PLUS: Currently enrolling at Hinge Health

Issue 002

 E&O Wednesdays.

Welcome back to E&O Wednesdays, the enrollment-focused digital health newsletter from Exits & Outcomes that’s for paying subscribers only. This fortnightly 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.

Lots of great feedback on Issue 001 of E&O Wednesdays two weeks back. Thanks to everyone who wrote in!

This is Issue 002 and if you like what you see, help me out by forwarding this to that one coworker you know who is really missing work travel right now. This newsletter will take them places. Encourage them to join as a paying subscriber too.

Here’s what’s happening this week:

• Vida Health announced: “a new app-based, coach-centered virtual congestive heart failure (CHF) management program set to launch in December of this year.” Vida has more than a dozen programs now. The program will address long-standing hypertension, hyperlipidemia, and diabetes too — since those are also common in this patient population.
• Pack Digital, one of the few digital health companies that have long-focused on a wide spectrum of chronic conditions, announced that it received Population Health Program Accreditation by the National Committee for Quality Assurance (NCQA) for Heart Health, Lung Health, Pain Management, Autoimmune, and Diabetes.
• I didn’t notice that nutrition-focused digital health company Zipongo rebranded to Foodsmart in October. Its also actively recruiting for a randomized control trial right now to investigate how its program helps with weight loss.
• This press release from Fitbit was fun. The company is in the seemingly years-long process of getting acquired by Google, but its latest devices offer advanced Amazon Alexa voice assistant features. Fitbit promises similar voice capabilities are coming from Google Assistant soon too.
• Still no word on Omada-Amwell. Starting to feel like it’ll be a JPM 2021 reveal. Meanwhile, Omada’s official Twitter account hasn’t tweeted in 12 days. But don’t read into it: I ran the numbers and they went 33 days without tweeting back in February-March 2020. More unhelpful data: Their longest silent period on Twitter (since late-2014 anyway) was back in 2016… 35 tweet-less days.
• One more thing… If you can make it through the gauntlet of pop-up and pushdown ads, this piece in Forbes is worth a skim. While my computer almost over-heated from all the auto-play commercials, I learned that the CEO of Ginger is married to the president of Doctor On Demand. Now, that is an interesting wrinkle to any potential digital health merger or roll-up that includes those two companies.

Was this forwarded to you? Why not become a paying subscriber to Exits & Outcomes today? Head to the pricing page of E&O right here and give me one more thing to be thankful for this week.

The slow-motion unraveling of CVS-Livongo

In mid-summer, word started to get around that CVS Health and Livongo had something of a falling out in the spring.

If you recall: At the beginning of 2020, Livongo was a public company but still a few months away from their $18.5 billion mega-merger with Teladoc. PBMs like CVS and Express Scripts have always been a significant sales channel for Livongo, so a disruption there — especially right at the start of the pandemic — would have been a difficult story for the company to spin.

Luckily: It somehow stayed completely quiet until the summer. That’s when a few Wall Street analysts mentioned it to their clients.

But let’s back up a minute: Since 2017, CVS has partnered with Livongo on the CVS Health Transform Diabetes Care program, which basically bundled Livongo’s cellular-enabled glucose meter and parts of its program into a CVS-branded one. Transform operated under a per-participant-per-month model, like most of Livongo’s programs.

The soured deal: At the end of Q1 2020, CVS made clear to Livongo that it wanted to move Transform to a more traditional per-employee-per-month model (PEPM), which means they would charge their employer clients based on covered lives and not on actual participants in the program. Livongo balked at that. So CVS pushed ahead with a new version of Transform that did not include Livongo. Part of the thinking, apparently, is that Transform can send participants to visit with providers at brick-and-mortar CVS clinics instead of relying on virtual care. More visits to CVS stores means bigger basket revenue, and so on. Ever the retailer.

Another repercussion: Notably, this disagreement around the Transform partnership also led to Livongo getting the boot from the CVS Point Solutions quasi-formulary. Just as Express Scripts has its Digital Health Formulary, CVS offers a similar thing it refers to as Point Solutions. Given the strong CVS-Livongo relationship at the time, when Point Solutions launched in March 2020, Livongo was one of the few companies included. But Livongo is no longer listed. Ouch.

While that Point Solutions de-listing was pretty much an immediate effect of the Transform dissolution, the rest of it continues to play out in slow motion.

But wait: Some existing CVS Transform customers are still enrolling their employees in a Livongo-powered Transform program for 2021. Their contracts likely extend through next year, so the change won’t affect them until then.

And earlier this year Livongo also made quick work of developing direct relationships with some of the self-insured employers it nearly lost as a result of the Transform fall-out. For those companies that Livongo manages to retain without the CVS go-between, there’s the obvious benefit of not having to pay CVS a (just a ballpark) 13 to 15 percent cut anymore.

New owner, new deal? There is hope, however, of a CVS-Livongo reconciliation. Livongo is under new ownership now, and Teladoc also has a cozy relationship with CVS. Teladoc powers CVS Minute Clinic’s video visits offering. Will Teladoc give into the PBM’s PEPM model request and resurrect a Livongo-powered Transform? Why wouldn’t they? PEPM is Teladoc’s primary business model too.

Fortune 500 Digital Health Stack: Activision Blizzard

Digital health companies love to boast how many customers they have in the Fortune 500. This recurring feature of E&O Wednesdays will dig into a different Fortune 500’s digital health stack each week.

Two weeks ago, I took a look at Walmart, which is sometimes called the largest private employer in the world thanks to its 2.2 million employees worldwide.

This week I’m digging into interactive entertainment (video games) juggernaut Activision Blizzard, which is the company behind the game Call of Duty.

Compared to Walmart, Activision Blizzard is pretty far down on the list of the Fortune 500s. However, the company has a reputation as an early adopter of digital health employee benefits. A big part of that may be that Activision has access to so many digital health services via its partner Collective Health.

Here’s a look at the Activision Blizzard Digital Health Stack:

Healthcare Bluebook is a cost transparency app and website that Activision employees can use to choose a provider based on how they price a particular medical procedure. Why would an employee care about the price? “If you use Healthcare Bluebook to find and visit a ‘green provider’ for your procedure you may be eligible for an automatic cash reward up to $500!” Site

Doctor on Demand is the company’s exclusive virtual visits provider: (“Telemedicine services are only covered through Doctor on Demand, and you will owe the full cost of telemedicine services provided through any other partner or medical provider.” Eek.) The visits are covered for members of the Collective Health PPO plan and most cost $49 a pop for users on the Collective Health CDHP. Site

Heal sends a doctor to you for house calls. (They do telehealth too but Activision only offers DoD for those. See above.) This service is only available in some geographies. Visits are $99 for CDHP plan members (who have not met their deductible) and $20 co-pay for Collective Health In-Network and PPO 500 members. But preventive care, like annual physicals, are covered at no cost across the board. Heal says that the doctors are typically available within two hours. Site

Grand Rounds offers a second opinions service via phone call, app, or website. The company can also set-up an in-person appointment with an in-network provider if the Activision employee needs the first opinion before getting that second one. Site

Progyny is a fertility treatment program: “Progyny gives you access to high-quality doctors and patient advocates to guide you through your fertility treatment plan. Through Progyny you have access to a SMART Cycle, which includes a fast-track to treatments with the highest chance of success (like in vitro fertilization with advanced screening).” Site

Rethink slightly tweaked its branding for Activision employees between 2020 and 2021. It no longer mentions the word autism but now focuses more on raising kids being tough and “family support when you need it.” Here’s the pitch: “Through Rethink, you gain 24/7 access to consultations with a dedicated behavior expert and unlimited use of the website filled with step-by-step videos, resources, and exclusive content developed to help families raising children with learning, social or behavioral challenges, or developmental disabilities. The program has no age restriction, requires no diagnosis, and is completely confidential.” Site

mySugr is an app-based diabetes program now owned by Roche. It includes connected diabetes technology, unlimited testing supplies, and coaching from Certified Diabetes Educators. Site

Virta offers programs to reverse prediabetes and Type 2 diabetes. Virta’s program focuses on “nutritional ketosis to treat the root causes of type 2 diabetes and prediabetes: insulin resistance and carbohydrate intolerance.” Site

Newtopia offers a range of app-based coaching programs for preventing various chronic conditions, including diabetes, heart disease, obesity, and stroke. Each of the programs uses a connected weight scale and an activity tracker. The company also offers an optional genetic test that looks at three genes related to eating and metabolism. Site

Physera, which Omada Health acquired this year, offers virtual physical therapy care to Activision employees for back, knee, neck, or shoulder aches: “After an initial live video visit, you’ll be prescribed a personalized treatment plan. But don’t worry, you won’t be left hanging. The app makes it easy to stay connected with your physical therapist, who’ll monitor your progress, adjust your exercises as needed, and provide support throughout treatment – all at no cost to you.” Site

Robin Care offers all Activision employees no-cost cancer care management, which includes “24/7 access to a team of coaches, oncology nurses, and social workers to help them navigate their journey. The web and mobile apps provide education, tools, and resources to empower patients every step of the way. From prepping for appointments to tracking how you feel, Robin Care is here to help.” Site

That’s your second Fortune 500 Digital Health Stack. And thanks to the reader who suggested this company… Which company should I do next time?

3 customers enrolling in Hinge Health right now.

Right now, three big companies are enrolling members in Hinge Health’s virtual MSK clinic’s services: The Southern Company, US Foods, and AmeriGas.

US Foods, a multi-billion dollar food and restaurant equipment company employs around 28,000 nationwide.

The Southern Company is similarly sized — both in revenue ($29 billion a year) and employees (around 29,000) — but is a gas and electric utility giant.

Finally, AmeriGas, is a bit smaller with more than 7,000 employees and between $5 and $10 billion in annual revenues. It’s the country’s largest retail distributor of propane gas.

And so ends Issue 002 of E&O Wednesdays. Find anything in here worth chewing on? Hit reply. All feedback is most welcome and appreciated.