9 Digital Health Partnerships with Health Systems

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Today we’re diving into the world of digital health partnerships with health systems. Of the hordes of tech-enabled services companies out there, those partnering with health systems and working to make change there are the ones I’m taking a close look at.

There are a ton of really great new tech-enabled services companies trying to address a myriad of underfunded and neglected services. I’m excited to see what these partnerships bring to the table and how they transform patient care.

In my mind, if you’ve successfully partnered with a large health system, that means that (1) hospital leadership thinks you have a viable, sustainable business model and (2) leadership considers that health tech firm’s mission a priority to their strategy.

Let’s dive in to the digital health players doing the most here.

In summary, here are 9 recent digital health partnerships with health systems that I’m eyeing:

• Tia – UCSF – Common Spirit
• Carbon Health – Froedert Health
• agilon – Maine Health
• Amedisys / Contessa – Baylor Scott & White
• Privia – Surgery Partners
• Strive – Bon Secours Mercy Health
• Fresenius – InterWell – Cricket Health
• Transcarent – RUSH
• CareMax – Steward

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Tia – UCSF – CommonSpirit

Women’s Health-focused startup Tia has notched two major health system partner under its belt. After raising about $132 million and announcing its first partnership with CommonSpirit Health in April 2021, Tia announced a second partnership with UCSF Health in the Bay Area and will open at least 10 de-novo clinics in the area.

The goal of these partnerships is to create a new, specialized front door to healthcare for women. With CommonSpirit, Tia plans to open women’s specialty primary care clinics in Phoenix (overlapping with CommonSpirit’s legacy Dignity Health footprint). Tia opened its first clinic in conjunction with the partnership in October.

With its foot in the door there, Tia then expanded into a partnership with UCSF Health, which appears to be a bit more robust on the surface. The UCSF JV plans to serve 40,000 women in the Bay Area starting with a single clinic and expanding to 10 built (de-novo) sites

Tia is doing a lot of great things in the grossly underfunded women’s health sector. I’m incredibly excited about the opportunity that Tia and other women’s health startups are pursuing since there are so many components of women’s health that need improvement.

More recently, the firm is expanding into fertility services, an area that is typically pretty lucrative. The interesting part here is that Tia itself isn’t planning on offering egg freezing or sperm testing, separating itself from monetary conflicts of interest with patient needs. From the outside looking in, Tia is doing everything right and I hope the firm sees continued success.

• Also, don’t forget about Diana Health, a similarly-focused startup that raised $11 million in January 2022 and announced a small partnership with HCA. It seems as if these women’s health-focused firms are getting their foot in the door rather quickly with health systems, piloting 1-2 clinics in certain markets and seeing what sticks.

What else am I missing about women’s health? Reply to this e-mail or hit me up on Twitter to let me know about other exciting things going on here.

Carbon – Froedert Health

Carbon Health announced a partnership with Milwaukee-based Froedert Health in April 2022. In what I imagine is similar to an expanded version of a urgent care management model, Froedert Health will join Carbon Health’s management platform called Carbon Health Connect. Carbon Health will manage new and existing primary care and urgent care clinics while expanding into other markets in Froedert’s footprint in the greater Milwaukee area.

Carbon is a name that I continue to keep a close eye on. The tech-enabled primary care player is growing aggressively through recent acquisition like its recent purchase of MedPost’s SCal footprint, bringing its total clinics to around 120.

Although the Covid boost to revenues and profitability for urgent care ops has likely played itself out (leading to some ‘Rona related layoffs), Carbon still has plenty of opportunities for growth in its core business and to continue to transform primary and urgent care at health systems into high quality offerings.

While there may be some pain short term given the capital environment and wind-down of the ‘Rona tailwinds, I’m optimistic about Carbon’s future as a viable offering for other health systems.

agilon – MaineHealth

In March 2022, agilon announced a notable partnership with MaineHealth, an integrated nonprofit health system with at least 9 hospitals and plenty of other outpatient care settings, to transition MaineHealth’s primary care delivery system to agilon’s platform.

The deal terms for agilon makes me think it’s a major win for the physician enablement platform. Under the new partnership, agilon expects to reach 80k additional Medicare Advantage lives and now has a presence in 12 states, 25 markets, 23 physician groups, and 2200 primary care physicians.

You guys know how bullish I am on the provider enablement space given my investment thesis on the future of the physician space. The biggest challenge for agilon and these other players – at least, as it relates to selling into health systems – is whether or not hospitals are willing to take the plunge into risk-based contracts. Health systems like and enjoy what is predictable and are resistant to change given their size and desire to maintain consistent revenue streams.

With that being said, Covid opened up the opportunity and appetite for risk-based contracting given the severe drop-off in fee-for-service revenues with the suspension of elective procedures and the drying up of ER visits (apart from Covid-related patients). In addition, fee-for-service and productivity models lend themselves to clinician burnout, the ramifications of which health systems are still dealing with in 2022 given staffing shortages across departments.

Risk-based stuff has started and will continue primarily with Medicare, but I imagine in the next 5-10 years we’ll start seeing some more substantial agreements being made on the commercial side. Time will tell!

Contessa/Amedisys – Baylor Scott & White

Amedisys’ Contessa Health, its hospital-at-home segment announced a partnership with Dallas health system Baylor Scott & White on June 9, 2022. The joint venture will extend new at-home care models, including hospital-at-home, SNF-at-home, and other care to eligible patients starting in 2023.

Although most of these programs are only available via waiver while the public health emergency continues on, it’s clear that most provider organizations believe that at-home care models like HaH are here to stay.

When Amedisys purchased Contessa back in 2021, Amedisys claimed that its TAM nearly doubled from the $250 million acquisition. It’s clear that Contessa is already paying dividends by forging new relationships with health systems akin to LHC Group’s strategy.

After purchasing Contessa Health, Amedisys has shifted its strategy to focus on Contessa as a core part of the business. Like I touched on in my LHC-Optum deal analysis, hospital-at-home is a huge path forward for home health, and focusing on high acuity in the home is a major opportunity if it’s achievable.

Privia – Surgery Partners

Surgery Partners announced a strategic partnership with Privia Health on February 3rd, 2022.

As part of the deal, Privia gets its foot in the door into the Montana market by buying into Great Falls Clinic, a physician practice wholly owned by SGRY. The buy-in will give Privia the ability to expand in the Montana market, acting as Privia’s ‘anchor practice’ in the state (65 providers, 24 specialties). The two companies will also establish a management company, of which Privia will be the majority owner.

Privia’s primary pursuit is to transition traditional fee-for-service practices into value-based arrangement in order to take on risk, which is also its biggest opportunity economically speaking. Surgery Partners is a significant partner to draw an agreement with and outpatient surgery is on the rise. Both Tenet’s USPI and Optum’s ASC segments are growing like wildfire, so keep an eye on this space and Privia’s presence here.

Strive – Bon Secours Mercy Health

Strive Health announced a notable partnership with Bon Secours Mercy Health in May 2022. Under the arrangement, Strive will manage BSMH’s chronic kidney disease patients through its platform and has been deploying its model through several health systems. CKD is in chronic need of change and needs innovation to make up for its lack of funding, so I’m excited to see how these partnerships develop.

The partnership will give Strive access to 8,000 CKD and ESRD patients across BSMH’s Ohio footprint, which brings Strive’s total number of managed up to 50,000 individuals struggling with kidney diseases.

Fresenius – InterWell – Cricket

Another big kidney care announcement happened on March 21, 2022 related to a new value-based care kidney merger. Fresenius Health Partners (a value-based subsidiary of the larger Fresenius), InterWell Health (a nephrology network), and privately held startup Cricket Health are merging to form a $2.4 billion VBC kidney care company.

The newly merged company will operate under the InterWell brand and will manage 100k covered lives. The combined entity has a $170 billion TAM and $6 billion in costs under management in what I imagine will be a fast-growing operation given the Fresenius backing.

To go along with the above scaled operation, InterWell 2.0 will benefit from great financial support & access to capital from the larger Fresenius org as well as several financial & healthcare investors including Cigna Ventures and Blue Cross.

This is a pretty dang big deal for the VBC push in the end-stage renal disease world along with the Strive partnership mentioned above. There is a lot of positive momentum in the kidney care space.

Even though the $2.4 billion merger is a drop in the bucket in the context of the larger ESRD market, it’s a sign of things to come as CMS is experimenting around with alternative payment models in the space, & Fresenius is the largest participant in the new APM for kidney care.

Along with the above joint ventures, healthcare giants Medtronic and DaVita most recently are teaming up to launch a new kidney-focused medical device company, announced on May 26, 2022. Based on the press release comments, NewCo will focus on developing new types of kidney failure therapies as well as work on new home-based products.

As you can see, lots happening for those mid-to-lower back organs.

Transcarent – Rush

After closing a $200 million funding round in early January (GREAT timing there, sheesh), Transcarent got busy quickly in what were probably already ongoing talks to partner with Rush University System for Health.

Notable about the funding round, Northwell Health, Rush, and Intermountain, three large health system players across New York, Chicago, and Salt Lake City, respectively, invested in the Glen Tullman-run digital health platform.

The partnership (announced Feb 2022) will allow 9k RUSH employees and associated family members to get access to Transcarent’s care team, which includes services across a number of verticals and robust healthcare offerings, most of which looks to be running through RUSH’s Centers of Excellence.

Transcarent’s focus on self-insured employers makes a ton of sense for health systems that already have built out services offerings across a substantial geographical area.

Thanks to Anil Saldanha on Twitter for reminding me of this deal announcement!

CareMax – Steward

In one of the more significant value-based deals announced in 2022, CareMax announced the acquisition of Steward Health Care’s Medicare Advantage business, comprised of 171,000 lives across 8 states. The deal creates one of the largest independent MA-focused value-based platforms in the U.S. and will close sometime in the back half of 2022.

Deal structure: CareMax acquires Steward’s MA service line (Steward VBC) for $135 million in cash and stock. The value-based player will now serve as Steward’s exclusive management service organization (MSO) for Steward VBC.

As part of the deal structure’s earn-out provisions, CareMax will need to convert an additional 100,000 FFS lives to risk and will have to maintain an 85% MLR for two consecutive quarters to maximize the provisions.

Steward Gets: $25 million in cash, 21% CMAX ownership immediately, and up to 41% ownership in CareMax equity (if earnouts are achieved). Steward also offloads $72 million in VBC A/R offloaded to CareMax, a very non-significant working capital value that CareMax is now funding.

CareMax Gets: Access to 50,000 MA lives, 112,000 MSSP lives, and 9,000 direct contracting lives, along with the opportunity to convert 830k+ additional members to risk, along with some of the best ranking and performing ACOs nationally. CareMax identified the transaction as a $1.6B to $1.7B revenue and $100M to $110M EBITDA opportunity (implied 6-7% margin) by 2025, assuming pretty rosy projections I detailed more below. The firm’s total value-based footprint would jump to 2,000 providers across 200,000 senior lives in 30 markets.

I wrote about this pretty recently – you can read my full analysis of this deal in the June 7 Hospitalogy edition here!

I wouldn’t be doing this space justice if I didn’t also mention the Oak Street and Advocate Aurora partnership which was announced all the way back in 2019!! What’s the latest development here? Could Oak Street conceivably do something similar with the Advocate & Atrium footprint by managing Medicare ACO lives? Surely there’s a large opportunity to be had here.

Conclusion

I’m extremely excited about the continued penetration of tech-enabled services injecting their innovative models into health systems. It’s a win-win in my mind. The digital health firm gets immediate patient scale, access to health system capital, and a partner with great brand presence in that market.

The health system gets to diversify revenue streams, outsourced to a specialized operator, and, most importantly, provide the patient with a better holistic experience and outcome.

Here’s the only thing that digital health firms might want to be wary about. Does attaching yourself to one health system in a particular market hamstring your future growth and ability to reach other hospitals and systems in that market? This move is something that operators and decision makers will have to figure out, and I’m glad I’m not the one having to make those decisions!

Which health system – health tech partnerships did I miss? Which ones are you eyeing? I’d love to hear more about how digital health players are partnering with the Old Guard of healthcare to make the system better for everyone.

Miscellaneous Maddenings

• Ohio State has officially, successfully trademarked the word THE. This is almost as bad as A&M claiming a football national championship in the 30’s.
• A little late to the game here, but I just finished the Broken Earth trilogy and really enjoyed it. The whole series was solid but I preferred the first book in particular. Looks like it’s getting a film or TV adaptation soon, so be on the lookout for that.
• CALM launched a very real, very touching suicide prevention campaign posting pillars of the last images of loved ones.

Hospitalogy Top Reads

• Jan-Felix dropped another great piece on value-based care enablers, including factors involved with transitioning to risk and the players involved in those spaces.
• Last week, Chrissy Farr wrote about the gaps in virtual care – where virtual care fits in, and where it needs supplementation.
• Tejas Inamdar wrote about Maryland’s all-payer hospital state payment system and its interesting origins
• Pitchbook published another brief on the top PE players in elder and senior care. Lots of big names with big investments here.

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