Blog - WTF Health Jessica DaMassa

“If I continue to hear how difficult it is for hospitals to make money, I would like for them to see what it’s like to operate a real business. They are overstaffed…they are overpaying…they are not responsible for quality or outcomes…there are no guarantees on their services…they can block competition from entering their markets…they can buy up market share – that’s not a real business.”
Well, lesson learned. If you ask Roger Jansen, Michigan State University Health Care’s Chief Innovation & Digital Health Officer, how he think things are going in US health systems when it comes to digital transformation and the integration of technology and value-based business models in hospitals, be prepared for a blunt conversation about how US healthcare model is failing and how the lack of incentive for change is keeping us all stuck in the same-old, same-old.
From digital health and telehealth to EMR and value-based care business models, we cover a lot of health innovation ground in this chat and get a reality check on whether or not things are really evolving inside health systems – and which stakeholders Roger believes hold the key to driving that change. (Hint: He identifies them as those who are already “footing the bill for the lavish lifestyles that healthcare administrators live that are probably well out-of-balance with the value that they actually bring to their corporations.”)
Roger on digital health? There’s better adoption and receptivity when it’s combined with “a service component that doesn’t add additional burden to the clinical component.”
On virtual care and telehealth? Down 70% since the pandemic’s lockdown days and more of a “behavior change problem” at this point than anything else.
When we get to EMRs around the 19-minute mark, things get extra spicy and we take a turn into “all this jibberish about volume versus value” and how value-based care models aren’t gaining meaningful traction either. It’s a big, bold reality check on the state-of-play of health tech, virtual care, and healthcare payment model innovation in health systems… watch now and let us know what you think!
*
Jessica DaMassa, the emerging ‘It girl’ of health tech interviewing, chats it up with the ‘who’s who’ of the health tech and healthcare innovation set on 'WTF Health - What's the Future, Health?' Catch 100's of interviews with leading health tech startups and the VC investors, health insurance companies, big pharma co's, and hospital systems helping bring their new ideas into the healthcare establishment. From AI and Big Data to digital health, virtual care, telehealth, digital therapeutics, payment model innovation, and investing, Jessica helps you spot the trends and figure out what’s next.

There are surprise profits in an overfunded sector, but then there are funding deals for staffing company Incredible Health ($80m), voice recorder Abridge ($12m), meditation company Interaxxon (Muse Headband) ($9m), medication company Arine ($29) & new virtual care medical group Keycare ($24)

Particle Health’s CEO Troy Bannister stops by to not only talk about the API platform company’s $25M Series B, but to also explain exactly what’s going on in that patient data ‘exchange-standardize-and-aggregate’ space that, these days, looks poised to pop as the 21st Century Cures Act Information Blocking Rule stands ready to make hospitals share data like never before.
Troy calls Particle a “network of networks” and what that means is that their API pulls patient records from organizations and businesses that are already aggregating them (so aggregating the aggregators) to get all the lab data and medical data a clinician would want to in order to have a more complete picture of their patient. For clients like One Medical or Omada Health, who deliver value-based care and take on risk, having such a robust historic data set on patients – along with a more complete picture of their comorbidities – helps improve decision making and outcomes.
So, how is Particle Health working now – and what will change – as the Information Blocking Rule gets implemented? Troy’s written about this for Forbes, and explains what has him fired up here too. Turns out their model has room to accommodate a big pivot: giving patients access to their own ‘network of networks’ record. Find out what sets Particle off in this new B2B2C direction and how they will be using that Series B funding to build out deeper analytical tools to help everyone make better sense of what the data in all those records can show us.
*
Jessica DaMassa, the emerging ‘It girl’ of health tech interviewing, chats it up with the ‘who’s who’ of the health tech and healthcare innovation set on 'WTF Health - What's the Future, Health?' Catch 100's of interviews with leading health tech startups and the VC investors, health insurance companies, big pharma co's, and hospital systems helping bring their new ideas into the healthcare establishment. From AI and Big Data to digital health, virtual care, telehealth, digital therapeutics, payment model innovation, and investing, Jessica helps you spot the trends and figure out what’s next.

What’s the bigger news coming out of Capital Rx: that the next-gen PBM just closed a $106 million dollar Series C? Or, that the health tech startup’s business model has expanded significantly over the past 18 months, from PBM-only to PBM-plus-PBA, meaning that instead of just servicing the pharmacy benefits management needs of employer groups directly, that now they’re also adding to their business by selling THEIR TECH to other carriers and health systems so they can use it to administrate their benefits plans??
Capital Rx’s CEO AJ Loiacono takes those questions in stride, lets us in on which “side” of the business fueled their 200% year-over-year growth in 2021, and gives us the details on that tech that his business developed and why its standout compared to the inefficient infrastructure that currently exists to administrate and process pharmacy claims.
The big deal here is that AJ and team are tackling one of the biggest friction points in the cost of pharmacy benefits: the cost to administer a plan. They reduce that cost, and the “net cost” of every drug is reduced. AJ says its in this way that Capital Rx operates at one-seventh the cost of his competitors, the “Big Three PBMs” (CVS’s Caremark, Express Scripts, and UnitedHealth’s OptumRx) and saves its customers an average 27% on their prescription drug spend.
Now that Capital Rx has their slick enterprise software, will the business continue to operate a dual PBM-plus-PBA model, or will they double-down on the PBA side? AJ lets us know what’s next and (spoiler alert) it sounds like things might go in a surprising direction. If Capital Rx’s software is so effective at doing all the things it takes to manage pharmacy claims -- underwriting sequences, implementation management and onboarding, communication, patient portals, network management, reimbursement networks, eligibility checks, etc. – what stops Capital Rx from processing other kinds of healthcare claims? Is a step into the medical claims processing side of the healthcare world on the roadmap? Tune in and find out!
*
Jessica DaMassa, the emerging ‘It girl’ of health tech interviewing, chats it up with the ‘who’s who’ of the health tech and healthcare innovation set on 'WTF Health - What's the Future, Health?' Catch 100's of interviews with leading health tech startups and the VC investors, health insurance companies, big pharma co's, and hospital systems helping bring their new ideas into the healthcare establishment. From AI and Big Data to digital health, virtual care, telehealth, digital therapeutics, payment model innovation, and investing, Jessica helps you spot the trends and figure out what’s next.

It’s a tale of two markets: on one side we have layoffs, sinking stock prices, and all sorts of trouble, but on the other side we’ve got some good bills passed and some pretty great fundraising! In this episode, Jess and Matthew dive more into the dual nature of the state of health tech. Is it the best of times and the worst of times? We find out, and talk through some recent multimillion-dollar deals: Cera raises $320 million; Birdie raises $30 million; Theator raises $24 million; Tebra raises $72 million; Diagnostic Robotics raises $45 million.

How will the reversal of Roe v. Wade impact virtual care and digital health companies from a health data privacy standpoint, particularly as States crack down on the use of telehealth as a mechanism for obtaining abortions and begin to look at digital health data as potential evidence in criminal cases where abortions are illegal?
Health data privacy expert and rightfully-so-self-proclaimed HIPAA Scholar, Deven McGraw, who spent three years as Deputy Director of the Health Information Privacy Office at HHS and currently leads Data Sharing and Stewardship at Invitae, gives us her hot take on what’s happened from a health data privacy standpoint and how it will impact health tech businesses and healthcare consumers in the short and long terms.
Deven’s take: “We’ve really jumped the shark in terms of what the consequences are of health data falling into the hands of people who intend to use it in order to pursue a criminal case either against a woman (or a man) seeking a service, or the provider that performed the service…”
So, what does that mean for those who are dealing with digital health data? What are the limitations as far as what HIPAA can protect for patients and what it can’t? What loopholes have Deven worried about the privacy law’s ability to stand-up to the challenges now posed by the Dobbs decision? And, what does all this mean for the telehealth-based businesses that are providing services to these patients?
We have a sweeping conversation about the shifting health data privacy landscape in the wake of Roe’s reversal in this latest episode of our special monthly Virtual Care Regulatory Round-up Series, sponsored by the health tech company powering the virtual care industry, Wheel.
*
Jessica DaMassa, the emerging ‘It girl’ of health tech interviewing, chats it up with the ‘who’s who’ of the health tech and healthcare innovation set on 'WTF Health - What's the Future, Health?' Catch 100's of interviews with leading health tech startups and the VC investors, health insurance companies, big pharma co's, and hospital systems helping bring their new ideas into the healthcare establishment. From AI and Big Data to digital health, virtual care, telehealth, digital therapeutics, payment model innovation, and investing, Jessica helps you spot the trends and figure out what’s next.