscar. Now he moves to the CEO office effective next Monday (3 April) and joins their board. Co-founder Mario Schlosser (left) steps back from CEO to president of technology, reporting to Bertolini, and joins the board. Joshua Kushner, a co-founder and major investor (Thrive Capital), as well as executive chairman of the board, is on the right in the leadership picture supplied with the Business Wire release.

Once a skeptic of insurtechs like Oscar, Bertolini by his statements is now a true believer. In a call with investors on Tuesday, he cited their technology that included digitization, individualization, and personal care. A major factor is that consumers are more comfortable since the pandemic with telehealth. Oscar was a pioneer in offering free telehealth with their plans.

Investors have pressed Oscar to get over to a profitable state by next year. Oscar has not been profitable since its 2012 founding by Schlosser, Kushner, and the long-departed Kevin Nazemi. In the time since Bertolini joined as an advisor, they have largely shed their Medicare Advantage business and concentrated on their individual market and ACA plans, which have seen huge growth along with overall record enrollment on the exchanges. But Oscar paused on new ACA signups in Florida and hauled back its glitchy and over-featured +Oscar tech platform [TTA 24 April 2021], which is now available unbundled. 2022 financials were substantially in the red with a loss of $610 million on revenue of $4 billion (Oscar release). However, the news of Bertolini moving to Oscar’s helm was met with a round of investor confidence. Share price moved from Monday’s close of $3.41 to $6.70 midday Tuesday and has largely stayed in the $6.00 range. Oscar release on Business Wire, FierceHealthcare, Healthcare Dive, YahooFinance

ViVE, the digital health spinoff of HLTH, concluded its annual meeting in Nashville this year with an announced attendance of 7,500, including 650 startups, 425 investors, and 330 hosted buyers. The energetic start on Sunday was sadly marked on Monday with the shooting at the local Covenant School where six were killed. Impressions from an anonymous attendee to HISTalk today were that most of the sessions were panels (which gets more people up front, but can be sunk by a dull moderator) versus individual speakers (who can either be fabulous or duds). Content could have been more inspiring and, as usual, many speakers are throwing out headlines for those in media to write about. This Editor has read relatively little so far but more will come this week. Highlights so far:

  • Nashville-based Wellvana Health, which provides technology for healthcare providers and health systems to implement value-based care, raised a stunning Series B of $84 million for a total raise of $140 million. Heritage Group and Valtruis co-led the investment with participation from Memorial Hermann Health System. The funding will be used to expand from its present 22 states and over 100,000 lives. Their current agreements are with multiple payers, Medicare Advantage, and three national contracts for the 2023 ACO REACH model. FierceHealthcare, Mobihealthnews
  • Everly Health is moving beyond its current home testing kits to integrate lab testing with telehealth. This will cover certain conditions, such as COVID-19, flu, sexually transmitted infections (STIs), urinary tract infections (UTIs), thyroid, weight management, and men’s and women’s health. Cost is out of pocket $59 and if insurance covers, $10-50. In its weight management program, Everly will offer GLP-1 drugs, a class of drugs that includes Ozempic and Wegovy, to qualified patients. FierceHealthcare
  • Amazon Web Services (AWS) announced 23 startups for their 2023 Healthcare Accelerator: Global Cohort for Workforce. This year’s accelerator cohort is finding solutions for the healthcare industry in three core areas for healthcare employees: retention, deployment, and training. More on the accelerator here and the list here, including 10 from the UK. FierceHealthcare
  • Health systems are demanding a quick ROI on their digital expenditures, according to a panel of CIOs and digital officers from Providence, Allegheny Health Network, Sutter Health, and Adventist Health. It should not be a surprise to anyone that they are looking for returns in the next year or so–yet are pushing forward with investments because of inflation and increased workforce pressures. FierceHealthcare

Another digital cognitive behavioral therapy trims. Better Therapeutics is reportedly releasing 35% of staff, or 15 people, in yet another cutback of another company in the formerly high, wide, and flying sector. Better specializes in prescription digital therapeutics to address cardiometabolic diseases such as diabetes. Better SPAC’d in 2021 [TTA 8 April 2021] hitting the market at $10.25 and currently trading on Nasdaq at about $0.60. According to their SEC filing, they are trying to stretch remaining cash to reach potential FDA marketing authorization and subsequent commercial launch of BT-001 in Type 2 diabetes. Better is in the same jam as competitors Pear Therapeutics and Akili Interactive, both paring back to the bone and looking for buyers, according to Mobihealthnews. Also LayoffsTracker. 

CoverMyMeds, a division of healthcare giant McKesson, is also laying off 815 by mid-April and closing its Scottsdale, Arizona office. The Arizona office has the company’s patient support center; workers there will be given the option to move to Columbus, Ohio. Other offices including Columbus (Franklinton) and Atlanta will be condensed and space leased out. CoverMyMeds automates the prior authorization process for medications for payers. What is unusual is that the company, bought for about $1 billion in 2017, accounted for $1.1 billion of McKesson’s $70.5 billion in 2022 revenue, and $136 million in McKesson profit–the most profitable of their four divisions. Columbus Dispatch, Layoffs.fyi

Short takes for Thursday: TimeDoc’s timely $48M, Glooko buys France’s DIABNEXT, Jio Health’s $20M, Pear’s Tokyo sleep-wake, Antidote’s $22M, and Centene’s new, young CEO signals big changes

March 24, 2022 | by

TimeDoc Health, a Chicago-based virtual care management platform that enables doctors to manage their patient populations between visits, has raised $48.5 million in a Series B funding round led by Aldrich Capital Partners.  This follows on a modest $5.7 million Series A round and equally modest seed rounds (Crunchbase). (This Editor notes that funding is becoming more modest this year anyway.) TimeDoc provides remote patient monitoring (RPM), chronic care management, and behavioral health monitoring, plus about 150 care coordinators who do it. The funding will be to add 20-40 new hires to the care coordinator group monthly and undoubtedly build out within and without its present 35 state coverage. The 2025 goal stated by their CEO is to serve one million patients monthly. Axios, Mobihealthnews

Palo Alto meets Paris, with Glooko buying DIABNEXT. The French company, which had been marketing its own diabetes management app, will be rebranding as GlookoXT, use the Glooko platform and continue to market its established app and remote monitoring products. Terms were not disclosed, but the DIABNEXT team will be joining the Glooko team. Glooko’s been hitting the European capitals, since last month they acquired Berlin-based xbird.  Release, Mobihealthnews

In Asia-Pacific news, Jio Health, based in Vietnam, now has $20 million in a Series B funding led by Singapore’s Heritas Capital. The startup is an interesting blend of telemedicine and e-prescribing via app, physical “smart” clinics, 300 branded pharmacies, and on-demand home care. Mobihealthnews

Sleepless in Tokyo? In Japan, Pear Therapeutics and SoftBank are teaming up to develop a digital therapeutic treating sleep-wake disorders. Pear has an FDA-approved prescription product for chronic insomnia, Somryst, and is pursuing a strategy of marketing sleep treatments in countries outside the US. Pear went public via a SPAC at end of 2021. Mobihealthnews

Telehealth is still captivating investors, with a $22 million Series A raise by the interestingly named Antidote Health. This tops off $12 million in seed funding by iAngels, Group 11, and Flint Capital. Their virtual consults are pitched as affordable either on a one-time or subscription basis. The raise will go towards adding chronic and primary care services, plus R&D activity, which includes advanced AI screening and clinical decision support system capabilities built on a claimed 20 year database.

And for those of us who are survivors of US health plans, top payer Centene, after 25 years of one man at the top, now has a new CEO, effective immediately. To no one’s great surprise, the pick is Sarah London, formerly vice chair of the Centene board of directors, one-third of their ‘value creation office’, and part of the Office of the Chairman. London previously headed Centene’s non-plan, primarily technology-based businesses. In 2020, she joined Centene from Optum Ventures, UnitedHealth’s VC arm, and prior to that was chief product officer of Optum Analytics. She fits a picture of Centene being a technology company for value-based care that also owns health plans, once sketched out by their now former CEO, Michael Neidorff.

Neidorff was a casualty of December’s shakeup by activist investor Politan Capital Management, along with three board members over the now-mandatory age 75 limit [TTA 18 Dec 21]. Since February, Neidorff has been on medical leave of absence from the BOD chairman’s position, with James Dallas, formerly of Medtronic, now acting chair. Neidorff is now 79 so would not be able to remain on the board unless an exception is made. He remains one of Centene’s largest individual shareholders, though he has sold millions of dollars of shares in recent years. We wish him a speedy recovery and a quiet retirement.

London’s youth at 41 and fast rise is a seismic change for Centene, and this Editor predicts a lot of changes to come quickly from top to bottom, including holdings, location, organization, and culture. Centene release, Healthcare Dive  Disclosure: this Editor worked for a division of WellCare that was acquired by Centene, and remained with the company for six months after the closing.

News/deals roundup: Amazon’s health accelerator, digital health library opens, Ziegler’s ‘Hospital at Home’ paper, SEHTA announces MedTech event; $670M in funding for Talkspace, Pear, DrChrono, NuvoAir

June 25, 2021 | by

First, the news….

Another Amazon angle on healthcare. This time, it’s the Amazon Web Services (AWS) Accelerator for healthcare startups. It’s designed as a virtual four-week technical, business, and mentorship for 10 select companies. Naturally, it’s targeted to cloud-based operations for companies with ‘demonstrated commercial traction’ in remote patient monitoring, voice technology, analytics, patient engagement, and virtual care technologies and systems. Applications opened on 21 June and proposals are due 23 July. It’s limited to US-based healthcare startups or international startups with existing US operations. This round is in collaboration with KidsX, the world’s largest pediatrics digital health accelerator formed by a consortium of over 50 children’s hospitals from North America, Europe, and Australia. AWS blog announcement, FierceHealthcare

A crowdsourced library exclusively for digital health resources and research now open. The Clinical and Translational Science Institute (CTSI) and Center for Health + Technology (CHeT) at the University of Rochester have created a crowdsourced library for the digital health community. It’s hosted by the Digital Medicine Society (DiMe); the link to the library is here. “Resources” are defined as specific pieces of specific regulations, guidances, policy, or literature that are relevant and useful “as-is”. 

Another free resource is investment bank Ziegler’s white paper on ‘Hospital at Home’. The paper addresses the leading Hospital at Home models, providers, and the reimbursement dynamics for this growing tech-enabled option serving acute patients requiring higher medical care. A worthwhile read (24 pages)-see if your tech can fit into these models.

In the UK, SEHTA (South East Health Technology Alliance) announced their 2021 International MedTech conference on 8 October in a hybrid live and virtual event format. The live portion will be at the Hilton London Tower Bridge Hotel. They’ve also added a new director, Sven Bunn, Life Sciences Programme Director at Barts NHS Health Trust & Queen Mary University of London. SEHTA news page

A lightning roundup of $670 million in deals that aren’t taking the summer off….

Talkspace finally executing its SPAC with Hudson Executive Investment Corp., with a deal expected to give the company $250 million in capital. It was originally announced in mid-January [TTA 14 Jan]. Talkspace is a consumer mental health app that helps a user assess their concerns, then matches them with a therapist. Shares are listed at $8.90 on Nasdaq with approximately 152 million shares outstanding for a valuation of $1.4 billion. Mobihealthnews

Pear Therapeutics is planning a hefty SPAC towards the end of this year with Thimble Point Acquisition Corp., backed by Pritzker family interests. It’s estimated that it will round up about $400 million giving it a valuation of $1.6 billion. The new Pear Holdings will trade on Nasdaq as “PEAR”. Pear develops end-to-end platforms for prescription digital therapeutics (PDTs) for serious diseases as stand-alone software treatments or jointly with pharmaceuticals. Pear release, FierceBiotech

Mobile-friendly EHR DrChrono now has a friendly $12 million in growth funding from ORIX Growth Capital. DrChrono also handles practice billing and management. This is on top of their January funding of $20 million, also by ORIX. Mobihealthnews (exclusive)

Stockholm-based digital respiratory care management system NuvoAir also raised $12 million (€10 million) to expand its chronic disease management and clinical trial platforms. It combines an app with data from a spirometer and sensors that attaches to asthma and COPD inhalers plus NuvoAir Cough, which assesses changes in nighttime coughing. The Series A was led by AlbionVC. Mobihealthnews, TechCrunch

New Year’s Deal and Event Roundup: Optum-Change Healthcare, Walgreens-Amerisource Bergen, December’s deal potpourri, CES and JPM

January 7, 2021 | by

Mutated COVID virii may be spreading, the UK locked down tight, but the deals with big numbers just keep on coming….

Change Healthcare not sold for pocket change. $13bn from the coffers of UnitedHealth Group’s Optum took it, though word was that it wasn’t for sale. Change will be part of OptumInsight to reinforce data analytics, technology-enabled services, and revenue cycle management. The deal pays common stock shareholders $25.75 per share in cash plus assumption of Change’s debt. Closing is slated for second half 2021. Neil de Crescenzo, Change’s CEO, will be CEO of OptumInsight which will integrate Change into its structure.

Change houses a dizzying group of diverse businesses including radiology, imaging, revenue cycle and payment management, consumer experience, clinical decision support, workflow integration, communication and payment solutions, network optimization, value-based care enablement….and that is about half of the list. The release emphasized RCM, provider payment, claims transaction analysis, and clinical decision support. It will be interesting what Optum chooses to retain and discard.  Press release, Fierce Healthcare, Forbes. Credit Suisse has also published a lengthy financial analysis (PDF) of the deal which opines that it’s likely to not run afoul of Federal anti-trust interest or significant conflicts of interest (Optum currently serves many payers other than UHC). There may be Federal concern about a concentration of data and transaction information as Change alone serves 19 of 20 major US payers and is a leader in network services and payments.

Walgreens Boots Alliance sells the majority of their Alliance Healthcare pharmaceutical wholesale businesses to AmerisourceBergen, a leading US drug wholesale company, for about $6.5 billion in cash and stock ($6.275 billion in cash and 2 million shares of AmerisourceBergen common stock). Interestingly, Walgreens is the single largest shareholder of Amerisource Bergen at 30 percent of common shares. Both Walgreens and Amerisource Bergen will continue their US distribution agreement until 2029 and Alliance UK with Boots until 2031. One way of interpreting this is fattening their ‘war chest’ for expansion, including their major bet with Village Medical. Perhaps a payer or a health tech company? Press release

December’s potpourri of Big Deals was rounded up by FierceHealthcare:

  • Alphabet’s Verily closed out 2020 with a massive $700 million funding round primarily from Alphabet to fund its commercial work
  • 23andMe got a lifeline of $82.5 million in Series F funding from an offering of $85 million in total equity shares. TTA analyzed why the bloom had faded from the genetic testing rose, so hot only a few years ago, last August and February. Bloomberg
  • New Agey Calm is meditating on $75 million in Series C funding and visualizing a valuation of $2 bn.
  • Pear Therapeutics, developer of prescription apps to treat addiction and insomnia, counted $80 million in Series D sheep. 
  • Provider CityBlock Health raised $160 million to support care for marginalized populations with complex needs and now has an estimated value of $2 bn.
  • On the payer side, Oscar Health raised $140 million in a venture round as we reported before Christmas.
  • And we reported on Everlywell’s digital home testing/telehealth consult Series D of $179 million in early December.

And the Big January Events Roll On, Virtually.  CES 2021 and the JP Morgan Healthcare conference for their clients will be held next week as usual, along with the usual constellation of independent conferences. These are usually a major venue for deals and deal announcements, and even in the virtual space, will likely be no different. One wonders if Haven’s closure [TTA 5 Jan] will be even whispered.

Mo’ money! Over $600 million in funding washes into digital health

March 8, 2016 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/Looney-Tunes-Were-in-the-Money.jpg” thumb_width=”150″ /]The unicorns may be getting gored, the bloom off the rose in health tech funding, and it’s a ‘hangover’ from 2015, but both January and February wound up being strong months for digital health funding, with over $600 million to companies in various stages. Mobihealthnews racks up the wins, leading with MindMaze (recovery for stroke patients) $100 million in February, Pear Therapeutics (digital tools + pharmaceuticals) with $20 million and Cala Health (hand/wrist tremor treatment) with $18 million. In remote patient monitoring, Vivify Health raised $17 million completing a 2014 round for $23 million and interestingly will use some of this funding to develop an IVR (interactive voice response) solution (Mobihealthnews 25 Feb). They don’t total in insurer Oscar which had a massive raise of $400 million bringing their funding over $765 million, not that far from Unicorn Territory–probably a good idea as they have some dizzying goals like 1 million members in five years from its current 145,000 members in New York and New Jersey, adding Texas and California. The caution on Oscar is that they are heavily dependent on narrow networks and exchange business that may be unsustainable. But if you sign up, you get a Misfit Flash tracker and access to their mobile app! Digital health funding in February reached $197 million (Mobihealthnews)