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.

Here’s what’s happening in recent weeks in the world of employer-focused or enrollment-based digital health:

• The news you know: Haven is no more. There’s not a lot that hasn’t said or speculated about its demise, so I’m going to continue to focus on what its ex-partners, who just consciously-uncoupled, are doing within their respective employee populations. JPMorgan Chase is working with Virgin Pulse and Newtopia as I wrote back in Issue 003. Amazon is doing quite a bit: Amazon Care, Halo, and Crossover Health are probably the big moves to watch. But I just found this flyer that explains a homegrown mindfulness program the company calls, hilariously, AmaZen, for its workers. And, finally, after digging into some of Berkshire Hathaway’s largest subsidiaries, I’m having trouble seeing much of anything related to digital health or innovative benefits.
• Wow, I know working with employers was revealed as part of its future strategy when AliveCor raised $65 million at the end of last year, but CEO Priya Abani just told attendees at JPMorgan’s healthcare event that the company is planning to roll out a PEPM cardiac care offering this year that AliveCor would sell to employers. First time I’ve heard that they were adding a PEPM revenue stream.
• This initiative from the American Telemedicine Association (ATA) and the Digital Medicine Society (DiME) focused on virtual-first medical practices is well-timed. That’s already a big trend for health tech in 2021.
• And, if that’s of interest, don’t miss this great column from former Propeller Health COO/CCO Chris Hogg that breaks down the virtual-first care opportunity.
• Remember a few weeks back (Issue 004) I wrote that Evernorth (Express Scripts) had removed Learn to Live from its Digital Health Formulary? Well, it turns out it was removed from the formulary’s website by mistake. Because of the holidays, it took a few weeks for Express Scripts to get back to me when I asked for an explanation for their apparent removal. ESI said Learn to Live is still in their formulary and, sure enough, they subsequently added them back to their website next to the SilverCloud programs under the behavioral health section. (So, Livongo remains the only one to be removed from a digital health formulary now (Issue 002) thanks to their spat with CVS.)
• While we’re talking about the Evernorth digital health formulary, be sure to check out this video interview with the program’s lead Mark Bini that WTF Health’s Jessica Demassa did last month. Bini revealed the next steps for the formulary: “The formulary will continue to expand horizontally into different disease categories. We’re looking at rare diseases now. We’re looking at oncology. We’re looking at longitudinal virtual health solutions and a number of digital therapeutics.” Bini goes on to suggest that some of these will be covered under the pharmacy benefit too.
• I mentioned Hinge Health’s $300 million funding already in E&O Mondays, but it’s worth bringing it up again here. The move clearly sets Hinge up for an IPO. (I’ll be keeping an eye out for other imminent signs of that.) What’s striking about Hinge is its focus on MSK. If it does go public soon, would that make it the first truly condition-specific virtual care provider to do so?
• One more thing… Did you read E&O Mondays this week? There’s a note in there about E&O’s underwriter for 2021, One Drop. That newsletter also breaks down some changes coming for the Enterprise and Business subscription plans next month.

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Omada Health: 43 percent CAGR 2017-2020

Omada Health founder and CEO Sean Duffy presented at JPMorgan’s healthcare event this week and included a number of growth metrics that I’ve rounded up below. (No, Duffy didn’t announce that Omada had been acquired by American Well. E&O reported that the two were in talks at the end of 2020, and I figured JPM was the most likely venue for an announcement.) Omada grew its number of employer customers from 360 in 2018 to 862 in 2019 to more than 1,300 in 2020. That’s more than 3x growth from 2018 to 2020. Omada’s wider client list includes employers, health plans and PBMs, and health systems. Interestingly, during the first quarter of 2020 Omada’s deals with customers only included more than one of its programs 5 percent of the time. By the fourth quarter of 2020 multi-product deals accounted for 22 percent of its customer agreements. Duffy said increasing multi-product deals was a key goal for 2020 as it significantly reduces CAC. Duffy said Omada’s second and third product lines are like new rocket boosters that the company is just starting to feel kick on now. Duffy shared that Omada’s overall revenues grew at a more than 43 percent CAGR from 2017 until 2020. Finally, Duffy shared four key growth levers for Omada in the coming years:

• Increase member enrollment in existing customers
• Partner with health systems to enable longitudinal capabilities
• Cross-sell new solutions into existing customers
• Expand into Medicare and Medicaid with existing service offerings

Not to be a broken record here, but bullet point number two does square rather nicely with American Well’s business. That said, given how long it’s been since I’ve heard about this potential deal, I’m starting to wonder if an Omada IPO is the more likely exit at this point.

Financial details of Talkspace’s B2B biz

Mostly direct-to-consumer digital mental health company Talkspace went public this week via a merger with a SPAC. I dug into the financial disclosures that compared Talkspace’s direct-to-consumer business with its still relatively new B2B initiatives. (A lot of this is on the slide I’ve included below, but I did find a few other interesting things so read on…) Pricing and User base: Consumer vs. B2B offerings Talkspace’s DTC therapy packages include weekly subscriptions of $65, $79, or $99. Live video interactions are only available in the two more expensive packages and the most expensive one includes more of those. The SPAC filing reveals that for these customers, the average member treatment length is 5.4 months and its monthly average per member is $263. Talkspace’s DTC psychiatry offering is priced on a fee-per-session basis only with $199 for the first session and $125 for follow-ups. During 2019 Talkspace averaged about 20,000 active DTC users. That number jumped to 28,000 by the end of 2020.

The company lists an average therapy session price of $65 for EAP customers and $70 for its behavioral health provider contracts. Like its DTC psychiatry offering, Talkspace’s B2B psychiatry service is also fee-per-session. A first visit is $180 in this context, however, and follow-up visits are $120 each on average. Talkspace doesn’t break out its actual users within its B2B business, but its total covered lives went from about 2 million during the first quarter of 2019 to about 39 million today. It also notes in one part of its filing that its active user base today is up to 46,000, so it might be fair to assume that its B2B user base is 18,000 active users right now.

Talkspace’s plans for future growth

The company is eyeing a number of ways to grow its business, including moving into sleep and wellness, going global with its offerings, building out its psychiatry service, and extending member retention with more self-service care products.

Fortune 500 Digital Health Stack: Boeing

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 Walmart, video game giant Activision Blizzard, JP Morgan Chase, and The Home Depot. This week, inspired by Hinge Health’s $300 million funding round, I dug into one of the digital MSK clinic’s highest-profile customers: Boeing. Aerospace giant Boeing makes airplanes, rockets, satellites, and missiles. It is in the top 30 of the Fortune 500 and it currently employs around 140,000 people worldwide (but that number is expected to continue to drop to around 130,000 by year-end). Here’s what Boeing’s digital health stack looks like today:

• Best Doctors: Boeing offers its employees a second opinion service via Best Doctors that it fully funds. (Best Doctors is, of course now owned by Teladoc, but there is no indication that Boeing uses Teladoc for virtual visits.) Site
• 98point6: As part of its response to COVID–19, Boeing inked a deal with 98point6 for a text-based primary care service. It covers the cost of 98point6 conversations for both employees and retirees on Boeing-sponsored health plans. (This might be why they don’t have a deal with a virtual visits provider?) Site
• Castlight: Boeing offers employees Castlight to help them better understand their benefits and to provide some price transparency of their care options. Site
• Hinge Health: Boeing employees also have access to Hinge Health’s digital MSK services, which Boeing describes as a “virtual exercise therapy program for joint pain. The offering includes wearable sensors, a tablet, and one-on-one health coaching. Site
• Livongo for Diabetes: Livongo for Diabetes is, of course, another Teladoc-owned program, and while I’ve found this program still listed among the benefits for Boeing employees, links to the sign-up page are broken. Site
• Omada: Boeing also offers Omada’s prevention programs to its employees, but it describes them as “obesity-related chronic disease prevention.” Site
• Optum: Like a few of the other stacks I’ve dug into, Boeing also offers Optum’s tobacco cessation program, which is called Quit Now. It includes texting, phone calls, and online chats from health coaches. Quit Now also can include medications if need be. Site
• Total Brain: Total Brain, formerly My Brain Solutions, is one of Boeing’s mental health-focused digital health benefits. It offers a self-care monitoring app and programs focused on brain health, stress reduction, and resilience. Site
• Vida Health Coaching: Starting in 2020, Vida replaced WebMD as Boeing’s go-to for lifestyle and general well-being coaching. Vida lists out nutrition, weight loss, and mental health as part of the offering it provides Boeing employees at no additional cost to them. Site

Besides WebMD, a couple of years back Boeing also dropped telemedicine provider CarenaMD, which is now a part of American Well (because Amwell acquired Avizia, which bought Carena.) That’s a wrap on Boeing’s stack. I’ve got one lined up for next week already thanks to a reader’s suggestion. Let me know which company’s digital health benefits you’d like to learn more about.

16 new Teladoc clients

Teladoc’s presentation from the JPMorgan event this week is well-worth checking out in-full here. The company floated its version of a virtual primary care offering (who doesn’t have one of those at this point?) and expanded its relationship with CGM-maker Dexcom. The most interesting slide to me included this graphic below, which shows Teladoc’s new clients along with a few that resulted from cross-selling into the customer base of its recent acquisitions. Is this a slow start? Two each?