(Full disclosure: One of us, Vishal Khetpal, advises as a venture scout for a firm called Necessary Ventures.) In health care, these nontraditional actors have included health insurance companies like Cigna and large hospital systems like the Mayo Clinic. Instead, much of the growth in venture funding-reaching $621 billion in 2021-has been fueled by nontraditional actors, like universities diversifying their endowment portfolios. These conflicts of interest are worth thinking about, as venture is no longer solely the domain of entrepreneurs and futurists in Silicon Valley. Seeing this play out, we began to ask ourselves: Is it ethical for health insurance companies to be investing in health care startups-and if it’s going to keep happening, what guardrails should be put in place? It certainly bears the appearance of a conflict of interest, with the potential to influence the quality of care for patients. By sending its customers to Ginger, Cigna was also boosting the platform’s user numbers and maximizing its return on investment. But given that Ginger’s valuation grew in multiples around the same time-at least in part because of the massive influx of customers from Cigna-it’s reasonable to suggest that the insurance company was double dipping. Yes, it is possible that those customers will benefit from the platform. After its financial investments in Ginger, Cigna began offering no-cost access to Ginger’s behavioral health services alongside its other mental health offerings in order to improve customers’ overall health and well-being, according to leadership. Something that made us, a pair of physicians, question the financial relationships at play here: The insurance companies provided Ginger with access to millions of potential users. But Cigna in particular brought something else.
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