[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/long-windy-road.jpg” thumb_width=”250″ /]Telemedicine consults between doctors and with their patients are, at long last, progressing on the Long And Winding Road, according to this sizable recap in the Life and Health section of this weekend’s Wall Street Journal. The focus is on virtual visit growth in the US, but it opens with Doctors Without Borders (MSF) connecting their doctors in Africa with their specialist network worldwide. Mercy Health provides 24/7 ICU/ER support for 38 local hospitals out of a Virtual Care Center outside St. Louis manned by ICU specialists. Their results? A 35 percent decrease in patients’ average length of stay and 30 percent fewer deaths than anticipated. The important statistics here are on acceptance: 72 percent of hospitals and 52 percent of practices are finally integrating some form of telemedicine into care; 74 percent of large employers are covering telemedicine cost–yet awareness is still lagging among prospective patients, with only 39 percent familiar with it according to a recent survey. Challenges remain in reimbursement (more…)
On Tuesday, the Federal District Court of Massachusetts not only dismissed the American Well patent infringement lawsuit against Teladoc, but also invalidated American Well‘s patent, held by co-founder Dr. Roy Schoenberg since 2009. It was invalidated on the grounds that the claims in the patent were “too abstract” to be patentable and do not “amount to an inventive concept.” American Well is appealing the court decision.
This author is wondering who thought this was such a novel technology as to warrant a patent? What were they thinking? Having worked on developing unified messaging systems for a mobile phone operator at the turn of the century (now that’s a scary 15 years ago) I am just picking myself off the floor after reading this.
Surely all these functions are no more than what is in every instant messaging program, dating back to 1990s? Replace the words “medical service provider” by “friends” or “contacts” and “consultation” by “chat” or “call” it seems to me you get … Skype and Face Time and more! [TTA 9 June 15]
Is a tipping point nearing? Soon? An article in Modern Healthcare that contains a heavy dollop of promotion headlines ‘telehealth’s’ adoption by insurers such as Blue Cross Blue Shield of Alabama, Anthem and Highmark. When read through, it’s mainly about telemedicine (video consults) but does touch on the vital signs monitoring that’s the basis of telehealth. Video consults through Teladoc and other services such as Doctor on Demand and American Well are gradually being reimbursed by private insurers, despite the concern that it would actually drive up cost by being an ‘add-on’ to an in-person visits. Medicaid increasingly covers it, and states are enacting ‘parity’ regulations equalizing in-office and virtual visits including, in many cases, telehealth. Yet the move for coverage is hampered by lack of reimbursement to doctors, or the perception of limited or no payment. Even Medicare, a big advocate for alternative models of care, currently pays little out for telehealth–$17.6 million on a $630 million+ program. The Congressional Budget Office is skeptical, despite the savings claimed by CONNECT for Health Act in both the Senate and House [TTA 12 Feb]. Virtual reality: More insurers are embracing telehealth
Readers may have read our article in April this year “Can State medical boards legally prevent telehealth activity?”. [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/12/US-district-court-1.jpg” thumb_width=”150″ /]In that article we examined the potential impact of a case brought by the Federal Trade Commission against the North Carolina State Board of Dental Examiners. The case went all the way to the Supreme Court which determined that the State Board of Dental Examiners was not protected by immunity from anti-trust law.
Teladoc is now locked in a case with the Texas Medical Board (TMB) that is very similar to the North Carolina case and it too has gone along a similar path so far. In the latest development of this case, last week a Federal Court, the US District Court in Texas, denied the application by the TMB to dismiss a case brought by Teladoc that claims that the TMB broke anti-trust law.
What has brought Teladoc and the TMB to court in this way? (more…)
The NY eHealth Collaborative, which develops policies and standards supporting NY state-wide initiatives in healthcare information/data exchange, including the development of the SHIN-NY (Statewide Health Information Network -NY), Wednesday night honored four major NY-based forces in healthcare in New York City. Steven Safyer MD, CEO of Montefiore Health System, Jason Gorevic of telemedicine provider Teladoc, Thomas Mahoney MD of Finger Lakes Health System and Lisa Perry of Community Health Care Association, NYS. While award ceremonies usually don’t come bearing insights, Dr Safyer’s was succinct in what health systems face: that price is compressing over time and that it’s about managing that, not ‘managing care’ which is the usual shorthand. NYeC News. This Editor missed the usual event in conjunction with the gala, NYeC’s Digital Health Conference, and hopes it makes a reappearance next year. NYeC also partners with the Partnership Fund for NYC in the three-year old New York Digital Health Accelerator (NYDHA) which has six companies in its 2015 five-month program.
A definite boost to telemedicine providers American Well, now-publicly traded Teladoc and Doctor on Demand is retail drugstore CVS Health piloting their services through CVS MinuteClinics, starting in 2016. CVS’ release is disappointingly heavy on company quotations, light on specifics, but what can be determined is that CVS will test various arrangements, including onsite telemedicine in stores, through CVS ‘digital properties’ (presumably online or through apps) and MinuteClinic provider consults with telemedicine provider doctors. It carefully avoids referring to the three companies as ‘partnerships’ though it generically refers to them deep in the release. CVS currently has 1,000 MinuteClinic locations in 32 states and plan to grow by 50 percent by 2017; they have been testing telemedicine in about 50 clinics in Texas and California.
Annoyingly, both CVS and the three companies improperly use ‘telehealth’ in describing their services when correctly they provide only doctor-patient video consults, or telemedicine. The clinic providers (or individuals) may be reporting vital signs data as part of the visit, but tools are not integrated. Equally annoying is CVS, in the release and in conferences, citing a paywalled study (at the not inconsiderable sum of $39.95 / €34.95 / £29.95!) in the Journal of General Internal Medicine (JGIM) of their results. If you are touting that “95 percent of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” –well, with results like that, make some arrangements and grant access to the study! CVS release, Medscape, FierceHealthIT
For those of us who have been Terminology Warriors going back to the oughts (see founder and EIC emeritus Steve Hards’ summary in ‘What is Telecare’), this is a useful summary of not only what is telemedicine and who is authorized to perform it, but also how it is developing (US focus) in state law and reimbursement (private and Medicare). Despite being published earlier this month, it is already dated as reimbursement parity laws have been passed in Connecticut and Delaware [TTA 10 July]. The richly IPO’d Teladoc is omitted on the provider list in point #21; Better is anomalous as it is less telemedicine than a personal health assistance service. 25 things to know about telemedicine (Becker’s Health IT and CIO Review)
About Better: they have joined with Johns Hopkins’ Sibley Memorial Hospital Innovation Hub to provide support for orthopedic episodes of care. These generally are for a 90 day period which extends from scheduling the procedure through post-discharge recovery, and are usually tied into a bundled payment from an insurer or Medicare. Johns Hopkins press release Hat tip to CEO Geoff Clapp.
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.
* 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…)
This week’s big news (so far) of Fitbit’s $732 million initial public offering–the largest consumer electronics IPO ever–comes despite the Jawbone IP lawsuits [TTA 11 June]. Count us among those who question this ‘vote of confidence’ as raising unrealistic expectations for health tech by a fitness tracker not truly part of real digital health. Telemedicine provider Teladoc appears headed on the same track with an IPO estimated to come in at $137 million, probably by next week. This generous pricing (~$20/share) comes despite never being profitable in 13 years. Like Fitbit, Teladoc is facing lawsuits from its major competitor American Well on IP [TTA 9 June], with Teladoc asking the US Patent and Trademark Office to review the validity of several American Well patents. Both IPOs are on the New York Stock Exchange (NYSE). MedCityNews examines Fitbit and Teladoc.
According to FierceHealthIT, last week three more states – Indiana, Minnesota and Nevada – enacted telemedicine parity laws, bringing the total to 27 plus the District of Columbia, to make it that much easier to provide – and to request provision – of a telemedicine service.
- Indiana’s requires coverage of the services under private insurance through video, audio or other media. The law prohibits a provider from having to obtain written consent for use of telemedicine.
- Minnesota’s law says health plans must cover and reimburse for telemedicine the same way and at the same cost as in-person service. Medicaid coverage, according to the law, is limited to three telehealth services per week per beneficiary.
- Nevada’s requires coverage and reimbursement for telehealth under private insurance and Medicaid, as well as workers compensation (the first state to include this) to the same extent and at the same price as provided in person.
Meanwhile MorningStar reports that a Federal Court ruled in favor of Teladoc, blocking as illegally limiting competition (more…)
(Boffo: extremely good or successful, sensational–Webster)
Adding to Monday’s news of ATA’s telemedicine accreditation program was American Well‘s near-simultaneous announcement of an $81 million Series C funding. This brings total funding for the eight year-old Boston-based company to over $128 million, though it is not yet profitable. According to Modern Healthcare, “The capital injection will be used to serve a number of big projects the firm has underway, company co-CEO Dr. Ido Schoenberg said in an interview. Among those are campaigning to ease regulatory constraints, scaling its provider networks and customer outreach, working with insurers to secure more favorable reimbursement and working on its technology, he said.” The institutional, private equity, and corporate investors alluded to in the company release were not disclosed. Its mobile app, Amwell, claims over 1 million downloads with a year-to-year 1,000 percent increase. Major partners include payers Anthem Health, EmblemHealth, the Blue Cross Blue Shields of Massachusetts and Louisiana, Optum Health as well as corporate clients. American Well press release, BostonInno, SEC filing. (Note to American Well: you’re telemedicine, not telehealth)
If this round of funding represents a substantial bet on American Well’s future, another is the new relationship between Walgreens‘ and rival MDLIVE. (more…)
mHealth Summit this year had an abundance of digital health company news announcements, not only from the conference but also timed to coincide with the heightened interest around it. Your Editor looks over the most interesting of them, briefly. Thanks to Ashley Gold of Politico’s Morning eHealth (@ashleygold, daily reports archived here), Stephanie Baum of MedCityNews (@stephlbaum) and Anne Zieger of Healthcare Dive for their coverage and their company in the press room!
Partners HealthCare researches, Validic expands, AliveCor and Omron ally, Happtique sells out, Doctor on Demand is telemental, Orange goes dental, VA Innovation Rocks
- Partners HealthCare/Center for Connected Health’s cHealth Compass will use panel and other research to help companies, device manufacturers, startups and investors determine what end users–consumer and provider–want out of personal health tech. Focus groups, interviews and usability testing will help to determine product design, evaluation, assess applications and feasibility as well as interim/final product testing. Partners is already organizing in Massachusetts a 2,000-patient database which rewards participants $50 on registration and $110 annually to be in a monthly survey panel. cHealth Compass website, BetaBoston (Boston Globe)
- Health data connector/aggregator Validic demonstrates the attractiveness of Anything Big Data on with new clients including the Everyday Health consumer/professional website and the adidas Group’s sport and fitness apps. Recently they added WebMD, Pfizer, University of Pittsburgh Medical Center (UPMC), NexJ Health and MedHost to their client list. The company claims that their ‘ecosystem’–probably the most popular buzzword at this year’s conference–of healthcare companies and tech developers now reaches over 100 million people with devices such as Omron, Alere, Qardio, Telcare, Jawbone and Withings. Release
- AliveCor accentuates the retail with Omron. AliveCor, which developed the first FDA-cleared ECG for smartphones and gained clearance for an atrial fibrillation algorithm in August, is collaborating with Japanese device manufacturer Omron on developing its retail presence. Omron’s devices are available in major drugstores such as Walgreens, RiteAid and Walmart so certainly AliveCor is due to benefit. AliveCor is also part of a revived QualcommLife (more on this in an upcoming article) Release, Mobihealthnews (Your Editor had the pleasure of meeting at last AliveCor’s CMO and founder Dr. Dave Albert.)
- Happtique sold to SocialWellth. Last year’s floor talk was about Happtique’s first class of certified apps and a security expert’s untimely discovery of major flaws (more…)
Will reimbursement by insurance payers and private employers (presumably self-insured) and a greater comfort level with the video consult mean that telemedicine will finally step out of the waiting room? This Economist article (free registration may be required) with high points from a recent Rome conference seems to not be able to make up its mind, though it tries to be positive. Taking a comparative view, Israel leads with ‘relatively lax guidelines’, with doctors able to e-prescribe and perform referrals to specialists online. China’s health-care reform focuses on telemedicine“, but Peteris Zilgalvis, a health official at the European Commission pointedly states “If you have a chaotic system and add technology, you get a chaotic system with technology” (Editor’s emphasis). The US is somewhere in between (more…)
Verizon is evidently sticking with its strategy of enterprise marketing when it comes to digital health. The Verizon Virtual Visits service released last week enables a video chat with a clinician via smartphone app (3G/4G OK as well as Wi-Fi; the full mobile enablement Verizon states as a key differentiator versus competitors such as American Well, MDLive and Teladoc) or alternatively, web portal. Prior to the average 30 minute chat, the service verifies eligibility and co-pay information, presents patients’ self-reported histories, symptoms, medication allergies and other information, then collects the co-pay; at the close if needed, an e-prescription via SureScripts is sent to the patient’s pharmacies. Verizon presents this as as a ‘white label’ service for groups such as health systems, insurers and health plans who will determine their unique co-pay and clinician mix. Clinicians can be contracted through Verizon’s provider network or, in a health system, their own or an in-house/contract mix. Neither clients nor third-party medical provider(s) have been announced yet, but VentureBeat states that the clients will be publicized in the next few months, which is deflating. Information Week, The IHCC. Verizon release.
Making news out of Tuesday’s Wired Health UK 2014 at the Royal College of General Practitioners (RCGP) in London is Babylon. From the app (iPhone, Android), appointments with a GP or specialist can be booked 12 hours a day, six days a week, with one of the almost 100 part time salaried and on call doctors in Babylon’s system or a BUPA (private healthcare/insurance system) physician. Also bookable through the app are diagnostic kits and blood tests; X-rays or scans would be at a partner facility. Have a question or want to check your symptoms? The app directs your text and pictures to a doctor or nurse. Need a prescription? Delivered to your home or a nearby pharmacy. Record storage is on your phone. All for £7.99/month for basic service or £24 per consult–both low prices that seem to be introductory (a/k/a not profitable) or for light users. Babylon is registered with the Care Quality Commission, an independent healthcare regulator, and has designated body status from NHS London.
Founder Ali Parsa, a former Goldman Sachs banker who previously founded Circle, approvingly says that booking an appointment is as simple as ‘booking a Hailo cab’ (in NYC, Uber). This is a more complete model than a ZocDoc or Vitals (US appointment services) with testing and a symptom checker, but it does not seem to have a video consult (more…)