Dispensed: What happened in Vegas, tough times for Juul, and big microbiome bets

Hello,

Welcome to Dispensed, Business Insider's newsletter recapping the healthcare stories that kept us busy this week.

This week, I was treated to a much different "skyline" during my stay at the MGM Grand in Las Vegas for the HLTH conference.

While there, I moderated a panel with healthcare investors and bankers, spoke onstage with Ancestry CEO Margo Georgiadis, attended an iconic Flo Rida concert - and of course picked up a lot of story ideas and tips.

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My week at HLTH

Already, I've pulled together the download on Google's health ambitions now that the Google Health team has been assembled under Dr. David Feinberg, who came to Google in January after a stint as the CEO of Geisinger Health System in Pennsylvania.

From how I understand it, there are lots of ways Google can touch on the massive health industry, and it'll be Feinberg and his team's job to make sure that happens responsibly and accurately.

Coming out of the conference, I got the sense that a lot of folks embedded in the healthcare industry are skeptical of what big tech players - Facebook in particular - can do in healthcare. Companies like Facebook and Google are facing scrutiny for how they're using consumers' data, and with health information comes a higher bar. Whether tech companies can live up to those higher expectations remains to be seen.

And I have the scoop on another massive funding round coming for primary care disruptors. This time, Iora Health is set to raise more than $100 million as it preps for 2020 and the addition of traditional Medicare patients to its model that charges a monthly fee to manage the care of patients on behalf of health plans, especially Medicare Advantage plans.

There also seemed to be a lot of interest around Walmart's new health clinics, which debuted in September. Walmart's vice president of health transformation Marcus Osbourne spoke onstage shortly after CVS Health CEO Larry Merlo, who also spoke about the company's health strategies via the HealthHUBs the company debuted earlier this year.

The presentations came a day after Walgreens announced it plans to close 150 of its health clinics, instead putting in Jenny Craig locations. It's one of those reminders that the retail clinic business hasn't fully been worked out just yet.

Simultaneously, I had some interesting conversations about who wasn't present at the conference: Notably, there weren't many health systems around, nor was there a massive patient presence, as some have pointed out (a common theme at industry conferences).

The lack of many health systems with the presence of a number of retailers and newer care models that bring services outside the hospital has me wondering if health systems are ready for the new competitors - or if those retailers and new models are about to eat health systems' lunch.

Thoughts on that? Email me at lramsey@businessinsider.com.

A tough week for Juul

Of course, outside the conference, news carried on. Especially, it was a week of reckoning for Juul, the Silicon Valley vaping company once valued at $38 billion. The company is facing a looming crackdown on its flavored pods.

• First: Layoffs, about 500 of them.
• Then there were the departures of the company's chief financial officer and chief marketing officer.
• On Wednesday, a former executive filed a lawsuit alleging the company knowingly sold 1 million tainted pods.
• On Thursday, Altria, which owns a third of Juul wrote down its investment by $4.5 billion. That brought the company's valuation down from $38 billion to $24 billion.

As always, Erin Brodwin, has the comprehensive timeline of Juul's tumultuous life as a company. You can get caught up here.

Following the downfall of uBiome, Erin looked around the health-tech industry to find the other microbiome bets that are still around. She rounded up a number of companies that are still working to target the community of microbes that live in and on us.

These 9 startups are betting that your gut is healthcare's next frontier, with millions in backing from investors like Marc Benioff and Vinod Khosla

• Investors including Marc Benioff and Vinod Khosla still see the microbiome as a lucrative opportunity, despite several recent high-profile failures.
• The microbiome refers to the community of bacteria living in and on us, most prominently in our gut.
• One of the failures involved a $600 million company called uBiome, which shut down after months of challenges and setbacks.
• Several other microbiome companies could find a way to capitalize on insights from our gut.

Before I shipped off to Vegas, I checked in with Alignment Healthcare, another player in the Medicare Advantage space (albeit, private-equity backed rather than venture-backed). At HLTH, I noticed that a lot of investors are keen to tap into the Medicare Advantage space, so will be curious to see what other kinds of bets are made there in the future.

Alignment Healthcare raised $270 million to upend healthcare for seniors. CEO John Kao told us how it's taking on the red-hot Medicare Advantage market.

• Alignment Healthcare provides health-insurance plans and services designed to help coordinate care, focused on Americans over age 65.
• The company is backed by private-equity firms Warburg Pincus and General Atlantic.
• Since its founding in 2013, the company's grown to 61,000 members, with plans to make $800 million in revenue in 2019.
• Here's how it plans to keep growing in the competitive Medicare Advantage market, where it faces rivals like Humana, CVS Health's Aetna, and UnitedHealth.

Business Insider in conversation

We've had a lot of chats this week/listened into some interesting podcasts! Here's a recap.

• Erin spoke to Vik Bajaj, the man who helped create Google's life sciences venture. Now he's launching a biotech hub to help solve healthcare's biggest problem.
• Clarrie Feinstein listened to a new episode of the "A Healthy Dose" podcast, in which the founder of One Medical, Tom Lee, reveals how his new venture called Galileo will take a fresh shot at fixing primary care.
• At HLTH on Sunday, I sat down with Seema Verma, the head of the Centers for Medicare and Medicaid Services. Verma oversees a budget of $1 trillion. We spoke with her about what she wants to see from the private-healthcare industry.

If you're in NYC this weekend and watching the marathon, keep an eye out for my dad and me! We'll be running and blogging the marathon for Business Insider. Here's hoping our training paid off!

Tips? Reactions from a week at HLTH? Questions about our job postings? Post-marathon food recommendations? I'm at lramsey@businessinsider.com, and you can reach the whole team at healthcare@businessinsider.com.

- Lydia