Behind the Scenes of Avhana Health’s Decision to be Acquired

Avhana Health grew its customer base more than 2,000% year over year in 2020, according to co-founder Noah Weiner. The digital health startup was taking off, but Weiner also “saw the writing on the wall” for 2021.

“We would either need to join forces with a larger company to support all our clients or raise more money,” Weiner said.

Baltimore-based Avhana chose the former, agreeing to be acquired by Amalgam Rx, a digital medicine and patient support company, after a courtship that only took four months and, due to the pandemic, was completed entirely online and in virtual meetings.

“It was a super-quick process,” Weiner said. “We were really impressed with the Amalgam team and saw an overlap in where the companies were going.”

Avhana’s precision medicine tools provide clinical decision support for doctors and are integrated into electronic health records, giving doctors patient-specific best practices in real time at the point of care.

Weiner helped install the electronic health record system at Johns Hopkins nearly a decade ago, and saw some functionality he thought could be improved. He founded Avhana with his brother, Nate, and the company was part of the DreamIT Health Baltimore accelerator at Johns Hopkins.

Noah Weiner first met Ryan Sysko, Amalgam’s CEO, at an award event where they bonded about their shared undergraduate alma mater, Lafayette College. They kept in touch through twice-a-year phone calls. During one of those calls last year, they realized the potential for both companies if they worked together, Weiner said. Sysko asked Chris Bergstrom, Amalgam’s president, to meet Weiner.

“We were just blown away following Noah and his team,” Bergstrom said. “Particularly, we were impressed with what they were doing in terms of taking an electronic medical record and transforming it from a digital filing cabinet into a tool that empowers clinicians to practice better care and optimize their decisions.”

In determining whether an acquisition makes sense, Bergstrom said he first asks two questions about the other company.

“Are they solving a synergistic problem we aren’t able to solve as well as they can? Do they have the team to continue to maintain that edge and deliver more value over time?” he said. “If both those things are true, and there’s a strategic fit with your mission, there’s a lot of reasons to bring the two together.”

Weiner, a first-time entrepreneur going through the acquisition process for the first time, said he quickly realized all the factors — and people — he had to consider while making his decision.

“You’re not only negotiating with the other party, you’re negotiating with your shareholders, your employees and your vendors,” he said.

Weiner personally had to consider going from being his own boss “at the top of the pyramid” to being part of an organization. He is now general manager of Avhana Health, which calls itself “an Amalgam Rx company.”

Ultimately, Weiner believed that while Avhana was successful going from “zero to one” alone, becoming part of Amalgam would help the company go from “one to 10.”

“Joining a larger team, there are so many more opportunities we can go after,” he said.

The two sides first engaged in acquisition talks in September, according to Weiner. A letter of intent was signed a month later, and the acquisition closed in January. All of Avhana’s employees were retained in the deal.

As precision medicine becomes a more integral part of patient care and health care in general, Bergstrom said Amalgam’s goal is to grow Avhana’s footprint from supporting under 10 million patients to more than 100 million patients and their providers. Amalgam, then, will bring those stakeholders together with payers and life sciences companies to be the “best enablers of value-based care in the country.”

Bergstrom envisions doctors using Avhana to rapidly identify patients in need of certain care, medications or procedures based on that patient’s medical profile and health insurance, and at the click of a button, implement those orders, which may include a companion digital therapy, perhaps by Amalgam.

“We think Avhana is on the curve of where health care is going,” Bergstrom said. “Personalized, value-based and integrated seamlessly into provider workflow and patients’ lives.”