Welcome back to E&O Wednesdays, the enrollment-focused digital health newsletter from Exits & Outcomes — 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.

 E&O Wednesdays.

This is Issue 004 and if you like what you see, help me out by forwarding this to whoever leads enrollment at your company. They should be reading this.

(Reminder: After this issue, paying subscribers will receive a note when the Optum report is up sometime next week. Newsletters resume in the New Year!)

Here’s what’s happening in recent weeks:

• Virgin Pulse added new partners to its Homebase for Health platform. It really does remind me of what Evernorth is doing with its Digital Health Formulary (more on that below). All of these programs are integrated into Virgin Pulse’s platform and Virgin’s customers can add them on at pre-negotiated rates. VP’s new partners include: Quest, Hello Heart, Helpsy, Ovia Health, Aaptiv, Zeamo, Healthcare Bluebook, Headspace, SilverCloud Health, Hinge Health, Kaia Health, Truth Initiative, Quit Genius, and dayzz.
• Mental health-focused Lyra Health has filed paperwork to raise $175 million. While many digital health companies might focus on cost-effectiveness or expanded access to care, Lyra also boldly takes a swipe at legacy mental health practices to make its case in its marketing materials. That upset a society of psychoanalysis practitioners who threatened legal action over it in February. Here’s their strongly worded letter.
• Freespira, formerly known as Palo Alto Life Sciences, inked (https://www.ibhsolutions.com/blog/ibh-announces-breakthrough-programs-for-panic-attacks-and-ptsd-in-partnership-with-freespira/) a deal with IBH (Integrated Behavioral Health) to distribute its digital intervention for panic attacks to employers and others as part of IBH’s managed behavioral health services.
• Digital MSK company Sword Health signed an agreement with BridgeHealth, which provides surgical advocacy, guidance, and Centers of Excellence (COE) programs to self-insured employers.
• One more thing… digital native health insurance company Oscar, which is legally named Mulberry Health (I like this brand better, honestly), announced that it had filed a confidential S-1.

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 put what’s left of your 2020 budget to good use.

Evernorth removes Learn to Live from Digital Health Formulary (Update: This was a mistake.)

Evernorth, the relatively new brand from Express Scripts and Cigna, recently removed Learn to Live’s behavioral health program from its Digital Health Formulary.

Update: Express Scripts did get back to me a week later (this was the week before new year’s) and they were surprised to find that their website no longer listed Learn to Live as part of their formulary: “It is an error that they were removed and we will be fixing that over the next few days.” ESI says Learn to Live never left the actual formulary, it was only deleted from Evernorth’s website about what’s included in it. Sure enough, it is now back on the site under “behavioral health” here.

The formulary launched almost exactly a year ago on December 12, 2019.

The formulary originally launched with offerings from Livongo, Propeller Health, Omada Health, Silvercloud, and a combined offering from Lifescan and Welldoc. And, as noted above, Learn to Live. Here’s the relevant line from the launch release:

“The first selected solutions on the formulary include… Learn to Live and SilverCloud Health digital mental health platforms for depression, anxiety and insomnia.”

Since the launch, Evernorth added other programs from Buoy Health, Hinge Health, RecoveryOne, Omada’s Physera, Quit Genius, Wildflower, and Prevail Health.

While Evernorth announced the addition of these programs back in October, it never acknowledged the removal of Learn to Live. I asked both Evernorth and Learn to Live for an explanation and will update this post when I learn more (And I did: See update above).

Even though this turned out to be a false alarm: The seemingly surreptitious deletion reminds me of when CVS unceremoniously plucked Livongo from its own version of a digital health formulation, Point Solutions Management, because (I assume) Livongo didn’t want to change its business model to PEPM for the CVS Transform Diabetes offering. (See Issue 002 and “The slow-motion unraveling of CVS-Livongo” for more on that.)

Fortune 500 Digital Health Stack: The Home Depot

The Home Depot describes itself as “the world’s largest home improvement retailer with nearly 400,000 orange-blooded associates and more than 2,200 stores in the U.S., Canada and Mexico.” Its employee benefits program is referred to as the “orange life” and it includes an extensive array of digital health programs.

Here’s a look at The Home Depot’s digital health stack:

Teladoc and Grand Rounds are listed as suggested resources for Home Depot employees facing a number of issues. Under cancer, Teladoc is listed as an option for “emotional support” and “Psychologists are available to help you manage through a new diagnosis or give you support throughout your journey.” Similarly, in the cancer resources section, Grand Rounds is white-labeled as Home Depot’s “Health Care Support Team” which the company says “will guide you through all your resources and options, including through any insurance and billing issues that you may encounter along your journey.” Teladoc and Grand Rounds are listed as tools employees should consider for various other medical issues, including elder care, death in the family, and feeling generally overwhelmed.

As part of its COVID-related CARE Solutions for Life, which looks to be an offering The Home Depot has through its partners Magellan and Aetna, employees have access to Livongo‘s mental health program, myStrength. “Need some motivation? With myStrength, you can get coping tips sent right to your phone. myStrength offers self-guided programs on stress, mindfulness, substance misuse and more to help you take on each day.” (Home Depot pays for this in full — or it is free because of COVID, maybe?) While it is a bit harder to find, as it would require a significant number of clicks to get to from Home Depot’s benefits portal, the Resources for Living site also includes a directory with a handful of health and fitness apps that it recommends.

Big Health‘s Daylight is another paid for in full program. “Home Depot, in partnership with Big Health, presents a digital therapeutic way to address worry and anxiety during these times of uncertainty.” Big Health’s Sleepio program, which focuses on mental health and sleep issues, is another one that Home Depot lists as fully-covered.

Aaptiv is another covered benefit for Home Depot employees: “Aaptiv is a trainer-led audio-based fitness app offering thousands of workouts for every fitness level” that includes yoga, walking, meditation, strength training, and more.

Home Depot links out to other mental health-related apps, but notes that it doesn’t necessarily endorse any of these and while they each have a free version, it doesn’t cover the cost of any premium versions of them or other in-app purchases. This list includes Calm, Happify, Vervo Goal Tracker, and Sound Bath.

As part of its fitness programs for employees, Home Depot has a six-week Mini Challenge focused on planking. The simple challenge is powered by the team behind Johnson & Johnson’s 7 Minute Workout app, which is referenced and linked a few times. It looks like the challenge doesn’t require the app, but it suggests employees download the app to learn how to strengthen their core and how to do a plank with proper form.

Beyond Aaptiv’s fitness programs, which Home Depot will cover the cost of for employees, it also promotes a number of free fitness apps to employees: MapMyRun, MyFitnessPal, AllTrials, C25K, and 5 Minute Yoga.

Similarly, Home Depot suggests a handful of nutrition and weight loss-related free apps, but it doesn’t cover the cost of any in-app purchases or premium services for these: Water Tracker, Fooducate, Yummly, Fetch Rewards, Supercook. MyFitnessPal is also listed in the nutrition section.

Home Depot offers employees the Quit For Life tobacco cessation program from Optum: “If you are ready to quit, Home Depot offers the Quit For Life program free of charge. Using proven techniques developed and tested over the past 25 years, they have helped hundreds of thousands of people successfully quit tobacco. The program helps people quit all forms of tobacco, including smokeless products.”

Another program listed in the “overwhelmed” category is Rethink Benefits. “Rethink Benefits provides family support when you need it, including 24/7 access to an online portal filled with thousands of step-by-step resources to help families raising children with learning, social or behavioral challenges, or developmental disabilities. Materials are available for all ages and abilities, from pre-kindergarten to young adult.”

So, that’s The Home Depot’s Digital Health Stack. Which Fortune 500’s digital health benefits should I dig into next? (Some of them keep this info pretty tight-lipped, so I may not get to every suggestion — but hit reply to suggest some anyway!)

Grand Rounds takes on Teladoc in virtual care

I’ve noticed that Grand Rounds and Teladoc seem to both creep up in many of the Fortune 500 Digital Health Stacks I’ve researched so far. There could be any number of reasons for this (like some kind of selection bias on my end), but it’s clear these two companies have managed to ink quite a few deals with big employers.

Until recently, anyway, they have also positioned themselves as complementary. Hard to say how intentional that was, but it worked.

Then, when the pandemic struck, Grand Rounds — and many others — started to expand deeper into virtual care. Here’s how the company reflected on the changes it had made during the pandemic on the occasion of its $175 million funding round in September:

Prior to the pandemic, Grand Rounds offered two things: clinical navigation services and second opinion services. Now, it’s adding a third: virtual care. A recent job post for a director of this new third vertical included this:

A more recent (and still active) job post shows that the company is taking a particular focus on behavioral health care:

While this move isn’t surprising, it does pit it against Amwell, Doctor on Demand, and Teladoc, its longtime (if unofficial) partner for many of their mutual enterprise customers in the US.

Now, there are signs of friction that this new overlap of services will create for customers.

Back in E&O Wednesdays Issue 002, I dug into Activision Blizzard’s digital health stack of employee benefits. The company, which also has a deal with Grand Rounds on second-opinions-as-a-service, had a surprisingly stern warning that employees should only use Doctor on Demand for virtual visits:

Activision also works with Heal to offer house visits to its employees, and Heal began to add virtual visits as a result of the pandemic too. So it might be that this Activision warning was about not using Heal for virtual visits — or Grand Rounds — or both.

In any case, as companies like Grand Rounds continue to platform out, I’m curious to track how self-insured employers message to employees which services, in particular, are off-limits.

Also, curious to see if these moves frustrate customers into consolidating the number of partnerships they have on this front. (After all, that list for Home Depot’s stack above is huge.)

Let’s call that Issue 004 of E&O Wednesdays. Hit reply. All feedback is most welcome and appreciated.