VA awards over $1 billion in Home Telehealth contracts–at long last (updated)

Breaking News, Updated  The Department of Veterans Affairs (VA) on 1 Feb issued over $1 billion in awards to four companies to provide Home Telehealth vital signs monitoring technologies to veterans in home care and monitoring. The four companies are Medtronic, Care Innovations, Iron Bow Technologies, and 1Vision LLC. The $1 billion is split evenly between the four ($258 million for each company over the five-year duration). The contracts are for an initial year (31 Jan 2018 end date listed on GovTribe.com), renewable annually for five years total. The bid process started in 2015 and the award had originally been scheduled for early-to-mid 2016.

On the suppliers:

  • Medtronic is the incumbent as a supplier since 2011, dating back to Cardiocom’s 2011 award for its home monitoring units (Cardiocom was acquired in August 2013). Medtronic is a Dublin, Ireland HQ’d company with a US headquarters in Minnesota.
  • Care Innovations is well known to our Readers as the developer of Health Harmony and the acquirer of the QuietCare telecare/behavioral monitoring used in senior housing. Their parent is Intel.
  • Iron Bow Technologies is a supplier to VA in other healthcare areas (telemedicine and store-and-forward) and is a large, privately held IT company with multiple Federal contracts and deep Federal contractor roots. Their revenue has been reported at over $462 million (Washington Technology Top 100 2016).
  • 1Vision LLC is a new company formed as a joint venture between HMS Technologies, Inc. and MBL Technologies, Inc. Neither are previously engaged as home telehealth providers, but both are Federal contractors. According to their individual websites, HMS is an IT systems integrator and MBL is engaged primarily in cybersecurity.

The question for this Editor is how Iron Bow and 1Vision, which are not telehealth (vital signs) monitoring companies but telemedicine and IT service providers respectively, will execute Home Telehealth with the VA. Have they partnered with yet-to-be disclosed providers in providing home telehealth services to the VA? (Watch this space)

While the award is the largest in US telehealth, the VA is, by this Editor’s experience in her last position with Viterion Corporation, extremely demanding on its service providers and will be even more so in the future. The future reasons are clear: 1) President Trump has put a Klieg light on the VA and 2) he’s named a new VA secretary, Dr David Shulkin, who is currently VA Undersecretary for Health (confirmation hearing notes courtesy of POLITICO, nomination approved by the Senate committee Tuesday, and easily confirmed Monday night 13 Feb), who has been highly engaged with HIT issues, including both the VistA EHR modernization/replacement and initiatives such as the recently unveiled Digital Health Platform [TTA 12 Jan]. (more…)

Jawbone out of the consumer fitness tracker business, going to clinical model, raising funds: report

Confirming reports from various sources last year [TTA 21 Dec] and prior (July) is a report in TechCrunch confirming what we already guessed: Jawbone is out of the consumer fitness tracker market, is aiming at a B2B2C market of health providers, and needs to raise a lot more money.

Key points in the article:

  • It intends to market a “health product and accompanying set of services sold primarily to clinicians and health providers working with patients”
  • It’s seeking additional funding from investors. TechCrunch‘s sources claim that is at an advanced stage, but no closings as of yet.

We noted in December that research/analytics company CB Insights calculated that 2015 wearable computing (a broader category that includes smartwatches) investment funding fell 63 percent from 2014 to a level comparable to 2012-13, in large part due to the cooling of the fitness segment. TechCrunch’s end of year report from eMarketer and other sources also noted that 2016 sales growth of the wearables sector, forecast at 60 percent, only achieved 25 percent growth and will be equally weak in 2017. Lack of demand, lack of loyalty (most fitness bands are discarded after 3-6 months), unreliable (TechCrunch makes much of customer displeasure), their looks and generally useless (in a clinical sense) data and the greater versatility (and appearance) of smartwatches for those who want them, are all factors. There’s a disenchantment here (‘who needs ’em?’) that mass marketing can’t overcome.

It is worthwhile reflecting that Jawbone, which started off in 1997 as an audio technology company, has burned through over $980 million in 14 funding rounds, generously provided by various VC luminaries of Silicon Valley. (One wonders how much equity is even left in the company, a la ‘The Producers’) (more…)

Updates on Anthem-Cigna, Aetna-Humana mergers

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/04/Thomas.jpg” thumb_width=”150″ /]For our Readers following the Continuing Soap Opera which involves the payer mergers of Aetna-Humana and Anthem-Cigna, some updates:

  • Anthem-Cigna still undecided by despite our 19 January report that the merger would be denied by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia. Reading the SEC 8-K filed in July 2015, the extension to 30 April is automatic if the merger is not consummated or is non-appealable by 31 January. Likely this is to Cigna’s chagrin, as multiple sources over the two years this has been going on have detailed the growing disagreements between the two companies. As we noted in January, Anthem is also running up against ‘the Blues rule’ where it does business as a Blue Cross Blue Shield plan. The arguments that this internal competition is beneficial are pretzel-like indeed.
  • A labor union investor, Westchester Putnam Counties Heavy & Highway Laborers Local 60 Benefits Funds, is suing Aetna for shareholder losses in the Federal District Court in the District of Connecticut (complaint here). The demand is for a jury trial and details what they believe to be false and misleading statements by management and not disclosing adverse facts.

Healthcare Dive is recommended for their two deeper dives: 1 Feb on Anthem-Cigna and the outcomes of both mergers, 30 Jan on the labor union lawsuit. The likelihood of either happening becomes more remote as time goes by, but there could be a surprise.

UnaliWear’s Kanega PERS watch nears US launch

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/531571-unaliwear-kanega-watch.jpg” thumb_width=”175″ /]Catching up with UnaliWear’s Kanega watch, which (unbelievably) we haven’t written about since 2015 but have noticed in the Austin tech news, we are cheered to hear that the company is nearing a market launch. This is after two 2016 raises: a November $3.5 million Series A at a $15 million valuation and a February $3.4 million seed round (CrunchBase). This Editor spoke with founder/developer Jean Anne Booth at the 2015 HIMSS Connected Health Conference/mHealth Summit (now PCHA Connected Health Conference) after seeing it in 2014, and was impressed by the design and workmanship of the watches at that time. Ms Booth, a self-described tech geek who developed and sold Luminary Micro, which created a microcontroller (MCU) platform, to Texas Instruments and is also an AMD alumna, wanted an emergency alert device that was stylishly designed to her mother’s exacting standards (a former fashion model and impeccable dresser, left above) and functionally advanced. Her initial designs were funded through a Kickstarter campaign [TTA 27 Mar 15]. As we reported before that in February, it’s quite apart from the usual run of PERS. [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/531584-unaliwear-kanega-watch.gif” thumb_width=”100″ /]Kanega is fully cellular, self-contained and voice-controlled with no buttons: GPS, emergency response connection, fall/inactivity detection, ‘guide me home’ location based voice assistance and medication reminder/assistance behind a high-contrast digital time display which makes it look like a regular (albeit fashionably chunky) watch (left). In mid-year, which is the scheduled market launch, the activation fee will be $50 with a monthly charge of $49.99. If you can’t wait, pre-orders are being takenPC Magazine

Your temporary tattoo, now with vital signs monitoring!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/graphene-tattoo.jpeg” thumb_width=”150″ /]Can you ever be too rich or too thin? The latter seems to be achievable when it comes to skin patches which can monitor key vital signs like skin temperature, take electroencephalography (EEG) and electromyography (EMG for muscles), and measure hydration. The graphene used in this sensor developed by University of Texas at Austin is 0.3-nm thick, in a polymer 463-nm thick. Unlike Stanford’s stretchy sensor we profiled in November, this doesn’t stretch, but is so thin as to be highly unobtrusive. It is made by growing single-layer graphene on a copper sheet, which is then coated by a stretchy support polymer. The copper is etched off and the polymer-graphene placed on temporary tattoo paper. The wearer doesn’t sense it because, as the researchers termed it, it is compliant with the nooks and crannies of human skin–and it doesn’t look obnoxious. It can be placed on the chest, on the arm or other locations as needed. Testing indicated good quality signals and in fact, detected EKG signals not registering on a conventional monitor. Presented at IEEE’s International Electron Devices Meeting (IEDM). IEEE Spectrum

AI as diagnostician in ophthalmology, dermatology. Faster adoption than IBM Watson?

Three recent articles from the IEEE (formally the Institute of Electronics and Electrical Engineers) Spectrum journal are significant in pointing to advances in artificial intelligence (AI) for specific medical conditions–and which may go into use faster and more cheaply than the massive machine learning/decision support program represented by IBM Watson Health.

A Chinese team developed CC-Cruiser to diagnose congenital cataracts, which affect children and cause irreversible blindness. The program developed algorithms that used a relatively narrow database of 410 images of congenital cataracts and 476 images of normal eyes. The CC-Cruiser team from Sun Yat-Sen and Xidian Universities developed algorithms to diagnose the existence of cataracts, predict the severity of the disease, and suggest treatment decisions. The program was subjected to five tests, with most of the critical ones over 90 percent accuracy versus doctor consults. There, according to researcher and ophthalmologist Haotian Lin, is the ‘rub’–that even with more information, he cannot project the system going to 100 percent accuracy. The other factor is the human one–face to face interaction. He strongly suggests that the CC-Cruiser system is a tool to complement and confirm doctor judgment, and could be used in non-specialized medical centers to diagnose and refer patients. Ophthalmologists vs. AI: It’s a Tie (Hat tip to former TTA Ireland Editor Toni Bunting)

In the diagnosis of skin cancers, a Stanford University team used GoogleNet Inception v3 to build a deep learning algorithm. This used a huge database of 130,000 lesion images from more than 2000 diseases. Inception was successful in performing on par with 21 board-certified dermatologists in differentiating certain skin lesions, for instance, keratinocyte carcinomas from benign seborrheic keratoses. The major limitations here are the human doctor’s ability to touch and feel the skin, which is key to diagnosis, and adding the context of the patient’s history. Even with this, Inception and similar systems could help to triage patients to a doctor faster. Computer Diagnoses Skin Cancers

Contrasting this with IEEE’s writeup on the slow development of IBM Watson Health’s systems, each having to be individually developed, continually refined, using massive datasets, best summarized in Dr Robert Wachter’s remark, “But in terms of a transformative technology that is changing the world, I don’t think anyone would say Watson is doing that today.” The ‘Watson May See You Someday’ article may be from mid-2015, but it’s only this week that Watson for Oncology has announced its first implementation in a regional medical center based in Jupiter, Florida. Watson for Oncology collaborates with Memorial Sloan-Kettering in NYC (MSK) (and was tested in other major academic centers). Currently it is limited to breast, lung, colorectal, cervical, ovarian and gastric cancers, with nine additional cancer types to be added this year. Mobihealthnews

What may change the world of medicine could be AI systems using smaller, specific datasets, with Watson Health for the big and complex diagnoses needing features like natural-language processing.

British Journal of Cardiology (BJC) Digital Healthcare Forum’s inaugural meeting

28 April, 9:30am-5pm, Royal College of Obstetricians and Gynaecologists, London 

Henry Purcell of the BJC was kind enough to post us with information on the first-ever BJC Digital Healthcare Forum. Organized by the BJC in association with the NHS, the Digital Health and Care Alliance (DHACA), and the Telehealth Quality Group, it is a novel ‘hands on’ meeting to assess if digital medicine can fill gaps in healthcare provision throughout the NHS. It is also in response to the massive pressures which winter has wrought on NHS health and social services. The Forum was designed by clinicians and leaders in healthcare informatics for UK commissioners, doctors and other HCPs involved in the management of long-term conditions (cardiovascular, obstructive pulmonary disease, diabetes etc.), as well as those engaged in health informatics, IT, and Trust CEOs. Speakers include Dr Malcolm Fisk of De Montfort University, our own Charles Lowe of DHACA, Professor Tony Young, National Clinical Director for Innovation (NHS England) and many more experts in digital health and care. For the latest information and to register, see the event website or the attached PDF.

Analysis of an underserved market: only 0.2% of migraine sufferers use migraine apps

research2guidance has published a short article on how migraine sufferers constitute an underserved market, and how present apps do not meet their needs. Here is an opportunity for app developers and companies to address a common and often near-intractable pain that affects everyday life. The author is David Ireland, Research Analyst, r2g Berlin.

Migraine is the third most prevalent illness in the world affecting 1 billion people worldwide^. However, this demographic of migraine sufferers is heavily underserved by mobile health applications, with only 0.2% of migraine sufferers using a migraine app*. But why? A major opportunity exists for an application with the right strategy, and the right balance of features and functionalities to lead the market, while having a positive impact on the health of migraine sufferers.

According to the Migraine Research Foundation (2017), migraine is the sixth most disabling illness in the world. More than 4 million people suffer from chronic migraine attacks every day. U.S. healthcare and loss of productivity costs are estimated to be around US$36 billion annually; just the cost of brain scans of headache sufferers alone comes in at around US$1 billion per year. Migraines are responsible for a huge loss in productivity, rendering 90% of sufferers unable to function normally, costing U.S. employers US$13 billion, and 113 million work days in 2016.

Far from being just a bad headache, migraine attacks can cause a diverse range of disabling symptoms such as severe pain, nausea and visual disturbance. While medications exist to help treat symptoms, migraine sufferers need to carefully manage their medication intake, while monitoring risk factors such as food, sleep and triggers to treat, and prevent the condition from becoming chronic. Tracking medication is critical, as most chronic migraine sufferers are a result of medication overuse^.

The main promise of migraine apps is to provide migraine sufferers with a way to better manage their condition, decreasing the chances of migraine attacks, of headaches intensifying into migraines, and of the condition becoming chronic. To achieve this, migraine apps could provide users with the following (in no particular order of priority):

  • Log-books / diaries: recording migraine events to help the user better understand their condition, while allowing for a better communication between the user and GP
  • Reporting: for analyzing and summarizing the users’ behavior, triggers, risk and symptoms, while allowing for a better communication between the user and GP
  • Information repository: peer-reviewed educational content aimed at educating the user on neurological conditions, and how best identify, treat, manage and prevent them
  • Pattern recognition: based on historical user data to notify the user of high-risk scenarios (more…)

Action This Day in US healthcare, coming to pharma, insurance, home care and innovation

Action This Day, in Churchill’s words. Today’s news of President Trump meeting with the CEOs of US pharmaceutical companies– Novartis, Merck, Johnson & Johnson, Lilly, Celgene, and Amgen–along with the PhRMA association head, indicates the speed of change that this two-week old Administration intends in healthcare. Trump’s points to the Pharma Giants: drug prices need to be brought down, especially for Medicare and Medicaid patients, through competitive bidding not price-fixing; bringing home production to the US; and that there is ‘global freeloading’ on US drugs. This last is a bit vague, and the pricing part may stir some Standard Republican Resistance, but what Trump also came down firmly for is speeding up the drug approval process. In return, the execs asked for tax reform.

Notable here is this quote:  “I’ll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market,” Trump said. “That includes price-fixing by the biggest dog in the market, Medicare, which is what’s happening.” The Hill, Business Insider

Does this mean an open door and encouragement for healthcare technology?

Certainly many startups, early-stage companies, and Grizzled Pioneers are eagerly anticipating a more open healthcare business environment than the many dictates, restrictions and the constant changing of goalposts they have faced for the past eight years. The hope is an openness of the Powers That Be on the Federal side (CMS, HHS, FDA) to innovation, patient-centered care and a change away from hammering constantly on lowering cost through a multitude of controls and top-down diktats on what Healthcare Should Be.

This Editor has seen companies straining to hang in there, playing the niches, moderating their equity raises, merging, projecting profitability sometime in the future. Some have not made it. One is the pioneer telehealth company Viterion Corporation, which was quietly dissolved by its parent company in Japan for various reasons at end of last year. (Editor’s disclaimer: I was marketing director for the company.)

Already innovation is reaching long-neglected areas like home care. Home support for the aging population isn’t buzzy, analytic or sexy, but it’s ready for change. The Financial Times takes a look at this $40 bn US market, focusing on the Hometeam caregiving service presently in New York, New Jersey and Pennsylvania, which has over $43 million in investment after only three years (Crunchbase); Honor, which has over $65 million in funding, operating California and Texas. Their points of difference from traditional home care agencies involve models and technology. Hometeam employs carers who are full employees with benefits and an average of $15/hour pay, double that of the usual minimum wage paid to independent contractors. They equip carers with iPads to track what happens in the home, and to report daily to families. Honor has an algorithm to help it scale up from the 100 or so carers who are the ‘break point’ in matching carers with patient needs. In contrast, the UK is far behind in development. The article looks at Vida which uses a mix of carers and technology for its private pay clients. Now approved by the Care Quality Commission, Vida is already in talks with local councils across London and Brighton. But funding is thin: £400,000 of start-up funding and planning to raise £1 million. Tech start-ups try to fix ailing US elderly care sector. If paywalled, search on the title. Hat tip to Susanne Woodman

Action Next Days? Predictions have been all over the place since the election. Many have been overheated (and highly political), but others explain the complexities of undoing the past six years. A reminder: the PPACA did not go into effect until 2010 and most of the provisions kicked in during 2011. Health tech law firm Epstein Becker Green trotted out its crystal ball (more…)

A curious ‘Ripple’ of an announcement involving Tunstall Americas

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/02/ripplenetwork_5890862790fc7.jpg” thumb_width=”300″ /] A startup company in the US, Ripple Network Technologies, announced on 31 January its Kickstarter campaign for what appears to be a small, stylish personal safety device styled like a small metal lock or locket. The release states that “Ripple users can discreetly signal their monitoring team for help with the click of a penny-sized Bluetooth wearable, designed by the creators of 360fly and Misfit Shine” that connects to a smartphone. One of the features is that there’s a partnership with Tunstall Americas to provide that 24/7 monitoring, with an extensive quote from CEO/president Casey Pittock.

It’s clearly aimed at a younger market than typical for PERS, concerned with stylish safety in ‘lone’ situations and not with ‘falling and I can’t get up’. The stated Kickstarter price is also appealing: $129 for the standard sensor, $199 for a specially designed sterling locket style, both inclusive of one year of monitoring service. Release is scheduled for April.

Despite this announcement, the Kickstarter site is not up yet. The Ripple website has a flashy animation homepage without detail, found only through their LinkedIn company page which also is bereft of details. Other than the release pickup on ReadItQuik.com, this Editor cannot locate the release on the standard PR release sites such as Business Wire or PRWeb. (The Tunstall Americas website has not been updated for news since last August.) A curious start indeed.

Update: Ripple’s communications director in the Comments has supplied the Kickstarter link which went live on 1 Feb, and is here. The website now has an Order Now button which links to the Kickstarter page. Key features: click once to receive a call from the monitoring center, or click 3 times or more to summon emergency help or a call per your profile setup. A potential drawback: no two-way communication except via phone and the BTE connection, which if you are separated from it (for instance, your purse is stolen), the system won’t work.

The requested raise is $50,000 by 3 March. PRNewswire release.

Two tenders up in Scotland and Wales (UK)

Susanne Woodman, our Reader who keeps an eye on telecare procurement tenders, has alerted our UK readers to two current postings:

Telecare IT Platform for East Lothian Council (Scotland).  This is for the purchase an integrated call handling facility and telecare asset management system to respond to alerts from telecare equipment in the homes of vulnerable people. Contract duration 60 months. Deadline 1 March. (Public Contracts Scotland)

NHS Wales Informatics Service–Velindre NHS Trust. The NHS in Cardiff, Wales is looking to appoint partners to develop solutions to engage citizens digitally in the proactive management of their health. It is anticipated that this could encompass a wide range of services from existing applications (Apps) to innovative joint developments. Contract notice will be published 4 April, but the notice as published does not have a deadline. (Tenders Electronic Daily)  See the Sell2Wales website for documentation.