Welcome back to E&O Wednesdays, the enrollment-focused digital health newsletter from Exits & Outcomes — for paying subscribers only. This every-other-Wednesday issue digs into digital health companies that sell to self-insured employers as well as others that rely on enrollment-based distribution for their digital health programs.
E&O Wednesdays
Here are a couple of quick notes on what’s happening in recent weeks in the world of employer-focused or enrollment-based digital health:
- I recently learned that the number I had in my Virgin Pulse report for the company’s most recent acquisition — $434 million was too low and that the actual number was $525 million. My original number was based on the price that Richard Branson’s holding company sold its substantial stake in the company for — my assumption was extrapolating out from what he got for his chunk of Virgin Pulse would yield the deal’s ultimate price tag.
- Speaking of Virgin Pulse, its former Chief Medical Officer Rajiv Kumar MD is now heading up a SPAC with some of the (early-stage digital health investor) BlueprintHealth team plus an exec from mattress company Casper. The SPAC is named Blueprint Health Merger Corp. and has a $200 million target.
- And speaking of SPACs, three of the people running the Health Assurance Acquisition Corp. that I’ve been tracking, just joined another SPAC called Revolution Healthcare Acquisition Corp. Hemant Taneja and Dr. Jennifer Schneider are both directors of the RHAC SPAC, while HAAC SPAC’s Evan Sotiriou is COO of both. RHAC SPAC looks to be more focused on digital health related to the life sciences.
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Anthem exec: Digital health companies should try to help payers win self-insured employer RFPs
I was surprised how much of the discussion at the DTx West event last month was focused on employer-focused digital health companies as the event was much more prescription digital therapeutic-focused.
In any case, one session I enjoyed was the payer panel, which included Anthem’s Deputy Chief Clinical Officer Liz Kwo M.D. Prior to Anthem, Kwo co-founded and led second opinions startup InfiniteMD, which Consumer Medical acquired in 2020.
Kwo’s parting shot was a tip that digital health companies looking to win payer contracts might consider helping the payer win an RFP with a new, potential employer client. I’d never heard that bit of advice before. Has that ever led to a longterm deal with a payer?
“The last thing I will say is, payers also have something called RFPs. So, we are going after clients. When we look at a potential sale solution — one recommendation, just coming at this from an entrepreneur’s background — you can potentially work with payers that are looking to win RFPs by pulling in a digital solution that would make sense for that specific population. I’ve seen that be very successful.”
Now enrolling: Redbull-Hinge, Bass Pro Shops-Vida
This recurring feature for E&O Wednesdays takes a look at which companies are currently enrolling their members in digital health programs. Sometimes these are big-name customer wins that digital health companies weren’t able to announce for whatever reason.
Here’s this issue’s round-up:
Vida Health has a number of enrollment programs underway. New campaigns launched this week for Boeing and Bass Pro Shops. BPS has some 40,000 employees across the US. I also noticed that Vida is now using Facebook ads to market to employee benefits managers, which seems new. (I noticed two weeks ago that that appeared to be the only way Accolade was using Facebook ads.) The Vida ad for Bass Pro Shops features an elderly gentleman sitting on a dock, fishing, and eating a sandwich:
“Are your eating habits starting to get the best of you? Get back on track with Vida. Free for Bass Pro Shops employees.”
Hinge Health is enrolling employees at Redbull with an ad that features a person on a dirt bike flying through the air with mountains in the background and the text:
“We deliver everything you need to eliminate your back or joint pain, no matter where you are.”
(Yes, I’ve begun to notice that these two companies are maybe the only ones consistently launching enrollment marketing campaigns via social media channels.)
Fortune 500 Digital Health Stack: Bank of America
Digital health companies love to boast how many Fortune 500 customers they have. This recurring feature of E&O Wednesdays digs into a different Fortune 500’s digital health stack. So far, in past Wednesdays issues, I’ve written about the digital health stacks of seven big companies: Walmart, Activision Blizzard, JP Morgan Chase, The Home Depot, Boeing, 3M, Chevron and BorgWarner.
This week, I dug into Bank of America’s digital health stack, which arguably features Teladoc as its centerpiece. But before we get to the list, I wanted to share some comments that Bank of America’s SVP and Sr. Benefits Consultant Matt Ponicall made way back in November 2017 at Teladoc’s Investor Day event.
High-level framing comments like this are rare from a big company like Bank of America. While they’re dated, I think they’re still instructive — especially since Ponicall points out how long it takes for big company’s like his to add a new benefits partner.
Teladoc started as a benefit some BoA employees had through Aetna but now it is available through all of its self-funded plans.
“We introduced Teladoc in 2015. I did not join the bank until September of 2015, so it was already in place when I got there. And the reason we did it — and this surprises people sometimes — well, it wasn’t about saving money.”
“At the end of the day, given our current utilization, if we saved $2 million? OK, that’s pretty much a rounding error. I spend $2.2 billion on healthcare every year for my employees. What we had done was we had rolled out some consumer-directed plans with higher deductibles: One qualified for an HSA and one with a $1,200 individual deductible. We felt that telemedicine was an opportunity for our employees to have accessible care at a much lower price point, [since] we are now asking our employees to pay the full freight of a doctor’s visit or an ER visit until they get through their deductible.”
Ponicall said that registration numbers were strong during their first year rolling out Teladoc but they began to dip by the end of 2015, which inspired his team to get creative with ways to encourage employees to register to Teladoc. The current methods included monthly emails and seasonal mailers.
“With Teladoc’s help and a company [named] Kinsa, we decided to do a promotion. A very simple promotion. We basically said, for the first 1,500 members who register for Teladoc, we are going to send you a free smart thermometer. These things cost about $20 and you can get them at Target. We said 1,500 because at the time we were averaging about 750 [Teladoc] registrations a month.”
“We said, ok we’ll give away a little thermometer. Some people might like it. Maybe we will double the registration. Just with that one campaign alone we got 5,000 registrations for Teladoc in one month.”
Between 2015 and 2016 BoA doubled the number of visits its covered lives made through Teladoc, which Ponicall attributed to the Kinsa promotion and his team’s efforts to discuss Teladoc in-person at off-site meetings with employees.
“The average PCP visit right now might be $150. A Teladoc visit for someone with our high deductible plan costs $40. Once you hit your deductible, we cover 80 percent, it only costs $8. Just that financial impact alone is meaningful for a lot of our employees.”
BoA created a multi-year marketing plan to go after particular segments of its covered lives that it believed would benefit from a less expensive, more accessible option than the ER or urgent care clinics. First, it made promoting Teladoc to all new hires part of its onboarding process. Then, it started to promote Teladoc to employees with college-aged kids or kids who recently graduated college. The thinking was these dependents might be in an unfamiliar town or city and could default to the ER if they didn’t know about Teladoc. Finally, BoA targeted employees who traveled frequently for business with a similar rationale.
Starting in 2018, BoA targeted its promotional efforts at new parents by creating new parent kits and offering telehealth education resources for new families. Those kits also included a free Kinsa thermometer.
Revisiting his past success, Ponicall also planned to launch another Kinsa-powered promotion in early 2018:
“One of the worst markets for ER utilization is Dallas and Fort Worth, Texas. Our ER utilization per 1,000 in that market is 350. It is by far our highest. And if anybody has ever been to Dallas or just driven down the highway, what you will see is that every other billboard is for free-standing emergency rooms. But they’re not really called emergency rooms. They say: ‘Come here, you will only wait 15 minutes to get care’, and in like size 2 font at the bottom it says, ‘By the way this is an emergency room and it will cost you $1,500 if you come see us.’ People think they are urgent care centers. I’ve just never seen a market like it.”
“What we are going to do is give our 11,000 employees in that market — we’re going to give them all a free Kinsa thermometer. When they load the application onto their phone for their Kinsa thermometer and they use it, we are actually going to push message that will say, ‘By the way, did you know you have Teladoc? Click here to have an appointment if you are registered or click here to register.'”
One last thing that’s worth mentioning from Ponicall’s comments back in November 2017: This was the same investor call where Teladoc was explaining its acquisition of second opinions service Best Doctors. So, of course, the analysts asked Ponicall if BoA would begin offering it to their employees.
“We don’t offer a second opinions service. I have spoken to the Best Doctors folks. The last company I was at had Best Doctors… We will be evaluating Best Doctors as an organization. It is a fairly new acquisition, and at Bank of America, it takes a really long time to onboard a new vendor, which a lot of vendors don’t realize when they come talk to us. But it takes at least a year just through our information security requirements. But that is definitely something that we will evaluate in the future.”
Narrator (that’s me): As far as I can tell, 3.5 years later, BoA still does not offer a second opinions service to its employees.
OK, here’s the Bank of America Digital Health Stack:
Teladoc: As Ponicall’s comments above make clear, historically BoA has required employees to pay a fee every time they used Teladoc’s services, but because of the pandemic those fees have been waived for both general medicine and mental health visits until at least 2022. Teladoc’s landing page for BoA employees lists out example use cases including “treatment for minor conditions like the flu, cough, sinus infections, and more” as well as “counseling for stress, anxiety, addiction, depression, and more.”
myStrength: This appears to be a relatively new offering from Bank of America but it does, at least, pre-date the Teladoc-Livongo merger. (That’s relevant because myStrength is, of course, a company Livongo acquired a few years back.) BoA sometimes positions myStrength as an offering focused on “emotional wellness” and other times it’s nestled under a heading like “mindfulness app”. “Whether you want to boost your mood, build your resiliency or find activities to support you during life’s challenges, myStrength can help. myStrength, a free online and mobile mindfulness app, offers personalized activities to support your emotional wellness. Register by visiting myStrength.com. Once registered, you’ll be able to download the app (recommended).”
Thrive Global: BoA’s mix of mental health offerings doesn’t end there, however, It also offers resilience training through its partner Thrive Global, which media mogul Arianna Huffington founded. BoA started its partnership with Thrive by offering resilience classes to its managers, but in the spring of 2020 it opened it up to all associates. “In addition, we’re offering ongoing daily mindfulness practice sessions to help you manage stress and build resilience. These sessions are intended to support you in developing and maintaining a regular mindfulness practice and enhancing your resilience, focus and wellbeing.” Elsewhere BoA described its offering from Thrive as “focusing on stress management, mindfulness, building resiliency and understanding mental health warning signs.”
Maven: Under a section called “Support for growing families” BoA offers Maven’s Family Support Program, which supports families with “pregnancy, adoption, fertility, infancy, egg freezing, surrogacy and postpartum support, all from the comfort of home and at no cost… The pregnancy and adoption/surrogacy programs are available for a full year after you welcome your baby — that’s great support, all the way to your baby’s first birthday.” Maven’s offering also includes “unlimited on-demand video appointments and messaging with practitioners” as well as access to Maven benefits navigators who can help BoA employees figure out care related to the list above.
Virgin Pulse: Virgin Pulse runs what Ponicall called back in 2017 “a pretty basic wellness program” for BoA. The company only seems to incentivize employees to fill out a health screener and a health questionnaire. Doing so earns them a $500 credit toward their annual medical premium or $1,000 if a covered spouse or partner completes them as well. Toward the end of 2020, Bank of America reported that more than 86 percent of employees and their spouses/partners complete the wellness activities each year. Of course, to complete those two activities, the BoA employee also needs to create an account with Virgin Pulse, which I’m guessing will then attempt to engage them in other wellness and fitness behaviors. Still, BoA does not appear to be incentivizing additional behaviors beyond the screener and survey.
Well, that’s a wrap on BoA’s stack.
Some of these stacks are easier to figure out than others (so no promises), but let me know which company’s digital health benefits you’d like to learn more about by hitting reply to this email. And if you happen to work at a Fortune 500 company (and I know that’s a lot of you), then please send me your benefits information.
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