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“We’re in a crisis of access and it’s not getting better,” says Jennifer Schneider, the CEO of Homeward, which emerged from stealth yesterday with an initial $20 million investment from General Catalyst.

Why it matters: Schneider, who helped steer Livongo through its IPO and $18.5 billion merger with Teladoc, has focused her new venture on rearchitecting care delivery for rural communities. 

Investors have written large checks to fuel the shift to value-based care, but activity has centered around urban markets. 

Meanwhile, patients in rural markets are facing poor and costly health outcomes.

Rural health care markets have a 23% higher mortality rate compared with urban markets, with half the number of primary care doctors and one-eighth the number of specialists, Schneider tells Sarah at ViVE.

What she’s saying: Value-based care is the only model that will succeed in rural communities, according to Schneider.

A lack of providers and a reliance on broadband for telehealth are among factors that have held back progress historically.  

And, while primary care has been front and center of emerging value-based care models and investment, taking responsibility for the total cost of care is crucial, considering specialty care accounts for 88% of costs, she added.

“The fee-for-service model can’t stay alive in rural (markets). There are not enough specialists.”

How it works: Homeward plans an in-network, value-based care platform that will partner with PC and specialty providers and Medicare Advantage plans. 

The hybrid model encompasses virtual, in-home remote patient monitoring, in-person care via mobile care units, and referrals to local facilities.

Homeward will rely on cellular connectivity to reach the most remote individuals. “A lot of digital health tools have relied on broadband; that’s no longer necessary.” 

Schneider expects Homeward to go live by end of summer. 

Yes, and: Hyper-personalization is key to achieving scale. 

“So many [startups] build a solution without deeply understanding the pain points that they are trying to solve,” she said. “Rural is not everyone standing around with a pitchfork and tractor.” 

Context: Schneider partnered with General Catalyst to assemble the Homeward team.   

Hires include former Livongo executives Amar Kendale, Bimal Shah, and Brian Vandenberg, as well as Aaron Friedkin from Blue Cross Blue Shield of Michigan. 

Homeward marks the debut investment from General Catalyst's new $800 million Creation fund. 

Of note: Homeward isn't the only startup led by a former Livongo leader. 

Glen Tullman, founder and former CEO of Livongo, is now steering Transcarent, a consumer-directed digital health company valued at $1.62 billion earlier this year. 

General Catalyst, an early investor in Livongo, also backs Transcarent.

Elsewhere, Russell Street Venture's Brad Smith launched rural health care navigator Main Street Health, with backing from Oak HC/FT last summer. 

The bottom line: Investor and entrepreneurial eyes are zeroing in on health equity, particularly rural health care, which is one of the most broken parts of the system. 

🏠 1 big thing: Homeward dispatch from ViVE

Illustration of a tractor plowing a field in the shape of a heart monitor that is petering out

It's happened in cardiology, diabetes and behavioral health — and now, a startup called Vivante Health wants to bring virtual tools to digestive care, raising $16 million in Series A funding led by 7wireVentures, the firm's partner, Robert Garber, tells Erin exclusively. 

Why it matters: Digital health companies focused on heart and metabolic issues have seen sky-high fundraises and valuations in recent years, but far less attention has gone towards digitizing support for gastrointestinal (GI) conditions.

"These conditions have been unfairly stigmatized," William Snyder, Vivante's CEO, tells Erin. "And I think people are getting more secure in discussing different aspects of their health, such as behavioral health."

"Finally, someone’s paying attention to GI care," says Garber.

Details: The new funding is the second part of a Series A that Vivante collected in 2020 under the direction of then-CEO Kimon Angelides. "It's essentially an A1," says Snyder, following a restructuring he has led.

New investors in the round include Human Capital, Intermountain Ventures, SemperVirens and Elements Health Ventures.

Previous backers FCA Venture Partners, NFP Ventures, Lifeforce Capital, and Big Pi Ventures also joined in.

State of play: Vivante is one of a relative few companies looking to digitize digestive care.

New York-based Oshi Health raised $23 million in a Series A round last fall co-led by Flare Capital Partners, Bessemer Venture Partners and Frist Cressey Ventures.

Digestive health "is a big market, a big opportunity, and it’s growing," says Namrata Rastogi, a primary care physician and health tech adviser.

By the numbers: GI illnesses are relatively common in the U.S., according to a large population-based study published in the American Journal of Gastroenterology by researchers at UCLA and Cedars-Sinai.

Digestive diseases account for more than 100 million hospital visits in the U.S. each year, the researchers write.

Of the roughly 72,000 people they surveyed, 61% reported having had at least one GI symptom in the past week.

Less than 20% of individuals with abdominal pain, bloating or diarrhea see a health care provider about their symptoms, the researchers note.

How it works: After users complete a questionnaire, Vivante connects them with a care team of nurses, a registered dietitian and health coach, and a set of connected devices for remote monitoring. Vivante also offers a microbiome test called GutCheck, but the science of microbiome testing is still early. 

Garber says it's just one of the data points Vivante uses to inform its approach, "It’s one piece of someone's overall GI story."

"With the microbiome, the question is whether it’s worth it," Rastogi tells Axios. "We’re learning more and more about gut bacteria and foods, but how all of that impacts a condition like IBS is still sort of unknown."

What we're watching: Diseases don't exist in silos (just as they don't abide by national borders), so experts tell Axios companies like Vivante may represent a kind of first phase of digital disease management.

In the near future, expect to see a consolidation of efforts to manage disease across multiple conditions, says Mintu Turakhia, a cardiac electrophysiologist and the director of the Stanford Center for Digital Health.

"We’ve been seeing ecosystems around chronic conditions," says Garber. "The holy grail is a single point of care for all those needs."

2. The BFD: $16M to digitize digestive care

Illustration of an x-ray of a stomach showing dollar bill signs. 

Jan-Felix Schneider, a deployment team lead at Palantir and self-described health tech nerd, unveiled a searchable database of digital health companies at ViVE called the Digital Care Directory.

Why it matters: It appears the sky has no limit in the burgeoning health tech sector, which was already raking in funding before totals skyrocketed last year. Who hasn't lost track of all the startups in the space?

Details: The directory is crowdsourced, so it isn't yet fully representative of all of the companies in the sector. But it does include a lot of the businesses on our radar.

Users can search the database by condition, treatment, type of specialty, population and even payment model.

The directory includes an option for owners of the listed companies to claim their business and add details, but for now, the button simply redirects to the companies' websites.

Users can also submit information on a provider that isn't listed.

By the numbers: There are 150 providers currently included in the database representing:

💭 Erin's thought bubble: I've been wanting to create a database like this for years and I'm excited to try this one out.

3. A digital health directory

Illustration of a hand tapping an app icon with a medical cross.

Lynx, an e-commerce platform for health care payments, raised $17.5m consisting of a $15m Series A and a $2.5m seed round. Obvious Ventures and .406 Ventures co-led the Series A with support from Frist Cressey Ventures. Other backers include Winter Street Ventures, Shields Capital and Huntington Avenue Ventures. https://www.lynx-fh.com 

Apollo Neuro, makers of a wearable for stress reduction, raised $15m in Series A funding led by Noetic Fund, bringing its valuation to over $100m. Individual investors including golf star Greg Norman also participated in the round.

4. Deals o' the day

Carrum Health named Stephen Howey director of provider operations from 98point6 Inc., where he was senior manager of product medicine.

BD named Niveditha (Nivi) Arumugam VP of research and development from Verily, where she spent six years, most recently as head of emerging medical devices.

CVS Health named Amaresh Siva SVP of digital technology and Musab Balbale SVP and chief merchant. While Siva was previously SVP of data at Lowe's Companies, Balbale was merchandising VP of beauty at Walmart.

Nomi Health named Sean Escobar provider engagement manager from CarePlus Medical Group, where he was director of business development.

5. It's Personnel

Hello, Health Tech readers. It's Tuesday.

👭 Situational awareness: It's International Women's Day, folks. ICYMI, check out Erin's live conversations with Everly Health's Julia Cheek and CRV's Kristin Baker Spohn. 

Plus, Sarah catches up with Homeward's CEO at ViVE. 

😎 It's 80 degrees today in Miami Beach, where Sarah is running around all week gathering intel at ViVE, and later, HPE. She could get used to this. 

💚 Thanks for reading Axios Pro Health Tech! Please ask your friends, colleagues and fellow conference-goers to sign up.

March 08, 2022

🏠 1 big thing: Homeward dispatch from ViVE