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Chair of the Board

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About ATA: As the only organization completely focused on accelerating the adoption of telehealth, ATA is working to change the way the world thinks about healthcare. We are committed to ensuring that everyone has access to safe, effective, and appropriate care when and where they need it, enabling the system to do more good for more people. We represent a broad and inclusive member network of technology solution providers and payers, as well as partner organizations and alliances. Together, we are working to advance industry adoption of telehealth and virtual care, promote responsible policy, advocate for government and market normalization, and provide education and resources to help integrate virtual care into emerging value-based delivery models.

COVID-19 Updates with the American Telemedicine Association

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CEO & Founder

Clinical trials have been transforming at a rapid pace to adapt to a drastically changed world as a result of the pandemic. Just like during any major event in history, there are those who readily seek new technologies and methodologies and emerge as winners. Those reluctant to adapt to their environment are left in the dust. To illustrate this reality, only 10.4% of Fortune 500 companies have survived since 1955. Blockbuster Video was late to realize the importance of online video-streaming technology, passed up on the opportunity to acquire Netflix, and became part of history after only a few years. Meanwhile, many clinical trial sponsors and CROs are beginning to realize that the traditional way of conducting clinical trials is becoming quickly antiquated. In addition to the need for new technology that enables remote and hybrid trials, there is a need for better quality data coming directly from the patient. What is Real World Data for the patient, study sponsor, or for the researcher? We can first start with what Real World Data is not. Real World Data is not the bulk purchase of de-identified data sets. It is not static data, a snapshot of someone’s health at one point in time. For it to be Real World Data, then, it must be real-time and longitudinal. It also must account for all people including people in under-served communities who are especially vulnerable and have suffered disproportionately during the pandemic. In other words, Real World Data needs to capture how and where people live, ease of access to healthcare, as well as other important social determinants of health.  Patients, as well as their family and caregivers, need seamless access to their longitudinal health timeline. Improved access to key health history of study participants can greatly improve the effectiveness and efficiency of clinical trials, while lowering their cost. For study sponsors, access to high quality, multidimensional Real World Data is extremely valuable for running analytics, machine learning, and AI to gain important insights for drug development. Researchers would like to measure the safety, efficacy, and quality of drugs. Most importantly, patients need to be engaged with their health data to ensure retention in the trial. Patients who had a great experience are more likely to return for future trials for which they qualify. To keep up with the rapidly changing environment and to emerge as a winner, CROs, Pharmaceutical companies, and life science enterprises need to embrace Real World Data that is patient-centric, longitudinal, multidimensional, and real-time. This will lead to more meaningful insights and Real World Evidence as well as better, faster, and cheaper clinical trials. Study participants will enjoy a better experience, and researchers will have access to better quality outcomes data, all feeding into the positive feedback loop leading to improved future trials.  Real World Data has tremendous value not just for Pharma but across the entire healthcare spectrum. Healthcare providers, especially those specializing in oncology or rare diseases, need the patient’s health history, often across multiple providers scattered across the country, to quickly onboard the patient, accurately diagnose the disease, and provide effective intervention as well as long-term follow-up care. Having a longitudinal health record not only saves time, it can save lives. Patient records are often offered in paper or CDs and typically take a minimum of 4-6 weeks to obtain with patient consent. The result is often a thick binder of health data that is not standardized, not intuitive, and cannot be readily utilized.  Providers and payers are now subject to the Interoperability and Patient Access final rule. On April 30, 2021, the requirements for hospitals with certain EHR capabilities to send admission, discharge and transfer notifications to other providers went into effect. On July 1, 2021, CMS began to enforce requirements for certain payers to support Patient Access and Provider Directory APIs.  Healthcare insurers are also adopting a patient-centric mindset as a result of the legislation. To truly adopt a patient-centric mindset is to anticipate the needs of the patient and provide them a comprehensive view of their health on-demand. With this, patients will be better able to identify actions that lower certain health risks. In addition, payers will be able better engage their patients and their caregivers, leading to an improved care journey. Payers will be able to capitalize on improved risk adjustments from access to real-time data. Patients could then benefit from a healthy lifestyle through lower insurance premiums. Real World Data is only real when the patient is in complete control of aggregating and sharing their EHR, genomics (DNA), wearables and medical devices. Pharma, payers and providers all obtain tremendous value from Real World Data. It is time they realize what is real and what is not.

The Future of Health Data: Real World Data is only Real when it includes the patient

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Managing Director, Life Science & Healthcare

This October, Silicon Valley Bank, a division of First Citizens Bank, published its annual<a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=blog&amp;utm_medium=events&amp;utm_campaign=us-2023-10-lg-sp-na-na-lh-na&amp;utm_content=na" target="_blank" style="background-color: transparent; color: rgb(0, 0, 0); font-size: 12px;"> </a><a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report?utm_source=blog&amp;utm_medium=events&amp;utm_campaign=us-2023-10-lg-sp-na-na-lh-na&amp;utm_content=na" target="_blank" style="background-color: transparent; color: rgb(11, 76, 180); font-size: 12px;">Future of Healthtech 2023 Report</a>, a comprehensive overview of the VC-backed healthtech innovation marketplace. The report contains a deep dive on the value-based care (VBC) space, including key trends, venture investment, opportunities and challenges in VBC. Mind the (care) gapThe US healthcare system has long struggled with steadily rising healthcare costs, overburdened providers and poorer relative outcomes. Even though the US spends much more of its GDP on healthcare than other countries, it has worse results. Compared with other high-income countries, the US has the highest rate of preventable deaths and infant deaths. The US has a history of inequality in access to care, with people of color and low-income individuals more likely to experience adverse health outcomes than the rest of the population. These issues stem in part from an inefficient fee-for-service (FFS) reimbursement model, which dictates how providers are paid. Under FFS, providers are paid for each service they provide and are rewarded for volume – they’re paid more if they deliver more care, even if they don’t achieve desired health outcomes. Because the FFS model focuses on volume rather than quality of care, it creates misaligned incentives for providers. VBC aims to change this dynamic by tying the reimbursement providers receive to the results they deliver to patients, rather than care volume. Providers are rewarded for hitting certain healthcare outcomes, quality and cost measures. Challenges Despite recent momentum, VBC’s adoption comes with challenges. One of the biggest hurdles is the financial risk providers must take on to participate in VBC contracts. Risk-based reimbursement models take time to achieve profitability, which is a risk that providers and investors are taking on at different levels. Most providers were built in a predominantly FFS system and must take on the operational and technical challenges that come with adapting to VBC, including care coordination, risk assessment and health outcomes measurement, all while navigating the limitations of the differing state CPOM (1) laws. Meaningful capital is also required to meet upfront capital reserves and there is a long delay in receiving cash shared savings payments. Undeniable pressure and momentum Though VBC adoption is still a work in progress, there is impressive recent momentum that is guiding the transformation. CMS is leaning further into VBC models, and in 2022 announced its aim to have all Medicare beneficiaries cared for by providers in VBC models by 2030. Payers, who are feeling the squeeze of rising medical costs, are doubling down on VBC models and growing partnerships with primary and specialty care VBC companies. VBC enablers, which offer technology-driven solutions to help providers and payers adopt VBC models, are seeing substantial growth and VC investment. Providers are realizing that while VBC comes with risk, it also allows for better outcomes, less administrative burden and more predictable revenue, with freedom to use those dollars more flexibly to meet patient needs. They can spend more time on preventive, holistic, equitable care that FFS models didn’t adequately support. Several recent strategic acquisitions by large payers and retailers in the VBC space have contributed to the positive momentum. This momentum is likely to accelerate as we see more incentives and government initiatives, better outcomes measurement data from early adopters and new innovative technology solutions. With the current strains on our system growing to unsustainable levels, the pressure has never been higher for VBC adoption and innovation in this space.Value-based care market map (2) <img src="https://lh7-us.googleusercontent.com/i8h-b0BoBycqKvJ7YHto2odvEtyWY-dvjG4kqXGUI5DKrBwCb6Od5fXnKTcqb0s3UGqIQK85P4dzJa7FnnzuHylDg9VBm2vTmtEGpXN5R34xVmKmbBVVeYnYX7wRUGrnz8wLo8nhHDvoBUbvJ6udDCg"></img>The spectrum of value-based careThe definition of VBC is subject to debate, but in the broadest sense, we consider it to include risk-taking entities, the companies caring for specific, high-cost populations (even if they do not take financial risk), as well as the technologies, products and services that enable the shift to VBC. Thus, the business models of VBC companies vary widely: Some derive 100% of their revenues from shared savings, some receive a combination of FFS revenue and shared savings, and others contract with risk-taking entities and are paid on a per-member-per-month (PMPM) basis. Full or global risk models involve two-sided risk, whereby providers share in both the upside of savings and the downside if care costs more than estimated. If costs come in lower than the benchmark, providers retain a predefined portion of the savings dollars. On the flip side, costs that are higher than the benchmark result in loss. Moderate risk models can involve one-sided risk or a capitated amount. Others take on no direct risk but offer tech powered solutions to enable providers and payers to adopt VBC models. As these tools evolve, we anticipate more payers and providers to dive deeper into VBC risk. Many companies have a combination of these various revenue models and risk levels, allowing providers and payers to dip their toes into VBC. We have also seen a recent burgeoning in specialty care VBC companies, which focus on patient populations that are both complex and high cost, such as kidney care, oncology and cardiology. Payers and primary care VBC companies are reducing risk by sub-contracting care to specialty care companies like Thyme Care and Strive Health.Mega-deals: VBC is a bright spotIt is not surprising that there has been a 116% decrease in mega-deal3 investments from 2021 to 2022 and 80% decrease from 2022 to 2023 given the bonus of cash companies raised in 2021 and 2022. Despite there being a lot of available investment dollars on the sidelines, investors are being disciplined on valuation. Many later-stage companies are revising growth projections and cutting costs to avoid fundraising this year to escape difficult valuation conversations. Valuations were very generous in 2021 and 2022, supported by strong public markets, which we do not have today. However, VBC is a bright spot, with half of this year’s mega-deals focused on VBC delivery or enablement: Carbon Health, Monogram Health, Strive Health, Aledade and Vytalize.  <img src="https://lh7-us.googleusercontent.com/OfqOnGRb7hJUzkdkfRdSARTuukNYEfGzPzWrTHsILGP0CBTgLjGsIyR6SSw6bKs4w0EPeJKK2zgJcuN5Or0j_ZZk4ko7KrrcjBHPaI6SvqYODdMvKN7-t65PhCPQiU1Z2xsySGA9p7uXTIKfIo7Rp1o"></img>Source: SVB’s Future of Healthtech report, Oct. 2023.  To view the full report, please visit<a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report" target="_blank" style="background-color: transparent; color: rgb(0, 0, 0); font-family: Arial, sans-serif; font-size: 12px;"> </a><a href="https://www.svb.com/trends-insights/reports/healthtech-trends-report" target="_blank" style="background-color: transparent; color: rgb(11, 76, 180); font-family: Arial, sans-serif; font-size: 12px;">https://www.svb.com/trends-insights/reports/healthtech-trends-report</a>Notes:<ol><li>Corporate Practice of Medicine</li><li>List is not exhaustive, select healthtech companies represented</li><li>Mega-deals are venture-backed investments ≥ $100M</li></ol>This material, including without limitation to the statistical information herein, is provided for informational purposes only. The material is based in part on information from third-party sources that we believe to be reliable but which has not been independently verified by us, and, as such, we do not represent the information is accurate or complete. The information should not be viewed as tax, accounting, investment, legal or other advice, nor is it to be relied on in making an investment or other decision. You should obtain relevant and specific professional advice before making any investment decision. Nothing relating to the material should be construed as a solicitation, offer or recommendation to acquire or dispose of any investment, or to engage in any other transaction. All non-SVB named companies listed throughout this document, as represented with the various statistical, thoughts, analysis and insights shared in this document, are independent third parties and are not affiliated with Silicon Valley Bank or First Citizens Bank &amp; Trust Company. All third-party trademarks, logos, and brand names are the property of their respective owners and are herein used for informational purposes only. Any predictions are based on subjective assessments and assumptions. Accordingly, any predictions, projections or analysis should not be viewed as factual and should not be relied upon as an accurate prediction of future results.

The State of Value-Based Care

Blog - 0215

On February 29, the Economist published an article succinctly titled “COVID-19 is now in 50 countries, and things will get worse.” They were very right. Exactly a month later, on March 29, the World Health Organization reported that 203 countries, areas or territories have been affected by the outbreak. Countries have been working furiously to “flatten the curve” – lower the reproductive rate of the virus -- to ease the burden on healthcare systems, buy time to find new treatments, and reduce the total number of infections throughout the course of the pandemic. With “social distancing” the key weapon in this fight, approximately 2.6 billion people, or one-third of the world’s population, are now under complete or partial lockdown. Large gatherings, day-to-day activities and business as usual have halted.  While there is no escaping the disruption this crisis is causing, there is a lot that employers can do to support their employees and employees’ families that will have a meaningful impact. Our Health on Demand research found that employees typically have a good deal of trust in their employers, and the steps you take now to help maintain their well-being -- physical, emotional, financial, and social – will echo far in the future. Here are 10 ways employers can help empower their workers to push through the uncertainty and persevere: <ul><li>Err on the side of over-communicating. Consistent communication can convey strong leadership, avoid confusion and reduce anxiety. A well-organized and supported COVID-19 communications team can take in the evolving information, distill the key implications, and distribute it effectively to the workforce. Remind employees and their managers of the support resources available through the company and in the public. </li><li>Provide testing &amp; coverage information. Employers who sponsor medical, life, disability, accident and special-risk insurance (such as business travel and expatriate coverage) should be familiar with the terms and conditions in their policies testing coverages, eligibility requirements and unique provisions for quarantine. Employers should also pay special attention to public health, law, and policy updates in their geography for further implications to testing and coverage information. Consistent messaging by managers about access to health benefits and leave is critical during a crisis. </li><li>Support mental health &amp; wellbeing. The COVID-19 pandemic is already resulting in increased stress, depression and anxiety. Employers have a role in communicating information and providing mental health support for their employees. Educating managers, making services available for those affected, and communicating the availability of Employee Assistance Programs and other support services (e.g., tele-therapy) that are in place will help to mitigate the mental health impact of the pandemic. </li><li>Encourage telemedicine. If you are an employer that provides telehealth benefits, it is imperative to communicate to employees the support that is available to them and the services available. Unnecessary exposure to infection at hospitals and care centers can be avoided through virtual care. Telemedicine or other forms of virtual care are good options for many issues. </li><li>Assist with pharmacy changes. Employers should support early refills (including for behavioral health-related prescriptions) and home delivery through a local pharmacy in order to minimize trips by employees to the pharmacy. Many employer are considering or have implemented a one-time override to allow for 90-day supplies of specialty medications. Furthermore, some employers have also extended the duration of existing authorization approvals for items such as prior authorization, step programs and quantity limit overrides to limit administrative burden, while continuing to do so for newly initiated therapies. </li><li>Leverage reliable resources. In your communications, be sure to direct employees to reliable sources of information on COVID-19, such as the WHO, Center for Disease Control (CDC), and their local public health entities. Reinforce to employees and their families that they should reference those and communications from you as their sources of truth as opposed to the 24/7 news cycle or social media. </li><li>Manage communications with local health systems &amp; public officials. A robust preparedness plan comprises governance structures, clear protocols and lines of communication. It also includes assessing supply chain viability and collaborating with public health entities. The National Association of County and City Health Officials (NACCHO) has put together a Directory of Local Health Departments by state. Be sure to monitor local, state and national legislative updates to understand what else you can do to support your employees and society to flatten the curve. </li><li>Put policies &amp; processes in place. All employers should review their existing pandemic crisis management and response plans and establish new protocols for the current environment as needed. Employers should seek legal counsel and follow the direction of local public health department officials if there are concerns about known, suspected or high-risk cases. If an employee is found to have been exposed to COVID-19, there should be protocols for transport, communication and decontamination.  </li><li>Comply with occupational health needs. To ensure employee safety, check to see if company policies are in alignment with the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the Environmental Protection Agency (EPA). As businesses resume operations and individuals return to work during the COVID-19 recovery phase, all employers must manage fitness for work and other occupational health practices to keep the workforce safe. </li><li>Think innovatively. Many organizations are innovating to support their workforce. We have seen employers adding hospitalization cash allowances, enhanced mental health benefits, special caregiving benefits, even allowances for creating a comfortable home-working space. Employers are also finding new ways to manage employees in the remote working culture, with innovative training and tools. Looking outside the box for solutions can help employees to thrive inside their homes. </li></ul>While it is important to ensure that employees have access to continually updated information, it is just as important to show empathy to ensure your key messages get through. In addition, as your organization works through this stressful process, remember to take notes! Lessons learned will help pinpoint and address vulnerable areas in your business and human capital strategies in preparation for the next crisis.

Ten Ways for Employers to Assist Their Employees during the COVID-19 Outbreak

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