• A decade ago, a digital health start-up like Castlight Health could pursue a single-point solution, in its case health data transparency, and be successful.
• Now the employer market wants broader solutions spanning from data transparency to health-care navigation and primary care, whether in-person or virtual, all of which Castlight now offers.
• Venture investing has picked up in the digital health sector, but so has consolidation.

In this weekly series, CNBC takes a look at companies that made the inaugural Disruptor 50 list, 10 years later.

Anyone who has used the U.S. health-care system knows that it can be a frustrating experience. The need for data transparency remains an issue, but as a business model, providing transparency in health data hasn't proven to be enough on its own.

Castlight Health was an original CNBC Disruptor 50 company, featured in the first year of the list in 2013 as a pioneer in the effort to pull back the veil on health-care data for the consumer. But how swiftly a single solution can become commoditized is one of the lessons from the history of the company. Its single-point transparency tool was quickly commoditized by managed care companies, leading to a decline in transparency-only revenue.

That type of risk remains today across many digital health providers seeking to convince the market to buy their tools. Even basic telehealth, which boomed during the pandemic, has become a commodity, according to Charles Rhyee, a health-care analyst at Cowen who has covered Castlight Health and Teladoc. This week, Amazon expanded its Amazon Care service nationally.

But Castlight hasn't gone away. Its history as a public company hasn't been a success as measured by the trading chart, with the stock recently as low $2 after a 2014 IPO which priced at $16 a share. But as it prepares to leave the public market in a private acquisition by primary care company Vera Whole Health, its business evolution speaks to how current digital health players are consolidating in a bid to provide the market what it wants: a broader set of services in the search for a system that produces better health outcomes.

This strategy has been many years in the works at Castlight. As health data transparency stalled as a source of growth, it acquired Jiff in 2017 to move into health-care navigation (think a self-service app guiding the consumer or a live expert). Navigation is now a core service it and competitors sell to a client base that includes many of the self-insured Fortune 500 companies.

And the problems that employers are solving have not changed, says Maeve O'Meara, current Castlight Health CEO (since 2019) and veteran of the company who has been with it for more than a decade. "Health care is still complicated, people don't know where to go, what care to get, or where and how to get it," O'Meara says. "We need to meet people where they are, whether it is a self-service app or experts, to help them navigate the broader health-care landscape." 

She says the original focus on data hasn't gone away, but it does need to be applied in new ways, with Castlight using data to understand an employee's specific needs and guide them to the appropriate care. "What has evolved for us is the ability to leverage data and create a set of options to direct employees to, whether physical health-care settings or virtual care, which can include telemedicine and additional condition-specific virtual tools."

That is a big change from 2013, or even earlier in 2010, when the company was focused on transparency and local providers.

"When I stepped into the CEO role, I believed that given the complexity of health care, we needed to address people in whatever channel made sense to them," O'Meara says.

Covid and the fog of digital health solutions

The market of corporate buyers is also a channel asking for a different form of engagement with the digital health companies.

While digital transformation of health care continues to accelerate, so has fatigue on the part of employers from all of the companies trying to sell point solutions, according to Rhyee. "In the early days, they took that call when it was a digital health start-up that was new," Rhyee said. "Employers historically were more willing to experiment than payers [insurance companies]. Now employers are looking for end-to-end solutions to provide multiple services and we have seen this continued consolidation."

Vera Whole Health with Castlight. Virgin Pulse and Welltok. Accolade buying PlushCare. Grand Rounds and Doctors on Demand. Teladoc and chronic care company Livongo.

"I have been in and around this space for a long time, and seen the cycles of both excitement and fatigue among employers," says O'Meara, but she added that the pandemic has also resulted in a new cycle of focus.

The pandemic put a specific spotlight on Castlight as it helped to build the vaccine.gov site with the federal government and CDC. But at a broader level, "there is more of a C-suite level conversation now about how complex it is to navigate health care," she said.

Covid has heightened employer awareness about health care, but it also has made them more attuned to the "patchwork" solutions they had in place, according to Megan Zweig, chief operating officer at Rock Health, which runs venture funds focused on health start-ups, and offers health-care research and advisory services.

Now Zweig says the market is at a transition point, with the majority of in-person care back, but the employers realizing the staying power of virtual offerings and moving away from "ad hoc" investments to a broader strategy in digital health that is intended to be sustainable. 

"In the past, it was more opportunistic, but now we're seeing more intention, a set of tactics and strategies," Zweig said.

The digital health transformation remains to a large degree about giving the consumer more control of the experience, but the promise of digital health, according to Rhyee, was never to lower cost alone, but rather to motivate members to be more engaged with their health, ideally resulting in better outcomes.

The triple aim of Fortune 500 buyers is cost efficiency, better health outcomes and better member experiences.

"Evolution wise, there is a realization that better outcomes lead to better costs," O'Meara said.

As companies including Castlight Health continue to expand the links between data and navigation and primary and chronic care — and possibly even into pharmacy and follow-up care — it remains an unknown if these business models can successfully complete the cycle from pointing an individual in the right direction to actually getting the individual to take the action needed to achieve a better outcome.

Benefits consulting firms say many health-care companies are now coming to their corporate clients with these combinations as the next stage in the digital health sector's evolution, but it is not yet guaranteed it is the right answer. "It will be interesting to see what happens," Rhyee said.

From private to public to private again

In leaving the stage as a publicly traded company, Castlight is now again going to be like many digital health companies — in fact, most never go public in the first place.

In the digital health space, it is much more likely to be acquired than go public. In 2021, there were eight completed IPOs and 15 SPAC mergers in the digital health space, which was by far the most ever, according to Rock Health data. But that is more a function of the hot IPO and SPAC market than change in digital health exit strategy. The number of acquisitions of digital health companies that closed in 2021 still far surpassed the IPOs.

More venture money than ever before is going into digital health, and acquisitions of digital health companies will continue to dominate as a function of the capital markets' history and the buyer market moving to broader solutions rather than contacts with many different point solutions. "If you are an employer and you want to build out the health-care offerings and programs, and mental health and wellbeing benefits, it's a lot of work to comb through all the pitches and contacts for all these narrow use cases," Zweig said.

Rhyee says it wouldn't be surprising to see a major insurer like Anthem ultimately acquire the combined Castlight and Vera Whole Health. Anthem is a long-time Castlight partner and after the private transaction is completed, expected to be an investor in the combined company.

It's not that every digital health company needs to be rolled up, and companies such as a Teladoc can continue to roll up services as publicly traded companies and achieve scale — though its stock has been under serious pressure since the pandemic boom — but many single-point solutions will get rolled up in one way or another.

O'Meara doesn't want to speculate on any future business combinations or transactions. But she does say that while large employers were really "the tip of the spear" in terms of driving the original innovation, payers including Anthem are now embracing the opportunity to help drive behavior change.

"Payers believe if they can influence members to make better decisions it can improve the cost of care and the outcome. They believe how we use technology with the member directly and at the point of care is valuable," O'Meara said.

"Castlight was a pioneer, and is a pioneer, in terms of bringing transparency to the market and transformational change in health care. It doesn't happen overnight," she added. "We are focused on building a company that transforms how employees access care and how employers pay for outcomes and that will be a big exciting business."

CNBC is now accepting nominations for the 2022 Disruptor 50 list, our annual look at private innovators using breakthrough technology to transform industries and become the next generation of great public companies. Submit your nomination by Friday, Feb. 11, at 3 pm Eastern time.