It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding.

The doors were blown off funding last quarter, so whither the year? Our first take 10 January on Rock Health’s 2018 report was that digital health was a cheery, seltzery fizzy, not bubbly as in economic bubbles.  Total funding came in at $8.1 billion–a full $2.3 bn or 42 percent–over 2017’s $5.7 bn, as projected in Q3 [TTA 11 Oct]–which indicates confidence and movement in the right direction.

What’s of concern? A continued concentration in funding–and lack of exiting.

  • From Q3, the full year total added $1.3 bn ($6.8 bn YTD Q3, full year $8.1 bn) 
  • The deals continue to be bigger and fewer–368 versus 359 for 2017, barely a rounding error
  • Seed funding declined; A, B, C rounds grew healthily–and D+ ballooned to $59M from $28M in 2017, nearly twice as much as C rounds
  • Length of time between funding rounds is declining at all levels

Exits continue to be anemic, with no IPOs (none since 2016!) and only 110 acquisitions by Rock Health’s count. (Rock only counts US only deals over $2 million, so this does not reflect a global picture.)

It’s not a bubble. Really! Or is it a developing one? Most of the article delivers on conclusions why Rock Health and its advisors do not believe there is a bubble in funding by examining six key attributes of bubbles. Yet even on their Bubble Meter, three out of the six are rated ‘Moderately Bubbly’–#2, #3, and #5–my brief comments follow. 

  1. Hype supersedes business fundamentals (well, we passed this fun cocktail party chatter point about 2013)
  2. High cash burn rates (not out of line for early stage companies)
  3. Unclear exit pathways (no IPOs since ’16 which bring market scrutiny into play. Oddly, Best Buy‘s August acquisition of GreatCall, and the latter’s earlier acquisitions of Lively and Healthsense didn’t rate a mention)
  4. Surge of cash from new investors (rising valuations per #5–and a more prosperous environment for investments of all types)
  5. High valuations decoupled from fundamentals (Rock Health didn’t consider Verily’s billion, which was after all in January)
  6. Fraud or misuse of funds (Theranos, Outcome dismissed by Rock as ‘outliers’, but no mention of Zenefits or HealthTap)

Having observed bubbles since 1980 in three industries– post-deregulation airlines in the 1980s, internet (dot.com) in the 1990s, and healthcare today (Theranos/Outcome), ‘moderately’ doesn’t diminish–it builds to a peak, then bursts. Dot.com’s bursting bubble led to a recession, hand in hand with an event called 9/11.

This Editor is most concerned with the #5 rating as it represents the largest divergence from reality and is the least fixable. While Verily has basically functioned as a ‘skunk works’ (or shell game–see here) for other areas of Google like Google Health, it hardly justifies a billion-dollar investment on that basis alone. $2 bn unicorn Zocdoc reportedly lives on boiler-room style sales to doctors with high churn, still has not fulfilled its long-promised international expansion, and has ceased its endless promises of transforming healthcare. Peleton is a health tech company that plumps out Rock Health’s expansive view of Health Tech Reality–it’s a tricked out internet connected fitness device. (One may as well include every fitness watch made.)

What is the largest divergence from reality? The longer term faltering of health tech/telecare/telehealth companies with real books of business. Two failures readily come to mind: Viterion (founded in 2003–disclosure, a former employer of this Editor) and 3rings (2015). Healthsense (2001) and Lively were bought by GreatCall for their IP, though Healthsense had a LTC business. Withings was bought back by the founder after Nokia failed to make a go of it. Canary Care was sold out of administration and reorganized. Even with larger companies, the well-publicized financial and management problems of publicly traded, highly valued, and dominant US telemed company Teladoc (since 2015 losing $239 million) and worldwide, Tunstall Healthcare’s doldrums (and lack of sale by Charterhouse) feed into this. 

All too many companies apparently cannot get funding or the fresh business guidance to develop. It is rare to see an RPM survivor of the early ’00s like GrandCare (2005). There are other long-term companies reportedly on the verge–names which this Editor cannot mention.

The reasons why are many. Some have lurched back and forth from the abyss or have made strategic errors a/k/a bad bets. Others like 3rings fall into the ‘running out of road and time’ category in a constrained NHS healthcare system. Beyond the Rock Health list and the eternal optimism of new companies, business duration correlates negatively with success. Perhaps it is that healthcare technology acceptance and profitability largely rests on stony, arid ground, no matter what side of the Atlantic. All that money moves on to the next shiny object.(Babylon Health?) There are of course some exceptions like Legrand which has bought several strong UK companies such as Tynetec (a long-time TTA supporter) and Jontek.

Debate welcomed in Comments.

Related: Becker’s Hospital Review has a list of seven highly valued early stage companies that failed in 2018–including the Theranos fraud. Bubble photo by Marc Sendra martorell on Unsplash

3rings’ well-handled transition to their March shutdown (updated)

In late summer [TTA 19 Sep] we learned that one of the most innovative UK companies in sensor-based assistive technology, 3rings, was ceasing operations as of March 2019’s end. We noted it was a planned shutdown that gave subscribers nearly six months to switch over to other technologies. Steve Purdham and his team have recommended three companies that in their estimation are good alternatives to 3rings in both their original electrical Plug (electric usage as a proxy for being up and around) and cloud-based IoT service. Three companies are recommended in detail based on needs. 3rings presents all three in detail with special offers, including a handy ‘how to’ on transitioning services.

  1. Clever Contact from Alertacall–a daily contact and reminder service
  2. Canary Care--motion sensor/IoT service which is fairly close to the way that 3rings developed. Canary Care has reorganized since last summer with new ownership [TTA 8 Nov].
  3. PPP Taking Care–pendant alarm

When asked to comment on Canary Care’s recent release (PDF) related to their service as a close fit to 3rings, Steve remarked that “As we plan our graceful close the key for us was to give all our customers significant notice of our intentions (almost 6 months) and where possible provide guidance as to ways forward. We also wanted to help as many of our customers to transition to technologies that would help them continue looking after their loved ones after March 1st 2019. Looking after all our customers means a lot to us so providing this help made sense. The team at Canary wanted to do a press release regarding their deal and I was happy to support it.”

The 3rings closing is regrettable, but the transition of their services to protect their customers deserves a ‘Well Done’. (Undoubtedly we will be hearing from Steve and the 3rings team in future.) Hat tip to Steve, Nicola Hughes of Canary Care/Lifecycle Software, and James Batchelor of Alertacall.

Canary Care re-emerges as Canary Care Global Ltd, confirms continued operations

imageCanary Care, which entered administration in late August, has been reorganized and continues as Canary Care Global Ltd, remaining in Abingdon. The purchaser in the pre-packaged sale, as Readers learned here, is Lifecycle Software Ltd. Their marketing office sent a release last week confirming their operations. Stuart Butterfield, who answered our inquiries in September, is now managing and technical director. He is quoted in the release: “This is a really positive development for our company. We will continue to provide the Canary Care product and service that our existing customers know and love. Our new owner provides us with the stability and resources to further enhance the Canary Care offering and we’re very excited and optimistic about the future and the opportunity to bring Canary Care to a wider audience.”

The administrator’s latest filing with Companies House is clearly a wrapup of the sale as the best possible outcome for the company. Shareholders included major investor Mercia Fund Management. A quick read of the administrator’s proposal is an object lesson how quickly an insolvency can happen. In section 2, the company went from seeking fresh funding to expand markets in May, having been turned down by Mercia due to their funding criteria, to having an interested buyer who ultimately was not approved by the shareholders by a hairsbreadth, to insolvency by August.

We do wish Canary Care luck with their new ownership and success in this very difficult time for acceptance of –and payment for–telecare and TECS services. Release (PDF) Hat tip to Nicola Hughes of Lifecycle Software

3rings assistive tech will be ringing off next March (UK) (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/02/3rings-logo-only.jpg” thumb_width=”150″ /]Another assistive technology/TECS company decides that they have reached the end of the road.

Mark Smith, one of our Readers and Business Development Director of 3rings, which has been featured more than a few times in these pages over the past six years from Kickstarter days, this morning passed along the sad news that 3rings is closing. From Steve Purdham, the founder and chairman (and updated by him today 19 September):

It is with great regret and sadness that we have to inform you that we will be bringing the 3rings Care plug and Internet of Things sensor service to a close. 

After a journey of 6 years we have taken this decision because the technology adoption within the Social care market is extremely slow moving, which means that we are not able to attain a sustainable business model that would give the quality, and daily operational support that we believe is the minimum we would expect to deliver, to look after you, our customers.

Our customers including individuals, regional council’s and housing association’s that use 3rings as a safety net of care, are very important to us and this is the reason why we haven’t waited until the last moment to notify you of our decision.

With this in mind, we will be maintaining support for the 3rings care service, including the Plug and IOT sensors platform until Friday 1st March 2019.

Given the extended notice period we feel that this provides enough time for you to make alternative arrangements.

The 3rings team strongly believe in the world of IoT sensors and true digital solutions to provide a safety net of care, 3rings has always evangelised this as our goal, we know that digital safety nets of care will change the face of social care in the future. With that in mind we are still exploring alternatives and should anything change we will inform you at the earliest opportunity.

We are truly sorry to have to deliver this message, but can I personally thank you for your support, we are immensely proud to have helped so many families and vulnerable people, and to have saved lives through the 3rings service.

Your support for the 3rings product range made a massive difference, and we thank you for your understanding and commitment to providing to the safety net of care for your loved ones or clients.

Should you wish to clarify anything or have any comments then please don’t hesitate to contact me directly either by email on steve@3rings.co.uk or call me on 01260-222853 or my mobile 07899 803555.

Yours sadly
Steve
Steve Purdham · Chairman

Steve, in his separate note to this Editor, explained that they chose this four-month-plus winding down in order to responsibly look after their customers so that they have enough time to transition to other monitoring systems. Individual users of 3rings will be separately notified as well.

It was, as Mark said, a shock, but as this Editor noted in the Canary Care article from earlier today, in many ways the TECS/AT/telehealth business has not progressed much since 2006. The funding, technology, and consumer acceptance are all better since the early 2000s, but there is a lot more competition with not enough market takeup to warrant it. Even 3rings’ integration with the very trendy Amazon Echo and the IoT space showed innovation, but not the reward.

The social care area is more developed in the UK than the US as a concept. In the US, we speak more about ‘social determinants of care’, with one determinant–transportation–getting most of the action and the money. When you look at the truly disproportionate amounts of investment in certain hot companies with sexy tech, for instance a few ‘unicorns’–the now expired Theranos being the Poster Child–where far smaller amounts funding tech that works in real companies with real customers would do immediate good and would change things in the long term (longer than 18 months, which is the usual VC horizon), one wonders if we haven’t gone a little bonkers.

Yet those of us in the industry remain hopeful. As Steve Purdham said to me in a separate note, “the market has all the tools to change face of social care but the families and the existing structures are so glacial in the acceptance of this change. It will come and it will make a massive difference when it does.” We’re all trying.

We wish Steve, Mark, and the 3rings team all the best–and perhaps a White Knight will Save the Plug. Hat tip to Gerry Allmark of UK Telehealthcare as well for the information.

Canary Care goes into administration, is acquired by Lifecycle Software (UK)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/09/Canary-Care.jpg” thumb_width=”150″ /]Abingdon-based Canary Care, a developer and marketer of wireless sensor-based home health monitoring systems, has gone both into administration (the closest US equivalent is Chapter 11 bankruptcy) and been acquired by Lifecycle Software Ltd., a developer of CRM and billing software for telecommunications, internet service providers, and utility companies. In US terms, this is basically a pre-packaged bankruptcy.

According to their listing on Companies House, the administration started on 31 August. At the end of August, Lifecycle acquired the company (5 September press release). The Lifecycle website now features that Canary Care will be ‘keeping your dearest nearest’.

Stuart Butterfield, a Canary Care director as well as interim managing and technical director, was kind enough to answer my inquiry about the company’s status with a message that expressed a great deal of hope:

So, we’re still very much alive, and will continue to provide the Canary Care product and service that our existing customers know and love. As you will be aware, adoption of TECS is painfully slow. However, our new owner provides us with the stability and resources to continue to develop the Canary Care offering and we’re very excited and optimistic about the future and the opportunity to bring Canary Care to a wider audience.

Innovative assistive technology/TECS, despite the investments by major players, remains a difficult area for funding and adoption not only in the UK but also in the far larger market of the US and Canada. While we see a Best Buy acquiring GreatCall, we’re also reminded that GreatCall picked up the remnants of Lively for the IP and Healthsense for their assisted living customers and for the technology. The “name” health tech companies of the early ’00s are largely gone or no longer independent (Viterion, Living Independently, HealthSpot, Cardiocom, WellAware…)

In many ways, we have not progressed much from, say, 2007, in the field, except for tech advances and the number of players.

We wish Canary Care and Lifecycle success–and the patience they will need with this market. Hat tips first to a UK industry insider who alerted this Editor, as well as Gerry Allmark, managing director of UK Telehealthcare for help in sourcing Companies House.