Sustainable transportation models for patient access to care at lower cost

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics) returns to the transportation aspect of social determinants of health earlier explored in her article on Veyo [TTA 21 Feb]. New on-demand services provide affordable ‘a to b’ transportation not only which is clean, safe and tailored to the patient’s needs, but also accountable to the health system or provider. A surprise here is that Circulation’s service is not smartphone dependent. 

Circulation, Inc. launched its Non-Emergency Medical Transportation (NEMT) system with just a few hospitals back in September 2016. This game changer company provides on-demand rides with a healthcare transportation platform and an Uber app.  To date, they have expanded significantly with over 30 new clients and ride access in over 25 states. Last week, I had the pleasure to speak with Robin Heffernan, PhD., the co-founder and CEO of Circulation, to learn how they have been able to achieve a successful cost-effective and reliable transportation system for patients and providers. A gently edited version of our conversation follows below.

How has Circulation reduced the cost of a ride with an NEMT system? How will cost savings trickle down?

Heffernan: Our health facility clients are saving costs on the ride component only.  When someone transitions from mostly using taxis to being able to use Uber rides, the cost of that ride is 40 to 50 percent less. We have not yet calculated the bigger total cost savings for our clients. When patients actually make their ride appointment, the savings begin because they are not missing a primary care appointment. Without a scheduled ride, they may decide to take an ambulance the next day to the ER for a basic cough.  I think this is a huge advance for this industry. From day one you are going to achieve significant savings on a pure ride cost basis, get increased patient satisfaction and see your patients actually getting to appointments on time. Health facilities can track for the first time a whole downstream value proposition, and actually tie transportation to appointments to costs like ED utilization. Our solution tracks this component with our clients.

How does Circulation’s transportation model impact value-based care? (more…)

Babylon Health ‘chatbot’ triage AI app raises £50 million in funding (UK)

click to enlargeBabylon Health, which has developed an AI-assisted chatbot to triage a potential patient in minutes, has raised a serious Series B of £50 million (US$60 million). Funders were Kinnevik AB, which had led the Series A, NNC Holdings, and Vostok New Ventures (Crunchbase). According to the FT (through TechCrunch), Babylon’s value is now north of $200 million. Revenues were not disclosed.

The current app uses texts to determine the level of further care, recommends a course of action, then connects the user if needed to a virtual doctor visit, or if acute to go to Accident & Emergency (US=emergency room or department). It also follows up with the user on their test results and health info. The funding will be used to enhance their current AI to extend to diagnosis. They are accumulating daily data on thousands of patients, machine learning which further refines the AI. Founder Dr. Ali Parsa, founder and CEO of Babylon, said in a statement. “Babylon scientists predict that we will shortly be able to diagnose and foresee personal health issues better than doctors, but this is about machines and medics cooperating, not competing.” Like other forms of telemedicine and triage (Zipnosis in health systems), it is designed to put healthcare access and affordability, as they claim, “into the hands of every person on earth”. The NHS pilot in north London [TTA 18 Jan] via the 111 hotline is testing Babylon as a ‘reliever’ though it directs only to a doctor appointment, not a video consult. BBC News, Mobihealthnews

ATA 2017 dispatch: Devices and doom

click to enlargeBruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the third and final article this week he’s written from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

This Editor agrees with his POV that drowning doctors in more and more data, whether previously accessible or not, isn’t a way forward to a successful business model. The current data is overwhelming–and not interoperable with EHRs. More and more data, looking for a home….

Orlando, April 26. Yesterday, I set aside several hours to walk by the booths of the 200+ exhibitors at the ATA show. As I slowly walked the Exhibit Hall, I was struck by the large number of in-home telehealth patient monitoring devices. (Names are omitted to protect the innocent.)

Colleagues had similar reactions. When I asked about exhibitors, the most common response was “I had no idea there were so many new telehealth monitoring devices that are FDA approved or in the process of obtaining approval.”

As I wandered from booth to booth, I was also struck by the failure of so many, if not most, monitoring device manufacturers to focus on the practical uses of their truly revolutionary technologies. At each monitoring device booth, I asked the same question, “How will the data be used?”  All too often, the answer was, “We provide daily patient data for physicians that have never been accessible before, and doctors receive daily graphs.”

My follow-up questions were always, “You believe busy doctors will look at data on their large patient population each day? Why don’t you provide alerts?” Again, there was a frequent answer, which was some variation of “Yes, now doctors can see daily events which will lead to extraordinary improvements in health outcomes, and we don’t want to create alert fatigue” (false positives that suggest a problem where one does not exist).

In my view, monitoring devices without suites of robust predictive analytics will fail. Doctors are already too busy, and anything that adds to their workload is immediately suspect. Moreover, we still live in a fee for service world, and now we are talking about new, uncompensated work.

As Jonathan Linkous said to me on the first day of the ATA show, “the technology is a tool to provide the service,” not the service itself. Patient monitoring device firms must realize they are offering a service. To succeed, their services must provide actionable analysis, not more and more data. If alerts are ready for prime time, then doctors will value the devices: They can rely on the associated algorithms to indicate when an intervention (also to be compensated) is needed.

Moreover, I strongly suspect doctors would prefer a few false alerts, with algorithms biased toward safety and results that can be quickly checked via the underlying data, as compared to wading through charts looking for anomalies.

A fundamental question for anyone is “what business are you really in?” To succeed, many of the ATA exhibitors need to reorient themselves from the business of providing great technology to the business of providing great service enabled by technology.

Mr. Judson’s first article, a discussion with ATA’s Jonathan Linkous on business models for telehealth is here. The second article on Mercy Health’s catalyzing telehealth innovation at the hospital level is here.

ATA2017 dispatch: Catalyzing telehealth innovation in hospitals

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the second article this week from the ATA floor. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar]. His discussion with ATA’s Jonathan Linkous on business models for telehealth is here.

Orlando, April 25. At the ATA show, I stopped at Mercy’s booth, and spoke with Keela Davis, who is Mercy’s Executive Director, Innovation and Product Development. In the booth, was a large, inspirational display of Mercy Virtual’s high-tech, widely-reported $54 millionhospital without beds.” The facility is the nerve center for Mercy Virtual’s telemedicine programs, which include TeleICU (remote monitoring of ICUs by Mercy specialists) as well as multiple other remote services for patients in hospitals and at home.

A great deal has been written about Mercy’s groundbreaking service and large investment in this facility. I asked Davis what led to the decision to build “the hospital without beds.” She said that first, a lot of experience in telehealth proceeded the investment decision. Undoubtedly this experience was required to simply decide what should be built in a facility designed for the technology that exists today and that will undoubtedly accommodate new technologies as they arise. Second, she also said, that it reflected “a visionary” decision on the part of Mercy’s leadership to make this commitment. Now, in her words, the facility has become “a symbol of our work.”

As a student of innovation, our discussion was notable on several fronts:

First, Davis noted that now that the facility exists it serves as a catalyst for innovation. Mercy is actively considering, as might be expected, a range of new telehealth services. While Davis was quick to point out that the facility was not the only source of telehealth innovation at Mercy, she did indicate it’s the hub for innovative ideas and discussions. Organizations build on their experience, their successes, and the demonstrated commitment of management to move forward with good ideas. Mercy’s facility now provides the tangible place that facilitates ongoing growth. In short, after conquering the first level of innovation, Mercy is poised to march forward with new, groundbreaking services.

Mercy’s facility is also a warning to organizations that see the telehealth future, but hesitate to act. As Mercy gains experience, it will have a team that understands the many, complex aspects of assessing and bringing new services to market. Plus, many of the underlying capital and investment requirements associated with creating these services have already happened. In short, it will soon be difficult for other healthcare entities eyeing services in the same arenas to match Mercy’s innovation machine.

The Theranos Story, ch. 40: investor fraud revealed in equipment, fake demos, testing

click to enlargeTheranos’ ‘Big Dig’ is larger than this German art installation representing a Hole to China. It was as smooth as the turf depicted. Set up some shell companies, buy equipment from Siemens, modify it to take the mini-samples for the Theranos Edison mini-lab–and run their customers’ blood tests on them. Get incentives from a credulous Arizona governor and legislature. Run fake tests for investors on this equipment. Promise $1 bn in 2014 gross profits. Then, when it all comes undone, tell the investors to take additional equity shares and not to sue, or else it’s Chapter 11. Oh yes, and settle with Arizona for nearly $5 million and CMS for $30,000 [Ch. 39].

The latest reveal in the Theranos Saga took place in busy Delaware Chancery Court in a lawsuit brought by investor Partner Fund Management (PFM) LP and two other associated funds, which invested over $96 million in 2014. The unsealed documents, part of the follow-up to a lawsuit originally filed in October 2016 [Ch. 21] and another filed this month to block the equity offer to investors, contain depositions from 22 former employees and (hold the presses) directors. The (paywalled) Wall Street Journal article revealed that Theranos bought commercial blood testing lab equipment from reputable companies including Siemens, modified them to take the miniature samples that Theranos collected, used them to conduct both customer testing and from the filing, “fake ‘demonstrations tests’ for prospective investors and business partners”. Theranos used a shell company, Protegic Procurement Company, to make the purchases. Former director Adm. Gary Roughead, USN (Ret.), was quoted as being unaware of the fact that there were “extensive commercial analyzers in use.”

Now it is not uncommon for competitors’ equipment to be used for reference purposes and testing, especially when the company still is in process for their regulatory approvals. However, the lawsuit claims that customer tests were run on these labs, and not for a limited time as Theranos claims. The demonstration test claims are even more damning as they show fraudulent intent to investors.

The other part of the PFM lawsuit alleges that Theranos investors, including them, were pressured to not sue and take the additional equity deal [Ch. 38] by an attorney representing Theranos, who suggested that the alternative was to seek Chapter 11 bankruptcy protection. “Theranos officials engineered the share offer in a way that would make it impossible for the funds to obtain “any recovery” as part of its bankruptcy filing.” The PFM filing to block was successful. On April 11, Theranos was stopped from going forward with the share-exchange plan, with that hearing scheduled for June 26, not ideal for a company which is buying time before the money runs out. Bloomberg

The ‘cherry on the fraud cake’ is Theranos’ wildly inflated projection of a $1 billion gross profit in 2014. Theranos, of course, states that “The suit is without merit, the assertions are baseless, and the plaintiff is engaging in revisionist history.” Is ‘fake news’ the next claim? Ars Technica, TechCrunch, Fortune, Engadget.

Rest assured that there are many other chapters to come, as the lawsuits continue, including one for $140 million by Walgreens Boots, and the Colman/Taubman-Dye suit in California. Our Theranos and related articles are indexed here.

ATA 2017 dispatch: The future is about business models and the consumer

Bruce Judson, our guest ATA 2017/Telehealth 2.0 reporter, is a bestselling author of books on business and technology issues in the evolving digital era. This is the first of several articles this week. Mr. Judson writes frequently for The Huffington Post. More on about him may be found in our review of his critique of the RAND telehealth study [25 Mar].

Orlando, April 24. Yesterday, the annual convention of the American Telemedicine Association (ATA) moved into full swing. At noon, Jonathan Linkous, ATA’s CEO, took a few minutes to talk with me. During our wide-ranging discussion, three notable themes emerged:

First and perhaps most important, Mr. Linkous believes that the future development of telehealth now stands with establishing viable business models. In his view, the speed of growth of the industry now depends on how the many participants in the healthcare system develop business models that lead to appropriate investments. He noted that this contrasts with the general focus on the evolving technology. Of course, the technology will continue to evolve and major advancements will occur for the foreseeable future. But, Mr. Linkous strongly believes that “the technology is here today.” In short, it’s now about how the technology is used and deployed. New advances will be incorporated into services and infrastructure as they occur. But, the past, telehealth is now moving into mainstream investment discussions. In his view, the leaders of every health organization are now assessing the role telehealth will play in the services they offer, and the investments they need to make now.  Now, it’s about making it work. We are no longer waiting for the technology to be viable.

Second, Mr. Linkous commented on the hype surrounding the industry. He was frank in recognizing that, as with all exciting, transformative industries, the hype cycle is in full swing. One telling comment: “Unlike the past, the industry now has real revenues,” with rapidly growing businesses. In short, we may not be past the hype, but the industry is quickly moving to fulfill realistic expectations.

Finally, Mr. Linkous concluded that the future growth of the telehealth industry would largely depend on the consumer. He cited a variety of factors: the growth of value-based care, the emerging influence of millennials who are comfortable with technology, and the overall consumerization of medicine.

Many industry participants have described themselves to me as B2B businesses. Undoubtedly, they are. It’s hard to refute Linkous’s conclusion: Ultimately, the growth of the industry, like the evolution of healthcare itself, will depend on consumer choices.

Anthem to Cigna: This merger is on, like it or not–and the clock is ticking

click to enlargeThe War of the Payers continues. Last we heard from Anthem and Cigna in February, they were filing and counter-filing each other in Delaware Chancery Court–Cigna to end their merger, Anthem to continue. Last Wednesday, Anthem filed an injunction to prevent the deal from expiring as per the merger agreement on 30 April. This injunction may be heard by the Chancery Court on 8 May, according to Anthem documents, but the main court documents are still under seal. (Law 360, via Healthcare Dive 24 April)

To recap the contentious background. The Federal District Court in DC, based on action by the US Department of Justice, first denied the merger on 8 February on antitrust and anti-competitive grounds [TTA 9 Feb]. Unlike the also denied Aetna-Humana merger, it was publicly known, to the point where it was cited in the District Court decision, that the companies had significant disagreements on the merger. After the denial, Anthem wasted no time in appealing for a reversal of the decision with the DC Court of Appeals. Cigna lost no time in wanting no part of any appeal of the ruling by Anthem–and filed in Delaware Chancery Court for $13 bn in damages in addition to the contractual breakup fee of $1.85 bn [TTA 14 Feb]. Two days later, Anthem filed in the same court for an injunction to delay the merger agreement’s legal termination [TTA 16 Feb]. In March, Cigna surprisingly filed a brief in support of Anthem’s appeal (Healthcare Dive), still in progress. Arguments began 24 March, which makes the likelihood of the appeals court decision by the 30 April date doubtful indeed–another reason for the injunction. Anthem has also denied rumors of an appeal to the Justice Department to save the merger (Reuters).

To be brief, as the clock ticks away, there remain rivers of bad blood and accusations of bad faith between these two organizations. Is this merger really necessary? No, it is not, and in our 16 February/21 February update (see analysis), this Editor goes into why Anthem’s persistence in pursuing this is extraordinarily harmful–to their customers and to both companies.

The Theranos Story, ch. 39: good news, bad news, and the ugly lawsuit news

click to enlargeIt’s that darn well again! Theranos‘ News of the Week ran the gamut from cheap, to expensive, to potentially business terminating.

Cheap was the settlement of the Center for Medicare and Medicaid Services (CMS) civil penalty against the company for a pinprick of $30,000. What remains: that Theranos cannot own or operate any labs for the next two years. As the company has downsized and done the Silicon Valley pivot to developing labs and testing platforms, the settlement is the barn door closing after the horse has exited and crossed the state line. Theranos press release,

Expensive was the settlement of the Arizona legal action brought by the state Attorney General, Mark Brnovich. $4.65 million settled matters, providing full refunds for 175,940 Arizona consumers who ordered between 2013 and 2016 approximately 1.5 million blood tests and 7.8 million results. Also on the tab are $200,000 in civil penalties, $25,000 in attorneys’ fees, and a claims administrator to dole out the refunds. While it was estimated that only 10.5 percent of tests were inaccurate, the consumer fraud charges were easier for Theranos to settle without admitting wrongdoing. A solid win for the AG as well. Background on this in Ch. 33. Ars Technica, Bloomberg, Theranos press release

Potentially disastrous is the go-ahead given to one of the many lawsuits against Theranos, also charging Elizabeth Holmes and former CEO Ramesh ‘Sunny’ Balwani. The US District Court for the Northern District of California ruled in the case brought by two shareholders, Robert Colman and Hilary Taubman-Dye, represented by Hagens Berman (Ch. 27), that most of the claims of investor fraud would proceed. Theranos’ sole success was having the charge of misrepresentation of securities under the California Corporations Code dismissed on the technicality of purchase from a third party seller. The more damning claims of direct misrepresentation by Ms Holmes and Mr Balwani, mentioning news articles and their advertising campaign, were upheld. Interestingly, the plaintiffs must now show cause why the third party sellers (Lucas Venture Group, Celadon Technology Fund, SharePost), should not be included as defendants. The stage is now set for a class-action lawsuit with potentially thousands of other investors. Theranos page on Hagens Berman website, District Court ruling document.

The final countdown is at the bank. In March, Theranos reported $150 million in cash (ch. 38), down from $200 million in January. Subtract $30,000 to CMS, $4.65 million to Arizona, legal fees, pending lawsuits, and running expenses–with no investors and revenue in–and a burn of about $50 million a quarter, it will be Taps for Theranos before end of year.

Health 2.0 conferences acquired by HIMSS (updated)

The T-shirted revolutionaries converge with the corporate suits. HIMSS has acquired the ten-year-old Health 2.0 conference organization. It will be operated as a strategic business unit, retaining its name within HIMSS. Current CEO Indu Subayia, MD, will join HIMSS as EVP of the Health 2.0 business unit. Co-chairman Matthew Holt is taking a more freewheeling role as a ‘globe-trotting ambassador’, co-hosting and developing the international conferences currently held in India, Barcelona Spain, and Japan. He will also co-host the US annual and Wintertech meetings in the Bay Area. Transaction terms were not disclosed.

Health 2.0 was originally founded as a ‘bleeding edge’ networking community of misfit tech developers, IT gearheads, clinician renegades, startup newbies, and intense patient advocates, soon joined by marketers, communicators, funders, journalists, academics, and others who for various reasons wanted to be part of The Shock of the New. Over time, the small gatherings of the tribes (a/k/a chapters and annual meetings) grew ever larger, along with the startups growing up (or flaming out) and increased corporate interest, while Health 2.0 developed into a sizable conference, media, and innovation consulting company with a claimed 50,000 members. HIMSS has always represented, in their CEO Steve Lieber’s words, the “more established, fully adopted technology arena”. With the acquisition, HIMSS “now has much more of a portfolio to help drive better health through IT” and, of course, a deep well of resources including dues (and sponsor/exhibit) paying companies and members.

Health 2.0 will be expanding their conference schedule and into “additive products and services” such as MarketConnect, introduced at the 2016 annual meeting as a broker for startups/emerging tech to connect with larger customers and partners, and the Digital Health Marketplace with the NY Economic Development Commission (NYEDC). Developing these services will “lower barriers, increasing access and then being a conduit for larger established organizations to tap into that early stage technology community,” according to Dr Subayia. (Update: The Catalyst division, which runs sponsored challenges, code-a-thons, and pilot programs, is not part of this transaction but will work closely with the conference team, per a Health 2.0 email 20 April.)

By expanding to the early-stage health tech community, it refreshes HIMSS, in Mr Lieber’s words, with “new directions”. They also acquire two high-profile globally-known figures in the health tech field.

Those in the health tech community are asking:

  • Will this truly create an ecosystem that benefits startups and early to mid-stage health tech, fostering innovation investment–or will it accelerate the big company acquisition trend already present in the past three years?
  • Will the conferences, to date fairly freewheeling affairs, change to the buttoned-up HIMSS corporate model? Many categories of attendees (e.g. full-time physicians, caregivers, volunteers) have been admitted free or at greatly discounted rates. The meetings, speakers, and networking were the focus, with exhibits and sponsorships available but in the background. Or will some of these meetings merge?
  • And what of the over 75 worldwide Health 2.0 chapters, many of which charge minimal memberships and meeting fees, versus HIMSS chapters which require substantial national corporate/individual memberships to join? Will there be cooperation? What will the chapter relationship be with the now HIMSS-owned Health 2.0 in future?  (Disclosure: this Editor is active in the Health 2.0 NYC chapter as a volunteer co-organizer/host)

Will the t-shirts change the suits, or vice versa? We’ll see….  HIMSS press releaseHealth 2.0 member letter (The Health Care Blog), Health 2.0 TV video.  Also Healthcare IT News (HIMSS Media)

A breakthrough wearable? Sweat analysis for cystic fibrosis and diabetes diagnosis.

click to enlargeResearchers at Stanford University School of Medicine and University of California-Berkeley have developed a wristband equipped with a sensor that can capture and analyze perspiration. The design stimulates the production of sweat, with the embedded sensors and microprocessors detecting the presence of different molecules and ions based on their electrical signals. In the abstract’s words, this is an “electrochemically enhanced iontophoresis interface, integrated in a wearable sweat analysis platform.” The wearable was tested in two separate studies for detecting a key indicator for cystic fibrosis (CF)–a high level of chloride ions–and in comparing levels of glucose in sweat to blood glucose for diabetes. The data is transmitted via smartphone to a server that analyzes the results in real time.

The potential for this wearable is considerable. First, for CF, it changes a 70-year-old protocol–that sweat is stimulated and collected in a 30-minute procedure, then sent to an outside lab to be analyzed with the usual delay. Children being screened for CF have trouble sitting still for the lengthy test. The second is that the test can be done anywhere with minimal training, making it suitable for underserved communities and developing areas of the world. The third is in CF drug development. CF genetics have multiple mutations, limiting drug usefulness. A test such of this in real time could speed drug clinical trials and human response.

The glucose testing was preliminary in comparing the glucose in sweat with standard blood glucose levels, but also proved that the platform could be used for other perspiration constituents, such as sodium and lactate. The ultimate intent of the researchers is to incorporate the technology into a smartwatch for continuous monitoring, but they recognize two challenges: reproducibility, to see whether measurements are consistent, and mapping all the constituents of sweat.

The report was published on 17 April in Proceedings of the National Academy of Sciences of the United States of America (PNAS). Abstract and full report (PDF, 6 pages). Stanford Medicine News Center

NantHealth/Soon-Shiong ch. 2: pay for play research at University of Utah?

Stat has returned to digging in the NantHealth/Dr Patrick Soon-Shiong garden to see if any more bones turn up. The writer examined the $12 million donation to the University of Utah and confirmed the POLITICO assertion that most of it ($10 million) went right back to NantHealth through a contract arrangement to pay for genetic sequencing of blood, tissue, and tumor samples. In this article are snippets of emails dating back to 2014 that indicated that even though NantHealth was at the time of the deal not yet capable of performing the work, they were specified along with the Utah Genome Project as one of the two teams to do the genome analytics. NantHealth by their own admission delayed for a few months when due in 2015 as they were not yet ready. The deal with Utah also gave NantHealth access to anonymized genetic and health data on hundreds of patients, specifically disease traits in families, their medical conditions, and relationships, if any, to others providing samples for analysis. This would have been of value not only to GPS Cancer but also to yet another Soon-Shiong company, GPS Heritage, which assesses a patient’s risk of inherited and rare diseases.

Pay for Play, which is what marketing types like your Editor call arrangements like this, removes any objectivity from this research. This is in addition to the donation arrangements, which present all sorts of taxation implications.

Regrettably, instead of trying to clear things up or being upfront about this business arrangement, Dr Soon-Shiong has chosen to make this a War of the Tweets, accusing Stat and POLITICO of bias, and to hide behind a now long-ago meeting with President Trump. (Sorry, Doctor, POTUS has other things on his mind like North Korea, ISIS and the American Economy–and he tweets more skillfully than you.) Everyone knows that finding treatments and cures for cancer is noble work, but there is also the appearance of cutting corners and a general air of dubiousness around the whole NantHealth enterprise. Mr Market is having its say as well in the share price. By the way, NantHealth lost $184 million in 2016Stat, Healthcare IT News.

Read Chapter 1, ‘Another Theranos on boil?’, here.

Readers invited: 7th Annual mHealth App Developer Economics Survey

click to enlargeResearch2Guidance is once again inviting TTA Readers to participate in R2G’s annual mHealth App Developer Economics Survey–their largest to-date study on the current status and future trends in digital health.

What’s the question?: The competition in the digital health market is heating up. 2016 saw the highest numbers of new entries into the mHealth app market since 2013. Yet consumer demand is not growing at the same speed; note the download growth curve! What are the business strategies in digital health that will be successful in 2017 and beyond?

In return for participating in the survey, you will not only have your say, but also more:
— See how your digital health project performs against market average
— Enter into the R2G prize draw to win an Apple Watch 2
— Receive the R2G report at no charge, which will cover digital health solution downloads, revenues and budgets, distribution channels, connectivity, country preference and much more.

The special link to the survey is here. Average time is 10-15 minutes, so grab a cup of coffee or tea, and go! The survey will be open till May (date TBD) and be published by Q4 this year. The survey is most applicable to mobile health app developers, project managers, publishers, co-founders, digital health experts, influencers, opinion makers, and investors–in other words, our Readers!

The R2G App Developer Economics Survey is supported by a stellar roster of distribution partners, accelerators, and media partners including Bayer, PCHAlliance, Health 2.0, dhaca…and TTA.

Q1 digital health investment: two perspectives from StartUp Health and Rock Health

StartUp Health’s and Rock Health’s investment/M&A roundups from Q1 2017 have just hit the deck. Before we dig into them, let’s start with the differences in methodology:

  • Rock Health tracks deals only over $2 million in value; StartUp Health seems to have no minimum or maximum; the latter includes early stage deals at a lower value.
  • StartUp Health gathers in international deals at all levels, whereas Rock Health includes only US-funded ventures.
  • Rock Health omits healthcare services companies (citing Forward, Oscar), biotech/diagnostic companies (GRAIL, Theranos), and software companies not solely focused on healthcare (Zenefits)
  • StartUp Health defines ‘digital health’ differently than Rock Health, with categories of ‘patient/consumer experience’, ‘wellness’, ‘personalized health/quantified self’, and ‘research’

StartUp Health is ‘over the moon’, breathlessly (appropriately as the home of the 25-year Health Moonshot) with Q1 trending, seeing the biggest investment quarter since 2010 at $2.5 bn. Topping up this number was GRAIL, which is developing a blood test for early cancer detection, with a massive Series B at $914 million. Far behind it in the $85-110 million range were (in descending order) Alignment Healthcare (population health), PatientsLikeMe (patient/consumer experience), Nuna (big data/analytics), and PointClickCare (EHR). Population health, patient/consumer experience, and research top their investment activity. Most deals are still seed and Series A (59 percent), but that is down five points from full year 2016; Series B’s share is up three points to 25 percent. But it remains a difficult bridge to cross to C+ rounds.

Rock Health splits the difference and calls it ‘business as usual’, surprised that there hasn’t been a tailspin. Its Q1 sandwiches between 2016 and 2015, well above 2015 but trending 23 percent below Q1 2016. Their biggest deals include the aforementioned Alignment, PatientsLikeMe and Nuna, omitting GRAIL and PointClickCare. Their top three investment categories are analytics/big data, care coordination, and telemedicine (over $50 million). Rock Health tracked almost 20 M&A, noting that many transactions are now ex-California. They also uniquely track public company performance. Here in 2016 is where Readers first noted weakness in NantHealth, but Fitbit and Castlight Health also had miserable quarters. Teladoc, Evolent Health (consulting), and Care.com had a good winter as well. Let’s see what Q2 brings.

‘Playing the niches’: telemedicine disrupting the optical industry with a 5 min vision exam

click to enlarge This Editor visited a ‘demo evening’ for Smart Vision Labs, which has developed an iPhone based system that takes a basic vision exam for fitting glasses or checking contact lenses that takes just five minutes. The system uses wavefront technology that takes photos of each eye for refraction measurements, including pupillary distance, and some patient questions, which are key to getting an accurate glasses prescription. The telemedicine part is that the digital data is stored and forwarded to a licensed ophthalmologist, who reviews it for basic conditions such as nearsightedness, farsightedness, and astigmatism. Smart Vision then emails the vision provider with the results and prescription within 24 hours, also storing it for the patient in a secure site they can access with a login.

The SVOne Enterprise (pictured) is the third generation of the original device developed by founder Yaopeng Zhou, PhD and Marc Albanese, who met while graduate students in electrical engineering at Boston University, working on research in adaptive optics at Boston’s Schepens Eye Research Institute. While MBA students, they revived their optical interest based on market opportunity. Some barriers to vision health they wanted to disrupt: the general shortage of ophthalmologists, optometrists, and opticians; the reluctance of many people to have their eyes examined, cost, time, and convenience. They started in 2013, raised $2.5 million between 2014-15, and capped it with a Series A of $6.1 million in 2015 through Techstar Ventures and four other investors (Crunchbase).

According to their new senior VP of marketing, Josef Katz, the SVOne can break many barriers by being quick, easy and accurate. “We’re disrupting a very established business, but we’re also expanding it.” (more…)

Another Theranos on boil? Patrick Soon-Shiong’s companies and the NantHealth Foundation (update)

Billionaire Patrick Soon-Shiong‘s drive to take down cancer through vaccines, genomics, software, and related health tech is one of the key missions of his NantHealth group and also the Foundation. Both fund research efforts such as Cancer Breakthroughs 2020, which is supported by former Vice President Joseph Biden. Reportedly, the well-wired Dr Soon-Shiong wooed President Trump for a role in his new Administration, one that has not materialized. In February, we noted his appearance at HIMSS17 promoting his cancer vaccine which was approved by FDA to advance to later clinical trials, and also unveiled Nant AI and the Nant Cloud–but also an article published in Stat that gazed through the NantHealth veil and found little to compliment, including the trademark infringement suit brought by the MD Anderson Cancer Center in Texas.

Apparent self-dealing among various NantHealth companies and investors, which started to be unwrapped in Stat, is now further investigated in a long POLITICO article. The report looks at transactions among the Chan Soon-Shiong NantHealth Foundation, the NantHealth companies, and other non-profits controlled by Dr Soon-Shiong, then at charitable donations to universities and hospitals that in turn support his research and other companies. Three citations in the article will attract the Reader’s notice (Editor’s emphasis):

Of the nearly $59.6 million in foundation expenditures between its founding in 2010 and 2015, the most recent year for which records are available, over 70 percent have gone to Soon-Shiong-affiliated not-for-profits and for-profits, along with entities that do business with his for-profit firms.

The foundation contributed $3 million out of a total of $12 million donated by Soon-Shiong-controlled entities to a University of Utah program to map the genomes of 1,000 state residents. University officials say they let Soon-Shiong’s entities write the grant specifications. The specifications gave a major advantage to his for-profit firms, which got the $10 million gene-mapping contract.

Soon-Shiong-controlled charities gave a total of $15 million — including $10 million from the NantHealth Foundation — to a fund that benefited Phoenix Children’s Hospital, which concluded a pair of deals with Soon-Shiong’s for-profit companies for many millions of dollars.

It’s dizzying, certainly by design. If true, it appears that Dr Soon-Shiong’s favorite charities happen to be his own businesses, which raise all sorts of ethical and legal questions. The investigation also calls into question not only these dealings but also the Foundation’s tax-exempt and additional special status as a medical research organization. Will the IRS come calling? How Washington’s favorite cancer fighter helps himself    Also Healthcare IT News, which delightfully called them ‘funding indiscretions’.

Updated. A canary in the coal mine is the NantHealth (NASDAQ: NH) share price, which has crashed from a 52-week high of $21 to a current value of $4.32. To clarify, it has been in precipitous decline since January, and not just from this report. There is trouble in Culver City. A quick look over at Yahoo!Finance news items now reveal a brace of law firms offering class action lawsuits to shareholders who believe they have suffered losses due to “materially false and misleading statements”, now updated for the above information.

Entra’s home blood test for chemotherapy patients; Haystack’s ‘one blood test’ for cancer (UK/US)

click to enlargeEntra is a London startup company developing a quick, home-based blood test for clinically valid blood counts. Targeted to the needs of chemotherapy patients, where blood counts are critical in their receiving and timing of treatments, the Affinity (photo left) is designed to take a small sample, analyze it, wirelessly send the information to the hospital or clinic, and enter into the patient’s EHR. It is currently being tested with The Royal Marsden Hospital, a leading UK cancer center, to validate its optical analytics and generate cost-effectiveness data. Blood counts are not only critical to correct patient treatment, but also to assigning and canceling appointments. Entra is being supported by £1.14 million in funding from Innovate UK, much of it through the Biomedical Catalyst. The timeline to commercial release is being estimated at two years. It’s anticipated that once verified, the blood count technology could be further developed for other uses. Gov.UK. Hat tip to our Eye on Tenders, Susanne Woodman

Raising funds for another type of blood testing is a NYC-based biotech company, Haystack, which is pioneering a single blood test for multiple cancers through proteome molecular profiling. Its goal is early detection of multiple cancers through one test using panels of biomarkers. The research team headed by John Wilson, PhD, who is affiliated with Cold Spring Harbor Laboratory, are ready first with pancreatic and lung cancer samples. This has gained the interest of pharma companies who are seeking a companion diagnostic for their drug trials. It was also a category winner at MedStartr’s #MedMo16 last December and presenter at #RISE2017 in March. Haystack’s MedStartr page. Video of Haystack’s presentation at #RISE2017 is on YouTube here (at 58:00) TTA is a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; event videos are available at Medstartr.tv.