The future demands that we continue addressing our most urgent social and environmental issues, and history shows us that intentionally taking risks during these times can produce outsized financial gains.
How software can accelerate the clean energy transition
Why We Invested in Twentyeight Health
There are significant barriers to accessing healthcare for low-income women and specifically for women of color. Some figures make clear these challenges: 45% of 18-29 year olds do not have a primary care physician; one in three doctors don’t accept new Medicaid patients; and, there are at least 72M women of reproductive age in the United States.
Specifically, access to quality sexual and reproductive healthcare is critical for the health and wellbeing of women, yet many women in the United States struggle to access quality and timely care. As a result, unintended pregnancy rates are 3x higher and maternal mortality is 2x higher for low-income women. While the gaps in access to care are clear, few solutions within the women’s health space cater specifically to underserved women, and as a result, many women struggle to access essential health services.
Solution
Twentyeight Health is a women's health platform focused on increasing access to reproductive and sexual health care for underserved communities. Twentyeight targets a large, underserved market as there are 38M underserved women in need of women’s health access. Medicaid alone spends over $200B on healthcare for women of reproductive age. Twentyeight’s vision is to become the digital healthcare home for women, building trust early and providing care throughout a woman’s lifetime via telemedicine, medication delivery and ongoing care. Twentyeight provides medically accurate, accessible, convenient healthcare and currently offers various methods of contraception, emergency contraception, prenatal vitamins, and STD treatments, amongst other services. Twentyeight is available today in 34 states and in Washington DC. In 2021, Twentyeight launched full Spanish language telehealth services for their healthcare offerings to cater to Spanish speakers, a largely underserved population as a Health Affairs study published in 2021 shows that Spanish speakers receive approximately one-third less care than other Americans.
Twentyeight has been strategic in its go to market strategy by initially offering contraceptive care to underserved women via its direct-to-consumer approach. As a result, Twentyeight developed strong relationships with thousands of women as a trusted healthcare provider while also gathering meaningful data around underserved women and their habits and health needs. Because Twentyeight builds long term relationships with their users by providing subscription-based access to birth control, the company is uniquely positioned to provide care coordination when users want to pause birth control and may be thinking about conception (or already pregnant). This fills a significant gap for health plans who want to proactively offer additional services to women at appropriate times to improve maternal outcomes and reduce costs but often cannot due so because of the lack of member engagement and accurate data. Now that Twentyeight has developed a strong foothold via its initial product offerings, it has expanded its healthcare offerings, such as herpes treatments, prenatal vitamins and emergency contraception. Twentyeight developed its own proprietary platform to easily engage with users, their provider network and their pharmacy partners. Additionally, the scalable platform will allow them to easily add additional healthcare offerings to the business.
Why We Invested
Twentyeight is specifically focused on reaching historically underserved populations via its platform and increasing access to health products and services for low income women. We found Twentyeight to be differentiated from other players offering digital health solutions to address women’s health for two main reasons:
Many women’s health solutions are point solutions - solutions that address and deliver on one specific need, often in isolation. However, while point solutions can target specific parts of the patient journey, it is important to keep in mind the holistic health of the woman in order to drive outcomes. Therefore, we are excited about Twentyeight’s approach to building a women’s health platform because we believe that winners will be solutions that address the woman’s whole health and/or integrate with other solutions to support various social and medical factors that may affect a woman’s health throughout various phases of her life.
A majority of the women’s health solutions currently in the market are offered as direct to consumer products that women pay for out of pocket. As a result, these solutions are often price prohibitive to underserved populations and therefore cater predominately to middle and high income populations. Therefore, low income women are typically unable to access these solutions. While Twentyeight has both direct to consumer and B2B business models, the services Twentyeight is offering are mostly fully reimbursed and so women do not pay out of pocket to access Twentyeight. Therefore, Twentyeight is reaching a population that has historically struggled to access these types of healthcare services.
Beyond reproductive health, Twentyeight seeks to increase women’s access to healthcare more broadly. The company aims to empower individuals with information, affordable access and convenience for their reproductive and sexual health. Twentyeight is comprised of doctors, public health experts, designers, engineers and builders who are committed to changing the face of healthcare for underserved communities.
Impact
We believe that Twentyeight can reach populations that have historically struggled to interact with the health system to improve health outcomes for women. Twentyeight’s user demographics indicate their success in engaging underserved populations: of Twentyeight’s users, 58% identify as BIPOC, 59% live in non-urban areas and 55% of users are on Medicaid. 63% of Twentyeight’s users report that they did not have access to birth control prior to joining Twentyeight. Overall, Twentyeight has impact on various levels: the company can reach populations that have historically been left out of the health system (underserved, low income women), help to prevent unintended pregnancies, and bring women into the health system for regular visits and preventive care to identify conditions or illnesses at an earlier stage to improve outcomes and lower costs.
Beware of Venture FOMO
Why We Invested in Perfect Power
By Chris Wu
The electric grid is transitioning from a centralized system, to one that is more distributed, renewable and accessible. New regulations, renewable energy mandates, tighter environmental regulations, the electrical grid’s evolving load profile, as well as the increased intermittency of our energy supply as more renewable energy comes online all serve to usher in a paradigm shift in the 100 year old energy grid.
The US Inflation Reduction Act (IRA) will dramatically reshape the makeup of electricity production in the US in the coming decades. The new law is a game changer for renewable energy development and energy storage installations; it is estimated that the IRA will more than triple US clean energy production and result in 40% of the country’s energy coming from renewable sources. In order to achieve this rapid transformation an additional 550 GW of electricity must be generated via renewable sources in less than 10 years time. In other words, meeting the emissions reduction goals of the IRA will hinge on the US’ ability to at least double the rate of renewable installations over the record levels observed in 2020 and 2021.
Perfect Power strives to be a next-generation, clean-focused project developer, and is well positioned to serve the electric grid during this critical point in the clean energy transition. Perfect Power’s mission is to acquire, develop, and opportunistically own and operate, a differentiated portfolio of dispatchable low-carbon generating assets which accelerate the transition of the power grid to a faster, safer, more reliable, and lower carbon future.
Solution
Perfect Power acquires, develops or redevelops, owns, and operates electric power generation assets. The company is focused solely on assets that enable the decarbonization of the electrical grid, specifically renewable energy generation and battery energy storage. Perfect Power finds attractive locations to build large solar or battery projects, takes control of those sites, and performs all the development work needed in order to get that project to a point where it has achieved its full “Notice to Proceed” (NTP) milestone and has the green light to proceed with construction/installation. At that point, Perfect Power has the option to either sell that project at a markup to a strategic or larger developer who would then proceed to invest the money necessary to build and operate the solar or energy storage project, or they have the option to build and operate the asset themselves. The buyer would be acquiring an asset that has had the development risk removed and is ready to immediately begin construction or installation.
The company looks to develop a geographically diverse portfolio in markets that are accessible, liquid, tradeable and compensatory such as ERCOT (in Texas) and CAISO (in California). Perfect Power develops utility scale front of the meter assets that have transmission or distribution system interconnection points. It can also opportunistically pursue commercial and industrial (C&I) projects in select markets that require dispatch to obtain payments, as well as distributed front of the meter assets interconnected to participate in the wholesale electric generation market. Perfect Power is able to aggregate and build a portfolio of energy storage projects at a significantly lower entry price and with relatively low overhead expenses given its business model and personnel’s expertise. Perfect Power currently owns, or has exclusivity, on a wide variety of development-stage projects including a pipeline of up to 200 MW of distributed energy storage projects, 300 MW of utility-scale solar projects & 250 MW of utility-scale energy storage projects in ERCOT, as well as a pipeline of up to 325 MW distributed energy storage projects in CAISO.
Why We Invested
Perfect Power has a proven team with deep expertise in power generation, renewable energy and energy storage in key markets, as well as a proven track record of asset development and management. Perfect Power was formed and is wholly owned by SER Capital, who handpicked the company’s leadership team. In addition, the SER Capital team has over 100 years of private equity experience in this space as well as senior executive level operating experience at both private and public companies in the energy industry that will be invaluable as they partner with management to help the company scale and grow.
We were impressed by Perfect Power’s ability to aggregate and build a sizable portfolio of energy storage and solar projects at a significantly lower entry price and with much lower overhead expenses than it would cost to acquire an established platform. We see an opportunity for Perfect Power’s platform to develop a differentiated portfolio of dispatchable low carbon generating assets which accelerate the transition of the power grid to a faster, safer, more reliable, and lower carbon future. As the electric grid is transitioning from high carbon intensity (e.g. coal-fired power plants) to a low carbon intensity; batteries will enable the integration of renewable energy and other resources based on demand instead of simply dispatching when the resources are available. We also were attracted to the flexibility of Perfect Power’s platform to either sell or build its projects, which gives it a distinct advantage.
Impact
In order to achieve the greenhouse gas reductions (GHG) needed to limit global warming to 1.5 degrees Celsius above pre-industrial levels and avoid the worst effects of climate change, we must scale up renewable energy capacity at a rapid pace. Today electricity production makes up about 25% of the United State’s total GHG emissions given that approximately 60% of our electricity still comes from burning fossil fuels - primarily coal and natural gas. Perfect Power’s platform will enable more than 1 GW of renewable energy generation, energy storage, and efficiency improvements to be built and come online, which will help decarbonize the grid by displacing GHG intensive forms of energy generation such as combined cycle gas or coal plants. The environmental impacts of solar generation are immediate and material as a true zero-carbon source of energy. Energy storage plays a critical role in integrating intermittent renewable energy into the grid. Together battery energy storage paired with solar generation forms a strong combination that provides reliable and clean power at scale for the energy grid.
Why We Invested in Watershed Health
Hospital readmissions place a large burden on the healthcare system. Each year, hospital readmissions cost payors ~$40B in disbursements and hospitals ~$560M in penalties alone. Many hospital readmissions are avoidable, and there has been an increased focus on reducing hospital readmissions to improve patient outcomes and reduce costs.
For example, the Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that “encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.” As can be seen in the HRRP’s mission, care coordination is a key consideration in improving outcomes and reducing readmissions. The care coordination market, which seeks to minimize the number of avoidable hospital readmissions, is large and growing.
Solution
Watershed Health is a community-wide care collaboration platform which connects clinical and non-clinical care teams to facilitate communication, streamline the exchange of data and improve care management. For this reason, Watershed is an optimal tool in the post-acute environment where it is used to manage the hand-offs between acute and post-acute care providers, enabling better continuity of care and sharing of data (including around the social determinants of health) to reduce readmissions and improve outcomes for patients. Specific stakeholders include hospitals, medical transportation providers, home health, in-patient rehab, and skilled-nursing facilities. Watershed interfaces with any electronic health record (EHR) through a simple, universal connector to create real-time data exchange between the various involved stakeholders (acute and post-acute care providers). The platform improves care coordination and reduces readmissions, thereby improving health outcomes, enables transparency and optimizes post-acute care networks.
Why We Invested
Whereas existing solutions simply collect health data, Watershed takes into consideration the needs of various stakeholders to continuously measure provider collaboration and patient outcomes. As a next generation platform, Watershed is designed for all providers in both acute care settings (hospitals and health systems) and post-acute care settings (including home health, in-patient rehab, skilled-nursing facilities) to drive improved outcomes for patients and cost reductions for health plans. Watershed is directly driving impact by supporting the transition to value based care. The platform aggregates member data and gives providers real time insights to manage care transitions in order to transition patients from acute care centers back into their communities. Watershed gives providers actionable insights needed to act in real time and the tools to collaborate across care settings to improve patient outcomes.
Watershed’s leadership team consists of healthcare experts with longstanding experience in their respective fields and strong industry networks that will prove useful in Watershed’s growth. The team has specific expertise on the transition to value based care, sales executives with experience scaling similar models and physicians with first hand knowledge of the patient journey and the unmet needs in this space. The team complements one another and each brings a unique set of skills and experiences that will help the company through its next phase of growth.
Impact
Watershed’s referral management and data & analytics platform drives better patient outcomes.
As an example, Watershed’s platform helped one hospice agency reduce the time between hospital discharge and hospice intake from 36 hours to 5 hours, resulting in a drastic reduction in 30-day readmission rate from 10.6% to 2.8%.
One of Watershed’s initial clients experienced a sustained decline in the 30-day hospital readmission rate: before Watershed, the hospital readmission rate in the region was approximately 18%. After a two-year rollout and expansion period, hospital readmission has dropped to between 9% and 11%.
Watershed has a unique ability to directly impact patient outcomes by improving care transitions and therefore reducing readmissions rates. Watershed has a significant amount of data and metrics that it aggregates on a regular basis which will prove helpful in better understanding how Watershed drives improved outcomes and lowers the cost of care.
