Cigna to Anthem: we’re calling it off too–and we want $13 bn in damages!

Breaking News  Not quite so tuneful or amicable is today’s other Funny Valentine, which is now in Divorce Court. Cigna officially wants out, out, out of its merger with Anthem in a big, big, big way. In addition to the contractual breakup fee of $1.85 bn, Cigna is suing for additional damages exceeding $13 bn.

The action versus Anthem in the Delaware Court of Chancery seeks to lawfully terminate the merger (already denied in the DC District Court, TTA 9 Feb) and to stop Anthem’s current move to extend the agreement to 30 April. The additional $13 bn in damages would recoup the unrealized premium that shareholders did not earn as a result of the merger failure.

Anthem stated last week following the District Court decision’s release that it would appeal. Healthcare Dive reported that filing took place yesterday in the District of Columbia Federal Court of Appeals.

The Cigna release is intriguing for its careful air-clearing and positioning. In their view, the merger “had the potential to expand choice, improve affordability and quality and further accelerate value-based care”. Then a wicked backhand to Anthem: “Anthem contracted for and assumed full responsibility to lead the federal and state regulatory approval process, as well as the litigation strategy, under the merger agreement. Cigna fulfilled all of its contractual obligations and fully cooperated with Anthem throughout the approval process.’

Financially, Cigna stresses its positive outlook of 12 to 18 percent growth and ‘significant capital available for deployment’, as well as touting that their “approach of focusing on health care services over sick care financing has never been more critical.” There is also an updated statement about their share repurchasing authority: “Cigna is also announcing that its Board of Directors has expanded the company’s share repurchase authority to an aggregate amount of $3.7 billion. Management has determined that it is prudent to cap the amount of the repurchase to $250 million per quarter until there is more clarity with respect to the litigation with Anthem.”

No press response yet from Anthem. Stay tuned. Also CNBC

Earlier today: Aetna’s Bertolini to Humana: Let’s call the whole thing off

Updated: Aetna’s Bertolini to Humana: Let’s call the whole thing off.

Updated–Humana exits individual exchange policy markets

Breaking News On this Valentine’s Day, a Romance Gone Flat. This morning, both Aetna and Humana formally announced the end of their merger, ruling out any appeal of the Federal District Court decision against it last month [TTA 24 Jan]. While positioned as a mutual agreement, Aetna CEO Mark Bertolini took the key quote in the release: “While we continue to believe that a combined company would create greater value for health care consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction. We are disappointed to take this course of action after 19 months of planning, but both companies need to move forward with their respective strategies in order to continue to meet member expectations. Our mutual respect for our companies’ capabilities has grown throughout this process, and we remain committed to a shared goal of helping drive the shift to a consumer-centric health care system.”

Humana’s release limited the announcement to one line and briskly moved on to what really counts–the financials. They will receive a breakup payment of $1 bn (after taxes, $630 million) from Aetna, with their 2017 financial guidance call/release taking place after 4pm EST today. Molina Healthcare, which was to receive certain Aetna Medicare Advantage assets from Aetna post-merger to relieve an over-dominance in some markets, will also receive an undisclosed termination fee. Ka-ching! CNBC, Hartford Courant (Aetna’s hometown paper)

UPDATED 2/14-16 Humana’s financial release announced an updated strategy, share repurchases, a nicely increased dividend–and, buried in the release, their exit effective 2018 from the ‘individual commercial’ business, which are individual policies offered in 11 states through the ACA-created Federal Marketplaces, citing an ‘unbalanced risk pool’ and losses estimated at $45 million for FY17. (By 2018, it may be a moot point.) It is ironic that Aetna’s exit from exchange policies due to unprofitability (or not, as it turned out to be in a few cases) proved to be one of the many bricks that broke the merger, in Judge Bates’ view. The truth is that Aetna and Humana are hardly alone in fleeing the exchanges, and that they have turned out to be unprofitable, as predicted.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/aetna-tweet.jpg” thumb_width=”250″ /]Consistent with their behavior over the 19 months of the proposed merger, both Aetna and Humana are publicly respectful, unlike….

These other two will never be one, something must be done? The demise of the Anthem-Cigna merger [TTA 9 Feb], now breaking up in Delaware Chancery Court, may mean a period of Payer Merger Quiet. Does this mean a refocusing on benefiting corporate and individual policyholders during the certain changes to come? Aetna may also proceed with a plan to move operations to Boston, which may affect hundreds of jobs, but has pledged to keep a presence in Hartford according to the Hartford Courant. Humana continues to be interested in investment opportunities and, from reports, another merger.

Goodness knows what the end will be! (Hat tip to Ira Gershwin for the title and the interpolated lyrics!)

Updated–MedStartr’s Rise of the Healthy Machines 1 March (NYC)

Wednesday 1 March, 1-6:30 pm (followed by cocktail reception to 8 pm), PriceWaterhouseCoopers, 300 Madison Avenue NYC

What’s new at #RISE2017? A new event page which has all the highlights, including the speaker roster and agenda.  The revised agenda focuses on population health and how machine learning/AI will change medicine and our notions of healthy living, with speakers and panelists from Teladoc, PwC, J&J, Prognos.ai, CityMD, mymee, DataArt, Enspektos and more. There’s also a new Healthy Machines Challenge application page, so if you have a young company with a technology which can help people live longer, healthier lives, apply for the $300,000 Challenge which finds and funds some of the best new ideas in digital health. Sponsors include PwC, DataArt, and McCarter & English LLP. Tickets are free to $75 for the full half-day with reception. TTA is a MedStartr supporter/media sponsor; Editor Donna is a host for this event and a MedStartr Mentor. Also check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare

Tender/RFI up: two more from EU-Supply (UK, IRL)

Susanne Woodman, our Reader who is our Eye on Tenders, has located two new tenders available on the EU-Supply site:

(NHSSBS)Telemedicine Advice and Guidance Service Deadline is 8 March 2017. Documents are attached and available after registration and log in. Contact Greg Reide, phone: +44-161-2123701

(CTM) Pobal on behalf of the Department of the Housing, Planning, Community and Local Government invites responses from organisations for the purpose of market research. This is a Request for Information and not a tender process. This is a market sounding exercise to obtain market information in respect of Telecare Equipment in relation to the Seniors Alert Scheme. Please refer to the Request for Information document which is available via this notice. Submissions should be sent to procurement@pobal.ie on or before 3.00pm, on Thursday the 2nd March 2017. Registration and log in required for further information.

Towards 2020: Big Tech developments predicted to impact healthcare delivery

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/Gartner-curve.png” thumb_width=”175″ /]Healthcare doesn’t stand outside major technology trends, and two we’ve covered extensively are machine learning and artificial intelligence (AI), which this Editor observed [TTA 3 Feb] may beat out Massive Data Crunchers like IBM Watson Health for many diagnoses. What has been ‘bubbling up’ in the past year is blockchain, the technology behind bitcoin which is a ‘distributed, secure transaction ledger’ that uses a private key. Each record block has an identifying hash that links each block into a virtual chain [TTA 16 July]. Brian Ahier, Director of Standards and Government Affairs at Medicity, Aetna’s data analytics/population health subsidiary, predicts in Health Data Management that both will be the Big Trends for the next three years, with a substantial discussion behind both, particularly AI (though citing global equity funding of $1.5 bn in AI for healthcare since 2012 seems a paltry reinforcement). There are links to two blockchain studies from Deloitte and IEEE (requires subscription or purchase) for further reference. Two other bonuses: a link to New School’s Melanie Swan’s blockchain blog with four potential uses in healthcare and a Gartner hype cycle chart (left above) identifying both machine learning and blockchain (distributed ledger) near the peak of the curve. His third trend, digital transformation, is less a trend than an admonition that our present business structures need to change, that they must realize the potential of fully utilizing data, and to consider the customer experience.

Buddi looking for two dynamic Sales Account Managers (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/12/lavender_set_34.jpg-buddi.jpg” thumb_width=”150″ /]A note from reader Fiona Carmichael advises us that the Buddi personal emergency response system is seeking two professionals to become UK Sales Account Managers. “Your role will have a key focus on driving new business within a B2B environment, as well as building and developing existing customer accounts for organic growth.” Please contact Fiona directly after you read the job description (docx). (This closes 28 Feb.)

(A reminder to our Readers that Who’s Hiring–and Who’s Available–are free services of TTA and a great way to connect with thousands of readers in the UK and the US. We post initially in Latest News and archive in ‘Who’s available?’ and ‘Who’s hiring’.)

Telestroke continues to expand (US)

Telestroke has expanded over the years and one of the most recent [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/emergency-2.jpg” thumb_width=”150″ /]implementations is in New York at a group of hospitals in Hudson Valley. Health Alliance of Hudson Valley announced last week that its Kingston Hospital is now operating a telestroke service provided by Neurocall that uses a team of 40 “tele-neurologists” based in New York, Texas and Florida.

Stroke is one of those medical emergencies where the speed of diagnosis – usually within minutes of symptoms appearing – can have life-long impact on the patient’s ability to return to an independent life. What is particularly complicated in a stroke is that it can be caused by a blood clot or a burst blood vessel and the treatment for the two types are very different. When a specialist who is able to identify the type of stroke quickly is not available at the hospital, as is commonly the case, the ability to use telemedicine has proved to be a great boon.

A survey in 2012 identified 56 telestroke programs across the US and no doubt this has grown over the years with many well known health service providers such as the Mayo Clinic, Massachusetts General and Cleveland Clinic operating a telestroke service as well as acting as a hub to regional and rural hospitals.

Stroke is the fourth leading cause of mortality in the USA and the leading cause of serious long term disability according to the American Heart Association. With only 1100 stroke specialists in the US, half of US hospitals do not have a stroke specialist on the staff and nearly half the US population live more than 60 miles from a stroke centre according to “Telestroke—the promise and the challenge“, a paper published last year in the British Medical Journal. These factors have led to telemedicine being firmly established as an important part of acute stroke treatment.

NY’s Northwell Health Home Care partners with HRS for telehealth tablets

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/HRS.jpg” thumb_width=”175″ /]New York State’s largest health system, Northwell Health, is partnering with Hoboken, New Jersey-based (and Blueprint Health grad) telehealth provider Health Recovery Systems (HRS) on introducing their tablets into their Home Care Network. The picture at left is of Bernard Feinstein, a 100-year-old Queens-resident Northwell Health patient, who seems to be easily using and handling the touchscreen tablet. HRS tablets are video-enabled for consults and monitor vital signs, connecting via Bluetooth to devices: stethoscope (heart and lung), pulse oximeter , blood pressure, and weight scale. If one enjoys examples of pretzel logic, the release states that Northwell’s telehealth implementation is one of the first–of Bluetooth-enabled monitoring in NY State home care and the first on Long Island. (Cable-connected telehealth systems have been commonplace since 2003, including Northwell’s home care.) The HRS partnership follows on Northwell Ventures’ $1 million Series A investment in Virginia-based telemedicine provider Avizia. Innovate LI,

Robotic cats, parrot aid dementia patients at Lincolnshire Manthorpe Centre (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/robotic-cat-3.jpg” thumb_width=”150″ /]An engaging item picked up from the P.E.T.S. (Patient Engagement Treatment Services) blog via LinkedIn updates is about the innovative use of robotic pets in dementia therapy at Lincolnshire Partnership NHS Foundation Trust’s (LPFT) Manthorpe Centre, which cares for adult patients suffering from dementia. The two robotic kitties appear to be comfort ‘animals’ that move and respond, but the robotic parrot is different. According to occupational therapist Liz Lester at LPFT, who introduced the robotic animals to the ward, Pete the Parrot was developed by a man whose mother had dementia. The lifesize parrot blinks, yawns and responds directly to voice control. The patients react to handling the animals with better moods and respond more positively. Lincolnshire Reporter

Checking on “Pete the Parrot”, this Editor found a series of articles on an Alzheimer’s blog (Reading Room) that reinforces the occupational therapist’s information. The “Pete the Parrot” is a widely available and inexpensive parrot toy which repeats what you say (and flaps wings). These are widely used as helpers for those with short-term memory loss and children with delayed speech (MaxiAids). This Editor would have greatly appreciated this in assisting her mother years ago who responded positively to stuffed animals and music, was verbal until near the end, but could have benefited greatly from a toy like this. Click on various links in the articles for users’ experiences and tips (including videos).

Jawbone still in business–with Fitbit in court

While most industry observers are perceiving Jawbone’s abandoning the consumer fitness tracker market, repositioning into the clinical B2B2C vitals market, and seeking fresh financing as a last-ditch effort to save the company, Jawbone continues to be highly active in one place–court. Last week, Jawbone filed a lawsuit against Fitbit and five former employees in California state court for theft of trade secrets and has rebutted Fitbit’s motion to dismiss in a 27-page filing. According to Fortune’s account of the lawsuit, Jawbone’s filing states: “Each of the defendants has been, for more than five months, the subject of a criminal grand jury investigation regarding theft of Jawbone’s trade secrets that is being conducted by the Department of Justice and the Department of Homeland Security,” a charge that Fitbit calls ‘fictional’ and false. The court hearing in San Francisco is 15 February.

The legal skirmishing, which largely has gone Fitbit’s way [TTA 27 July] in the US International Trade Commission, indicates that Jawbone is still spending money to protect what is left of value in the company–its patents and intellectual property (whatever hasn’t been voided). Jawbone $100 million ‘gem’: the BodyMedia patents acquired in 2013 [TTA 30 Apr 13]. BodyMedia had FDA Class II clearance but a clunky form factor. This IP is a critical save if they want to go clinical. Fitbit’s shares continue to go down, an indicator that the mud is rising. Also Bloomberg with video.

The Theranos Story, ch. 35: Arizona lab in violation, is there a biotech ‘Theranos effect’?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]And we were starting to grow nostalgic for our Weekly Episodes! One would expect Nary A Peep from Theranos until the lawsuits start to move forward, they set up another Board of Experts, and/or if the Alphabet Agencies (FDA, SEC, DOJ) decide to take their own actions. A short article out of the (thoroughly paywalled) Wall Street Journal, summed up in MarketWatch, confirms that as suspected, the September 2016 Federal inspection of the Scottsdale, Arizona lab turned up multiple lab and patient notification violations. According to a Federal inspection report cited in the WSJ article, lab staff inaccurately configured a machine processing blood coagulation tests; “Theranos additionally failed to verify that devices’ precision or accuracy were in line with their manufacturer’s instructions for tests such as those for blood-glucose, pregnancy and triglycerides.” Patients were not notified of potentially inaccurate diabetes test results. This provides an extra entreé for the dining pleasure of the Arizona Office of the Attorney General (OAG), which last month put out a bid solicitation for outside counsel to assist in planned actions against Theranos for fraudulent blood testing [Ch. 33]. Hat tip to Bill Oravecz of Stone Health Innovations

No Theranos Effect? The biotech, VC and investor community has put on its Game Face and declared everything’s just fine, and move on. Theranos–now seen as an outlier. After all, they didn’t present their data and kept everything tightly under wraps. (But two years ago, who questioned that? Few.) Unicorns continue to romp, with the Business Insider article mentioning Samumed’s $12 billion valuation for alopecia and wrinkle drugs, none past Phase 2 clinical trials, plus others like Neon Therapeutics and Unity Biotechnology with sizable raises. So no more Theranoses…till the next time.

See here for the 34 previous TTA chapters in this Continuing, Consistently Amazing Saga.

Further clarification on telehealth tenders and the North Yorkshire County Council

From Reader Vicki comes this clarification on what this Editor incorrectly reported as an open tender [TTA 9 Jan]. We are separately printing her comment to the original article, as a service to those interested in providing assistive technology to North Yorkshire:

A tender has not been issued by North Yorkshire County Council. There is some information regarding a market engagement event and an outline of the Council’s intentions. This reads:

This reads:
Thank you for your interest. The Council is shaping the future of assistive technology in North Yorkshire, and has carried out some initial engagement with the wider market, in May 2016, to shape our future of the assistive technology strategy that we are developing. To allow sufficient time to ensure that a robust strategy is in place which reflects the needs of people in North Yorkshire and the available market, we are delaying the launch of the new service until 1 April 2018. We are currently working on the draft assistive technology strategy which we will be consulting on in spring/summer 2017. It is our intention to launch the procurement exercise following this consultation. Further information and all the contract documentation will be made available through YORtender.

Our thanks to Vicki–Ed. Donna

Anthem-Cigna merger nixed, finally (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /] Breaking News. Not with a bang, but a whimper. Late Wednesday 8 Feb, the anticipated decision derailing the $54 million Anthem-Cigna merger was released by the Federal District Court, District of Columbia. Judge Amy Berman Jackson’s decision denying the merger was very much along the anti-competitive and anti-trust rationales contained in the 19 January advance report by the New York Post. There’s little that hasn’t already been explored in our prior reports, so we will leave the rehashing to sources like CNBC. The general consensus is that the four Big Payer Merger participants (Aetna and Humana merger denied [TTA 24 Jan]) will be moving on, perhaps to their advantage as most of the premises for merging, based on ACA’s effects, are expected to change, drastically.

Cigna must also be relieved after its reported ‘merger remorse’ after too many rumored disagreements with Anthem. According to Bloomberg, Cigna is sitting on $7 to $14 billion deployable capital, with the high end including extra debt. (Does this include the $1.85 bn breakup fee that Anthem owes to Cigna? Stay tuned on how Anthem tries to get out of this.) And the American Medical Association is beyond delighted (release).

Of course, there’s a lot of speculation about all that loose cash being deployed on new merger targets, which include the Usual Suspects of Humana, WellCare, Centene and Molina. Some free advice: all these companies should, for the next year, sit quietly and breathe deeply (as many employees who would be redundant in any merger are). They should also take care of business (TCB!), refocus on serving their policyholders, make their processes far less onerous on providers, and let it all shake out rather than rushing out to find out Who To Buy. (New Attorney General Jeff Sessions was sworn in this morning, and many changes are coming in both healthcare policy and the judiciary.) Also Neil Versel’s pointed take in MedCityNews.

Humana-Omada Health diabetes prevention program could cut $3 bn in Medicare expense: study

A study performed by insurer Humana using the Omada Health program for diabetes prevention effectively lowered weight, improved cholesterol, blood glucose and mood. 500 volunteer subjects from Humana’s Medicare Advantage program, enrolled during 2015, lost an average of 13 to 14 pounds over a year (7.5 to 8 percent). They also saw improvements in cholesterol levels, blood glucose levels and subjective measures of moods and self-care. Individuals were chosen from administrative medical claims based on metabolic syndrome diagnosis or a combination of three of four of the following diagnoses: prediabetes, hypertension, dyslipidemia, and obesity. Based on the researchers’ calculations, this type of prevention program among this group if widely implemented among overweight adults could reduce Medicare costs by $3 bn over 10 years, not only for diabetes but also heart disease and high blood pressure.

Omada Health’s program included an online small group support, personalized health coaching, digital tracking tools, and a weekly behavior change curriculum. These one-hour lessons focused on a single topic were delivered via laptop, tablet, or smartphone, and included interactive games or exercises, written reflections, and goal-setting activities. The content was approved by the CDC Diabetes Prevention Recognition Program. Data was gathered via wireless scale, pedometer for physical activity, online food intake logging and standard lab results. “In conclusion, this study demonstrated that older adults who agreed to participate in this program were able to engage meaningfully and gain important health and wellness benefits during a relatively short time frame.”

While the cost reduction estimate is exactly that, other studies directionally confirm health improvement and savings: the National Diabetes Prevention Program (NDPP) which is the model for the Omada program, the BMJ/Noom Health study, and the Fruit Street/VSee telehealth program being used by St. Jude Children’s Research Hospital, University of South Florida and University of Michigan. mHealth Intelligence, study (full text in Journal of Aging and Health/Sage Journals)

TytoCare remote diagnostics comparable to in-person exam results: study

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/Mom_using_on_child_ear.jpg” thumb_width=”150″ /]A study of the Tyto Care remote diagnostic device, conducted by Schneider Children’s Medical Center and the Sackler School of Medicine, found that the quality of readings by Tyto Care was ‘on par’ with in-person medical exams using conventional otoscopes and stethoscopes. Ears, heart, lungs and throats of 137 children aged 2-18 seeking care from the emergency department of a tertiary care facility were examined first conventionally and then again by a second remote physician using exam data captured by the TytoCare all-in-one device and attachments. Using standard statistical methods, the results were compared and the study reported “good to excellent agreement for all exams conducted using TytoCare and conventional exam tools, with a p-value <.001.” The study also recorded a separate five-point measure of patient experience and results averaged 4.4 and 4.5 out of 5 (excellent). No adverse events were recorded.

What is lacking in the release are the diagnoses of the young patients, but presumably those results will be presented with the final study. Formal presentations will be at the Israel Society for Clinical Pediatrics (HIPAK) meeting on 8 February in Tel Aviv and at the American Telemedicine Association (ATA) conference 23-25 April in Orlando, Florida. This positive report on efficacy will also aid their rollout with American Well, announced at the end of 2016 [TTA 2 Dec]. Harry Wang at Parks Associates in their blog also named TytoCare one of the two standouts of CES 2017–and the other, Partron (Croise) is not yet on the market.

Tender up: NHS Shared Business Services (SBS) (UK)

Susanne Woodman, our Reader who is our Eye on Tenders, has found this on the Gov.UK contracts finder site:

Lease of telehealth equipment and peripherals by NHS Shared Business Services. Tender # is RA212802. Location is listed as postal code M50 2UW which is Salford, Lancashire. No value assigned. The RFQ expires on Monday 20th February at 12pm. Questions accepted until Wednesday 15th February 2017 at 12:00 with responses returned by Friday the 17th. Quote procedure and more information is via Multiquote.