Rock Health’s Q3 report: funding and mega-deals cool down

Too hot not to cool down? This year’s digital health funding, as reported by Rock Health, may be ‘just one of those things’ depending on what happens next quarter. After a torrid Q2 which brought first half 2017 to an explosive $3.5 bn [TTA 11 July], Q3 added only $1.2 bn for a total $4.7 bn. Bear in mind that this is larger than the full years of 2014-2016, and that Rock Health tracks only US deals over $2 million in value from venture capital, excluding government and grant funding. Rock Health’s report concentrates on deal sizes, trends, and types of companies. Here’s what this Editor found to be interesting:

Here’s what this Editor found to be interesting:

  • Number of deals is at a record: 268 digital health funding deals across 261 companies. In 2016, 240 digital health venture deals had closed by the end of Q3 in 2016.
  • Few mega-deals this quarter: The only ones are 23andMe with a $250 million round in September followed by cancer data company Tempus’ $70M Series C round. Average deal size dropped to $14.6 million. The cooling is great enough for Rock Health to predict that there may not be any IPOs this year–23andMe was considered the leading candidate but instead went for another round.
  • 16 percent of companies funded in Q3 are led by women CEOs, up from 11 percent. Of course, this is influenced by 23andMe’s founder/CEO Anne Wojcicki. But almost more importantly, there’s been a breakthrough in that women’s and reproductive health companies continue to gain funding traction, and most are led by women.
  • The two top categories for funding through Q3 are consumer: health information and personal health and tracking tools.
  • Yet companies are shifting to a B2B business model from B2C, with 23andMe in the lead targeting drug discovery via the Genentech deal they have had for a long time. 61 percent of digital health startups that Rock Health tracks converted from B2C to B2B. No surprise to this Editor as consumer adoption is a slow and costly road.
  • Exits are also cooling down as long-cycle reality hits. The ‘nine-inning ball game’ stated by an investor is, given healthcare’s long cycles, regulation, and slow adoption, is more like 15. 
  • Some recovery in public companies making money in earnings per share (EPS). Teladoc‘s recovered, while NantHealth continues in the doldrums. (Perhaps it’s Cher suing Patrick Soon-Shiong?)

Awaiting StartUp Health‘s always numerically bigger report, but this Editor’s bet is that it won’t be ‘crazy’ like Q2 [TTA 15 July]. Rock Health Q3 report.

‘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. 

Warby Parker’s home eye testing app, executive hire

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/05/warby-parker-prescription-check.jpg” thumb_width=”150″ /]An app for a home eye test–but is it wise? Warby Parker, the well-known online eyewear company, is testing an app that enables an eye test at home. Currently ‘Prescription Check’ is being tested on Warby Parker customers between the ages of 18 and 40 in California, Florida, New York, and Virginia. Initially, Warby Parker uses the information to confirm that the existing prescription is still correct; updated prescriptions are in the future.

Without brick-and-mortar locations, the company is obviously using this to retain current customers and gather in new ones, away from local optician stores–the market that Smart Vision Labs is courting with its optician-administered, ophthalmologist-reviewed five-minute vision exam to lure in one-stop-shopping-seeking millennials [TTA 11 Apr] for both glasses and checking contact lenses. Both companies recommend a professional eye exam at least every two to three years.

Unlike Smart Vision Labs, Warby Parker is already being opposed by the American Optometric Association (AOA) which disdains DIY eye exams. South Carolina also recently passed legislation banning smartphone-based eye exams. Prescription Check is also similar to Opternative, which charges $40-60 for an online exam including contact lenses. Healthcare Dive, TechCrunch, Mobihealthnews

Warby Parker’s seriousness on eye testing is underlined by their announcement of David Rose as their new VP of Computer Vision. Mr Rose was the founder of the Vitality GlowCaps bottle-top med reminder, purchased by what is now NantHealth in 2011. He was also one of the first digital health entrepreneurs this Editor met at her first Connected Health Symposium in 2009, where he showed the GlowCap 1.0 to all who would listen! Mobihealthnews 

NantHealth/Soon-Shiong ch. 2: pay for play research at University of Utah?

Stat has returned to digging in the NantHealth/Dr Patrick Soon-Shiong garden to see if any more bones turn up. The writer examined the $12 million donation to the University of Utah and confirmed the POLITICO assertion that most of it ($10 million) went right back to NantHealth through a contract arrangement to pay for genetic sequencing of blood, tissue, and tumor samples. In this article are snippets of emails dating back to 2014 that indicated that even though NantHealth was at the time of the deal not yet capable of performing the work, they were specified along with the Utah Genome Project as one of the two teams to do the genome analytics. NantHealth by their own admission delayed for a few months when due in 2015 as they were not yet ready. The deal with Utah also gave NantHealth access to anonymized genetic and health data on hundreds of patients, specifically disease traits in families, their medical conditions, and relationships, if any, to others providing samples for analysis. This would have been of value not only to GPS Cancer but also to yet another Soon-Shiong company, GPS Heritage, which assesses a patient’s risk of inherited and rare diseases.

Pay for Play, which is what marketing types like your Editor call arrangements like this, removes any objectivity from this research. This is in addition to the donation arrangements, which present all sorts of taxation implications.

Regrettably, instead of trying to clear things up or being upfront about this business arrangement, Dr Soon-Shiong has chosen to make this a War of the Tweets, accusing Stat and POLITICO of bias, and to hide behind a now long-ago meeting with President Trump. (Sorry, Doctor, POTUS has other things on his mind like North Korea, ISIS and the American Economy–and he tweets more skillfully than you.) Everyone knows that finding treatments and cures for cancer is noble work, but there is also the appearance of cutting corners and a general air of dubiousness around the whole NantHealth enterprise. Mr Market is having its say as well in the share price. By the way, NantHealth lost $184 million in 2016Stat, Healthcare IT News.

Read Chapter 1, ‘Another Theranos on boil?’, here.

Q1 digital health investment: two perspectives from StartUp Health and Rock Health

StartUp Health’s and Rock Health’s investment/M&A roundups from Q1 2017 have just hit the deck. Before we dig into them, let’s start with the differences in methodology:

  • Rock Health tracks deals only over $2 million in value; StartUp Health seems to have no minimum or maximum; the latter includes early stage deals at a lower value.
  • StartUp Health gathers in international deals at all levels, whereas Rock Health includes only US-funded ventures.
  • Rock Health omits healthcare services companies (citing Forward, Oscar), biotech/diagnostic companies (GRAIL, Theranos), and software companies not solely focused on healthcare (Zenefits)
  • StartUp Health defines ‘digital health’ differently than Rock Health, with categories of ‘patient/consumer experience’, ‘wellness’, ‘personalized health/quantified self’, and ‘research’

StartUp Health is ‘over the moon’, breathlessly (appropriately as the home of the 25-year Health Moonshot) with Q1 trending, seeing the biggest investment quarter since 2010 at $2.5 bn. Topping up this number was GRAIL, which is developing a blood test for early cancer detection, with a massive Series B at $914 million. Far behind it in the $85-110 million range were (in descending order) Alignment Healthcare (population health), PatientsLikeMe (patient/consumer experience), Nuna (big data/analytics), and PointClickCare (EHR). Population health, patient/consumer experience, and research top their investment activity. Most deals are still seed and Series A (59 percent), but that is down five points from full year 2016; Series B’s share is up three points to 25 percent. But it remains a difficult bridge to cross to C+ rounds.

Rock Health splits the difference and calls it ‘business as usual’, surprised that there hasn’t been a tailspin. Its Q1 sandwiches between 2016 and 2015, well above 2015 but trending 23 percent below Q1 2016. Their biggest deals include the aforementioned Alignment, PatientsLikeMe and Nuna, omitting GRAIL and PointClickCare. Their top three investment categories are analytics/big data, care coordination, and telemedicine (over $50 million). Rock Health tracked almost 20 M&A, noting that many transactions are now ex-California. They also uniquely track public company performance. Here in 2016 is where Readers first noted weakness in NantHealth, but Fitbit and Castlight Health also had miserable quarters. Teladoc, Evolent Health (consulting), and Care.com had a good winter as well. Let’s see what Q2 brings.

Another Theranos on boil? Patrick Soon-Shiong’s companies and the NantHealth Foundation (update)

Billionaire Patrick Soon-Shiong‘s drive to take down cancer through vaccines, genomics, software, and related health tech is one of the key missions of his NantHealth group and also the Foundation. Both fund research efforts such as Cancer Breakthroughs 2020, which is supported by former Vice President Joseph Biden. Reportedly, the well-wired Dr Soon-Shiong wooed President Trump for a role in his new Administration, one that has not materialized. In February, we noted his appearance at HIMSS17 promoting his cancer vaccine which was approved by FDA to advance to later clinical trials, and also unveiled Nant AI and the Nant Cloud–but also an article published in Stat that gazed through the NantHealth veil and found little to compliment, including the trademark infringement suit brought by the MD Anderson Cancer Center in Texas.

Apparent self-dealing among various NantHealth companies and investors, which started to be unwrapped in Stat, is now further investigated in a long POLITICO article. The report looks at transactions among the Chan Soon-Shiong NantHealth Foundation, the NantHealth companies, and other non-profits controlled by Dr Soon-Shiong, then at charitable donations to universities and hospitals that in turn support his research and other companies. Three citations in the article will attract the Reader’s notice (Editor’s emphasis):

Of the nearly $59.6 million in foundation expenditures between its founding in 2010 and 2015, the most recent year for which records are available, over 70 percent have gone to Soon-Shiong-affiliated not-for-profits and for-profits, along with entities that do business with his for-profit firms.

The foundation contributed $3 million out of a total of $12 million donated by Soon-Shiong-controlled entities to a University of Utah program to map the genomes of 1,000 state residents. University officials say they let Soon-Shiong’s entities write the grant specifications. The specifications gave a major advantage to his for-profit firms, which got the $10 million gene-mapping contract.

Soon-Shiong-controlled charities gave a total of $15 million — including $10 million from the NantHealth Foundation — to a fund that benefited Phoenix Children’s Hospital, which concluded a pair of deals with Soon-Shiong’s for-profit companies for many millions of dollars.

It’s dizzying, certainly by design. If true, it appears that Dr Soon-Shiong’s favorite charities happen to be his own businesses, which raise all sorts of ethical and legal questions. The investigation also calls into question not only these dealings but also the Foundation’s tax-exempt and additional special status as a medical research organization. Will the IRS come calling? How Washington’s favorite cancer fighter helps himself    Also Healthcare IT News, which delightfully called them ‘funding indiscretions’.

Updated. A canary in the coal mine is the NantHealth (NASDAQ: NH) share price, which has crashed from a 52-week high of $21 to a current value of $4.32. To clarify, it has been in precipitous decline since January, and not just from this report. There is trouble in Culver City. A quick look over at Yahoo!Finance news items now reveal a brace of law firms offering class action lawsuits to shareholders who believe they have suffered losses due to “materially false and misleading statements”, now updated for the above information.

#HIMSS17 roundup: machine learning, Proteus, Soon-Shiong/NantWorks’ cancer vax, Uniphy Health, more

HIMSS17 is over for another year, but there is plenty of related reading left for anyone who is not still recovering from sensory overload. There wasn’t big news made, other than Speaker John Boehner trying to have it both ways about what the House needs to do about replacing the failing ACA a/k/a Obamacare. Here’s our serving:

  • If you are interested in the diffusion of workflow technologies into healthcare, including machine learning and AI, there’s a long-form three-part series in Healthcare IT News that this Editor noted has suddenly become a little difficult to find–but we did. The articles also helpfully list vendors that list certain areas of expertise in their exhibitor keywords.
  • Mobihealthnews produced a two-page wrap up that links to various MHN articles where applicable. Of interest:
    • a wound measurement app that Intermountain Healthcare developed with Johns Hopkins spinoff Tissue Analytics
    • Children’s Health of Dallas Texas is using the Proteus Health ingestible med sensor with a group of teenaged organ post-transplant patients to improve med compliance
    • the Medisafe med management app has a new feature that alerts users to drug, food and alcohol interactions with their regimen, which is to this writer’s knowledge the first-ever med app to do this
    • Info security spending is rising, according to the Thales Data Threat Report. This year, 81 percent of U.S. healthcare organizations and 76 percent of global healthcare organizations will increase information security spending.
  • Healthcare and sports mogul Patrick Soon-Shiong presented on NantHealth‘s progress on a cancer vaccine that became a significant part of the former VP Joe Biden’s initiative, Cancer Breakthroughs 2020. Dr Soon-Shiong stated that the FDA has given approval to advance the vaccine into later clinical trials, and also unveiled Nant AI, an augmented intelligence platform to high-speed process genome activity of cancer tumors and the Nant Cloud, a cloud server which can generate bioinformatic data at 26 seconds per patient. This is in addition to the NantHealth GPS Cancer diagnostic tool used to isolate new mutations in a given tumor. HealthcareITNews MedCityNews takes a dimmer view, noting two recent cancer vaccine failures. Dimmer still is Stat’s takedown of Dr Soon-Shiong, which reportedly was the talk of HIMSS.
  • Leading up to HIMSS, Newark’s own Uniphy Health announced UH4, the latest generation of its enterprise-wide communications and clinical collaboration platform for hospitals and clinics to facilitate the ‘real-time health system’. Release

Not enough? DestinationHIMSS, produced by Healthcare IT News/HIMSS Media, has its usual potpourri of official reporting here.

Rock Health’s mid-year report: 2015 investment leveling off

Rock Health‘s 2015 report is revealing in one aspect–that the authors try to put a game face on what is a flat situation in digital health investment for first half. Not even the most optimistic of the digerati expected a lift of 16 percent as we saw in 2014 versus 2013 [TTA 2 July 14], but the 8.7 percent fall off from 2014’s blistering $2.3 billion to $2.1 billion in 2015 year-to-date was unexpected. StartUp Health’s report indicated a slower start to 2015, though slightly less, so the reports correspond. Digital health still is growing faster than software, biotech and medical device.

Other highlights:

* The top six categories accounted for 50 percent of investment funding: wearables, analytics, consumer engagement, telemedicine, enterprise wellness, EHR/clinical workflow

*  In M&A action, this year’s first half has almost matched 2014’s full year total, but with only 13 percent of the investment. Most are digital health companies acquiring others for small amounts. (more…)

Onward the 76 Hundred! Healthcare M&A, funding jam the news

Healthcare mergers, acquistions, investments and joint ventures are doing their own Charge of the Light Brigade as we cross the mid-year bar.

* Onward the 76 Hundred! 7,600 startups around the world are developing solutions in digital health, according to accelerator/investor StartUp Health’s 2015 mid-year report. It also notes that ‘personalized solutions’ are the It Girl of digital health, and that data analytics/big data has fallen to third in investor interest after wellness/benefits (largely skewed by Zenefits) and patient/consumer 
experience received large funding rounds. Cheering news is that StartUp Health notes that investment in 50+ health companies is remaining steady. But the rest might be a bit frothy. The Gimlet Eye’s tut-tut: “whatever Zenefits is, it can’t produce enough Employee Wellness and manage enough HR to be worth an investment of $500 million”. For our Readers, we give you a direct link to their 2015 Midyear Funding Insights Report. (We await RockHealth’s take on the the Year to Date.)

* Onward with an IPO! Telemedicine darling Teladoc (TDOC, NYSE) is even more so with a smashing initial public offering, targeted to open at $19 which closed on Wednesday at $28 and today (Thursday) at same. Rosy forecasts abound despite those annoying losses ($12.7 million in 1st quarter ’14) and court action (Dallas News, TTA 9 June) . We at TTA are sticklers on terminology; still, we were happily surprised to see USA Today in our corner chiding Mr Gorevic on his misapplication of telehealth for telemedicine.

* Onward to Invest in Each Other! The new Allscripts-NantHealth deal gives new meaning to swap. EHR Allscripts bought a $200m, 10 percent equity stake in NantHealth, the health informatics chunk of Dr. Patrick Soon-Shiong’s NantWorks mini-conglomerate. Meanwhile another Soon-Shiong company bought stock valued at $100m in Allscripts. Neil Versel in MedCity News

* Onward from Amsterdam to Tel Aviv! MedCity News and Reuters also report that Teva Pharmaceuticals and Philips Healthcare have inked a joint investment (more…)

Recent developments in digital health – RSM event report

The third successive year’s sellout “Recent developments in digital health” event, hosted by the Royal Society of Medicine (RSM) in London, UK, attracted prestigious speakers from across the NHS, industry and academia and provided delegates with a comprehensive overview of digital healthcare advancements in 2015.

Organised by Dr Andrew Harper, from the Telemedicine & eHealth Section at the RSM, the meeting provided insight into how the NHS is lining up to integrate and deploy digital health technologies to advance patient care.

Attracting senior NHS England members including: Paul Rice, Head of Technology Strategy; Dr Mahiben Marruthappu and Dr Harpreet Sood, Senior Fellows to the Chief Executive, the vision for digital health integration and deployment throughout the NHS was finely characterised and explained to delegates.

These sessions were supplemented by real-world experiences from Dr Dominic (more…)

Ka-ching! Mid-year digital health funding hits $2.3 B: Rock Health

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/stick_figure_push_up_arrow_400_clr.png” thumb_width=”120″ /]It’s geometric! Rock Health’s total of $2.3 billion in digital health funding as of June 2014 just rocketed through the $1.97 billion 2013 full year total. Year over year to date, it’s up over 16 percent. And there’s stardust on every sub-sector: software, digital health, biotech and even medical device, the laggard (negative growth) in previous reports. Funding rounds must have taken vitamins, because they are 50 percent larger on average at $15 million versus last year’s $10 million. But there’s the same concentration on big deals like NantHealth, Flatiron Health, Alignment Healthcare and Proteus, heavily skewed towards payer administration, digital health devices, data analytics and healthcare consumer engagement. But the clouds on the horizon are there. Last year’s disproportion in seed/Series A accelerates, and the ‘down the line’ weakness continues with proportionally fewer companies reaching B, C and D rounds. Crowdfunding has also lost its luster–50 percent off with Indiegogo dominating–but its blowout with Healbe GoBe [TTA 26 June, CEWeek] accounted for 41 percent of total crowdfunding dollars; MedStartr stayed in the game at a distant second. IPOs haven’t been great, the ‘digital health index’ is an underperform yet funders are still itchy to cash out multi-round companies like Practice Fusion (EHR/billing), Proteus and ZocDoc via IPO. VentureBeat. Rock Health report on Slideshare.

BlackBerry’s investment: what’s in it for NantHealth

This week’s news of BlackBerry Ltd’s minority investment in the Dr. Patrick Soon-Shiong eight-company combine called NantHealth has generally focused on BlackBerry. Across the board, BlackBerry is depicted as the party badly needing a raison d’être. Down for the count in both retail and enterprise mobile phone markets it dominated for years, BB’s six-months-in-the-saddle CEO is now going back to those same enterprises singing the wonders of their QNX operating system and upcoming BBM Protected communication platform to highly regulated verticals which need max security: healthcare, finance, law enforcement, government. Although FierceCMO inaccurately reported that BlackBerry was acquiring NantHealth (Reuters/WSJ reports to contrary), it’s generated yawns from former tea-leaf readers such as ZDNet as yet another flail of the Berry as it sinks beneath the waves. Add to this the bewilderingly written CNBC ‘Commentary’ under BlackBerry CEO John Chen’s byline–who should fire the ghostwriter for inept generation of blue smoke and mirrors–and you wonder why the very smart Dr. Soon-Shiong even desires the association with a company most consider the equivalent of silent movies. It is certainly not for the investment money, which the doctor has more than most countries–an expenditure carefully considered at BlackBerry, undoubtedly. 

Cui bono? NantHealth first, BlackBerry second is your Editor’s contrarian bet. Consider these three factors:

  1. Way down the column in most coverage is that BlackBerry and NantHealth are developing a healthcare smartphoneIt will be optimized for 3D images and CT scans but fully usable as a normal smartphone. Release date: late 2014-early 2015 (Reuters). (more…)

Voice-enabled devices–pointer to the future?

LA billionaire and healthcare investor par excellence Patrick Soon-Shiong (his NantHealth raised $31 million earlier this year and owns Vitality, eviti, iSirona, iCOS) has just made a sizable $8 million investment in Fluential, which is developing a voice interface and speech-optimized recognition software for digital health, wellness, and weight management, to run on anything mobile including wearables, and to be released in the spring of 2014. If this works (and better than Siri), it has major implications across the board in the future shape of both consumer and clinical health tech, especially for older adults and those with mobility concerns. Mobihealthnews.