Short takes: Walgreens now majority share of VillageMD, CareCentrix; Lark Health lifts $100M, UnitedHealth Group’s profitable Q3 and Change delay

Walgreens has ‘gone big’ with its VillageMD primary care practice investment, putting on the table $5.2 billion. It’s now t the majority owner with 63% of the company, up from 30% last year. Their projected number of co-located full-service Village Medical practices is projected to grow to 600 by 2025, up from a current 52. VillageMD is still planning an IPO in 2022, making for a potential great ROI for Walgreens. Walgreens Boots Alliance also invested $330 million in CareCentrix, a post-acute and home care provider, for 55% of the company. CareCentrix was a recent investor in Vesta Healthcare [TTA 9 April]. Wrapping it all up is their new Walgreens Health, for tech-enabled consumer-directed primary care, post-acute care, and home care.

Weight loss and chronic conditions app Lark Health flew into a $100 million Series D, led by Deerfield Management Company, with PFM Health Sciences and returning investors Franklin Templeton, King River Capital, Castlepeak, IPD, Olive Tree Capital, and Marvell Technology co-founder Weili Dai. Their total funding since 2011 is over $195 million (Crunchbase). Lark claims an AI-based platform for individual coaching in weight loss along with related conditions such as diabetes, pre-diabetes, diabetes prevention, cardiovascular, and behavioral health. The platform logs and provides immediate feedback on food and tracks data from sources like Apple Health. The new funds will be used for R&D and to expand its virtual care integrations to more payers. Current payer partnerships include Anthem, Highmark BCBS, and Medical Mutual. Release, MedCityNews, FierceHealthcare

UnitedHealth Group, parent of UnitedHealthcare and Optum, reported $4.1 billion in profit for Q3, notching $72.3 billion in revenue for the quarter, a tidy gain over year prior’s $65.1 billion. The mega-acquisition of Change Healthcare to fold into OptumInsight is further delayed, being worked towards a closing of early 2022, having hit more than a few strong regulatory headwinds and the rocks of DOJ [TTA 14 Aug].  Becker’s Payer Issues, FierceHealthcare 

UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’

UnitedHealthcare and its parent UnitedHealth Group (UHG) have been busy in the past few weeks. Of most interest to our Readers with an interest in data analytics is UnitedHealthcare’s pilot of a social determinants of health (SDOH) initiative that uses de-identified claims data to identify members at high health risk due to social factors. UnitedHealthcare call center staffers then contact members to further determine needs and to assist them with appropriate community resources. These can include assistance with childcare, obtaining internet access, financial assistance with medical bills, healthy food options, and local support groups. Staffers are also trained to extend the conversation beyond the first call.

SDOH factors can impact up to 80% of a person’s health, according to research performed by the Robert Wood Johnson Foundation.

The predictive analytics model for SDOH was developed with Optum from data gathered from 300 markets and across 100 metrics. Call center staff are also clued to members with needs through keywords or phrases that indicate a need for assistance: “I’m hungry” or “I’m struggling to make ends meet”. The initiative also allows employers to design interventions for their employees.

The pilot is for two employer products, Advocate4Me Elite and Advocate4Me Premier. About half of the contacted members in the pilot have accepted assistance. UnitedHealthcare plans to roll the program out to other fully insured employer plans later this year. Release, FierceHealthcare

UnitedHealth Group, the parent of UnitedHealthcare and Optum, published its annual corporate Sustainability Report. where SDOH has a considerable part. It’s a roadmap for transformation into a high-performing health plan that is part of a modern, high-performing health system–a very high bar for UHG as the largest US health plan. This builds on six points detailed on page 9, most of which SDOH affects:

  • Expanding access to care
  • Improving health care affordability
  • Enhancing the health care experience
  • Achieving better health outcomes
  • Advancing health equity
  • Building healthy communities

SDOH has become significant enough to become the subject of a House bill, HR 2503, the Social Determinants Accelerator Act of 2021, to support community groups in coordinating health and social services through grants, technical assistance, information exchange. It, of course, would not be complete without a federal inter-agency technical advisory council. There is a similar bill in a Senate committee and funding made available to the Centers for Disease Control and Prevention’s Social Determinants of Health Program. FierceHealthcare

Reflections in a Gimlet Eye: further skeptical thoughts on the Teladoc acquisition of Livongo (updated)

Gimlet EyePerhaps it’s Reflections in a Gimlet Eye, but this Editor remains bemused and slightly dyspeptic about the acquisition of ‘health signals’ remote patient monitoring management platform Livongo by telehealth giant Teladoc.

Here’s the latest, courtesy of Credit Suisse equity research analyst Jailendra Singh on deal rationale and the potential synergies, based on his Q&A with Teladoc and Livongo management (link here):

  • Livongo: “The company was not for sale, and LVGO did not view the transaction with TDOC as a sale. Instead, management views the deal as a merger of the two leaders in virtual care.” 
  • It had nothing to do with pressure from CVS and UnitedHealth Group (UNH). 
  • There are major cross-selling opportunities, starting with an overlap of 25 percent of their clients. There are also opportunities with the InTouch Health client base in acute care, Aetna plus UNH on the health plan side, and employer administrative services only (ASO) plans. This is part of the calculation of synergies totaling $500 million in 2025 which they believe are conservative given the math.
  • They are also seeking to approach their client base before the closing through a reseller agreement, as Teladoc was able to do with InTouch.

Mr. Singh’s analysis is conservative and sober from a strictly financial viewpoint. His two-page analysis is, as usual, worth the read. 

But then we stumble across one particularly helium-charged claim. It’s projected that Teladoc and Livongo would have a combined company market cap of $38 bn, whereas the pre-pandemic value of the companies was $8 bn. (Steve Kraus, Partner at Bessemer Venture Partners, now on the board of Ginger, as quoted in Forbes). That is optimistic, considering that patient primary care virtual visits have flattened down to about 7.4 percent of visits as of June (Commonwealth Fund/Harvard/Phreesia study). It’s assuming a great deal that people will continue to shy away from in-person care going forward. Perhaps to a degree this will, as in-person fear is only starting to flatten, but not everything can be done virtually, even RPM. Telehealth and RPM also present challenges for practices in value-based care models, in workflows, and even with the liberalization of Medicare reimbursements, financially.

Livongo’s great asset, which was understandably compelling for Teladoc, is chronic condition management, RPM, and all that patient data, which can be broadened past their diabetes base (with a small one in behavioral health courtesy of their myStrength acquisition) into other chronic conditions which was Livongo’s strategy anyway. To be determined is how compelling this will be for Teladoc’s customer base and for new customers, particularly if the economic environment is constrained and health plans don’t get on board. 

So why is Mr. Market not mad about this ‘merger’? TDOC has taken a spill since its (adjusted) close on 4 August at $249, and is trading below $200 at $193. LVGO took a lesser hit, from $144 to $121. Another Bessemer Venture Partners investor, Morgan Cheatham, in the Forbes article linked above, was quoted that Livongo had clear market leadership in the employer and health plan market, then expressed surprise at why Livongo agreed to be acquired: “The company had a real shot at becoming a $100 billion business by running the ‘digital hospital’ playbook. In some ways, the acquisition feels premature.” Teladoc’s COO David Sides promised that the combined company will aid practices in the transition from hospital to home care, touting the consumer focus of both companies. (Have they consulted already burdened and strained providers how this can be made easier for them and fit into value-based care models as well as their financials?) But they may have to make more acquisitions to facilitate this. So $18.5 billion plus $1 bn for InTouch isn’t enough to get the job done?

Is it synergy, the wave of the future, or an overloaded Christmas Tree of features, not benefits?

Reminder: to date, neither company has been profitable.

So, what does this mean for other digital health companies? Initially, it’s quite positive that Teladoc could round up nearly $20bn in six months. John Halamka MD, a well-known digital health visionary now at Mayo Clinic, sees it as a bridge to the digital health ecosystem including other companies. A contrarian view was expressed by Mr. Cheatham.  Teladoc-Livongo is a challenge for other digital health companies in that they won’t, and cannot, be Teladocs and Livongos–in other words, an unrealistically high bar for them. “Why can’t Telavongo build this?”

Finally, a personal and slightly jaundiced view from this Editor. Let’s take a good hard look at the Human Factors that make companies go. This is an acquisition by Teladoc of smaller Livongo, despite the merger statements. Employees in both companies are wondering who will go, who will stay, who they will report to if they stay, and where they will be. They have about four to six months to mull what their future might look like at a tough economic time. This will — not may, will–have an effect on operations and attitudes, especially at Livongo.

There are some doubleplus ungood signs that make the assertion that this is a “merger” of companies questionable:

  • Jennifer Schneider, MD, president of Livongo, has stated that both companies are currently hiring and don’t plan layoffs as a result of the merger (Becker’s Health IT). Blanket statements like this are usually made at the start to assure employees. Anyone who has been through a merger knows there are overlapping areas such as HR, marketing, and financial. There are only so many chairs at the organizational table especially at the director and above level. The happy talk doesn’t change the reality that not everyone will be given the option to stay.
  • Statements on similar cultures notwithstanding, the fact is that both companies have different cultures and experiences because they have radically different histories and personalities running them. This Editor would suspect that Livongo employees, having come up in a young and smaller company, in an intense entrepreneurial environment, with employees who were among the first 50 or 100, have a great identification with Livongo and pride in their success.
  • Not one Livongo senior executive was named publicly as taking a new operational role in the merged entity. (Board seats don’t count. But then again, they will be walking away with a major payday, reputed to be in the hundreds of millions for the top executives. What they will do with their future is a major unknown.)
  • The HQ will be in Purchase. Most Livongo employees are in California.
  • The company will be named Teladoc and will not be renamed. That says a lot, even though industry wags are calling it Telavongo and other names.

One would hope that both companies make every effort to reorganize the company staffs in a way where layoffs are minimal, those who are packaged out are treated generously, but better, valued employees from both companies are retained and incentivized to stay–sooner rather than in 4th quarter–in a fair and unbiased evaluative process in how they support their businesses presently and going forward as part of the combined companies future. But this is not typically the case.

One would also hope that the clients and individuals who pay the bills were told, timed with the public announcement, that this was happening and what it means for them. Leaving them to read the announcement online is usually what happens. It’s not automatic, and I’ve seen this treated as an afterthought in both large companies and small, with line of business folks scrambling to put together customer messages, and delayed in getting them approved as after all they have to go through both corporate and investor communications. This is typically the case, as communications cease to be a priority at the market/LOB level when the SEC or DOJ are involved.

Reminder: the Human Factors will fly this aircraft–or auger it in. 

Agree? Disagree? Comments welcomed.  TTA’s earlier ‘skeptical take’ commentary here.

Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C

In non-COVID-19 news, Optum has confirmed to industry press that they have acquired post-acute management company naviHealth. Becker’s HealthIT cites sources that the purchase price is in the vicinity of $1 billion. Continuing their PAC-MAN path, this pharmacy benefit, population health, and care services wing of UnitedHealth Group in the past six months finalized the purchase of DaVita Medical Group from renal treatment giant DaVita for over $4.3 bn and is reportedly closing on a full acquisition of virtual behavioral health provider AbleTo [TTA 29 Apr] for a less stunning $470 million.

naviHealth provides post-acute care clinical decision-making tools that manage pre and post-acute care as part of value-based care programs such as the Bundled Payments for Care Improvement (BPCI) program with CMS. Their customer base includes health plans (4.5 million members within Medicare Advantage alone), over 140 hospitals, and post-acute care providers such as nursing homes, LTC facilities, rehabilitation, and home health. The company will retain current management and staff, and operate as a stand-alone company within OptumHealth. It’s a well-paid exit for Cardinal Health and Clayton, Dubilier & Rice. Also MedCityNews

Amwell raises $194 million in a second Series C. The former American Well did not need telehealth to receive a gratifying boost from its investors Allianz X and Takeda Pharmaceuticals. This follows on a February $60 million venture round from Chetrit Ventures (BostInno). Amwell has raised $711 million in nine funding rounds (Crunchbase). Their main business has been with payers, health systems, and employers. In April, they added a branded program, Amwell Private Practice, for practices under 100 providers for these mostly shuttered offices to reach their patients at home and to continue care. Release, Mobihealthnews.

Post-COVID back to work: for workplace screening, testing, contact tracing, there’s an app for that

If you’re looking forward to going back to the office without the children and the dog barking, and seeing people other than your family, don’t expect to go back to “The Office” Normal with kibitzing over the divider and in the kitchen/break room. Chances are the latter will be locked, and the nearest person over the divider will be six feet away. There will not only be serious physical changes to the office, starting with many fewer people there, but also apps to track your health and who you come in contact with. Your employer will be managing your potential risk for infection of yourself and others.

  • UnitedHealth Group and Microsoft’s ‘ProtectWell’ app will screen your health everyday (using Microsoft’s COVID-19 triaging Healthcare Bot and Azure. If there’s a risk of exposure or if you are exhibiting symptoms, it will direct you to a COVID-19 testing process that enables closed-loop ordering and reporting of test results directly back to employers, managed (of course) by UnitedHealth. The app will also provide guidelines and resources for a safer work environment, including physical distancing, personal hygiene, sanitation, and more. UHG and Microsoft are furnishing the app to employers at no charge. UHG has already implemented this ‘contact tracing lite’ for frontline workers and will roll out to its over 320,000 employees; Microsoft will do the same for its US-based workers. Release
  • Enterprise software company Appian released Workforce Safety and Readiness, an app to enable HR departments to plan and maintain a return to work for employees and to maintain a safer workplace. This ’employee re-entry’ app as their CEO Matt Calkins put it, is not for every company. The app will quiz employees on factors such as health data, possible virus exposures, and details about their jobs to determine when and how they should return, based on their jobs plus CDC and state guidance, both of which keep shifting; state and local guidance in particular is keeping more than one law firm quite busy. The app can then push information to workers about their new hours, area, and similar. When the employee is back to work, they can then use the app to provide feedback on crowding and lack supplies such as hand sanitizer or wipes. The app is built on a HIPAA-compliant system and originated with a self-reporting disease app. Appian is targeting larger companies with thousands of employees on a $5,000 per month subscription model. Appian page, The Protocol
  • Companies large and small have devised their own mass testing procedures for current workers and those returning, as early as the next two weeks. This next article from Protocol details several approaches, mostly around detecting the imminently ill.
  • PWC has already set up a contact tracing system for returning workers, an app that tracks contacts with the phones of others of a person who self-reports being ill. While the privacy seems pretty robust–it works on employee self-reporting and his or her AD ID on my phone, then all the other phones it had contact with over the past X days via Bluetooth. As PWC’s David Sapin of their connected solutions area put it, “But if you’re going to come back into the workplace, you need to accept having this type of app on your phone.”
  • For a really dystopian view, see this article in Bloomberg. You may be scanned thermally, have an elevator operator (back to the past!), and lots and lots of sensors monitoring your comings and goings. Facilities departments will be retrofitting for anti-microbial surfaces and plexiglass guards. Before you are allowed to return, if you are allowed to return, you may be pre-assessed for risk before you are allowed to, with bonus point for antibodies. And when you’re back in your ‘six feet office’, you’ll have many more rules governing daily desk coverings, how you interact with your colleagues, walk in the hall, go to the bathroom. Hint: buy acrylic polycarbonate manufacturer stock. ZDNet

Of course, one wonders if Unintended Consequences will be to very firmly establish a remote workforce, which is anathema to some companies, or encouraging further outsourcing of work to offshore entities.

Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]This Editor has been at two healthcare conferences in the last four business days (with tomorrow being a third). They should be abuzz about how the CVS-Aetna merger may transform healthcare delivery. To her surprise, there’s been a surprising lack of talk. There is a certain element of ‘old news’, as the initial reports date back five weeks but the sheer size of it ($240bn combined future value, $69bn purchase, an estimated $750 million in near-term synergies), being the largest health insurance deal in history, and the anticipated effects on the health delivery model normally would be a breaking news topic. To this Editor, it is a sign that no one truly knows what to make of it, and perhaps it’s too big–or threatening–to grasp for provider and payer executives especially.

For an overview of what we saw at the time as reasons why and possible competitor reaction, Readers should look back to our original article [TTA 28 Oct]. It’s being presented by both companies as a vertical merger of two complementary organizations, which already were moving towards this model, integrating their different services into “America’s front door to quality health care” (CVS CEO Larry Merlo)–a lower cost setting that saves premium dollars and brings integrated care to consumers’ doorsteps.

CVS brings to the table huge point of care assets: 9,700 pharmacy locations, 1,100 MinuteClinics, Omnicare’s senior pharmacy solutions, Coram’s infusion services, and the more than 4,000 CVS Health nursing professionals providing in-clinic and home-based care. Aetna has about 23.1 million medical members, 14.5 million dental members, and 15.2 million pharmacy benefit management (PBM) services members. Aetna also has a wealth of advanced data analytics capabilities through two subsidiaries, ActiveHealth Management and  Medicity’s health information exchange technology.

Seeking Alpha has an intriguing POV on this entry into a ‘new era’: that both CVS and Aetna consider this to be a long-term reshaping of their business model under the threat posed by Amazon, and are willing to do this despite little short-term financial benefit for either company. The problem as the writer sees it: execution. This is re-engineering care on a national scale, and its benefits are based upon combining intangibles, a murky area indeed especially in healthcare. Time is also a factor, as Amazon is getting pharmacy licenses in multiple states, and is rather an expert at combining intangibles.

Does it signal that the approach to a ‘new era’ in healthcare is accelerating? If this is a preview, 2018 will be extremely interesting. Our ‘canary in the coal mine’ may tweet–or fall over on its perch, asphyxiated.

Some additional points to consider: (more…)

Optum/UnitedHealth clinches $1.3 bn deal for Advisory Board’s healthcare practice

The Advisory Board consultancy group confirmed its splitup and sale, as originally reported by TTA in mid-July. The Optum data analytics/information/consultancy unit of UnitedHealth Group is acquiring the healthcare practice for $1.3 bn and the education consultancy will be purchased by Vista Equity Partners for $1.55 bn. 

According to Bloomberg, The Advisory Board has 3,800 employees and roughly $807 million in annual revenue. Reports indicate that it has served over 4,400 healthcare clients. According to the Washington Business Journal, regulatory filings show it will operate as a wholly owned subsidiary of Optum headed by Advisory Board Chairman and CEO Robert Musslewhite. As to relocation, Advisory Board spokespersons confirmed that they will still be moving into a new headquarters on New York Avenue NW, indicating that a move to Minnetonka is not imminent and that at least some of the management will stay. There is no word on relocation out of Washington for the education practice. At closing, outstanding shares of Advisory Board will convert at $52.65 per share, plus an additional amount per share based on the after-tax value of Advisory Board’s 7.6 percent stake in publicly traded Evolent Health. The deal is expected to close by early 2018.

This confirms an earlier trend of healthcare consultancies merging and cross-acquiring. In July, Dublin’s UDG Healthcare acquired Philadelphia-based healthcare consultancy Vynamic last week, gaining a US foothold, then added marketing/communications company Cambridge BioMarketing in Boston. Rumors still have publicly-traded Evolent Health as a likely acquirer or acquiree of a healthcare consultancy. WTOP, Reuters

 

Connected Health Summit 2017 San Diego — last chance to book!!

29-31 August, The Omni Hotel, San Diego

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/07/CH17-Banner_20Discount_300x145.jpg” thumb_width=”200″ /]Starting tomorrow, but not too late to book! Take a trip to Southern California for the end of the traditional summer season (sob!). This year’s Connected Health Summit, organized by research organization Parks Associates, spotlights health technologies as part of the Internet of Things (IoT) and the transformational impact of these connected solutions on the US healthcare system. Presentations are organized around:

  • Remote health monitoring for accountable care
  • Consumer-centric wellness and fitness solutions
  • Independent living technologies and services, including reinventing home health
  • Innovative virtual/convenience care models

Keynoters include 

  • John W. Cosgriff, Chief Strategy Officer, UnitedHealthcare
  • Saquib Rahim MD, MBA, Chief Medical Officer, Aetna
  • Vidya Raman-Tangella, Senior Vice President, and Head, UHC Innovation Center of Excellence, UnitedHealth Group
  • Dale Rayman, Senior Vice President, Actuarial Consulting & Business Development, Sharecare
  • Chanin Wendling, AVP, Informatics, Geisinger Health System

Latest press release info on the conference and the convergence of connected health, IoT, and smart home is here.

For more information and to still save 20 percent, click on the Connected Health Summit’s link here. Telehealth & Telecare Aware is pleased once again to be a media supporter of CHS 2017. Twitter at #CONNHealth17