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Many people probably don't like to talk about it, but tens of millions of them are suffering from gastrointestinal issues, adding up to billions of dollars in avoidable spending. They're so prevalent that one in five working-age adults has been diagnosed with a GI condition, not to mention all of those who haven't been diagnosed and aren't being treated.
"GI is a massive, and woefully underserved, patient population, and a category marked by enormous spending and unsatisfactory care," said Sam Holliday, CEO of Oshi Health, a virtual care company dedicated to GI health, which announced a $23 million Series A funding round on Tuesday.
"Payers are seeing GI as a top-three specialty care cost category, and employers continue to pay more each year for GI care with little evidence of improved outcomes."
The cause of this, he told me, is the healthcare industry’s traditional payment model. For example, while dietary and psychological interventions lead to improved patient outcomes, they're too difficult for patients to execute alone, plus they require an investment of time and resources from specialized clinicians that isn't covered, or encouraged, by providers.
"This is because the industry’s current fee-for-service reimbursement system incentivizes GI clinics to perform numerous procedures like colonoscopies and endoscopies rather than investing in proven dietary and psychosocial support. This leaves patients wanting these services, unable to find them at GI clinics, and forced to source and pay for their own specialized providers," Holliday explained.
Oshi is looking to fix these problems by completely redesigning GI care delivery. Its model is virtual-first, and it addresses two core tenets: increasing access to the care in order to solve the needs of the patient, while also lowering the total cost of care for both patients and purchasers.
Each member of Oshi Health is given access to a personalized integrated care team, including gastroenterologists, nurse practitioners, mental health professionals, and dietitians, all of whom are assisted by health coaches that support lifestyle change and care plan compliance. All care is delivered via telehealth and Oshi coordinates any in-person care with those providers.
Conditions treated by Oshi include anything from confirmed GI conditions such as inflammatory bowel diseases like Crohn’s, ulcerative colitis, and irritable bowel syndrome. In addition, the platform can also help diagnose people experiencing chronic GI symptoms such as constipation, abdominal pain, bloating, diarrhea or acid reflux.
"Gastrointestinal conditions affect tens of millions of Americans. Onset of chronic GI symptoms is usually young, in the 20’s and 30’s, closing their world at a time when they should be most active. We’re seeing patients coming to us with a preliminary diagnosis, but still searching for answers about what triggers symptoms and how to manage their condition when medications alone are not working," said Holliday.
"We’re also seeing a significant population that has never been diagnosed but struggled for years with chronic debilitating symptoms. Our ability to get patients a diagnosis makes us unique from other solutions that can only provide education and symptom tracking."
By helping to diagnose and treat these diseases, the benefits of Oshi to the patient come in a number of forms. It can help cut down on unnecessary procedures, meaning patients don't have to suffer through an colonoscopy or endoscopy, which can cost between $1,500 to $4,000. It also reduces reliance on medication, which can be expensive, and it also helps patient avoids symptom escalations that often lead to ER visits.
"This whole-person, proactive approach lowers the total cost of care and improves outcomes, while our close alignment with employers and payers ensures that patients do not bear the brunt of these expense," said Holliday.
Oshi's customer are employers and health plans and, so far, the company has revealed that it is working with a national payer and that it has several additional customers launching in the coming months. It has worked with hundreds of patients since launching less than a year ago.
The new funding round was co-led by Flare Capital Partners, Bessemer Venture Partners, and Frist Cressey Ventures, along with a strategic investment from CVS Health Ventures. Also participating were Takeda Digital Ventures, Jonathan Bush, Nat Turner, Zach Weinberg, Eric M. Stone, and Russell Glass. The company has now raised $29.5 million.
The funds will be used to scale Oshi Health’s platform, meaning that it is looking to gain new employer and payer coverage so that it can reach more people who have GI issues. It will also be investing in its clinical team and technology platform.
"The exciting thing about this funding is that it brings together a tremendous group of investors aligned behind our approach who are energized by our early results and ready to help scale our care across the country," said Holliday.
"We believe this funding and the backing by a stellar group of investors is a spotlight on the need for better gastrointestinal care. It’s been an enormous area of spend defined by an unsatisfactory care experience for far too long. We’re excited to show the world a new version of GI care that is a great experience, improves outcomes and quality of life and reduces the total cost of care for patients and purchasers."
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