Preventive care delivers personalized prophylactic care to patients and facilitates clinical decision support to practitioners, as opposed to reactive care, which intervenes after health conditions deteriorate. Preventive care technologies track physiological and biometric data through connected devices in real time and store them in a patient portal, housing electronic health records. This data is analyzed continuously by artificial intelligence (AI) algorithms to predict and warn patients and healthcare providers of potential health issues.
The growing frequency of chronic diseases and the rise in associated costs are a substantial burden to reactive care in the US. Many providers are now offering advanced preventive health solutions to individuals and corporate clients to mitigate risk of conditions such as cancer, diabetes, and heart disease.
Many preventive care providers have transitioned to virtual care, Covid-19 testing and vaccination, and workplace re-entry services for their members and corporate clients to ensure continuous care.
One Medical’s memberships rose 29% YoY to 511,000 in Q3 2020.
Crossover provided members with Covid-19 screening and testing services and mental health support, as well as telemedicine services for members who tested positive.
Livongo saw its number of enrolled diabetes members more than double in Q3 2020 to 442,724.
Catapult Health achieved record 22% volume growth in September 2020.
Oak Street Health served 59,500 at-risk patients, up 38% YoY, in Q3 2020.
Cityblock Health recorded a 2,000% surge in telehealth visits between March 20 and June 30.
We have identified six segments for the preventive healthcare industry. Direct primary care providers account for nearly one-third of companies in our coverage. The next largest segment consists of passive remote monitoring platforms that offer connected devices to track patient vitals. These startups compete with established clinics and hospitals which have also adopted a value-based approach to offer an extensive range of preventive care services.
We have also determined that many of the disruptors that offer direct primary care, digital therapeutics, and specialized chronic care platforms are in their growth stage, with funding directed towards scaling up operations to serve the rising demand for chronic care prevention and treatment as well as the escalating medical costs. However, most passive remote monitoring platforms and diagnostic tools are still in the early or seed stages.
Disruptors in the preventive care landscape attempt to build more personalized and value-based relationships with members through real-time monitoring coupled with intelligent analytics to predict potential health issues. Many disruptors operate on a subscription-based model charging for the use of an in-house platform/app with fees averaging USD 150 per month. They offer real-time care by leveraging information from sensors/wearables and coordinate with providers via telemedicine so patients can reach out to practitioners in the comfort of their homes and share vitals through the same platform to have interventions before escalations.
We have identified One Medical as the leading direct primary care provider given its large member base and long history of operations. The direct primary care segment dominates the preventive healthcare industry in terms of funding, accounting for more than half of total funds raised as of June 2021. Despite a smaller number of players, both digital therapeutics and chronic care management platforms have also attracted a much larger share of funding compared to passive remote monitoring platforms. Noteworthy digital therapeutics and chronic care management platforms include Sharecare, Hinge Health, and Virta Health.
Oak Street Health is a value-based direct primary care provider for Medicare-eligible patients aged 65 years and above, with a focus on undeserving underserved communities. Oak Street generates the majority of its revenue (over 95%) through capitations, whereby Medicare provides a fixed payment per patient per month in advance for its services. Oak Street is therefore liable for medical costs in excess of the fixed payment and is able to retain any surplus created if costs are lower. The company opened its 100th center in August 2021, up from 54 in March 2020 when the Covid-19 pandemic hit. Oak Street Health plans to open an additional 46 to 48 centers for the full year. The company also experienced a steady increase in at-risk patients, which stood at 88,500 in June 2021.
Despite strong growth in the company’s topline in 2020 (up 59% YoY to USD 882.8 million), the company’s operating losses widened (up 77% YoY to USD 183.5 million) as a result of the growth in the number of centers and an increase in additional staff. In 2021, Oak Street Health expects revenue to range between USD 1.37 - 1.40 billion, implying a growth rate of 55% to 59% YoY. Adjusted EBITDA loss, however, is expected to increase to a range of USD 220 - 240 million amid rising medical costs. Beyond 2021, the company expects to receive an increase in per-patient revenue due to the higher disease burden of its at-risk patients.
Oak Street Health commenced trading on the New York Stock Exchange in August 2020, under the ticker symbol "OSH", raising USD 328 million from the initial public offering.
Direct Primary Care (DPC):
Digital Therapeutics (DTx):
Specialized Chronic Care Platforms:
The incumbents in the preventive care landscape are mainly established healthcare providers, who have expanded their scope to include preventive primary care in addition to their existing healthcare services. In-house developments and partnerships with tech companies remain the most popular entry strategies to the preventive care landscape. We expect leading incumbents such as Cleveland Clinic and Mayo Clinic to stand to benefit given their access to a larger patient pool and specialization in highly prevalent chronic conditions such as diabetes and heart diseases. Other incumbents that operate large drugstore chains such as Walgreens have also entered this space via partnerships with direct primary care providers.
Cleveland Clinic, an accountable care organization established in 1921, is one of the top five hospitals in the US. Cleveland Clinic has 18 hospitals, 4,500 physicians and scientists, 17,000 nurses, and approximately 1,900 residents and fellows globally. The hospital ranks first in cardiology and urology in the US, and offers a wide range of other specialties. As of 2019, Cleveland had the highest number of patients and hospital beds among our incumbents; 2.4 million unique patients, 10 million outpatients, 309,000 admissions and 59,000 virtual visits with more than 6,000 hospital beds.
Cleveland Clinic provides preventative care through a value-based care model. It aims to reduce healthcare costs by managing chronic conditions proactively, reducing preventable hospitalizations, and optimizing care through services such as virtual visits.
Cleveland has been developing in-house ventures, such as Cleveland Diagnostics, which offer early diagnostic solutions for conditions such as cancer. As of 2013, Cleveland Clinic registered 1.5 million patients on MyChart, its health management portal, which allows patients to access their health records and connect with physicians. In September 2016, Cleveland partnered with Microsoft to predict patient risk of cardiac arrest using data from patient vitals and lab tests using Microsoft Azure, a cloud computing service. In March 2019, it established the Center for Clinical Artificial Intelligence to improve machine learning cancer detection.