Utah telehealth expansion bill passes Senate and House

The bill to expand telehealth in Utah, which was amended by a click to enlargeUtah Senate committee on February 14th (see previous TTA article) has now been passed by both the Senate and the House of Representative in the state. The amended bill was passed by the Senate on Thursday last week and by the House the next day according to the Utah government website.

The original bill, HB154, sponsored by Rep. Ken Ivory, had a controversial clause restricting the prescription of abortion medication during a telemedicine consultation. The amendment removed this restriction on the basis that such restrictions have been successfully challenged in the courts in other states.

The bill is now being “enrolled” and is expected to be signed into law in due course.

HIMSS17 dispatches: Mayo maps neonate telemedicine, Amwell-Samsung, Samsung-T-Mobile

Mayo maps out an enterprise telehealth (telemedicine) support structure. Here’s how the Mayo Clinic deployed neonatology remote telemedicine to their sites in Minnesota, Arizona, and Florida. There’s plenty of flow charts and summary points in this presentation deck around team building, staffing consistently and reporting that improves processes. Hat tip to our HIMSS correspondent on the scene, Bill Oravecz of Stone Health Innovations. Update: If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser. If you are interested, you may be able to obtain through contacting the two session presenters, Susan Kapraun and Jenna A. Beck, MHA, directly.

American Well and Samsung are partnering on integrating care delivery. Their joint release is low on details, but towards the end there’s an indication that American Well, its partners, and other providers and payers will be able to offer their services to Samsung customers. Other reports (Healthcare Dive) indicate the partnership is destined to enhance Amwell’s Exchange platform between payers and providers. Partners listed are Cleveland Clinic, New York-Presbyterian Medical Center and Anthem (undoubtedly resting after sparring with Cigna). Also Healthcare IT News.

Separately, Samsung also announced a partnership with T-Mobile for developing IoT in the senior care space. This would pair Samsung’s ARTIK Cloud with T-Mobile’s cellular network for Breezie, a social engagement for seniors interface built on a Samsung tablet which has apps and connects to various peripherals for post-acute care and daily living. It sounds interesting, but once again the release hampers the reporter by being as clear as mud in what it’s all about. See if you can decipher this: ARTIK Cloud permits “Amazon Alexa, Samsung SmartThings, iHealth Feel Wireless Blood Pressure Monitor and the Pulse Oximeter – to intelligently communicate with each other.” “Each Breezie interface has more than 40 preconfigured accessibility settings and sensor driven analytics to adjust for different levels of digital literacy, as well as physical and cognitive ability.” The Breezie website is far more revealing. Healthcare Dive also takes a whack at it towards the end of the above article.

The Theranos Story, ch. 37: the Object Lessons for future healthcare entrepreneurs

click to enlargeThere’s an interesting take on the Theranos debacle in Entrepreneur by management consultant/author Steve Tobak. He takes a step back from the healthcare technology that didn’t work, the big money lost and the puffery, where most of us have concentrated. Mr Tobak instead sketches a case study of a Startup House of Cards as an Object Lesson in how entrepreneurialism is NOT supposed to work.

Theranos was a Top Ten List of fatal errors. This Editor’s summary:

  1. They generated no revenue. In just over a decade, Theranos blew through hundreds of millions in funding (he says $700 million, the WSJ has estimated $900 million).
  2. They weren’t anywhere near break-even. By the time Theranos was in 40 Walgreens Wellness Centers, it should have been on a road to break-even and scalable.
  3. The company was built as a fraud from the start or near-start, much like Enron and WorldCom
  4. The company was doomed by a culture of utter secrecy (Editor’s note: none of their technology was peer reviewed, tested or published)
  5. The company was doomed by Ms Holmes’ falsity and hubris in not having a backup plan; black turtlenecks aren’t it
  6. The company was doomed by its own hype: a PR machine AND gullible press, who created a Steve Jobs-esque icon sans accomplishments out of Ms Holmes
  7. The company sold a bill of goods to EVERYONE, including multiple Federal regulators, patients and the public (Editor’s note: he doesn’t mention the Board of Directors and Stanford University!)
  8. Investors, swept up in the private equity bubble, didn’t do their due diligence (though some did)
  9. Ms Holmes had no ability to run this business, but she controlled it 100 percent so no one said boo
  10. “This is what happens when people treat ventures so casually and callously that risk becomes immaterial.”–Mr Tobak

Perhaps we should be grateful that the Edison lab didn’t actually work with all these dysfunctions on parade!

The close to this article is sobering: “Today, there are 186 venture-backed startups valued at $1 billion or more and countless companies valued above $100 million, according to CB Insights. Not too long ago, Theranos was near the top of that unicorn list with a valuation of $9 billion. We still have no idea if it’s a one-off or the beginning of a trend. Remember the Theranos saga as a cautionary tale. Nothing about it is the way business should be. Nothing.” And it will continue, because $900 million makes Theranos a Big Cautionary Tale. Hat tip to our Eye on Theranos, Bill Oravecz of Stone Health Innovations.

See here for the 36 previous TTA chapters in this Continuing, Consistently Amazing Saga

HIMSS17 dispatch: developing a telehealth IT team in health system and multi-site networks

Reader Bill Oravecz of Stone Health Innovations is attending HIMSS17 in Orlando, and was kind enough to forward a ‘hot off the presses’ link to this presentation deck given by Jay Weems of Avera eCARE (downloadable as PDF). The subject is ‘Telehealth Workforce Offers Unique Competencies & Opportunities’ and covers how telehealth/telemedicine IT is developed in a health system, mentoring rural originating sites in building proficiencies, and Avera’s experience in supporting a 13-state, multi-system, multi-specialty network. This is more about telemedicine (virtual consults) but offers lessons in developing both in a B2B model.

Update If you are using Chrome, you may have difficulty downloading session handouts from the HIMSS17 website Schedule pages. Try another browser.

HIMSS17 news flashes: Lenovo, Orbita, Tactio, Garmin, Parallax, Entra Health, Philips, IBM

Voice commands a new frontier in telehealth. Why not dispense with the pill dispenser, the smartphone, the tablet? Lenovo Health and Orbita have put together a solution that works via Amazon Alexa. The Orbita Voice is a voice-controlled speaker for the home that connects with the Lenovo Smart Assistant to “help patients with chronic and post-acute care needs be more fully engaged in their wellness at home. Enhancing a patient’s ability to access and share information with providers, caregivers, and family members contributes to improved care journey management, treatment adherence, and medication compliance.” The release isn’t informative as to how it will do this, but apparently it’s all in the programming. This is the second Lenovo Health initiative on view in the past few months. This Editor saw at NYeC Digital Health their Authoritative Identity Management Exchange establishing a universal, verifiable patient ID system [TTA 19 Jan video] and was impressed.

Canada’s Tactio telehealth platform is adding Garmin wearables to its compatible peripherals. TactioRPM is a mobile platform that combines mobile apps, hundreds of connected health integrations (Garmin, A&D, Fitbit, Roche, Nonin, Omron and Welch Allyn), patient questionnaires, digital coaching programs and HIPAA-compliant messaging. TactioRPM has FDA Class 1, CE and ANVISA (Brazil) clearances. Release via Yahoo Finance

Parallax Health Management (PHM) is presenting with Entra Health (mobile HIT) and Microsoft Cloud its remote patient monitoring systems. Based on the PHM website, they are tablet based with a raft of peripherals for the multiple-chronic condition patient. The release highlights their chief medical officer, Bob Arnot, MD who is well known in the US as an author and television presenter.

Philips announced US FDA 510(k) clearance of the IntelliVue Guardian software system, which pairs with the single-use, adhesive Philips Wearable Sensor for continuous clinical-grade monitoring of high-acuity patients. The software gained CE Mark certification last October. They also debuted a mobile app called Jovia Coach for healthcare systems to reach patients at risk for Type 2 diabetes. MedCityNews.  Philips’ ongoing Intensive Ambulatory Care (IAC) pilot program with Banner Health in Arizona so far has delivered impressive reductions in overall costs of care by 34.5 percent and hospitalizations by 49.5 percent. LeadingAge/CAST

IBM Watson heralds cognitive computing, or computers that learn, according to IBM CEO Ginni Rometty, and will profoundly change medicine as well as IBM, as they are betting the company on it. In the meantime, they have announced the Watson Platform for Health Cloud and a specialized Watson Health Consulting Services unit. Health Data Management. An elephant in the ointment is that the prestigious MD Anderson Cancer Center, part of the University of Texas, has put their Watson program, the Oncology Expert Advisor, on indefinite hold as it checks out other contractors after sinking $62 million into OEA over three years without a measurable result. Forbes

The Theranos Story, ch. 36: Their money–and time–are running out

click to enlargeA garage sale soon for Theranos? A report in the Wall Street Journal, citing sources on a January investor call, revealed that Theranos has $200 million on hand, but zero revenue in 2015 and 2016. $200 million on hand sounds like–and is–a lot. But Theranos is, once again, oh so special. It’s less than 25 percent of their over $900 million raise. They’ve made no money in the past two years and are likely to make none in 2017 with an unapproved miniLab. Their CEO cannot run a lab by Federal action. They’ve laid off all but 200+ employees, all of whom with any shred of intelligence are job hunting. Then think of all the lawsuits: Walgreens Boots seeking to claw back its $140 million, individual and class actions on behalf of other investors, and the looming Arizona state fraud action. It’s a mere pittance when Theranos has to hire armies of attorneys who charge Billable Hours Galore and will likely lose some if not all of the lawsuits. This Editor is making an educated guess that at least one legal team is working on a bankruptcy filing. Fortune, TechCrunch, Business Insider

Forbes, like TechCrunch once a hyper-overdrive cheerleader for Ms Elizabeth Holmes and Theranos, offers up a profile of John P.A. Ioannidis, MD, DSC who holds the C.F. Rehnborg Chair in Disease at Stanford University and is director of the Stanford Prevention Research Center at the School of Medicine. Dr Ioannidis, according to the article, was the first to raise questions about Theranos’ methodology based on the obvious–that Theranos had published nothing in scientific journals. Theranos’ general counsel then reached out to suggest co-authoring an article with Ms Holmes in a major journal. Per Dr Ioannidis, it would support “the company view that FDA clearance offered the highest possible level of evidence for any diagnostics blood test technology.” They also said, “recant your existing views and writings about these misgivings.” He did neither, to his credit. The article interestingly does not explore the heat he, in as prestigious a position as he was, must have received, based on the close ties this Editor and others have noted between Stanford and Ms Holmes. Hat tip to Bill Oravecz of Stone Health Innovations

“This is the way the world ends/Not with a bang but a whimper.” T.S. Eliot puts a fine point on a Hollow Company, indeed.

See here for the 35 previous TTA chapters in this Continuing, Consistently Amazing Saga.

Tender up: Durham Smart County on Social Isolation

Susanne Woodman, our Eye on Tenders, has uncovered an interesting one that potentially involves telehealth.

Title: Durham Smart County – Tackling the Healthcare Causes and Consequences of Social Isolation. Small Business Research Initiative (SBRI)
Description: Durham County Council’s Corporate Management Team has signed off an innovative approach to stimulating high value economic activity in County Durham. This approach explicitly links economic development activity to delivering transformative public health outcomes: using “problems” as assets, as opportunities for innovative product and service development and catalysing the establishment of a commercial cluster in healthcare.
Coverage area: Durham and Tees Valley
Expression of interest by 31 March
Contact: Vicky Watson, email vicky.watson2@durham.gov.uk, telephone 03000 264860
Address: Durham County Hall, Durham, County Durham, DH1 5UL, UK
https://procontract.due-north.com/Advert/Index?advertId=3dbec8c1-4df4-e611-80dd-005056b64545

Disrupting the pathways of Social Determinants of Health: the transportation solution

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].

More and more people are starting to have conversations around the Social Determinants of Health.  And for the first time, the c-suite within healthcare companies are talking about transportation.  People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members.  It is great that people are becoming aware of transportation and talking about it.Todd Thomas, VP Strategic Business Development at Veyo

Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems.  In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation.  The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price.  None had any initiative to adapt to new technologies or evolve their business models.  Medical professionals and companies across the US had come to expect poor service as the norm.  It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be.  And ultimately closed a huge care gap for transportation-dependent patients. (more…)

Utah Senate removes telehealth bill abortion restrictions

The controversial topic of abortion has been the centre of discussion of a new telehealth bill in Utah. The bill, HB 154, introduced by Republican Rep Ken Ivory, primarily addresses the issue of insurance coverage for telehealth in Utah and proposes to amend two previous acts and the Utah Insurance Code to achieve this. However, the bill also contained a controversial final clause which stated “A practitioner treating a patient through telehealth services, as described in Title 26, Chapter 59, Telehealth Act, may not issue a prescription through electronic prescribing for a drug or treatment to cause an abortion, except in cases of rape, incest, or if the life of the mother would be endangered without an abortion”

Last week it was reported (in Healthcare IT News) that the bill was discussed in the Public Utilities, Energy and Technology Standing Committee. Similar restrictions on prescribing abortion medication following telemedicine consultations were legally challenged in Idaho by Planned Parenthood resulting in the ban being lifted at the end of January (mobilehealthnews, mhealthintelligence). Earlier, in June 2015, another legal challenge, this time in Iowa, went all the way to the Supreme Court which rejected a state requirement for doctors to see abortion patients in person and ruled that the regional Planned Parenthood unit  could continue to provide abortion inducing medication using remote video consultations.

According to data published by the Guttmacher Institute, as of February 1, 2017, there are 19 states which require a physician to be physically present when abortion inducing medication is prescribed (see Medication Abortion).

This week, when the Utah bill was discussed in the Senate Health and Human Services Committee an amendment proposed by Republican Senator Brian Shiozawa removing the above abortion clause was accepted. Shiozawa expressed fears that a constitutional challenge could give negative publicity to  telehealth as a whole. The bill now moves to the Senate for consideration.

Tender up: NHS Hammersmith and Fulham CCG (UK) seeking telemedicine for care homes

Susanne Woodman, our Eye on Tenders, has located a London-based one on Ted.Europa.eu worth your notice.

Who: NHS Hammersmith and Fulham Clinical Commissioning Group (CCG), on behalf of the North West London Clinical Commissioning Groups comprising of NHS Central London CCG, NHS West London CCG, NHS Hounslow CCG, NHS Ealing CCG, NHS Brent CCG, NHS Harrow CCG and NHS Hillingdon CCG is seeking to appoint a provider to deliver a 24/7, 365 day per year Telemedicine-clinical support function to support care homes initially across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical Commissioning Group (CWHHE CCGs) areas.

What for: A provider to deliver a 24/7, 365 day per year telemedicine-clinical support function to support care homes initially across Central London, West London, Hammersmith and Fulham, Hounslow and Ealing Clinical Commissioning Group (CWHHE CCGs) areas.

  • This facility will be introduced to 43 residential and nursing homes across the geography covered by the CWHHE CCGs, with a phased implementation over the 3 years of the programme.
  • If the service is successful, the CCGs reserve the right to extend the provision to include residential and nursing homes and patients and carers living outside care homes in the NHS Brent CCG, NHS Harrow CCG and NHS Hillingdon CCG areas.

Tender receipt date: March 8, 2017 at 12pm

Value excluding VAT: £7 900 000.00

The procurement documents are available for unrestricted and full direct access, free of charge, at http://nhssbs.eu-supply.com (log in required)

What is the future of digital technology in NHS England for the haves and have-nots?

This thoughtful essay published on The King’s Fund blog by David Maguire discusses the uncertain way forward for digitizing health within NHS England as part of the sustainability and transformation plan (STP). There’s a certain lack of vision and support from the top; there is £4.2 billion in funding over the next five years from the Department of Health, but priorities including ‘Paperless by 2020’ are unclear. There needs to be a ‘clear and definitive plan’, but at the same time, local innovation shouldn’t be stifled. Local areas vary widely in capability and resources. As Mr Maguire points out, some are still using Windows XP and others are well advanced in data analytics; some are more willing to take risks and have a “collective vision”. In a funding-constrained environment, local areas may find themselves scraping up, pooling resources to create the systems they need, and sharing that knowledge. Seizing opportunities for digital development in the NHS Hat tip to Susanne Woodman.

A reminder that the Digital Health and Care Congress is on 11-12 July. Preview video and the event page; the Digital Health Congress fact sheet includes information on sponsoring or exhibiting. To make the event more accessible, there are new reduced rates for groups and students, plus bursary spots available for patients and carers. TTA is again a media partner of the Digital Health Congress 2017. Updates on Twitter @kfdigital17

Anthem to Cigna: That’s Sabotage! You’re staying, like it or not! (updated 21 Feb)

Breaking News in The War of the Payers. Late on Wednesday (15 Feb), Anthem received a temporary restraining order to block Cigna from terminating the merger. Judge Travis Laster’s decision in the Delaware Court of Chancery maintains the “legal status quo’ until an April 10 hearing, where he will hear arguments from both sides. Anthem is now able to proceed with a fast-tracked appeal in the DC Federal Court of Appeals to overturn the February 8 DC District Federal Court decision that denied the merger. The sole extension in the merger agreement is to April 30, which will be preceded by the Chancery Court hearing 20 days prior. Bloomberg, WSJ (via 4-traders.com)

Wednesday morning, Anthem had filed a temporary restraining order in Chancery Court to keep Cigna from ankling the merger, which would make an appeal moot. It was positioned in their February 15 release as “a temporary restraining order to enjoin Cigna from terminating, and taking any action contrary to the terms of, the Merger Agreement, specific performance compelling Cigna to comply with the Merger Agreement and damages.” Cigna wanted out immediately, as we noted on Feb 14, seeing no hope in challenging the District of Columbia Federal District Court ruling as Anthem does, and took the position that the extension was invalid. They also sought an additional $13 billion in damages for shareholders beyond the $1.85 billion breakup fee.

The language Anthem used in Wednesday’s release to justify the filing was harsh: “…Cigna does not have a right to terminate the Merger Agreement at all because it has failed to perform fully its obligations in a manner that has proximately caused or resulted in the failure of the merger to have been consummated.” Anthem then accused Cigna of actively working to sabotage the merger: “Cigna’s lawsuit and purported termination is the next step in Cigna’s campaign to sabotage the merger and to try to deflect attention from its repeated willful breaches of the Merger Agreement in support of such effort.”Also Forbes

Bottom line: ‘Cigna, you’re a bad and faithless partner, but we are going to force a merger by any means possible anyway.’ Cigna blames Anthem for botching the merger approvals. Does prolonging any of this make sense?

Updated 21 Feb The differences started at the very beginning, with C-level disputes on who would lead a merged company and other areas of governance, so obvious (and public) they were cited by DC Federal District Judge Amy Berman Jackson’s Feb. 8 decision. David Balto, an antitrust lawyer in Washington, dubbed it ‘a shotgun marriage that went sour’ and not to discount Cigna’s case for damages due to business harm. After reading this article, you’ll wonder why they even started. Hartford Courant

Analysis Any merger between Anthem and Cigna has become, despite the language, a hostile takeover, worthy of Frank Lorenzo in this Editor’s airline days, or more recently, Carl Icahn. Having worked for Mr Lorenzo years ago, observing from my tiny chair way over on the sidelines, I learned that hostile takeovers and poorly thought-out mergers don’t work out well, in service delivery or economics, short or long term. They usually end badly, in bankruptcy court, with many tears shed and lives wrecked.

Memo to Anthem and Cigna–is this really necessary? Here we are dealing with insurance, and service to policyholders/members, affecting both their health and wealth. You both talk a good game about saving on medical costs, accelerating the progress of value-based care, delivering value to shareholders, and improving quality. But you hate each other and have from the start. Playing the game of Who Blinks First, and the distraction of a long and bitter legal battle, cannot be anything other than harmful to your members, employees, doctor and health system providers, your bottom lines, and your future.

This is not the airline business, beverages or detergent. It’s people’s lives here–have you both forgotten? Enough! Stop now! Get back to the business of healthcare!

Previously and related in TTA: Cigna to Anthem: we’re calling it off too, Aetna’s Bertolini to Humana: let’s call the whole thing off, Anthem-Cigna merger nixed

Iron Bow partners with Vivify Health for $258 million VA telehealth contract

One mystery solved! Iron Bow Technologies announced that its telehealth delivery partner for their award of $258 million in the Veterans Affairs Home Telehealth program is Plano, Texas-based Vivify Health. As noted in our original article [TTA 6 Feb] on the much-delayed VA remote patient monitoring award, Iron Bow was an existing contractor in other VA Telehealth services, Clinical Video Telehealth (video conferencing) and Store-and-Forward (clinical imaging review), but did not have vital signs RPM capability. The addition of Vivify with its mobile and tablet-based solutions and integrated peripherals adds that capability.

Vivify structures its main telehealth solutions based on escalating patient ‘risk’: 1) healthy and ‘at risk’ (may have early stage disease), 2) rising risk (has complex chronic disease) and 3) high risk (for hospitalization). The approaches are scaled up from engagement on BYOD mobile and web for (1), to vital signs monitoring and telemedicine clinician visits via mobile and tablet (2), to the highest level of an integrated kit with tablet and integrated peripherals (3). These further divide into five ‘pathways’ which are more product-oriented.

Cost is, of course, a factor, with VA a very demanding client in this regard as individual VISN (region) budgets are tight. Medtronic, the incumbent, has not only been using the venerable Cardiocom Commander Flex hub, but also provides VA with Interactive Voice Monitoring (IVR) which is an inexpensive patient management solution. (Ed. note: having worked with IVR in the past, it can work well if used with primarily lower-risk patients, is structured/implemented properly and integrated with live clinical check-ins.) Vivify’s system is all new–and not inexpensive, especially at the high-risk level. From their website, Vivify uses BYOD for the lower levels and the integrated kit for the highest and poorer outcome patients. This Editor notes they offer a voice telephony care solution which presumably is IVR. This gives them a welcome flexibility in price, but also a complexity which will be a training issue with VA care coordinators.

Other factors affect mobile-based solutions. Many at risk at-home veterans are older and thus don’t have smartphones or tablets. Reliable broadband connectivity is also an issue. Many don’t have Wi-Fi, which is a prerequisite for tablet use, and may live in areas with poor cellular reception.

The other work and labor-intensive parts for Vivify and Iron Bow are to integrate their reporting platform into VA’s complex and secure systems, which also involves a highly structured updating process: CPRS (computerized patient record systems), the VistA EHR and whatever replaces it (Epic is being trialed in Boise, Idaho–scroll down to ‘Big Decisions’ and Dr Shulkin).

Founded in 2009, Vivify has compiled an impressive track record with CHRISTUS Health (TX), RWJ Health (NJ), Trinity Health (MI), Centura Health (CO) and other large systems plus home care. It has also been conservative in its venture funding, with $23.4 million to date and its last big round from LabCorp and others in 2014 (CrunchBase).

Release. Hat tip to Vivify’s Bill Paschall via LinkedIn.  P.S. Stay tuned for an announcement of 1Vision’s partner. 

Editor’s clarification: The VA Home Telehealth contract is structured as a one-year base period, followed by four one-year optional periods, for five years total. The awarded amount over the five-year period is $258 million for Iron Bow/Vivify. It is the same amount/term for each of the three other awarded companies, totaling just over $1 billion for the five-year program. This is comparable to the 2011 five-year program value of $1.3 billion divided over six awardees. Thanks to Josie Smoot of Iron Bow Technologies’ press office.

Cigna to Anthem: we’re calling it off too–and we want $13 bn in damages!

Breaking News  Not quite so tuneful or amicable is today’s other Funny Valentine, which is now in Divorce Court. Cigna officially wants out, out, out of its merger with Anthem in a big, big, big way. In addition to the contractual breakup fee of $1.85 bn, Cigna is suing for additional damages exceeding $13 bn.

The action versus Anthem in the Delaware Court of Chancery seeks to lawfully terminate the merger (already denied in the DC District Court, TTA 9 Feb) and to stop Anthem’s current move to extend the agreement to 30 April. The additional $13 bn in damages would recoup the unrealized premium that shareholders did not earn as a result of the merger failure.

Anthem stated last week following the District Court decision’s release that it would appeal. Healthcare Dive reported that filing took place yesterday in the District of Columbia Federal Court of Appeals.

The Cigna release is intriguing for its careful air-clearing and positioning. In their view, the merger “had the potential to expand choice, improve affordability and quality and further accelerate value-based care”. Then a wicked backhand to Anthem: “Anthem contracted for and assumed full responsibility to lead the federal and state regulatory approval process, as well as the litigation strategy, under the merger agreement. Cigna fulfilled all of its contractual obligations and fully cooperated with Anthem throughout the approval process.’

Financially, Cigna stresses its positive outlook of 12 to 18 percent growth and ‘significant capital available for deployment’, as well as touting that their “approach of focusing on health care services over sick care financing has never been more critical.” There is also an updated statement about their share repurchasing authority: “Cigna is also announcing that its Board of Directors has expanded the company’s share repurchase authority to an aggregate amount of $3.7 billion. Management has determined that it is prudent to cap the amount of the repurchase to $250 million per quarter until there is more clarity with respect to the litigation with Anthem.”

No press response yet from Anthem. Stay tuned. Also CNBC

Earlier today: Aetna’s Bertolini to Humana: Let’s call the whole thing off

Updated: Aetna’s Bertolini to Humana: Let’s call the whole thing off.

Updated–Humana exits individual exchange policy markets

Breaking News On this Valentine’s Day, a Romance Gone Flat. This morning, both Aetna and Humana formally announced the end of their merger, ruling out any appeal of the Federal District Court decision against it last month [TTA 24 Jan]. While positioned as a mutual agreement, Aetna CEO Mark Bertolini took the key quote in the release: “While we continue to believe that a combined company would create greater value for health care consumers through improved affordability and quality, the current environment makes it too challenging to continue pursuing the transaction. We are disappointed to take this course of action after 19 months of planning, but both companies need to move forward with their respective strategies in order to continue to meet member expectations. Our mutual respect for our companies’ capabilities has grown throughout this process, and we remain committed to a shared goal of helping drive the shift to a consumer-centric health care system.”

Humana’s release limited the announcement to one line and briskly moved on to what really counts–the financials. They will receive a breakup payment of $1 bn (after taxes, $630 million) from Aetna, with their 2017 financial guidance call/release taking place after 4pm EST today. Molina Healthcare, which was to receive certain Aetna Medicare Advantage assets from Aetna post-merger to relieve an over-dominance in some markets, will also receive an undisclosed termination fee. Ka-ching! CNBC, Hartford Courant (Aetna’s hometown paper)

UPDATED 2/14-16 Humana’s financial release announced an updated strategy, share repurchases, a nicely increased dividend–and, buried in the release, their exit effective 2018 from the ‘individual commercial’ business, which are individual policies offered in 11 states through the ACA-created Federal Marketplaces, citing an ‘unbalanced risk pool’ and losses estimated at $45 million for FY17. (By 2018, it may be a moot point.) It is ironic that Aetna’s exit from exchange policies due to unprofitability (or not, as it turned out to be in a few cases) proved to be one of the many bricks that broke the merger, in Judge Bates’ view. The truth is that Aetna and Humana are hardly alone in fleeing the exchanges, and that they have turned out to be unprofitable, as predicted.

click to enlargeConsistent with their behavior over the 19 months of the proposed merger, both Aetna and Humana are publicly respectful, unlike….

These other two will never be one, something must be done? The demise of the Anthem-Cigna merger [TTA 9 Feb], now breaking up in Delaware Chancery Court, may mean a period of Payer Merger Quiet. Does this mean a refocusing on benefiting corporate and individual policyholders during the certain changes to come? Aetna may also proceed with a plan to move operations to Boston, which may affect hundreds of jobs, but has pledged to keep a presence in Hartford according to the Hartford Courant. Humana continues to be interested in investment opportunities and, from reports, another merger.

Goodness knows what the end will be! (Hat tip to Ira Gershwin for the title and the interpolated lyrics!)

Updated–MedStartr’s Rise of the Healthy Machines 1 March (NYC)

Wednesday 1 March, 1-6:30 pm (followed by cocktail reception to 8 pm), PriceWaterhouseCoopers, 300 Madison Avenue NYC

What’s new at #RISE2017? A new event page which has all the highlights, including the speaker roster and agenda.  The revised agenda focuses on population health and how machine learning/AI will change medicine and our notions of healthy living, with speakers and panelists from Teladoc, PwC, J&J, Prognos.ai, CityMD, mymee, DataArt, Enspektos and more. There’s also a new Healthy Machines Challenge application page, so if you have a young company with a technology which can help people live longer, healthier lives, apply for the $300,000 Challenge which finds and funds some of the best new ideas in digital health. Sponsors include PwC, DataArt, and McCarter & English LLP. Tickets are free to $75 for the full half-day with reception. TTA is a MedStartr supporter/media sponsor; Editor Donna is a host for this event and a MedStartr Mentor. Also check the MedStartr page to find and fund some of the most interesting startup ideas in healthcare