Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

click to enlargeOur Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

click to enlargeLove that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

The Theranos Story, ch. 45: a ‘Christmas present’ $100 million loan from Fortress averts bankruptcy (updated 8 Jan)

click to enlargeA present or a Trojan Horse? Revealed on Christmas Eve by the intrepid John Carreyrou of the Wall Street Journal (paywalled) is Theranos’ securing of a $100 million loan from Fortress Investment Group LLC. This Editor notes the word ‘loan’, and loans come with conditions. Mr. Carreyrou revealed that according to an email sent by (unbelievably still in place) CEO Elizabeth Holmes on Friday 22 December and reviewed by the WSJ, it is “subject to achieving certain product and operational milestones.” 

As our Readers know, with the Walgreens Boots settlement in August, cash on hand from June was about $54 million with a burn rate of $10 million per month [TTA 3 Aug]. Technically, Theranos was out of funds by December. This Editor thought the next article on Theranos would be an obituary issued from their warehouse in Newark, California. Updated: As of 8 Jan, there is no announcement on the Theranos website or comment to press.

According to the article, Fortress specializes in distressed investments. “The loan from Fortress is collateralized by Theranos’s patent portfolio and the deal grants Fortress warrants for 4% of the company’s equity, Ms. Holmes told investors in her email. She said she anticipated the loan would provide Theranos “sufficient liquidity through 2018” which is quite a fan dance.

Interestingly, Japan’s SoftBank Group completed its acquisition of Fortress yesterday (release). 

Our takeaway is that the IP is worth far more than the company and that is what has been bought. SoftBank would dearly like another entree into Silicon Valley for their tech portfolio and can use that IP, if not at Theranos, elsewhere. For Fortress, which has $36.1 billion in assets under management and now backed by SoftBank, $100 million is pocket change with a smidge of lint. Remaining investors also have likely written down the value on their investment. It’s a bit of a tweak on the expected denouement, but do not bet on Theranos and Ms. Holmes rising like phoenixes from the ashes of their Edison lab equipment.

Updated: Theranos’ last words on their website tout their accepted/presented publications and posters, but there is no further word on Theranos’ actual sale of Zika virus detection technology or the much-touted miniLab. It’s all a far cry from the palmy days three years ago of co-marketing with Walgreens and Ms. Holmes headlining Forbes, Fortune, and dozens of healthcare conferences and accumulating nearly a billion in funding as The Greatest Thing Since Sliced Bread.

Prediction for 2018: Ms. Holmes will be removed and replaced, then the company will be reorganized and/or renamed.

Full WSJ article on Yahoo! Finance. CNBC. Gizmodo. Our prior chapters on the Theranos Story are here

Wanted: an Eye on Tenders (UK)

TTA is seeking an Eye on Tenders for the UK for 2018. This would involve an occasional search for telehealth and telecare tenders on sites such as TED (Tenders Electronic Daily) or Gov.UK Contracts Finder, with a few excursions to the parallel Scottish or Welsh websites. As UK Readers know, in order to access and search these sites for opportunities, you must be able to log in as a supplier or buyer, which our Editors cannot. All our correspondent need do is supply the links as they come up and Editor Donna will do the rest.

This valuable service to our Readers has been provided to date by Susanne Woodman of BRE. We thank her and hope that one of our Readers will be able to carry on. Please join me in appreciation for her services here (comments below). Email Editor Donna in confidence if you are interested in contributing!

2017 wrapup: state telehealth reimbursement policies and progress made

click to enlargeOur first 2017 wrapup is from the Center for Connected Health Policy at the National Telehealth Policy Resource Center which has helpfully organized the state of telehealth reimbursement policies in the 50 US states into an interactive map. 2017 state legislative actions are available in a summary sheet cross-referenced with linked bill numbers. 63 pieces of legislation focusing on telehealth or telemedicine were approved by 34 state legislatures this year.

True policy wonks will want to peruse on their holiday time the 262-page full report of policies as of October.

Based on the report, one of the major changes is in private payer reimbursement: “36 states and DC have laws that govern private payer reimbursement of telehealth. This number has increased by two since April 2017, although additional states have made modifications to their private payer law. Some laws require reimbursement be equal to inperson coverage, however not all laws mandate reimbursement.” The rest of the findings are highlighted in the infographic (left above) and the CCHP release.

Becker’s Hospital Review also surveyed the changes this year, as did mHealth Intelligence.

Far from a tipping point: only 18 percent of consumers using telemedicine. An expectation gap? (US)

When will we get there? And what needs to happen? Telemedicine provider Avizia surveyed both consumers and healthcare professionals earlier this year, and the results are not encouraging. For the huge investments made by telemedicine and telehealth companies, along with providers and payers, the key finding here is that only 18 percent of the 403 consumers surveyed in March had even used telehealth.

Of that 18 percent (N=72), it’s been a positive experience:

  • On a 1 to 10 scale, with 10 signifying a “great experience,” 62 percent of consumers who used telehealth ranked their experience a 10, 9, or 8.
  • Consumers who used telehealth appreciated time savings and convenience (59 percent), faster service and shorter wait times to see the doctor (55 percent), and cost savings due to less travel (43 percent)

Modern Healthcare also sponsored the outreach to healthcare professionals who are subscribers, locating 444 respondents whose organizations currently use telehealth or telemedicine.

  • They are most interested in telehealth’s ability to expand access or reach to patients (72 percent). Barriers are reimbursement (41 percent), program cost (40 percent), and clinician resistance (22 percent)
  • Their #1 use cases are for stroke and neurology (72 percent), followed by behavioral health (41 percent) and intensive care (20 percent).

What’s unsaid in this write-up? Consumers and clinicians clearly have differing expectations on how they want to use telemedicine. Consumers are largely using it as an alternative to an in-person visit for less serious medical needs. Clinicians use it for very serious situations–stroke, neurology, mental illness, ICU. Perhaps this is why the takeup of telehealth among consumers is low.

Mike Baird, CEO of Avizia, is quoted in the release as saying “Health systems are investing in telehealth, even as uptick is slow among consumers, because they understand the potential of the technology to impact patient care in a profound way.” But as a Grizzled Pioneer in this field said to this Editor in confidence, how many of these companies have the revenues and patient investors to enable them to stay alive till they get to the Promised Land–and how far is it? Closing the Telehealth Gap (white paper requires free registration and download)Becker’s Hospital Review

One more Prior Information Notice–and Yes, Prime Minister, some Advice (UK)

Our Eye on Tenders, Susanne Woodman of BRE, is proferring one more Prior Information Notice (PIN) via TED.Europa.eu. This is for the Suffolk County Council for the management of domiciliary care for the County from Autumn 2019. In the context of providing care, ‘maximising technology’ is mentioned. From TED: “We are looking to engage with providers to help us shape what future services, contract models/processes might look like in the future. If you are interested in being involved in this market engagement process, please contact ACSHomeCareandHousingSPARTeam@suffolk.gov.uk who will provide further details about future events.”

Susanne has also pointed Readers to the Gov.UK ‘Correspondence’ page. The Council for Science and Technology (CST) makes four recommendations to Prime Minister Theresa May on how technology could help address the specific challenges affecting social care and support. The page includes links to the CST letter of recommendations and the PM’s response. 

End of year action: Vivify/InTouch, InTouch/TruClinic, Medtronic, NYCEDC winners, ActiveProtective, Adidas exits wearables, Fitbit (updated)

  • Dallas-based Vivify Health is partnering with California’s InTouch Health to integrate their telehealth remote patient management with InTouch Health’s acute care video consult/device platform. For InTouch, it is a move into the home by using Vivify’s Managed Kit and BYOD and related APIs. For Vivify, this helps in their post-acute RPM sell to large healthcare organizations. (Is their VA partner Iron Bow somewhere in the mix?) Their VA Home Telehealth rival Medtronic announced their partnership with American Well a few months ago [TTA 21 Oct]. InTouch release via Telecom Reseller
  • Updated. InTouch also announced their agreement on Jan 4 to purchase DTC telehealth provider TruClinic furthering their move into home telehealth. TruClinic will be merged into InTouch. Heading it up will be recently appointed EVP of Marketing and Consumer Solutions Steve Cashman, who founded and headed pioneering but overly ambitious for the market health kiosk HealthSpot [TTA roundup here]. Release  (Our update on the state of health kiosks here)
  • Speaking of Medtronic Care Management Services, MCCM touted its VA Home Telehealth ties to Healthcare Analytics News. Intriguing claim: they’ve treated 310,000 veterans since 2011 (Cardiocom, the 2011 awardee, was purchased in 2013). VA itself credits only 156,000 patients to Home Telehealth in Federal FY 2014 (the last official count), 43,000 patients in 2010 and 144,000 in 2013. A very rough estimate by this Editor is that they were about 25 percent of the veterans in the program.
  • Announced at last week’s NYC Economic Development Commission (NYCEDC) Health 2.0 Digital Health Forum attended by this Editor were the winners of the third annual NYCEDC/HITLAB’s Digital Health Breakthrough Network accelerator program for pre-revenue startups: Altopax (VR behavioral health), Navimize (doctor/hospital scheduling), Tatch (sleep quality biometrics), and PainQX (pain level monitoring). The Forum also had Digital Health Marketplace matchmaking meetings for 65 NYC-based health tech companies with prospective clients. The Marketplace furnishes competitive grants to offset the cost of piloting between growth-stage tech companies and providers. Release, MedCityNews
  • ActiveProtective‘s controversial protective airbag to cushion hips from falls by high-risk older adults [TTA 10 Jan] gained $4.7 million in Series A funding led by Generator Ventures. Mobihealthnews
  • Adidas is shuttering its wearable device development unit and condensing its offerings, focusing on the Runtastic GPS-guided exercise offering and a shopping app. It follows similar moves at Nike and Under Armour proving that big names in sports fitness clothing couldn’t pull off wearables. Mobihealthnews
  • Meanwhile, Fitbit’s Ionic continues to develop with now an App Gallery with 60 apps–11 of which are health/fitness related–and more than 100 watch faces. (Wonder if any are Mickey Mouse?) What we termed a ‘Hail Mary’ pass may actually get past the goal line. Mobihealthnews

FCC’s actions on Rural Health Care and Connect2Health for cancer–relief from ‘net neut’ neurosis

Hot Air Relief Here. There’s been much of it expended on the so-called ‘net neutrality’ issue which can be summarized as follows: The Federal Communications Commission (FCC) is getting out of treating internet service providers (ISPs) like broadcast carriers, returning ISP speed/access enforcement to the Federal Trade Commission (FTC) as it was in 2015. Developments around 5G data and faster ISP speeds made the FCC’s involvement resemble a relic of the 1960s ‘vast wasteland’ FCC which imposed ‘equal time’ and content restrictions on broadcasters which were in effect through the 1980s and even into the 1990s. It’s taken our attention in healthcare away from FCC’s pertinent work in expanding the Rural Health Care program which covers some of the costs of broadband service for rural health care providers.

On the 15th, the FCC adopted a notice of proposed rulemaking (NPRM) which triggers comment on the Rural Health Care program rule changes, importantly an increase in the present $400 million cap. It also gives a one-time funding boost by carrying forward previously unused funds. Telecompetitor is succinct on the rule changes and commissioners’ comments, some of which point to certain providers overbuilding capacity, the number of providers in the program has actually decreased, and that the point of it is to make service more affordable. FCC Release, Notice of Proposed Rulemaking, Full listing of documents  This may also stimulate private-public efforts such as Microsoft’s which attempt to close the rural digital connectivity gap through innovations such as the Rural Airband Initiative and utilization of TV white spaces [TTA 22 Aug].

Here’s some more FCC Good News. The Connect2Health Task Force and the National Cancer Institute announced a few days earlier that they are jointly working in the Appalachia region of Kentucky to study the relationship between better broadband and improved cancer care for patients in critical need counties. Appalachia is one of the poorest rural areas in the US with soaring cancer mortality. Only about half the state of Kentucky has internet and about 20 percent cannot access at all. The FCC is also inviting fixed or mobile broadband providers, health technology companies, device manufacturers, and healthcare facilities―to contact the Task Force. The project is Linking & Amplifying User-Centered Networks through Connect Health (LAUNCH): A Demonstration of Broadband-Enabled Health for Rural Populations in Appalachia. mHealth Intelligence, FCC Release

Tender Alert: Oxfordshire County Council, Housing & Care 21 Birmingham

Our Tender Watcher, Susanne Woodman, has two more before we break for the holiday season–which may make your 2018 brighter!

  • Oxfordshire County Council: This is for a comprehensive telecare service for call monitoring of telecare alarms, a 24/7 emergency response service for telecare alarms, plus the installation, assessment and review of telecare and associated equipment. The Service Provider(s) will work closely with the Equipment Service Provider. This starts in April 2018 for five years with option to extend for two; value not correctly posted (£1?). Closing 15 January 2018. Gov.UK 
  • Housing and Care 21: This is an open future opportunity for providers to indicate interest in providing a new warden call supplier to maintain the existing stock of warden call products across the estate. The contract will be for one to five years with funding of £500k per year. This includes bridging equipment from analogue to digital. The approach to market date is 9 April 2018 with a start date of 1 July. More information at Gov.UK.

The ‘health kiosk’ idea is alive and kicking from New York to France

click to enlarge[Photo: NYP] The $40 million+ failure of HealthSpot Station last year [TTA 14 June 16] might have signaled the demise of the health kiosk (telemedicine + multiple vital measurement devices) concept. Basic stations with consumer engagement/mobile tie-ins such as Higi have been gaining traction at retail locations [TTA 30 Mar] such as RiteAid (which bought the assets and IP of HealthSpot) and Publix supermarkets. CVS MinuteClinics in northeast Ohio and Florida have allied over the past two years with Cleveland Clinic and American Well to integrate records and telemedicine. But the kiosk model is gaining a second life with these recent iterations.

  • NewYork-Presbyterian, Walgreens (Duane Reade) and American Well: Kiosks located in private rooms at select Duane Reade drugstores (left above) connect to NYP OnDemand using American Well telemedicine and Weill Cornell Medicine emergency medicine physicians. In addition to the live consult, the patient can send select vital signs information to the doctor using a forehead thermometer, a blood pressure cuff, a pulse oximeter, and a dermascope for a high-resolution view of skin conditions. Pediatric emergency physicians are available through NYP OnDemand weekdays between 6 – 9pm. Prescriptions are e-prescribed to the patient’s preferred pharmacy. The first kiosk opened this week at 40 Wall Street with additional locations to open in 2018. NYP OnDemand telemedicine consults are also available to NY area residents through the Walgreens website. American Well release, Healthcare IT News, MedCityNews
  • H4D (Health for Development): French doctor Franck Baudino wanted to reach those who live in what the French term ‘health deserts’ in their rural areas. Over the past nine years, he developed a booth-type kiosk connecting to a live doctor and with vitals instrumentation. The Consult Station is fully equipped with a wide range of vitals instrumentation, including vision, audio, eye, and blood glucose, functioning almost as a remote doctor’s office. In France, to gain access, all users need do is pop in their carte vitale. Reportedly the kiosks can treat 90 percent of common illnesses. Prescriptions are printed out in the booth. Consult Stations are now in France, Italy, Portugal, Philippines, Canada, Belgium, UAE and were recently cleared by FDA as a Class II device. ZDNet  

Tender/PIN Alert: NHS North of England, Highlands & Islands Enterprise NHS Market Ready

Susanne Woodman, our Eye on Tenders, is still scanning the skies for opportunities. Here are two important ones:

  • NHS North of England (NOE): The Commercial Procurement Collaborative (CPC) is seeking to appoint providers to a framework agreement for the provision of a range of healthcare consultancy services for use by the NHS and other eligible bodies. The new framework starts 1 March, extending for four years with a value of £10m. The agreement has six Lots with different requirements and awards will be to six providers per Lot. Documents can be requested until 19 January 2018. Tender information is located at the CPC page–detailed information can be seen by clicking on the ‘View New Contract Notice’ button. 
  • Highlands and Islands Enterprise (HIE)-NHS Market Ready: HIE leads the Northern Innovation Hub (NIH). The relevant part for healthcare technology is NHS Market Ready, to benefit small and emerging businesses and social enterprises which want to present, test and trial products and services and secure commercial opportunities with the NHS. This is a PIN so applicants can obtain descriptive documents and demonstrate interest at Public Contracts Scotland–click on the tabs. Also Scottish Business News Network on  the NIH’s £16 million initiative for businesses in the Highland Council Area

A basket of reflections, considerations on CVS-Aetna: Epic, Cerner, the model, and hospitals’ role

click to enlargeWith the holidays and the end of the year coming in a little over two short weeks, there’s plenty of room for thoughts, reasoned speculation, and some unusual takes on the CVS-Aetna merger. This Editor remains in her belief that among us, there’s a bit of exhaustion and an attitude of ‘wait and see’ around the topic among us. The canaries have a case of the vapors….

Let’s sort through some of the more interesting POVs expressed of late by our fellow pressies, which Readers can consider in between cups of good cheer and bites of All That Food. Bear in mind that this merger has a long road to go on a hard road, with potholes marked DOJ and (in this Editor’s opinion) HHS, before it’s a done deal in 2018.

  • A big win for Epic. Currently the EHR for CVS’ MinuteClinics and most recently the care management programs of CVS Specialty, Epic is bullish on the opportunities in what their VP of population health termed the ‘gray space’ in the patient experience outside of the traditional sites of care. In October, CVS added Epic’s Healthy Planet population health analytics platform to learn more about drug dispensing patterns and medication adherence–this Editor believes in preparation for merger talks. The open question this Editor has after all the glow in this article is how Aetna’s varied systems (e.g. ActiveHealth, Medicity, and others) would integrate into Epic, and the price of poker, because with Epic it’s never free. Ask any hospital. Healthcare IT News.
    • Certainly, their main competitor Cerner is feeling the heat after a slowdown in its VA plans, the single largest EHR implementation ever. Congress has held up initial funding making the contract effective (Washington Technology). It is geometrically more complicated than their simultaneous DoD implementation, with $10 billion estimated over 10 years (FCW). Other wrenches in the works: a fresh CliniComp lawsuit against Cerner based on infringement against their 2003 patent on remote hosting, and their appeal of the no-bid award to Cerner [TTA 23 Aug] against VA. Kansas City Business Journal, Healthcare IT News
  • Is it going to increase cost? It might. And what about info sharing with providers? A Harvard Medical School professor opined to Marketplace that instead of self-treatment at home for a cold, the patient might actually traipse to a MinuteClinic for care, thus driving up healthcare costs. This resembles the RAND logic around telemedicine consult expense we deflated in a series of articles back in the spring. Information sharing with regular providers is a bigger issue which urgent cares, telemedicine, and clinics already are dealing with. The paradox is that integration with a payer, with a retailer’s ability to track ancillary purchases such as OTC meds and DME purchases, might actually help that issue. But will it? Will a combined CVS-Aetna share information or hoard it, further disempowering patients? This Stat article calls on Mark Bertolini to promote shared information, engagement, and accountability to balance the scales.
  • Do we really need hospitals? If they don’t change, we might need a lot less of them except for highly specialized treatment. And this is likely a good thing. The HBR points out that CVS-Aetna is hardly the only threat to the traditional hospital–there’s Johns Hopkins’ Hospital at Home program for older adults, UnitedHealthcare’s growing network of providers under OptumCare, including the recent deal for DaVita dialysis centers, and free-standing, low-cost “neighborhood” hospitals, almost like pop-up stores. The article doesn’t mention ‘consult stations’ like Europe’s H4D, which is proving that the kiosk idea isn’t dead. 

The reality is that we won’t know what this merger entails until it actually happens, if it happens–and its final shape will take years to mold. Related: CVS-Aetna: the canary says that DOJ likely to review mergerAnalysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?CVS’ bid for Aetna–will it happen, and kick off a trend? (what will Amazon and other retailers, including supermarkets, do?)

Tender Alert: NHS England, London South Bank, Univ. of Leeds, NHS Digital, Halifax, Healthy New Towns

We have a specially wrapped and large present from Susanne Woodman, our Eye on Tenders. Some are high value, all have short deadlines, so read up!

  • NHS England: This is through the NHS South, Central and West Commissioning Support Unit and is for a Dynamic Purchasing System (DPS) for the procurement of online consultation systems. It is for a little over two years starting January 2018 and valued at £45 million. Closing is 29 December. Details at Gov.UK.
  • London South Bank University: This is for a Summative Assessment (Evaluation) of Simulation for Digital Health (SimDH). This would result in three reports to delivered electronically to be reviewed by the project team (LSBU) and project funders (GLA & ERDF). This is deadlined on Thursday 14 December, but an inquiry on this might invite further dialogue. Value is £13k. Gov.UK
  • University of Leeds: This is for an app specification and design, to engage participants in clinical trials, to thank and build relationships with these 600,000+ people in the UK. Again, an early close of 20 December, valued at £100k – £500k. Gov.UK
  • NHS Digital: The De-identification Project will implement a strategic approach to de-identifying data flowing into or out of NHS Digital or requiring linkage with NHS Digital data. Status is ‘open early engagement’ which means they are judging interest from potential suppliers. Another early closing of 18 December. Gov.UK
  • Borough of Calderdale, Halifax: Seeking provision of a community alarm and mobile response service; comprising of a community alarm – call monitoring centre, mobile response, and the installation of various pieces of assistive technology, carbon monoxide detectors and smoke detectors. The contract is for 36 months with extension up to 24 months. Value excluding VAT: £2,250, 000. Deadline is 10 January 2018. TED
  • NHS England–Healthy New Towns: This program is to support a vision of healthcare in a Healthy New Town. Responses should include: rationale for system transformation, key challenges and priorities for the healthcare sector, barriers to implementation and overcoming them, and the role of the Healthy New Towns programme in NHS England’s Five Year Forward View and Business Plan. This NHS England link may not work, so see attached PDF for requirements (thanks Susanne!). Deadline is 19 January 2018. Here’s more on it: 
    • As set out in the Specification of Requirements, the desired outcomes of the Healthy New Towns programme and the guidance are that: (A) Neighbourhoods, town and cities built in England after 2019 have:
      • populations with reduced levels of preventable disease;
      • communities with improved health and wellbeing; and
      • health and social care provision that is more effective and better for users
      (B) The guidance that this commission helps deliver has played a major role in achieving the above, because:
      • the guide and the process of developing it have built momentum and support; and
      • the guide collates good practice and shares it in a compelling, highly useable way.

      In a context of pressure on the NHS caused by preventable disease and changing demographics, how, in your role as New Care Models support partner for the Healthy New Towns programme, will you help us achieve these outcomes?

Babylon Health: correcting our NW London CCG report; objects to concerns raised by CQC report (latest updates)

Correcting and commenting on our earlier report. This Editor had earlier published on 11 Dec, as follow up to the extensive coverage on Babylon Health’s ‘GP at hand’ pilot activity in London, summarizing a report in Digital Health stating that the North West London Collaboration of Clinical Commissioning Groups (CCG) ended plans for expanding a test of the Babylon video consult/symptom checker app for GP practices in that area and that the app could be ‘manipulated’ to secure GP appointments faster and would not reduce demands on GPs. The original article was first corrected at an NHS England‘s representative’s request to reinforce that this was a local CCG project and that NHS England was not involved. The second request we received last Friday was from Babylon Health’s PR representative, Giles Kenningham, principal at Trafalgar Strategy. It was certainly strong and quoted here, edited as indicated to remove the link to the original article and Mr. Kenningham’s signature:

Your recent article on Babylon is factually wrong and misleading (link removed):
You claim the babylon app was dropped after being manipulated by patients. The term ‘manipualtion’ has been removed from the board papers and is wrong. Similarly the planned pilot had never begun so there so nothing to roll out.
This story is based on incorrect board papers which have now been corrected.

Please find a spokesman quote below. (closing signature removed)

A spokesperson for Babylon said:

“No pilot was ever carried out, nor any agreement signed with Babylon for such a pilot.

“Discussions were held after Babylon was selected in a competitive procurement exercise as the best technology to trial in GP practices across North West London. Subsequently, a decision was taken not to fund the pilot.”

This Editor then checked on the Digital Health article and found it had been removed without any follow-up or correction. Thus on Friday 8 Dec, this Editor removed the article, thanked Mr. Kenningham for bringing it to attention, and added that our report cited Digital Health as the source. I also requested a reference or third-party confirmation of his corrections. (This last request was not received as of the time of this writing.)

Wanting to get to the bottom of this for our Readers–and as a marketer who’s corrected more than a few inaccurate reports, your Editor has located the CCG’s report which is here published 22 November. It corresponds with Mr. Kenningham’s full note. The CCG report appears to have been revised (the URL indicates a v3), there never was a Babylon pilot, this version does not use the word ‘manipulation’, and the end result was that the CCG decided not to proceed to the pilot stage. In short, it appears to this Editor that the Digital Health report was based on an earlier and incorrect version of the report (perhaps as early as 25 Oct) and we are of course happy to correct. My fault and apology to our Readers and to Babylon in that I should have located the 22 Nov revised report prior to publishing the article and essentially provided a correction to Digital Health‘s report.

However, the CCG’s report on their Babylon evaluation contains two findings that were included in Digital Health‘s now-deleted article and give some pause. The CCG used focus groups of potential users, which surfaced that, in the CCG’s words, “The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment. The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand for GP services.”

Our Editor Chrys has pointed out the Pulse article which also comments on this and was corrected for the CCG’s revised report. The comments here by practicing GPs are worth reading. Scroll down and you’ll see that  ‘gaming the system’ has happened using direct triage in practices using personal phone consults–no app required. Can this even work?

Focus groups are highly subjective, but they are great ways of surfacing the flaws that developers and companies have gone blind to.

We hope that Babylon Health does take this feedback seriously. This Editor makes no secret of her advocacy of technology that can speed the obtaining of care, but based on her experience with early-stage companies, every critique, every hole that can be kicked in a service, delivery, and logistics, exposing a weakness should be appreciated–and ruthlessly scrutinized for flaws that need solutions. This becomes harder to do when you’ve achieved Big Funding. Babylon is typically burning a hole through it (The Times, 1 Oct–hat tip to Chrys). The pressure on now to find The Road to Breakeven must be stunning.

Important updates: Speaking of finding solutions, Babylon differs strongly with the findings of the Care Quality Commission (CQC)(not to be confused with the CCG), in the CQC report on their service published on Friday 8 December. 

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CVS-Aetna: the canary says that DOJ likely to review merger–plus further analysis and developments

click to enlargeThe canary is still tweeting. News reports indicate that the US Department of Justice (DOJ) will be in the lead reviewing the CVS acquisition of Aetna. This should be no surprise to our Readers. This Editor’s first analysis noted regulatory necessity and earlier this week, more explicitly predicted either the Federal Trade Commission (FTC) or the DOJ would be reviewing.

The New York Post’s Beltway sources (for ex-US readers, it’s the mass market News Corp. paper/site) are talking up DOJ:

President Trump’s Department of Justice appears to be the agency that will review CVS Health’s $69 billion merger with Aetna, sources tell The Post. While the decision is not yet final, the move would not be good news for the merging parties, sources said. “I think they would prefer it to be at the Federal Trade Commission,” one Washington, DC, source said.

The article explains that it’s a tossup as to bailiwicks–FTC reviews retail and drugstore mergers, DOJ insurance mergers. A sound but (by CVS) unwelcome reason for DOJ to review the merger is their familiarity with Aetna after DOJ opposing its failed merger with Humana in Federal court less than a year in the past. Their expertise would be wasted and politically, a cup that FTC would wish to pass inasmuch they are also short on commissioners.

As the Third Century Greek philosopher Sextus Empiricus stated, ‘The mills of the gods grind slowly, but they grind small’ (or ‘exceeding fine’ in more modern citations), which means that justice, at least in the Federal definition, will be served eventually.

  • The Trump Administration has let DOJ question the AT&T/Time Warner merger on antitrust reasons up, down, and sideways, to the point where it is nearly derailed. Much the same can be expected here.
  • The businesses create a new type of healthcare system. Expect HHS to have a say.
  • Congress is already demanding hearings, which given the short time to Christmas break will likely be January. 
  • What may help Aetna’s cause is that the merger with Humana was a friendly one; the decision, at least in the press, was accepted with grace. 

But as wags have said for at least two centuries, you can always tell the pioneers by the arrows in their back. When you’re redesigning the Conestoga Wagons, it has to be expected–which is why the experts gathering here in NYC over the past week have had not much to say about it to date.

Certainly it has been a downer for investment pickers, though both companies had significant profitability challenges facing them in the future. We refer here to several articles in Seeking Alpha where it’s predicted that the acquisition will boost CVS’ growth, but saddle it with huge debt: $45B in new debt, $21B in new equity, plus using $4B in available cash. Are they overpaying? Will it reduce internal cost and boost profitability? Will it do what they say they’ll do, which is to bend the cost curve down by start-to-finish engagement with customers? What pieces are missing? And time is a critical factor–how long this will take to realize is not projected. If you like stock and value charts and graphs, here’s the place. Seeking Alpha (by author): Ciura, Arnold, Ward

Other retailers will have their say. We’ve noted earlier that the vast supermarkets like Publix, Wegmans, Shop Rite or Ahold (Stop & Shop, Giant) are likely looking at opportunities with logical alliances or buy-ins to insurers like Oscar, Clover, Bright Health, or the smaller Blues. Target is already allied with CVS for their in-store drugstores. And then there is retail/online giant Walmart. The Wal-Martians need plenty of healthcare and Humana, based on local Louisville-area reports, is in play after not merging with Aetna.

Looming over all this is Amazon. A little-noticed report in Becker’s from July indicated that their 1492 unit has set about extracting data from legacy EHRs and to build a telehealth platform on Amazon hardware such as Echo. Already noted has been their buying of pharmacy licenses in various states. None of which can make any of the usual healthcare suspects happy.

Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?

click to enlargeThis Editor has been at two healthcare conferences in the last four business days (with tomorrow being a third). They should be abuzz about how the CVS-Aetna merger may transform healthcare delivery. To her surprise, there’s been a surprising lack of talk. There is a certain element of ‘old news’, as the initial reports date back five weeks but the sheer size of it ($240bn combined future value, $69bn purchase, an estimated $750 million in near-term synergies), being the largest health insurance deal in history, and the anticipated effects on the health delivery model normally would be a breaking news topic. To this Editor, it is a sign that no one truly knows what to make of it, and perhaps it’s too big–or threatening–to grasp for provider and payer executives especially.

For an overview of what we saw at the time as reasons why and possible competitor reaction, Readers should look back to our original article [TTA 28 Oct]. It’s being presented by both companies as a vertical merger of two complementary organizations, which already were moving towards this model, integrating their different services into “America’s front door to quality health care” (CVS CEO Larry Merlo)–a lower cost setting that saves premium dollars and brings integrated care to consumers’ doorsteps.

CVS brings to the table huge point of care assets: 9,700 pharmacy locations, 1,100 MinuteClinics, Omnicare’s senior pharmacy solutions, Coram’s infusion services, and the more than 4,000 CVS Health nursing professionals providing in-clinic and home-based care. Aetna has about 23.1 million medical members, 14.5 million dental members, and 15.2 million pharmacy benefit management (PBM) services members. Aetna also has a wealth of advanced data analytics capabilities through two subsidiaries, ActiveHealth Management and  Medicity’s health information exchange technology.

Seeking Alpha has an intriguing POV on this entry into a ‘new era’: that both CVS and Aetna consider this to be a long-term reshaping of their business model under the threat posed by Amazon, and are willing to do this despite little short-term financial benefit for either company. The problem as the writer sees it: execution. This is re-engineering care on a national scale, and its benefits are based upon combining intangibles, a murky area indeed especially in healthcare. Time is also a factor, as Amazon is getting pharmacy licenses in multiple states, and is rather an expert at combining intangibles.

Does it signal that the approach to a ‘new era’ in healthcare is accelerating? If this is a preview, 2018 will be extremely interesting. Our ‘canary in the coal mine’ may tweet–or fall over on its perch, asphyxiated.

Some additional points to consider: (more…)