Pearl Health finds a Pearl: Walgreens

Pearl Health teams up with Walgreens

“It’s thought that approximately one in 10,000 wild oysters yields a pearl; only a fraction of those, still, will be large and lustrous enough to make for a lucky find — your chances of this, it turns out, are about one in a million.” – Pearl Health 2022 year in review

Pearl Health, a physician enablement player primarily focused on ACO REACH to this point, just found its one in a million oyster. On September 12, Pearl announced a strategic collaboration with Walgreens. While the details surrounding the partnership itself are a bit high level (for now), Pearl just set itself up for potentially a huge win with a national player that owns one of the largest healthcare delivery organizations in the country in VillageMD.

Here’s the initial scope of the capital-light joint venture:

• Pearl: will provide its tech and analytics to identify patients that can benefit from Walgreens-led healthcare programs
• Walgreens: will provide prescription fulfillment, medication adherence, immunizations, care gap closure, diagnostic testing, and discharge transition management to the JV

Per Axios, it seems like Walgreens will look to provide MSO services to health systems and physician practices. “The idea is to marry Pearl’s operating system and capabilities to Walgreens’ care delivery assets. Walgreens will act as a management services organization for doctors and hospitals, he said.”

More on Walgreens: Over the past few years , Walgreens has put down some significant capital on healthcare in an attempt to redefine its business, namely VillageMD:

The most significant of these plays was acquiring Summit Health, a hybrid urgent care – physician practice platform, for $8.9 billion in late 2022.

VillageMD is a hell of a healthcare delivery vehicle. Along with the below, VillageMD/Summit is sneakily one of the largest employers of providers in the US with 4,100 as of the last update.

But a transformation like one Walgreens is undertaking doesn’t happen overnight, and people are skeptical. Now it looks like Walgreens needs some help. After a 40% decline (and a 60% 5-year decline) in stock price, along with announcing a CEO transition right after a dismal quarter, the writing is on the wall.

*Oof. C’mon now! Low blow.*

Enter Pearl Health.

Pearl raised $75M in January 2023 in a Series B led by a16z ($20M of which in debt), bringing its total funding raised to over $100M after an $18M Series A in September 2021.

Since that raise, Pearl has scaled to working with 800 primary care providers, expanding to 29 states with plans to grow to up to 2,500 physicians by the end of 2024:

(Source)

Right before this, Pearl also notched a partnership with Santé Physicians IPA out in California, a 1,000 physician-strong group, providing the affiliation with Pearl’s tech capabilities.

Based on the geographic overlays above, the two footprints look very complementary, potentially meaning that Walgreens intends to scale Pearl where VillageMD isn’t. It’s an expansion play to leverage Pearl along with Walgreens Health assets not named VillageMD, reaching new physicians and patients faster than they could on their own.

While most advanced primary care players are aligning with specific payors (OSH-Aetna, CenterWell-Humana) Walgreens’ strategy is to capture the long-tail payor market. In a recent Axios article:

“How we differentiate ourselves is, we want to be able to partner with every health plan, every health system every, doctor,” John Driscoll, executive vice president and president of U.S. healthcare at Walgreens Boots Alliance, told Axios.”

Walgreens is positioning this MSO to create a compelling, payor-agnostic MSO model that includes home care, retail pharmacy, DME, and specialty pharmacy components that other MSOs likely cannot match. That could create a compelling offering for health systems, which reminds me of the CareMax and Steward Health arrangement.

Bigger Picture: Since its bad Q3, Walgreens had alluded to wanting to find some asset-light care models along with better analytics. Pearl fits that bill nicely as a freshly funded player in a fast-growing area of healthcare. Walgreens is a nice ally from a healthcare delivery footprint perspective, and also a drug distribution perspective. Advanced primary care activity continues to stay red-hot, as laggards like Walmart and Walgreens catch up to stay relevant in the new paradigm of retail health. We’ll see how big the scope of this partnership actually gets, and it’ll be fun to watch!

Partnerships and Strategy Updates:

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

Telehealth Regulation Rift: Senators opposed DEA’s proposed telehealth guidelines, citing potential adverse impacts on patient care. This is a developing story, so stay tuned. (Link)

Akili’s Model Shift: Akili Interactive Labs pivoted away from its prescription model, opting for a DTC route, and also resulting in a 40% workforce reduction. Might as well pivot to video game development and sell your product on Steam, then. I’m half joking. (Link)

Value in Risk: Lumeris wrote a nice article on how two-sided risk models need to be the norm for the future of value-based care. I wholeheartedly agree, considering it’s called risk for a reason! “two-sided risk Accountable Care Organizations (ACOs) generated savings over double the amount per beneficiary compared to their one-sided counterparts.” (Link)

Decongestant Doubts: In a kind of insane development, it turns out that the FDA kept cold drugs on the market that essentially…didn’t work? And they knew this info…since 2007? (Link)

Medical Cost Variation: The latest site neutral slam-piece study is out from BCBSA, which identified disparities in reimbursement based on site of service. Jokes aside, continue to keep an eye on potential site-neutral regulation. It has been a discussion point for quite some time now. (Link)

CMMI’s New Models: CMMI is looking to unveil two new payment models in behavioral and maternal health later this year, pending a government shutdown. The programs would include heavy-Medicaid involvement. (Link)

White Bagging 2023: A good update from Drug Channels discusses white bagging in healthcare, and whether it’s saving money or simply shifting costs. (Link)

Centura Health Breakup: Centura Health’s partnership ended due to divergent visions, as expressed by Centura’s former CEO. Looking at an article like this about a former joint operating company between two large health systems, I can’t help but think that the cross-market megamergers may suffer a similar fate as far as strategic direction and governance woes. (Link)

ICHRA Adoption Rate: A study revealed that 89% of employers might consider ICHRAs for health benefits within the next three years. (Link)

Obamacare’s Rebound: An interesting report from Politico dove into how an initially disastrous Obamacare initiative – co-ops – experienced an unexpected recovery in 3 entities. (Link)

PBM Reform Insights: A recent Brookings Institution piece argued that the proposed PBM reforms in Congress might be ineffectual or even counterproductive. Sick. (Link)

Orthopedic Care Evolution: McKinsey wrote a nice analysis on enhancing U.S. orthopedic care through identification of patient-centric pathways. (Link)

24/7 Virtual Care: Atrium Health launched a digital front door for patients, now offering around-the-clock virtual primary care services. (Link)

Healthcare Provider Supply: Trilliant Health analyzed the distribution of physicians and allied health providers across major U.S. regions. (Link)

Partnership Announcements:

• In late August, Alo formed a CIN in collaboration with Blue Cross NC (Alo is the physician enablement JV formed in November ‘21 between BC NC and Deerfield Management). Alo also partnered with Innovaccer on VBC analytics and its data platform. “The Alo CIN currently has more than 30 participating independent practices and provider groups that share a passion for delivering high-quality care and better value to more than 100,000 covered lives throughout North Carolina.” (Link)
• Geisinger expanded its partnership with Best Buy Health and Geek Squad to bolster tech-driven care at home. (Link)
• Navina and Privia Health collaborated to empower physicians using transformative AI technology. (Link)
• CHS collaborated with Mindoula to introduce virtual behavioral health services to its 700 affiliated PCP offices. (Link)
• GE HealthCare partnered with Mayo Clinic to speed up advancements in imaging and AI. (Link)
• Mark Cuban Cost Plus Drug Company partnered with COPD Foundation to expand access to Tiotropium Bromide Inhalation Powder for chronic obstructive pulmonary disease patients in the U.S. (Link)
• GoodRx joined forces with Walgreens to reduce prices for 200 medications. (Link). GoodRx also formed a partnership with MedImpact for prescription drug discounts. (Link)
• Dana-Farber and Beth Israel Deaconess announced plans to open a standalone cancer center. (Link)
• Kroger Health partnered with Performance Kitchen in a food-as-medicine play to provide medically tailored meals for chronic conditions. (Link)
• Carrum Health announced its affiliation with the White House CancerX Initiative to expedite innovative cancer care solutions. (Link)
• ShiftMed partnered with Hennepin Healthcare for on-demand, W-2 workforce solutions. (Link)
• Tampa General Hospital adopted the ThinkAndor Virtual Hospital system. (Link)

Hospitalogy Top Reads

My favorite healthcare essays from the week

• Carbon Health’s CPO Ayokunle Omojola penned a great analysis and thought-provoking piece on How to build sustainably differentiated tech enabled healthcare services businesses: “My hypothesis is that innovations in reimbursement, operations, or patient acquisition correlate more highly with success, than clinical innovations do. Even if you discover an approach with better clinical outcomes for patients, unless you also have figured out the economics in advance, you’ll likely be out of business before payors adopt it (because there’s no actual urgency for them to adopt it).” (Link)
• How Epic took over the hospital market – a great dive into Epic’s strategy from ModernHealthcare’s Gabriel Perna. (Link)
• a16z’s latest essay focuses on ‘jobs to be done’ in healthcare given the two emergent use cases: intelligent aggregation of large datasets to inform decision-making; and labor-intensive tasks with little / no software adoption in the arena. Nice little chart below. Near term, I’m much more bullish on the admin & back-office functions than the clinical side of things. The essay is a nice little breakdown of their investment thesis. (Link)

• Trilliant Health took a nice data-driven dive into the supply of various physician, clinician and APP groups across select markets. (Link)
• Devoted Health published an interesting paper on its care delivery model Patient Priorities Care – a clinical framework designed to align primary and specialty care around patient-specific idiosyncratic needs. (Link)

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