Biggest health insurer plans to deny ER bills if it doubts you had an emergency

Multistory glass-and-brick building with UnitedHealthcare logo on exterior.

Enlarge / UnitedHealth Group Inc. headquarters stands in Minnetonka, Minnesota, U.S., on Wednesday, March 9, 2016. (credit: Getty | Bloomberg)

Doctors and hospitals are condemning plans by UnitedHealthcare—the country’s largest health insurance company—to retroactively deny emergency medical care coverage to members if UHC decides the reason for the emergency medical care wasn’t actually an emergency.

In the future, if one of UHC’s 70 million members submits a claim for an emergency department visit, UHC will carefully review what health problems led to the visit, the “intensity of diagnostic services performed” at the emergency department (ED), and some context for the visit, like the member’s underlying health conditions and outside circumstances. If UHC decides the medical situation didn’t constitute an emergency, it will provide “no coverage or limited coverage,” depending on the member’s specific insurance plan.

Emergency medical doctors and hospitals were quick to rebuke the plan. They say it sets a dangerous precedent of requiring patients to assess their own medical problems before seeking emergency care, which could end up delaying or preventing critical and even life-saving treatment.

Read 18 remaining paragraphs | Comments

#acep, #american-hospital-association, #emergency-medical-care, #health-insurance, #hospitals, #policy, #science, #unitedhealthcare

0

Substack acquires team from community consulting startup People & Company

New media poster child Substack announced today that they’ve added a small community-building consultancy team to its ranks, acquiring the Brooklyn-based startup People & Company.

The small firm has been working with clients to build up their community efforts and its team will now be tasked with building up some of the newsletter company’s upstart efforts for writers in its network.

In a blog post, Substack co-founder Hamish McKenzie said that the company had previously used the People & Co. team to consult on their fellowship and mentorship programs and that members of the team would now be working on a variety of new efforts from scaling programs to help writers with legal support and health insurance to community-guided projects like workshops and meetups to help crowdsource insights.

“These people are the best in the world at what they do, and now they’re not only working for Substack, but they’re also working for you,” McKenzie wrote.

Beyond Substack, previous partners with People & Company include Porsche AG, Nike and Surfrider.

Substack has been blazing ahead in recent months, adding new partners and raising cash as it aims to bring on more and more subscribers to its network. The firm shared back in late March that it had raised a $65 million round at a reported valuation around $650 million according earlier reporting by Axios.

#axios, #brooklyn, #co-founder, #crowdsource, #digital-media, #hamish-mckenzie, #health-insurance, #nike, #porsche-ag, #substack, #tc, #websites, #world-wide-web

0

Risk startup LogicGate confirms data breach

Risk and compliance startup LogicGate has confirmed a data breach. But unless you’re a customer, you probably didn’t hear about it.

An email sent by LogicGate to customers earlier this month said on February 23 an unauthorized third-party obtained credentials to its Amazon Web Services-hosted cloud storage servers storing customer backup files for its flagship platform Risk Cloud, which helps companies to identify and manage their risk and compliance with data protection and security standards. LogicGate says its Risk Cloud can also help find security vulnerabilities before they are exploited by malicious hackers.

The credentials “appear to have been used by an unauthorized third party to decrypt particular files stored in AWS S3 buckets in the LogicGate Risk Cloud backup environment,” the email read.

“Only data uploaded to your Risk Cloud environment on or prior to February 23, 2021, would have been included in that backup file. Further, to the extent you have stored attachments in the Risk Cloud, we did not identify decrypt events associated with such attachments,” it added.

LogicGate did not say how the AWS credentials were compromised. An email update sent by LogicGate last Friday said the company anticipates finding the root cause of the incident by this week.

But LogicGate has not made any public statement about the breach. It’s also not clear if the company contacted all of its customers or only those whose data was accessed. LogicGate counts Capco, SoFi, and Blue Cross Blue Shield of Kansas City as customers.

We sent a list of questions, including how many customers were affected and if the company has alerted U.S. state authorities as required by state data breach notification laws. When reached, LogicGate chief executive Matt Kunkel confirmed the breach but declined to comment citing an ongoing investigation. “We believe it’s best to communicate developments directly to our customers,” he said.

Kunkel would not say, when asked, if the attacker also exfiltrated the decrypted customer data from its servers.

Data breach notification laws vary by state, but companies that fail to report security incidents can face heavy fines. Under Europe’s GDPR rules, companies can face fines of up to 4% of their annual turnover for violations.

In December, LogicGate secured $8.75 million in fresh funding, totaling more than $40 million since it launched in 2015.


Are you a LogicGate customer? Send tips securely over Signal and WhatsApp to +1 646-755-8849. You can also send files or documents using our SecureDrop. Learn more

#amazon, #amazon-web-services, #blue-cross-blue-shield, #capco, #cloud, #cloud-computing, #cloud-storage, #computer-security, #computing, #data-breach, #data-security, #europe, #health-insurance, #securedrop, #security, #security-breaches, #sofi, #united-states

0

As working out goes virtual, Moxie raises $6.3M Seed+ round led by Resolute Ventures

With the pandemic sending the planet indoors to workout, the at-home fitness market has boomed. It was only in October last year that three-year-old Future closed $24 million in Series B and Playbook (streaming for personal trainers) raised $9.3 million in a Series A. Into this market launched Moxie, a platform that allowed fitness instructors to broadcast live and recorded classes, access licensed music playlists and deploy a CRM and payment tools. Classes range from $5-$25 and various subscriptions and packages are offered.

Moxie has now raised a $6.3M ‘Seed+’ funding round led by Resolute Ventures with participation from Bessemer Ventures, Greycroft Ventures, Gokul Rajaram, and additional investors. With the $2.1M Seed round from last October, that means Moxie has now raised a total of $8.4M.

With the funding, Moxie now plans to better optimize the user experience with a curated selection of top Moxie classes; new tools that help connect users to instructors; and the ability to preview classes before attending.

The company claims to have experienced “exponential growth” because of its convenience in the pandemic era, with 8,000 classes and 1 million class-minutes completed in March. Moxie’s independent instructors set their own schedules and prices, and get to keep 85% of what they earn on the platform.

The company will also now launch ‘Moxie Benefits’ in partnership with Stride Health, provide instructors with access to health insurance, dental and vision plans, life insurance, and other benefits.

Also planned is ‘Moxie Teams’, enabling groups of instructors to join together to form small businesses on the platform, not unlike the way some Uber drivers form teams.

Jason Goldberg, CEO and founder said in a statement: “Moxie was born during the pandemic alongside thousands of independent fitness instructors who were forced out of gyms and studios and suddenly had to become entrepreneurs and navigate the new frontier of virtual fitness. Now we are seeing widespread adoption of online fitness into people’s lives, and Moxie’s growth proves that these shifts in consumer behavior have staying power. We know that 89% of Moxie users plan to continue virtual workouts post COVID — they love the convenience.”

Resolute Ventures Partner & Co-Founder Raanan Bar-Cohen said: “Our investment theory has always been to identify entrepreneurial founders solving for today’s problems. With Moxie, we saw an experienced operator in Jason, with a product that solved for the issues that instructors and consumers had experienced in the shift to online fitness, as well as a clear roadmap for continued success.”

So why has Moxie managed to cleave to the new virtual workout culture? Goldberg tells me it’s down to a range of factors.

For starters, it’s a two-sided fitness marketplace that has live interactive group fitness classes, unlike VOD apps, and, crucially, unlike Peloton. Additionally, any instructor can teach on Moxie, rather than wait to be picked as a ‘star’ by Peloton. Since 90% of classes are live group fitness classes, they are effectively replacing yoga studios and HIIT classes, rather than personal training. He says many top instructors are now earning $6-figures on the platform.

Certainly, Moxie has managed to capitalize on the fact that while gyms are closed, it’s easy to do virtual classes. Will they still stick around when the pandemic is over? Presumably many will find it more convenient than schlepping to the gym and less intimidating than joining classes in person. Additionally, users can switch classes as easily as switching TV channels.

As Goldberg told me via email: “Covid forced everyone to try virtual fitness for the first time. Guess what? People found it more convenient and more connected than going to offline gyms. And guess what? Peloton is not for everyone.”

#3m, #bessemer-ventures, #ceo, #co-founder, #companies, #crm, #drinks, #education, #future, #gokul-rajaram, #health-insurance, #jason-goldberg, #life-insurance, #moxie, #online-fitness, #peloton, #playbook, #resolute-ventures, #tc, #uber

0

Ro raises $500M to grow its remote and in-home primary care platform

Healthcare tech startup Ro has raised $500 million to help fuel continued growth of its hybrid telehealth/in-home primary care platform, which also includes a growing pharmacy business as the company pursues a strategy of vertical integration to optimize delivery and reduce costs for clients. The company’s latest raise is a Series D round, and means it has now raised over $876 million since its 2017 founding.

That may seem like a lot of money, but as Ro fo-founder and CEO Zachariah Reitano told me in an interview, it’s actually “peanuts” when it comes to the healthcare industry – which is part of why they founded the company in the first place.

“Sometimes people talk about how great it is to be in the healthcare arena, in tech circles,” Reitano said. “They say, ‘Oh, healthcare is a $4 trillion market – it’s so massive.’  But that’s the worst thing in the entire world; it’s awful how large it is. And I think what we have the opportunity to cut it in half with technology.”

That’s what Reitano says will be the primary focus of this round of funding: Fueling its efforts around vertical integration of healthcare services and technology, to further the eventual end goal of reducing costs to patients through the efficiencies realized in that process.

“To me, what I’m really excited about is being able to continue to invest in that infrastructure and add even more,” Reitano told me. “We’ll continue to invest in telemedicine, we’ll continue to invest in our logistics and pharmacy, and continue to invest in in-home care, as well as the connection between the three, and then we’ll also invest in additional diagnostics, remote patient monitoring – so collecting and distributing devices to patients to go from reactive to proactive care.”

Ro’s model focuses on primary care delivered direct to consumer, without involving any payer or employer-funded and guided care programs. The idea is to reduce costs through vertical integration and other efficiency engineering efforts in order to get them to the point where they’re effectively on par with your out-of-pocket expense with co-pays anyway. Reitano explained that the insurance system as it exists in the U.S. now only effectively masks individual costs, making it less clear that much of what a person pays out in healthcare costs comes out of their pocket anyway, whether it’s through taxation, or employers allocating more of the funds they have available for compensation to healthcare, vs. take-home pay.

Image Credits: Ro

That’s what’s behind Ro’s recent push into operating its own pharmacies, and growing that footprint to include more all the time. Reitano told me that the company will have 10 pharmacies by the end o this year, and 15 by the end of next, all placed strategically around the country to ensure that it can provide next-day shipping to patients at ground shipping rates pretty much anywhere in the U.S.

Doing that kind of vertical optimization has enabled Ro to offer 500 common drugs at $5 per month, including treatments for heart disease, anxiety, depression and diabetes — with a plan to ramp it to 1,000 drugs available at that price by year’s end. That’s roughly equal to the co-pay required for many insurers for the same treatments.

Meanwhile, Reitano says Ro has seen big changes in the healthcare system generally that favor its model and accelerate its hybrid care plans owing to the COVID-19 pandemic.

“I would say that there are two most profound impacts of the pandemic on the healthcare system,” he said. “One is that it simultaneously shed light on all of the inequities for the entire country to see, right at the same time where we all cared about it. So those things were sort of known for the people impacted day to day — the geographic inequity, the financial inequity, the racial inequity. If someone felt that that inequity, then they would talk about it, but it wasn’t something everyone cared about at the same time. So this massive spotlight was shed on the healthcare system. And the second was that everyone’s healthcare journey now starts online, even if it is going to end in person, it will still start online.”

Ro’s model all along has espoused this time of healthcare delivery, with remote care and telehealth appointments handling most day-to-day needs, and follow-up in person care delivered to the home when required. That obviously generate a lot of efficiencies, while ensuring that older patients and those with mobility issues also don’t need to leave the house and make a regular trip into their physician’s office for what amounts to a 15-minute visit that could’ve been handled over video.

Ro co-founders Rob Schutz, Zachariah Reitano and Saman Rahmanian (left to right)

Ro co-founders Rob Schutz, Zachariah Reitano and Saman Rahmanian (left to right)

According to most industry observers, Reitano is likely right that healthcare probably won’t go back to the old, inefficient model of favoring primarily in-person care after the pandemic ends. One of the positive outcomes of the COVID-19 situation has been proving that telehealth is more than capable of handling a lot of the primary care needs of a lot of people, particularly when supplemented with remote monitoring and ongoing proactive health measures, too.

While Ro doesn’t work with insurance currently, Reitano points out that he’s not against the concept entirely – he just says that health insurance as it exists now doesn’t actual work as intended, since it’s meant to pool risk against an, expensive, uncertain and rare outcome. Eventually, he believes there’s a place for insurance in the overall healthcare mix, but first the industry needs to face a reckoning wherein its incentive structure is realigned to its actual core customer – patients themselves.

#articles, #ceo, #depression, #diabetes, #funding, #health, #health-insurance, #healthcare, #healthcare-industry, #pharmacy, #physician, #ro, #tc, #technology, #telehealth, #telemedicine, #united-states

0

Oscar Health’s IPO filing will test the venture-backed insurance model

Late Friday, Oscar Health filed to go public, adding another company to today’s burgeoning IPO market. The New York-based health insurance unicorn has raised well north of $1 billion during its life, making its public debut a critical event for a host of investors.

Oscar Health lists a placeholder raise value of $100 million in its IPO filing, providing only directional guidance that its public offering will raise nine figures of capital.

Both Oscar and the high-profile SPAC for Clover Medical will prove to be a test for the venture capital industry’s faith in their ability to disrupt traditional healthcare companies.

The eight-year-old company, launched to capitalize on the sweeping health insurance reforms passed under the administration of President Barack Obama offers insurance products to individuals, families and small businesses. The company claimed 529,000 “members” as of January 31, 2021. Oscar Health touts that number as indicative of its success, with its growth since January 31 2017 “representing a compound annual growth rate, or CAGR, of 59%.”

However, while Oscar has shown a strong ability to raise private funds and scale the revenues of its neoinsurance business, like many insurance-focused startups that TechCrunch has covered in recent years, it’s a deeply unprofitable enterprise.

Inside Oscar Health

To understand Oscar Health we have to dig a bit into insurance terminology, but it’ll be as painless as we can manage. So, how did the company perform in 2020? Here are its 2020 metrics, and their 2019 comps:

  • Total premiums earned: $1.67 billion (+61% from $1.04 billion).
  • Premiums ceded to reinsurers: $1.22 billion (+113%, from $572.3 million).
  • Net premium earned: $455 million (-3% from $468.9 million).
  • Total revenue: $462.8 million (-5% from $488.2 million).
  • Total insurance costs: $525.9 million (-8.7% from $576.1 million).
  • Total operating expenses: $865.1 million (+16% from $747.6 million).
  • Operating loss: $402.3 million (+56% from $259.4 million).

Let’s walk through the numbers together. Oscar Health did a great job raising its total premium volume in 2020, or, in simpler terms, it sold way more insurance last year than it did in 2019. But it also ceded a lot more premium to reinsurance companies in 2020 than it did in 2019. So what? Ceding premiums is contra-revenue, but can serve to boost overall insurance margins.

As we can see in the net premium earned line, Oscar’s totals fell in 2020 compared to 2019 thanks to greatly expanded premium ceding. Indeed, its total revenue fell in 2020 compared to 2019 thanks to that effort. But the premium ceding seems to be working for the company, as its total insurance costs (our addition of its claims line item and “other insurance costs” category) fell from 2020 to 2019, despite selling far more insurance last year.

Sadly, all that work did not mean that the company’s total operating expenses fell. They did not, rising 16% or so in 2020 compared to 2019. And as we all know, more operating costs and fewer revenues mean that operating losses rose, and they did.

Oscar Health’s net losses track closely to its operating losses, so we spared you more data. Now to better understand the basic economics of Oscar Health’s insurance business, let’s get our hands dirty.

#ec-consumer-health, #fundings-exits, #health-insurance, #insurance, #oscar-health, #startups, #tc

0

LA-based Sidecar Health’s low-cost, cash-pay health insurance service is now valued at $1 billion

Meet Sidecar Health, the newest member of the tech industry’s billion dollar healthcare startup club.

The valuation comes thanks to $125 million in new funding that the company will use to expand its new model for health insurance. Sidecar Health’s insurance plans give consumers the ability to pay directly for care — often at steep discounts to the prices that patients would be charged through traditional insurance plans.

A typical Sidecar Health plan costs $240 per-member, per-month and its flexibility has made it a popular choice for the nation’s 20 million to 30 million uninsured individuals, according to chief executive officer Patrick Quigley.

The core of Sidecar’s plan is an ability to offer its policy holders the ability to pay directly for their medical care — and shop around to find the best provider using pricing information that the company provides through its mobile app.

Sidecar’s app provides real-time, geo-located information on the costs of any number of medical procedures, consultations, or drugs — and allows its users to shop at the places that offer them the best deal — in some cases the company will even pay money back if a price-savvy healthcare shopper finds a better deal.

If this all sounds kind of dystopian and nightmarish — well, welcome to the world of American healthcare!

In an ideal world, low-cost medical care would be a right, not a privilege and a baseline level of healthcare access would be available to everyone — including an ability to pay a set price for drugs, consultations and treatment. But if you live in America, bargain hunting for care may be the best bet to curb skyrocketing healthcare costs — at least for now.

While Sidecar pitches its service for everyone, the average age of the company’s current patient population is 33 years-old, Quigley said.  “It’s typically people that earn more than $45,000 a year and less than $75,000,” said Quigley of the company’s demographics.

The way it works is that Sidecar issues its insured members what’s basically a debit card that they use to pay for care, prescriptions, and consultations directly. The money comes from Sidecar’s claims accounts and is paid directly to doctors. By avoiding the middleman (traditional insurance companies), Sidecar can reduce overhead for care providers who like to get paid directly and will offer discounts in exchange for receiving cash in hand.

“It is 40% cheaper than the traditional commercial insurance companies would pay,” said Quigley.

Sidecar covers around 170,000 medical conditions and procedures, according to Quigley — including things from horse therapy (it’s a thing) for anxiety relief to heart transplants and chemotherapy, Quigley said.

Sidecar is currently available in 16 states and hopes to expand to most of the country on the back of its latest round of funding.

And while the company is working with uninsured patient populations now, it’s hoping to also expand its footprint with government-backed healthcare plans and into employer-sponsored health insurance as well.

It’s still early days for the service, which has only been around through two open enrollment periods for would-be plan members to sign up. And while the company doesn’t disclose its membership figures, Quigley said it would end the year above 30,000 members.

“It’s still super early,” Quigley said. 

Despite the stage of the business, investors are convinced that the business model has an opportunity to transform health insurance in the US. 

“The extraordinary level of transparency Sidecar Health brings to the marketplace has the  potential to fundamentally change how millions of Americans shop for healthcare,” said Molly  Bonakdarpour, a partner at the Drive Capital, which provided early backing for the company. “We think Sidecar Health’s team of consumer,  technology and healthcare veterans is well positioned to capitalize on the large healthcare  insurtech opportunity.” 

For the latest round, Drive Capital was joined by new investors including BOND, Tiger Global and Menlo Ventures, according to a statement.

Sidecar Health will use the investment to expand its geographic footprint, grow its team and  invest in new insurance products that build on its success in the uninsured market. The first of  these will be an ACA or “Obamacare” offering for 2022, followed by a product for the self funded employer market. 

“We believe we can take $1 trillion in waste out of the U.S. healthcare system,” Quigley said. 

#affordable-care-act, #america, #articles, #chief-executive-officer, #drive-capital, #health, #health-insurance, #healthcare, #insurance, #menlo-ventures, #partner, #sidecar, #tc, #tiger-global, #united-states

0

Omnipresent raises $15.8M Series A for its platform to employ remote-workers globally

Omnipresent, which helps companies employ remote-working local teams worldwide, has closed a $15.8M Series A funding round. The fundraise was led by an undisclosed investor with participation from existing investors, Episode 1, Playfair Capital and Truesight Ventures. The company said it closed the round five months after it’s July 2020 $2m in seed round.

Founders Matthew Wilson and Guenther Eisinger started the company as part of Entrepreneur First’s London cohort in 2019.

Omnipresent says it ensures the process of remote-hiring costs a fraction of what it would if the company did it on their own, by using Omnipresent’s platform to onboard employees compliantly in 150 countries. It provides employees with local contracts, tax contributions, and local and international benefits such as health insurance, pensions and equity options. 

In a joint statement, Guenther Eisinger and Matthew Wilson, Co-CEOs of Omnipresent said: “Even before the pandemic we recognized the revolutionary potential of breaking down legal and administrative barriers of international employment. As former business owners, we had first-hand experience of what a headache it is to navigate the complexity and bureaucracy of building global teams. Now with the pandemic and the global shift towards remote working it’s confirmed that we are on the right track.”

Wilson told me in an interview: “For instance, in Canada, we have a Canadian entity and we enter into an employment relationship with that person in Canada, on behalf of our client, so they don’t have to set up any of the legal infrastructure themselves in Canada, or any of the 149 countries that we operate in. We then manage all the ongoing administration of the employment relationship, whether that’s from an HR perspective, from an employee benefits perspective, or if they want to get health care for instance.”

The company competes with other firms like Remote.com and Boundless HQ.

Carina Namih, General Partner at Episode 1 Ventures commented: “While talent is evenly distributed around the world, for too long, opportunities have not been. I have experienced first hand the challenge of hiring globally. Omnipresent has already become a crucial piece of infrastructure for global teams working across different countries.”

Joe Thornton, General Partner at Playfair Capital commented: “Remote work undoubtedly represents the future of the modern workforce. The sooner companies adapt, the sooner they will reap the massive competitive advantage associated with a globally distributed workforce, including increased workforce productivity and satisfaction and a larger and more diverse pool of talent from which to recruit workers.”

Omnipresent said its own employer surveys show that over 85% of employers will be employing remote or international employees in 2021.

#canada, #employment, #entrepreneur, #episode-1-ventures, #europe, #general-partner, #health-insurance, #london, #playfair-capital, #remote-com, #tc, #telecommuting, #truesight-ventures, #workforce

0

CoreCare raises $3 million for managing billing and payments from public health benefit providers

CoreCare, a provider of revenue management services for healthcare companies dealing with public health benefit providers, has raised $3 million in a seed financing round.

The company, which uses machine learning, automates large swaths of billing and revenue cycle management to reduce the burden on hospitals, according to chief executive, Dennis Antonelos.

Already, companies like Creative Solutions in Healthcare, a nursing facility operator in Texas, which operates nearly 80 locations has signed up for the service.

Antonelos started the company in January, had the first product up by March and was accepted to Y Combinator in April. It now boasts over a dozen customers in Texas.

With the new $3 million in hand from investors including Primetime Partners, Goat Capital, Funders Club and Liquid2Ventures, Antonelos said the company would look to expand its sales and marketing and product capabilities.

CoreCare automates processing of billing and paperwork and clinical notes by linking electronic health records and medicare and medicaid information services and payers.

“We’re going through the organization and eliminating administrative waste so the organization can invest newly found resources into patient care,” Antonelos said.

The company uses a standard software as a service payment model and charges somewhere between $300 to $500 per-facility, per-month, according to Antonelos.

“These initial results are outstanding,” said Gary Blake, president, and co-founder of Creative Solutions in Healthcare, and one of CoreCare’s early customers. “In only a matter of months working with CoreCare’s CoreAccess software, we’ve seen a notable impact on our financial position. It has truly exceeded our expectations. CoreCare has changed the way we work with Managed Care, from top to bottom. We have been able to streamline our entire billing process, reduce admin costs, shorten the number of accounts receivable (AR) days and free up cash for growth. Every healthcare provider that works with managed care should work with CoreCare.”

#articles, #goat-capital, #health, #health-insurance, #healthcare, #machine-learning, #medicare, #tc, #texas, #y-combinator

0

Twentyeight Health is a telemedicine company expanding access to women’s health and reproductive care

New York’s Twentyeight Health is taking the wildly telemedicine services for women’s health popularized by companies like Nurx and bringing them to a patient population that previously hadn’t had access. 

The mission to provide women who are Medicaid or underinsured should not be deprived of the same kinds of care that patients who have more income security or better healthcare coverage enjoy, according to the company’s founder, Amy Fan.

The mission, and the company’s technology, have managed to convince a slew of investors who have poured $5.1 million in seed funding into the new startup. Third Prime led the round, which included investments from Town Hall Ventures, SteelSky Ventures, Aglaé Ventures, GingerBread Capital, Rucker Park Capital, Predictive VC, and angel investors like Stu Libby, Zoe Barry, and Wan Li Zhu.

“Women who are on Medicaid, who are underinsured or without health insurance often struggle to find access to reproductive health services, and these struggles have only increased with COVID-19 pandemic limiting access to in-person appointments,” said Amy Fan, co-founder of Twentyeight Health, in a statement. “We are fighting for healthcare equity, ensuring that all women, particularly BIPOC women and women from low-income backgrounds, can access high quality, dignified and convenient care.”

To ensure that its catering to underserved communities, the company works with Bottomless Closet, a workforce entry program for women, and the 8 colleges in the City University of New York ecosystem including LaGuardia College, which has 45,000 students with 70% coming from families making less than $30,000 in annual income.

The company’s services are currently available across Florida, Maryland, New York, New Jersey, North Carolina and Pennsylvania and it’s the only telemedicine company focused on contraception services to accept Medicaid.

In another example of how awesome this company is, it’s also working to provide free birth control for women who aren’t able to pay out of pocket and are uninsured through a partnership with Bedsider’s Contraceptive Access Fund. The company also donates 2% of its revenue to Bedsider and the National Institute for Reproductive Health. (Y’all, this company is amaze.)

To sign up for the service, new customers fill out a medical questionnaire online. Once the questionnaire is reviewed by a US board-certified doctor within 24 hours customers can access over 100 FDA-approved brands of birth control pills, patches, rings, shots, and emergency contraception and receive a shipment within three days.

Twentyeight Health provides ongoing care through online audio consultations and doctor follow up messages to discuss issues around updating prescriptions or addressing side effects, the company said.

“Today, low-income women are three times more likely to have an unintended pregnancy than the average woman in the U.S., and nearly one-third of physicians nationwide aren’t accepting new Medicaid patients,” said Bruno Van Tuykom, co-founder of Twentyeight Health, in a statement. “This underscores why offering high-quality reproductive care that is inclusive of people across race, income bracket, or health insurance status is more important than ever.”

Launched in 2018, Twentyeight Health said it would use the new cash to continue to expand its services across the U.S.

 

#articles, #birth-control, #co-founder, #contraception, #fda, #florida, #health, #health-insurance, #health-services, #maryland, #medicaid, #new-jersey, #new-york, #north-carolina, #pennsylvania, #tc, #telehealth, #telemedicine, #town-hall-ventures, #united-states

0

Papa raises $18 million to expand its business connecting older adults with virtual and in-person companions

The Miami-based startup Papa has raised an additional $18 million as it looks to expand its business connecting elderly Americans and families with physical and virtual companions, which the company calls “pals.”

The company’s services are already available in 17 states and Papa is going to expand to another four states in the next few months, according to chief executive Andrew Parker.

Parker launched the business after reaching out on Facebook to find someone who could serve as a pal for his own grandfather in Florida.

After realizing that there was a need among elderly residents across the state for companionship and assistance that differed from the kind of in-person care that would typically be provided by a caregiver, Parker launched the service. The kinds of companionship Papa’s employees offer range from helping with everyday tasks — including transportation, light household chores, advising with health benefits and doctor’s appointments, and grocery delivery — to just conversation.

With the social isolation brought on by responses to the COVID-19 pandemic there are even more reasons for the company’s service, Parker said. Roughly half of adults consider themselves lonely, and social isolation increases the risk of death by 29%, according to statistics provided by the company.

“We created Papa with the singular goal of supporting older adults and their families throughout the aging journey,” said Parker, in a statement. “The COVID-19 pandemic has unfortunately only intensified circumstances leading to loneliness and isolation, and we’re honored to be able to offer solutions to help families during this difficult time.” 

Papa’s pals go through a stringent vetting process, according to Parker, and only about 8% of all applicants become pals.

These pals get paid an hourly rate of around $15 per hour and have the opportunity to receive bonuses and other incentives, and are now available for virtual and in-person sessions with the older adults they’re matched with.

“We have about 20,000 potential Papa pals apply a month,” said Parker. In the company’s early days it only accepted college students to work as pals, but now the company is accepting a broader range of potential employees, with assistants ranging from 18 to 45 years old. The average age, Parker said, is 29.

Papa monitors and manages all virtual interactions between the company’s employees and their charges, flagging issues that may be raised in discussions, like depression and potential problems getting access to food or medications. The monitoring is designed to ensure that meal plans, therapists or medication can be made available to the company’s charges, said Parker.

Now that there’s $18 million more in financing for the company to work with, thanks to new lead investor Comcast Ventures and other backers — including Canaan, Initialized Capital, Sound Ventures, Pivotal Ventures, the founders of Flatiron Health and their investment group Operator Partners, along with Behance founder, Scott Belsky — Papa is focused on developing new products and expanding the scope of its services.

The company has raised $31 million to date and expects to be operating in all 50 states by January 2021. The company’s companion services are available to members through health plans and as an employer benefit.

“Papa is enabling a growing number of older Americans to age at home, while reducing the cost of care for health plans and creating meaningful jobs for companion care professionals,” said Fatima Husain, principal at Comcast Ventures, in a statement. “

#comcast-ventures, #fatima-husain, #flatiron-health, #florida, #health-insurance, #initialized-capital, #investment, #miami, #operator-partners, #recent-funding, #scott-belsky, #sound-ventures, #startups, #tc, #video-on-demand

0

BIMA nabs $30M more for micro- health and life insurance aimed at emerging markets

The coronavirus global health pandemic — and the new emphasis on social distancing to slow down the spread of COVID-19 — has put healthcare and tech services used to enable healthcare remotely under the spotlight. Today a startup that’s building microinsurance and healthcare services specifically targeting emerging markets is announcing a round of funding to meet a surge in demand for its services.

BIMA, a startup that provides life and health insurance policies, along with telemedicine to support the latter, all via a mobile-first platform targeting consumers in emerging markets whose primary entry point to online services is via phones, not computers, is today announcing that it has raised $30 million in funding, a growth round that the Stockholm/London-based startup plans to use to double down on its health services in the wake increased demand around COVID-19.

The company currently provides telemedicine as a service connected to its health insurance, and it has expanded to include health programs for managing illnesses and offering discounts for pharmacies, and the plan seems to be to bring more services into the mix.

This is the same approach we’re seeing from other insurance startups targeting emerging economies, including China’s Waterdrop, which recently raised $230 million. Looking at the network of services Waterdrop is building, including crowdfunding, gives you an idea of what else BIMA might potentially look to add in, too.

The round is being led by a new investor — China’s CreditEase Fintech Investment Fund (CEFIF) — with previous backers LeapFrog Investments and insurance giant Allianz (who were in BIMA’s previous, $97 million round) also participating.

The startup is not disclosing its valuation this time around, but in its previous round the company was valued at $300 million, and it has grown considerably since then.

BIMA has now clocked up 2 million tele-doctor consultations and has some 35 million insurance and health policies on its books, growing its customer base by some 11 million people in the last two years. It’s now active in 10 countries — Ghana, Tanzania and Senegal in Africa; and Bangladesh, Cambodia, Indonesia, Malaysia, Pakistan, Philippines and Sri Lanka across Asia.

At a time when we have seen a number of insure tech startups emerge in the US and Europe — with some, like Lemonade, growing into publicly-listed companies — BIMA is very notable in part because of who it targets.

It’s not higher economic brackets, or necessarily segments with disposable income, or those in developed markets with stable economies. Rather, its focus is, in its words, underserved families that typically live on less than $10 per day and are at high risk of illness or injury, with 75% of its customers accessing insurance services for the very first time, BIMA notes.

“Telemedicine and insurance are needed more than ever and COVID accelerated awareness and acceptance for these types of products amongst emerging consumers and government. They’ve gone from ‘nice to have’ to a necessity,” said Mathilda Strom, who co-founded the company with CEO Gustaf Agartson, in an interview. “Utilisation nearly doubled in our telemedicine services.” BIMA covers COVID and pandemics in general in its policies, she added. “We have paid out COVID-related claims to families of people who suffered or passed away from the illness.”

It’s also working with health authorities that have been overwhelmed in the pandemic. Pakistani government and Indonesian government now use BIMA to off-load their health services by providing teledoctor consultations or doctors chats to customers.

Aiming at developing economies where middle classes are still only materialising, currencies are potentially unstable, and there is still a lack of infrastructure means that BIMA is contending with a combination of factors that makes the bar high for entry, but it’s also potentially more rewarding because of the lack of competition and tapping a demand that is still rapidly growing.

“The onset of COVID-19 has brought home the value of telemedicine, to help prevent the spread of disease, and the importance of insurance, for peace of mind,” said Agartson in a statement.

“Through digital solutions, and a human touch, we’ve been able to serve hard to reach communities with tools and services that bring them a sense of security at such a challenging time. The funds we have raised will allow us to expand our operations and further invest in our product offering that will help us scale quickly to meet the unprecedented demand for our services.”

It’s interesting to see CreditEase, a Chinese investor, as part of this round: the idea of all-in, full service health services companies banked around the insurance proposition has been one cultivated in the Chinese market. But even with the development of HMOs in the US, it’s interesting that there have been relatively few startups around the world trying to develop similar models. BIMA stands out in part because of that.

“We are very impressed by BIMA’s innovative integration of micro insurance and tele-doctor services, which provide critical coverage to meet large unmet demand in emerging markets, and whose value is accentuated further by the current pandemic,” said Dennis Cong, managing partner at CEFIF, in a statement. “We are very happy to have the opportunity to join this meaningful journey, along with the established leading shareholders, and support the company to grow its business and expand its leadership position in its served markets.”

“The market that BIMA is serving is vast and demand for health services is tremendous,” added Stewart Langdon, a partner at LeapFrog Investments. “BIMA’s unique digital capabilities empower emerging market consumers to access many health and insurance services on a single, easy to use platform. That includes protection for millions of first-time buyers of insurance who would otherwise remain unprotected and at risk.”

“We are happy to continue our partnership with BIMA and jointly deliver telemedicine and remote healthcare services in developing markets,” said Nazim Cetin, CEO at Allianz X, in a statement. “We believe the demand for these services will continue to increase and want to manifest BIMA’s leading position in the market by providing support with our experience and network.”

#bima, #covid-19, #emerging-markets, #health, #health-insurance, #insurance, #recent-funding, #startups, #tc

0

Five success factors for behavioral health startups

Telehealth, or remote, tech-enabled healthcare, has existed for years in primary medical care through companies like Teladoc (NYSE: TDOC)Doctors on Demand and MDLIVE.

In recent years, the application of telehealth had rapidly expanded to address specific chronic and behavioral health issues like mental health, weight loss and nutrition, addiction, diabetes and hypertension, etc. These are real and oftentimes very severe issues faced by people all over the world, yet until now have seen little to no use of technology in providing care.

We believe behavioral health is particularly suited to benefit from the digitization trends COVID-19 has accelerated. Previously, we’ve written about the pandemic’s impact on online learning and education, both for K-12 students and adult learners. But behavioral health is another area impacted by the fundamental change in consumers’ behavior today. Below are four reasons we think the time is now for behavioral health startups — followed by five key factors we think characterize successful companies in this area.

Telehealth can significantly lower the cost of care

Traditional behavioral healthcare is cost-prohibitive for most people. In-person therapy costs $100+ per session in the U.S., and many mental health and substance-use providers don’t accept insurance because they don’t get paid enough by insurers.

By contrast, telehealth reduces overhead costs and scales more effectively. Leveraging technology, providers can treat more patients in less time with almost zero marginal costs. Mobile-based communications enable asynchronous care that further helps providers scale. Access to digital content gives patients on-going support without the need for a human on the other side. This is particularly useful in treating behavioral health issues where ongoing support and motivation may be necessary.

Technology unlocks supply in “shadow markets” of providers

Globally, we face an extreme shortage of behavioral health providers. For example, the United States has fewer than 30,000 licensed psychiatrists (translating to <1 for every 10,000 people). Outside of big cities, the problem gets worse: ~50-60% of nonmetro counties have no psychologists or psychiatrists at all.

Even when providers are available, wait times for appointments are notoriously long. This is a huge issue when behavioral health conditions often require timely intervention.

We are seeing new platforms build large networks of certified coaches, licensed psychologists and psychiatrists, and other providers, aggregating supply in what has historically been a scarce and a highly fragmented provider population.

Behavioral/mental health issues are losing their stigma

We believe the stigma associated with mental illness and other behavioral health conditions is dissipating. More and more public figures are speaking out about their struggle with anxiety, depression, addiction and other behavioral health issues. Our zeitgeist is shifting fast, and there’s an all-time high in people seeking help as the Google Trends data below demonstrates.

google trends search: "therapist near me," 2015- 2010

Image Credits: Google

Note: The anomalous dip in March/April ’20 was driven by mandatory shelter-in-place due to COVID-19.

Policy and regulations are changing quickly

#battery-ventures, #column, #coronavirus, #counseling, #covid-19, #depression, #digital-health, #extra-crunch, #headspace, #health, #health-insurance, #healthcare, #hypertension, #livongo, #market-analysis, #meditation, #online-learning, #smartphone, #startups, #talkspace, #tc, #telehealth, #venture-capital, #vida-health

0

Y Combinator’s Vitable Health is bringing basic healthcare to underserved populations

Joseph Kitonga, the 23-year-old entrepreneur behind Vitable Health, first saw the need for a new kind of healthcare service growing up in Philadelphia and seeing the experience of the home healthcare workers who worked at his parents’ business.

The Kitongas immigrated to the United States a decade ago and settled down in Philadelphia, where they started a home-care business matching workers with patients in need. What was surprising to the younger Kitonga was that the people who worked for his parents taking care of others couldn’t afford basic healthcare coverage themselves.

It was that observation that provided the seed for the business idea that would become Vitable Health, Kitonga’s first business and a recent member of Y Combinator’s latest summer cohort.

The company provides affordable acute healthcare coverage to underinsured or un-insured populations and was born out of his experience watching employees of his parents’ home healthcare agency struggle to receive basic healthcare coverage.

A lot of caregivers make $10 per hour, which is too much to qualify for Medicaid and too little to afford health insurance, Kitonga says.

Even with the Affordable Care Act, many workers in the home-care business that Kitonga’s parents ran in Philadelphia were unable to receive care.

So Kitonga built a service that could cover everything but catastrophic coverage for lower costs than the company’s customers would have to pay if they went to an urgent care facility.

Vitable is able to lower the cost of care through its use of nurse practitioners instead of doctors to provide the care. For a small monthly fee, the company will send providers to make house calls or customers can receive a consultation over the phone.

“We focus on acute and preventive coverage,” says Kitonga. “Most high deductible plans are geared toward providing catastrophic coverage.”

What Kitonga saw with his parents’ employees was that they would wind up going to the emergency room and put $1,300 in charges on their credit cards rather than pay for insurance per month.

Vitable’s lowest plan levels start at $15 per month and the co-payment is $30, according to Kitonga. Vitable’s technicians will do in-home lab tests.

There’s just no low-cost care option available for the population that Kitonga wants to serve, he said. These are people who will be referred to emergency rooms by nearby care providers because they lack the necessary insurance. “The population that we service has been ignored by healthcare providers,” said Kitonga.

For now, the service is only available in Philadelphia, but Kitonga says there are already 1,000 people who receive care through Vitable. “We work with a lot of small businesses that might have 10 or 20 employees,” Kitonga said.

 

#entrepreneur, #health, #health-insurance, #medicaid, #philadelphia, #recent-funding, #startups, #tc, #united-states, #vitable-health, #y-combinator

0

Russia’s BestDoctor attracts international investors for its $4.5M round

The private medical insurance market is expanding year on year by over 5%, and that includes in Russia where the insurance market – which grew by 4% in 2019 – has reached a value of almost $22 billion.

So it’s not that surprising that Russian insurtech startup BestDoctor has now closed its third round of financing for $4.5 million. Lead investors AddVenture, based out of Moscow, and Target Global, based out of Berlin, were joined by the London-based LVL1 fund, which had previously invested in the company.

BestDoctor is an online medical insurance platform offering private medical insurance for companies and their employees. As well as insurance, its also delivers 24/7 health support and medical consultations via its mobile app. Users can also get access to recommendations on preventive care and online support from BestDoctor physicians. The idea is that users save up to 23% on their annual medical expenses, and up to 95% of users renew the contract after a year.
 
Its clients largely consist of Russian corporates including Voximplant, Faberlic, Ivideon, Prisma Labs and Rambler Group, which add up to over 30,000 people. It also collaborates with 11,000 clinics across Russia.

Mark Sanevich, BestDoctor’s CEO and co-founder says the need for online medical services was amplified during the pandemic: “Our business received a strong boost. Now we are going to focus on establishing a comprehensive platform on the basis of medical insurance.”

Target Global Managing Partner Mikhail Lobanov said: “BestDoctor is a rare example of a company that combines medicine and high-tech, while directly connecting employers with medical clinics. High-tech private medical insurance, with the ability to consult a doctor 24/7 ensures transparency of all expenses.”

AddVenture managing partner Maxim Medvedev said: “By summer 2019, BestDoctor had a good head start: it had large enterprise clients, the company figured out the market’s problems and needs, and dozens of product ideas were tested.”

BestDoctor plans to spend the newly raised funds on developing its software and also plans to expand its sales activity, concentrating on new product segments.

#addventure, #berlin, #europe, #health-insurance, #insurance, #london, #managing-partner, #moscow, #prisma-labs, #russia, #target-global, #tc

0

Fringe pitches a monthly stipend for app purchases and subscriptions as the newest employee benefit

Fringe is a new company pitching employers on a service offering lifestyle benefits for their employees in addition to, or instead of, more traditional benefits packages.

“We didn’t think it made sense that employees need to be sick, disabled, dead or 65+ to benefit from their benefits,” wrote Fringe chief executive Jordan Peace, in an email.

The Richmond, Virginia-based company was founded by five college friends from Virginia Tech rounded up by Peace and Jason Murray, who serves as the company’s head of Strategy and Finance. The two men previously owned a financial planning firm called Greenhouse Money, which worked with small businesses to set up benefits packages and retirement accounts.

During that time, the two men had a revelation… employees at these small and medium-sized businesses didn’t just want retirement or healthcare benefits, they wanted perks that were more applicable to their day-to-day lives. Because Murray and Peace couldn’t find a company that offered a flexible benefits package on things like Netflix, Amazon or Hulu subscriptions, Uber rides, Grubhub orders or Instacart deliveries, they built one themselves.

As they grew their business they brought in college friends, including Isaiah Goodall as the vice president of partnerships, Chris Luhrman as the vice president of operations and Andrew Dunlap as the head of product.

Peace and Murray first launched the business in 2018 and now count over 100 delivery services, exercise apps, cleaning services and other apps of convenience among their offerings.

For their part, employers pay $5 per employee covered per month and set up a monthly stipend (that may or may not be subtracted from a total benefits package) of somewhere between $50 and $200 that employees can spend on subscription services.

It’s a pitch to employers that Peace says is especially compelling as office culture changes in the wake of massive office closures and work-from-home orders from major U.S. companies as a response to the COVID-19 epidemic.

“In-office perks and even most ‘off-site’ perks (gyms, massage spas, etc.) are all null and void,” wrote Peace. “Even post-COVID, it’s highly likely that many of these aspects of office culture will bear less significance with many CEOs vowing to allow ‘WFH forever.’ This means companies need a way to package their office culture and ship them home. Fringe is perfectly positioned for this and determined to be the first name that comes to mind to provide a solution.”

Peace sees this as the next step in the evolution of benefits offerings for employees. He traces its legacy to the development of private health insurance and 401k retirement plans. “After another 40 years lifestyle benefits are the newest breakthrough — and like its predecessors, will be almost universally adopted in the next 5 years,” Peace wrote.

#amazon, #employee-benefits, #fringe, #grubhub, #health-insurance, #instacart, #startups, #tc, #uber, #virginia-tech

0

How $20 billion health care behemoth Blue Shield of California sees startups

In the two years since Jeff Semenchuk took the reins in the newly created position of chief innovation officer for Blue Shield of California, the nonprofit health insurer with $20 billion in revenues has stepped up its investments in startup companies.

As one of California’s largest insurance providers with more than four million members, Blue Shield plays an outsized role in technology adoption among physicians, hospital networks and patients. With that in mind, and with the acceleration of entrepreneurial activity around the multitrillion health care market, Semenchuk was brought on board after serving as chief executive of Yaro (now Virgin Plus) and CIO of Hyatt Hotels and co-founder of Citi Ventures.

Semenchuk said he sees Blue Shield as working to create a new health care system: “It’s not to perpetuate the health care system we have today.” Increasingly, startups have a role to play in that revisioning of health care services in America, according to Semenchuk.

“What I would say has happened over the last two years is that we have really focused on transformational innovation,” he added.

Investing in those transformational technologies involves taking cash directly from Blue Shield’s balance sheet for investments. The company doesn’t operate a corporate venture capital fund in the traditional sense, instead making strategic investments under the auspices of Semenchuk or Chief Financial Officer Sandra Clarke.*

#blue-shield, #extra-crunch, #fundraising, #health, #health-insurance, #healthcare, #healthtech, #startups, #tc, #venture-capital

0

With the real estate industry facing headwinds, SoftBank-backed Compass lays off 15% of staff

Compass, the real-estate brokerage startup backed by roughly $1.6 billion in venture funding, has laid off 15% of its staff as a result of the shifting economic fortunes created by the global response to the novel coronavirus pandemic, according to an internal email seen by TechCrunch.

Citing economic fallout that has seen stock markets plummet 30 percent in just 22 days, Compass chief executive Robert Reffkin wrote that the company has seen an over 60 percent decline in real estate showings and is modeling a six-month decline in revenue of 50 percent.

“We aren’t just facing an economic recession, we are facing an economic standstill,” Reffkin wrote. As the country’s unemployment rate soars to a projected 10 percent, Reffkin wrote that the company had no choice but to cut its workforce.

The 15 percent reduction in staffing is being accompanied by an 80% reduction in its concierge business for the moment. As part of the reductions in corporate spending, Reffkin cut his own salary to nothing and reduced the entire executive team’s salary by 25 percent.

For the employees that are laid off, the company said it would provide an “enhanced severance and COBRA health insurance” along with letting employees hang on to their company laptops and providing tools, training, and networking help so that they can try to get a new job.

The news from Compass is just one indicator of a potential reckoning coming for the booming property tech investment category.

Earlier today, TechCrunch reported that Zillow was suspending its homebuying activities as a result of the new economic reality.

Zillow said it decided to halt its offers to sellers after several states, including California, Illinois, Louisiana, Ohio, New York and Nevada, implemented emergency orders requiring people to stay home and stopping all non-essential business activities, including some real estate-related activities.

Opendoor and Redfin made similar decisions to pause homebuying. Meanwhile other real estate companies are also laying off staff. The co-working startup Convene laid off staff as well, citing current market conditions.

Reffkin is hopeful that the economy will turn around and predicted that the economy could recover in the next 100 days, ending his email saying that he looks forward to a return to normalcy for Compass and the broader market.

“I feel hopeful that China’s apparent success at reducing the spread of the Coronavirus and restarting their enormous economy may provide a blueprint for our future, as well,” Reffkin wrote. “And I feel hopeful because of the ways I see people throughout our company and throughout our society stepping up during this challenging time.”

To date, Compass has raised $1.6 billion in financing from investors including the Canadian Pension Plan Investment Board, Fidelity, Wellington Management, Softbank Vision Fund, and the Qatar Investment Authority, according to Crunchbase.

#california, #companies, #compass, #convene, #executive, #health-insurance, #illinois, #industries, #louisiana, #nevada, #new-york, #ohio, #real-estate, #redfin, #tc, #techcrunch, #telecommuting, #zillow

0