A year’s end newsletter to our Readers: a few wishes for Under the Tree, a few Quirky Predictions for 2025

December 19, 2024 | by | No Comments

It’s hard for your Editor to believe, but this is actually the 15th year since Steve Hards was most kind and invited me to contribute a few articles to what was then simply Telecare Aware.

A lot has happened since then, professionally and personally. I’m grateful for the opportunity that TTA has given me to Cover the Healthcare Waterfront, relying on multiple sources from super-local to Mainstream News to the Usual Sources. 

Most of all, this forum (and it is one!) stays true to the course that now Editor Emeritus Steve set some years ago:

Telecare Aware’s editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.

In that, though I’ve occasionally gone far afield (and down some rabbit holes) into exclusively US issues such as how healthcare gets paid, its politics, and the financial landscape (from bubble to devastation to recovery), I believe they hold true in the UK and in other countries. 

So one wish I have from Santa for 2025 is for More Comments. I’m very interested in knowing what you think about topics that are covered and your take on them. Using hits as a guide, it is hard to predict. Sometimes it is breaking news, a major data breach, or Walgreens’ continuing soap opera. Perhaps you want more audio commentary or article audio files, which I’ve experimented with via Soundcloud. So…What do you think?

A second wish: for other writers to join me here as lead/topic providers or better, contributors, for news outside the US. Specifically, I believe Readers want to know what is going on in the UK and Europe, but ‘standard sources’ are either not focused on health tech, paywalled, or overly specific ‘inside baseball’. Steve and I have long recommended Roy Lilley’s newsletter and UK Telehealthcare.

So…if you know of reporting on UK or EU issues, please direct me there. Better yet, contribute an article! Or two! We are small and cannot pay, but if the facts are there and the writing is sound, you’ll be published and can republish elsewhere. (This is exclusive of Perspectives, which are non-promotional thought pieces contributed by companies’ marketing areas. And we thank them!)

A third wish: speaking of marketing, I am a marketing and communications consultant by trade. Yet I am very shy about putting my shingle out there and asking Readers for leads to companies that might need marketing help, short-term or long term. My LinkedIn profile has most of my CV and key information on what I’ve done and where I’ve worked, but for a full overview about my capabilities across branding, program, planning, and products, email me here. 

Now for the Quirky Predictions–I’ll keep it short and open to debate:

2025 will continue international rebuilding of companies in healthcare and health tech. But the tear-downs will continue to clear the table. Overall, there’s optimism in the air with a new administration. It doesn’t feel like a rerun of 2023 where everyone thought it was going to be Romping Unicorns post-pandemic and the Big Guns were snapping up Big Buys like Signify Health and Oak Street Health for Big Bucks. We know now how that worked out for Walgreens, CVS, Walmart, and even Amazon (which I predict will be rethinking–and retrenching). We are starting from a low level and hopefully leveling up from there.

That doesn’t mean that there won’t be more Shotgun Mergers by VCs that avoid the new merger guidelines and a few Chapter 7s and 11s (UK=administration) along the way. There will be more layoffs. Funding rounds for both healthcare and digital health will be moderate. Down rounds that reduce valuation will still be with us. Investors will push for more control–witness what is happening at Walgreens and CVS, and what happened at Centene.  There will be more big changes at Walgreens, CVS, Elevance, Centene, Cigna, and many others considered mainstays of healthcare–and don’t rule out Amazon and Walmart. But by the end of year, barring a Bird Flu Pandemic, space aliens landing from the Plague of Drones in US and international skies, or an Unraveling of Sanity, overall we will be doing a lot better.

Robert F. Kennedy Jr. will be turning up the heat on Health. He will be confirmed as head of Health and Human Services and will, within a year, refocus it along its name. Health rather than Sick Care. A lot of substances ranging from vaccines to PFAS to various dyes and additives in food will be questioned at FDA, restricted, and brought to the national consciousness. As a personality, he is extremely intelligent and dynamic–knows how to absorb the most complex information and move on it. He knows that Make America Healthy Again is his Main Chance and also to be true to his legendary father’s legacy. It will make a lot of drug and chemical companies rather…nervous. (I am less sanguine about Dr. Mehmet Oz as head of CMS and his ability to clean up that puzzle palace, but hopeful.)

Speaking of heat, I wouldn’t want to be a C-level at any of the major health plans that are in multiple lines of integrated business.  The assassination of Brian Thompson and earlier the massive Change Healthcare hack ripped the cast and bandages off the entire system. The sheer hostility to payers was startling enough for UHG CEO Andrew Witty to write a massively defensive op-ed in the NY Times–and the hostility has hardly dimmed with the jailing of Luigi Mangione who has turned into a folk hero to some. (Yeesh! I cannot think of anything less moral.) The incoming administration and Congress is restive and major changes will be coming from there. Already there is a bipartisan Congressional bill (the PBM Bill) requiring the divestiture of pharmacy benefit management (PBM) companies from insurers within three years. While it will not be passed by the 118th Congress, it will be reintroduced by the 119th after 3 January if you look at who is backing it. This is the kind of movement to simplify how healthcare is delivered and paid for that crosses ideologies and finds a wide spectrum of support from Bernie Sanders to RFK, Jr. and presumably the re-elected President. 

Once the PBM string is pulled, what then comes into focus is insurer ownership and control of providers. UHG/Optum owns or is affiliated (meaning ACO or partial ownership) with 10% of US practices. DOJ is already after UHG for the Change Healthcare acquisition on security grounds. The more aggressive posture around anti-trust will not change in this administration and only slightly moderate with a new FTC chair. (Lina Khan’s term has expired though she may try to hang on, but her bête noire Amazon is still in trouble with their One Medical Bad Bet.)  The few payer organizations that only offer health plans, like Molina, Oscar, and Clover, will start to look very smart indeed. Perhaps smaller and less controlling is actually…better. And more profitable.

Running in parallel: the lack of trust in Big Pharma and the cost of drugs from them. They’re next.

We will need to get much more realistic about AI, what it is capable of, and its social effects. It is spreading into everything like kudzu (try entering into most browsers) but what we will be finding out is that a lot of what is ‘AI’ sold to companies as labor-saving is half-baked. It doesn’t work well. Some of it falls into the ‘uncanny valley’ of unease as too humanoid. If a company or service relies on it for decision making, it may not make those decisions better than humans. Reportedly UnitedHealthcare uses AI for a claims decision model, something that is cited as flawed. Bad decisions incite human anger, and lack of human contact is like being in a perpetual voice jail.

There is also growing evidence that in writing and researching, over-dependence on AI prompts and drafts destroys the ability to remember and creatively connect both on the fly and under consideration, in the ability to move an argument logically to a conclusion utilizing persuasive writing and speech skills. This especially affects the young. I’m hearing reports on this from the hiring front, where young grads cannot write without AI assistance and are stunted in their verbal skills. AI in writing gets to be a crutch (I use a tool for grammar–and about 10% of the time it’s off.). And have we forgotten that AI is dependent on content….GIGO from the early computing days still applies. We don’t want to be the Eloi, do we? (Look up your H.G. Wells)

And one last prediction. The mass market weight loss fad hyping GLP-1 drugs (Wegovy, Ozempic, Mounjaro, Zepbound) will implode. These drugs are now readily available, less expensive, and cheerily advertised on social media, radio, and TV by drug manufacturers and telehealth prescribers. These are promoted for weight loss alone, not for weight loss to better manage Type II diabetes or true obesity. What will pop the bubble? Side effects of slow digestion like stomach paralysis. Diarrhea, nausea, intestinal distress, even pancreatitis and suicidal ideation. Little known is that 80-90% of clinical trial participants experienced at least one adverse event. If you survive these, a weight gain rebound often happens once off the injections. Metabolic modifications ain’t beanbag. If you have a diversified telehealth company like Teladoc and you get into this business, it may not make a difference (?)–but sole providers like Calibrate (among many) will feel the pain. (Does anyone remember the much-touted Alli/Orlistat that reduced the fat absorbed by the digestive tract and those side effects?)

May you and your loved ones have a Merry Christmas, Happy Hanukkah, and a Happy New Year…however you and yours celebrate! We will be on a two-week break and return, along with many of you, on 6 January.

News roundup: Precision’s $102M raise, more on BCI; Withings clears BPM Pro 2; Nebraska 1st state to sue Change/UHG, related insider trading update; VA Oracle go-lives may resume; ATA intros CODE; ClearDATA HITRUST certified

December 19, 2024 | by | No Comments

One more funding. A competitor of Elon Musk’s Neuralink, Precision Neuroscience. closed their Series C at $102 million. This round was led by General Equity Holdings, with participation from firms including B Capital; Duquesne Family Office, the investment firm of Stanley F. Druckenmiller; and Steadview Capital, bringing their total funding to $155 million. The total brings them according to their release as one of the best-funded brain-computer interface (BCI) company after Neuralink, whose funding is unknown. The funding will be used to advance its clinical research and expedite development of its cutting-edge brain implant. 

Precision is the developer of the Layer 7 Cortical Interface to treat motor paralysis. At the time of their last funding in January 2023, this Editor noted that their difference was to treat neurological illnesses and events such as stroke, traumatic brain injury, and dementia. Their focus remains largely there: severe spinal cord injury, stroke, ALS. So far, the investigational device has been tested its device in 27 patients through research partnerships and was designated by FDA as a Breakthrough Device.

More on BCI in this must-read article by Timmy Broderick for STAT. The upcoming issues around BCI now center around the engagement of CMS (Centers for Medicare and Medicaid Studies) for coding, coverage, and payment for devices after the investigational stage; privacy issues about neural data; and continued support after implantation. This last one is acute as these companies are young. There has already been the example of Second Sight’s bankruptcy, leaving subjects stranded with useless retinal devices in their eyes. BCI to this Editor will develop through 2025–and be a major focus of investment by 2026-2027.

Withings gains FDA clearance, intros BPM Pro 2. A professional-level product for hypertension and chronic heart failure (CHF) targeted to care teams to connect with their patients, the FDA clearance covers blood pressure and pulse rate measurement in adults with arm circumferences of 9 to 17 inches (22 cm to 42 cm) or 16 to 20 inches (40 to 52 cm). What is really interesting about the connected (Wi-Fi, cellular, BT) device is that care teams can program the device through the Patient Insights feature for the patient to interact with the device in real time. Through a small screen, it asks questions that help to track the patient’s condition, reinforce medication adherence, and assess their satisfaction. It also has a Retake Measure feature to retake a reading if results exceed predetermined thresholds and increases accuracy. Withings plans to upgrade the device to take a 1-lead ECG to detect atrial fibrillation; this is a separate clearance and expected to become available in 2025. The device is not yet CE Marked. Withings was named a CES 2025 Innovation Awards Honoree in the Digital Health category. (Photo, Withings website) Release, Mobihealthnews, MedCityNews

UHG’s Mound of Misery multiplies with Nebraska’s Change Healthcare lawsuit, plus separate but related insider trading. 

  • Nebraska became the first state to sue UnitedHealth Group, Optum, and Change Healthcare over those affected by the late February ALPHV/BlackCat hack of Change’s systems. In Nebraska alone, it affected 575,000 individuals. (It is actually hard to find someone who was not affected by the hacking of the leading exchange for major claims clearing and payments.) Nebraska’s attorney general Mike Hilgers is suing because of the company’s carelessness in handling data and, even worse, in its slow notification of those affected. Our Readers will recall that Change/UHG initially tried to push off notification on healthcare providers. When HHS threw the ball back to Change [TTA 5 June], notices didn’t go out until August-September. The charges in state law center on consumer law: financial data protection and consumer protection statutes, deceptive trade practices, and Federal standards on privacy (HIPAA, and HIT protection. The lawsuit was filed by the AG in the District Court of Lancaster County, Nebraska. Nebraska Examiner
  • The Change acquisition and later problems were possibly the catalyst for stock sales by senior/C-level UHG executives, including UnitedHealthcare CEO Brian Thompson. The $300 million Hollywood (Florida) Firefighters Pension Fund initiated a class action lawsuit alleging that the sales were made while the Department of Justice (DOJ) was considering an anti-trust action against UHG that would revisit the so-called ‘firewall’ between it and Change.  The complaint specifically mentions that UHG executives were aware of it as early as October 2023. The Wall Street Journal revealed the investigation on 27 February 2024–the same time as the Change breach was revealed, cracking the stock almost immediately. Executives including Thompson ($15 million), UHG CEO Andrew Witty, and board chairman Stephen Hemsley ($102 million) were named. The class action covers the period for stock purchased between 14 March 2022 and 27 February 2024. UHG has until 1 March 2025 to answer the complaint. Healthcare Finance News  (This is likely to affect the settlement of the Thompson estate–Ed.)

VA confirms that additional Oracle EHR implementations may go live in 2025, after 18 months of dead stop. The Oracle Cerner EHR is reportedly ‘running better’ at the current six sites where it is operating: five VA only (including 20 community clinics and about 100 support sites), and the sixth at Lovell jointly with the Military Health System (MHS). The restart of EHR Modernization (EHRM) was confirmed earlier during budget hearings by Kurt DelBene, assistant secretary for information and technology and chief information officer. Crash and lag downtimes are reduced by half and incident tickets by 60% since the last updates in August.  Timing remains indefinite for 2025 (FY ends 30 September 2025) but current VA Secretary Denis McDonough confirmed that primarily VA staff will continue to work on it under the Trump Administration. “The overwhelming majority of VA professionals who work on EHRM will be working on EHRM on January 21st, just as they were on January 19th,” McDonough said at an 11 December press conference. Federal News Network

Short takes:

  • The American Telemedicine Association (ATA) launched its new ATA Center of Digital Excellence (CODE) last week. CODE is constructed as an alliance with leading health systems for the development and implementation of digital health best practices that prioritize patient-centered care, equitable access, and improved clinical and operational outcomes. Tools span enhancement of workflows and patient engagement to improve healthcare accessibility. ATA release
  • ClearDATA’s CyberHealth platform and cloud managed services have earned Certified status by HITRUST for information security. ClearDATA provides healthcare specific managed cloud security, compliance and operations solutions. HITRUST, the Health Information Trust Alliance, is a non-profit that sets standards for data organizations through the HITRUST CSF framework. Release

Rounding up last of 2024’s M&A/fundings: Redesign Health’s $175M, HEALWELL AI buys Orion Health, startup Tuva Health’s $5M

December 19, 2024 | by | No Comments

The largest of the year-end fundings (so far) goes to Redesign Health. Best described as a designer and funder of startup health companies which are then spun off, Redesign gained a $175 million investment for a new fund from Declaration Partners, Euclidean Capital, and True North Advisors. Unlike your typical seed funder or incubator, Redesign takes an activist role in forming startups before spinning them off. Its model includes in-house experts to advise on formation, connecting the startup to existing relationships with healthcare organizations and demand generation systems, and access to networks of investors and talent experts. Redesign has used this model with more than 60 companies. These companies have had over 15 million patients and generated >$1 billion of revenue. The fresh funding will be used to start up new companies in eight areas, including ‘preparing for an aging population’. Release, MedCityNews 

Once spun off, the organizations are on their own. Some have been acquired: Jabra Enhance in hearing aids (GN Hearing) and Vault Workforce Screening (Sterling). One notably got into trouble–Calibrate, which was sold for $20 million in an October 2023 ‘reorganization’ to private equity firm Madryn Asset Management along with other investors [TTA 26 Oct 2023]. A pioneer in DTC telehealth programs for GLP-1 weight loss drugs, Calibrate was caught in the squeeze between scarcity of those drugs (Ozempic, Wegovy) and the entry of Teladoc, unable to fulfill its programs nor, at that time, to get insurance reimbursement. It is now benefiting from being in a very hot sector of weight loss drugs. Prior to the sale, Calibrate raised about $160 million in funding [TTA 15 Feb]. Interestingly, Calibrate is still listed in the Redesign portfolio including career openings.

Redesign itself had some rocky times earlier this year with their layoff of 77 from their New York-based staff of 200 to 250 (estimated). The cuts were from the areas that support new venture creation. The new funding is the first sign that Redesign is getting back into the business of forming new companies versus maintaining the portfolio.

New Zealand’s Orion Health to be acquired by Canada’s HEALWELL AI. The final price is NZ$200 million/CA$165 million (US$115 million) for 100% of Orion’s private shares. CA$86 million will be paid in cash and the balance will be paid in HEALWELL stock plus CA$20.5 million in a 3-year performance-based arrangement. Closing is anticipated to be April 2025, after Orion divests itself of non-strategic assets and the usual approvals by shareholders, regulators, and the Toronto Stock Exchange.

Orion Health’s products–Orchestral, Amadeus, and Virtuoso–are data exchange, patient record, and analytics platforms to benefit clinicians and patients. Their largest customers are in Canada, Australia, and New Zealand, plus the NHS in the UK, giving HEALWELL AI an international footprint. HEALWELL AI is based in Toronto and is an artificial intelligence company focused on preventative care through the early identification and detection of disease. Their release announcing the transaction is interesting because of the complexity of the funding (dare we say leveraged?). HEALWELL has $47.6 million in funding over six rounds (Crunchbase). It trades in the vicinity of CA$ 2.00 which gives it a valuation of CA$354 million. Mobihealthnews

Orion Health was last mentioned here with their win two years ago of Saudi Arabia’s health information exchange. The founder, Ian McCrae for the past 30 years, stepped down in August 2022 for health reasons. Replacing him was Brad Porter, his son-in-law. 

On the other end of the spectrum, Tuva Health emerges from stealth with $5 million. The round was led by Virtue, with participation from Box Group and Y Combinator, and notable health tech angel investors. New York-based Tuva has an open-source data model for healthcare analytics and data management to be used by healthcare providers, payers, life sciences companies, and research institutions as an open standard for healthcare data transformation. Their software gives users the ability to transform claims and EHR datasets into analytics-ready data tables via an open-source data model with built-in normalization, data quality testing, and enrichment. 1,500 experts are currently working in collaboration on the model. Their initial partnerships are with Oscar Health and CareAbout Health.  The principals and founders, Aaron Neiderhiser and Coco Zuloaga, are former senior executives from Health Catalyst and Strive Health. Release, FierceHealthcare

Federal budget continuing resolution battle derailed or delayed some telehealth extensions, physician fee increase, PBM reforms (updated 21 Dec)

December 19, 2024 | by | No Comments

Updated for the final bill passed 21 December. It’s one day to the Friday 20 December shutdown deadline for the expiring Federal budget extension. How can this be? The continuing resolution (CR) that would extend Federal budgets to 14 March 2025 is running into severe headwinds in Congress. Conservative Republicans in both houses, plus President-elect Donald Trump, and DOGE co-heads Elon Musk and Vivek Ramaswamy have come out against the 1,547-page CR.

Nearly all legislators have NOT read it, to no one’s surprise. Instead of a clean CR that extends the budget, it’s hung like a Christmas tree with ornaments like provisions on health care (discussed below).  Among the ornaments: permitting year-round sales of E15 ethanol fuel (a really bad idea), $100 billion in badly needed disaster aid, the rebuilding of the wrecked Francis Scott Key Bridge in Baltimore–and, outrageously, a pay raise for Congress members, the concealment of information given to the House around the events of 6 January 2021 (Section 605), and the refunding of the Global Engagement Center (GEC) in the State Department that censored social media accounts! (Somehow the spending-free requirement requiring AM radio in all vehicles sold in the US, a linchpin of our national Emergency Alert System, was forgotten.) All of these should have been handled in discrete bills passed much earlier (or defunded as planned), reducing the CR to a manageable 100 pages or less. Why wasn’t it?

For context, the current 118th Congress ends on 3 January 2025. New Members will be sworn in on that date if not before (in the case of vacant seats). Control of Congress will remain with Republicans in the House and switch to them in the Senate. The 119th Congress is able to immediately address this on 3 January.

If the government shuts down after Friday–most of it is on vacation or out of session anyway–what continues are essential functions such as the military, government benefits, Medicare, the VA, and law enforcement. Non-essential employees won’t be coming into work. National parks, for instance, will be closed–but it is winter.

In healthcare, what was tossed on the tree at various points:

In telehealth, the American Telemedicine Association (ATA) applauded, perhaps too early, the following measures:

  • 2-year extension of Medicare telehealth flexibilities (Ed.–for geographic and originating sites plus types of providers)
  • 2-year extension of first dollar coverage of High Deductible Health Plans-Health Savings Accounts (HDHP-HSA) tax provision (Ed.–commercial coverage)
  • 5-year extension of Acute Hospital Care at Home program (Ed.–originally developed during the pandemic. The Hospital at Home Users group has a webinar at 4pm Thursday–direct link to registration– to discuss contingencies around delay or no extension. )
  • Allows cardiopulmonary rehabilitation services to be furnished via telehealth at a beneficiary’s home under Medicare in 2025 and 2026
  • 5-year extension of the Medicare Diabetes Prevention Program (MDPP) Expanded Model through 2030 and allows beneficiaries to participate virtually and in-person (Ed.–This consists of a one year course that promotes dietary changes, physical activity, and other behaviors to help people lose weight. Providers are paid both for sessions attended and weight loss outcomes. The big guns behind this are Teladoc, which has a lot riding on this, and Omada Health.)
  • Enacts the SPEAK Act which facilitates guidance and access to best practices on providing telehealth services accessibly

The Medicare physician fee schedule (Medicare PFS) has a 2.5% increase. This counteracts a 2.8% decrease enacted in November.

Bonuses to alternative payment models and a reauthorization of the SUPPORT Act for dealing with the opioid crisis.

PBM reforms. The bonuses would be paid for by transparency requirements for pharmacy benefit management (PBM) companies, including banning spread pricing in Medicaid and ensuring Part D plan sponsors delink PBM fees from the price of a drug. The PBM trade lobby charges that the delinking alone will increase premiums in Part D by $13 billion and benefit drug manufacturers.

Updated: Mario Aguilar in the STAT HealthTech newsletter reported the inclusion of a required GAO report on wearable devices: “Within 18 months, the government accountability office must produce a report on “(1) the potential for such devices to accurately prescribe treatments; (2) an examination of the benefits and challenges of artificial intelligence to augment such capabilities; and (3) policy options to enhance the benefits and mitigate potential challenges of developing or using  such devices.” I sent a few messages trying to figure out what exactly the deal is, but the language has been attached to telehealth legislation since at least May.”

FierceHealthcare 16 Dec, 16 Dec. Fox News  CBS News    

Update 21 December   A much-contracted and simplified bill was passed on Friday 0’dark:30 by first the House then the Senate for the presidential signature. The full text of the bill is here. The healthcare provisions included were in Division C, table of contents on page 91, and extended through 31 March 2025. Only three were extended–the rest have to wait for a bill or bills in regular order:

  • The Special Diabetes Program (Sec. 3102)
  • Telehealth flexibilities (Sec. 3207)
  • Hospital care at home (Sec. 3208)

More to develop when the 119th Congress convenes on 3 January.

Perspectives: How Telehealth is Transforming Access for Limited English Proficiency (LEP) Patients

December 13, 2024 | by | No Comments

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s contribution is from Mark Knudsen, the president of AMN Language Services. Mark brings experience from previous roles at AMN Healthcare, Synzi, and Stratus Video. He holds a Master of Arts (M.A.) in Theological Studies at Regent College. AMN Healthcare Language Services (AMN LS) is a healthcare language solutions provider that offers a range of services for patients with limited English proficiency, hearing impairments, or deafness. 

For millions of Americans with limited English proficiency (LEP), accessing healthcare can feel like trying to solve a puzzle with missing pieces.

Telehealth, once considered a temporary solution to the pandemic, is filling in those gaps, removing language barriers that have long hindered LEP patients from understanding their care. It is clearly here to stay.

The integration of medically trained language interpreters into many telehealth platforms has been making it easier for LEP patients and those who are deaf or hard of hearing to converse with healthcare providers in their preferred language, and ultimately, providing better quality care for patients. This access is essential for effective diagnosis, treatment, and follow-up, helping patients understand their health information.

In rural or underserved areas, where access to specialized healthcare is limited, telehealth becomes especially valuable. Finding qualified bilingual providers or medically qualified interpreters who speak specific languages in these regions is often challenging. Telehealth overcomes this obstacle by connecting LEP patients with language-appropriate care from professionals across the country. This not only reduces travel burdens but also minimizes misunderstandings that could lead to incorrect treatments, offering patients a reliable, culturally competent care experience.

Telehealth’s cost-effectiveness is another advantage. Telehealth consultations are generally more affordable than in-person visits, and the built-in interpretation services help lower access barriers for patients. For healthcare organizations, telehealth also presents a scalable, sustainable approach to language access, allowing them to provide high-quality care to diverse populations without the logistical challenges and costs of in-person interpretation.

However, telehealth still faces challenges in ensuring equitable language access. Some platforms lack sufficient language and accessibility features, creating frustrations for LEP patients. Additionally, some healthcare providers may try to “shortcut” interpretation by relying on family members or unqualified bilingual staff instead of trained medical interpreters. While this may seem practical in the moment, it’s not an adequate substitute for professional interpretation, can lead to misunderstandings that compromise care, and in most cases is considered a violation of the patient’s civil rights under the Affordable Care Act.

Integrating language services seamlessly into the telehealth workflow is also key. If language support isn’t user-friendly, it can create extra burdens for both patients and providers. Patients may struggle to navigate complex systems to request interpretation, while providers may face disruptions. Without careful integration, telehealth’s potential for LEP populations is limited by poor user experience.

To fully realize telehealth’s potential, care delivery platforms must prioritize accessibility and patient experience, designing features that provide equitable access to quality care. This means genuinely understanding the needs of LEP and deaf or hard-of-hearing patients and offering effective communication channels.

Telehealth is becoming a staple in healthcare and the focus is shifting toward making it a permanent, optimized part of healthcare delivery and integrating it with existing platforms such as EHR systems. Incorporating language interpretation services into these platforms could clearly streamline workflows for clinicians, making it easier to connect patients with the right resources with a click of a button.

Additionally, integrating language services into telehealth workflows could not only improve the patient experience and patient care but also improve clinician satisfaction by reducing administrative burdens, allowing them to focus on patient care rather than logistical issues. This streamlined process can lead to higher job satisfaction and potentially reduce burnout rates for physicians and nurses alike.

The future of telehealth lies not just in maintaining its accessibility but in reimagining how it can serve every patient, regardless of language or ability. The responsibility rests on healthcare providers and tech innovators to forge a path where language and hearing impairments are no longer obstacles to quality care. The real challenge now? Not simply to sustain telehealth, but to elevate it to a level where it is genuinely inclusive, fully intuitive, and universally transformative.

Short takes: improving healthcare worker safety; CareMax may ax 530 jobs in bankruptcy/sale, finds 2nd buyer; $15M Series A for Evidently, $35M Series B for Hyro AI

December 11, 2024 | by | No Comments

 

Healthcare workers–not executives–are far more likely to be victims of violence in hospital and clinic settings. The bare facts are that pre-pandemic, health workers were five times more likely while at work than other industry workers to be physically attacked (2018, Bureau of Labor Statistics). Post-Covid, the lid came off, based on American Hospital Association reports and the Massachusetts Health and Hospital Association (MHA). In the American College of Emergency Physicians (AECP) annual poll this year, 91% of emergency physicians were either personally threatened or knew a colleague who had. MHA developed a list of recommendations here as part of a code of conduct. AI and security alert companies have also found that hospitals are prime customers. Much more by Neil Versel in Healthcare Dive.

CareMax delivers Christmas coal to 530 stockings. The senior healthcare provider that filed Chapter 11 on 17 November agreed to sell their management services organization (MSO) assets to Revere Medical, formerly Stewardship Health [TTA 8 Nov]. On Thanksgiving week CareMax disclosed that most of the clinical care centers (core centers) would go to ClareMedica Health Partners. in a ‘stalking horse’ purchase agreement that requires bankruptcy court approval. Both the Revere Medical and ClareMedica purchases were part of the Prearranged Plan with the secured lenders, often called a pre-packaged bankruptcy. ClareMedica is a value-based care provider with 12 clinics in Florida.   Release

Their turkey was just about finished when CareMax filed a WARN notice to Florida Commerce notifying the state that the purchasers are not obliged to retain CareMax employees. The letter to Florida states that any retained employees will be notified by 17 January for the MSO/Revere Medical portion and by ClareMedica by 16 January for non-physician employees and 25 January for physicians. All the rest will be terminated by 31 January. Positions included are C-level executives, VPs, various officer titles down to pharmacists, RNs, and care managers. Until the sales receive final approval as part of the restructuring, the notice is conditional.

Another interesting wrinkle. Ralph de la Torre, MD, the former CEO of Steward Health, is a 15% owner of CareMax and is on the board of directors. This has aroused a serious level of Federal interest, since de la Torre has had a contempt of Congress warrant served and is at the center of a Federal probe on international corruption.  Healthcare Dive, Becker’s, Becker’s ‘9 things to know…’

Funding rounds in the year-end closeout.

Evidently closed a pre-Christmas $15 million Series A. Evidently is a developer of cognitive AI healthcare workflow platforms that automates low-level tasks involving clinical data and knowledge – tasks that underlie patient care, revenue cycle, clinical research, and population health. The funding for the Palo Alto-based company was led by DN Capital with participation from FRAMEWORK, Clear Ventures, and Fellows Fund. Previous funding was a lean $1.1 million. The improved workflow is designed to increase financial and efficiency gains. Their own study indicates that it reduces transplant referral chart prep time by over 90%. Financial News UK (release), CityBiz

Hyro AI extended its Series B with a $35 million raise. New York-based Hyro’s fresh funding was led by Healthier Capital, joining previous investors including Macquarie Capital, Liberty Mutual, Twilio Inc., and Black Opal Ventures. Their total funding now tops $50 million. Hyro uses LLMs to power plug-and-play chat and voice interfaces automating the usual tasks of contact centers, including patient registration, routing, scheduling, IT helpdesk ticketing, frequently asked questions, and prescription refills. These can be up to 60-70% of call activity. The additional funding will be used for expanding their outbound calling offering and conversational intelligence analytics suite. Hyro blog/press release, FierceHealthcare

Breaking: Walgreens in talks to sell out to PE Sycamore Partners

December 10, 2024 | by | No Comments

The other shoe drops. Clunk. Walgreens Boots Alliance is in talks to sell to private equity firm Sycamore Partners, according to the proverbial “people familiar with the matter” speaking with the Wall Street Journal. The deal could close as early next year.

WBA would exit public markets, where it is currently trading at a little over $10 for a market capitalization just short of $9 billion. Shares rose abruptly at about 1pm Eastern Time (NY).

It is quite a fall from its value even five years ago at close to $60/share. Other factors are their acquisition binge of latter years including Shields Health and VillageMD, as well as declining brick-and-mortar store sales.

According to the article, it would be a very large apple for Sycamore Partners to eat and digest. Sycamore has an aggregate committed capital of approximately $10 billion according to Transacted.  It would be likely that some parts of the present Walgreens and WBA would be sold off or partners would be invited in, according to the WSJ’s ‘people familiar…’.

The house cleaning promised by CEO Tim Wentworth is coming to pass, fast, undoubtedly spurred by Stefano Pessina.

Walgreens is slated to report its next quarterly results on 9 January.

Hat tip to Endpoints. One of their reporters contacted Walgreens and received this response: “We don’t comment on rumors or speculation about our business.” a Walgreens spokesperson told Endpoints News.

This story is developing. 

Perspectives: Virtual Nursing Optimism Grows, But Providers Remain in Early Stages

December 10, 2024 | by | No Comments

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s contribution is from Lisbeth Votruba, MSN, RN, CAVRN, the Chief Clinical Officer for AvaSure. She is a pioneering nurse executive committed to continuous improvement of healthcare and the diffusion of new technologies to drive patient and staff safety. Her Master of Science in Nursing is from Columbia University School of Nursing. In this article, Ms. Votruba reviews the state of virtual nursing in US health systems and how they can progress into a system-wide strategy for integrating virtual care into widespread clinical use. AvaSure is an intelligent virtual care platform that deploys AI-powered virtual sitting and virtual nursing solutions and is a trusted partner of 1,100+ hospitals with experience in over 5,000 deployments.

Looking at healthcare news headlines, one might think inpatient virtual care is ubiquitous and everyone else is saving millions of dollars through virtual nursing. Or one might get the impression the nursing shortage is over because AI is easing administrative strain. It turns out the truth lies somewhere in the middle. 

A new survey reveals that most health systems remain in the early stages of virtual nursing adoption in acute care settings. In 2024, just 10% of hospital leaders and 14% of IT leaders have reached the phase where virtual care is a standard part of care delivery. In both groups, 30% reported no virtual care.

Those were among the major takeaways from two recent surveys of 369 hospital clinical and information technology leaders on the topic of inpatient virtual care.

Over the last year and a half, hospital leaders grew more firmly committed to the concept of virtual nursing with those believing it will be an integral part of care delivery, growing from 66% to 74%. However, as of October 2024, one out of three respondents had yet to implement virtual care in any inpatient department.

Progressing through the early stages of virtual care
Based on survey results and firsthand observation, most providers are still in the early exploration phase, which is stage 2 of the 5-stage Inpatient Virtual Care Maturity Model (see graphic). The 5-stage process represents a blueprint for care model redesign led by change-management-oriented, outcome-focused leaders.

Few survey respondents have progressed to stage 3, strategic advancement, in which providers establish infrastructure and advance virtual care use for admission, discharge, education, mentoring, and rounding. None has advanced to stage 5, mature virtual care, which is characterized by full integration of virtual care with an emphasis on optimizing workflows, operational efficiency, and outcomes.

Key survey findings

Despite these slow steps toward inpatient virtual care maturity, the annual survey revealed that:

  • 74% of hospital leaders believe virtual care is or will become integral to care delivery models in acute inpatient care, up from 66% in last year’s survey.
  • Hospital leaders continue to prioritize virtual nursing, with an average ranking of 6.2 on a prioritization scale of 1 to 10. Among health IT leaders, the average ranking was 6.
  • 46% of hospital leaders are piloting or have implemented virtual care for inpatient acute care, up from 38% a year ago.

Virtual care use cases and metrics
Hospital leaders consider the top use cases for virtual care to be virtual sitting (39%), patient discharge (33%), admission documentation support (32%), high-acuity monitoring (18%), patient education (18%), and virtual consults (18%).

Survey respondents’ most frequently cited metrics to measure the success of virtual care programs include patient safety, patient experience, workload burden for staff, patient outcomes, patient flow, nurse retention, workforce costs, and nurse safety, satisfaction and retention.

The use of virtual care solutions to reduce burnout among nurses and other clinicians is consistent with the US Surgeon General’s advisory on building a thriving health workforce. Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses.

The path to virtual care maturity requires not just investing in new technology; it also requires organizational alignment, solid change management processes, and buy-in at all levels of the organization. Adopting an intelligent platform that seamlessly blends remote and in-person care with AI-powered virtual sitting and virtual nursing could be a critical step towards accelerating virtual care maturity. However, making a significant difference requires more than just adopting technology; it also calls for establishing specific objectives and taking deliberate steps to build these initiatives.

About the survey:

The Virtual Care Insight Survey was conducted online within the U.S. by Joslin Insight on behalf of AvaSure between September 19 and October 7, 2024. The survey received responses from 340 healthcare professionals primarily working in acute care settings. At least 30% were nurse leaders or key decision-makers (collectively referred to as hospital leaders). This study’s sample data is accurate to within +5.3 percentage points using a 95% confidence level.

To complement the survey of hospital leaders, AvaSure gathered insights from 29 hospital IT leaders (mostly CIOs) regarding Inpatient Virtual Care Adoption.

The full survey report is available for download here: https://avasure.com/resource/2024-virtual-care-insight-survey-report/

News roundup: OnMed to debut CareStation at January CES, former HealthTap employees sue investor MDV, maternal monitoring spotlight with PeriGen/Texas Children’s in Malawi, Ouma Health-Marani Health partner

December 10, 2024 | by | No Comments

The ‘doc-in-box’ an idea that won’t die–but maybe it’ll work this time?? OnMed, which pioneered a telemedicine kiosk that TTA last reported on in October 2019 with placements at Tampa General Hospital, will be debuting it five years later (!) at CES this January in Las Vegas. The “Clinic-in-a-Box” offers a telemedicine live virtual consult with a virtual clinician working with the patient to assess vital signs such as weight, blood pressure, temperature, oxygen levels (SpO2), and thermal imaging. Unlike the Tampa Hospital kiosks, these will not dispense medications but the clinician can e-prescribe to a pharmacy of the patient’s choice. The one – or two booth self-cleaning kiosk has been placed in Tampa, Auburn, Tuskegee, Milam County, Connecticut, and Georgia in multiple settings including a homeless shelter, sheriff’s office, universities, public buildings, and supermarkets. Their website has demonstration videos here. Their target has also changed from five years ago to concentrate on underserved areas, citing the 80% of U.S. counties lacking sufficient primary care and 83 million Americans living in healthcare deserts.

Our Readers will be reminded of Forward’s recent implosion [TTA 14 Nov, 15 Nov] after two CarePods installed, and in the Wayback Machine, HealthSpot Station which managed to get to 50 placements before fading to black in mid-2016 [TTA 17 Nov 2023]. Like HealthSpot, OnMed’s kiosk is dependent on a synchronous virtual consult, but is more compact and self-cleaning. It also does not have the claustrophobia concerns that plagued Forward and HealthSpot–the clear windows ‘fog’ only when the consult starts. OnMed release, HIStalk Monday Morning 9 Dec

Moving smartly to the courts, a group of former HealthTap employees and shareholders have sued the company. Four plaintiffs have filed in Delaware Chancery Court (as the California company is incorporated there) against controlling VC Mohr Davidow Ventures (MDV) and five board members and executives. The suit charges that going back to 2018, MDV took over the company, replaced the CEO with Bill Gossman, a MDV partner, and switched the telehealth provider from an enterprise-focused to a direct-to-consumer model. At the time, they had a contract with UK’s Bupa. Walking away from corporate contracts drastically reduced the value of the company, driving it from what the plaintiffs claim was a billion-dollar valuation to the brink of insolvency, in a strategy to drive out other investors and repel outside funding, leaving MDV as the only other source of funding. MDV purchased notes in what is depicted as repeated self-interested financing and is now issuing millions of shares in this private company which further dilute the value of existing shares. The company is now controlled by MDV and allied entities. 

In May 2018, when CEO Ron Gutman was fired by the board, accused of “acts of intimidation, abuse, and mistrust, and that [he] repeatedly mistreated, threatened, harassed and verbally abused employees”, the plaintiffs claim that HealthTap “had tens of millions of dollars in cash and accounts receivable and was nearing profitability.” They seek an order declaring that the plaintiffs breached their fiduciary duties and award damages. The lawsuit was dated 24 October 2024. Mobihealthnews

In this time of year that celebrates the birth of Jesus Christ, let us celebrate two partnerships that promise safer pregnancies and births.

  • In Malawi, PeriGen‘s perinatal software and Texas Children’s Hospital (TCH) are partnering with the Area 25 maternal health centre in their capital, Lilongwe, for diagnosing high-risk pregnancies and developing fetal conditions. Area 25 is the only clinic equipped with PeriGen in the joint program with TCH. In three years of the program, the number of stillbirths and neonatal deaths at the centre have fallen by 82%. PeriGen’s AI-based ‘early warning system’ requires less time, equipment and fewer skilled staff, which is critical for areas without sufficient health workers and high rates of fetal abnormalities. The Guardian,  HIStalk Monday Morning 9 Dec
  • Back in the US, Austin’s Ouma Health and Minnesota’s Marani Health are partnering with their respective maternal health technologies to create an integrated solution. Ouma offers 24/7 maternity telehealth and Marani has devices and an AI-powered platform for remote patient management. They are targeting areas that are underserved or without access to maternity care. Ouma currently works with over a dozen Medicaid Managed Care Organizations (MCOs) nationwide. Release

Previously, the two companies jointly submitted a proposal to the Centers for Disease Control and Prevention (CDC) and the University of Wisconsin-Madison Prevention Research Center. In October, they were awarded a $5 million grant to fund community-engaged research to address maternal and child health disparities in Wisconsin. Release  In March 2023, Ouma also partnered with in-home care provider MedArrive an in-home care provider, is partnering with Ouma Health, for maternal-fetal care of women on Medicaid coverage. 

Breaking: suspect in UnitedHealthcare CEO’s murder arrested in Pennsylvania, to be arraigned tonight (updated)

December 10, 2024 | by | No Comments

The suspect in the assassination-style murder of UnitedHealthcare CEO Brian Thompson was arrested this morning (Monday 9 Dec). Luigi Mangione, aged 26, was located today at a McDonald’s restaurant in Altoona, PA after an employee recognized him from wanted posters and media coverage. Altoona is a small city about 95 miles east of Pittsburgh.

One of the four fake IDs in his possession was used to check into an Upper West Side hostel. This was a fake NJ Motor Vehicle Commission driver’s license (Real ID!) with a false name and address in Maplewood NJ, a suburb of Newark near NYC. Police also found in his possession a ‘ghost gun’ with a suppressor that is consistent in appearance to the one used in the shooting. Updated: The gun was assembled from parts, possibly from a kit or separately purchased as replacement parts, with a 3D printed receiver. A receiver is the business components of a firearm–the firing pin, bolt, and breech block.

Mangione was due to be arraigned this evening at the courthouse in Altoona on gun charges. He will likely be extradited to Manhattan.

According to his LinkedIn profile (which is still up), Mangione was a University of Pennsylvania graduate with a six-year combined undergraduate and master’s degree in engineering, specializing in computer and information science. He is listed as currently employed at TrueCar, a car researching and dealer service, as a data engineer, but the Daily Mail reports that he left that position in February 2023 and suffered a spinal injury sometime last year. He was from Towson, Maryland and his LinkedIn profile had him living in Honolulu. The family owns and develops resort and golf club property in the Baltimore suburbs, operates the Lorien Health Services nursing homes, is in the travel business, and owns WCBM-AM, a 50,000 watt talk radio format station.

Luigi Mangione’s manifesto (not fully published) and social media postings reflect a distinct anger towards corporate America, according to the NYPD, and medicine and insurance companies as ‘parasites’, possibly personal because of the treatment of a sick relative. He also admired the writings of the murderous Unabomber, who terrorized individuals and academia for 20 years. The shell casings of ammunition found at the New York Hilton crime scene engraved with ‘delay’, ‘deny’ and ‘depose’ were the first indication that the shooter committed this murder in the name of a cause best known to him. New York Post updates, Pittsburgh Post-Gazette  This story is, of course, developing.

Brian Thompson’s private funeral was today (Monday) in Minnesota.

Updated Tuesday: Mangione and his local attorney Tom Dickey are contesting extradition to New York. This was determined during his court hearing at the Blair County Courthouse in Hollidaysburg, PA, near Altoona. Mangione, the suspect in the murder of Brian Thompson, raged on the way into the hearing this morning but remained quiet once in court. The Manhattan district attorney will request extradition via a ‘Governor’s Warrant’ from NY Governor Kathy Hochul, which will be sent to PA Governor Josh Shapiro. This processing could take up to 45 days. In the meantime, Mangione will be held on the gun charge and the false IDs at a state prison in Huntington. Over $8,000 in cash was also found in his backpack when arrested, which he maintains was planted by police. The three-page handwritten ‘manifesto’ positions himself as a hero and scores the corruption and greed of “United” that “they continue to abuse our country for immense profit because the American public has allwed (sic) them to get away with it.”

The extent of Mangione’s back injury was severe. According to the landlord of the co-living space Mangione inhabited for six months in 2023, “his lower vertebrae were almost like a half-inch off, and I think it pinched a nerve.” A former high school classmate said he lost touch with his family and ‘went missing’ after back surgery did not go well earlier this year.

The McDonald’s employee who called Altoona police to check this particular guest eating hash browns has been threatened on social media. 

Masimo update: SEC announces investigation of RTW Investments and role in proxy war voting

December 6, 2024 | by | No Comments

The Securities and Exchange Commission comes knocking on RTW Investments’ door…and they have no sense of humor. Though the proxy war is over now for two months and Politan Capital Management is firmly in control, with losing founder Joe Kiani departing in a classic ‘you’re fired/I quit’ scenario that’s dissolved in a flurry of lawsuits from New York to California [TTA 15 Nov], the next shoe dropping can land Kiani and his ally Roderick Wong of RTW into some extremely hot soup, to strain two metaphors.

The SEC is now investigating the “empty voting” scheme apparently used by Kiani’s side in the proxy war. Masimo had already sued Kiani and RTW in the US District Court for the Southern District of New York charging that they used empty voting to manipulate the shareholder vote in favor of Kiani. Masimo is claiming that this action rigged 19% of the vote under Kiani’s and allies’ control. As noted in our November article, empty voting is done through put options or by selling the shares after the record date but before the shareholder meeting. It’s a way for an investor to build up share control and sway the outcome of a shareholder vote at little cost.

Strata-gee yesterday (5 Dec) reported that Bloomberg News (paywalled), during last week’s pre-Thanksgiving ‘news black hole’, broke that the SEC is probing RTW, a $6.5 billion hedge fund. Its head Roderick Wong is cooperating with the probe. He characterized it to his investors as a ‘fact-finding investigation’ and accurately characterized it as “the existence of a probe doesn’t mean laws were broken” in a message on Monday 25 November. A SEC probe is not necessarily safe as milk–see the last part of this article.

However, as Strata-gee reports, empty voting is not necessarily illegal. It is Masimo’s stating that it has evidence that Kiani and RTW conspired to form an insider group–and insider groups always ring bells for the SEC especially during a proxy fight. And where there’s the SEC, there is the Department of Justice. Witness the interest in insider trading in the form of stock sales by executives at UnitedHealth Group while a DOJ probe was happening but not public–and the resurgence of interest in UHG’s legal difficulties as part of the shocking recent events–which have caused industry executives to scrub their profiles from corporate websites. Healthcare Dive.

Why this matters to us in healthcare tech. Masimo makes consumer and professional medical devices, including smartwatches, that measure vital signs including pulse oximetry where they have a brace of patents. Their global revenue in 2023 was over $2 billion. Medical Design and Outsourcing  Last year at this time, Masimo was the David wrestling Goliath Apple to the mats with  ITC (International Trade Commission) bans on the new Apple Watch 9 and Ultra 2 last Christmas season, forcing Apple to pull them from sale and disable the feature violating the Masimo patents. Masimo continues to challenge Apple patents in court with mixed results, most recently reported in mid-October. Since the new Masimo is actively selling or spinning off its audio brands, what remains is their healthcare technology business.

A cautionary tale. This Editor, as a subscriber to Strata-gee (an audio business specialist website) after finding Editor Ted Green’s talented writing there in following the Masimo Mess, wanted to share from today’s subscriber email his description of a SEC probe at a former employer. Basically, the SEC doesn’t launch investigations unless they have good reason to do so, and they turn your company’s life upside down doing it. Mr. Wong will be holding court for a group of guests for awhile. Editor Ted has a reminiscence of when it happened at the well-known audio brand Onkyo, which was treated as a suspect in the legendary Crazy Eddie (“his prices are insaaaaane!”) retail electronics chain fraud.

Have I ever told you the story about the day, many years ago, when about 20 agents of the Securities and Exchange Commission (SEC) and the Federal Bureau of Investigation (FBI) came storming through the main entrance of Onkyo USA, marched into the President’s office (who was in a meeting that was hastily dismissed) and delivered a Search Warrant? (This is not a joke!) I learned a few things that day about the men and women of the SEC: 1) Most of them were armed with weapons that could deliver deadly force; 2) They were as serious as a heart attack; and 3) They would take office space in our facility and stay for weeks, as they forensically examined everything about our business. It turned out that this was part of an investigation into Crazy Eddie, a New York dealer that they suspected had engaged in illegal activities. As one of their top suppliers, Onkyo was considered a potential co-conspirator until we proved we weren’t…which, thankfully, we did – and they came to see us as one of the victims of Eddie Antar’s scheme and NOT a partner.

No apologies rendered, I’d guess. Or payback for the sandwiches and coffee.

Weekend short takes: Merative’s $25M funding, Risant closes on Cone Health, Aya buys Cross Country staffing for $615M, Supreme Group acquires Amendola PR

December 6, 2024 | by | No Comments

Merative data analytics raises $25 million from Morgan Health. The latter, a JPMorgan Chase business unit focused on employer-sponsored insurance, is investing in Merative to expand its capabilities for employers to manage data with integrated tools and have a more comprehensive, integrated view of health care quality and cost to make improvements. Merative’s products include the employer-focused platform Truven, their employer/payer analytics Health Insights, and their MarketScan databases of real world claims data plus insights for evidence studies. Merative’s markets include employers, health plans, healthcare providers, governments, life sciences, and benefits advisors. Their majority owner is Francisco Partners. Release, MedCity News

Risant Health closed on the purchase of Cone Health of Greensboro, North Carolina. It was originally announced in July. Cone has four acute care hospitals, a behavioral health facility, an insurance plan, and an ACO with 200,000 patients. It is located within the Piedmont Triad metro area and its surrounding counties. It is Risant’s second system after the founding system of Geisinger in Pennsylvania. There was no transaction cost but Risant will provide a minimum of $1 billion in capital to the system in the next five years.  Cone Health closed its 2023 fiscal year on 30 September with $2.8 billion in total operating revenue. Risant is Kaiser Permanente’s nonprofit/community-based hospital system initiative. FierceHealthcare, Cone Health Release

Healthcare staffing is worth some large cash, with Aya Healthcare buying Cross Country Healthcare for $615 million. Their offer for Cross Country shares, traded on Nasdaq, is for $18.61 per share, a 67% premium over the closing price on 3 December. The Aya deal will take it private with an expected closing in the first half of 2025. Aya’s expertise is in travel nursing, allied health, and staffing for professionals in per diem, permanent, interim leadership, locum tenens, and non-clinical roles. Cross Country will remain as a separate brand in healthcare staffing and include providing clinical services in non-clinical settings, such as schools and homes. Release, Benzinga, Mobihealthnews

And in one last acquisition, independent PR agency Amendola Communications is being acquired by Supreme Group. Purchase price was not disclosed but current head Jodi Amendola will continue as president of the agency as a standalone operation under Supreme Group. Amendola is the fifth acquisition by Trinity Hunt Partners-backed Supreme since June 2023. Ms. Amendola was one of our Perspectives contributors in April. We wish them the best! Release

BT Group hacked by Black Basta, China’s Salt Typhoon breached 8 telecoms in dozens of countries, government records

December 6, 2024 | by | No Comments

Telecoms, as linkages to digital health tools and remote patient monitoring, are vital–and lately the target of hackers.

BT Group’s BT Conferencing business division shut down some of its servers following a Black Basta RaaS ransomware breach. After an initial denial to Bleeping Computer, other reports confirmed that the breach was successful in snatching 500GB of data, including financial and organizational data, “users data and personal docs,” NDA documents, confidential information, and more (see screenshot of Black Basta’s leak site, left). BT confirmed that only some servers for the Conferencing business were taken offline and that live conferencing services were unaffected. According to Bleeping Computer, “The cybercrime group also published folder listings and multiple screenshots of documents requested by the company during the hiring process as proof of their claims. The ransomware gang also added a countdown to their dark web leak site, saying the allegedly stolen data would be leaked next week.” BT Group is continuing to monitor and is coordinating with international law enforcement entities. The Russian-based Black Basta since 2022 has been quite successful at its ransomware-as-a service business; its affiliates have breached over 500 organizations and collected $100 million in ransom payments from over 90 victims, according to CISA and the FBI.

Chinese state-sponsored hackers are no slouches in the telecom hacking business either. Their operation dubbed Salt Typhoon has breached at least eight telecom operations and their operations in dozens of countries. Anne Neuberger, deputy national security adviser to the currently expiring administration, seemed not to be overly alarmed that this activity has been going on for a year or two, stating that “at this time, we don’t believe any classified communications have been compromised. ” Companies confirmed by CISA and the FBI are T-Mobile, Verizon, AT&T, and Lumen Technologies. T-Mobile’s breach came via a connected wireline provider’s network, but their chief security officer stated that T-Mobile has no more attacker activity within its network.

Access to telecom allowed the Chinese hackers to intercept and steal internet traffic from internet service providers. Neuberger also confirmed that some government traffic had been compromised–that of government officials, the US government’s wiretapping platform, and there was theft of law enforcement request data and customer call records. Salt Typhoon has also used nom de plumes FamousSparrow, Earth Estries, Ghost Emperor, and UNC2286 to breach Southeast Asia government entities and telecom companies since at least 2019. FBI advice–encryption. Bleeping Computer

News roundup: VA’s 2025 EHR budget + vendor breach, Neuralink robot arm study, linking mood prediction to sleep, CoachCare buys Revolution Health RPM/CCM, Seen Health’s $22M launch, Spectrum.Life in Deloitte Ireland’s Fast 50

December 5, 2024 | by | No Comments

It’s $869 million for the EHR budget. The total budget for the Department of Veterans Affairs for FY2025, which started back on 1 October but is still unapproved by Congress, is $369 billion.

  • The overall EHR budget of $869 million includes current operations of VistA, Oracle Health, and exchange with the DOD/MHS system
  • Drilling down, the budget section for Oracle Cerner for the EHRM (EHR Modernization) has $375 million earmarked for the federal EHR contract. This addresses clinicians’ issues and supports healthcare deployment strategies that optimize resources throughout procedures.

VA decided in FY2023 that there would be no further deployments of Oracle Health’s EHR until the current multiple issues present at the existing six facilities using the Oracle Cerner EHR as well as the James Lovell joint MHS/VA implementation completed earlier this year were at least on a pathway to resolution. However, VA Secretary Denis McDonough said in April during early House Veterans’ Affairs Committee hearings on FY 2025 and 2026 budgets that there was the possibility that implementation may resume before the end of FY2025 using carryover funding, not FY2025 allocated funding. Whether Secretary McDonough will be remaining under the Trump Administration is, of course, subject to change.

In June, VA extended its contract with Oracle Health for another 11 months, not having much of a choice. In July, VA was sued by Laurette Santos, a VA clinical social worker in the White City, Oregon facility, over worker accessibility standards and lack of Federally mandated assistive technology in the Oracle EHR.

Additional funds are on request for IT–$6.2 billion for IT systems–and $10 million for AI research and development. ExecutiveGov

VA’s breach problem. It’s located with a vendor for medical transcription, DBP, Inc. According to the Veterans Health Administration release, the attack on DBP’s server encrypted files that were then potentially copied by the hacker. DBP shut down the server and disconnected it from the internet, preventing additional attacks. The vendor purchased new hardware and implemented new security controls. 2,302 veterans were affected with some or all the following information exposed: full name, medical record information, or Social Security number. It was also geographically wide: Maine, Boston, Connecticut, Baltimore Amarillo TX, and Minneapolis MN.

Neuralink moves forward with feasibility study with a robotic arm. Four months after Elon Musk proposed the N1 implant be capable of moving an Optimus (Tesla Bot) robotic arm or leg, Neuralink has an approved feasibility study, code named CONVOY, to investigate whether the N1 implant can move an Optimus robotic arm. Start date is not disclosed. This follows on the announcement of the clinical trial with Health Canada for the “Canadian Precise Robotically Implanted Brain-Computer Interface” (CAN-PRIME) for N1 brain implant and its R1 robot, which is used to place the 64-thread implant into the brain, and approval last month for Blindsight, an implant for sight restoration. [TTA 27 Nov]. Mobihealthnews

Quantifying the link between sleep and predicting moods. This relatively lean bit of research from South Korea uses machine learning (ML) to predict mood episodes in mood disorder patients using only sleep and circadian rhythm data from wearable devices including smartphones used by 168 patients generating 267 days of data. The researchers derived 36 sleep and circadian rhythm features to enable accurate next-day predictions for depressive, manic, and hypomanic episodes. A key finding that daily circadian phase shifts were the most significant predictors: delays were linked to depressive episodes, advances to manic episodes. The study has implications for symptom evaluation and for treatment effectiveness. Mobihealthnews, NPJ Digital Medicine

Acquisitions and funding:

CoachCare acquires Revolution Health Solutions in the busy RPM/CCM space. Both companies offer chronic care management (CCM) services enhanced by remote patient monitoring (RPM) and outsourced teams. CoachCare’s acquisition cost and staff transitions were not disclosed. CoachCare, based in NYC, has raised about $49 million over five rounds in an unusual way–four under $1 million, then in July a private equity round of $48 million from Topmark Partners and Integrity Growth Partners. They claim 150,000 patients and hundreds of healthcare organizations along with five other acquisitions. Revolution Health Solutions, based in Dallas, had no funding rounds listed on Crunchbase. They were founded and led by Jenn Gillette Tompkins who positions it as a partnership (her LinkedIn post).  Release

Seen Health comes out of stealth with $22 million. The Series A has five investors: Virtue, 8VC, Basis Set Ventures, Prime Time Partners, and Astrana Health. Seen is leveraging off the PACE model (Program of All-Inclusive Care for the Elderly) that helps chronically ill and infirm older adults remain in their homes and out of a nursing home by constructing a care team containing a social worker, nurse, dietician, primary care provider, and others. PACE models that started in San Francisco’s Asian and Pacific Islander communities in the 1970s have also been supplemented with digital health telemonitoring, such as QuietCare in 2006-9 (Editor’s note). Despite their advantages, PACE programs only cover 5% of older adults. Twin brothers Xing and Yang Su decided to build on PACE, creating culturally apt physical centers and equipping them with technology such as an EHR and geofencing that prevents wandering. Their programs will also include care at home coordinated with local agencies to provide low or no-cost care. The financing will be used to build out their first center in Los Angeles County’s San Gabriel Valley that focuses on the Asian and Pacific Islander (API) communities along with the needed technology and to build out their team. MedCityNews

Some nice recognition for Ireland’s Spectrum.Life. It ranked #41st in Deloitte Ireland’s 2024 Technology Fast 50 Awards, which recognize the fastest growing Irish tech companies. Spectrum.Life’s digital platform supports digital health, mental health, and wellbeing for employers and employees in the workplace, insurers, and educators. Their services are used by 9.8 million insurance members, 3,000 corporate clients, 60+ universities and 650,000 university students. WireNews

Breaking: UnitedHealthcare CEO Brian Thompson murdered in NYC

December 4, 2024 | by | No Comments

No other words other than shocking, awful, and terrible. Brian Thompson, CEO of UnitedHealthcare, was murdered by gunshot around 6.45am this morning 4 December, outside the New York Hilton on Sixth Avenue (Avenue of the Americas) between 53rd and 54th Streets.

We know very little at this point. Reports indicate that a masked man approached outside the hotel and shot Mr. Thompson several times including in the chest near the 54th Street side entrance, then fled down Sixth Avenue towards Central Park nearby on a bicycle. Mr. Thompson was taken to Mount Sinai Hospital as critical and pronounced dead. The shooting is being depicted as ‘targeted’ and as an ‘assassination’. The suspect was described as a white male wearing a cream-colored jacket, black mask, black gloves, black and white sneakers, and a grey backpack. (Other than the cream jacket in winter, totally unremarkable) Witness reports indicate that the suspect was waiting outside the hotel and was not a guest. (The Hilton is a standard place to meet people near Rockefeller Center and the business district.)

Mr. Thompson was in NYC scheduled to speak at UHG’s Investor Day conference today at the Hilton, the site of many meetings and conferences. UnitedHealth Group CEO Andrew Witty halted the meeting around 8am.

A personal note. For this Editor working two blocks away years ago at what was then the Burlington Building, in account management for the Campbell-Ewald ad agency on Eastern Airlines, the Hilton was an ‘all hours’ safe haven during long crazy hours, to meet a friend, grab a drink, or just to get out of the office. Nearby tonight is the Rockefeller Center Christmas Tree lighting. Thousands will be there. He will not be.

We at TTA extend our sympathies to Brian Thompson’s family, friends, co-workers, and everyone he touched. We hope the NYPD swiftly locates and arrests the suspect, bringing him to justice. This is developing.

Daily Mail, New York Post

Wojcicki: I’m transforming 23andMe to be ‘viable’ and thriving–but had ‘no idea why her board resigned’

December 4, 2024 | by | No Comments

Transform it till it survives. That seems to be the meme of 23andMe’s CEO/founder Anne Wojcicki in a “CBS Mornings” ‘exclusive’ with co-host Gayle King. Dropping on 27 November (Wednesday morning before Thanksgiving), the 10-minute segment was primarily a pre-recorded eight-minute interview done in a ‘living room’ setting earlier with an introduction and closing commentary with two others. For a non-business interviewer, King directed it better than expected, though the context was soft, with an intro and early questioning that focused on the company’s problems and a Fortune article (more below), then moving towards the end to Wojcicki’s family and personal challenges this year. 

Wojcicki believes that the company is ‘viable’ and ‘transforming’ under her. King redirected Wojcicki from her initial corporate boilerplate-speak twice within the first few minutes back to the troubles of the company, including “How does a company survive when it’s lost 98% of its value though?” The answer was rather pat: “We absolutely are in a situation where we’re figuring out cash burn and we’re looking at all the ways that we’re gonna drive revenue growth.” which is about as much as a CEO and controlling shareholder would want to say about a public company potentially facing shareholder lawsuits.

King touched on the instances of last year’s massive data breach [TTA 19 Jan, 2 Feb], the layoff in November of 40% of its remaining workforce [TTA 14 Nov], and the entire resignation of the board [TTA 17 Sept]. This last elicited the surprising revelation that Wojcicki had “no idea why her board resigned” nor “great insights into what the strategic differences were” or that “there was not an overt disagreement.” King did not drill down into that brace of amazing statements about a hand-picked board of a public company during a financial crisis, trying to decide on a course of action whether to sell or go private. She also did not address the role that the data breach and 23andMe’s widely derided treatment of their customers had in precipitating the company’s decline.

Regarding content in the generally negative Fortune article from October, Wojcicki rebutted the former employees’ view that all decisions ran through her and that she was “outwardly charming, but stubborn and controlling behind the scenes.” saying that ‘”I love getting feedback” and that she encouraged everyone to voice their opinions and share suggestions, which is not quite the same as a collaborative management style or delegation. To her, her vision was centered on using genetic data for consumer empowerment, research, and discovery. Unfortunately, the company moved away from the consumer part which remained largely one-off testing, despite the late adoption of a subscription model and refocusing on consumer products such as GLP-1 drugs. The corporate focus became drug discovery and development (closed) and the GSK data (ended).

To Wojcicki, the closures and layoffs are justified in what she envisions as the ultimate transformation of the company, her new mantra. King closed by asking her about her one and five-year predictions for the company. At one year, Wojcicki without blinking and with a small smile said that 23andMe would be “thriving”. Five years? With a large, confident, and convincing smile, with clasped hands, Wojcicki said it would be “transforming healthcare”. This Editor has heard that song before.