News briefs, catchup edition: UnitedHealth/Change decision October?, CVS wins $8B Signify Health auction, Walgreens majority buy of CareCentrix, FTC requests more info on Amazon-One Medical

September 15, 2022 | by

Your Editor is semi-returned from Almost Two Weeks in Another Town, with a few more days to close out September (and summer into autumn) coming up. A lot of big news broke despite the usually slow Labor Day holiday week.

UnitedHealthcare Group/Change Healthcare Federal lawsuit to be decided in October–reports. The bench trial in the US District Court in Washington DC pitted the Department of Justice and state plaintiffs against UHG’s massive $13 billion acquisition of claims and EDI/data processing giant Change. It concluded 16 August with closing arguments presented 8 September. Dealreporter via Seeking Alpha reported that UHG and Change effectively countered DOJ’s antitrust objections to the acquisition. Change Healthcare had previously sold their claims editing business to TPG Capital to ease antitrust concerns.  Whether that will be enough in the current environment with greater sensitivities around healthcare consolidation remains to be seen. If approved, Change will be folded into OptumInsight. For a deeper dive into the issues, see TTA’s earlier reporting 3 August and 23 March.

CVS Health beat out other contenders with an $8 billion cash bid for Signify Health. It was a busy Labor Day for CVS as Signify’s board met and decided that day on CVS’ cash offer of $30.50 per share in their unusual auction. Amazon, UnitedHealth Group, and little-known Option Care Health were the other bidders. Signify is a strategic boost for CVS in becoming a major player in primary care, provider enablement, and home health as we’ve summarized here from CVS’ Q2 earnings call. Signify’s capabilities in in-home health delivery and provider services were cheaper to buy than to develop. Based on the weight given to it in the CVS release, Signify’s Caravan Health and their Medicare ACOs furnishing value-based care management services to 170 providers was a significant factor in the top price paid.

New Mountain Capital and their investors own 60% of Signify and will be exiting. Signify had in July announced their own exit from the costly and problematic Episodes of Care/BPCI business acquired with Remedy Partners back in 2019. This led to most of the over 480 staff layoffs announced last month. The sale is, as usual, pending regulatory approvals and isn’t expected to close until first half 2023. Kyle Armbrester, Signify’s CEO Kyle Armbrester will continue to lead the company as part of CVS Health. Healthcare Finance, FierceHealthcare

Rival Walgreens Boots Alliance completed their acquisition of a majority share of home care coordination platform CareCentrix. Walgreens’ final payment was $330 million for 55% of the company at an $800 million valuation. As noted previously, Walgreens ‘go big or go home’ strategy in primary care kicked off in 2020 with growing investments in VillageMD, culminating in last year’s $5.2 billion for 63% of the company. The plan is to co-locate Village Medical offices with 600 Walgreens locations by 2025 [TTA 14 Oct 2021]. CVS’ recent actions can be seen as a reaction to Walgreens’ aggressive moves. Healthcare Finance

Amazon now under FTC scrutiny for One Medical acquisition. If shutting down the much-publicized Amazon Care wasn’t quite enough last month, the Federal Trade Commission (FTC) will be reviewing Amazon’s $3.9 billion buy of One Medical. This was announced in a 1Life Healthcare (parent of One Medical) 8-K filing with the Securities and Exchange Commission (SEC). Both 1Life and Amazon received requests for additional information on 2 September, above and beyond the usual required Hart-Scott-Rodino Act (HSR) reports that will be reviewed by the FTC and DOJ. Effectively it extends the HSR waiting period by 30 days after One Medical and Amazon have substantially complied with the additional information ‘second request’.

The FTC isn’t winning popularity contests with Amazon’s legal department, as the agency is reviewing their acquisition of iRobot, maker of robot vacuum cleaners. Mobihealthnews

News roundup: RPM at 79 ScionHealth hospitals, 74% of employers like virtual care despite concerns, Alma Health garners $130M, NIH’s $25M for cancer care telehealth research, Parks’ virtual Connected Health Summit 30-31 Aug

August 30, 2022 | by

Winding up August with one last roundup…get along lil’ dogies….

Remote patient monitoring coupled with home care debuting at ScionHealth hospitals. Louisville, Kentucky-based ScionHealth, a network of 79 hospitals in 25 states, is working with Cadence Care monitoring to manage qualifying chronic care patients. Cadence’s Care in Sync RPM will first support managing hypertension, heart failure, diabetes, and chronic obstructive pulmonary disease for ambulatory patients in 18 community hospitals across 12 states, with plans to roll out to the full network. Monitoring includes blood pressure, heart rate, pulse oximeter, glucose levels, and weight. These are tracked by care teams backed up by Cadence clinicians and telehealth. ScionHealth was formed from last year’s acquisition of Kindred Healthcare by LifePoint Health to create a network of 61 long-term acute care hospitals and 18 community hospital campuses. Cadence release, HealthcareITNews

What’s not to like about virtual care? 74% of the 135 employers surveyed like the idea, but 84% had real concerns about its ability to integrate virtual and in-person services, leading to duplication of services, unnecessary care, wasteful spending, and a fragmented care experience. These concerns ranged from 57% to 69% of those surveyed. The survey by the Business Group on Health found that these large employers were very interested in virtual primary care, with 32% offering these services in 2022, projecting out to over double — 69% — doing so in three years, 2025. In terms of spending, for the first time cancer care drives more cost than musculoskeletal (MSK) conditions, attributed to pandemic-related care delays. Business Group on Health release, FierceHealthcare

A cheery note to close August is that New York City-based Alma Health has raised a Series D of $130 million in this depressed market. While its website is very much patient-facing, Alma is primarily a membership network for mental health providers to help them be in-network with payers and simplify reimbursement to thrive in private practice. Alma claims guaranteed payback for every session in two weeks and credentialing with major insurance payers in under 45 days. It also provides a practice platform for providers in all 50 states. The Series D builds upon its August 2021 Series C of $50 million, with total outside funding since 2018 of $220 million. Investors include lead on the Series D Thoma Bravo, Cigna’s venture arm, and Optum Ventures, plus lead on the Series B and C Insight Partners, lead on the Series A Tusk Venture Partners, with Primary Venture Partners and Sound Ventures. Valuation is estimated at $800 million. FierceHealthcare, Alma release

NIH’s $25 million for research into telehealth and cancer care. Four universities and institutions will lead NIH/National Cancer Institute-funded research on the effectiveness and demographic makeup of those using telehealth as part of their cancer care:

  • NYU Grossman School of Medicine: the Telehealth Research and Innovation for Veterans with Cancer (THRIVE) Telehealth Research Center will work with the Veterans Health Administration (VHA) to uncover information about the impact of demographics on care delivery
  • University of Pennsylvania: Telehealth Research Center of Excellence (Penn TRACE) takes another aspect, telehealth strategiesand their impact on shared decision-making for lung cancer care 
  • Northwestern University: Scalable Telehealth Cancer Care (STELLAR), which will study how telehealth can be used to manage and limit behaviors such as smoking and inactivity
  • Memorial Sloan-Kettering:  MATCHES (Making Telehealth Delivery of Cancer Care at Home Effective and Safe) Telehealth Research Center, focusing on telehealth’s effectiveness on treatment of breast and prostate cancer, including remote patient monitoring and telehealth. 

mHealth Intelligence, NIH release

Not too late for Parks Associates’ virtual sessions as part of their Connected Health Summit series. Two new Summit Sessions will be online Tuesday 30 and Wednesday 31 August. More information and registration here.

Aug 30 – New Opportunities in Connected Health Services: Monitoring and Home Care
• Health and Safety Monitoring
• Home Care Services

Aug 31 – Successful Strategies for Engaging Consumers
• Choice in Care: Telehealth, Kiosks, and Retail Clinics
• AI in Health: Creating Personalized Insights
• Wellness and Consumer Engagement

Part of Wednesday’s session will include “Who’s Paying for Healthcare? New Business Models”. There’s a surprising finding–74% of US internet households with children at home have used telehealth services in the past 12 months versus 32% without kids at home, and 70% are likely to use telehealth the next time they are sick. If you cannot make these sessions, their last virtual  TTA is a past supporter of the Connected Health Summit. Parks release.

Oracle in Federal court class-action lawsuit on global privacy violations; Cerner VA EHR had 498 major outage incidents, 7% of time since rollout

August 25, 2022 | by

Oracle’s miseries multiply, both in Federal Court and with the VA. The first is taking place in the US District Court for the Northern District of California. Three plaintiffs in a class-action suit charge in a complaint filed on Friday 19 August that Oracle is running a giant ‘surveillance state’ on billions of people. From the complaint, “the regularly conducted business practices of defendant Oracle America, Inc. (“Oracle”) amount to a deliberate and purposeful surveillance of the general population via their digital and online existence. In the course of functioning as a worldwide data broker, Oracle has created a network that tracks in real-time and records indefinitely the personal information of hundreds of millions of people” and sells this information to third-parties, without consent of course.

The complaint, filed 19 August, states that Oracle’s BlueKai Data Management Platform, which includes the Oracle Data Marketplace–likely the world’s largest commercial data exchange–and to the point, the Oracle ID Graph “synchronizes the vast amounts of personal data Oracle has amassed; that is, it matches personal data that can be determined to share a common origin with other personal data.” The charge is essentially that Oracle spies on you and has set up the world’s largest surveillance database of billions of people using the billions of data points most everyone generates online over decades.

All three plaintiffs are privacy-rights advocates: Michael Katz-Lacabe of the Center for Human Rights and Privacy; Dr. Jennifer Golbeck, director of the University of Maryland’s Social Intelligence Lab; and Dr. Johnny Ryan, a Senior Fellow at the Irish Council for Civil Liberties (ICCL), and at the Open Markets Institute. 

Dr. Ryan’s organization, the ICCL, stated that “Oracle’s dossiers about people include names, home addresses, emails, purchases online and in the real world, physical movements in the real world, income, interests and political views, and a detailed account of online activity: for example, one Oracle database included a record of a German man who used a prepaid debit card to place a €10 bet on an esports betting site.”

No dates have been set for hearings or as requested, a jury trial.

In Europe, Oracle had faced similar action along with Salesforce on privacy violations under GDPR. The Privacy Collective’s case was ruled inadmissible by a judge in the Netherlands last year, but is being appealed.

If the action proceeds, this strikes at the heart not only of Oracle’s data business but also Google and any data analytics or brokerage company. Look over your shoulder…someone’s coming after you.  TechMonitor.ai

Meanwhile, back at the endless tsuris called the VA EHR implementation, Oracle Cerner got more verbal beatdowns from the VA’s Secretary of Veterans Affairs and Senate committee members. FedScoop, through a FOIA (Freedom of Information Act) request living up to its name, was able to quantify the system outages in the Cerner Millenium system between 8 Sept 2020 and 10 June 2022. Of the 640 days the system was in place, it was out or nearly out for about 45 days, or 7%, when time lost in all of the 498 incidents is calculated.

  • 428 incomplete functionality incidents (930 hours of the system partially not working)
  • 49 degradations (103 hours of degraded performance)
  •  24 outage incidents (40 hours of complete down time) 

Where responsible parties could be identified, Oracle Cerner was responsible for about two-thirds of the incidents. Interestingly, the remainder were attributed to the VA. As to root causes, the VA could not identify them in about 50% of the cases. There’s some squirreliness in VA’s internal reporting on multi-day outages, which are more serious because the longer the outage, the more damage and the harder it is to pin down a cause.

Secretary of Veterans Affairs Denis McDonough said to FedScoop: “The bottom line is that my confidence in the EHR is badly shaken.” which has to count as an understatement significant enough to hold off further implementation until 2023. House Veterans Affairs Subcommittee on Technology Modernizing Ranking Member Mike Bost, R-Ill., said: “The number of incidents listed in this disclosure is alarming. Some part of the Cerner system has been down more often than not for nearly two years.” 

The Showboat of Misery keeps Rollin’ Down the River: the 4 Aug outage, the Senate hearing with Oracle’s Mike Sicilia, the infamous ‘unknown queue’ 21 July and 21 June

Week-end news roundup: Fitbit revives with 3 new watches, Sena Health hospital-at-home, SteadyMD surveys telehealth clinicians, 9.4% fewer adult dental visits in England, save the date for ATA 2023

August 25, 2022 | by

Fitbit’s three new wearables–will they revive the brand? Fitbit, now owned by Google, announced the debut of two new smartwatches and one fitness tracker, available now for preorder and shipping in September. Will buyers find them more attractive than their predecessors? From left to right:

Fitbit Inspire 3 upgrades from the predecessor with a color display and similar $99.95 price. Monitors for irregular heartbeat, reminders to move, wakey-wakey alarm, apps, and more.

Fitbit Versa 4 is a thin, light fitness smartwatch with sleep, SpO2 monitoring, GPS, irregular heartbeat, stress, pay hands free, Amazon Alexa, and connects to your smartphone. Four colors, will set you back $229.95.

Fitbit Sense 2 is chunkier with more information and tracking on health and stress than Versa 4 for a higher price at $299.95.

Readers can weigh in on whether these will be attractive, as the Fitbit brand has, over the past two years, almost vanished from the fitness smartwatch consciousness. GearPatrol, Mobihealthnews

New entrant in the developing hospital-to-home service provision area Sena Health is partnering with southern New Jersey’s Salem Medical Center to deliver Salem’s hospital-to-home program. Sena’s capabilities with Salem include up to 23 hospital-level services at home and 24/7 care coordinators. To qualify, patients must have been seen in the ER and evaluated on certain criteria. When cared for at home, they receive two in-person nursing visits daily and can connect with a dedicated clinical team if needed. Hospital-to-home is being trialed all over the country and is considered to be ‘hot’, but at this point is not all that widespread. HealthcareITNews. 

SteadyMD conducted a survey among a group of potential workers for their telehealth care team, among 1,700 clinicians: doctors (35%), nurse practitioners (52%), and therapists (12%). Some interesting findings such as:

  • Experienced (10 years +) doctors and therapists are most interested in telehealth practice, with nurse-practitioners (NPs) less so
  • Flexible schedules and working from home are the main attractions
  • Night shifts are attractive to 86% of therapists. Doctors and therapists average about 60%. But the latter two are far more interested in weekend work–not the therapists.
  • Telehealth as a full time delivery of care goes between 50 and 69% for each. Clinicians want more hours if the arrangement is part-time.

SteadyMD is a telehealth infrastructure provider that works with healthcare organizations, labs and diagnostics companies in 50 US states.

Something that can’t be delivered by telehealth except for diagnosis is your annual dental visit and treatments, and it’s down 9.5% in England, based on a report published by NHS Digital. The tracking of NHS adult dental visits covers the 24 months prior to June 2022 compared to the 24 months prior to June 2021. When compared to the 24 months up to June 2019, the reduction is 25.3%. Since dental practices closed except for emergency care due to Covid in March of 2020, there is an overlap in the numbers. They do indicate that dental treatments have not recovered in volume from before the pandemic. One good sign is that child dental treatment has strongly rebounded, up 42.1% in the 12 months prior to June 2022 versus up to June 2021, but still down over 20% compared to the 12 months prior to June 2019. Regional data is included in the NHS Digital report (link above).

The American Telemedicine Association announced its 2023 ATA annual conference will be in San Antonio, 5-7 March 2023. More information on “From Now What? to How To! The Vision and Realities of Telehealth Adoption” already is up on their website here.

Breaking: Amazon Care shutting down after three years–what’s next? (updated)

August 25, 2022 | by

Amazon Care to cease operations after 31 December. Amazon Health Services is throwing in the towel on its primary care service for enterprise customers, after failing to make much headway with its mix of virtual care, in-home, and telehealth services. An internal email from Neil Lindsay, Amazon Health Services senior vice president, sent today (24 Aug) to employees but leaked to the press, stated that “This decision wasn’t made lightly and only became clear after many months of careful consideration. Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term.”

Employees who have been part of Amazon Care may have the opportunity to transfer to other parts of Health Services, according to the memo, or will be ‘supported’ in finding other roles within or outside the company. The total number of employees was not disclosed, but this Editor expects layoffs to be announced by the fall as Amazon Care winds down.

Amazon has been moving in a different direction with enterprises for some months. Reportedly the decision was made to ditch Amazon Care prior to agreeing to acquire One Medical, which was announced late in July. However, recently revealed negotiations actually started last February, with One Medical pitting Amazon against CVS until CVS dropped its bid effort [TTA 19 August]. 

As this Editor noted last month with the One Medical acquisition, “…for this Editor it is clear that Amazon with One Medical is buying itself into in-person and virtual primary care for the employer market, where it had limited success with its present largely virtual offering, and entreé with commercial plans and MA.” With One Medical, they will be acquiring an operation with 790,000 patients (including 40,000 at-risk, presumably Iora’s), 8,000 company clients, 125 physical offices in 21 US metros (including projected), and an established telehealth/telemedicine protocol. In other words, a ready-made provider and enterprise base to build on and sell into, for instance Amazon products like Pharmacy and PillPack.

Not addressed is what will be done, if anything, to transition current employer agreements for Amazon Care to One Medical.

It’s now a matter of whether HHS, DOJ, and FTC will agree to the buy or ask for additional divestitures. One conflict–Amazon Care–has just been removed. And this may clear the deck for other acquisitions, such as Signify Health [TTA 24 Aug], if Amazon wins the auction against CVS, UnitedHealth Group, and Option Care Health, though for a newcomer to healthcare Signify may very well be A Bridge Too Far.

What’s in play?

  • One Medical’s Iora Health and its high needs/high costs Medicare patient base. This has very much been held in the background, leading this Editor to think it will be sold to another health plan.
  • The status of the previous agreement with Crossover Health for 115,000 Amazon employees and dependents, delivered through their employer-based onsite clinics in 11 states in addition to concierge care [TTA 17 May]
  • Another previous agreement with Ginger for telemental health, only announced last week.

Amazon was touting Amazon Care as recently as earlier this year to shareholders. They had acquired employers outside Amazon such as Hilton, but not quickly enough. Expansion talk and the usual touting within the industry weren’t happening. There was an ‘air of mystery’ about what Amazon Care was doing, going back to the beginning.

Perhaps a major ‘tell’ was that Kristen Helton, general manager in charge of Amazon Care, was reported two weeks ago by Bloomberg News to be taking an “extended break to spend the summer with her family.” She had been in the GM position for three years after joining Amazon in 2015.

Count Amazon Care as one expensive learning course in the insanely costly University of Healthcare Delivery. This won’t be the first lesson, but Amazon can afford the tuition.

Geek Wire, FierceHealthcare, 

Signify Health bidding war ensues, waged by Amazon, UnitedHealth Group, CVS, Option Care Health

August 24, 2022 | by

What a difference less than two weeks makes. We noted on 11 August that in-home health and value-based provider services company Signify Health was up for sale in an unusual auction, with CVS Health the first disclosed bidder. Yesterday, three more companies jumped into the mix, UnitedHealth Group (the 9,000 elephant of US health), Amazon (with One Medical still pending), and little-known Option Care Health, a public (Nasdaq: OPCH) home infusion care company.

Reports in the Wall Street Journal (paywalled) indicate Signify’s value in the auction may top $8 billion. Bids are due around Labor Day. The board will be meeting next Monday to discuss the bids to date. Signify’s current value is about $5 billion.

The share price closed today just above $27, a major rise from last week’s close of $21 (Yahoo Finance).

The UHG bid is above $30, with Amazon close by, according to Bloomberg News sources. The CVS bid is not known. A buy by Amazon would put the company in Instant Major Healthcare Player territory. This Editor believes that with UHG and CVS, antitrust may factor in, especially considering Signify’s recent ownership of the ACO MSO Caravan Health.  

Option Care may not be well known, but it has impressive backing from Goldman Sachs and has been profitable. Their interest is Signify’s home health network and access to providers through Caravan. Another backer, Walgreens Boots Alliance, just sold 11 million shares on the secondary market, reducing its holdings from 20.5 percent to approximately 14.4 percent.

There’s no bar, of course, to the board ending the auction at any time and awarding the company. Healthcare Finance, FierceHealthcare

Babylon Health: fending off bubbly rumors of acquisition this week

August 16, 2022 | by

On Monday, the New York Stock Exchange stopped trading of Babylon Holdings Limited (NYSE:BBLN), the corporate name of Babylon Health. The reason was a sudden spike in the share price along with a huge spike in trading volume. Price moved from $0.76 to $0.96 from 12.45 pm ET to 1.15pm, with volume spiking from ~3,000 to 1 million (see the bottom bar chart). The volume and price shift automatically trigger a stop trade. Based on the Yahoo Finance chart, it resumed Tuesday morning and cruised down to just above recent prices at $0.77 closing today at $0.79, along with a drop in trading volume nearer the recent averages.

Babylon issued two terse press releases: the first on Monday 3.59pm ET which stated “that it is not engaged in nor has it had contact or discussions with any potential acquirer”, then a second on Tuesday at 6am which briefly addressed the ‘M&A speculation’ and the sudden (but short-lived) 20% rise in share price. The response from CEO Ali Parsa was that they “delivered very strong financial results and operational performance that demonstrate its continued momentum. Babylon is taking active steps to maximize shareholder value and to improve its shareholder base and capital structure.” 

Babylon Health went public last October in likely the last of the major healthcare SPACs at a debut of over $10 and a valuation that exceeded $4 billion. Its current value represents a 90% loss, not much different than what happened to the share values of Amwell and Teladoc, as well as other health tech SPACs [TTA 15 July]. Before the SPAC, they raised $200 million and bought Meritage Medical Network and First Choice Medical Group, opening an office in Palo Alto. Babylon also bought the remainder of Higi health kiosks they did not own in December, closing out an investment option with Higi in May that this Editor thought was puzzling for starters.

Babylon’s Q2 financials were, as we noted, a mixed picture but encouraging [TTA 11 Aug] in their US growth and lack of drama. The company had previously stated that it intends to save $100 million in Q3 and discharge about 100 people as part of this. This is nothing that would prompt a sudden swoop by an investor or investors–not disclosed–reminiscent of the buccaneering days of T. Boone Pickens. But in recent weeks there’s been a change in the investment climate. Certain companies such as CVS and Allscripts plus health plans have signaled that they want to buy healthy health tech companies at the right (discounted) price that fill in their tech gaps. ‘Second generation’ remote patient monitoring (RPM) and telehealth are having a hot moment. For traders, it’s the boring dog days of August in a market that’s had more down than up days this year.

The market action was a blip, but one that benefited Babylon and certainly put it back in the news. Which can’t hurt.

Mr. Parsa announced back in January at JPM that Babylon’s goal was to close 2022 at $1 billion in revenue, triple that of 2021. With Q2 revenue of $265 million, they are on track (he quoted a run rate of $80 million per month). There is also the Transcarent/Glen Tullman (late of Livongo) investment connection that came over via the Higi acquisition. Transcarent is heavily invested in value-based care models for self-insured employers as a benefit for their employees, as is Babylon. Dots are here and ready to be connected.

 Also HISTalk.

Weekend short takes: May telehealth claims up to 5.4%; three health plan breaches, one at its law firm–affecting over 400,000 patients; layoffs hit Calm, Truepill (updated)

August 12, 2022 | by

FAIR Health’s telehealth claims took two bumps up in both April and May. In April, telehealth medical claims moved slightly upward to 4.9% from March’s 4.6%, but May increased 10% to 5.4%, a percentage not seen since May 2021. Mental health conditions still make up the vast bulk of claims at 62.8%, but 3.6% of telehealth claims involve COVID-19 diagnoses, with 3.2% of claims for respiratory diseases and infections. This is attributed to a regional increase in the Southern and Western states of the latest variants of COVID-19. FAIR Health monthly tracker main page

Priority Health, a Michigan-based nonprofit health plan company, was breached through its law firm Warner Norcross & Judd (WNJ). The October 2021 breach at WNJ wasn’t reported to Priority Health until 6 June. The unauthorized party potentially accessed first and last names, pharmacy and claim information, drug names, and prescription dates from certain prescriptions filled in 2012. 120,000 members were affected. What the information was doing at the plan’s law firm was not disclosed. Priority Health is Michigan’s second-largest plan with over one million members.

In other breaches, Texas-based Behavioral Health Group (BHG), had a data incident that affected 197,507 individuals. The unauthorized party had potentially removed certain files and folders from portions of its network on 5 December 2021.  The files include names, Social Security numbers, driver’s license numbers, financial account information, biometrics, medication information, medical record numbers, dates of service, passports, payment card information, and health insurance information. However, the information accessed doesn’t appear to have been misused.

First Choice Community Healthcare in Albuquerque, New Mexico, also had a data security incident that involved 101,541 patients. The PHI in the 27 March breach included names, Social Security numbers, patient ID numbers, medications, dates of service, diagnosis and treatment information, birth dates, health insurance information, medical record numbers, patient account numbers, and provider information. Again, there appears to be no misuse to date. HealthITSecurity

More health tech companies lay off staff.

  • Calm, one of those incessantly advertised (in US) meditation apps, is discharging 20% (90) staffers, at least 12 in marketing, according to a report in the Wall Street Journal (may be paywalled). From this Editor’s LinkedIn post in response to early reports:
    • Calm was strategically ‘off’ in spending. They overspent on direct to consumer–expensive TV spots on major networks and sponsorships, paid social and search. If you wanted Calm’s full features, you paid for them. Expensive meditation apps are merely a “nice to have” and there are a bunch of free ones available. 
    • There’s also too much app overlap and mistargeting out there. Calm was trying to sell the app to businesses as a benefit (ROTFL) but was hedging its bets with buying Ripple, which designs apps for care coordination and condition management (another crowded area).
    • Another sign–new sole CEO named this summer. Now sole CEO David Ko came from Ripple and the two Calm founders moved over to co-chair roles.
    • This is a company that raised well north of $200 million to become a $2 billion unicorn as early as 2019, another sign of too much cash, too soon, and VCs/equity investors following the fad. ‘Mindfulness’ became a fad as early as 2018.
  • Truepill is up to its third layoff–33% or 175 staff, including all UK staff plus much of the product and data teams.  Their cutbacks relate to multiple failures, the first in betting on ADHD controlled substances, the second in blowing through vast amounts of funding but unable to obtain more (a Series D of $142 million but unable to float a Series E). Truepill’s ADHD med bet fell apart with its relationship with Cerebral, now under Federal investigation [TTA 16 June]. As early as May, Truepill, Cerebral’s primary mail order provider, had stopped filling their prescriptions for Schedule 2 medications [TTA 1 June]. This follows on a June layoff of 15% or 150 people. Truepill had also expanded into telehealth and diagnostics, two areas which will only be lightly supported going forward. TechCrunch

Week-end news roundup: Allscripts on the acquisition hunt, Amwell’s CVS telehealth deal, Cerner’s $1.8M racial discrimination settlement, predicting Parkinson’s progression via smartwatch data

August 12, 2022 | by

Another company on the hunt for strategic buys. Health IT and EHR company Allscripts is seeking to add to its Veradigm analytics, research, and provider/payer platforms with some strategic acquisitions. Announced on its Q2 earnings call by new CEO Rick Poulton is the intent to expand the company from its current provider base into a more diverse one serving payers and life sciences. Allscripts does have some free cash–about $700 million–having recently sold its hospital and large physician practice EHRs to Constellation Software/N. Harris Group, though there were some settlements around their Practice Fusion EHR now incorporated into Veradigm [TTA 2 Apr]. With a free cash flow from continuing operations around $120 million and about 7% growth, they feel the time is here for some accretive, strategic, and proven acquisitions–at the right price. FierceHealthcare

Amwell’s Q2 earnings call also had good news for shareholders, who of late haven’t had much to cheer. CEO Ido Schoenberg, MD announced that Amwell will provide CVS Health’s Virtual Primary Care, formally launched in late May  Amwell will be providing primary, behavioral health, and chronic care management through the platform. CVS will be providing these services to Aetna fully-insured, self-insured plan sponsors, and CVS Caremark clients effective first half 2023. As this Editor wrote earlier this week, CVS Health is making no secret of its intent to expand into delivering primary care and home health. One way Virtual Primary Care will be leveraged is converting in-store health services to virtual, such as non-emergency treatment and nutrition/wellness programs. CVS is even dabbling into blockchain with downloadable non-fungible tokens (NFTs) for virtual services. HealthcareFinance 

Cerner, on the other hand, is paying out $1.8 million to settle a racial discrimination lawsuit brought by the US Department of Labor. As a Federal contractor, Cerner went under review by the Office of Federal Contract Compliance Programs. That office alleged that Cerner systematically discriminated against qualified Black and Asian applicants who applied for positions at five facilities in Missouri and Kansas between 2015 and 2019. Cerner agreed to pay $1,860,000 in back pay and interest to 1,870 applicants in areas such as medical billing, system engineers and technical solution analysts. Certainly Oracle wanted to get this off the plate before the cutover on 1 October. HealthcareFinance, Department of Labor release

Can enough data collected build a predictive model for the progression of  Parkinson’s? Koneksa, a digital biomarker builder, is working with the Michael J. Fox Foundation for Parkinson’s Research to build a predictive model on how Parkinson’s will progress over time in an individual. The Fox Foundation already has a database to analyze — the Parkinson’s Progression Markers Initiative, launched in 2010, with health information and biosamples from Parkinson’s patients. Added to this will be data from Verily’s smartwatch:  activity tracking, gait analysis, and sleep cycles, which will be analyzed using Koneksa’s algorithms and additional machine learning. The award by the Fox Foundation was not disclosed, but it is the second for Koneksa after another grant awarded in mid-June to analyze vocal abnormalities relating to early progression of the disease, in conjunction with Northwestern University. FierceHealthcare

Mid-week news roundup (updated 18 Aug): CVS eyeing Signify Health for in-home/VBC; Babylon Health mixed pic of revenue and losses up; Geisinger doubles telemed specialties; connected IoT devices expand cyber-insecurity (more); Owlet layoffs

August 11, 2022 | by

CVS has dropped another sandal as to their quest to add primary care and home health to their portfolio [TTA 5 Aug]. Reports indicates that CVS Health is bidding to acquire Signify Health, which is up for sale. Signify is best known as a major provider of in-home health care in both evaluations and community-based services, with users such as health plans, health systems, community groups, non-profits, and government. In March, they added provider value-based care with Caravan Health, a mid-sized Accountable Care Organization (ACO) management service organization (MSO), for $250 million.  This would give CVS both leverage in in-home care and access to value-based care models in health systems and practices, adding a network of jumbo (100,000 lives+) ACOs to Aetna’s 500 ACOs.

Signify did take a bit of a bath with its acquisition/merger of Remedy Partners in 2019 which marked their entry into the Federal shared savings programs around Episodes of Care. While it created a $600 million company. Remedy’s Episodes of Care in the CMS Bundled Payments for Care Improvement (BPCI) program was always problematic for Signify on multiple levels (Editor’s experience). Signify announced its exit from the successor BPCI-A (Advanced) model last month to concentrate on home care and the Caravan business. The wind-down, which will take some time as these are Federal programs through CMS, will save Signify about $115-120 million in costs, compared to their annual direct and shared costs of $145 million. Restructuring costs such as severance may be only $35 million. After IPO-ing in February 2021 at $24 per share, it has only recently climbed to $23, having recently hit a 52-week low of $10.70. FierceHealthcare, HealthcareFinanceNews

Updated Perhaps in preparation for acquisition, Signify Health is shedding 489 people starting 1 October, including 45 in Connecticut, with the remainder in Texas, South Dakota, and New York. The information comes from required notices to the Connecticut Department of Labor. The majority of employees affected are remote workers. It appears to be related to Signify’s winding up of BPCI and Episodes of Care activity which are likely on calendar year contracts. The legacy company, Remedy Partners, had been headquartered in Connecticut with staff in New York. Moving forward with layoffs now makes the company more attractive for sale, as the separation expenses will not be an acquiring company liability. The 1 October start date is also a tell.  CT Insider, Becker’s

A mixed picture for Babylon Health. Its Q2 results were up substantially in revenue–4.6x year-over-year from $57.5 million to $265.4 million–along with key indicators such as US members up 220% and a 7.5% improvement in medical margins over three quarters. The US has been very very good to Babylon with value-based care membership growing 3.2x year-on-year to a total of approximately 269,000 US VBC members with 40% of its VBC revenue from Medicare contracts. However, losses are up along with growth–$157.1 million compared to $64.9 million loss PY. Babylon at end of July announced worldwide layoffs of at least 100 people of its current 2,500 in their bid to save $100 million in Q3. Babylon release, Mobihealthnews

Geisinger Health was one of the pioneers in telehealth and remote patient monitoring, from ur-days in the early 2010s to today. Much of its patient base in Pennsylvania is rural or semi-rural, living well away from care centers, with a clinician base equally scattered. They went with a single system–Teladoc–integrated into Epic. By the early days of the pandemic, Geisinger was able to expand their telehealth coverage from 20 to more than 70 specialties, 200 providers to more than 2,000 providers, and over two years (2020-2022) completing over 784,000 telehealth visits to homes, local clinics, or local hospitals. Case study in HealthcareITNews

If you’re a health system CIO managing lots of connected devices, you may need to go to a psychiatrist with your feelings of insecurity. That’s the gist of a new report, the Insecurity of Connected Devices in Healthcare 2022. A new-to-this-Editor cybersecurity firm, Cynerio, partnered with researchers at the Ponemon Institute to survey 517 executives at US health systems to find that their Internet of Medical Things (IoMT)/Internet of Things (IoT) vulnerabilities haven’t changed much since this Editor banged the gong about them well before the pandemic:

  • Cyberattacks–frequent: 56% of respondents experienced 1+ cyberattacks in the past 24 months involving IoMT/IoT devices; 58% averaged 9+ cyberattacks. Adverse impacts on patient care were reported by 45% and 53% of those resulted in increased mortality rates. 24% of hospitals noted an impact on their mortality rates.
  • Data breaches are routine: 43% of hospitals had one in the past two years
  • Risks may be high, but the reaction is sluggish: 71% rated security risks as high or very high, but only 21% report a mature stage of proactive security actions. 46% performed accepted procedures such as scanning for devices, but only 33% keep inventory.
  • Ka-ching! Goes the ransomware! When attacked, 47% paid the ransom, and 32% were in the $250-500,000 range.

The full report is available for download here. Those who prefer a webinar must wait till 17 August at 2pm (EDT)–registration here.  Cynerio release, HealthcareITNews

Updated. Having sat in on the webinar, some further information points from the Ponemon survey deepen the ‘gravity of the risk’:

  • IoT is different because a hack or cyberransoming prevents the device from working. It isn’t fixed by backup as data can be.
  • Health systems are still using IoT computer systems running Windows XT/95–and earlier (!)
  • The average total cost of the largest data breaches is $13 million–the most common cost is in the $1-5 million range. 
  • 88% of these data breaches involved at least one IoT/MT device
  • Risks are known, but action is lagging. 72% of health organizations report a high level of urgency in securing devices–yet 67% of organizations do not keep an inventory of IoT/IoMT devices that they scan
  • 79% don’t consider their activities to be ‘mature’
  • Security investment doesn’t reflect the gravity of the risk–only 3.4% of IT budgets focus on IoT/MT device security.

And in sad layoff news, Owlet Baby Care is shedding an unknown number of employees. Here is the notice on LinkedIn. We noted their FDA problems and a fast pivot last in February, but their going public via a SPAC has been rocky at best with shares lingering at $2 from the IPO at $8. Marketing a pricey baby monitor direct to consumer is expensive, even if it meets a need, and this is likely a cash crunch. At least the ‘leader of people & culture’ is giving them a proper sendoff of thanks–and more usefully, providing their contact information for potential job openings with other companies.

[This is in contrast to the gone-viral spectacle of the CEO of something called HyperSocial posting on LinkedIn his angst about laying off staff–along with a selfie of him weeping. Not exactly confidence-making and All About Him. This Editor’s comment is one of 6,000-odd posts which are largely doubtful to negative.]

Oracle’s Big Vision will be missing a lot of people; layoffs hit Cerner, customer experience, marketing staff

August 2, 2022 | by

‘Healthcare Transformation’ will ring hollow for the many employees at Oracle and Cerner who will be getting 60-day notices — or less — to depart.

One group is within Oracle in the US customer experience division and marketing, and apparently more. According to Bloomberg, the customer experience area that provides analytics and advertising services had been lagging for some time and has been reorganized, losing in the process junior sales employees, a division sales director, and marketing positions. Numbers are not provided, nor information on severance. Also Becker’s.

On the Oracle thread on TheLayoff.com, Oracle Cloud Infrastructure (OCI) North America has been substantially downsized effective 15 August, especially those supporting a Startups product. 

More extensive are the Cerner cuts. This Editor has been following postings as they happen on both the Reddit r/cernercorporation and TheLayoff threads (Oracle thread here). Areas mentioned appear to be primarily internal/non-customer facing: technical project management in population health, enterprise change management, enterprise process improvement, multiple VPs, sales engineers, application services/support, marketing (of course), talent acquisition, and other areas. People ranged from new hires who had offers pulled, to those under one year, to highly experienced employees with a decade or two in the company. UK tech site The Register has an estimate from one posting of 10,000 layoffs. Given that Cerner has about 20,000 employees, that is close to 50%.

As is typical of mass layoffs, those at Cerner reported that they were notified en masse by managers on Monday through snap meetings. Their packages were cleverly designed to skate through the 60-day WARN notice to the state in the US, providing for an end date in 60 days, just before the official cutover to Oracle on 1 October. Severance packages without insurance or benefits after the 60 days were two weeks for every year at Cerner, not particularly generous given the uncertain economy and freezes all over tech. If the individual sought and was offered a position at Oracle, the severance package would be pulled, which is the usual maneuver to discourage any internal job-seeking from this group.

There is no indication of any cuts to Cerner outside the US, yet. The Independent, citing The Information, indicated that further Oracle cuts may come from Canada, India, and Europe. Oracle has a goal of saving $1 billion.

In this Editor’s view, Oracle is erasing Cerner as fast as it can [TTA 19 July] and doing internal housecleaning (bloodletting) at the same time. As to the former, Mike Sicilia’s testimony to the Senate committee about Cerner at the VA [TTA 28 July] had a distinct tone of cleaning up the previous regime’s mess–this should be no surprise. Yet Cerner’s tippy-top management remains in place, with generous compensation and separation arrangements in place [TTA 19 July with links to prior articles]. Cerner’s healthcare customers should take note, either way.

Having been there and done that more than once, our best wishes to everyone affected. Remember that you are not your job, pack up your learnings in your kit bag for a new journey, and you will land a good job soon.

Hat tip to HISTalk as well for covering this story and reaching many on the provider and partner side in the industry that we do not.

Week-end roundup of not-good news: Teladoc’s Q2 $3B net loss, shares down 24%; Humana, Centene, Molina reorg and downscale; layoffs at Included Health, Capsule, Noom, Kry/Livi, Babylon Health, more (updated)

July 30, 2022 | by

Teladoc continues to be buffeted by wake turbulence from the Livongo acquisition. The company took a $3 billion goodwill impairment charge in Q2, adding to the $6.3 billion impairment charge in Q1. The total impairment of $9.3 billion was the bulk of the first half loss of nearly $10 billion. While their revenue of $592.4 million exceeded analyst projections of $588 million, adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) of $46.7 million were barely up from projections and were down from $66.8 million year prior. Losses per share mounted to $19.22, versus $0.86 in Q2 2021.

Another weak spot is their online therapy service, BetterHelp, which in the US is pursuing a substantial TV campaign. CEO Jason Gorevic in the earnings release pointed out competitors buying the business at low margins and consumer spending pullbacks. Teladoc’s forward projections are bolstered by Primary360 and Chronic Care Complete. Projected revenue for Q3 is $600 million to $620 million. Shares on Thursday took a 24% hit, adding to the over 50% YTD drop misery. At best, Teladoc will muddle through the remainder of the year, if they are lucky. MarketWatch, Mobihealthnews, FierceHealthcare

Health plans are also presenting a mixed picture. 

  • Humana announced a healthy earnings picture for the quarter and YTD. It earned $696 million in profit for Q2, up nearly 20% year over year. For first half, Humana earned $1.6 billion, an increase of 14.8% from 2021’s $1.4 billion. Cited were growth in their primary care clinics, Medicaid membership, and investment in Medicare Advantage. Earnings surpassed Wall Street projections and Humana increased its guidance to $24.75 in earnings per share. At the same time, they announced a reorganization of its operating units that separates their insurance services (retail health plans and related) and CenterWell for healthcare services including home health. Some key executives will be departing, including the current head of retail health plans who will stay until early 2023, ending a 30 year Humana career. FierceHealthcare, Healthcare Dive
  • Under new leadership, Centene posted a Q2 loss of $172 million which in reality was a significant improvement over Q2 2021’s $535 million and looked on favorably by analysts.
    • Their ‘value creation plan’ has sold off its two specialty pharmacy operations to multiple investors, using third-party vendors in future, and agreed this week to sell its international holdings in Spain and Central Europe — Ribera Salud, Torrejón Salud, and Pro Diagnostics Group — to Vivalto Santé, France’s third-largest private hospital company.
    • Medicaid, their largest business line, has been growing by 7%.
    • Centene is continuing to divest much of its considerable owned and leased real estate holdings, which marks a radical change from the former and now late CEO’s* ‘edifice complex’ to house his ‘cubie culture’. As a result, it is taking a $1.45 billion impairment charge.  Healthcare Dive. [* Michael Neidorff passed away on 7 April, after 25 years as CEO, a record which undoubtedly will never be matched at a health plan.)
    • A cloud in this picture: Centene’s important Medicare Advantage CMS Star quality ratings for 2023 will be “disappointing” which was attributed to the WellCare acquisition (accounting for most of the MA plans), two different operating models between the companies, and the sudden transition to a remote workforce. For plans, WellCare operated on a centralized model, Centene on a decentralized one, and the new management now seems to prefer the former. (Disclosure: your Editor worked over two years for WellCare in marketing, but not in MA.) Healthcare Dive
  • One of the few ‘pure’ health plans without a services division, Molina Healthcare, is also going the real estate divestment route and going full virtual for its workforce. Their real estate holdings will be scaled down by about two-thirds for both owned and leased buildings. Molina does business in 19 states and owns or leases space across the US. Net income for the second quarter increased 34% to $248 million on higher revenue of $8 billion. Healthcare Dive

Many of last year’s fast-growing health tech companies are scaling back in the past two months as fast as they grew in last year’s hothouse–and sharing the trajectory of other tech companies as well as telehealth as VCs, PEs, and shareholders are saying ‘where’s the money?’. 

  • Included Health, the virtual health company created from the merger of Grand Rounds and Doctor on Demand plus the later acquisition of care concierge Included Health, rebranding under that name, has cut staff by 6%. The two main companies continued to operate separately as their markets and accounts were very different: Grand Rounds for second opinion services for employees, and Doctor on Demand for about 3 million telehealth consults in first half 2020. As Readers know, the entire telehealth area is now settling down to a steady but not inflated level–and competition is incredibly fierce. FierceHealthcare
  • Unicorns backed by big sports figures aren’t immune either. Whoop, a Boston-based wearable fitness tech startup with a valuation of $3.6 billion, is laying off 15% of its staff. (Link above)
  • Digital pharmacy/telemedicine Capsule is releasing 13% of its over 900 member staff, putting a distinct damper on the already depressed NYC Silicon Alley.  FierceHealthcare also notes layoffs at weight loss program Calibrate (24%), the $7 billion valued Ro for telehealth for everything from hair loss to fertility (18%), Cedar in healthcare payments (24%), and constantly advertising Noom weight loss (495 people). Updated: Calibrate’s 150-person layoff was reported as particularly brutally handled with employees. Many were newly hired the previous week, given 30 minutes notice of a two-minute webinar notice, then their laptops were wiped. Given that the company makes much of its empathy in weight loss, facilitating prescription of GLP-1 along with virtual coaching, for a hefty price of course. HISTalk 8/3/22
  • Buried in their list are layoffs at Stockholm-based Kry, better known as Livi in the UK, US, and France, with 100 employees (10%).
  • Layoffs.fyi, a tracker, also lists Babylon Health as this month planning redundancies of 100 people of its current 2,500 in their bid to save $100 million in Q3. Bloomberg

Oracle’s ‘new sheriff’ moving to fix Cerner EHR implementation in the VA: the Senate hearing

July 28, 2022 | by

Last week’s (20 July) hearing on the VA’s increasingly wobbly EHR transition from VistA to Cerner showcased Oracle’s executive vice president for industries Mike Sicilia. His testimony to the Senate Committee on Veterans’ Affairs had a heaping helping of ‘the new sheriff has arrived in Dodge City’.  As of six weeks ago, after the Transformational Big Vision kvelling faded, Cerner’s painful stumbles became Oracle’s VA Migraine [TTA 21 July, 21 June]. Cerner is now part of the Oracle Global Health business unit that falls under him.

First, the pledge made in his statement: “Unlike Cerner alone, Oracle brings an order of magnitude more engineering resources and scale to this formidable challenge.” After outlining the work that Oracle has done for CDC and NIH on Covid-19, he testified:

You should consider that in effect the VA, the Department of Defense (DoD) and the Coast Guard obtained a new, vastly more resourced technology partner overnight to augment Cerner. We also strongly believe in this mission and consider it not only a contractual obligation but a moral one to improve healthcare for our nation’s veterans and their caregivers. We intend to exceed expectations. 

Of the list of 36 issues detailed by the committee to VA Deputy Secretary Remy, Sicilia condensed them into three main areas: performance, design, and functionality. The concrete moves are:

  • Oracle will move the implementation to the cloud and rewrite Cerner’s pharmacy module, completing both tasks within 6-9 months
  • They have set up a ‘war room’ consisting of Oracle’s top talent of senior engineers and developers, working on the entire DoD/VA EHR systems as priority #1, with the first order of work a top-to-bottom analysis. While integrating with the Cerner team, the statement makes it clear that Oracle “brings an order of magnitude larger engineering team than Cerner”.
  • The Cerner EHR system is currently running on a dated architecture with technology that is in some cases two decades old and thus will be moved within 6-9 months to Oracle’s Generation 2 cloud. (That must be reassuring to thousands of hospitals and practices!)
  • Shortly after the closing, Oracle fixed a database bug that caused 13 of the last 15 outages, and as of last week there were no further outages. 
  • Testifying on the status of the “unknown queue”,  he stated it was designed to account for human error rather than to mitigate it, so it will be redesigned–it will be automated more on the front end and on the back end will have a better process.
  • Oracle will “start over” with the Cerner pharmacy module, rebuilding it as a showcase of a cloud-optimized web application.

VA’s EHR leaders also testified at the Senate hearing. Terry Adirim, Executive Director of the Electronic Health Record Modernization Integration Office at the VA, confirmed that unsurprisingly, Cerner’s next rollouts scheduled for the Boise VA Medical Center and other centers have been postponed indefinitely due to multiple ongoing system stability issues: change control and testing; challenges with increased capacity; basic functionality; its resilience design, and its response in last resort disaster situations. These specific issues overlapped but were more specific than those covered in Sicilia’s statement, which focused on the actions that Oracle would take.

Adirim and Kurt DelBene, the VA’s CIO, were roasted by the senators as painting a “very rosy picture”. The OIG report itemized at least 60 recommendations before going further. Adirim, to his credit, noted that DoD had similar stability issues in its system which was a warning, but the VA’s system is far more complex and care oriented than DoD which presumably exacerbated those issues. FedScoop and especially HISTalk’s Monday Morning Update 7/25/22

Amazon moves to acquire One Medical provider network for $3.9B (updated)

July 27, 2022 | by | 1 Comment

Amazon joining the in-person provider network space for real. Amazon Health Services last week moved beyond experimenting with in-person care via provider agreements (Crossover Health, TTA 17 May) to being in the provider business with an agreement to acquire One Medical. Earlier this month, news leaked that One Medical as 1Life Healthcare was up for sale to the right buyer, having spurned CVS, and after watching their stock on Nasdaq plummet 75%.

  • The cash deal for $3.9 billion including assumption of debt is certainly a good one, representing $18 per share, a premium to their $14 share IPO in January 2020. (The stock closed last Wednesday before the announcement at just above $10 per share then plumped to ~$17 where it remains.)
  • The announcement is oddly not on One Medical’s website but is on Amazon’s here.
  • The buy is subject to shareholder and the usual regulatory approvals. The IPO was managed by JP Morgan Securities and Morgan Stanley. It is primarily backed by Alphabet (Google).
  • One Medical’s CEO Amir Dan Rubin will stay on, but there is no other executive transition mention.
  • Also not mentioned: the Iora Health operation that serves primarily Medicare patients in full-risk value-based care models such as Medicare Advantage (MA) and Medicare shared savings, quite opposite to One Medical’s membership-based concierge model. However, Iora’s website is largely cut over to One Medical’s identity and their coverage is limited to seven states.

There is a huge amount of opinion on the buy, but for this Editor it is clear that Amazon with One Medical is buying itself into in-person and virtual primary care for the employer market, where it had limited success with its present largely virtual offering, and entree with commercial plans and MA. One Medical has over 700,000 patients, 8,000 company clients and has 125 physical offices in 12 major US markets including NYC, Los Angeles, Boston, and Atlanta. It has never turned a profit. Looking at their website, they welcome primarily commercial plans and MA (but not Medicare supplement plans).

Amazon, with both a virtual plus provider network, now has a huge advantage over Teladoc and Amwell, both of which have previously brushed off Amazon as a threat to their business. There is the potential to run two models: the current Amazon Care pay-as-you-go model and the One Medical corporate/concierge model. This puts Amazon squarely in UHC’s Optum Health territory, which owns or has agreements with over 5% of US primary care practices, is fully in value-based care models such as Medicare shared savings through its ACOs, and is aggressively virtual plus integrating services such as data analytics, pharmacy, and financial. Becker’s

What doesn’t quite fit is Iora Health and the higher cost/higher care needs Medicare market that is less profitable and requires advanced risk management, a skill set that Amazon doesn’t have. This Editor will make a small prediction that Iora will be sold or spun off after the sale.

This Editor continues to believe that the real game for Amazon is monetizing patient data. That has gained traction since we opined that was the real Amazon Game in June and October last year, To restate it: Amazon Care’s structure, offerings, cheap pricing, feeds our opinion that Amazon’s real aim is to accumulate and own national healthcare data on the service’s users. Then they will monetize it by selling it to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Patients may want to think twice. This opinion is now shared by those with bigger voices, such as the American Economic Liberties Project. In their statement, they urged that the government block the buy due to Amazon’s cavalier attitudes towards customer data and far too much internal access, unsecured, to customer information (Revealnews.org from Wired). Adding PHI to this is like putting gasoline on a raging fire, and One Medical customers are apparently concerned. For what it’s worth, Senator Bernie Sanders has already tweeted against it.   MarketWatch

Whether this current administration and the DOJ will actually care about PHI and patient privacy is anyone’s guess, but TTA has noted that Amazon months ago beefed up its DC lobbying presence last year. According to Opensecrets.org, they spent $19.3 million last year. In fairness, Amazon is a leading Federal service provider, via Amazon Web Services. (Did you know that AWS stores the CIA’s information?)  One Medical is also relatively small–not a Village MD/Village Medical, now majority owned by Walgreens Boots. This is why this Editor believes that HHS, DOJ, and FTC will give it a pass, unlike UHG’s acquisition of Change Healthcare, especially if Amazon agrees to divest itself of the Iora Health business.

Treat yourself to the speculation, including that it will be added as an Amazon Prime benefit to the 44% of Americans who actually spend for an Amazon Prime membership. It may very well change part of the delivery model for primary care, and force other traditional providers to provide more integrated care, which is as old as Kaiser and Geisinger. It may demolish telehealth providers like Teladoc and Amwell. But as we’ve also noted, Amazon, like founder Jeff Bezos, deflects and veils its intents very well. FierceHealthcare 7/25, FierceHealthcare 7/21, Motley Fool, Healthcare Dive

Midweek heat wave roundup: GE Healthcare’s new name, hospital-to-home health trending big, over 2 million patient records hacked

July 20, 2022 | by

GE’s breakup into three public companies, announced last November [TTA 12 Nov 21], has been formalized with brand names. No surprise, the healthcare business has but a teeny tiny change to GE HealthCare (logo left) and after the spinoff will be trading sometime in early 2023 under GEHC on Nasdaq because “GE HealthCare will benefit from the exchange’s profile and track record as a market for innovative, technology-led public companies, particularly in the healthcare sector. The heritage ‘meatball’ (as we called it in marketing internally, but formally the Monogram) will be retained but the color will change from poison green to “compassion purple” to reflect more humanity and warmth and achieve greater distinction”. The hardest hit part of GE, the energy businesses, will be spun off as GE Vernova and key color an ‘evergreen’. What is left will be GE Aerospace, retaining its name and change its color to an ‘upper atmosphere’ blue that is almost black. Outer space, anyone? GE release, interview on YouTube

Au courant is hospital-to-home (H2H) and home health, digitally enabled mais bien sûr.

  • Mass General Brigham (MGB) is reportedly expanding its current 25-bed program to 200 in the next 2.5 years. Since 2016, MGB has treated nearly 1,800 H2H patients. By end of 2023, they plan 90 hospital-at-home beds managed across Massachusetts General Hospital, Brigham and Women’s Hospital, Newton-Wellesley Hospital, and Salem Hospital. Their new head for home-based care will be Heather O’Sullivan, who comes from EVP and chief clinical innovation officer spots at Kindred at Home, acquired by Humana in 2021. FierceHealthcare
  • Out in rural Wisconsin, Marshfield Clinic is rolling out a H2H program with DispatchHealth, to coordinate medical care for injuries and illnesses including viral infections, COPD exacerbations, congestive heart failure, and more. The goal is to reduce non-emergency ED visits. DispatchHealth can also perform services such as onsite diagnostics, mobile imaging, and CLIA-certified labs for kidney function, electrolytes, and urinalysis. In March 2021, they closed a $200 million Series D bringing their funding to unicorn level. HealthcareITNews
  • UHG’s Optum has moved closer on its $5.5 billion acquisition of LHC Group home health and hospice [TTA 31 Mar] with shareholder approval on 21 June. Once closed later this year, LHC will be integrated into Optum Health. LHC operates in 37 states and the District of Columbia, employing about 30,000 individuals. Home Health Care News, Becker’s

And what would a week with a heat wave that melts runways at RAF Brize Norton and Luton be without a couple of big data breaches to heat up things? Stolen: an iPad chock full of 75,000 Kaiser Permanente patients’ PHI from Kaiser’s Los Angeles Medical Center’s COVID-19 testing center. While the information on the iPad included first and last names, dates of birth, medical record numbers, and dates and location of service (but not SSN or financial information), Kaiser was able to remotely erase the data. At this point, there is no evidence of theft or misuse. NBC Los Angeles, Becker’s   An even larger breach of 2 million records came via a February hack attack on health provider debt collector Professional Finance Company (PFC). Hackers got into PFC’s computers and accessed patient names, addresses, SSN, health insurance, and medical treatment data. Among the 650 client companies affected were Banner Health and Nevada physician network Renown Health. Healthcare Dive

Cerner’s business now consolidated under Oracle Health

July 19, 2022 | by

The internal memo doesn’t say so but doesn’t really have to. The sunsetting of the Cerner brand (logo left) has begun. HISTalk this evening reported on Friday 15 July’s Cerner internal announcement posted on Reddit, vetted by the Kansas City Business Journal (paywalled), and it’s not all that surprising:

  • The business unit is now called Oracle Health Global Industry Unit (GIU) or Oracle Health
  • The chairman of Oracle Health will be David Feinberg, MD, late CEO of Cerner and previously of UCLA Health, Geisinger Health, and Google’s last effort at Health. 
  • Travis Dalton is being promoted to run the Oracle Health GIU as General Manager from running Cerner Government Services as Client Services Officer
  • Cerner’s engineering and product executives will be reporting to Oracle’s Don Johnson who runs all Oracle engineering for all applications and platform services. This includes former CTO Jerome Labat who received a stay deal along with Dr. Feinberg [TTA 21 Jan, 26 Jan]. Mr. Labat has at least 11 million good reasons (and Dr. Feinberg 22 million) to stay for the next year and a day from the closing on 8 June.
  • Cerner’s corporate functions, such as IT, finance, legal, and HR, will move into Oracle’s centralized, global teams, which typically means that pink slips will be the order of the day if they haven’t already been received
  • More disclosed to employees at a town hall on that Friday 
  • No external announcement has been made as of 1845 19 July (Eastern Time)

Our Readers who have been following the acquisition and personally been through acquisitions know the stage was set by Larry Ellison’s Big Pronouncements on Healthcare Transformation at the closing [TTA 14 June]. It was all about what Oracle would be doing in building a national health record database and more, with nary a mention of Cerner. The eventual elimination of the Cerner name should thus be no surprise to industry observers. Cerner was a pearl bought at a great price ($28 billion) to make Oracle the Visionary Leader In Healthcare and provide Mr. Ellison with a Grand Finale.

How this will be received by health system and provider customers–including DOD and the ever-troublesome VA–is anyone’s guess. This Editor has previously speculated that health systems with Cerner EHRs were not going to be enthusiastic about replacing Cerner’s current third-party vendors with Oracle services and technology, especially if they worked well or if Oracle costs more. If the move to OCI–Oracle Cloud Infrastructure–doesn’t go as smooth as brand new glass, another black mark in the copybook. The other would be resentment of Oracle’s announced and completely expected hard sell on other services to make up the cost of the pearl. [TTA 15 June]

Almost an ideal scenario for Epic to sell against, one would think. As for the VA, Oracle needs to fix the Cerner Millenium rollout now under heavy scrutiny–fast and right.