Comings and goings, short takes and upcoming events: MedStartr Wed night, Mad*Pow acquired, Teladoc’s new COO, JAMA ponders telepharmacy, NHS London anxiety apps partner (updated)

MedStartr Hyper Accelerator Pitch Night is tomorrow (Wednesday) night, 6pm, 31 July at Rent 24 in midtown Manhattan. Presenters are from the fourth MedStartr Hyper Accelerator Class including several MedStartr Venture Fund II portfolio companies. Attend through the Meetup link–still only $20 for presentations, snacks, drinks but may be higher tomorrow or at the door. If you missed it, follow MedStartr on Meetup.

And 31 July is also the deadline to apply for the summer session of Health Wildcatters’ Texas Healthcare Challenge on 9-10 August. More information here.

Our friends over at The King’s Fund have several upcoming events of interest:

And our friends at UKTelehealthcare remind us that there are several events coming up where they are organizing or supporting. Click the link on the right sidebar advert for more information on:

  • 1st-2nd October 2019 – HETT (Health Excellence Through Technology, formerly The UK Health Show), ExCel, London
  • 10th-11th October 2019 – Suppliers’ Forum and Providers’ Forum, Barnet & Southgate College
  • 22nd October 2019 – Cambridgeshire TECS MarketPlace,The Burgess Hall, Westwood Rd, St. Ives PE27 6WU

The Mad*Pow design consultancy is being acquired by Tech Mahindra of New Delhi. Mad*Pow’s original focus was on design for health, financial wellbeing, and social impact, and in early days held several interesting NY-area meetings. Tech Mahindra is the digital tech offshoot of the Mahindra multi-national industrial and IT giant. Yet in the Mad*Pow email to industry contacts, “Exciting News! Mad*Pow and Tech Mahindra Enter Formal Partnership” it was positioned as a majority stake and that they would continue to operate under their own name in Boston–neither of which were mentioned in the Tech Mahindra release. Hmmmm……

Verily she rolls along to Harvard. Luba Greenwood is departing the Alphabet/Google subsidiary to lecture at Harvard and work on several boards. She joined them as head of strategic business development and corporate ventures in February of 2018. She will be lecturing at The Paulson School of Engineering in a joint course with the Harvard Graduate School of Design. Mobihealthnews points out other recent key departures at Verily and a puzzling ‘why it matters’ about educating the next generation of digital health employees on a variety of viewpoints where digital health can lower versus increase costs.

Teladoc has a new COO, David Sides, who is joining from a CEO position at Streamline Health, a revenue cycle management company. The previous COO/CFO left after investors alleged insider trading and an inappropriate employee affair. Cited in Modern Healthcare is Mr. Sides’ experience in international markets, where Teladoc has been expanding through acquisitions. Teladoc announced today increased revenue for 2nd Q but earnings are still in the loss column. Yahoo Finance His position at Streamline is being taken by their chairman, Wyche T. (“Tee”) Green, III who will serve as Interim President and CEO. Release. Streamline is on NASDAQ and trading today at $1.35. 

Speaking of puzzling, JAMA indulges in an editorial around DTC telehealth and the conflict they perceive between convenience it entails and lower-quality patient care. Of course, their definition of telemedicine is primarily around telepharmacy. And like DTC medications, they are concerned about how these companies are appealing and growing. “However, it is clear that the companies want to expand to more complex acute care and disease management; for example, Lemonaid Health has expanded to include laboratory testing. Some companies envision a transformation of their platforms into 1-stop shops for comprehensive care.”

This Editor wonders if JAMA would consider two NHS-approved mental wellbeing services, Good Thinking and My Possible Self, partnering to create a tool to tackle depression, stress and anxiety in London, especially the latter in London.  My Possible Self is part of the DigitalHealth.London Accelerator program. Mobihealthnews

Comings & goings: The TeleDentists go DTC, gains Reis as CEO; University of Warwick spinoff Augmented Insights debuts (UK); a new CEO leads GrandCare Systems

The TeleDentists leap in with a new CEO. A year-old startup, The TeleDentists, has announced it will be going direct-to-consumer with teledentistry consults. This will permit anyone with a dental problem or emergency to consult with a dentist 24/7, schedule a local appointment in 24-48 hours. and even, if required, prescribe a non-narcotic prescription to a local pharmacy. Cost for the DTC service is not yet disclosed. Currently, the Kansas City-based company has provided their dental network services through several telehealth and telemedicine service providers such as Call A Doctor Plus as well as several brick-and-mortar clinic locations.

If dentistry sounds logical for telemedicine, consider that about 2 million people annually in the US use ERs for dental emergencies; 39 percent didn’t visit a dentist last year. Yet teledentistry is just getting started and is unusually underdeveloped, if you except the retail tooth aligners. Several US groups are piloting it to community health and underserved groups, with Philips reportedly considering a trial in Europe (mHealth Intelligence). This Editor notes that on their advisory board is a co-founder of Teladoc.  Release

The TeleDentists’ co-founder, Maria Kunstadter, DDS, last week announced the arrival of a new company CEO, Howard Reis. Mr. Reis started with health tech back in the 1990s with Nynex Science and Technology piloting telemedicine clinical trials at four Boston hospitals, which qualifies him among the most Grizzled Pioneers. He also was business development VP for Teleradiology Specialists and founding partner of The Castleton Group, a LTC telehealth company, and has worked in professional services for Accenture, Telmarc and SAIC/Bellcore. Most recently, he started teleradiology/telehealth firm HealthePractices. Over the past few years, Mr. Reis has also been prominent in the NY metro digital health scene. Congratulations and much success!  

In the UK, the University of Warwick has unveiled a spinoff, Augmented Insights Ltd. AI will be concentrating on machine learning and AI services that analyze long term health and care data, automating the extraction in real time of personalized, predictive and preventative insights from ongoing patient data. It will be headed by Dr. James Amor, whom this Editor met last summer in NYC. Long term plans center on marketing their analytics services to tech providers. Interested parties or potential users may contact Dr. Amor in Leamington Spa at James@augmentedinsights.co.uk |Congratulations to Dr. Amor and his team! 

And in more Grizzled Pioneer news, there’s a new CEO at GrandCare Systems who’s been engaged with the company since nearly their start in 1993 and in its present form in 2005. Laura Mitchell takes the helm as CEO after various positions there including Chief Marketing Officer and several years leading her own healthcare and marketing consulting firm. Nick Mitchell rejoins as chief technology officer and lead software developer. Founders Charlie Hillman remain as an advisor and Gaytha Traynor as COO. Their offices have also moved to the Kreilkamp Building, 215 N Main Street, Suite 130, in downtown West Bend Wisconsin. GrandCare remains a ‘family affair’ as this profile notes. Congratulations–again!

Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated)

Breaking News. Teladoc–one of the two giants in telemedicine–has been placed on ‘under corrective action’ status in its latest (15 May) two-year accreditation with the National Committee for Quality Assurance, better known by its initials, NCQA. Their next review is slated for six months (18 Nov).

According to the earliest breaking report on Seeking Alpha, a business and stock market website, the move to ‘corrective action’ status has been brewing for some time. Teladoc was the first telemedicine company to win this coveted status in 2013. Now, of course, all major telemedicine players have this accreditation.

This is the latest mark against the company, which has gone through some recent ‘interesting times’ financially with accounting problems based on booking stock awards (2018), the CFO’s resignation, and lack of replacement. The report by a ‘bear’ on the stock indicates that its large contract with Aetna, among others, is up for renewal.

Exactly what this ‘corrective action’ is related to has not been made public by either NCQA or Teladoc. Comments under the article sourced from a Wells Fargo analyst that the action is arising from a workflow that Teladoc uses for credentialing providers.

A good portion of this article discusses revisions on the Teladoc website and marketing materials which ensues when something like this happens and it is the basis for a superiority or credentialing claim.

NCQA is a non-profit that advocates quality standards and measures for healthcare organizations, health plans, and organizations that provide services to the former. Their standards are widespread in the industry as a means of review and accreditation for providers and hospitals, as well as incorporated into quality metrics used by HHS and CMS. For those who may not be able to access the full article–requires free membership (but you’ll get emails) registration with the Seeking Alpha site–attached is a PDF of the article.

Update: While to the ‘bear’ Teladoc is a glass half empty and cracked, to another Seeking Alpha writer, the glass is more than half full even though the company continues to run substantial losses. Here’s an analysis that is mostly positive, though acknowledging the issues above.

News roundup: Teladoc acquires MédecinDirect, Blue Cedar closes $17M Series B, Hill-Rom buys Voalte, Withings bolsters sleep tracking

Teladoc grows its global reach with the MédecinDirect acquisition. Paris-based MédecinDirect currently has 24/7 telehealth operations within France, with patients able to text, video, or phone GPs or specialist doctors 24/7. Terms were not disclosed and the sale is subject to regulatory approval, but expected to close within the first half of this year. Founded by François Lescure, a pharmacist, and Marc Guillemo, a digital marketer, in 2008, the company’s client base grew to more than 40 leading insurance partners and nearly half of the top 30 private medical insurers (PMIs) in France.  MédecinDirect will become the French unit of Teladoc, which now has operations in the UK, Australia, Canada, Spain, Portugal, Hungary, China, Chile and Brazil, covering 130 countries in more than 30 languages with a growing specialist base from earlier acquisitions Best Doctors and Advanced Medical. Teladoc seems to have moved on from its financial and accounting problems that marred 2018, but still is not profitableRelease, Mobihealthnews.

App security innovator Blue Cedar closes on its Series B for $17 million. New investor C5 Capital, a specialist venture capital firm focused on cyber security, joins $10 million (2016) Series A investors Benhamou Global Ventures, Generation Ventures, Grayhawk Capital, and Sway Ventures. Daniel Freeman from C5 Capital will join Blue Cedar’s Board of Directors, Blue Cedar pioneered the approach of securing data from the app to the provider location on a client’s servers or in the cloud, without the smartphone or other mobile device being managed and without additional coding. TTA last year profiled Doncaster UK-based MediBioSense Ltd. using Blue Cedar to protect their VitalPatch app [TTA 23 Jan 18] and later as a case study in how digital partnerships happen and develop [TTA 17 Feb 18]. Release, Blue Cedar blog.

Hill-Rom increases its technology bets with Voalte. Voalte is a mobile communications platform used by hospitals and large healthcare organizations for care teams to securely exchange information and data. The privately held company from Sarasota Florida currently serves 200 healthcare customers, 220,000 caregivers, and more than 84,000 devices. Terms of the acquisition were not disclosed but is expected to close during Hill-Rom’s fiscal third quarter of 2019. Hill-Rom, primarily known for its ubiquitous hospital beds, late last year teamed with Israeli company Early Sense to create a smart hospital bed that monitors heart and respiration rates [TTA 12 Dec 18], which ties nicely with Voalte’s monitoring. Release.

Tossing the sheets in your bed at home? The newly reconstituted Withings comes to the rescue with deepening its sleep monitoring with an upgraded sleep sensor mat that detects sleep breathing disturbances in frequency and intensity. The connected Withings Sleep app monitors sleep cycles, heart rate and snoring, displaying scores through the companion Health Mate App. Not quite a sleep apnea diagnostic, but significant breathing interruption detected during sleep could indicate the need for further investigation.  Mobihealthnews

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

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

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

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

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

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

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

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

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

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

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

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

Debate welcomed in Comments.

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

News roundup: CVS-Aetna still on hold, blockchainers Change acquires PokitDoc, Teladoc’s COO resigns under insider cloud, Clapp joins Cricket

Federal Judge Richard Leon of the Washington, DC District Court is taking a consideration break on the integration of CVS and Aetna, after holding it up on 3 December. The Department of Justice (DOJ) originally recommended that the merger was legal under anti-trust law after Aetna divested its prescription drug plan to WellCare and both companies’ settlements with several states. Judge Leon, reviewing under the Tunney Act requirement that the merger meet the public interest, is waiting for the DOJ to respond to further steps that CVS has taken to keep the companies separate. According to Seeking Alpha, CVS will take “constructive measures on pricing and sensitive information” and that an outside monitor would be brought in to monitor the companies commitments. Hartford Courant

Health IT software company Change Healthcare acquired assets of San Mateo-based PokitDoc, a healthcare API and blockchain developer. PokitDoc has developed blockchain transaction networks for EHR and identity verification, automatic adjudication and smart contracts. Its APIs are used by Doctor on Demand, Zipnosis, PillPack, and available on Salesforce Health Cloud. Change’s own blockchain platform was developed in 2017. McKesson owns 70 percent of Change. PokitDoc had funding up to $55 million prior to purchase, the value of which was not disclosed. Mobihealthnews, Health Data Management

Teladoc cut loose its COO/CFO after insider trading and sexual misconduct allegations. Mark Hirschhorn resigned on 17 December from the telemedicine company after being instrumental in the company’s recent revenue and visit growth (albeit with a downward spiral on the share value). Mr. Hirschhorn was alleged to have not only have had a sexual relationship with a (much younger) subordinate while married, but also engaged in mutual insider trading…of Teladoc stock. The steamy details of the affair(s) and an equally seamy tale of a whistleblower’s fate are in the Southern Investigative Reporting Foundation’s ‘The Investigator’. For those more concerned about Teladoc’s financial future, a bullish analysis of their stock value and trends is over at Seeking Alpha. Adding to the fire: a class action lawsuit was also filed against Teladoc on behalf of the company’s shareholders, accusing the company of misleading or false statements. Also Mobihealthnews.

And it’s cheering to announce that a respected long-time telehealth executive has found a new perch. Geoff Clapp has joined Cricket Health, a provider of integrated technology around kidney health, as Chief Product Officer. Geoff is an authentic Grizzled Pioneer, having joined early telehealth RPM company HealthHero back in 1998, then their acquirer Bosch Healthcare. He was also founder of Better, which partnered with the Mayo Clinic on providing virtual care coordinators at popular prices for both consumers and health systems. Since then he has consulted for companies as diverse as Telcare (diabetes), Oration (sold to just-acquired PokitDoc), and in venture capital. Congratulations–and happy new year in the new job! Release

A mHealth refutation of ‘Why Telemedicine is a Bust’

Worth your time over a long coffee is David Doherty’s lengthy analysis of a recent article published on the CNBC website on the ‘failure’ to date of what was supposed to revolutionize healthcare, the telemedicine ‘video visit’. Mr. Doherty counters point-by-point that the concept of telemedicine is already out of date–that the future of healthcare is with mobile devices, such as the EKG-taking KardiaMobile. He points to the distrust of large telemedicine companies such as Doctor on Demand and American Well as being heavily wedded to health insurers (the prevalent business model), selling/trading patient information, and breaking the individual doctor-patient relationship.

Mr. Doherty sees the future of telemedicine enabling individual doctors to better serve their patients on several levels–video consults, monitoring, and via high-quality apps–seamlessly.  But the insurer-employer-practice model is hard to break indeed, as American Well, Teladoc, and Doctor on Demand–all of which started with a DTC model–found out. And reimbursement is improved, but discouraging. mHealth Insight

International acquisition roundup: Doro and Welbeing; Teladoc and Advance Medical

Two international telecare/telehealth/telemedicine M&A deals made the news this last week.

Sweden’s Doro AB acquired Welbeing, headquartered in Eastbourne UK. Welbeing (formally Wealden and Eastbourne Lifeline) is a telecare provider of home-based personal alarms which supports about 75,000 residents in local systems. Their revenue in last fiscal year (ending 9/17) was £7.6 million (SEK 90m). Doro operates in the UK and about 40 countries, with a core business in mobile phones specially designed for older adults. Their Doro Care solutions provide digital telecare and social services for older adults and the disabled in the home. Doro is paying SEK 130 million (£11.1 million) for the acquisition of Welbeing, equal to eight times estimated EBITDA for the financial year 2017/2018, with 85 percent cash and 15 percent in Doro shares with a bonus based on financial performance. Release 

Making a few headlines in the US is telemedicine leader Teladoc’s purchase of Barcelona’s Advance Medical for a hefty $352 million, giving Teladoc a major international footprint especially valuable for its corporate clients and major payers. Advance Medical provides complete telemedicine services in 125 countries in over 20 languages. Even more valuable is their knowledge of local healthcare delivery systems, global expert medical opinion, and chronic care. The acquisition also gives Teladoc an international network of offices and a significant entreé with international health insurance companies. Mobihealthnews, Seeking Alpha (Teladoc investor slideshow)

CVS-Aetna: It’s not integrated healthcare, it’s experiential retail!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]This very interesting take on financial analysis site Seeking Alpha draws another insight from the CVS-Aetna merger–it’s actually part of the rising commercial real estate trend of experiential retail. Here’s the logic. CVS MinuteClinics increase traffic to CVS stores. If they are part of a shopping center, that means those patients might grab a meal, coffee, or shop. Reportedly CVS and Aetna will add nurses and nutritionists, which will further increase attraction, stickiness, and traffic. 

CVS and Walgreens‘ clinics have started, in the new model, to become significant, even anchor, tenants of shopping centers, filling up the empty storefronts left by traditional retail. Doctors’ offices, urgent cares like CityMD, and hospital-run outpatient clinics are filling retail spaces and anchoring new developments. Another part of the experience–fitness clubs, which are also converting vacant office spaces–a line extension increasingly popular with health systems. CVS also bought out department store Target’s drugstores and in-store clinics, which is another model (fill a prescription, buy socks or a TV). Another line extension is partnerships with urgent cares or outpatient clinics, not much of a stretch since CVS already has affiliations with health systems in many areas.

Add telemedicine (Aetna’s partnership with Teladoc) to the above: both MinuteClinics and in-home become 24/7 operations. Not mentioned here is that Aetna can add in-person or kiosk services in CVS stores to file claims, answer questions, or sell coverage.

As this model becomes clearer, big supermarket operators like Ahold (Stop & Shop, Giant), Wegmans, Publix, Shop Rite and others, which have pharmacies in most locations, may ally with or merge with insurers or health systems–or partner with CVS-Aetna. There is also the 9,000 lb. elephant called Walmart, which is 2/3 of the way to an experiential model including nutrition, diet, and fitness (ask any WalMartian). Further insights on how this merger is forcing retailers to adapt are in Drug Store News.

CVS-Aetna could very well be a major mover in experiential retail, which may save all those strip malls. But this article points out, as this Editor has already, that the full shape of what could be experiential healthcare will take years to work and shake out, assuming the merger is approved. Our prior coverage is here.

January’s Crazy Week: JP Morgan, StartUp Health, Health 2.0 WinterTech…and CES takes the cake!

This week is Crazy Week for healthcare and technology folk, with multiple major events centered in San Francisco and Las Vegas.

JP Morgan’s 36th annual healthcare conference started today 8 Jan through Thursday 11 Jan in San Francisco. It annually hosts 450 companies presenting to 9,000 attendees. It attracts hundreds of investors and is A Very Big Deal for both investors and companies angling for same. It kicked off with Medtronic‘s Omar Ishrak touting their success with Tyrx, an anti-microbial resorbable envelope for their cardiac devices to prevent post-surgical infection. In value-based care, it may not be in itself reimbursable, but improves outcomes (MedCityNews). The official hashtag for the conference is #JPMHC18 but there’s also #JPM18.

Of interest to Readers will be Teladoc’s presentation at JPM, provided by Seeking Alpha

CNBC’s tip sheet on the action. Genalyte‘s lab-on-a-chip demos their blood sampling in 15 minutes technique to MedCityNews writer. And Vive La Biotech–why American investors should be looking at French companies.

Within the event is the invite-only StartUp Health Festival Monday and Tuesday which hashtags at #startuphealth. Separately, but with many of the usual suspects, is Health 2.0’s one-day WinterTech conference in San Francisco the following day on Wednesday 10 Jan, also with an investment focus. (You can imagine the investor and company hopping between conference locations!) Alex Fair is also leading a Meetup tweetup for the week–more information here. You may also want to check out #pinksockspinksocks is an ad hoc group dedicated to health and wellness innovation and doctor-patient connectedness.

Further south, the sprawl of Las Vegas has been taken over by the sprawl of CES (aptly dubbed ‘Whoa!’) starting Tuesday 9 Jan through Friday 12 Jan. The substantial health tech focus (more…)

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Our Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]Love that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/stick_figure_push_up_arrow_400_clr.png” thumb_width=”100″ /]Telehealth/telemedicine case studies are many, but those of us in the field are always on the hunt for fresh results. And the results seem to be fairly successful.

Cuyahoga County in Ohio instituted a telehealth program for its 569-person Educational Service Center this past July. In the first 90 days, 45 telemedicine consultations were completed with an average savings of $342 for each visit. Median wait time to the doctor consult was 2 minutes, 23 seconds. This amounted to a 130 percent return on investment, or $48,000. This is over the summer, when many employees were on leave, and does not calculate productivity gains, e.g. less sick time. The ESC goal is 80 percent utilization. This last would boggle the Big Minds over at the RAND Corporation which criticized the 88 percent rise in utilization when CalPERS members used Teladoc. TTA 8 Mar, 25 Mar  The provider of telehealth services is First Stop Health. Healthcare IT News.

BMJ reviewed 44 studies (of over 2,100 studies surveyed in the last five years) to identify factors around telehealth effectiveness and efficiency. “The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.” Patient satisfaction was achieved when providers delivered healthcare via videoconference or any other telehealth method. Telehealth and patient satisfaction: a systematic review and narrative analysis (PDF)

The American Academy of Family Physicians (AAFP) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care hosted a Capitol Hill meeting on telehealth in primary care 9 November. The conundrum that PCPs face: telehealth is well-suited to primary care, the CPT codes are there, physician time can be easily recorded, and patients now are comfortable with it–but connectivity, health plans, and expansion of the referral network beyond the local are still not there. Regina Holliday, a well-known patient advocate who will be speaking at MedMo17, spoke about telehealth’s great advantages in mental health, especially to younger patients who want anonymous counseling and those in rural areas where it’s hundreds of miles to a mental health clinic or a psychiatrist. AAFP Forum Report

Medtronic, American Well mega-partner for telehealth + telemedicine for chronic care

Boston-based American Well and Dublin-based Medtronic announced this week a partnership to integrate telemedicine and telehealth for chronic care management, targeting complex, chronic and co-morbid patients. Under the agreement, American Well’s telemedicine services will integrate into Medtronic Care Management Services (MCMS) video-enabled telehealth platforms for remote patient monitoring and video consults. The goal is to provide more information so that clinicians gain a more complete view of a patient’s health status when making care decisions, thus reducing the cost of care and improving patient outcomes. Care for patients with multiple chronic conditions accounts for over 70 percent of healthcare spending, according to an AHRQ study.

American Well is currently partnered with 250 healthcare partners in the US and more than 750 health systems and 975 hospitals, along with most major health plans. MCMS has two video telehealth platforms including the mobile NetResponse and the LinkView Wi-Fi tabletop. Their most recent activity is with the Midwest’s Mercy healthcare system for data sharing and analysis to gather clinical evidence for medical device innovation and patient access. MCMS platforms are also being integrated into the VA’s Home Telehealth program [TTA 6 Feb and 15 Feb]. It indicates that Medtronic is seeking to grow its telehealth device business, which has largely (except for VA) been a backwater in the immense Medtronic empire.

This is a very logical and in this Editor’s estimation, overdue type of partnership between a telehealth provider to enhance telehealth and RPM. (An easy bet: expect Teladoc to follow with another telehealth provider)

American Well/Medtronic release, Healthcare Informatics, MassDevice

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.

The REAL acute care: hurricanes, health tech, and what happens when electricity goes out

This afternoon, as this New York-based Editor is observing the light touch of the far bands of Hurricane José’s pass through the area (wind, spotty rain, some coastal flooding and erosion), yet another Category 5 hurricane (Maria) is on track to attack the already-wrecked-from-Irma Puerto Rico and northern Caribbean, thoughts turn to where healthcare technology can help those who need it most–and where the response could be a lot better. (Add one more–the 7.1 magnitude earthquake south of Mexico City)

Laurie Orlov, a Florida resident, has a typically acerbic take on Florida’s evacuation for Irma and those left behind to deal with no electricity, no assistance. Florida has the highest percentage of over-65 residents. Those who could relocated, but this Editor from a poll of her friends there found that they didn’t quite know where to go safely if not out of state, for this storm was predicted first to devastate the east coast, then it changed course late and barreled up the west (Gulf) coast. Its storm surges unexpected produced record flooding in northeastern Florida, well outside the main track. Older people who stayed in shelters or stayed put in homes, senior apartments, 55+ communities, or long-term care were blacked out for days, in sweltering heat. If their facilities didn’t have backup generators and electrical systems that worked, they were unable to charge their phones, use the elevator, recharge electric wheelchairs, or power up oxygen units. Families couldn’t reach them either. Solutions: restore inexpensive phone landlines (which hardwired, mostly work), backup phone batteries, external power sources like old laptops, and backup generators in senior communities (which would not have prevented prevent bad fuses/wiring from frying the AC, as in the nursing home in Hollywood where eight died).  Aging In Place Tech 

It’s another reason why senior communities and housing are supposed to have disaster preparedness/evacuation plans in place. (If you are a family member, it should be included in your community selection checklist and local records should be checked. This Editor recently wrote an article on this subject (PDF) that mentions disaster and incident planning twice. (Disclaimer: the sponsoring company is a marketing client of this Editor.) In nursing homes, they are mandatory–and often not executable or enforced, as this article from Kaiser Health News points out. 

Another solution good for all: purchase 200-400 watt battery packs that recharge with solar panels, AC, and car batteries (AARP anyone?). Campers and tailgaters use these and they range below $500 with the panels. Concerned with high-power lithium-ion batteries and their tendency to go boom? You’ll have to wait, but the US Army Research Laboratory and University of Maryland have developed a flexible, aqueous lithium-ion battery that reaches the 4.0 volt mark desired for household electronics without the explosive risks associated with standard lithium-ion power–a future and safer alternative. Armed With Science

Telemedicine and telehealth are not being fully utilized to their potential in disaster response and recovery, but the efforts are starting. Medical teams are starting to use telehealth and telemedicine as adjunct care. It has already been deployed successfully in Texas during Harvey. Many evacuees were sent to drier Dallas and the Hutchinson arena, where Dallas-based Children’s Health used telemedicine for emergency off-hour coverage. Doctor on Demand and MDLive gave free direct support to those affected in Texas and Louisiana through 8 September, as well as Teladoc, American Well, and HealthTap for a longer period to members and non-members. Where there are large numbers of evacuees concentrated in an area, telemedicine is now deployed on a limited basis. Doctor on Demand releaseSTAT News, MedCityNews 

But what about using affordable mobile health for the thousands who long term will be in rented homes, far away from their local practitioners–and the doctors themselves who’ve been displaced? What will Doctor on Demand and their sister telemedicine companies have available for these displaced people? What about Puerto Rico, USVI, and the Caribbean islands, where first you have to rebuild the cellular network so medical units can be more effective, then for the longer term? (Can Microsoft’s ‘white space’ be part of the solution?)  

One telehealth company, DictumHealth, has a special interest and track record in both pediatric telehealth and global remote deployments where the weather is hot, the situation is acute, and medical help is limited. Dictum sent their ruggedized IDM100 tablet units and peripherals to Aster Volunteers who aid the permanently displaced in three Jordanian refugee camps in collaboration with the UNHCR and also for pediatric care at the San Josecito School in Costa Rica. In speaking with both Amber Bogard and Elizabeth Keate of Dictum, they are actively engaging with medical relief agencies in both the US and the Caribbean. More to come on this.

‘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.