Is the clock at the funding pub pointing to ‘last call’? (Updated)

click to enlargeAnd we were having such a good time! UPDATED Having ridden a few hype curves (in health tech and out–remember airline deregulation?) and with the bruises to prove it, this Editor believes that she can spot a Cracking Market at forty paces. The hands on the clock appear to be near closing time, even as we party on. After all, DTC telehealth is forecast to be $25 bn in the US by 2025 (GrandView Research), if we make it that far!

Where are the sharp noises coming from?

  • The continuing fail of unicorns like Theranos [TTA 4 May and prior], now resorting to bullying the Wall Street Journal and negotiating with the alphabet (SEC, DOJ, FDA, CMS…), and the troubles of Zenefits. 
  • Another notable unicorn, the doctor booking site ZocDoc, being called out at last on their customer churn, low margins, and high customer acquisition costs. (As well as an irritant to doctors and office managers) New York Business Journal
  • Extremely high and perhaps insane rounds of funding to young companies with a lot of competition or a questionable niche. Higi is an odd little kiosk + consumer engagement program located in primarily Rite Aid drugstores–odd enough to score $40 million in its first venture round. (Ed. note: I shop at Rite Aid–and have never seen one.)This is after the failure of HealthSpot Station, which burned through approximately $43 million through its entire short but showy life. The low-cost, largely exchange plan insurer Oscar Health raised $400 million this February  ($727 million total) while UnitedHealth and others are dropping money-losing plans in most states. Over 50 percent of exchange co-ops went out of business in 2015, leaving doctors, health systems and patients holding their baggage. Again, low margins, high cost and high customer acquisition costs.
  • We’ve previously noted that funders are seeking ‘validation in similarity’–that a few targeted niches are piling up funding, such as doctor appointment setting, sleep trackers and wellness engagement [TTA 30 Dec 15]
  • Tunstall’s continuing difficulty in a sale or additional financing, which influence the UK and EU markets.
  • NEW More patent fights with the aim of draining or knocking out competition. We’re presently seeing it with American Well litigating Teladoc over patent infringement starting last year, which is only now (March) reaching court. It didn’t stop Teladoc’s IPO, but it publicly revealed the cost: $5 million in previously unplanned lobbying and legal costs, which include their fight with the Texas Medical Board on practicing telemedicine–which is beneficial for the entire industry. (But I would not want to be the one in the legal department explaining this budget line.) Politico, scroll down. But these lawsuits have unintended consequences–just ask the no-longer-extant Bosch Healthcare about the price of losing one. (more…)

Blueprint Health graduates the Winter 2016 class

Tomorrow afternoon (April 27) is Graduation Day–Demo Day–for ten startup companies which address problems across the healthcare spectrum. They are:

● Blue Mesa Health – Helps employers reduce health costs through a digital diabetes prevention program
● HealthKick – Provides employers with curated perks for branded health and wellness services
● NexHealth – Provides a mobile-first appointment booking and reminder platform for doctor’s offices
● PatientPrep – Increases physician productivity and patient satisfaction by collecting data prior to a visit
● Rappora – Streamlines the coordination, management and time tracking of home care employees (more…)

The mixed picture of health tech investment: a potpourri

One picture is generally positive–plenty of opportunity in the aging and ill population, particularly in data integration from various sources, and value-based care. Everyone loves the excitement that a startup with a novel technology or way it can make knowledge more useful brings to the field.  Another picture is one of pitfalls aplenty, from overhyping technology (poster child, Theranos) to overestimating growth, overspending and especially picking the wrong (nervous, impatient) investors at the wrong time, which have left a general patina of mistrust around digital health. There’s also the fact that healthcare is a highly, confusingly regulated, long-cycle business that’s challenged money-wise, whether in the US, UK, Europe or Asia. Some advice to startups contained in these two articles, including from the principals of StartUp Health accelerator (who’ve seen it all), has to do with building trust, finding the right investors, the right advice/advisors, collaboration (though that is difficult with IP), finding proven (affordable) management and a sustainable (and resilient) culture. Underpromise, overdeliver.  TechCrunch, Healthcare Dive

No wonder that investment was flat in 2015, and that much of the news is around acquisitions that rearrange companies and/or offerings. The latest today is Allscripts‘ and GI Partners’ acquisition of behavioral EHR/care coordination company Netsmart for $950 million; Allscripts is moving its homecare business into Netsmart’s CareFabric suite. Kansas City Business Journal, Healthcare Dive  In addition we’ll cite our earlier Mo’ Money article on the $600 million in various digital health investments. UPMC, which had invested in Vivify Health’s telehealth/RPM platform, is spreading $3 million around partly in-house to six health tech projects developed under the Pittsburgh Health Data Alliance. And in an example of Wearables Confusion, investors put $16 million into LifeBeam to develop another DTC ‘holistic’ health wearable (LifeBeam’s origins are sensors for aerospace and defense) while early wrist fitness entrant Pebble has laid off 40 staff in an attempt to refocus on…fitness.

Early-stage companies are also alliancing and merging. Fresh out of Newark and the New Jersey Institute of Technology’s NJ Innovation Institute, the merger of Practice Unite (which knits together secure mobile clinician/patient communications into a customized platform) and Uniphy Health (physician engagement), is an example of complimentary enlargement. This expands care collaboration offerings and shades over into patient engagement if you look at the PHM quadrant here. According to Director/Chief Medical Officer Stuart Hochron, MD (who was a Practice Unite founder), “We’re really pleased with the outcome of this merger. It’s given us the capital and resources that we need to scale.” It’s also good to see that both the founders and the CTO are moving into the new Uniphy Health–and staying in Newark.  Release

Mo’ money! Over $600 million in funding washes into digital health

click to enlargeThe unicorns may be getting gored, the bloom off the rose in health tech funding, and it’s a ‘hangover’ from 2015, but both January and February wound up being strong months for digital health funding, with over $600 million to companies in various stages. Mobihealthnews racks up the wins, leading with MindMaze (recovery for stroke patients) $100 million in February, Pear Therapeutics (digital tools + pharmaceuticals) with $20 million and Cala Health (hand/wrist tremor treatment) with $18 million. In remote patient monitoring, Vivify Health raised $17 million completing a 2014 round for $23 million and interestingly will use some of this funding to develop an IVR (interactive voice response) solution (Mobihealthnews 25 Feb). They don’t total in insurer Oscar which had a massive raise of $400 million bringing their funding over $765 million, not that far from Unicorn Territory–probably a good idea as they have some dizzying goals like 1 million members in five years from its current 145,000 members in New York and New Jersey, adding Texas and California. The caution on Oscar is that they are heavily dependent on narrow networks and exchange business that may be unsustainable. But if you sign up, you get a Misfit Flash tracker and access to their mobile app! Digital health funding in February reached $197 million (Mobihealthnews)

‘VC tourism’ in Health Tech Land is over (updated)

The ‘silly money’ is packing its bags and taking the next flight from the Coast. An exceedingly tart take out of Fast Company confirms what your Editors have noticed in Rock Health and other year-end reports. Funding for digital health may have surpassed $4.2 billion in 2015, but it barely eked over 2014’s total of $2.3 billion despite rising geometrically since 2011 [TTA 16 Dec 15, revised by Rock Health since then]. Since then, we’ve had the Trouble Every Day of ‘unicorns’ (overreaching) Theranos and (ludicrously) Zenefits [TTA 17 Feb]; EHR Practice Fusion stalled out and cutting 25 percent of its staff, hoping to be acquired by athenahealth–or anyone (Healthcare Dive); shaky Fitbit shares [TTA 20 Feb]. Perhaps the high point was last year’s ‘Corvette Summer’ with yet another big round to a company yet to fulfill its promise, ZocDoc [TTA 15 Aug 15]. Even Castlight Health with decent revenue (still at a loss) has been dubbed an ‘absolute horror show’ when it comes to its share prices, if you were foolish enough to buy it at or near its IPO.

Fortunately a large dose of sanity may prevail among VCs with a sobering realization–no different than five or ten years ago–that investment has to be strategic and far longer than the usual 18 month-and-out time frame. Too many companies have systems which work the same niche–you don’t need 50 companies doing these things: data analytics for care management, patient engagement platforms, med reminders or diabetes management. [We’ve already noted the ‘sameness’ in companies getting funded in 2015, almost as if investors were seeking reassurance in similarity, a sure sign of a coming fail–TTA 30 Dec 15.]

Developers must fill a need–uniquely. And have a superb business plan, squeeze the nickels till they squeak and forget about the party culture. Investors: Dumb Money For Digital Health Will Vanish As Quickly As It Came In

 

ATA 2016 announces keynoters

click to enlargeAmerican Telemedicine Association 2016 Conference and Trade Show
Sat 14-Tues 17 May, Minneapolis Convention Center

ATA 2016 is the world’s largest and most comprehensive meeting focused on telemedicine, digital, connected and mobile health. Over 6,000 healthcare professionals and entrepreneurs in the telemedicine, telehealth and mHealth area are expected to attend the 75+ sessions and visit the over 300 exhibitors in the main hall. Keynote speakers announced are:

  • Nicholas Negroponte, co-founder of the MIT Media Lab
  • James Peake, former US Secretary of Veterans Affairs
  • John Noseworthy, MD, President and CEO of the Mayo Clinic
  • David Shulkin, MD, Under Secretary of Health for the VA
  • Jack Resneck, Board of Trustees, American Medical Association
  • Jonathan Perlin, MD, PhD, MSHA, MACP, FACMI, President, American Hospital Association
  • Reed Tuckson, President, Board of Directors, American Telemedicine Association

Register today through 15 April to save $150. More information here on schedule, keynotes, housing and Minneapolis (which is lovely in the spring when the snow is all gone!). TTA is again a media partner of ATA’s annual meeting.

Technology for Aging in Place 2016

click to enlargeLaurie Orlov’s updated view of technologies that assist home caregiving/living, and her observations on trends for both boomers and those well over 65, is hot off the (virtual) presses and available here on her website. It is US-market oriented, but the trends explored here will be of interest internationally. The focus in this study is home-based systems for safety, alerts, activity/location tracking (telecare), home care/caregiving tools and what this Editor would call ‘health monitoring light’–med minders and logging apps versus medically-oriented telehealth (vital signs, save for AliveCor) and telemedicine (virtual visits/consults).

Highlights:

  • In communication, internet non-usage among 75+ has declined to 50 percent over the past 15 years.
  • The tablet form factor is losing ground as smartphones get bigger. Older adults and smartphones are beginning to ‘get along’ partly as they grow larger, but also that feature and simple phones are becoming less available.
  • Also losing ground is senior housing–residents are delaying entry to assisted living until they are mid 80s and frailer. Savings and debt in the boomer group is low and high, respectively.
  • Investors are caring more about home care, with large investments ($80 million) in three regional home care worker startups: Honor (San Francisco), Home Hero (Los Angeles), and Hometeam (New York/New Jersey), caregiving apps and chronic care management (CareSync, with an $18 million raise).
  • Dementia care support tools are (finally) developing into its own category.

Surprising conclusions: PERS alerting stays strong, but changes to be mobile-enabled and more cosmetic; a lot of convergence of categories and forms; and the term ‘health tech’ will replace ‘digital health’. Oh my!

Health tech innovations are doing little for baby boomers

click to enlargeWonder why the duck is upside down and sinking? Maybe it’s looking for all that transformative tech! Versus The King’s Fund sunny article above is Laurie Orlov in Boomer Health Tech Watch. Her POV is that as of right now, health tech innovations are not moving the needle for obese (39 percent) and chronically diseased US baby boomers. They aren’t downloading health apps and wearing wearables. Workplace wellness programs? Au contraire, they make us feel less well (Harvard Business Review) and anxious that we’re getting spied on by the company. Maybe we realize that All That Data isn’t secure (healthcare being a Hacker’s Holiday Camp), so we’re not playing the game. And the cost of care that the ACA was supposed to level off? Not if you’re a self-insured Boomer struggling to pay an ever-higher monthly premium, or even in a corporate high-deductible plan, paying increased deductibles, restricted networks, ever-higher treatment costs and fighting your insurer at nearly every turn. Add to that safety risks of procedures, mistakes compounded by EHRs [Dr Robert Wachter, TTA 16 April]  and (not mentioned) hospital-acquired infections. No wonder investment has cooled. Health and tech innovations do little for baby boomers

A ‘top 50’ of 2016 US health tech, med tech conferences

An unusually diverse list of conferences on health/medical technology and medical devices has been compiled by Pannam Imaging, which manufactures complex, mid-to-low volume integrated human-machine interfaces of use in several industries including healthcare technology. Many focus on medical devices, life sciences and biotech (BIO International in June) but some are on cybersecurity–and d.Health Summit (the d. is for disruptive) on 4 May in NYC is new to this Editor. Are all of them worth attending? Depends on your interest and market, but it’s not the usual suspects. Top MedTech Conferences: 50 Conferences on Health Tech, Medical Devices, and Medical Technology Worth Attending in 2016

Medstartr Momentum 2015: did you miss it? (Video)

Let’s go to the video. Monday’s Medstartr Momentum/Health 2.0 NYC event was a Broadway Showstopper at Microsoft’s NYC Tech Center. Now available is a (so far) uncut video on medstartr.tv (scroll down to 11/30). There’s no play/skip bar on this, only a pause, so you may want to investigate a linked Health 2.0 NYC Livestream video page which has segmented the sessions and these have a play/skip bar.

Speakers included Susannah Fox, the CTO of HHS as well as 24 panelists, and 5 Momentum Talks representing Patients (Regina Holliday) Providers (Cheryl Pegus, NYU), Partners (Amy Cueva, MAD*POW), Institutions (Wen Dombrowski, MD, Northwell), and investors (Peter Frishauf.) There were four pitch sessions through the day featuring early-stage companies organized around Wearable Health Tech, Hospitals 2.0 and Pharma Tech 2.0. Hat tip to founder Alex Fair, his team, Steve Greene and the 15 sponsors who made it happen. TTA is a long-time media sponsor of Health 2.0 NYC.

HCF Catalyst’s first startup/scaleup accelerators–apply by 27 Nov (Australia)

HCF, Australia’s largest non-profit healthcare fund, has started Australia’s first true accelerator for health tech, HCF Catalyst. While accelerators have been around now for the better part of 10 years in the US and UK, they are new Down Under. Both startup and scaleup programs are on offer.

  • Startup: a three-month education/support program with a following three-month incubation program; initial investment of AU$50,000 and a next-round opportunity for up to AU$100,000 from the Slingshot Venture Fund. Qualifying teams should have, to quote their page, an idea that aligns to one of the HCF Catalyst themes, a fantastic team, able to deliver an MVP within three months of starting and global aspirations. See information and apply here.
  • Scaleup: for early-stage companies with business which are in growth mode, this is an access program that includes mentoring and coaching–no funding but access to investors, mentoring, coaching and a ‘demo day’. More information and to apply here.

Partners include Sparke Helmore, PWC, University of Newcastle, Artesian Capital Management and IBM SoftLayer. Hat tip to George Margelis via Twitter and Shawn Larkin, HCF Managing Director on LinkedIn.

66% of ‘tech-savvy seniors’ dissatisfied with current health tech

Yes, those same people who–gee whiz–designed computers, did their own programs in MS-DOS and went from Palm Pilots to BlackBerries to iPhones, are already over or hitting 65 (3.9 million in US in 2015)–and they aren’t happy with what’s being served up to them in healthcare tech. The Accenture study across 10 countries and over 10,000 adults points out the demand–67 percent–and the dissatisfaction–66 percent. They want independent self-care tools, wearables to monitor themselves, online communities like PatientsLikeMe, patient navigators and health record tools. Moreover, the more comfortable they are with and value technology, the more likely they are already using technology for tracking weight and cholesterol levels. Couple this with the ‘Drawn and Quartered’ Parks Associates research [TTA 11 Aug 14] and moving past the mHealth hype earlier this week, the study points out a strong market for apps, online tools and other digital health–but designed not for a peer group of most designers, nor to be ‘cool’. Helloooo designers! Wake up! Laurie Orlov does point out on AgeInPlaceTech that there’s not much new here, but that we shouldn’t move on. Accenture release, Modern Healthcare, Fred Pennic in HIT Consultant, Stephanie Baum in MedCityNews

Rubber Bands – The next big thing in wearable sensors?

Rubberbands

When you’re ten years old, pinging rubber bands across the classroom is fun. Getting caught doing so by your teacher is not. However you have to admit it’s kind of a novel use for those flexible little bands. Now Irish researchers may have upped the game by finding another, even more novel application for them.

The team at AMBER, the Science Foundation Ireland-funded materials science centre, and the School of Physics TCD, working with researchers from the University of Surrey, have discovered a method of creating wearable sensors from shop-bought rubber bands. If you were listening back in class, you’ll remember that rubber doesn’t normally conduct electricity. However, the researchers whose findings have just been published in ACS Nano, a leading international nanoscience publication, discovered that by adding graphene the rubber bands became electrically conductive. In tests, the bands were strongly affected by any electrical current flowing through them if the band was stretched, which means tiny movements such as breath and pulse could be sensed by the technology.

The potential of graphene to be used in wearable sensors was noted by our TTA Editor-In-Chief, Donna, in her Pointer to the Future item back in 2011, Nanosheets and graphene: powering sensors, computers. Because rubber is available widely and cheaply, this latest development could open up major possibilities in the manufacturing of wearable sensors worldwide. Which means we can all look forward to finding graphene infused biosensors in everything from our bras to our bionic underpants.

Read more: TANN IrelandENGINEERING.com

Electronic Alerts in EHRs Reduce Urinary Tract Infections (Study – US)

According to the World Health Organisation, urinary tract infections (UTIs) win top prize for most frequent health care-associated infection in high-income countries. And the cause?…A massive 75% of all of hospital acquired UTIs result from having a urinary catheter fitted (i.e. a tube inserted into the bladder through the urethra to drain urine). And it’s far from unusual to have this procedure done, for between 15 to 25 percent of hospitalized patients have one fitted during their hospital stay (Source CDC). Having a urinary tract infection can be nasty enough but if left untreated serious consequences can result including permanent kidney damage.

The most effective way to reduce the incidence of UTIs (apart from not having a catheter fitted in the first place) is by removing the catheter as soon as it is no longer needed. Unfortunately, all too often this does not happen. That’s why the findings from this new study from the University of Pennsylvania are significant. Results showed that automated alerts in Electronic Health Records (EHRs) reduced urinary tract infections in hospital patients with urinary catheters.

The EHR alert system worked by prompting physicians to specify the reason for inserting the patient’s catheter. On the basis of the reason selected, the system then helped them decide (a) whether urinary catheters were needed in the first place and (b) alerted them to reassess the need for catheters that had not been removed within a recommended time period. And it was no small-fry study. (more…)

Pilot Health Tech NYC winners announced (US)

Last Thursday, the 11 winners of the second annual Pilot Health Tech NYC program were announced at Alexandria Center, NYC. A joint initiative of the New York City Economic Development Corporation (NYCEDC) and Health 2.0, it provides early-stage health tech companies based in NYC a ‘test bed’ in partnership with many of the most prestigious metro area healthcare organizations, and another platform to keep health tech growing in the city. Each project represents a distinct need in the spectrum and a common theme is integration of care into workflow. Some needs are obvious: senior care, pediatrics, rehabilitation, cardiac disease and diabetes management. Others are less so: vision, medication adherence, data analytics, blood donation and social support.

The winners are supported by $1 million in funding to operate and report results from the individual pilots which will take place starting in late summer through end of year. An interesting fact from the announcement release is that the Pilot Health Tech inaugural class companies [TTA 1 July 2013] have raised over $150 million in private investment since their win: AdhereTech, eCaring, Rip Road, Vital Care Services, BioDigital, Flatiron Health, Sense Health, Bio-Signal Group, Opticology and StarlingHealth (acquired by Hill-Rom).

The winners (some of which we’ve been following like GeriJoy, NonnaTech and eCaring) and their partners are:

  • Smart Vision Labs / SUNY College of Optometry
  • GeriJoy / Pace University
  • QoL Devices, Inc. / Montefiore Medical Center
  • Urgent Software, LLC / Mount Sinai Health System
  • Nonnatech / ElderServe
  • Fit4D/ HealthFirst
  • AllazoHealth / Accountable Care Coalition of Greater New York
  • Canopy Apps / Visiting Nurse Service of New York (VNSNY)
  • Healthify / VillageCare
  • Tactonic Technologies / NYU Langone, Rusk Rehab Center
  • Hindsait, Inc. / NY Blood Center

More information in their release. Many thanks to NYCEDC and Eric Vieira of ELabNYC (another NYCEDC initiative) and CUNY.

Related reading: ELabNYC Pitch Day in March

Technology which resonates with the 50+ consumer

If you are a health tech developer, entrepreneur or marketer lost in the forest of the 50+ market, Laurie Orlov of Aging in Place Technology Watch and the new Boomer Health Tech Watch just handed you a map with her latest study for AARP, Challenging Innovators: Matching offerings to the needs of older adults (link to PDF). To appeal successfully to the multiple segments and sub-segments of 50+, there’s more to it than a strong belief that your tech would have been just the thing for your mum or grandmere. The hurdles like reluctant long-term care providers and tech-unfamiliar older adults are significant. Misreading the market, making the tech too complex or identifying it too strongly with ‘old folks’ usually lead to ‘lights out’. Ms Orlov’s pointers take you through testing, crowdfunding, accelerators, the right way to price disrupt, transition point mapping, partnerships and more. A recommended guide.

Over at Aging in Place, Ms Orlov serves up another idea with The ideal wearable for seniors – why not a much-modified PERS which incorporates smartwatch/fitness band capabilities such as dehydration monitoring, activity, blood pressure and other tracking, putting them up on a smartphone app.