The Kidney Care Race: Interwell Health, Strive Health Find Major Partners

Welcome back to another edition of Hospitalogy. It’s a cool 99 degrees in Dallas, Texas and you might think that sounds dreadful…until you look at the previous 30 days of weather and realize that this feels like a brisk fall day for folks in North Texas.

The Kidney Care Race: Interwell Health, Strive Health Find Major Partners

Kidney care is ripe for change, and there are a number of companies working toward driving that change. To that end, we’ve seen a flurry of large funding rounds and notable partnerships of late:

Oak Street-Strive: On August 23, Strive Health and Oak Street Health launched a national collaboration to provide value-based kidney care to people with stage 4 chronic kidney disease through end-stage kidney disease across Oak Street Health’s 21-state footprint. Through the partnership, Strive will work with Oak Street Health’s care team to help manage chronic kidney disease (CKD) patients to prevent hospitalizations, drive down costs, and improve overall patient care.

Humana-Interwell: Also on August 23, and as if on cue, Humana Inc. and Interwell Health announced an agreement for Humana’s Medicare Advantage members living with chronic kidney disease in 13 states and members across the country living with end-stage kidney disease. Under the agreement, Humana members get access to Interwell services:

• “With this new agreement, these members have access throughout their healthcare journey to Interwell’s comprehensive care and specialized resources, including 1,700 network nephrologists, renal care coordinators, and in-home virtual support from dietitians, nurses, social workers, pharmacists, and care coordinators.”

Oak Street Health is also intimately familiar with Interwell. In fact, earlier this year, the two companies launched a joint venture called OakWell in 3 markets. Across Chicago, Houston, and DFW (shout out), Oak Street is working with Interwell to provide primary care services within Interwell-managed dialysis centers.

• OakWell care teams are focused on manage chronic conditions, reschedule missed dialysis treatments, conduct video visits for urgent needs, and provide additional services such as behavioral health and renal pharmacy support. They will also coordinate kidney transplants when possible.

Keep Monogram Health on your radar in this space, too. Bucking the fundraising trend earlier this year, Monogram raised a massive $375M funding round led by CVS, Cigna, Humana, Memorial Hermann, and SCAN. In late 2022, Monogram partnered with Humana in almost identical fashion to the Interwell structure across 4 states. As of early 2023, Monogram operated in 34 states.

Strive Health raised $166M in a Series C led by NEA, and who else was involved but…also CVS!

And of course, I’d be a fool not to mention DaVita and Fresenius – the duopoly making their own plans behind the scenes, American Renal Associates, and US Renal Care (raising $328M announced in May), along Panoramic Health, a large participant in Kidney Care Choices, and plenty of smaller providers across the nation who deserve the praise but don’t get the sexy headlines.

Bigger picture: Payors are paying attention to chronic kidney disease aiming to drive down costs while providing better care for patients – both in the home and within clinics. Most of the care delivery is focused on end-stage renal disease (stage 4 & 5) bolstered by CMMI’s current Kidney Care Choices model, but the goal is to move to earlier, more preventative stages over time.

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Partnerships and Strategy Updates:

Anything affecting decision making in healthcare – notable moves and strategies for healthcare operators to keep on your radar.

MSSP Results: The Medicare Shared Savings Program saved Medicare $1.8 billion in 2022 (0.24% savings), marking the sixth consecutive year of overall savings. Low-revenue ACOs, mainly composed of physicians and serving rural areas, earned more shared savings and led high-revenue ACOs in net savings per capita. I’ll be covering these results in an upcoming send. (Link)

UAE Expands Hospital Investment: The UAE’s PureHealth has purified (okay…purchased) Circle Health Group, the largest UK-based private health system, for $1.2B – from Centene, which moved into London and bought Circle back in 2019, acquiring the remaining 60% of the company in 2021 for a reported $700M (implies $1.17B value). The announcement comes on the heels of Pure Health completing a $490M minority investment in the fourth largest private for-profit health system in the U.S. Ardent Health Services. This might be the only time I link an Arabian news source so that’s kinda cool. But at the same time…what exactly is Pure Health? To that end, it looks like PureHealth’s ultimate goal is to create a ‘global healthcare network that revolutionises patient care.’ The Abu Dhabi Crown Prince Court holds a presence in London, owning Manchester City as well. Abu Dhabi wealth fund also invested $2B into PE firm Silver Lake and owns a minority stake in the investment firm. Silver Lake’s portfolio includes healthcare investments like Verily, GoodRx, Carbon Health, Noom, and Red Ventures, which holds a notable media joint venture called RVO Health with Optum. Things get pretty interesting when you poke around! (Link)

• “The acquisition of Circle Health Group forms part of PureHealth’s global expansion programme. In May this year, the group announced it had taken a minority stake worth $490m in Ardent Health Services, a US healthcare provider.”

Microsoft, Epic, and AI: Microsoft and Epic expanded their AI collaboration to enhance the role of generative AI in healthcare, announcing Nuance as one of Epic’s Partner and Pals vendor program and embedding Nuance’s ambient documentation solution within Epic workflows, among other interesting clinician and administrative productivity tools. (Link)

Medicare Advantage Reviews: This was an interesting look into Medicare Advantage plans ranked by JD Power, which measured MA plans based on 8 consumer-facing factors. (Link)

Nursing Homes Crisis: The WSJ published a great article on the state of nursing homes in America – significant challenges have impacted American nursing homes, leading to their decline as illustrated in the charts within. (Link – paywall)

Kaiser Strike Vote: 85,000 Kaiser workers are set to potentially vote on authorizing what might be the largest healthcare strike in US history. (Link)

MedExpress Firings: Over 100 Optum-owned MedExpress Urgent Care Clinics laid off or transferred all their nurses to other settings. Looks like a major staffing restructure within the urgent care setting. (Link)

Amazon’s Strategy: Amazon introduced consumer-oriented dynamic healthcare pricing to its Clinic model, allowing consumers to pay a premium to get in front of a clinician faster. (Link)

Florida Medicaid Suit: Florida is facing a lawsuit from a family alleging the state kicked them off the insurance prior to checking eligibility requirements. (Link)

Boston Medical Deal: Boston Medical Center’s Union Resident Physicians struck a tentative agreement after 4 months of negotiations, which includes a 20% raise over 3 years among other favorable terms for residents. (Link)

Oregon Nurse Law: The state of Oregon established law mandating specific nurse-to-patient staffing ratios, joining a small contingency of other states with similar measures. (Link)

Value-Based Care Push: Health systems showed increased dedication to transitioning towards value-based care. (Link)

Rite Aid’s Struggle: Rite Aid is reportedly considering a bankruptcy filing in response to debt and looming opioid lawsuits. (Link)

Cigna’s Exit: Cigna announced its withdrawal from the ACA marketplaces in Missouri and Kansas by 2024. (Link)

CVS’s Cordavis Launch: CVS Health introduced a new service named Cordavis. (Link)

EOM List Update: The final EOM list predominantly favored larger practices, although AON strategies provided support for smaller groups. (Link)

NC Medicaid Dilemma: North Carolina’s Medicaid expansion plan remained clouded with uncertainty. (Link)

Partnership Announcements:

1. Epic integrated Talkdesk into its ‘Partners and Pals’ program following the Abridge announcement last week and the Microsoft announcement above. (Link)
2. Northwell Health extended its transplant and primary care offerings into New Jersey. (Link)
3. ShiftMed and Dignity Health Global Education initiated a collaboration aimed at providing training and upskilling for healthcare professionals. (Link)
4. The union of Allina Health and Aetna is the first in Minnesota to introduce an integrated billing experience for its users. Ironic. (Link)
5. Mark Cuban Cost Plus Drugs announced a partnership with DREXI to enhance access to medications. (Link)
6. Jasper Health, a cancer care firm, partnered with Covet Health to offer cancer care support services to Covet members. (Link)
7. Resilient Healthcare teamed up with Community Hospital Corporation to expand the ‘Hospital At Home’ program across the nation. (Link)
8. PatientPay announced its integration with PointClickCare, enabling more efficient and streamlined patient payments collection. (Link)

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Finance and M&A Updates:

Anything related to the financial side of healthcare and M&A.

Enhabit Home Health & Hospice is actively exploring strategic alternatives – including a potential sale – following months of communication on the topic. (Link)

Clark Memorial Health and Scott Memorial Health are expected to fully join Norton Healthcare, as Lifepoint Health transitions its ownership interest in the joint venture to Norton. (Link)

GoHealth shares fell 15% in early Friday trade after the company announced that reporting persons and CB Stockholders have informed its Special Committee that they are withdrawing their takeover proposal. (Link)

Cano Health named a permanent CEO as its founder stepped down from the board. Rumor has it that Cano is currently pursuing a sales process. (Link)

Reuters reported that healthcare revenue cycle management firm Waystar might be eyeing an $8 billion valuation in its U.S. IPO. Nope, not THAT Waystar. (Link)

Cleveland Clinic revealed a slight $21M operating loss, yet had a $145M net gain in the second quarter of 2023. (Link)

UPMC experienced an $86M operating loss in Q2 due to higher expenses and increased utilization on the health plan book of business. (Link)

SEC Oversight: The SEC heightened its scrutiny on private equity and hedge funds. “The rules restrict the ability of private-equity and hedge funds to entice large investors by offering them special deals, known as side letters, for better terms than other investors. The SEC will also require private funds to provide their investors quarterly financial statements detailing their performance and expenses, and to undergo annual audits.” (Link)

Healthcare software vendor NextGen is considering a sale, according to insider sources. (Link)

Nutex Health acquired Population Health Associates and Managed Care Insurance Consultants. (Link)

California is providing relief funds to hospitals, offering interest free loans and hundreds of millions of dollars to 17 struggling hospitals in the state. (Link)

Danaher is purchasing Life Sciences company Abcam for $5.7B. (Link)

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Digital Health and Innovation Updates:

Notable fundraising announcements, health tech product launches, breakthrough innovation, and reasons for optimism.

A report that dropped this week suggests that Truepill is planning to drastically reduce its share price by 90%. (Link)

Atropos Health is venturing into life sciences via its real-world data platform. (Link)

Here’s a pretty cool report out on a trial for Parkinson’s and a promising early-stage therapy. (Link)

Trilliant Health made its National Provider Directory open to everyone – basic API access is available at no cost. (Link)

Health Affairs did a great job of broke the unique characteristics found within the newly announced Making Care Primary Model. (Link)

Fundraising Announcements:

• Rapport Therapeutics, focused on developing precision neurology medications, secured $150M in funding. (Link)
• Nursa, a nurse staffing platform company, completed an $80M Series B funding round led by Drive Capital. (Link)
• Clinetic, a Durham-based technology company aiding health systems and life sciences companies in efficient clinical research, raised $5M. (Link)
• Zivian Health, creators of a SaaS platform designed to expand compliant collaborations to medical enterprises, insurers, and telehealth companies, raised $3M. (Link)
• Synthpop, which offers a system of AI assistants for healthcare providers, raised $2.6M in seed funding. (Link)
• Questa Capital, a venture firm, raised a $397M fund aimed at health tech investments. (Link)

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The Healthcare Hype Cycle:

This is the spot where I cover the buzzy, hot topics in healthcare. Currently the flavor of the month is AI in Healthcare.

Innovaccer has released “Sara”, AI assistants spanning four different AI platforms. (Link)

Suki implemented its ambient AI products across multiple EHRs. (Link)

An insane video by UCSF on YouTube on how a woman paralyzed regained her voice through a brain implant combined with AI. (Link)

Also on the Parkinson’s theme this week, the Economist highlighted the potential of detecting Parkinson’s disease at its early stages through an eye exam, especially with the help of AI-driven eye scans. (Link)

AI NLP models have the capability to pull SDOH data from clinical annotations. “A study by the Regenstrief Institute and Indiana University has demonstrated the potential of using natural language processing technology to extract social risk factor information from clinical notes.” (Link)

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Miscellaneous Maddenings

Fun, random stories & updates from Blake

• MyGolfSpy released its annual golf ball test, more comprehensive than ever this year, and perfect timing for me as I’m dabbling around with new golf balls. I typically play the Vice Pro Plus for cost but have recently played the TP5x and Chrome Soft LS, neither of which seems to have performed particularly well.
• Blake’s Bets for college football are back! Here are my plays for week 1. We’ll keep a running tally – 5 a week:
  • Texas -35 vs. Rice (we’re gonna crush em)
  • Florida State +2.5 vs LSU
  • Clemson -12.5 @ Duke
  • West Virginia +20 @ Penn State
  • Colorado +20.5 @ TCU (Coach Prime!!)

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Hospitalogy Top Reads

My favorite healthcare essays from the week

• Nikhil Krishnan shared a nice piece on how individuals, regardless of their technical proficiency, can analyze public healthcare datasets. (Link)
• A recent analysis shared by MedCity News shows that members enrolled in Medicare Advantage (MA) programs tend to use post-acute services less frequently compared to those enrolled in Traditional Medicare. (Link)
• This was an interesting study from JAMA presenting an article that delves into the trends observed in cumulative disenrollment in the Medicare Advantage Program over a decade, from 2011-2020. (Link)
• Daniel Kaplan continued his series on post-acute care covering current trends across SNFs, home health, hospice, senior living, and home medical equipment. (Link)

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