Hospital Bed & Breakfast
By Jared Dashevsky, MD
Hospital Bed & Breakfast
MyMichigan Health announced it will officially launch a hospital at home (HaH) program, joining 100+ other U.S. hospitals that are trying to deliver high-value care. While the HaH concept has been around for over two decades, only now is it starting to take off.
HaH programs allow for intensive care in the comfort of the patient’s home. The program is for patients who are sick enough to be hospitalized but stable enough to be treated in their homes by visiting (in-person or virtual) doctors and nurses. With well-monitored care, HaH is safer, cheaper (no need to pay for fixed facility costs) and more effective than traditional hospital care (link).
There have been several barriers to HaH adoption throughout the healthcare system:
- Reimbursement ➡️ no matter how good the experience is for the patient, if hospitals are losing money by not treating the patient in-house, they won’t adopt HaH.
- Physician buy-in ➡️ even if hospitals adopt the program, physicians need to trust that outcomes will be the same, if not better, than care in the hospital. HaH is quite untraditional.
- Tech-enabled ➡️ a lot of technology goes into HaH programs, especially if there’s virtual care. The patient will need access to the internet and other technology. The reliance on tech could perpetuate existing health inequities and disparities.
HaH 🤝 Covid-19
The surge in hospital demand during the pandemic prompted CMS to create an Acute Hospital Care at Home Program to reimburse hospitals for HaH programs (link). The number of hospitals participating grew from 12 to 186, largely because there was/is a solid reimbursement program in place to care for patients at home.
Once the public health emergency ends, so will CMS’ HaH program. Since the HaH program has been so popular, I envision CMS will create a more formalized design of the program and reimbursement model. More and more hospitals will then hop on the HaH train to remain competitive.
Lastly, where CMS goes, so do startups. I predict we’ll see current and new startups shift their focus to creating necessary tools and resources for hospitals to run robust HaH models. This can be a hot area for remote patient monitoring companies, travel nursing agencies and telehealth platforms.
The Chronic Care Management Boom
Chronic care management platform Omada Health raised $192M in Series E funding (link). Investment in digital health has increased 40% YoY for the past seven years and shows no signs of slowing down, especially in the chronic care space (link).
Omada Health uses digital technology and personalized coaching (see Omada Insights Lab) to help patients manage their chronic conditions including diabetes, high blood pressure and musculoskeletal (MSK) conditions.
The company has raised $256M to date and plans to use its recent funding to improve Omada Insights Lab and further personalize patient care and coaching.
The chronic care management space is flooded with startups, many of which are raising funds and growing quickly.
- Teledoc launched a new chronic care management program, Chronic Care Complete, last week. Chronic Care Complete targets patients with diabetes, pre-diabetes and hypertension (link).
- Remote patient monitoring platform Athelas raised $132M in January (link). The company helps doctors and patients better manage their blood pressure, blood sugars and medication.
- Virta Health, one of the largest chronic care management startups focused on type 2 diabetes, raised $132M last year, valuing the company at $2 billion (link).
- Omada Health acquired MSK platform Physera back in 2020 (link).
- MSK platform Hinge Health raised a whopping $400M at a $6.2B valuation last year, further asserting itself as the dominant player in the MSK chronic care space (link).
The digital health therapeutics market is expected to reach $295.4B by 2028 at a CAGR of 15.1% (link). The chronic care market will only expand as lifespans increase and people live longer with their chronic conditions. Chronic conditions are the leading drivers of the U.S. healthcare system’s $4.1T health expenditures (link). So, to say there’s a dire need for startups to innovate within the chronic care space to lower costs and improve quality is an understatement.
Not Your Cheapest Ride
FAIR Health found that charges for ground ambulance transportation have steadily increased over the past four years. Unfortunately, patients remain unprotected against surprise medical bills from ground ambulance services (link).
The average charge for advance life support (ALS) ground ambulance services increased across all insurance types since 2017:
- Out-of-network patients (or uninsured) = +22.6%
- Private-insured patients = +56%
- Medicare patients = +5%
Patients seldom have a choice in selecting the ambulance company covered by their insurance, since they’re in an emergency situation—duh. So, it’s no surprise around 50% of ambulance rides include an out-of-network charge (average = $1,277 in 2020), putting the patient at risk of a surprise medical bill (link). Congress said it’ll continue to think of solutions to prevent this.
The Medical Transportation Biz
DocGo (formerly, Ambulnz) provides on-demand patient transfer between clinical settings and offers in-person medical services or follow-up treatment when a traditional doctor’s appointment isn’t needed (link).
The company is B2B, partnering with public institutions, corporations (Uber, Equinox) and health systems like Mount Sinai and Jefferson. DocGo, to my knowledge, is one of the few prominent companies in the Medical Transportation industry that’s eating up the market share.
Connecting the Dots
Ground ambulance carriers will continue to increase the cost of their services while lobbying against any surprise billing restrictions at the same time. Companies like DocGo will increase their competitiveness against traditional ground ambulances with its speed, efficiency, technology, low costs and strategic partnerships. Since the medical transportation business is only going to grow with an aging population, we’ll inevitably see new companies sprout up trying to tackle problems such as high transportation costs for patients.
OUTSIDE THE HUDDLE
- Primary care, historically one of the lowest-paying fields in medicine, has been experiencing huge growth in private investments over the past decade, from $15M in 2010 to $16B last year.
- Aflac, you know, the one with a duck, is partnering with Neuroflow to beef up its mental health offerings.
- The US maternal mortality rate, among the lowest of developed nations, continues to increase per the CDC’s 2020 report. The statistics continue to reveal large disparities, with 53.3 deaths per 100k live births among Black women compared to 19.1 deaths per 100k live births among white women. These numbers are astronomically high. In New Zealand, for example, the maternal mortality rate is 1.7 deaths per 100k live births.
- News from the Covid-19 front:
- Variantyx received $41.5M in funding. The company produces advanced whole genome testing technology with a special focus on precision oncology. Think of this as personalized cancer treatment, where drugs are aimed at specific targets found only in or on the cells in a patient’s tumor. Pretty cool!
- 🤔 What I’m thinking about: Last week in Fitt Insider’s newsletter, they mentioned the supplement industry is on track to be a $505B business by 2028. Many of these supplements are poorly studied, but if people continue using them, there’s a big business! Give the newsletter a read (and subscribe).*
- 🎵 Jam of the Week: Cold War by Cautious Clay.
- 📘 In Memory: Dr. Paul Farmer, a legend and pioneer in global health, passed away suddenly last week. The global and public health community lost one of the best. Here’s the first book I read by him: Infections and Inequalities. This book changed the way I view healthcare. You should read it.
- 🇺🇦 Resources for Ukraine: Russia’s continued effort to invade and take over Ukraine is frightening and inhuman. My thoughts and prayers are with everyone who lives in Ukraine. Check out this list of actions you can take to help and places to donate.
- Dog Food 🤝 Clean Planet: Chippin’s dog food contains spirulina which absorbs CO2 while most protein development emits it. Chippin creates better treats and food for our dogs and the planet. Enjoy 25% off Chippin here. Your dog will thank you.*