News roundup: Phreesia’s IPO, Chiptech enters UK telecare market, PatientsLikeMe goes to UHG, Medopad-Tencent UK Parkinson’s pilot, Oxford VR goes to HK, Cigna Singapore’s telehealth intro, HIMSS exiting Cleveland

Patient check-in tablet Phreesia is preparing for an IPO, filing of its S-1 form this week. The number of shares and pricing is not yet announced. Phreesia, which specializes in patient intake in the office via a rugged PhreesiaPad tablet and software that integrates with major EHRs such as Epic, Cerner, and Allscripts, has survived not only 14 years, but also in New York City. Phreesia has enjoyed a relatively low profile on the health tech scene, yet it has raised close to $100 million through a Series D (Crunchbase) and maintained much the same founding leadership (Chaim Indig, Evan Roberts, Michael Weintraub). Their business includes 1,600 health firms and 70 million patient intakes annually, for $100 million in revenue in its last fiscal year, up 25 percent from previous. Timing of the IPO is not yet forecast. Mobihealthnews, Business Insider.

Coming to the UK and Europe markets are New Zealand’s Chiptech telecare systems. Chiptech has both traditional in-home and mobile monitored PERS, pill dispensers, and a smartphone-based lone worker alert device. According to their website, they are the leading provider of monitored personal alarms in Australasia. Chiptech also announced a new CEO, veteran David Hammond, whose background includes leadership roles at UTC and Chubb. 

In M&A news, UnitedHealth Group bought the contested PatientsLikeMe, which runs an online service that helps patients find people with similar health conditions. PatientsLikeMe had raised $100 million in 2017, selling a majority stake to Shenzhen-based iCarbonX, backed by Chinese giant Tencent. That investment put the company under scrutiny by CFIUS–Committee on Foreign Investment in the United States. CFIUS is especially looking at Chinese investment in companies that deal with sensitive data, trade secrets, and national security–and coming down hard. Companies like Tencent are working with the Chinese government to amass millions of patient records and data points, with no regard for consent, and to build massive medical databases [TTA 17 Apr].

Tencent has multiple strategic investments in data-driven health companies, including an interesting Parkinson’s clinical trial in the UK with London startup Medopad, which developed an app that tests cognitive abilities across a series of tasks and captures it into what’s dubbed the Markerless Motion Capture and Analysis System (MMCAS). It is being tested on about 40 patients at a private mental health clinic in London called (appropriately) Dementech Neurosciences. Forbes

Mental health is hot, and Oxford VR, a spinout of Oxford University, is pairing with AXA HK and the Chinese University of Hong Kong (CUHK) to develop treatments for common mental health conditions such as social avoidance, anxiety and depressive symptoms. ‘Yes I Can’ uses virtual reality (VR) sessions over three to six weeks. In the true Chinese model (it’s free, but you don’t control where your data goes), it will also be offered to AXA’s corporate customers as part of their employee benefits services to drive better mental health outcomes in Asia. Mobihealthnews

Elsewhere in Asia-Pacific, Cigna Singapore launched a telemedicine service, Cigna Virtual Clinic, where users can access real-time doctor consults via a mobile app. Cigna is using Doctor Anywhere for the service. Telemedicine in Singapore is supervised by the Singapore Ministry of Health’s Licencing and Adaptation Programme (LEAP), “a regulatory sandbox initiative that allows the safe development of new and innovative healthcare models to be piloted in a controlled environment”. Insurance Business Asia

Back in the US, HIMSS is exiting its 30,000 square foot bricks-and-mortar office in downtown Cleveland’s Global Center for Health Innovation (a/k/a the Medical Mart). The exit will be over the next year. This is after a three-year extension of its lease inked in 2018. According to Crain’s Cleveland Business, their sources “described the move as a shift in strategy by the nonprofit that has gone through a leadership change.”

2017’s transition in digital health funding: is it maturity or a reconsideration?

Rock Health’s topline for 2017 digital health funding is impressively upbeat, casting it as “the end of the beginning in digital health, the start of a new era with new challenges”. Digging into it, there is a continued slowing that Rock Health itself predicted back in their 3rd Quarter report [TTA 3 Oct 17]. It seems that the big did get bigger, but if you weren’t on the train in 2016 or prior, 2017 wasn’t the year you left the station. Their findings bear this out, keeping in mind that their tracking is for US companies with deals over $2 million in value, which excludes much of the action from young and international companies:

  • No digital health IPOs this year, in a weak year in general for IPOs
  • For the companies already in public markets, they outperformed the S&P 500 31 percent to 19 percent
  • Average deals hit an all-time high of $16.7M ($5.8 bn over 345 deals) 
  • Big money went to better-developed, more mature companies like Outcome Health and Peloton exercise equipment at $500 million and $325 million. Rock Health duly notes Outcome Health’s troubles since. (To this Editor, Peloton is not a digital health company despite its glitzy overlay of video and exercise community.)  
  • Seven $100 million + mega-deals front-loaded in the first half of the year. Second half’s sole big deal was genetic testing and data marketer 23andme. The dominant category of business? Consumer health information represented by Outcome, 23andme, PatientPoint, PatientsLikeMe, and ShareCare, most with a B2B2C model.
  • Looking at deals by stage, not surprisingly the funding at D and later rounds soared to an average size of $74 million (from 2016’s $46 million). Seed and A rounds’ average funding at $7 million, while the majority, hasn’t varied much since 2011. Series B funding was also flat at $17 million on average.
  • Exits continued to be weak, indicating the reality of healthcare investing being long haul. M&A deals declined for the second straight year to 119–18 percent fewer than 2016 and 36 percent fewer than 2015

Also Modern Healthcare.

This Editor’s opinion? One damper on 2017 was the $900 million credulously blown on Theranos. Call it the Theranos Effect.

As usual we will look at StartUp Health‘s always numerically bigger report after release, but this Editor’s bet is that it won’t be ‘crazy’ like earlier in 2017. 

‘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. 

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.

Sonde Health using voice as a biomarker for diagnosis

Back in 2013, we profiled Max Little of the UK-based Parkinson’s Voice Initiative, who was in the fairly early stages of voice testing and analysis to aid early diagnosis of this disease. By 2015, he had over 17,000 voice samples, was partnering with the Michael J Fox Foundation, and was seeking to develop a non-invasive, quick, accurate test based on acoustic markers. Dr Little is an Oxford University PhD, currently a Wellcome Trust/MIT fellow at the MIT Media Lab. The Voice Initiative has additional support from PatientsLikeMe, Twilio and Aculabcloud.  But also developed at MIT, by Thomas Quatieri’s team at MIT’s Lincoln Laboratory, is a broader platform for voice diagnosis. This has been applied to mental health conditions such as depression, respiratory and cardiovascular conditions, and in pilots for TBI, cognitive impairment and…Parkinson’s. This has been licensed to Sonde Health, which hasn’t much on their website but is out of the Boston-based PureTech R&D/venture firm. The acoustic markers they cite are ‘dynamic changes in pitch and harmonics, articulation timing and hoarseness or breathiness that indicate and requires no analysis of words’. MedCityNews, MedTechBoston

The evolution of Facebook: implications for social health

The Telegraph’s recent retrospective on Facebook and its evolution from 2004’s ‘Thefacebook’ of Harvard University students to the Facebook that many of us use now, with Chat, timeline and a converged mobile and desktop design, led reader Mike Clark to drop Editor Charles a line about how healthcare isn’t maximizing social media and internet-based innovation. Recent studies have indicated that these social patient communities benefit their members. Agreed, but there are increasing qualifications–and qualms.

Back in 2014, Facebook made some noises on forming its own online health communities, a move that was widely derided as Facebook monetizing yet another slice of personal (health) data from users. While Charles has made the excellent point that “almost all good health apps are essentially the tailored interface to an internet service that sits behind it, a fact often forgotten by commentators”, Editor Donna on her side of the Atlantic has seen concerns mount on privacy, security and the stealthy commercialization/monetization of many popular online patient support groups (OSGs) which Carolyn Thomas (‘The Heart Sister’) skewers here, excepting those with solid non-profit firewalling (academic, government, clinical). Example she gives: Patients Like Me, which markets health data gathered from members to companies developing products to sell to patients. How many members, with a disease or chronic condition on their mind, will browse through to this page that says in part: “Except for the restricted personal information you entered when registering for the site, you should expect that every piece of information you submit (even if it is not currently displayed) may be shared with our partners and any member of PatientsLikeMe, including other patients.”

We’ve also noted that genomics data may not be sufficiently de-identified so that it can’t be matched through inference [TTA 31 Oct 15], with the potential for sale. And of course Hackermania Running Wild continues (see here).

For now general information sites like WebMD and personalized reference sites such as Medivisor feel more secure to users, as well as small non-commercialized OSGs and ‘closed’ telehealth/telemedicine systems.

Rounding up the funding rounds of 2015–and the deals some would like to see (?)

Mobihealthnews rounded up 2015’s hot funding in the mobile health/health tech-related space, with helpful links to their articles. They cite as we have previously [TTA 16 Dec] Rock Health‘s flattish year-to-year 2015 total of $4.3 bn, but also StartUp Health’s bloom-off-rose 2015 digital health total of $5.8 bn–larger than Rock Health’s tote, but 17 percent off their 2014 total of $7 bn. If you consider the proportions: the top 10 deals raised $738 million–$130 million alone to the endlessly funded but yet to take over the world ZocDoc –the roster below $20m remains the longest, which is completely in accord with the lower part of Rock Health’s pyramid of angel-A-B rounds.

Yet Aditi Pai’s detailed summary strikes this Editor as useful in an unanticipated way. There is a certain sameness in the products and services of these companies, as if funders are seeking validation in similarity. ZocDoc, DoctoLib and Vitals–doctor profiles and appointment booking. Sharecare, Welltok, Novu, Noom, AbilTo, SocialWellth, Health Recovery Solutions, Jiff–health and wellness engagement programs/apps, many for corporate programs. Whoop, Sano, Sproutling, TuringSensor, Valencell, Moff and four others–wearables. Hello, Sleepace, Sproutling (baby)–sleep tracking. Klara, SkinVision, Spruce–dermatology apps. Beyond the gloomy forecast for unicorns (Theranos being the Child on the Milk Carton), how many of these corporate wellness programs, sleep trackers and wearables will be around in 2017? Mobihealthnews’ 2015 funding roundup.

MedCityNews takes a lighter-hearted (I think) look at 2016 deals. IBM would buy athenahealth mainly for its EHR and practice management data, plus data aggregator Validic, to beef up Watson; 23andMe, past its two years of troubles after stepping on FDA Superman’s cape, would buy PatientsLikeMe (endangering its community shaped credibility? 23PatientsLikeMe?) and the best–Theranos bought by Boston Heart Diagnostics/Eurofin (EU lab testing giant), which would reduce this unicorn to a pony…but one that might make it. Theranos also made VentureBeat’s list of Likely Carcasses in the Valley of Unicorn Death (to quote the article’s author). Chris Seper’s Deals He’d Like To See.

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

Facebooking health: good for communities, not for privacy?

In a Reuters exclusive, Facebook is reportedly considering creating online communities which will support those with various medical conditions, as well as ‘preventative care’ applications for those minding their healthy lifestyle. According to Reuters’ sources, Facebook representatives have been meeting with medical industry experts and entrepreneurs. They are also starting a research and development unit to test new health apps. It is not a far reach to assume that Facebook, which is always seeking to maximize its profitability dependent on digital ad revenues (second only to Google), yet finding its younger audience on the decline, is attempting to grapple with the concerns of its older-skewing audience–and also seeking a way to monetize another slice of data. Yet the 55+ audience is wary of Facebook given (more…)

Diagnosing Parkinson’s in a 30 second phone call

…and with 99 percent accuracy is the claim made in this TED video by Max Little, an applied mathematician who has devised a voice test/analysis explained in this video. The challenge is to enable early diagnosis as there is no blood test and other diseases can mimic Parkinson’s disease. Neurological tests must be done in a doctor’s office and cost $300. This is algorithmically based, non-invasive and uses precision voice analysis. Parkinson’s is one of the most widespread neurological diseases, affecting 6.3 million people worldwide (the Parkinson’s Disease Foundation estimates 7-10 million) with at least 1 million in the US and 127,000 in the UK (Parkinson’s UK). He now is examining 10,000 voices gathered on his website, the Parkinson’s Voice Initiative with Aculab and PatientsLikeMe. Mr. Little is a TEDGlobal 2012 Fellow and a Wellcome Trust-MIT Postdoctoral Research Fellow. TED Talks page. Hat tip to readers Bob Pyke and Wen Dombrowski, MD.

[This video is no longer available on this site but may be findable via an internet search]