TTA’s Summer Unlockdown: Walgreens-VillageMD deal, digital health funding breaks record, Fitbit shines unflattering light on Google, Doctor on Demand’s rich Series D, KCC’s videophone initiative

 

 

Not many stories this week, but they were all eventful. US digital health funding broke last year’s record after a shaky start, not including Doctor on Demand’s Series D. It took a while, but Walgreens’ struck hard with VillageMD primary care deal. Google may be stumbling with little Fitbit. And KCC innovates with video’phone’ tablets. 

News Roundup: Doctor on Demand’s $75M Series D, Google’s Fitbit buy scrutinized, $5.4 bn digital health funding breaks record (Three big stories)
Kent County Council announces videophones for vulnerable residents in £1.5 million COVID response initiative (UK) (2,000 of them)
Walgreens Boots goes big with billion-dollar medical office deal with VillageMD (See the competition move–and raise ’em)

No fireworks near your Editor except illegal ones, but we have a few legal ones on hand. Ransomware is sending up mortars. COVID’s effect on telehealth is a flitter-glitter comet, but patient counts to date misfire. Samsung starbursts tele-genomics. We’re waving sparklers for the SURE Recovery app from King’s College London. And telehealth celebrated with some nifty Roman candles from the FCC, but Huawei and ZTE were sent the smoke bombs. Happy US Independence Day (a/k/a The Colonial Rebellion)–a day early!

News roundup: Teladoc closes InTouch, Samsung bets on tele-genomics, SURE Recovery app, Optimize.health’s seed round, Walgreens’ Microsoft boost
Hackermania runs wild, Required Reading Department: The Anatomy of a Ransomware Attack (Weekend reading for you and your IT department)
Do Huawei and ZTE present security threats to the US and global communications networks? The FCC says yes. (Recognizing geopolitical reality)
FCC approves 70 more COVID-19 telehealth funding applications for an additional $32 million (A major support for growth for small to large organizations)
Hackermania runs wild…all the way to the bank! Ransomware strikes Crozer-Keystone, UCSF med school, others (Hackers in their basements didn’t break for COVID)
COVID effect on US practices: in-person visits down 37%, telehealth peaks at 14%; ATA asks Congress to make expansion permanent (Patients still not visiting their doctors, virtual or not)
The TeleDentists now in 14 states with Anthem (Recognition of an oft-forgotten but key part of medicine)

On the First Day of Summer, there’s hot news with NHS finally giving up on its NHSX COVID tracing app and a few changes over at NHSX. Otherwise, we observe some semblance of a return to Business As Usual. A former unicorn goes bankrupt, a telecare company brings out a new product, the VA has more drama around its EHR. But still plenty of COVID related news, including its hopefully permanent telehealth stimulus, without any drugs!

Breaking: NHSX COVID contact tracing app exits stage left. Enter the Apple and Google dance team. (Not a surprise to anyone, and some changes made)

News Roundup (updated): Proteus files Ch. 11, VA’s EHR tests now fall–maybe, making US telehealth expansion permanent, Rennova’s rural telehealth bet, Oysta’s Lite, Fitbit’s Ready to Work jumps on the screening bandwagon
Where in the world is the NHS COVID contact tracing app? Apps rolling out globally, but will they roll out before it’s treatable?
(Apps have problems, but the protocols are getting better every day)

Despite other events, COVID still makes the news. Malcolm Fisk and his team studied how telehealth responded at the start of the pandemic in three countries. The ‘Thank And Praise’ virtual wall continues to accept thanks for healthcare workers. ATA’s now virtual conference may have been boosted by other cancellations. And finally, COVID struck the courts and held up the Cigna-Anthem breakup settlement–only three years in the making!

Another COVID casualty: a final decision on the Cigna-Anthem damages settlement (It’s only 3 years and billions at stake!)
ATA’s annual conference now 22-26 June–and fully virtual; announces three awards and Fellows (Plenty of names from US, UK, EU)
Thank and Praise’ to healthcare workers continues (UK) (A service that deserves notice for its graciousness)
Telehealth and the response to COVID-19 in Australia, UK, and US: the paper (Malcolm Fisk and team’s comparative study)

Gasping under our fabric masks, we are wheezing the Almost Summertime Blues. Is NHS a little blue with its unready contact tracing app and having to do things the Old Fashioned Way? Higi is not at all blue with a $30 million Series B infusion led by–Babylon Health–nor Propeller Health, 34 EU health tech startups, and Amazon. Google’s attorneys will roast in an Arizona summer. And finally, BMJ discovers that masks might make your breathing a lot more difficult–and concentrate whatever virus you’re exhaling.

Babylon Health leads a $30 million Series B for Higi health kiosks (An interesting series–of mutual interests in the US of A)
News roundup: LabCorp CRO boosts Medable, Propeller Health gains 510(k), EU’s 34 medtech startups, Amazon’s healthcare moves, Google’s Arizona privacy lawsuit
NHS’ COVID contact tracing service started today–but where’s the app? Australia?
(Looks like the old fashioned un-digital way)
Why ‘masking up’ isn’t such a great idea–more than a false sense of security (And 6 other reasons why)

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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

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News Roundup: Doctor on Demand’s $75M Series D, Google’s Fitbit buy scrutinized, $5.4 bn digital health funding breaks record

More evidence that telehealth has advanced 10 years in Pandemic Time. Doctor on Demand, estimated to be the #3 telemedicine provider behind Teladoc and Amwell, announced a Series D raise of $75 million, led by VC General Atlantic plus their prior investors. This increases their total funding to $240 million.

Unlike the latter two, DOD actively courts individual users in addition to companies and health plans. In May, they announced that they were the first to be covered under Medicare Part B as part of the CMS expansion of telehealth services in response to the pandemic (and for the duration, which is likely to be extended past July), which would reach 33 million beneficiaries. Other recent partnerships include a pilot with Walmart for Virtual Primary Care in three states (Colorado, Minnesota, Wisconsin) in conjunction with Grand Rounds and HEALTHScope Benefits as well as with Humana for On Hand Virtual Primary Care (regrettably only a video clip on the DOD press site with the noisome Jim Cramer). DOD covers urgent, chronic, preventative care, and behavioral health and claims about 98 million users, doubled the number of covered lives in 1st half 2020, and passed 3 million visits. Crunchbase NewsMobihealthnews

Google’s Fitbit acquisition scrutinized by EU and Australia regulators, beaten up by consumer groups in US, EU, Canada, Australia, and Brazil. None too happy about this acquisition is a swath of powerful opponents.

  • EU regulators have sent 60-page questionnaires to both Google and Fitbit competitors asking re the effect the $2.1 bn acquisition will have on the wearables space, whether it will present disadvantages to competitors in Google’s Play store, and how Google will use the data in their advertising and targeting businesses. While #2 and 3 are no-brainers (of course it will present a competitive disadvantage! of course, they’ll use the data!), it signals further investigation. The next waypost is 20 July where EU regulators will present their decision.
  • The Australian Competition and Consumer Commission (ACCC) announced in mid-June their concerns in a preliminary decision, though they don’t have the jurisdiction to block it. “Buying Fitbit will allow Google to build an even more comprehensive set of user data, further cementing its position and raising barriers to entry to potential rivals,” according to ACCC Chairman Rod Sims. This adds to the controversy Down Under on how Google and other internet companies use personal information. Final statement is 13 August. Reuters
  • The US Department of Justice is also evaluating it, as is the Federal Trade Commission. But an acquisition like this doesn’t easily fall under antitrust regulation as Google and Fitbit aren’t direct competitors. Fitbit has only about 5 percent of the fitness wearable market. However, this plays into another related investigation by DOJ — Google’s abuse of advertising data and its dominance of the market in tech tools such as Google Ad Manager in the US. DOJ asked competitors for information at the end of June. There are separate investigations by state attorneys general and also by Congress of Google and Apple. Reuters
  • The consumer group opposition rounds up the usual suspects like Open Markets Institute, Omidyar Network, Center for Digital Democracy, Open Knowledge and Public Citizen in the US, and in the EU Open Society European Policy Institute and Access Now. Their grounds expressed in a letter to regulators in the above countries are the usual dire-sounding collection of “exceptionally valuable health and location datasets, and data collection capabilities.” Sound and fury….

It will keep Google’s attorneys in DC, Brussels, and elsewhere quite busy for a lot longer than perhaps Google anticipated. Meanwhile, Fitbit is in the Twilight Zone. The Verge, Android Authority, FierceHealthcare 

US digital health companies smash funding records in 1st half 2020. Despite–or because of–the pandemic, US digital health investment funding tracked by Rock Health is at a torrid pace of $5.4 bn–$1.2 bn above the record first half posted in 2019.  That is despite a pullback in 1st Q + April.

Investors came roaring back in May and June, spurred by telehealth success and a rallying market, closing 2nd Q with $2.4 bn in investment. That was 33 percent higher than the $1.8 bn quarterly average for the prior three years. And the deals were big: on average $25.1 million, with the big boosts in Series C and bridge financing. M&A is still cloudy, but what isn’t? Notably, Rock Health is not projecting a final year number, a good move after they stubbed their collective toe on last year’s final investment total, down from both forecast and 2018. [TTA 7 Feb]

The big moves of 1st half in real digital health (not fitness) were Teladoc-InTouch Health (just closed at $600 million stock and cash) and Optum-AbleTo (at a staggering $470 million, which has apparently not moved past the ‘advanced talks’ state). Two of last year’s Big IPOs–Phreesia and Livongo— are doing just fine; Health Catalyst not so much. The bubble bath we predicted turned out to be a cleansing one–but there’s six months more to go. Also Mobihealthnews

News Roundup (updated): Proteus files Ch. 11, VA’s EHR tests now fall–maybe, making US telehealth expansion permanent, Rennova’s rural telehealth bet, Oysta’s Lite, Fitbit’s Ready to Work jumps on the screening bandwagon

Proteus Health, the company which pioneered what was initially derided as a ‘tattletale pill’, filed Chapter 11 bankruptcy today (16 June). As early as December, their layoffs of nearly 300 and closure of several sites was a strong clue that, as we put it, Proteus would be no-teous without a big win. Exactly the opposite happened with the unexpected early end of their Otsuka partnership with Abilify [TTA 17 Jan]. Proteus had raised about $500 million in venture capital from Novartis plus technology investors and family offices. Their combination of a pill with an ingestible sensor, a patch that detects ingestion and that sends information to a smartphone app was ingenious, but in a business model was meant for high-cost medications. Proteus’ current partnerships include TennCare (TN Medicaid), plus Xealth and Froedtert to integrate medication information into electronic health records. At one point, Proteus was valued at $1.5 bn by Forbes, making it one of the early healthcare unicorns.  CNBC, FierceHealthcare

VA further delayed in implementing Cerner-Leidos EHR. POLITICO’s Morning eHealth earlier this month reported from congressional sources that further testing would be delayed to the fall at the earliest and possibly 2021. The project to replace VistA stands at $16 bn. Contributing to delay was an April COVID outbreak in Spokane at a veterans’ home, which pushed patients into the VA medical center. 

In further DC news, several senators are advocating that the relaxing of restrictions on telehealth during COVID should largely be made permanent. According to the lead senator, Brian Schatz (D-HI), Medicare beneficiaries using telehealth services increased 11,718% in 45 days. Many telehealth requirements were waived, including geographic, coding of audio-video and telephonic telehealth billing, and HIPAA platform requirements. Other senators are introducing bills to support remote patient monitoring programs in community health centers’ rural health clinics. FierceHealthcare

The climate for telehealth has improved to the point where smaller players with side bets are now betting with bigger chips. Rennova Health, a mid-South healthcare provider with a side in software, is merging its software and genetic testing interpretation divisions, Health Technology Solutions, Inc. (HTS) and Advanced Molecular Services Group, Inc., (AMSG) with TPT Global Tech. The combined company will be called InnovaQor after an existing subsidiary of TPT and plans to create a next-generation telehealth platform targeted to rural health systems. Release, Becker’s Hospital Review

Oysta Technology has launched the Oysta Lite with an SOS button, GPS, safety zone mapping for travel, and two-way voice. The SOS connects to their IntelliCare platform which provides status monitoring, reporting, and device management plus connecting to the telecare service provider. They are specifically targeting post-lockdown monitoring of frail elderly.  Press flyer/release.

Fitbit jumps on the crowded COVID workplace screening bandwagon with Ready to Work, a employer-sponsored program that uses individual data collected via the Fitbit device such as resting heart rate, heart rate variability and breathing rate. Combined with self-reported symptoms, temperature, and potential exposure, the Daily Check-In app then provides guidance on whether the employee should go to work or remain at home. According to the Fitbit release, a higher heart rate–as little as two beats a minute–can be indicative of an immune system response before the onset of symptoms. TTA has earlier reported [19 May] on other COVID workplace screeners such as UHC/Microsoft’s ProtectWell app, Appian, and (in-house) PWC. FierceHealthcare also lists several others on the cart: Castlight Health, Collective Health, Carbon Health, VitalTech, and Zebra Technologies. However, at this stage, few employees are leaving remote work for in office, and fewer still may even return to the office.

Considering 2019’s digital health investment picture: leveling off may be a Good Thing

2019 proved to be a leveling-off year for digital health investment. The bath may prove to be more cleansing than bubbly.

We noted that the always-fizzy Rock Health engaged in some revisionist history on its forecasts when the final numbers came in–$7.4bn in total investment and 359 deals, a 10 percent drop versus 2018. When we looked back at our 2019 mid-year article on Rock Health’s forecast [TTA 25 July], they projected that the year would end at $8.4 bn and 360 deals versus 2018’s $8.2 bn and 376 deals. That is a full $1bn under forecast and $0.8 below 2018. Ouch!

In their account, the 10 percent dip versus 2018 is due to average deal size–decreasing to $19.8M in 2019–and a drop in late-stage deals. Their analysts attribute this to wobbliness around some high-profile IPOs, citing Uber, Lyft, and Slack, as well as the near-collapse of WeWork right before its IPO towards the end of 2019.

New investors and repeat investors increased to 627 from 585 in 2018, with no real change in composition.

The headliners of 2019 were:

  • Amazon’s acquisition of Health Navigator adding symptom-checking tools to its health offerings
  • Google’s buy of Fitbit
  • Optum’s purchase of Vivify Health, which gives it a full remote patient monitoring (RPM) suite (right when CMS is setting reimbursement codes for RPM in Medicare)
  • Best Buy’s addition of Critical Signal Technologies for RPM
  • Phreesia, Livongo’s and Health Catalyst’s IPOs. For Livongo and Health Catalyst, current share prices are off from their IPOs and shortly after: past $25 for LVGO and $31 for HCAT. Phreesia closed today at a healthy $33, substantially up from PHR’s debut at $15. (Change Healthcare, on the other hand, is up a little from its IPO at $16, which isn’t bad considering their circumstances on their financing.)

Rock Health only counts US deals in excess of $2 million, which excludes the global picture, but includes some questionable (in this Editor’s estimation) ‘digital health’ players like Peloton, explained in the 25 July article.

Rock Health’s analysts close (and justify their revisions) through discussions with VCs expecting further headwinds in the market–then turn around and positively note the Federal backing of further developments in building the foundation for connected health as tailwinds. No bubbly forecasts for 2020–we’ll have to wait.

Is this necessarily bad? This Editor likes an occasional dose of reason and is not displeased at Rock Health’s absence of kvelling.

Confirming the picture is Mercom Capital’s analysis which also recorded a 6 percent dip 2019/2018: $8.9bn with 615 deals, dropping from the $9.5bn and 698 deals in 2018. Their ‘catchment’ is more global than Rock Health, and encompasses consumer-centric and patient-centric technologies and sub-technologies. Total corporate funding reached $10.1bn.

News roundup: Proteus may be no-teous, DOJ leads on Google-Fitbit, HHS’ mud fight, Leeds leading in health tech, malware miseries, comings and goings

Proteus stumbles hard, cuts back. The original ‘tattle-tale pill’ company, Proteus Digital Health, plans to lay off 292 people in the San Francisco Bay Area and to permanently close its three Redwood City and Hayward locations, starting 18 January, according to notices sent to California state and local offices, including the state employment development department. It is unclear where Proteus will be located after the closures.

This followed after Proteus failed to launch a twelfth funding round of $100 million. According to reports, they furloughed most of their employees for two weeks in November and are reorganizing. This is after a substantial number of investors have put in about $487M in funding through a Series H (Crunchbase), including a game-changing investment by Novartis dating back to 2010.  Proteus achieved unicorn status about three years ago, but its high-priced pill tracking technology with a pill sensor tracked by a skin-worn monitor reporting into a smartphone has a built-in limited market to expensive medication. Otsuka Pharmaceutical in 2017 partnered with Proteus for an FDA-cleared digital medicine system called Abilify MyCite that basically put an off-patent behavioral drug back into a more expensive tracking methodology. But Proteus remains a great idea on tracking compliance in search of a real market, and may not have much of a future. San Jose Mercury News, CNBC

But ingestible detectable pills are still being tested. On Monday, as Proteus’ bad news broke, eTectRx announced its FDA clearance of the ID-Cap System and its testing at Brigham and Women’s Hospital and Fenway Health, focusing on HIV medication when used for treatment and prevention. Release, HISTalk

Department of Justice taking the lead on scrutinizing Google’s Fitbit acquisition. The Federal Trade Commission also sought jurisdiction over the transaction. According to the New York Post, “both agencies are concerned that a Google-owned Fitbit would give the search giant an even bigger window into people’s private data, including sensitive health information, sources said. Under the Hart-Scott-Rodino Act, all large mergers must file proposals with both the DOJ and the FTC, but only one antitrust agency reviews the merger.”

Coal from stockings being thrown about at HHS. According to POLITICO and the New York Times, the disagreements between Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), and the Cabinet-level Secretary of Health and Human Services (HHS), Alex Azar, have boiled over, enough to have to be settled by the President’s acting chief of staff, Mick Mulvaney. According to the Times, both President Trump and VP Mike Pence have told them to find a way to work together. Both are administration appointees, but President Trump has not been reluctant to cut a mis-performing or overly contrary appointee loose. The latest salvo from those obviously not on Ms. Verma’s side was the revelation that she requested compensation for jewelry stolen on a business trip, contrary to government policy of course. She was compensated for other items which is standard. (Isn’t that what homeowners’ insurance is for? And what sensible person actually travels with valuable jewelry?) Under Ms. Verma, CMS has been quite progressive in developing new business models in Medicare fee-for-service, moving providers to two-sided risk, and innovating in both Medicare and Medicaid. It will either be settled, or one or both will be gone. Pass the popcorn.

Leeds picks up another health tech company. Mindwave Ventures is opening an office there, as well as appointing Dr Victoria Betton and Dr Janak Gunatilleke to the roles of chief innovation officer and chief operating officer. Mindwave develops technologies around digital products and services in healthcare and health research. Leeds reportedly is home to over 250 health tech companies and holds an annual Leeds Digital Festival in the spring [TTA 11 April].

Ransomware attack hits Hackensack Meridian. Systems were down for about a week. While this large New Jersey health system hasn’t admitted it, sources told the Asbury Park Press that it was ransomware. And if it’s not ransomware, its Emotet and Trickbot. Read ZDNet and be very apprehensive for 2020, indeed, as apparently healthcare is just one big target.

Comings and Goings: There may be some end of year bombshells, but after last week’s big news about John Halamka, it’s been fairly quiet. Paul Walker, whom this Editor knew at New York eHealth Collaborative, has joined CommonWell Health Alliance as executive director. Mr. Walker was most recently Philips Interoperability Solutions’ vice president of strategy and business development. CommonWell’s goal is improving healthcare interoperability and its services are used by more than 15,000 care provider sites nationwide. Blog release, Healthcare Innovation ….Dr. Jacqueline Shreibati, the chief medical officer for AliveCor, is joining Google Health in the health research area. Mum’s the word when it comes to Fitbit (see above). CNBC ….Peter Knight has pleaded guilty to falsifying educational credentials to gain his position as chief information and digital office at Oxford University Hospitals NHS Foundation Trust. He held that position from August 2016 until September 2018. BBC News

Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, off a bridge too far?

Breaking News. Has this finally blown the lid off Google’s quest for data on everyone? This week’s uncovering, whistleblowing, and general backlash on Google’s agreement with Ascension Health, the largest non-profit health system in the US and the largest Catholic health system on the Planet Earth, revealed by the Wall Street Journal (paywalled) has put a bright light exactly where Google (and Apple, Facebook, and Amazon), do not want it.

Why do these giants want your health data? It’s all about where it can be used and sold. For instance, it can be used in research studies. It can be sold for use in EHR integration. But their services and predictive data is ‘where it’s at’. With enough accumulated data on both your health records and personal life (e.g. not enough exercise, food consumption), their AI and machine learning modeling can predict your health progression (or deterioration), along with probable diagnosis, outcomes, treatment options, and your cost curve. Advertising clicks and merchandising products (baby monitors, PERS, exercise equipment) are only the beginning–health systems and insurers are the main chance. In a worst-case and misuse scenario, the data modeling can make you look like a liability to an employer or an insurer, making you both unemployable and expensively/uninsurable in a private insurance system.

In Google’s latest, their Project Nightingale business associate agreement (BAA) with Ascension Health, permissible under HIPAA, allowed them apparently to access in the initial phase at least 10 million identified health records which were transmitted to Google without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names and dates of birth. This transfer and the Google agreement were announced by Ascension on 11 November. Ultimately, 50 million records are planned to be transferred from Ascension in 21 states. According to a whistleblower on the project quoted in The Guardian, there are real concerns about individuals handling identified data, the depth of the records, how it’s being handled, and how Google will be using the data. Ascension doesn’t seem to share that concern, stating that their goal is to “optimize the health and wellness of individuals and communities, and deliver a comprehensive portfolio of digital capabilities that enhance the experience of Ascension consumers, patients and clinical providers across the continuum of care” which is a bit of word salad that leads right to Google’s Cloud and G Suite capabilities.

This was enough to kick off an inquiry by Health and Human Services (HHS). A spokesperson confirmed to Healthcare Dive that “HHS’ Office of Civil Rights is opening an investigation into “Project Nightingale.” The agency “would like to learn more information about this mass collection of individuals’ medical records with respect to the implications for patient privacy under HIPAA,” OCR Director Roger Severino said in an emailed statement.”

Project Nightingale cannot help but aggravate existing antitrust concerns by Congress and state attorneys general on these companies and their safeguards on privacy. An example is the pushback around Google’s $2.1 bn acquisition of Fitbit, which one observer dubbed ‘extraordinary’ given Fitbit’s recent business challenges, and data analytics company Looker. DOJ’s antitrust division has been looking into how Google’s personalized advertising transactions work and increasingly there are calls from both ends of the US political spectrum to ‘break them up.’ Yahoo News

Google and Ascension Health may very well be the ‘bridge too far’ that curbs the relentless and largely hidden appetite for personal information by Google, Amazon, Apple, and Facebook that is making their very consumers very, very nervous. Transparency, which seems to be a theme in many of these articles, isn’t a solution. Scrutiny, oversight with teeth, and restrictions are.

Also STAT News , The Verge on Google’s real ambitions in healthcare, and a tart take on Google’s recent lack of success with acquisitions in ZDNet, ‘Why everything Google touches turns to garbage’. Healthcare IT News tries to be reassuring, but the devil may be in Google’s tools not being compliant with HIPAA standards.  Further down in the article, Readers will see that HIPAA states that the agreement covers access to the PHI of the covered entity (Ascension) only to have it carry out its healthcare functions, not for the business associate’s (Google’s) independent use or purposes. 

News and event roundup: Amazon PillPack, Humana joins CTA, NH’s telemedicine go, Fitbit Lives Healthy in Singapore, supporting Helsinki’s older adults, events

Now that we are past the unofficial end of summer, it’s time to spin that lasso and rope us some news.

Amazon’s PillPack loses a critical data partner. Electronic prescriptions clearinghouse Surescripts terminated their data contract with ReMy Health, which supplied PillPack with information on patients’ prescriptions. Surescripts found fraud in several areas of their relationship with ReMy Health including medication history, drug pricing, and insurance billing. Now PillPack has to obtain it the old-fashioned way–by asking the patient. This can lead to errors and inaccuracies in things like dosages and whether a drug is brand-name or generic. Now PillPack, in the lurch, is seeking a direct relationship with Surescripts. Seeking Alpha, CNBC

Health plan Humana is the first payer to join the Consumer Technology Association (CTA). Humana has been building up his data analytics and digital health capabilities with new ‘studios’ in Boston and hiring USAA’s CTO.  It’s piloting an app for Medicare Advantage patients to connect them with pharmacists and medication management via Aspen RxHealth plus working on a virtual digital primary model with telemedicine provider Doctor on Demand. Fierce Healthcare

New Hampshire is joining the telemedicine reimbursement bandwagon, with its legislature and Gov. Sununu approving primary care providers and pediatricians to bill Medicaid and private insurance for telemedicine visits starting in January 2020. This also ties into rural telehealth. AP, Mobihealthnews

Internationally….Fitbit is partnering with Singapore’s Health Promotion Board (HPB) for the Live Healthy SG behavioral change program, based on the Fitbit Premium program, starting in late October. Mobihealthnews A-P   In Finland, Digital Service Center Helsinki is creating digital tools and virtual care systems to enable older adults to safely and independently live at home, including socialization to prevent loneliness. It’s a significant challenge as over 22 percent of Finland’s population is over 65. Mobihealthnews Europe-UK

Events:

The 9th International Digital Public Health Conference series (#DPH2019), 20-23 November, Marseille, France. This conference is billed as the digital health partner of the 12th European Public Health Conference and brings together the areas of public health, computer and data science, medtech, and NGOs. Conference information here.

Aging 2.0 New York Global Innovation Showcase 4 December, NYC. One of a series of global Aging 2.o events, startups will present aging-focused innovations. Want to pitch? It’s still open–apply here. Register to attend here. Additional information on this and on CREATE’s Design for Older Adults Workshop on 21-22 October at Weill Cornell is here.

 

Can chronic disease apps get adopted? Is it as simple as four steps? HBR states the obvious.

“Why Apps for Managing Chronic Disease Haven’t Been Widely Used, and How to Fix It” is an enticing title, and in the Harvard Business Review no less.

Here’s the advice that two Harvard Business School professors have for app developers. First, find an organization–an employer, an integrated health system that includes a payer–that’s willing to pay for your app. Then work the “adopt-diffuse-use-improve” cycle. Get them to adopt it, diffuse it through potential users (as in getting them to try the app), get them to continue using it, and improve the product.

You have to sled through about 500 words of exposition to get to this conclusion, obvious to anyone who’s worked in the field more than a couple of months. And oh, as if these steps were so easy to achieve! There’s the given example of Fitbit buying the Twine Health tracking/coaching app in a bid for a more integrated chronic disease management (CDM) approach–for those who’ve tracked Fitbit, and even the professors, its success remains to be seen. 

There are some nuggets of confirmation useful for presentations, such as you can’t generally sell monitoring apps direct to consumer because managing chronic disease is largely something to be avoided, except for the few with a different attitude, and most believe that insurers should pay for them at least in part. For clinicians, reimbursement and the differential between remote patient monitoring and in-person visits is a big factor.

What’s not mentioned: sustainable pricing that’s low enough for a health system, high enough to support a business; clinicians fitting All That Data into a clinical workflow, much less a patient record in an EHR. 

The race to develop a blood glucose skin patch monitor speeds up with UCSD pilot

Are thin-film/adhesive patch glucose monitors the thing this year? University of California San Diego Health (UCSD Health)  opened earlier this month a clinical trial of their self-adhesive ‘tattoo’ type glucose monitor. This monitor measures the glucose present in perspiration through two electrodes embedded in the thin adhesive film that apply a small amount of electrical current to make glucose molecules in the skin rise. The clinical trial sampling people with Types 1 and 2 diabetes ages 18-60 with fasting plasma glucose (FPG) > 126 mg/dL, or hemoglobin A1c (HbA1c) > 6.5%. Those in the trial will be comparing their readings from the thin film monitor with a standard glucometer through June 2019. Patients wearing the sensors will receive a minimum of two doses of pilocarpine gel to induce sweat, at fasting and at time points ranging between 15 to 200 minutes post meal. Neither the article nor the clinical trial explain the reading process.

In a Mobihealthnews interview with Patrick Mercier, codirector of UCSD’s Center for Wearable Sensors, the sensor can be produced for under $1, comparable to a blood glucose test strip.

Tattoo-type sensors and strips made the news about two-three years ago in their early stages of development and now are resurfacing with both trials and investment. Sano received $6 million from Fitbit for its combination of sensor and mobile app. The University of Bath has designed a multi-sensor patch that doesn’t need gel to raise a sweat; it measures interstitial fluid located between cells within the body-hair follicles [TTA 24 Apr]. We are rapidly moving towards less-invasive monitoring systems and better diabetes management.

End of year action: Vivify/InTouch, InTouch/TruClinic, Medtronic, NYCEDC winners, ActiveProtective, Adidas exits wearables, Fitbit (updated)

  • Dallas-based Vivify Health is partnering with California’s InTouch Health to integrate their telehealth remote patient management with InTouch Health’s acute care video consult/device platform. For InTouch, it is a move into the home by using Vivify’s Managed Kit and BYOD and related APIs. For Vivify, this helps in their post-acute RPM sell to large healthcare organizations. (Is their VA partner Iron Bow somewhere in the mix?) Their VA Home Telehealth rival Medtronic announced their partnership with American Well a few months ago [TTA 21 Oct]. InTouch release via Telecom Reseller
  • Updated. InTouch also announced their agreement on Jan 4 to purchase DTC telehealth provider TruClinic furthering their move into home telehealth. TruClinic will be merged into InTouch. Heading it up will be recently appointed EVP of Marketing and Consumer Solutions Steve Cashman, who founded and headed pioneering but overly ambitious for the market health kiosk HealthSpot [TTA roundup here]. Release  (Our update on the state of health kiosks here)
  • Speaking of Medtronic Care Management Services, MCCM touted its VA Home Telehealth ties to Healthcare Analytics News. Intriguing claim: they’ve treated 310,000 veterans since 2011 (Cardiocom, the 2011 awardee, was purchased in 2013). VA itself credits only 156,000 patients to Home Telehealth in Federal FY 2014 (the last official count), 43,000 patients in 2010 and 144,000 in 2013. A very rough estimate by this Editor is that they were about 25 percent of the veterans in the program.
  • Announced at last week’s NYC Economic Development Commission (NYCEDC) Health 2.0 Digital Health Forum attended by this Editor were the winners of the third annual NYCEDC/HITLAB’s Digital Health Breakthrough Network accelerator program for pre-revenue startups: Altopax (VR behavioral health), Navimize (doctor/hospital scheduling), Tatch (sleep quality biometrics), and PainQX (pain level monitoring). The Forum also had Digital Health Marketplace matchmaking meetings for 65 NYC-based health tech companies with prospective clients. The Marketplace furnishes competitive grants to offset the cost of piloting between growth-stage tech companies and providers. Release, MedCityNews
  • ActiveProtective‘s controversial protective airbag to cushion hips from falls by high-risk older adults [TTA 10 Jan] gained $4.7 million in Series A funding led by Generator Ventures. Mobihealthnews
  • Adidas is shuttering its wearable device development unit and condensing its offerings, focusing on the Runtastic GPS-guided exercise offering and a shopping app. It follows similar moves at Nike and Under Armour proving that big names in sports fitness clothing couldn’t pull off wearables. Mobihealthnews
  • Meanwhile, Fitbit’s Ionic continues to develop with now an App Gallery with 60 apps–11 of which are health/fitness related–and more than 100 watch faces. (Wonder if any are Mickey Mouse?) What we termed a ‘Hail Mary’ pass may actually get past the goal line. Mobihealthnews

Some quick, cheerful updates from Welbeing, CarePredict, Tunstall, Tynetec, Hasbro, Fitbit

It’s Friday, and in search of cheerful topics, here are some updates on doings from telecare, telehealth, and related companies we’ve recently noted on TTA:

Welbeing‘s opened a new head office at Technology Business Park in Moy Avenue in Eastbourne….CarePredict‘s AI for ADL system using the Tempo wearable has new implementations at LifeWell Senior Living’s community in Santa Fe, New Mexico (their third with CarePredict) and a three-year commitment with the Avanti Towne Lake community, Cypress, Texas. Dave Muoio has an interview with CEO Satish Movva on Mobihealthnews….Tunstall is partnering with Milpitas, California-based noHold’s Albert bot to create a virtual assistant for Tunstall’s mobile Smart Hub product, currently in Australia and in trials in Europe and the USA….Tynetec (advert above) has been closely associated and fundraised with the Dementia Dog Project and DogsforGood. An article in the Express highlights both in the beneficial role of pets with Alzheimers and dementia sufferers…. In robotic pet news, Hasbro is upgrading its ‘Joy for All’ companion pets through a Brown University research program, Affordable Robotic Intelligence for Elderly Support (ARIES) to add medication reminders, basic artificial intelligence, and more (Mobihealthnews)….Fitbit continues its march to a clinicalized product touting diabetes management partnerships with Medtronic and DexCom, plus clinical trials detecting sleep apnea through its SpO2 sensor. 3rd quarter sales were up 23 percent to $244 million and 40 percent from repeat purchasers, but they took an $8 million loss from a distributor (MedCityNews).

Fitbit unveils Ionic smartwatch earlier than expected. Their ‘Hail Mary’ pass?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/08/Ionic-photo.jpg” thumb_width=”150″ /]Surprisingly, Fitbit has formally unveiled today (28 August) its first smartwatch, the Fitbit Ionic, on its 10th anniversary of its first tracker. It’s a slow news week in the US, being the week before the Labor Day holiday 4 Sept and in the UK this Monday with the summer bank holiday. The announcement also feels a bit like a soft reveal in a slow period. However, the industry expected an announcement later this year, so this is considered to be positive.

There’s plenty of functionality, though the watch itself from the photos (this is Engadget’s, as the press release did not supply close up pictures) is rather brick-like on the wrist. Balancing that out is a knockout of a 1.42-inch, 348 x 250 px display, the best and brightest yet in the reviewer’s estimation. It also curves a bit through nano-molding technology (NMT) to fit more comfortably on the wrist than the previous Alta tracker.

Engadget‘s test drive of an early version of the Ionic is thorough. It confirms that Fitbit went with its own proprietary OS, contactless payment and a subscription-based custom workout guide called Fitbit Coach, a rebranded Fitstar. More functions related to healthcare are:

  • Updated heart rate monitor
  • A new SpO2 blood oxygen sensor. There’s a bit of tease in the release which gives its potential in health use: “…a relative SpO2 sensor for estimating blood oxygen levels opens the potential for tracking important new indicators about your health, such as sleep apnea”
  • Sleep tracking through monitoring pulse and movement for stages of sleep (deep, REM, light, etc.). The Engadget reviewer noted the uncertain quality of tracking.
  • Integrated connection to the new edition of the Aria weight scale (release), also due in the fall

Pricing has been set at $300/£300 with the usual extra accouterments of dress and sport bands. If you can’t wait, pre-sale starts today on Fitbit.com with retail on-sale globally starting October 2017, without a specific date. For developers, the Fitbit app software development kit (SDK) will be open to developers in September 2017. 

Will this ‘Hail Mary Pass‘ save Fitbit? Like most smartwatches, it feels like a solution in search of a problem. It depends on how many true believers will upgrade from the Alta to the Ionic, or buy this rather than an Apple Watch, where first-half sales are up 50 percent versus last year to an estimated 2-3 million new units, partly on Fitbit’s faltering back. The big roll of the dice is going with a proprietary OS. Health and other apps are dependent on developers, who are going to have to make a business decision on the watch’s sales and acceptance to commit to a one-off app. 4th Quarter sales will tell….Our earlier coverage of Fitbit and related smartwatches is here.

 

Shouldn’t we be concentrating on digital therapeutics rather than ‘health apps’?

Where the money and attention are going. The first generation of Quantified Self apps was all about viewing your data and storing it online in a vault or graphs…somewhere, usually proprietary. Your Pebble, Fitbit, or Jawbone tracked, you crunched the numbers and found the meaning. At the same time, there are wellness companies like Welltok, ShapeUp, Keas, Virgin HealthMiles, and RedBrick Health, usually working with companies or insurers, that use various methods (money, gamification, other rewards) to influence lifestyle and improve a person’s health in a quantified, verifiable, but general way. What’s happened? There are now apps that combine both data and behavior change, focusing on a specific but important (again) condition, coach to change behavior and verify results rigorously through clinical trials. Some, like Omada Health, prove through those clinical trials that their program successfully changes pre-diabetic indicators, such as weight loss, decrease cholesterol and improved glucose control–without medication. This results in big savings for insurance companies, one reason why a $50 million Series C was led by Cigna. Another model is to work with pharmaceutical companies to better guide treatment. Propeller Health with its asthma/COPD inhaler tracker is partnering with pharma GlaxoSmithKline on a digital platform to better manage lung patient usage, and surely this will go through a clinical trial. We will be seeing more of this type of convergence in medical apps. (The rebooted Jawbone Health Hub is moving in this exact direction.) The Forbes article, while short, is written by someone who knows the business of apps– the co-founder of the AppNext distribution/monetization platform. He does achieve his aim in making us think differently about the potential of ‘health apps’. 

Fitbit’s smartwatch on track; Intel exits the game

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/Fitbit-smartwatch.jpg” thumb_width=”200″ /]Fitbit’s ‘Project Higgs’ in-house designed smartwatch is, by all reports, on schedule to hit the market later this year in time for the holidays, at least in Wall Street’s expectations. To the FT (may be paywalled) CEO James Park reassured, “The product is on track to meet our expectations and the expectations that we’ve set for investors. It’s going to be, in my opinion, our best product yet.” It will be waterproof, a battery that lasts several days, have mobile payment capability (from the Coin acquisition), simple health tracking,  heart rate monitor, sleep tracking, stream music (Spotify and Pandora are rumored), and its own app store. It will be either Wi-Fi or smartphone connected. TechRadar’s agglomeration of rumors include pricing ($199 to $299 –about £231), swappable bands, a full-color screen with 1,000 nits of brightness, an aluminum body and built-in GPS. The most interesting part is the proprietary operating system which uses Javascript. Also Pocket-Lint articles 18 July and 19 July

Intel, however, is giving up the smartwatch and fitness tracking chase. In 2014 they acquired Basis in a well-publicized move and enlisted hip celebrities like 50 Cent to endorse their products versus the likes of Apple and Fitbit. In November about 80 percent of the group was let go, according to CNBC, and entirely eliminated this month. The New Technologies Group is now focusing on augmented reality. CNBC

‘Record-shattering’ Q2 for digital health deals: Rock Health’s volte-face

In a pirouette worthy of Nureyev in his prime, Rock Health’s latest Digital Health Funding review for Q2 and the first half of 2017 bangs the drum loudly. With $3.5 bn invested in 188 digital health companies, it’s a record in their tracking. (∗See below for their parameters, which focus on larger fundings and omit others by type.) Q2 reversed the muddling results of Q1 [TTA 11 April] and then some. If the torrid pace is maintained and the market doesn’t take a pratfall, this year will easily surpass 2016’s full year venture funding at $4.3 bn and 304 investments.

Looking at trends, the average deal size has ballooned to $18.7 million from the 2015-16 range of $14 million. Seven $100 million+ deals led the way: Outcome Health, Peloton, Modernizing Medicine, PatientPoint, Alignment Healthcare, PatientsLikeMe, and ShareCare. Of these, three are consumer health information (Outcome, PatientPoint, ShareCare), with PatientsLikeMe closely related with a patient community focus; as the lead category of investment overall, there’s now gold in consumer health. All seven businesses are located outside of Silicon Valley, a refreshing change. A surprise is Modernizing Medicine in the settled (we thought) EHR-clinical workflow category. There’s also an interesting analysis of the shift in top categories from last year to this, which takes out the $100 million+ deals (click to enlarge): [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/Top-Funded-Categories-Midyear-Funding-Report-2017-1200×744.png” thumb_width=”200″ /]

Other changes from the usual: no IPOs and a slowing pace of M&A: 58 this year versus first half 2016’s 87 and full year 146. Their public company index is brighter, with positive gains in first half led by Teladoc (up 110 percent YTD), Care.com (up 80 percent), and consulting favorite Evolent Health (up 70 percent–with United Healthcare’s acquisition of The Advisory Board’s healthcare practice, can an acquisition be far away?). Remaining in the doldrums are NantHealth, Fitbit, and Castlight Health. Rock Health Digital Funding Review First Half 2017

Soon up will be StartUp Health’s first half analysis, which takes a different cut at the companies and looks at the balance of deals by funding series.

∗ Rock Health tracks deals over $2 million in value from venture capital, excluding government and grant funding. They omit non-US deals, even if heavily US funded; healthcare services companies (Oscar), biotech/diagnostic companies (GRAIL), and software companies not solely focused on healthcare (Zenefits), but include fitness companies like Peloton. 

Jawbone finally T-bones, founder starts Jawbone Health Hub (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/05/The-End-Pic-typewriter.jpg” thumb_width=”200″ /]Confirming the decline of the fitness tracker/wearables business, Jawbone is finally over and done. Their liquidation this week was initially reported by The Information (subscription only) and that co-founder/CEO Hosain Rahman has started a new company, Jawbone Health Hub. JHH will work on medical software and hardware, as well as eventually servicing the buggy existing Jawbone products† which were sold off to a third party last September. JHH is also reportedly hiring many former Jawbone staff and on job boards such as Glassdoor. 

Jawbone’s demise comes after a troubled 18 months, starting with a $165 million private equity raise in January 2016 led by the Kuwait Investment Authority, rumors of financial problems, repositioning into clinical medical monitoring, and abandoning what was left of consumer market support. There is also the continuing saga of court actions with Fitbit over trade secrets, employee poachings, and IP–all additional reasons for the founder to walk away. The only value left in Jawbone is that IP which includes BodyMedia patents and anything left that wasn’t voided by a court. Fitbit shares are also sinking, currently trading at a near 52-week low of just above $5.

‘Death by overfunding’? Updated During its lifetime from wireless audio speaker innovator Aliphcom to wearables leader with the Jawbone UP, Jawbone raised $938 million (Crunchbase), and at one point was valued at $3 billion. An interesting take from a Reuters article was that one consensus among Silicon Valley tech funders was that the company would have been far easier to acquire had it raised less money. Jawbone ranks only behind solar tech Solyndra among largest failures among venture-backed companies. (The difference, of course, was that Jawbone didn’t take $500 million of public stimulus money, as Solyndra did before it failed.)

The words ‘Chapter 7’ have not been included in reports but Sherwood Partners, a busy Mountain View CA financial restructuring company that has wound down plenty of startups through unicorns, was reported to be in charge of the liquidation process plus any remaining legal actions with Fitbit. None of the usual sources have been able to obtain statements from Mr. Rahman and ‘the information’ remains limited. The Verge, TechCrunch, Business Insider 

†Editor Charles’ struggles with seven personal Jawbone UPs were often typical of the user experience.