Issue 0004
Welcome back to E&O: National Virtual Clinics, a digital health newsletter from Exits & Outcomes — for paying subscribers only.
E&O: National Virtual Clinics
Every other week we’ll dig into digital health companies that operate virtual-first medical practices with direct patient acquisition and in-network provider agreements with payers. Most haven’t scaled nationwide yet, and I’ll track state-by-state rollouts in each issue (see below).
(This newsletter is a reboot of a concept I launched last year. It’s still a bit of a prototype. What do you think?)
Hit reply if you know of a virtual clinic that should have gotten a mention below but didn’t. There are many — please help: I want to track them all.
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Growth metrics: Ophelia Health, Talkiatry, Bicycle Health, and Boulder Care
Earlier this month, the Drug Enforcement Agency (DEA) hosted a public listening session on prescribing controlled substances via telemedicine. While the DEA said it received more than 180 requests to speak at its live-streamed event, it only had time for a few dozen presenters. A couple of those speakers were executives from virtual clinics. As part of their opening remarks, they revealed some interesting growth metrics about their respective companies, which I’ve collected below (along with comparisons to similar comments they made back in March via letters to the DEA):
Dr. Stephen Martin, Medical Director for Research, Education, and Quality, at Boulder Care, a virtual clinic focused on addiction treatment:
“Since the suspension of an in-person visit in March of 2020, our clinical team has conducted over 50,000 visits on secure video and engaged in 600,000 secure telecommunication touch points with several thousand patients. Almost 90 percent of our patients have Medicaid coverage — the most underserved population in substance use disorders and who have the greatest needs. Over 30 percent of our patients live in HRSA-designated rural areas and the vast majority lack transportation.”
In its written comments to the DEA in March, Boulder said it had conducted “nearly” 50,000 visits.
Dr. Brian Clear, Chief Medical Officer, Bicycle Health, a virtual clinic focused on opioid use disorder (OUD):
“Through the flexibilities permitted by the waivers, at Bicycle, we’ve come to employ 80 addiction medicine specialist providers and treat over 11,000 patients with opioid use disorder across 37 states.”
“We see a 90-day retention rate of 70 percent compared to in-person norms of about 50 percent. We’re able to see and begin treatment for over two-thirds of new enrollees within 24 hours of their initial outreach. Nineteen out of 20 patients who begin care with us achieve their initial effective treatment dose within seven days, and 80 percent of our patient population completes a drug screen in any given month.”
“…18.2 percent of our patients are rural, 67 percent are employed, and over 20 percent of new patients have not engaged with any medical opioid use disorder treatment program before. We’re reaching patients who have not previously been reached. As a result, like our patients, our providers also tend to stick with us and stick with telemedicine. We consistently see a less than 1.5 percent quarterly provider turnover rate.”
In written comments this past March, Clear broke down the types of providers in Bicycle’s employ at the time:
“…an addiction medicine specialty group of 13 addiction medicine specialist physicians, 57 Advanced Practice Clinicians, and 9 Licensed Clinical Social Workers collectively responsible for the care of roughly 10,000 patients…”
Robert Krayn, Co-founder and CEO, Talkiatry, a virtual psychiatry clinic:
“Talkiatry is a nationwide psychiatry group. We directly employ over 300 Board-certified psychiatrists across the country. We employ five nurse practitioners, all of whom are Board-certified in psychiatric mental health. We treat hundreds of thousands of patients annually. The average cost per visit for a Talkiatry patient is on average less than $30. We operate at the pinnacle of quality. Each psychiatrist is directly overseen by a chief psychiatrist, who spends 90 percent of their time on administrative duties. They oversee a cohort of no more than 50 doctors at a 19 time.”
In his written comments to DEA this past March, Krayn was more specific about Talkiatry’s total number of patients treated:
“With 400+ employed psychiatrists across 49 markets, Talkiatry has already brought access to mental health treatment to more than 125,000 patients.”
Jessica Rigsby, Head of Legal Compliance, Ophelia Health, a virtual clinic focused on opioid dependence and addiction:
“Our data speaks for itself. At Ophelia, we’ve treated over 10,000 patients during the past three years with only 10 overdose-related deaths reported to us. That is one-tenth of one percent and it’s well below the incredibly high rate of mortality otherwise observed among individuals with OUD which is typically 1 to 2 percent annually, possibly higher at this point with dangerous Fentanyl exposure.”
In written comments to the DEA from March, Rigsby wrote that Ophelia had treated “almost 10,000 patients” over the last three years. So, the company crossed the 10,000th patient-treated milestone sometime in the past six months.
How Adobe markets in-network virtual clinics to its employees
I’m trying to better understand how important jumbo, self-insured employers are to virtual clinic companies that operate as in-network providers.
Long-time readers of E&O know that I spend quite a bit of time poring over the employee-facing marketing materials that HR departments send out to encourage them to sign up for their various health and wellness benefits.
In my research, I’ve only ever come across one big employer that has promoted a list of in-network virtual clinics to its employees: Adobe.
An impressive list of in-network virtual clinics are available to US-based Adobe employees with an Aetna-administered health plan. Adobe and Aetna pitch the list like so:
“With telehealth and virtual mental well-being programs, you have another way to get the help you need from providers that are part of your network. And whatever you’re facing, you have the same support for counseling or medications for mental health concerns. You can see them where and when it’s convenient — you choose. One telehealth/virtual session will cost the same as an in-person office visit.”
Here it is broken down into various categories along with age requirements and state availability:
Clinics that launched in new states: Done, Accomplish Health, and Swing Care
This is a recurring feature that tracks virtual clinics’ state-by-state launches as they build up to nationwide footprints.
Done in Texas and New York: ADHD-focused virtual clinic Done went live with its ADHD therapy services in Texas in mid-September. It launched therapy services in New York this past July. The company describes the services, which include cognitive behavioral therapy, like so:
“At Done., we believe in helping you reach your fullest potential. We are excited to announce our new ADHD Therapy service. Therapy can help you find new strategies and give you the right tools to manage your ADHD holistically. All of our providers are exclusively licensed therapists with years of experience in ADHD. Sign up for your first session today.”
Accomplish Health in California, Arizona, and Washington: Medical weight management services went live in three new states in August. That brings Accomplish Health’s footprint up to 14 states by my count. Accomplish also recently became in-network with UnitedHealth. More on Accomplish:
“Accomplish Health is a fee-for-service, telehealth obesity medicine practice. We are a turn-key, outsourced practice that partners with health system bariatric surgery practices. By partnering with health system bariatric practices we can help them expand access to comprehensive obesity care with no upfront cost or operating expense.”
Swing Care is now in Illinois, Tennessee, and Texas. Fibromyalgia-focused virtual clinic Swing Care is now live in three states. Swing accepts BCBS Texas, UnitedHealth, and Medicare. More on Swing:
“Swing Care was started in 2022 to provide virtual care for fibromyalgia. Our goal is to deliver world-class treatment, when and where you need it. We democratize access to experienced clinicians and fibromyalgia experts, cutting-edge digital medicine, and proven pharmaceutical treatments.”
Deals: WW-Sequence, Vita-Hopelab, Miga-Sana
Here’s a quick run-down of recent virtual clinic partnerships, deals, and other miscellany:
The news you know: Weight Watchers acquired virtual weight loss clinic Sequence earlier this year for a total consideration of $132 million. Here’s how the acquisition payments broke down, according to SEC filings:
“As consideration for the Acquisition, the Company agreed to pay an aggregate amount equal to [$132 million] … the Merger Consideration has been paid, or is payable, as follows:
- (i) approximately [$64.2 million] in cash (inclusive of approximately [$25.8 million] of cash on the balance sheet of Sequence)
- and approximately [$34.7 million] in the form of … Company common stock (valued at $4.34 per share), in each case, paid on or payable following the Closing Date,
- (ii) [$16 million] in cash to be paid on April 10, 2024, and
- (iii) [$16 million] in cash to be paid on April 10, 2025, in each case, subject to the adjustments and deductions set forth in the Merger Agreement.”
Miga-Sana: Earlier this month Miga, a virtual heart health clinic, inked a distribution deal with Sana Benefits that will make Miga’s care services available to small businesses. Up until this point Miga has focused on Medicare patients. Here’s what it wrote in the announcement about its go-to-market shift:
“In addition to Sana Benefits, Miga is available through Medicare in California, Florida, Massachusetts, New Jersey, New York, North Carolina, and Texas, representing over 10 million eligible patients. Miga will continue to expand its availability through employer-sponsored insurance, which is the largest source of health benefits in the United States, as well as Medicare Advantage.”
Vita Health-Hopelab: This week Hopelab announced an investment in mental health-focused virtual clinic Vita Health. No dollar amount was disclosed but an SEC filing from the end of July shows that Vita has raised $8.3 million to date. Remember: Vita, which is its own company, originally spun out of suicide prevention-focused digital therapeutics company Oui Therapeutics.
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