Issue 348
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Exits & Outcomes Newsletter
This week’s newsletter is focused entirely on the finances and growth metrics of Big Health… an important company that has been navigating a difficult transition from selling wellness programs as an employee benefit (mostly via PBMs) to selling FDA-cleared, prescription digital therapeutics to providers and health systems. Read on below for more. Was this forwarded to you? Click this link for more info on how to become a paying subscriber.
Big Health’s 2024 revenue was half of what it was in 2023. 2025 brings runway worries and MAC pricing frustration.
Big Health appears to be in dire straits. The company ended May 2025 with just $6 million in cash and a monthly burn rate of about $1.3 million. That gave the company just a few months of runway — the middle of October is likely as long as Big can make it without new funds. E&O has learned that in June 2025, Big Health had a signed but non-binding term sheet co-led by two investors that would have secured $15 million for the company. It had a close date at the end of July. While it is possible the company managed to secure some kind of funding, I can’t find any evidence of that. (I emailed the company but did not receive a reply before press time.) In what is probably a negative sign: in the first week of August, three Big Health board members resigned: Anand Shah, Betsy Atkins, and the company’s former CEO Arun Gupta.
Headcount and expenses: The company’s burn rate was about $1.6 million per month in 2024, and it managed to decrease it in early 2025 to under $1.3 million. It also aimed to continue to decrease its burn rate during 2025. Big decreased its spending in 2024 in part by reducing its average headcount for the year to 97 — down from 167 in 2023. Overall administrative expenses totaled $29.3 million in 2024, down from $53.9 million in 2023. Staff costs made up most of the figure for 2024 — about $20.8 million.
Big Health 2024 revenue was half of what it was in 2023: Last year Big Health brought in $10.6 million in revenue, down sharply from $21.6 million in 2023. As E&O reported a year ago, the company’s revenue only dipped slightly between 2022 ($22.6 million) and 2023. The significant decline in 2024 is, obviously, alarming. The company managed to narrow its losses, however: $19.3 million in 2024 vs. $33.7 million in 2023.
Highlights from Big’s employer business: The company landed one new large employer client that it launched in the first quarter of 2025. Big Health is also generating revenue from Spark Direct, the wellness program it acquired from Limbix in 2023. Spark is currently live with four customers.
Geographic breakdown of revenue: While revenue from the UK remained a minority of Big Health’s overall revenue for 2024, it actually increased year-over-year. Big brought in $2.1 million in UK revenue for 2024, up from $1.7 million in the prior year. Big Health is in its third year of a five-year fixed-price agreement with NHS Scotland. It still hopes to ink a broader agreement with NHS England, but it conceded that will likely not happen in 2025 — it is now hoping it does in 2026.
As Big Health wrote to the NHS earlier this year (emphasis is mine):
“In May 2022 NICE recommended Sleepio as the first-line treatment for insomnia because it is: More clinically effective than sleeping pills and sleep hygiene; In-year cost-saving for the NHS by reducing GP appointments and prescription costs. More than 900 days later, Sleepio is not yet funded by the NHS in England. In contrast, a drug has a 90 day funding mandate.”
Limbix purchase price breakdown: As E&O reported last year, Big Health’s 2023 acquisition of Limbix was for a total consideration under $4 million. The purchase price broke down like so: $2.3 million for developed technology, $1.1 million for R&D in-the-works tech, and $460,000 for customer relationships.
Shift toward prescription pathway includes progress and hurdles: While employer contracts remain Big Health’s main revenue driver, 2024 marked a decisive shift toward prescription digital therapeutics and selling to providers and health systems. As E&O has reported, Big Health secured two FDA clearances (SleepioRx and DaylightRx) and successfully lobbied CMS to create new reimbursement codes uniquely tailored to its two FDA-cleared products. Big Health’s main obstacle currently is that CMS delegated the pricing decision of the supply code for its devices to the regional MACs. Big and its supporters continue to urge CMS to create national pricing for the code or to give the MACs better instructions on how to price and reimburse them. As Big wrote in a recent letter to CMS earlier this month:
“As of August 26, 2025, only one MAC had a published payment rate for this service. Two other MACs have established payment rates but have not yet posted them to their public website. In these limited circumstances where rates have been established, the payment rates are woefully inadequate as the payment rate represents only relatively small percent of the costs that provider practices incur when furnishing these devices to their patients.”
“For two MACs, the carrier payment rates were set to the national Outpatient Prospective Payment System (OPPS) rate for DMHT ($128). Unfortunately, current pricing under OPPS simply crosswalks the rate for G0552 to the rate for the furnishing/supply of RPM/RTM devices, which is not appropriate for DMHTs. The other MAC has set a payment rate at less than half of the OPPS rate ($51), representing an even greater negative margin between the reimbursement rate and the costs incurred. This inadequate payment is a direct barrier for providers who want to offer this service to their patients but who cannot afford to incur that magnitude of loss for each patient. Providers intending to or implementing these DMHTs into their care in these above noted MACs have notified Big Health that they need to pause the use of these treatments as the payment is insufficient to cover the costs.”
PDTs as the future for Big and its road to profitability in 2026: Despite the challenges above, Big Health is betting that its new Rx business line will drive a return to revenue growth in 2025 and ultimately lead to profitability by 2026. I assume that rosy outlook hinges on a payment rate closer to the $800 to $1,200 range that Big Health has mentioned in previously letters to CMS and in comments to the press. Not surprisingly, Big Health is increasingly focusing its sales and marketing spend on its Rx business and less so on its employer wellness business.
Remember: Historically, Big Health priced its non-FDA-cleared Sleepio and Daylight at around $400 per participant when it sold to employers. (More on that in E&O’s deep dive report into Big Health from 2023.)
All of that appears to be moot if the company hasn’t raised some kind of funding to extend its runway beyond October.
So, what happens to Big Health if it runs out of cash? If it has failed to raise new funding, I wonder if Big Health could find a home with its partner Swing Therapeutics. Swing’s virtual clinics prescribe at least one of Big’s PDTs to its patients — so the companies already see potential in a tie-up. Swing Therapeutics also recently raised funds from former Pear CEO Corey McCann’s T.Rx Capital, which previously invested in another virtual clinic that prescribes Pear’s old PDTs, PursueCare. Would those three companies make sense as a prescription digital therapeutics + virtual clinic roll-up? Finally, as E&O reported last week, Swing made a mysterious M&A move recently, which cost it about $3.3 million in equity.
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