Welcome back to E&O Wednesdays, the enrollment-focused digital health newsletter from Exits & Outcomes — for paying subscribers only. This every-other-Wednesday 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:
- Christina Farr’s (ex-CNBC, now at OMERS Ventures) Second Opinion newsletter had its best piece yet with an analysis of the healthcare navigators space — second opinions services, doctor finders, etc. (Accolade and Grand Rounds are two prominent examples). Read it here and see below for a more contrarian take on the future of navigators from Glen Tullman.
- The Clinic, the joint venture between American Well and The Cleveland Clinic, just launched its own second opinions service that uses both Amwell’s platform and Cleveland Clinic’s specialists.
- And is it just me or is everyone talking about a “digital front door” for healthcare again? I remember that phrase getting a lot of play in 2010 starting in the UK as NHS began its search for its (still elusive?) digital front door.
- Hinge Health made three big hires this week. Jim Pursley, formerly the longtime Chief Commercial Officer at Livongo Health, is now Hinge’s President. Lex Annison joined as Chief Operating Officer from Google. And Hinge has a new CFO, Ron Will, who has 30 years of experience including a lot of big mergers (but no IPO experience — as far as I could tell.)
- Crossover Health announced its “fourth pivot” in the company’s history: “Our Fourth Pivot is a shift to becoming a true health and wellness lifestyle company. A lifestyle brand is something people love to be associated with because of what it represents, how it makes them feel, and what it inspires them to be (think Nike, Peloton, Lululemon, etc.). With all of our new capabilities, we are finally in a position to provide not just a ‘clinic without walls’ but also a new and valuable health ‘membership.’ We’re moving from simply treating sickness to helping our members address the behaviors and conditions that will not only improve but sustain their health—and ultimately help them live their best lives.”
- Willis Towers Watson tapped mental health provider Lyra Health “as a preferred mental health care solutions provider based on an in-depth review of capabilities and performance.”
- Meanwhile, Ginger partnered with digital pharmacy Capsule so that the mental health provider can “prescribe medications, support adherence, and transition members off of medications when appropriate.”
- One more thing…
Was this forwarded to you? Well, we don’t take kindly to strangers around here. (Unless they quickly click this link and become paying subscribers today.)
Tullman talks Haven, hospital-at-home, HAAC SPAC
Glen Tullman, the former Co-founder and CEO of Livongo, made some interesting comments during a fireside chat at the Wharton Health Care Business Conference this week. He talked a bit about Haven. He expressed incredulity at the concept of healthcare navigators. And he might have revealed a bit about what we can expect about the HAAC SPAC he is operating with General Catalyst‘s Hemant Taneja.
Tullman: Haven didn’t fail
“Only a few years ago, a company called Haven started. And it was interesting because three of the smartest companies in the world — Amazon, JP Morgan Chase, Berkshire Hathaway — got together and the statement was ‘We no longer feel that we are aligned with payers, PBMs, or health systems, because every time our costs go up, they make more money. And so there is no longer an alignment, we’re going to try to do this ourselves.’ While some people said, ‘See: Haven failed.’ Haven didn’t fail. Haven learned a lot, and I think that was the first step of inventing the future of healthcare system. I think we are going to see that as we see all the various [people involved with Haven] come back.”
Platforms and navigators aren’t the answer
“I do think we are going to be moving more and more toward platforms, but I don’t think of them as platforms as much as a different kind of consumer experience. We have platforms today. Large payers have put lots of apps on one platform. In fact, there are private companies, entrepreneurial companies that have sought to pull together a bunch of different apps on one platform. The issue today is with all of the innovation and all of the expenditure, for the average person, healthcare today is more confusing, more complex, and more costly than ever before.”
“After all of this innovation! So, you kind of say, so what has gone wrong?” “Well, we haven’t focused on the most important piece of that. We haven’t focused on an experience that people know how to navigate and use. [Instead,] we have done something that is kind of crazy. We’ve said, well, it’s so hard. Let’s put yet another person, called a ‘navigator’, in between them and the experience. Whereas, what we know is, when you use Google, AirBnB, or Uber, imagine if you had to call somebody every time you wanted to use it. Imagine if you had to go to a training course if you had to use Uber or Google. They’d have to train billions of people… Nothing smart has instructions anymore.”
HAAC SPAC hints: Hospital-at-home?
“The SPAC is looking at what can we do to move healthcare closer to the consumer. Again, one of the trends we are seeing is the Walgreens and pharmacies of the world have become much more frontline in the delivery of care. And I think that will be more and more so.”
“Think of the home pregnancy test. That started in a hospital. It moved to a clinic. It moved to Walgreens, and now you can do it at home. And it’s a tenth of the cost of what it was. That’s how healthcare should work, and I think we are going to see more and more services delivered either at-home or at your local Walgreens or CVS or at a work clinic or a retail clinic.”
“It’s interesting: About 30 percent of the procedures done in a hospital [in the US] are done at home in the rest of the world. If you are at home, as we have all learned, there is less likelihood of serious infection and it is a heck of a lot more convenient. It’s also about half the cost of doing it in the hospital. So, I think we are going to see dramatic change in the health industry come up… That’s not only going to be what our HAAC does but it will also be my next focus, which is how do we create businesses that actually make it easier to stay healthy, that take a lot more risk than ever before, and that are focused not on taking margin out but on adding value in…”
More HAAC SPAC hints: A better Castlight + HSA-based incentives?
“Something is wrong here if they will spend more time with me to help me buy a pair of blue jeans than they will to explain a healthcare procedure to me that’s really important, and in some cases, really expensive. By the way, I asked what exactly [the MRI] would cost, and they said ‘Well, this will be covered by your insurance.’ I said, well what if I want to pay cash? They said: ‘Well, I don’t know, you’d have to come in for us to tell you that price.’ That’s crazy. And, ultimately, the range of pricing for an MRI in the city of Chicago is something like $700 to $3,000 for the exact same procedure on the exact same equipment.”
“The only challenge is none of us know that and we’re not paying directly for it. When we solve that, when we get that information out there and we have a stake in that transaction, then that will change almost overnight. That’s a big part of it. How do we get, not just consumer-informed care and consumer-directed care, but how do we give consumers a piece of that so that they care about that as much as they care about when they book travel and they price compare or when they buy anything else in the market.”
Lots of provocative comments here. Tullman is one of those speakers who is always great but also almost always on message. I’m sure he’s said some of the above before, but a lot of that was new material. I think he’s dropping big hints about what the HAAC SPAC is up to.
Now enrolling: PetSmart-Hinge, Prudential-Vida and more
This is a new recurring feature for E&O Wednesdays that I’ve been able to sprinkle in throughout past issues of this newsletter: Now Enrolling. I’ll take a look at which companies are currently enrolling their members in digital health programs. Sometimes these are big-name customer wins that digital health companies weren’t able to announce for whatever reason. Here’s this issue’s round-up:
Vida Health has a number of enrollment programs underway. Prudential is enrolling employees in Vida Health’s various programs including marketing specifically aimed at diabetes management and stress. Taylor Corporation Companies, a private, 12,000-employee interactive print and marketing firm is too. Finally, the Self-Insured Schools of California (SISC) is enrolling its employees in Vida’s programs. “SISC covers districts all over the state and our combined annual budgets total $2.5 billion dollars. We are now the largest public school pool in the U.S.” Site
Hinge Health is enrolling employees at PetSmart and the creative features a couple walking their pet bulldog, (a nice touch!). “We deliver everything you need to eliminate your back or joint pain, no matter where you are.” Site
Teladoc actually uses a different Facebook page to market to its employer customers’ covered populations. It uses its main page to market DTC. The employer-facing one is called “Teladoc $0 Copay Benefit.” It hasn’t run a campaign since October, however, when it ran a number of them targeting various labor unions around the country. Site
Not a current enrollment program but worth noting: Accolade is using Facebook ads to target benefits leaders at employers, which is unusual — most of these companies use the channel for enrollment. Site
Fortune 500 Digital Health Stack: BorgWarner
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 seven big companies: Walmart, Activision Blizzard, JP Morgan Chase, The Home Depot, Boeing, 3M and Chevron.
This week, I pored through the medical benefits offered to employees at one of the world’s largest automotive parts suppliers, BorgWarner.
Here’s what their (notably sparse) digital health stack looks like for 2021:
MDLive: BorgWarner suggests its employees use MDLive if they would like to talk to a doctor, therapist, psychiatrist, or specialist. The out-of-pocket cost is one of the highest I’ve ever seen for something that is supposedly a benefit to employees: “At under $55/visit, this option provides a cost-effective solution when it comes to care that qualifies for telemedicine.” (That’s obviously a maximum fee — maybe it is that high for certain specialists — so hopefully it’s typically closer to half that.) The company also notes that “Your visit will tie into your deductible and out-of-pocket max for the plan year.” Site
Livongo for Diabetes Management: BorgWarner employees with diabetes have access to Livongo’s diabetes management program at no additional cost. The pitch is Livongo’s standard one: “A $75/month benefit, paid for by your employer or health plan. Unlimited supplies, smart meter and coaching at no cost to you.” Interesting that BorgWarner has no mental health programs on offer outside of virtual visits with providers via MDLive. It also has no hypertension management programs in its benefits — even though Livongo offers both of these in addition to its diabetes management program. Site
Omada for Diabetes Prevention: BW pitches Omada’s DPP program as diabetes prevention and more: “We offer a breakthrough online program that inspires healthy habits. This comprehensive 16-week program is available to employees and their covered spouses and dependents over the age of 18. It is designed to help individuals lose weight, which can help reduce the risk factors for type 2 diabetes and other chronic diseases.” To enroll, BW employees need to take a one-minute health test to see if they qualify first. Like Livongo, this program is offered at no additional cost to the employee.
myCigna (for everything else): BW depends on Cigna for its in-house provider directory and second opinions service, instead of working with a company like Grand Rounds or 2nd.MD. BW also promotes Cigna’s in-house, telephonic-based health coaching programs for smoking cessation, weight management, stress management, healthy eating, and a vague category called simply “disease management”. There’s obvious overlap there with the offerings from Livongo and Omada. Site Well, that’s a wrap on BorgWarner’s stack. This is a good bellwether that I’ll keep an eye on to figure out shifts in Cigna’s strategy around digital health partners vs. homegrown programs. Some of these stacks are easier to figure out than others (so no promises), but let me know which company’s digital health benefits you’d like to learn more about by hitting reply to this email. And if you happen to work at a Fortune 500 company (and I know that’s a lot of you), then please send me your benefits information.
Links to E&O’s reports, databases, newsletters
Click below for dedicated pages for each of those categories:
- Read through the long-form E&O research reports here.
- Search and sort the E&O databases here.
- Skim more than 90 past issues of E&O newsletters here.
