Comings, goings, and more: YouTube goes healthy, COVID vax distribution and EMA hack, IPO/M&A roundup, Japan’s health tech startups highlighted at CES

Short takes on news snippets from just about everywhere. It’s been that kind of a week. (Picture: the famous Raymond Loewy-designed ’49 Studebaker Commander, of which it was joked ‘you can’t tell whether it’s coming or going)

Google-owned YouTube has decided to take a more organized approach to healthcare content with the hiring from CVS Health of Garth Graham, MD, who will serve as its director and global head of healthcare. At CVS, he was chief community health officer and president of the Aetna Foundation. His portfolio will include the development of content from providers including the Cleveland Clinic, the Mayo Clinic, the National Academy of Health, and Harvard’s School of Public Health. It’s seen as a platform for video-formatted health education both US and globally. The importance to Google is evident in the reporting line: Dr. Graham will report to Karen DeSalvo, MD, the chief health officer at Google. One wonders if the next step is the curating (a/k/a demonetizing or removal) of health content not Google-generated. FierceHealthcare, YouTube press release

Some states have done well on COVID-19 distribution. Others haven’t. It apparently doesn’t matter if you’re large or small. In the US, states were given vaccines based on CDC information and consultation with them. The states then designed their own distribution and priorities. Here’s a running tally on Becker’s Hospital Review Meanwhile, back in Hackerville, the European Medicines Agency (EMA) confirmed on 12 January that data relating to regulatory submissions by Moderna, Pfizer, and BioNTech that were on a hacked server was leaked to the internet. Becker’s

In IPO/M&A news:

Centene Corporation is acquiring Magellan Health, a behavioral health, specialty healthcare, and pharmacy management company, for $2.2 billion. Centene continues its transformation into a UnitedHealthcare structured company, with payer programs on one side and health services including population health management, data analytics and other areas of health tech on the other side. Magellan will be operated independently. The deal requires Federal and state review, and is expected to close in second half 2021. Release  Magellan this week announced its lead investment in a $20 million Series B raise by Philadelphia-based NeuroFlow, a clinical behavioral health monitoring system. Philadelphia Business Journal

Amwell announced a public offering of over 11 million shares. The date and pricing for the offering were not mentioned in the release, but at the current share price of $28, this would raise in excess of $308 million. This is on top of their socko IPO last September which raised in excess of $700 million. 

Behavioral therapy continues to be hot, with online behavioral therapy company Talkspace going the SPAC ‘blank check’ route in merging with investor company Hudson Executive Investment. It provides them with $250 million cash. Estimated net revenue is $125 million in 2021, up 69 percent from 2020, creating an enterprise value of $1.4 bn, which is quite a reach. Healthcare Dive, release.

Medicare Advantage payer Clover Health of Jersey City, NJ also went the SPAC route this week with Social Capital Hedosophia Holdings Corp. III, giving it an enterprise value of approximately $3.7 billion. Clover Health styles itself as a health tech company as it analyzes member health and behavioral data to improve medical outcomes and lower costs for patients, many of whom have multiple chronic conditions or are classified as underserved.  Release

Israel’s Itamar Health, which focuses on integrating sleep apnea management into the cardiac patient care pathway, is buying SF-based Spry Health for an undisclosed amount. Founded in 2014, Spry has an FDA-cleared wrist-worn device, the Loop System, that monitors SpO2, respiration rate, and heart rate. Itamar plans to develop a wrist-worn device based on their Peripheral Arterial Tonometry (PAT) immediately, with initial market launch anticipated in 2022. Release

Hinge Health’s Series D raised $300 million and a new valuation of the company at $3 bn. (Remember when $1 bn was a unicorn amount?) Hinge’s specialty is musculoskeletal–a virtual MSK Clinic for back and joint pain care and rehab including access to physical therapists, physicians, health coaches, and wearable sensors to guide exercise therapy. Release

In startup news…Under the radar, Japan has been developing a crop of health tech startups. They were highlighted at this year’s virtual CES by Jetro–the Japan External Trade Organization. Their CES web page has a teaser video and sortable profiles on companies, many of which look very interesting. According to their materials, there are perhaps 10,000 Japan startups but few of them make it out of Japan. This Editor looked forward to their presentation on ‘Turning the Super Aging Society into a Super Smart Society’ yesterday evening, but virtual doesn’t mean that links work or events actually happen, so our reporting will attach some statistics on their super-aging society, as well as a comparison with other countries (PDF).

2021 predictions: telehealth law and if at all possible, stay away from FDA (US)

crystal-ballFoley & Lardner rolls out five predictions for telehealth/digital health law and policy in the US:

1. Licensing: More Efforts to Increase Reciprocity and Reduce Barriers. During the current PHE, HHS and states waived many telehealth requirements, including HIPAA and licensing. As the PHE does not look to be ending anytime soon, look for this to continue and eventually be part of Federal policy as soon as the fall. The status quo in Medicare is rural telehealth only–and that restriction is being recognized as absurd. (Related TTA article on the 2021 Physician Fee Schedule [PFS])

2. Modalities: Technology-Neutral State Laws that Prioritize Quality of Care. States are all over the place with telehealth. Currently, changes have been through legislation with others by executive order or regulation. The American Telemedicine Association published a guide to standard practice and terminology language mid-last year (revised in September) to help guide state lawmakers. One can only hope they follow this recommendation from the ATA. 

3. Privacy: Greater Sensitivity to Patient-as-Consumer in Digital Health. Increased privacy regulations will run up against interoperability and data sharing. In this Editor’s view, this will continue to be a battleground, as in data sharing, there’s Gold In Them Thar Hills and Big Tech has its eye on it.

4. Enforcement: OIG/DOJ Will Build on Prior Investigations. This is the area of Medicare overpayment, wrong payment, and fraudulent tele- and TV marketing of medications, genetic testing, and DME. This massive takedown including opioids made headlines last year [TTA 2 Oct] and included $4.5 bn in fake telemedicine claims. It’s kind of a no-brainer that with the expansion of telehealth, this will continue. It’s always been on the Fed’s radar screen.

5. Payment: Continued Expansion of Telehealth Reimbursement. Again, a ‘Captain Obvious’ with the changes in the 2021 PFS plus resistant states like NY and Massachusetts finally on board with parity (ATA on NY and MA). There are some interesting adds that employers will increasingly pay for tele-primary care, behavioral health, and specialty care like fertility, which again is a no-brainer when your workforce is remote and you want to keep them online. Where telehealth needs a permanent boost is in Federal value-based care programs run by CMS, like shared savings and Primary Care First.

So you’re introducing a telehealth platform or device that you’d like to say ‘FDA-cleared’. This may not be the time to deal with FDA.  Bradley Merrill Thompson of Epstein Becker & Green, P.C., well known to be one of the leading lights in telehealth law and advocacy since Ur-Days, makes a very convincing case to avoid the FDA 510(k) process–if you can. 1) FDA is jammed. 2) it’s a long haul, nearly a year as of 2019, probably longer for 2020 and 3) if you are de novo without any predicate device, you have maybe a 50 percent chance of success.  His anecdotal take is that FDA clearance doesn’t lead to a boost in revenue. Mr. Thompson has also studied the fearsome Warning Letters, and the few for 2020 mostly involved exaggerated or unproven claims around COVID-19. None involved unapproved claims for a digital health product. 

In this Editor’s view, customers won’t be hung up on an FDA clearance if you do what you say you’re going to do at the price they want to pay. Investors need to know this. Some markets do require FDA clearance, however. This Editor experienced this working for her first digital health company, Living Independently Group, where GE Healthcare before acquiring insisted that we take the system through an unnecessary Class I (!) approval. In dealing with vital signs monitoring and Federal purchasing, our Class II filing at Viterion was required. His advice is to watch your claims and work on your business model. Much, much more from Mr. Thompson in Mobihealthnews.

COVID-19 and telehealth–promise or peril? And the perils of digital health in conflict countries and India.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) has published its latest issue today (13 Jan). JISfTeH is one of the few journals which shine a bright spot on digital health in developing countries. This month concentrates on conflict countries and COVID in India: 

  • Scaling Up Digital Health In Conflict Countries discusses the lack of any form of digital health and coordination in Afghanistan, Somalia, Sudan, and, with some exception, Nigeria. It compounds the extreme lack of healthcare services–for instance, 23 percent of Afghanis have poor access to healthcare, resulting in a high mortality rate. It can change. Rwanda, once synonymous with war, has one of the best healthcare systems in Africa due to the use of digital health services. India is using digital health in combating the TB explosion of 300,000 cases in one year. The exception in Nigeria is the liftoff of 54Gene, a genomic studies company in the world’s most genetically-diverse continent, which has secured $4.5 million in seed funding.
  • Speaking of India, telehealth has been kickstarted there due to COVID-19. The Indian Government is prioritizing the use of telehealth in the population and both public and private institutions have rolled out initiatives. India’s challenges are how patients pay for it (70% of healthcare expenses out of pocket) and how it reaches the two-thirds of population in rural areas where there is inadequate telecom and broadband for services. The irony, of course, is that India is a huge exporter of software and telecom services to the world. COVID-19 As A Catalyst for Telehealth Growth In India: Some Insights.

The editorial by Richard E. Scott of Canada and Prof. Maurice Mars of South Africa, COVID-19 and eHealth: A Promise or Peril Paradox?, cautions on the floodgates opening for telehealth in COVID’s wake. Spontaneous telehealth, where “healthcare providers themselves saw the value of an eHealth solution and implemented it independently and without traditional steps or approval” is quite separate from evidence- and needs-based telehealth. There is a lot of pressure at the national level, by the WHO, and by vendors to ‘make hay while the sun shines’. “Enthusiasm must be tempered with thoughtful guidance” on multiple and quite variable factors.

The Theranos Story, ch. 69: Elizabeth Holmes ‘faked it till she made it’–like other Silicon Valley startups? (Updated)

Lifestyles of the Rich, Famous, and Busted, Silicon Valley Style. As promised by the prosecution in the cases being brought against Elizabeth Holmes, the CEO/founder of Theranos, and separately with COO Ramesh ‘Sunny’ Balwani, they are proceeding with filings that connect Theranos’ continued defrauding of investors with Holmes’ extravagant lifestyle and desire for fame. “The causal connection between Defendant’s fraud and the benefits at issue is strong,” the filing stated, going on to detail how the fraud funded hotels, private jet travel, and “multiple assistants” paid by the company who also assisted with her personal needs.  “In addition to the tangible benefits that she received from her fraud, she also was the beneficiary of a great deal of favorable attention from the media, business leaders, and dignitaries”. Sustaining the illusion was necessary to continue the lifestyle and recognition.

Countering the prosecution filing on Friday was–of course–a defense filing that attributed Silicon Valley’s ‘fake it till you make it’ startup culture as a rationale for Holmes’ and Theranos’ actions. That filing states “founders in this area frequently use exaggeration and dramatic promises to generate needed attention for their companies and attract capital.” The “culture of secrecy” that concealed Theranos’ fraud?  “…if it is admitted Ms. Holmes surely could present evidence that other Silicon Valley start-ups used similar practices, and that persons at Theranos were aware of these practices.” In November, they also filed to block as ‘unfairly prejudicial’ any mention of Holmes’ lifestyle as irrelevant to her guilt or fraud. 

Another fake was pretending that problems didn’t exist and everything was just ducky. The prosecution also introduced emails that confirmed Holmes’ direct awareness of problems with the blood tests in 2014. One example was from her brother Christian, who worked in product management. It requested a meeting to discuss a customer complaint where it was “pretty obvious that we have issues with calcium, potassium and sodium specifically.” According to the filing, “Theranos emails contain many examples of customer complaints routinely being escalated” to Elizabeth Holmes and other senior company personnel. At trial, the evidence will show that defendant shaped Theranos’s response to those complaints, prioritizing the company’s reputation over patient safety.” This Editor would argue that it’s no different with car manufacturers (Ford and the now lower-case GM) than startups to spin a response, but the proper reaction to clinical product faults would be to pull back the offending tests and solve the problem before going any further. But the Edison lab and their technology didn’t work.

Updated with further analysis. In retrospect, it’s obvious that Theranos crossed the ethical line between massive hype (expected) and outright fraud (not), which is why the defense is fighting so hard to keep Silicon Valley Lifestyle and Startup Culture out of the case unless it can be spun their way. A key: Holmes’ emotional state and a psychiatric evaluation have also been introduced by the defense, countered by the prosecution. In this case, the fraud was based on dual ethical nightmares, the first worse than the second: faking of medical results, then defrauding small and large investors by faking company performance. Too many just wanted to believe, like the X Files. But we should not forget another high-profile hype and fraud that happened around the same time, Outcome Health [TTA’s articles here].  Outcome Health’s fraud was strictly financial–ad performance falsification leading to fraud and money laundering. They defrauded Big Pharma advertising and some of the largest global investors like Goldman Sachs. The Federal lawsuits on Outcome have gone very quiet after settlements, plea bargains, and COVID halting court actions.

Thanks in large part to Theranos and Outcome Health, that startup culture is mostly kaput. The lessons are learned–we believe. A modicum of modesty along with a large dose of telehealth/telemedicine/data analytics is The 2020-2021 Thing. A lasting effect? Perhaps. Small-batch blood testing is only now recovering from being radioactive.

Before the start of the company’s collapse in 2016, Theranos had raised a reported $900 million ($700 million in some accounts) and was privately valued at $9 bn. Few of the investors clawed back their money. Fraud doesn’t work. It never works.

The trial in Federal District Court, San Jose, is now scheduled for jury selection 13 July. It was moved just before Christmas from 9 March by Judge Edward J. Davila due to California’s COVID-19 surge (MassDevice). So here we are five years later It promises to be popcorn-worthy, with possible appearances by famous men such as Henry Kissinger, Rupert Murdoch, and former Defense Secretary James Mattis. CNBC, Bloomberg For those interested in the full sturm und drang by chapter, it is here.

Digital Health as Boom Town: 2020’s dizzying funding rounded up by Mercom Capital, StartUp Health

BOOM! Mercom Capital Group published their Q4 and 2020 roundup of global digital health investment and, no surprise, the investment picture for just about anything digital health was in sharp contrast to most of the COVID-afflicted world economy.

The topline:

  • Global VC funding (private equity and corporate venture capital) was $14.8 bn across 637 deals. It was a 66 percent increase in funding compared to 2019’s $8.9 bn in 615 deals. The modest increase in deal number and huge increase in funding points to the acquisition of more established companies requiring Big Deals.
  • Total corporate funding, including VC, debt, and public market financing, totaled $21.6 billion

 

In a stunning change, telemedicine was Top Of The Pops, with $4.3 bn in investment, 139 percent over 2019’s $1.8 bn. It was over double the former star categories of data analytics and mHealth apps.

The top five disclosed M&A transactions in 2020 they tracked were:

  • Teladoc’s acquisition of Livongo Health for $18.5 bn
  • Blackstone’s acquisition of a majority stake in Ancestry.com for $4.7 bn (despite the ‘bloom off the rose’ of consumer genetic testing)
  • Philips’ acquisition of BioTelemetry in cardiac monitoring for $2.8 bn
  • Invitae’s acquisition of ArcherDX for $1.4 bn
  • WellSky’s acquisition of Allscripts’s CarePort Health (CarePort) for $1.35 bn

The Executive Summary is available for free download at the link in the release. The full report will set you back $599 – $999, depending on the version.

StartUp Health has slightly different numbers but in total investment tracks almost to Mercom Capital’s estimate at $21.5 bn. For telemedicine, it still triples year-over-year but StartUp’s totals are lower: 2019’s $1.1 bn to 2020’s $3.1 bn. Part of the difference may be remote monitoring, which StartUp considers separately. It doubled from $417 million to $941 million. Their deal counts were also higher: 764 in 2020 compared to 716 in 2019. Another fun fact in their tracking are their city leaders in health innovation funding: Beijing, Tel Aviv, and London, confirming that New York and the San Francisco metro no longer have money, interest, or their former attraction. A fuller list would have been interesting. More is in their Part 1 study. Part 2, to be released next week, will cover their dozen ‘health moonshots’.

Telehealth claims rose 3,060 percent to October, settling in to over 5 percent of all claims–led by mental health (US)

Utilization statistics confirm telehealth’s staggering rise and stabilization. US private insurance telehealth claims data, collected by non-profit FAIR Health in the year October 2019 to October 2020, rose from 0.18 percent of medical claim lines in October 2019 to 5.61 percent in October 2020, a 3,060 percent increase. While the percentages may be low, this tracks with the rise and fall of telehealth visits from February tracked by the last Commonwealth Fund/Phreesia/Harvard University study in October to about 6 percent of medical visits [TTA 29 Oct 20] as well as Epic’s tracking into September [TTA 2 Sept].

According to FAIR’s claim data, telehealth utilization peaked in April at 13 percent, falling in May to 8.69 percent, 6.85 percent in June, and 6 percent in August. This followed the trends reported by both Commonwealth Fund and Epic.

Telehealth visits ticked up September to October, tracking with the rise of positive COVID diagnoses. Telehealth share of medical claim lines rose 10.6 percent nationally, from 5.07 percent in September 2020 to 5.61 percent in October 2020

In every month, mental health led the top five diagnoses in the 30-50 percent range, cresting above 51 percent in October. This points to a greater acceptance of telehealth treatment in this specialty, which is positive, but also the distressing rise in CoronaDepression which TTA has been tracking in both the US and UK [TTA 18 Dec 20]

‘Exposure to communicable diseases’ were, up to September, not consistently among the top five reasons for telehealth visits. They re-emerged on the list in October. In other months as well as October, ‘respiratory diseases and infections’ may have been where active COVID was categorized. Other telehealth conditions were ‘joint/soft tissue diseases’ and ‘developmental disorders’. CPT/HCPCS codes are also listed for reference.

To view FAIR Health’s monthly national and regional analyses, go to their Monthly Telehealth Regional Tracker. Release.

New Year’s Deal and Event Roundup: Optum-Change Healthcare, Walgreens-Amerisource Bergen, December’s deal potpourri, CES and JPM

Mutated COVID virii may be spreading, the UK locked down tight, but the deals with big numbers just keep on coming….

Change Healthcare not sold for pocket change. $13bn from the coffers of UnitedHealth Group’s Optum took it, though word was that it wasn’t for sale. Change will be part of OptumInsight to reinforce data analytics, technology-enabled services, and revenue cycle management. The deal pays common stock shareholders $25.75 per share in cash plus assumption of Change’s debt. Closing is slated for second half 2021. Neil de Crescenzo, Change’s CEO, will be CEO of OptumInsight which will integrate Change into its structure.

Change houses a dizzying group of diverse businesses including radiology, imaging, revenue cycle and payment management, consumer experience, clinical decision support, workflow integration, communication and payment solutions, network optimization, value-based care enablement….and that is about half of the list. The release emphasized RCM, provider payment, claims transaction analysis, and clinical decision support. It will be interesting what Optum chooses to retain and discard.  Press release, Fierce Healthcare, Forbes. Credit Suisse has also published a lengthy financial analysis (PDF) of the deal which opines that it’s likely to not run afoul of Federal anti-trust interest or significant conflicts of interest (Optum currently serves many payers other than UHC). There may be Federal concern about a concentration of data and transaction information as Change alone serves 19 of 20 major US payers and is a leader in network services and payments.

Walgreens Boots Alliance sells the majority of their Alliance Healthcare pharmaceutical wholesale businesses to AmerisourceBergen, a leading US drug wholesale company, for about $6.5 billion in cash and stock ($6.275 billion in cash and 2 million shares of AmerisourceBergen common stock). Interestingly, Walgreens is the single largest shareholder of Amerisource Bergen at 30 percent of common shares. Both Walgreens and Amerisource Bergen will continue their US distribution agreement until 2029 and Alliance UK with Boots until 2031. One way of interpreting this is fattening their ‘war chest’ for expansion, including their major bet with Village Medical. Perhaps a payer or a health tech company? Press release

December’s potpourri of Big Deals was rounded up by FierceHealthcare:

  • Alphabet’s Verily closed out 2020 with a massive $700 million funding round primarily from Alphabet to fund its commercial work
  • 23andMe got a lifeline of $82.5 million in Series F funding from an offering of $85 million in total equity shares. TTA analyzed why the bloom had faded from the genetic testing rose, so hot only a few years ago, last August and February. Bloomberg
  • New Agey Calm is meditating on $75 million in Series C funding and visualizing a valuation of $2 bn.
  • Pear Therapeutics, developer of prescription apps to treat addiction and insomnia, counted $80 million in Series D sheep. 
  • Provider CityBlock Health raised $160 million to support care for marginalized populations with complex needs and now has an estimated value of $2 bn.
  • On the payer side, Oscar Health raised $140 million in a venture round as we reported before Christmas.
  • And we reported on Everlywell’s digital home testing/telehealth consult Series D of $179 million in early December.

And the Big January Events Roll On, Virtually.  CES 2021 and the JP Morgan Healthcare conference for their clients will be held next week as usual, along with the usual constellation of independent conferences. These are usually a major venue for deals and deal announcements, and even in the virtual space, will likely be no different. One wonders if Haven’s closure [TTA 5 Jan] will be even whispered.

Haven finds no haven in healthcare, will close in February

Man Plans, God Laughs. Haven, the joint venture cobbled together by JP Morgan, Berkshire Hathaway, and Amazon to transform corporate healthcare three years ago, will be shuttering next month. The website has but a single page of signoff. All it is missing is a bit of sad synth music like the air crash simulations and analyses so popular on YouTube.

Haven’s founding in January 2018 made for expansive, far-seeing (sic) 50,000-foot quotes by JPM’s Jamie Dimon and B-H’s Warren Buffett about the ‘hungry tapeworm’ of healthcare costs and the need to simplify it for their million-odd employees. Surely it made for great speeches at annual meetings and glossy Annual Report pages. But in its three years of existence, Haven never found a home. It had the ambitious mission of “partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs” and setting up an independent company “free from profit-making incentives and constraints” [TTA 31 Jan 2018]. Yet it spent its first six months without a CEO, over a year without a name, and never created a clear direction. 

Atul Gawande, MD, one of the big thinkers on the broken US healthcare system, joined as CEO six months in, but oddly did not give up his teaching, clinical, and writing commitments. It left the sense that for the doctor, Haven was a part-time gig [TTA 21 June 2018]. One can imagine how Dr. Gawande, without a strong business management background, dealt with the egos of the Bezos-Dimon-Buffett trio without a strong backup team to deal with them, get a plan together, and execute.

The signs of failure were increasingly apparent by the Year of the Pandemic. Health systems and insurers–the ones with the data and the leverage–were never bought (though WellCare, a leading Medicare Advantage payer, was up for sale in 2019 and snapped up by Centene) or even engaged in partnerships. Management fled starting in 2019, accelerating in 2020: COO Jack Stoddard for personal reasons in May 2019, then in 2020 financial head Liam Brenner and people head Bryan Jones in April, Dr. Gawande in May, Head of Measurement Dana Safran in July, and CTO Serkan Kutan in September. Becker’s Hospital Review The one partner with retail consumer healthcare experience–Amazon–increasingly and publicly pulled off in its own beneficial directions, acquiring PillPack in mid-2019 as the first move towards a PBM, then in the past few months pushing Amazon Care for large employers and creating Amazon Pharmacy. The other two companies also, according to reports, executed their own projects with their own teams.

The small employee group (under 60) may find spots at one of the three companies. The official announcement states they will ‘collaborate informally’. Not with a bang, but with a whimper. Fierce Healthcare, CNBC, HISTalk.

We wish you a Merry Christmas and a Happier 2021!

Editor Emeritus Steve and Editor Donna wish all our Readers a Merry Christmas and a Happy New Year, no matter how (much or little) you (can) celebrate it. Take a break, have a Kit Kat or something indulgent like a bottle of Pol Roger.

We hope you like this little angel and candle from 1906. (Our angel would have known Pol Roger, which dates back to 1849, but not Kit Kat.)

No matter what, we will be bidding goodbye to 2020, which has resembled a cross between Medieval Times and the Spanish Inquisition without the entertainment value.

Unless something earth-shattering happens (and one can never rule that out), TTA will be back on the week of 4 January.

4 min 40 seconds of holiday cheer: Liverpool FC visits Alder Hey Children’s Hospital

The pandemic put paid, unfortunately, to the annual visit of the Liverpool Football Club (the Reds) to Alder Hey Children’s Hospital in West Derby. The virtual visits were made possible thanks to a telemedicine robot, an innovative piece of equipment funded by the Alder Hey Children’s Charity.

The short article and video clip of the virtual visit by the first team does speak for itself.

News roundup, lockdown edition: Oscar Health’s $140M raise, IPO filing; Centene’s Diameter Health investment; Abbott’s telehealth-guided COVID antigen test

Before we break for the Christmas and New Year’s festive season, though most of us are partially or fully locked down for travel and get-togethers, binge-watching the telly for comfort, a few items of interest–we’ll keep it short:

An Oscar Health Double Header. Not only did this relatively new payer in the individual, small group, and Medicare Advantage markets gain a $140 million funding round last week, adding to a $225 million raise in June (Fierce Healthcare), but they quietly filed their S-1 registration with the US Securities and Exchange Commission (SEC) to go public on Monday (Healthcare Dive, Oscar release). Since their founding in 2012, the company has raised $1.6 bn in 10 rounds. The fresh funding will go towards 19 new markets and four new states in 2021, adding to their current 18 states and 211 counties. 

Speaking of payers getting into other lines of business, Centene Corporation, which has Medicare plans with different brands in all 50 states, seems to be moving in a different direction with some recent acquisitions and investments. Centene was the lead investor in an $18 million Series B round for Diameter Health, an enterprise data interoperability developer. Optum Ventures, LRVHealth, Connecticut Innovations, and Activate Venture Partners also participated. Fierce Healthcare Centene recently finalized their acquisition of Apixio (AI-assisted clinical data mining of unstructured data) [TTA 14 Nov] and is acquiring Pantherx, a specialty pharmacy focused on orphan medications and rare diseases, to blend into their Envolve Pharmacy Solutions unit. It does appear that Centene is moving into the UnitedHealthcare/Optum model of dividing services and innovations which can be sold to third parties (Optum) from their health plan and pharmacy businesses (UHC), which may be less profitable in the next few years.

An antigen test for COVID-19 with a telehealth spin is Abbott Pharmaceuticals’ BinaxNOW 15-minute antigen test. It is the first at home, telehealth guided test to get an FDA emergency use authorization (EUA). The Ag Card Home Test requires a prescription and used telehealth to guide users through the sample self-collection process, then to help them read and understand their results. MedTech Dive  It was followed up this week by Quidel’s EUA for a dipstick-style collection with a reading in minutes, similar to that of a pregnancy test, but is only cleared for healthcare settings for now. MedTech Dive

Above: Rockefeller Center, 2011. This year’s tree was mangy and the decorations leading to the plaza scarce.

Developing a medical, healthcare, or life sciences product? Here’s a R&D resource.

Your Editor, as part of her reactivated marketing consulting work, speaks with various companies across the (primarily US) healthcare spectrum. Earlier this week, I was introduced to the work of MIDI Product Development, a research and development consultancy since 1972 for medical, life sciences, and healthcare products. Their proprietary DevelopmentDNA™ innovation and design control approach to product development performs for the client the research, design, and engineering, taking into account technical/IP, regulatory compliance (FDA Class I, II, III), manufacturing, and human usability requirements. Their products are diverse in, for instance, imaging, tabletop units, ‘lab on a chip’, LASIK surgical systems, MRI, and PET scanners. In this time of pandemic, they have developed a Rapid SARS-CoV-2 Device/Disposable, a Disinfection Fogging Device to combat HAIs (Hospital Acquired Infections) and COVID-19 in hospitals and beyond healthcare environments, and a UVC-LED System to combat HAIs from spreading room-to-room via foot traffic.

In speaking with Gregory Montalbano, one of the two principals with his brother Chris, they are interested in working with diverse health technology companies, including home healthcare. The company is located near New York City in Smithtown, Long Island, and, unlike many consultancies that rent out labs, they have their own 15,000 square foot facility. MIDI has worked with companies in the UK, Europe, the Middle East, and Asia/Pacific. Their website is linked above including their contact information. We’d be pleased if you mention that you read about them in TTA. Or contact Editor Donna in confidence.

News roundup: Milken Institute’s telehealth brief with ATA push on Congress, GoodRx confirms 62% are CoronaDepressed, Johns Hopkins’ COVID mortality risk study and calculators

The hot US health tech issue is retaining, consolidating, and adding to the gains that telehealth and remote patient monitoring (RPM) made during the pandemic. The influential Milken Institute (formally the Milken Institute Center for the Future of Aging, Center for Public Health, and FasterCures) has published a short white paper on how best to increase access to telehealth services and support innovation as part of that aim. Their five core recommendations are: 

  1. Permanently lift Medicare location restrictions on telehealth to ensure that older adults can receive a variety of services in their homes and communities, regardless of where they live. (This was also recommended by the Taskforce on Telehealth Policy (TTP) [TTA 18 Sep] which was jointly formed by the ATA, NCQA, and the Alliance for Connected Care.)
  2. Meet the growing need for behavioral health care by addressing barriers to remote care and expanding the availability of telebehavioral  health services.
  3. Increase equitable access to telehealth services through digital technology, literacy programs, and broadband coverage.
  4. Support development and implementation of innovative telehealth and mobile health technology for prevention, well-being, clinical care, and research.
  5. Develop and document clear data sharing standards to support transitions of care across acute, post-acute, and long-term care settings, including care provided in the home and in residential care facilities. 

The consensus is that CMS’ 2021 Physician Fee Schedule post-pandemic (public health emergency=PHE) does not do nearly enough in that it returns–of legal necessity–to the status quo ante geographic restrictions, though it devised a temporary Category 3 to store over 50 telehealth billing codes [TTA 3 Dec]. The American Telemedicine Association (ATA) was joined by multiple organizations on Monday in pressing Congressional leaders to extend national telehealth ‘flexibilities’ as part of the $1.4 trillion omnibus spending deal that is needed to avoid a government shutdown on Friday (yes, this Friday) at midnight. The organizations joining the ATA on the letter to Congress are the Alliance for Connected Care, College of Healthcare Information Management Executives, Connected Health Initiative, eHealth Initiative, Health Innovation Alliance, HIMSS, and PCHAlliance. ATA release.

We are shocked, shocked that CoronaDepression worsens in those already suffering. Prescription discounter GoodRx analyzed prescription fill trends for anxiety and depression meds and found that they reached an all-time high in 2020–9.5 percent higher than the previous high in 2016. It peaked in April as the pandemic was underway, and possibly reflected some stockpiling.

Of their sample of 1,042 individuals diagnosed with anxiety and depression prior to the pandemic:

  • 22 percent responded that their symptoms were “much worse”
  • 40 percent said they were “worse”
  • 28 percent stated that symptoms were the “same”
  • a surprising 10 percent said symptoms were “better” or “much better” 

One of the main factors in that 62 percent reporting worse/much worse was the length of quarantine. “Those who reported quarantining due to COVID-19 were far more likely to report “worse” or “much worse” symptoms compared to those who did not quarantine. Over 70% of those who reported quarantining for more than one week said their depression and/or anxiety symptoms were “worse” or “much worse.” Loss of job and income, plus COVID-related events affecting friends and family, were also key in worsening symptoms. Many also had difficulty reaching their doctors/therapists and renewing medication. The study was conducted 1-10 November. GoodRx study

More depressing news (sic) of mental health challenges to older adults in the Isolation Age: The Future of Remote Care Technology, Lockdown Loneliness feared more than COVID, and the PLOS One study.

But cheer up and carry on, your COVID mortality risk may not be as bad as you think. A team of researchers at the Johns Hopkins Bloomberg School of Public Health created a COVID mortality risk calculator, based on algorithms calculating factors such as age, gender, sociodemographic factors, location, and a variety of different health conditions. Risk scores are grouped into five categories from lower than average/close to average to high.  While primarily for public health authorities to prioritize populations for vaccination, uninfected individuals can use it to determine their personal risk of future infection and complications after infection. It’s easy to use and your results may surprise you. There is also an interactive US map of the risk level of major cities, counties, and states. The study is published in a paper that appears in the journal Nature Medicine.  Johns Hopkins release, risk calculator

AI-powered contact tracing as part of an ‘application ecosystem’ for COVID-19 information and vaccination

Following up with Avaya UK on October’s Perspectives on COVID-19 contact tracing and the use of AI to automate virtual agents for initial contact, they have released details on their contact tracing application that integrates with current Avaya software or into a company’s call center system. Based on their materials, it automates the initial contact with the individual using natural language text to a smartphone or tablet messaging app, web chat, or email. AI in the contact tracing app helps to screen the response and directs it to the correct agent. Augmentation tools provide real-time prompts and suggestions during a live call with the individual. Notifications can also be automated and also individual follow up can be made via text message. Additional features are detailed on their web page and in the contact tracing overview (PDF). Having heard horror stories from friends who have been subject to contact tracing and follow up apps in the wake of COVID-19 contacts and diagnoses, a great annoyance was daily live phone calls with agents repeatedly asking the same information and making the same assistance offers. Text messages would have been far more acceptable and directive.

Contact tracing is a part of their OneCloud Communications Platform as a Service (CPaaS) which enables organizations to design their own applications and workflows with a platform that supports SMS, MMS, voice, messaging, transcriptions, and digital channels. With vaccination now front and center, for provider organizations, OneCloud can be used to build systems for COVID-19 vaccination information access, recruiting staff, and administering the process. Additional details are in their OneCloud CPaaS overview.

This week, OneCloud for healthcare was awarded Frost & Sullivan’s Competitive Strategy Leadership Award. Release.

Hat tip to Mary Burtt of AxiCom UK

Amazon’s feint into large employer telehealth; HealthLake dives into structured health data analytics

Much ado about…..? Amazon is reportedly making an effort to lure large employers into its Amazon Care telehealth and in-person care platform. Amazon Care is a health benefit presently offered to Amazon employees, with telehealth nationally and in-person for Seattle area residents.  

About 300 Amazon employees use it, which is low given their employee size and after 15 months. Since internal takeup has to date been limited, this Editor observes that Amazon may be testing the scaleup waters by inviting other companies in. These reports indicate that online real estate marketplace Zillow was approached but has moved no further with it. Companies would be charged a per member per month fee plus a ‘technology fee’. 

For those interested in telehealth’s positioning among US employers, the Credit Suisse report by Jailendra Singh’s team makes important points on where both Teladoc and Amwell stand with employers and health plans–and it’s not promising for Amazon:

  • Telehealth has been adopted by 90 percent of employers, but it’s a fraction of benefit spending for them
  • What’s important to employers is not the cost of the program, but employee engagement, the potential volume of medical cost savings, and management of chronic conditions
  • Telehealth vendors are increasingly ‘carved into’ contracted health plans
  • Between direct employer contracts and health plans, Teladoc is settled into this segment, and diversified into medical systems with new acquisitions InTouch Health and chronic care management with Livongo. Amwell is situated in the white-label provider market with health systems and health plans, with few employer contracts. 

 AMZN Making a Push in Telehealth For Large Employers: Appears to Be More Noise than Substance

A better-positioned initiative for healthcare providers that Amazon just announced is HealthLake, which is a HIPAA-eligible AWS cloud service for storing and analyzing structured and unstructured data at petabyte scale. The ‘lake’ is the data lake in the cloud. It copies health data in the Fast Healthcare Interoperability Resources (FHIR) format, and analyzes unstructured data uses specialized machine learning models, like natural language processing, to automatically extract meaningful medical information. Current users, according to their website, are Cerner, Konica Minolta, and Orion Health. Hat tip to HISTalk.

Who are the top tech influencers in UK, Germany, and France? Tyto PR compiles a ‘Tech 500 Power List’.

A snack for the weekend. The close of this Year Like No Other (which to this Editor feels like Unfinished Business) brings the usual year-end lists and predictions for 2021, which we all hope will be a better year. UK/EU PR agency, Tyto PR (not to be confused with telehealth/RPM company Tyto Care and with no business relationship), has prepared the former, covering 500 tech influencers in the UK, Germany, and France. While the list is general tech, there’s some representation of health tech and influencers, especially political and academic. The main page lists the top 50 in UK, with pages in German and French for their respective top 50 lists.

#1 on the UK list is Matt Hancock, who needs no introduction to our UK Readers. #3 is Liz Aschall-Payne, CEO of ORCHA (Organisation for the Review of Care and Health Apps), which reviews and rates medical and health apps, and on whose LinkedIn feed this Editor viewed it. In October, we noted their partnership with the US’ American Telemedicine Association (ATA) on the app rating problem. On all the lists, there are a lot of politicians and professors, by their own admission, attributed to COVID-19. The list main site, for your review.