Humana

More important now than ever, telehealth will long outlast the pandemic that drove its growth.

Telehealth

<div>
 
 Based in Los Angeles, Heal provides a platform (via mobile app and web) to arrange doctor house calls and telehealth sessions. Heal first started as only a house call healthcare service provider, but expanded to telehealth in 2019. The telehealth operation is still closely connected with its house call operations as telehealth sessions via Heal can only be arranged on follow-up basis by a doctor who has already visited the patient. Heal&rsquo;s at home services are covered by in-network insurers such as Medicare, Aetna, Humana, Wellcare, United Healthcare, and Anthem Blue Cross. Patients without insurance coverage are charged a flat fee of USD 79 per telehealth call and USD 159 per home visit .
 
 
 In 2019, as a part of its telehealth launch, Heal introduced Heal Hub, which provides doctors access to patient vital signs in real-time, including blood pressure, blood sugar, and heart rate. In July 2020, Heal raised USD 100 million in funding for its expansions in new geographic regions, namely Chicago, Charlotte, North Carolina, and Houston, Texas.
 
</div>

<div>
 
 Buoy Health is a healthcare service that helps patients connect with healthcare providers covered by their health insurance to help analyze symptoms. The company aims to keep people from using internet searches to diagnose their health issues and direct patients to appropriate care before conditions escalate. Patients can interact with a health assistant that leverages both AI and Generative AI tools to help patients reach a diagnosis and triage to the appropriate care. The company also has a business-to-business (B2B) offering, targeting employers to reduce healthcare costs.
 
 
 In November 2020, the company raised USD 37.5 million in Series C funding, bringing the company&rsquo;s total funding to USD 68.2 million. The new funding is expected to be used for expanding artificial intelligence (AI) and tech features, improving its clinical and insurance navigation capabilities, and increasing its workforce.
 
</div>

<div>
 
 Cohere Health provides a platform for improving the prior authorization and clinical review processes in healthcare. Its platform uses artificial intelligence (AI) to automate and streamline clinical review and prior authorization processes by applying evidence-based guidelines, integrating with electronic medical records (EMR), and facilitating communication between health plans and providers. Cohere Health offers two delivery options for its platform: Cohere PaaS and Cohere Complete. Cohere PaaS allows health plans to license the platform as a service (PaaS) and use it with their own internal staff. Cohere Complete includes the platform plus intake and clinical staff to provide fully outsourced and delegated specialty services.
 
 
 The company partners with healthcare plans and physicians, offering its platform on a subscription basis.
 
 
 Cohere Health notes that as of January 2024, it is able to immediately approve 83% of authorization requests. On requests requiring clinician review, turnaround time averages 4.5 days and just nine hours for urgent cases.&nbsp;
 
 
 
 
 Funding and financials
 
 
 In February 2024, the company raised USD 
 50 million in a funding round led by Deerfield Management, along with contributions from other investors. The raised capital was set aside to aid the company&rsquo;s expansion efforts. 
 
 
 
</div>

Redefining hospital care with the comfort of home

Hospital-at-Home

<div>
 
 At Heal, we believe improving health outcomes starts by meeting patients where they're most comfortable: at home. That&rsquo;s why we provide value-based, in-home primary care to seniors on Medicare and select Medicare Advantage plans. Heal&rsquo;s service model allows board-certified doctors and nurse practitioners to spend more time with their patients, so care is never rushed, and a strong patient-provider relationship is established. We serve seniors at all stages of their health journey, from preventive care -- like flu shots and annual physicals -- to treating common illnesses and managing chronic conditions. Our services also include telemedicine visits and remote health monitoring, so getting quality care when its needed is easier than ever. With easy and convenient phone support for scheduling or other questions, we offer appointments 8am-6pm, 7 days/week &ndash; including weekends and holidays.
 
</div>

<div>
 
 DispatchHealth is a provider of mobile and virtual healthcare for people of all ages in the comfort of their own homes. DispatchHealt was founded in 2013 and was formerly known as True North Health Navigation. It aims to create an integrated, convenient, triage, and care delivery solution that extends the capabilities of the patient's care team and provides quality care in the home while decreasing costs. It was founded in 2013 and headquartered in Denver, Colorado.
 
</div>

<div>
 
 Monogram Health is a value-based specialty provider of in-home evidence-based care and benefit management services to patients suffering from polychronic conditions such as chronic kidney disease and end-stage renal disease. To transform the way health care is delivered for those with polychronic conditions, the company uses an innovative in-homecare delivery model and a technology-driven array of evidence-based clinical services, such as complex case and disease management, utilization management, and medication therapy management. This innovative care model has been shown to improve patient outcomes and quality of life while lowering medical costs across the healthcare continuum. Monogram Health, based in Nashville, Tennessee, has numerous value-based partnerships with leading health plans and risk-bearing providers to care for patients across all insurance products and 34 states.
 
</div>

Membership-based, non-insurance healthcare companies helping maintain a steady state of well being.

Preventive Healthcare

Omada is a prevention-focused digital therapeutics startup that helps members achieve health goals through lifestyle changes. It offers five evidence-based, virtual prevention programs for managing hypertension, behavioral health, musculoskeletal (MSK) issues, obesity and prediabetes, and diabetes.&nbsp;Omada offers real-time data tracking through connected devices (such as wireless scales, blood pressure, and glucose monitors) and access to personalized coaching sessions via a mobile app as part of its prevention program. It also provides an online community of peers with similar health conditions to discuss challenges and provide support. In May 2021, Omada became the first fully-virtual healthcare provider to earn the National Committee for Quality Assurance’s Population Health Program Accreditation for its type 2 diabetes and type 2 diabetes + hypertension programs.Unlike its peers, Omada operates a performance-based business model where it charges clients an enrollment fee based on the number of users and a performance fee based on how much weight their employees lose.&nbsp; By February 2022, Omada had more than 550,000 members from more than 1,700 enterprise clients across all 50 US states.&nbsp;Key Customers and PartnershipsIts B2B employer and health plan client base include key clients such as American Eagle, Kaiser Permanente, Costco Wholesale, 3M, and Marvin. Additionally, the company has partnered with health systems and hospitals such as Intermountain Healthcare to provide its preventive programs as a covered benefit. In <a href="https://sp-edge.com/updates/15587">January 2023</a>, the company partnered with health service company Castell (a subsidiary of Intermountain Healthcare) to provide its diabetes programs to members from Intermountain Healthcare’s primary care providers in its Utah Medical Group. Further in <a href="https://sp-edge.com/updates/25245">January 2024</a>, the company partnered with Amazon to expand access to its cardiometabolic program.&nbsp;In May 2020, the company purchased virtual physical therapy startup Physera.&nbsp;Funding and FinancialsIn <a href="https://sp-edge.com/updates/8703">February 2022</a>, Omada concluded a USD 192 million Series E funding round to hire more employees, further expand its offerings, as well as to invest in its Omada Insights Lab, which uses health data for better chronic care delivery.

<div>
 
 Livongo offers preventative healthcare solutions for people with chronic conditions. The company started with a focus only on diabetes, but now has expanded to cover conditions such as hypertension, weight management, and mental health. Livongo aggregates and interprets large amounts of health data from remote monitoring devices to create actionable, personalized health plans and interfere before conditions escalate.
 
 
 Livongo had 410,000 members from 1,328 corporate clients as of September 2020 and costs around USD 68 per employee per month on average for the diabetics program, which includes USD 30 per month in diabetes management products. The company claims that the program can reduce medical spending by USD 88 per member per month. Moreover, Livongo provides continuous remote monitoring through connected devices, data storage, and analytic solutions.
 
 
 In August 2020, Livongo merged with Teladoc Health, a leading telehealth provider, in a deal which valued Livongo at USD 18.5 billion.
 
</div>

A concentration of wealth and a willingness to adopt age-in-place technologies present new opportunities.

Age Tech

<div>
 
 Monogram Health provides access to in-home and virtual physician and nurse practitioner visits for patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
 
 
 Monogram&rsquo;s managed services platform establishes partnerships with health plans (e.g., Humana, WellCare Health Plans) to bring disease management, utilization management, and medication therapy management to its patients. Monogram&rsquo;s team of nurses, nephrologists, dieticians, pharmacists, and social workers coordinate with the patient&rsquo;s care network to manage their care requirements. The company uses technology to remotely monitor patient biometrics and predictive analytics to identify patients at high risk of progression, medication errors, and care gaps.&nbsp;&nbsp;
 
 
 According to the company, it has tripled the rates of home dialysis to 28% (national average 10%), doubled planned dialysis transitions to 45% (national average 20%), and reduced readmission rates by half to 18% (national average 35%).&nbsp;&nbsp;
 
 
 As of January 2024, the company noted that 
 company&rsquo;s plan partners, which include Cigna, Humana, Aetna, and the US Department of Veterans Affairs, have seen significant improvements, including doubled dialysis transitions and reduced readmission rates.
 
 
 Key customers and partnerships
 
 
 In March 2021, Monogram partnered with Medicare Advantage (MA), a healthcare and insurance coverage plan under Cigna, a multinational US-based insurance company. The partnership entails access to Cigna&rsquo;s customers in 18 states, including Florida, Texas, Pennsylvania, Illinois, North Carolina, South Carolina, New Jersey, Delaware, Maryland, Missouri, Kansas, Colorado, and the District of Columbia.&nbsp;
 
 
 More recently, in January 2024, Monogram partnered with health insurer Blue Cross Blue Shield of Arizona (AZ Blue), to enhance kidney disease care. Through the partnership, Monogram extended its in-home care services and benefit management services to AZ Blue's nearly two million members. Monogram also assumed financial responsibility for some AZ Blue members with kidney disease, giving patients access to a wide range of services, including complex disease management and medication therapy management. 
 
 
 
 
 Funding and financials
 
 
 In January 2023, the company raised USD 375 million in growth funding from several strategic investors including CVS Health, Humana, SCAN Health Plan, Cigna Ventures, and Memorial Hermann Health System, along with participation from other venture capital firms. The funds were set aside to continue to deploy the company&rsquo;s clinical services and delivery model for its at-home kidney and chronic condition care service. The funding round also helped the company support its goal of growing its partnerships with healthcare investors.
 
</div>

Daughters of Charity Health Centers is a non-profit health care organization offering primary and preventive health services to all members of the community, regardless of their ability to pay. The Daughters of Charity have provided access to high-quality, compassionate health care.

Main Street Health is a provider of value-based, care-focused healthcare services aimed at addressing rural wellness concerns. The company's healthcare services are data-driven, and it provides partner clinics with employees, technology, critical access hospitals, community health centers, and possibilities to flourish in the care delivery model, allowing rural residents to receive the high-quality treatment they need.

YMCA of South Florida is a nonprofit committed to strengthening communities through youth development.

Nourish KC will create wholesome meals, rescue fresh local food, and work as a community partner.

MLK Sr. Community Resources Collaborative offers resources to assist families in acquiring the skills necessary to handle everyday difficulties and achieve the outcomes they require throughout their lives.

Louisiana Mental Health Association is to provide services, education, and advocacy for persons who need mental and behavioral health.

Justice and Dignity Center is available to help and provide resources to any groups who want to collaborate and bring love and unity to our communities to make it a better place for everyone.

PsychArmor is dedicated to bridging the gap between the military and civilian communities. We provide education & certifications for mental health providers, corporations, organizations, hospitals and clinics on how to specifically work with the military.

Greater Fort Lauderdale Diaper Bank is to provide diapers to disadvantaged families and Partnering Community Organizations.

Gladewaves that everyone has the right to food, shelter, education, company, and the resources required to have a useful life.

Flowing with Blessings is to offer sanitation and dignity to the unhoused community in the Atlanta area through the mobile Shower Project.

American Cancer Society is a nationwide voluntary health organization dedicated to eliminate cancer in the United States.   The society is organized into eleven geographical divisions of both medical and lay volunteers operating in more than 900 offices throughout the United States. Its activities include providing grants to researchers, funding 47 Nobel Laureate researchers, discovering the link between smoking and cancer, and serving one million callers every year through its National Cancer Information Center.   American Cancer Society also runs public health advertising campaigns and organizes projects such as the Relay For Life and the Great American Smokeout. It operates a series of thrift stores to raise money for its operations. The company generates income by marketing its name for antismoking nicotine patches and orange juice.   American Cancer Society was founded in 1913 and is based in Atlanta, Georgia with an additional office in Austin, Texas. It was formerly known as American Society for the Control of Cancer and changed its name in 1945.

Monogram Health is a value-based specialty provider of in-home evidence-based care and benefit management services to patients suffering from polychronic conditions such as chronic kidney disease and end-stage renal disease. To transform the way health care is delivered for those with polychronic conditions, the company uses an innovative in-home care delivery model and a technology-driven array of evidence-based clinical services, such as complex case and disease management, utilization management, and medication therapy management. This innovative care model has been shown to improve patient outcomes and quality of life while lowering medical costs across the healthcare continuum. Monogram Health, based in Nashville, Tennessee, has numerous value-based partnerships with leading health plans and risk-bearing providers to care for patients across all insurance products and 34 states.

DispatchHealth is a provider of mobile and virtual healthcare for people of all ages in the comfort of their own homes.  DispatchHealt was founded in 2013 and was formerly known as True North Health Navigation. It aims to create an integrated, convenient, triage, and care delivery solution that extends the capabilities of the patient's care team and provides quality care in the home while decreasing costs. It was founded in 2013 and headquartered in Denver, Colorado.

Aspen RxHealth is a service powered by an app-based platform that connects pharmacists with patients in need of enhanced medication services. Its application makes it easy for health plans and providers to connect their patients with an on-demand community of pharmacists who have time and expertise to provide clinical service.

Buoy provides a personalized all-in-one platform to help guide consumers back to health. Whether it's chatting about symptoms with Buoy Assistant to get help in the moment of sickness or researching benefits through Buoy Dashboard, Buoy is available 24/7 to help make self-diagnosis and navigating the healthcare system simple and easy. For employers, Buoy can be custom configured to surface benefits information and wellness programs, guide employees to in-network providers, and fully integrate with other health portals.  The company was founded in 2014 and is headquartered in Boston, Massachusetts.

At Heal, we believe improving health outcomes starts by meeting patients where they're most comfortable: at home. That’s why we provide value-based, in-home primary care to seniors on Medicare and select Medicare Advantage plans. Heal’s service model allows board-certified doctors and nurse practitioners to spend more time with their patients, so care is never rushed, and a strong patient-provider relationship is established. We serve seniors at all stages of their health journey, from preventive care -- like flu shots and annual physicals -- to treating common illnesses and managing chronic conditions. Our services also include telemedicine visits and remote health monitoring, so getting quality care when its needed is easier than ever. With easy and convenient phone support for scheduling or other questions, we offer appointments 8am-6pm, 7 days/week – including weekends and holidays.

Cohere Health is a healthcare technology company, focused on improving the efficiency and effectiveness of healthcare delivery. Cohere Health aims to simplify the complexities of the healthcare system by leveraging technology to streamline processes, enhance communication, and ultimately improve patient outcomes. The company may provide solutions to various stakeholders in the healthcare ecosystem, including patients, providers, and payers.

Accolade is a health, wellness, and fitness company that features personalized health and benefits solutions that help to improve the experience, outcomes, and cost of healthcare for employers. It specializes in healthcare process improvement, healthcare savings, employee engagement, and personalized advocacy. The company was founded in 2007 and headquartered in Plymouth Meeting, Pennsylvania.

Healthcare professionals across the globe trust the ClearDATA HITRUST-certified cloud to safeguard their sensitive data and power their critical applications available across the major public cloud platforms. For healthcare organizations, customers receive one of the most comprehensive Business Associate Agreements (BAA) in the industry, combined with market-leading healthcare-exclusive security and compliance solutions, and multi-cloud expertise. ClearDATA’s innovative platform of solutions and services protects customers from data privacy risks, improves their data management, and scales their healthcare IT infrastructure, enabling the industry to focus on making healthcare better by improving healthcare delivery, every single day.

Iora Health is dedicated to providing possible service and care for each patient without any of the barriers or excuses that plague the current system. They’ve completely redesigned Primary Care to help patients better manage their health and navigate the health care system. Every patient gets a personal physician as well as a personal health coach who stays in close contact during and between office visits, both of whom are available by email, text, or video in addition to in-person visits. In addition, they provide educational offerings, including group visits, to help patients stay on track with their health goals.

Circulation uses cutting-edge technology to manage the logistics and transportation throughout healthcare. It drives efficiency and better outcomes of populations throughout the U.S. As Uber’s Preferred Healthcare Partner, Circulation provides the first customizable, digital platform to coordinate convenient non-emergency transportation for all areas of healthcare. Circulation is utilized by patients, caregivers, providers, staff, and volunteers. The Circulation platform is compliant with the Health Insurance Portability and Accountability Act (HIPAA) to protect the privacy and security of its patients and clients. This platform seamlessly integrates with Uber’s API as well as other ride providers.

Livongo is a consumer digital health company that empowers people with chronic conditions to live a better life. It has developed a completely new approach to diabetes management that combines the latest technology with coaching. By offering the right information, tools, and support, at the right time, we provide our members with real-time, personalized insights, and support to make diabetes management easier. Its approach is leading to better financial and clinical outcomes while also creating a better experience for people with diabetes and their care team of family, friends, and medical professionals.  It was founded in 2008 and is headquartered in Mountain View, California.

Omada Health is a digital care company that offers innovative and clinically effective digital health programs to empower individuals to engage in their health and lead healthier lives. The program is personalized to meet each participant’s unique needs as they evolve, ranging from diabetes prevention, type 2 diabetes management, hypertension, behavioral health, and musculoskeletal issues. Omada combines professional health coaching, connected health devices, real-time data, and personalized feedback to deliver clinically meaningful results. The company is the largest CDC-recognized provider of the National Diabetes Prevention Program.

Eons Inc. owns and operates an online community for baby boomers. The company's Website allows the users to keep in touch with friends, connect with interesting people, and share life experiences. The company was incorporated in 2005.

Humana creates innovative solutions and resources that help people with their healthcare needs. The company is an innovator with a commitment to service, health, and wellness. Their focus on people, choice, engagement and innovation guides our business practices and decision-making. In addition to group health plans, Humana's diverse lines of business work to serve all types of consumers. Humana was founded in 1964 and is based in Louisville, Kentucky, United States.

<div> Humana creates innovative solutions and resources that help people with their healthcare needs. The company is an innovator with a commitment to service, health, and wellness. Their focus on people, choice, engagement and innovation guides our business practices and decision-making. In addition to group health plans, Humana\'s diverse lines of business work to serve all types of consumers. Humana was founded in 1964 and is based in Louisville, Kentucky, United States. </div>

Humana

Featured Industries

EDGE Insights

Digital Health (Q2 2023): Funding flow steady; first AI-drug enters Phase II clinical trials

Recent Updates

Cigna announces USD 10 billion stock buyback; abandons deal with Humana

Cigna and Humana in talks to merge in deal valued at USD 140 billion

About EDGE

Contact Us

Resources

Area of Focus

Technology Research Made Effortless