TTA’s Memorial Day Weekend Emergence: a TechForce19 participant reflects on the process, Optum buys naviHealth, Amwell’s Series C, and projecting a post-COVID workplace

 

Sloooowly emerging from our homes into the sunshine, and maybe back into our offices soon, we have a first-person participant view of TechForce19. Back in the office, there will be a whole lot of app tracking and separation going on, if we return. In other news, Optum continues its buying spree, Amwell raises a few dollars, and DHACA has a #WebinarWednesday coming up in June. 

Reflections of a TechForce19 Participant (What it’s like to be in the center of a tornado!)
Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C (More $ in analytics, telehealth)
DHACA home testing webinar 20th May 10am–next one 3 June (DHACA’s #WebinarWednesday)
Post-COVID back to work: for workplace screening, testing, contact tracing, there’s an app for that (You’ll be in a very different looking office with plenty of new rules–if you return there)

Even in Lockdown Lands, it is still Spring. Springing back is Curve Health, repurposing Call9’s telehealth and system. Theranos’ prosecutors had a spring in their step with 12 new charges. And maybe springing the UK free to recover is on the government’s mind with reopening guidance on the post-pandemic workplace.

Founder of Call9 springing back with Curve Health for nursing home telemedicine (Timely with corona’s unfortunate spotlight on SNFs)
The Theranos Story, ch. 63: 12 new wire fraud, conspiracy, forfeiture charges for Holmes, Balwani (The Feds Strike Back)
Important UK government guidance on safer workplaces during and after the COVID-19 pandemic (Kudos to the government–it’s time to revive the economy)

Babylon Health debuts in the US, contact tracing nears rollout in the UK, as an ‘immunity passport’ is contemplated, COVID and telehealth in three countries compared, and a lighter look at technology’s generation gap ‘all in the family’. And..this weekend, we commemorated V-E Day at 75!

Mount Sinai Health Partners (NY) launches Babylon Health telehealth app (Babylon’s app debut to millions competes against established virtual visits)
Is a COVID-19 ‘immunity passport’ next for the UK to get back to work? (Needs reliable antibody testing, as well as a much flatter curve)
Contact tracing in the UK: the biggest digital health test yet? (It’s not the insecurity of data that may hold it back)
Telehealth and the response to COVID-19 in Australia, UK, and US: video (The Malcolm Fisk interview on another view of the ‘genie out of the bottle’)
Has the ‘river of knowledge’ reversed its natural course? A lighter look at technology’s other effects. (Falling into the generation gap)
Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated) (Needs 80% uptake to work)

Now that the COVID-19 threat may be receding, what’s the future? The view from our telescope or our genie bottle, both good and not so good. We have good news from The TeleDentists, AliveCor, and AbleTo that are upvotes for pioneers. And clinical trials are a fresh pivot for digital health.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals (Is the genie out of the bottle? What do you see?)
Anthem Blue Cross Blue Shield adds virtual dental care with The TeleDentists in 9 states (Another vote for remote dentistry)
AliveCor, OMRON announce cardiac monitoring strategic alliance, equity investment (Good news for a pioneer in cardiac monitoring)
The Future of Clinical Trials in the Post-Pandemic Era: HITLAB Seminar Series 6 May (Ongoing series, how CROs may be part of the future for digital health)
Optum rumored on the digital health acquisition hunt again with AbleTo virtual behavioral health (AbleTo a pioneer with traction; a trend further discussed in the lead article)

Alerts on Saturday? Thanks for the feedback–and we’ll try these for awhile.

A full spectrum of news this week. NHSX has made 18 companies very happy in the TechForce19 challenge. We find out more about Tunstall’s ownership change/refinancing. DHACA’s second webinar is coming up on Wednesday 29 April. In the middle, NHSX’s COVID-19 contact tracing app raises privacy questions. And sad news for the industry in the loss of Doug Miles of UKTelehealthcare.

NHSX announces TechForce19 challenge awards, COVID-19 contact tracing app in test for mid-May launch (UK) (Good and not so good news, if you care about privacy)
CEO to CEO: TSA’s Alyson Scurfield interview with Tunstall CEO Gordon Sutherland (updated) (More hot gen on Tunstall’s ownership and financing)
RIP Doug Miles, founder of UKTelehealthcare (A sad loss of a telecare influencer)
Doing more for less in primary care – DHACA’s Wednesday webinars on 22 and 29 April (2nd one coming up on Wed!)

We’ve either flattened or flattered the curve with this week’s news. Flattening the curve is Vayyar’s sensor biomonitoring in Israel, Legrand’s care home support, the FCC, and dental telehealth including The TeleDentists. But flattering that curve is Medopad’s pivoting to Huma and more.

Medopad rebrands, pivots as Huma, acquires BioBeats and TLT, names Alan Milburn as chairman (UK) (Moving from diseases to wellbeing with a splash)
Beyond telehealth: sensor-based vital signs monitoring for early coronavirus symptoms being tested in Israel (Advanced sensor tech)
Legrand launches care home support fund, adds to hospital staff and caregiver support initiatives (Wide-ranging support for multiple worthy efforts at this viral time)
FCC opens application window for $200 million telehealth cost reimbursement program (Financial help for providers, but a lot of hoops to jump)
Cigna launches dental telehealth with Dental Virtual Care–including The TeleDentists (Payer support for dental telehealth, finally)

It was easy to forget that it was Easter and Passover Week as the days blur when you’re sheltering and working at home. But some reasons for cheer are present. There’s an injection of telehealth optimism from Dr. Topol, money for Tunstall and Tyto Care, and Care Innovations’ going to CRO Land. Even Ms. Holmes enjoyed good news, with the Theranos trial charges shrinking like the Wicked Witch of the West. And giving thanks to our healthcare workers–better than banging pots as in the US–is Thank And Praise’s Healthcare Thanking Wall.

A ‘digital wall’ gives thanks and praise to UK healthcare workers (An appropriate message for this week)
After the COVID Deluge: a Topol-esque view of what (tele)medicine will look like (The good doctor administers a dose of future cheer during these Bad News Weeks)
Tunstall Healthcare secures funding from Barings, M&G (A lifeline?)
Care Innovations sold to PRA Health Sciences; launches COVID-19 patient monitoring program (News we missed)
Tyto Care telehealth diagnostics raises $50 million in venture round (Big vote for remote monitoring)
The Theranos Story, ch. 62: Holmes’ attorneys request breaking ‘shelter in place’ orders for trial prep–and a coronavirus testing patent twist (Prosecution charges also deteriorating bit by bit?)

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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Optum buys naviHealth for reported $1 billion; Amwell raises $194 million in Series C

In non-COVID-19 news, Optum has confirmed to industry press that they have acquired post-acute management company naviHealth. Becker’s HealthIT cites sources that the purchase price is in the vicinity of $1 billion. Continuing their PAC-MAN path, this pharmacy benefit, population health, and care services wing of UnitedHealth Group in the past six months finalized the purchase of DaVita Medical Group from renal treatment giant DaVita for over $4.3 bn and is reportedly closing on a full acquisition of virtual behavioral health provider AbleTo [TTA 29 Apr] for a less stunning $470 million.

naviHealth provides post-acute care clinical decision-making tools that manage pre and post-acute care as part of value-based care programs such as the Bundled Payments for Care Improvement (BPCI) program with CMS. Their customer base includes health plans (4.5 million members within Medicare Advantage alone), over 140 hospitals, and post-acute care providers such as nursing homes, LTC facilities, rehabilitation, and home health. The company will retain current management and staff, and operate as a stand-alone company within OptumHealth. It’s a well-paid exit for Cardinal Health and Clayton, Dubilier & Rice. Also MedCityNews

Amwell raises $194 million in a second Series C. The former American Well did not need telehealth to receive a gratifying boost from its investors Allianz X and Takeda Pharmaceuticals. This follows on a February $60 million venture round from Chetrit Ventures (BostInno). Amwell has raised $711 million in nine funding rounds (Crunchbase). Their main business has been with payers, health systems, and employers. In April, they added a branded program, Amwell Private Practice, for practices under 100 providers for these mostly shuttered offices to reach their patients at home and to continue care. Release, Mobihealthnews.

TTA Spring Weekend Wrapup: ‘Curving’ nursing home telehealth, Theranos’ 12 new charges, and UK’s eight guides to the post-pandemic workplace

 

Even in Lockdown Lands, it is still Spring. Springing back is Curve Health, repurposing Call9’s telehealth and system. Theranos’ prosecutors had a spring in their step with 12 new charges. And maybe springing the UK free to recover is on the government’s mind with reopening guidance on the post-pandemic workplace.

Founder of Call9 springing back with Curve Health for nursing home telemedicine (Timely with corona’s unfortunate spotlight on SNFs)
The Theranos Story, ch. 63: 12 new wire fraud, conspiracy, forfeiture charges for Holmes, Balwani (The Feds Strike Back)
Important UK government guidance on safer workplaces during and after the COVID-19 pandemic (Kudos to the government–it’s time to revive the economy)

Babylon Health debuts in the US, contact tracing nears rollout in the UK, as an ‘immunity passport’ is contemplated, COVID and telehealth in three countries compared, and a lighter look at technology’s generation gap ‘all in the family’. And..this weekend, we commemorated V-E Day at 75!

Mount Sinai Health Partners (NY) launches Babylon Health telehealth app (Babylon’s app debut to millions competes against established virtual visits)
Is a COVID-19 ‘immunity passport’ next for the UK to get back to work? (Needs reliable antibody testing, as well as a much flatter curve)
Contact tracing in the UK: the biggest digital health test yet? (It’s not the insecurity of data that may hold it back)
Telehealth and the response to COVID-19 in Australia, UK, and US: video (The Malcolm Fisk interview on another view of the ‘genie out of the bottle’)
Has the ‘river of knowledge’ reversed its natural course? A lighter look at technology’s other effects. (Falling into the generation gap)
Contact tracing app ready for Isle of Wight trial this week: Hancock. But is it ready for rollout? (updated) (Needs 80% uptake to work)

Now that the COVID-19 threat may be receding, what’s the future? The view from our telescope or our genie bottle, both good and not so good. We have good news from The TeleDentists, AliveCor, and AbleTo that are upvotes for pioneers. And clinical trials are a fresh pivot for digital health.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals (Is the genie out of the bottle? What do you see?)
Anthem Blue Cross Blue Shield adds virtual dental care with The TeleDentists in 9 states (Another vote for remote dentistry)
AliveCor, OMRON announce cardiac monitoring strategic alliance, equity investment (Good news for a pioneer in cardiac monitoring)
The Future of Clinical Trials in the Post-Pandemic Era: HITLAB Seminar Series 6 May (Ongoing series, how CROs may be part of the future for digital health)
Optum rumored on the digital health acquisition hunt again with AbleTo virtual behavioral health (AbleTo a pioneer with traction; a trend further discussed in the lead article)

Alerts on Saturday? Thanks for the feedback–and we’ll try these for awhile.

A full spectrum of news this week. NHSX has made 18 companies very happy in the TechForce19 challenge. We find out more about Tunstall’s ownership change/refinancing. DHACA’s second webinar is coming up on Wednesday 29 April. In the middle, NHSX’s COVID-19 contact tracing app raises privacy questions. And sad news for the industry in the loss of Doug Miles of UKTelehealthcare.

NHSX announces TechForce19 challenge awards, COVID-19 contact tracing app in test for mid-May launch (UK) (Good and not so good news, if you care about privacy)
CEO to CEO: TSA’s Alyson Scurfield interview with Tunstall CEO Gordon Sutherland (updated) (More hot gen on Tunstall’s ownership and financing)
RIP Doug Miles, founder of UKTelehealthcare (A sad loss of a telecare influencer)
Doing more for less in primary care – DHACA’s Wednesday webinars on 22 and 29 April (2nd one coming up on Wed!)

Do you prefer this Alert on Saturdays? Our information seems to indicate greater readership on the weekend. Tell us what you think–email Editor Donna in confidence.

We’ve either flattened or flattered the curve with this week’s news. Flattening the curve is Vayyar’s sensor biomonitoring in Israel, Legrand’s care home support, the FCC, and dental telehealth including The TeleDentists. But flattering that curve is Medopad’s pivoting to Huma and more.

Medopad rebrands, pivots as Huma, acquires BioBeats and TLT, names Alan Milburn as chairman (UK) (Moving from diseases to wellbeing with a splash)
Beyond telehealth: sensor-based vital signs monitoring for early coronavirus symptoms being tested in Israel (Advanced sensor tech)
Legrand launches care home support fund, adds to hospital staff and caregiver support initiatives (Wide-ranging support for multiple worthy efforts at this viral time)
FCC opens application window for $200 million telehealth cost reimbursement program (Financial help for providers, but a lot of hoops to jump)
Cigna launches dental telehealth with Dental Virtual Care–including The TeleDentists (Payer support for dental telehealth, finally)

It was easy to forget that it was Easter and Passover Week as the days blur when you’re sheltering and working at home. But some reasons for cheer are present. There’s an injection of telehealth optimism from Dr. Topol, money for Tunstall and Tyto Care, and Care Innovations’ going to CRO Land. Even Ms. Holmes enjoyed good news, with the Theranos trial charges shrinking like the Wicked Witch of the West. And giving thanks to our healthcare workers–better than banging pots as in the US–is Thank And Praise’s Healthcare Thanking Wall.

A ‘digital wall’ gives thanks and praise to UK healthcare workers (An appropriate message for this week)
After the COVID Deluge: a Topol-esque view of what (tele)medicine will look like (The good doctor administers a dose of future cheer during these Bad News Weeks)
Tunstall Healthcare secures funding from Barings, M&G (A lifeline?)
Care Innovations sold to PRA Health Sciences; launches COVID-19 patient monitoring program (News we missed)
Tyto Care telehealth diagnostics raises $50 million in venture round (Big vote for remote monitoring)
The Theranos Story, ch. 62: Holmes’ attorneys request breaking ‘shelter in place’ orders for trial prep–and a coronavirus testing patent twist (Prosecution charges also deteriorating bit by bit?)

Did you forget it’s Spring? Your Editor finds a shiny silver tulip in in CMS’ major telehealth expansion versus C-19. We also caught up with Industry News that was largely (but not entirely) free of Virus News. (At this point, Theranos News would be comic relief….) Sadly, the entire spring season of conferences is gone either to virtual or vapor.

Virus-(almost) free news: Cera’s $70m raise, Rx.Health’s RxStitch, remote teledentistry to rescue, Alcuris responds, Caravan buys Wellpepper, and Teladoc’s heavy reading
Further ‘virtualization’ of industry meetings: DHACA Day, HITLAB, NAACOS, HXD, now ATA 2020 (updated) (Cabin fever strikes deep, but there is nowhere to creep…)
CMS clarifies telehealth policy expansion for Medicare in COVID-19 health emergency, including non-HIPAA compliant platforms (US) (BIG news in expanding telehealth)

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


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Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Founder of Call9 springing back with Curve Health for nursing home telemedicine

Tim Peck MD, founder of Call9, which provided in-facility emergency care staff with telehealth capability for nursing homes, announced a new venture also targeted to nursing home/skilled nursing home (SNF) and rehabilitative health. Curve Health will provide telemedicine and health information exchange technology to SNFs and physician groups. Physicians calling on SNF patients will be able to access patient information before a telemedicine visit. According to Dr. Peck, Curve Health’s telehealth and HIE software are built on that of Call9’s. POLITICO Morning e-Health.

Call9 closed operations last July after four years and $34 million in investment. It achieved some success in New York state, covering 3,700 beds and a total of 11,000 patients treated. While they experienced measurable success–in a 200-bed SNF, they achieved a 50 percent reduction in ER admissions and a savings of $8M per year–made inroads with major payers like Anthem and Healthfirst plus expanded into community telemedicine, it ran into a funding wall all too common with this sector. While the book of business was decent and they had gone through two well-funded rounds, Call9 could not move easily into a Series C. Value-based care is a great buzzword and beloved by CMS, but it is a long payout curve, too long for many investors. More discussion on this is in our article 26 June 2019

It is a shame as New York has been the epicenter of COVID-19 nursing home fatalities, due to a foolish (and this Editor is understating) state mandate of returning recovering patients right back to their nursing homes, which could not provide the level of care or isolate them. These patients often worsened, but also infected other patients and staff. Perhaps this could have been mitigated by Call9 or similar–but likely not.

Sadly, there’s a spotlight on nursing homes, rehabs, and LTC because of this pandemic. We look forward to more news from Dr. Peck and Curve Health in this specialized and underserved area of telehealth.

Telehealth and the response to COVID-19 in Australia, UK, and US: video

Malcolm Fisk, whom our Readers know as Senior Researcher at the De Montfort University in Leicester, was kind enough to forward information on a recent video interview with André Martinuzzi of the Living Innovation Project, a Europe-wide innovation group with 14 partners ‘co-creating the way we will live in 2030’.

This 17:30-minute video covers a lot of ground on the UK response to the coronavirus (the uncertainty as of mid-April), how the UK, US, and Australia have used telehealth in response, and how telehealth can ‘stick’ after the crisis, but only if we design an inclusive infrastructure. You can view the video on the Living Innovation page by clicking on ‘View Video’ on the upper right hand side, or go directly to YouTube.

There’s a brief preview in the video of Dr. Fisk’s paper (awaiting publication, co-authored with Anne Livingstone and Sabrina Pit) on ‘Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom and the United States’. Telehealth was very rapidly put into use for diagnosis, monitoring, and home treatment of COVID patients. Restrictions were lifted and investments made in communicating the availability of telehealth. However, the infrastructure for telehealth is strained, especially in the US with a mixed, primarily private model dependent on payers or individuals paying per virtual visit. In the UK, health trusts have encouraged the use of telephonic and audio/video models. In Australia, telehealth, particularly in remote areas, is well established. TTA will keep Readers posted on the publication of this paper. A big hat tip to Malcolm Fisk.

10 years in 2 months: prognosticating the longer-term effect of COVID-19 on telehealth, practices, and hospitals

crystal-ballThis Editor recounted last night in the article below on The TeleDentists’ fresh agreements with Cigna and Anthem the observation of a former associate who has been in the thick of the remote patient monitoring wars for some years that telehealth/telemedicine has progressed 10 years in 2 months. Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), stated to the Wall Street Journal (paywalled),  “I think the genie’s out of the bottle on this one. I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.” Even in a short period of time, CMS-reported telehealth visits as of 28 March trebled from 100,000 to 300,000. When the April numbers are in, it would not be surprising to see it grow well into seven figures.

The genie may be out of the bottle, but what will the genie do? Genies are, after all, unpredictable, and fly around.  Out of the smoke, some educated guesses:

  • Insecure, non-HIPAA compliant audio/video platforms will be the first which should be struck from CMS approval. Zoom has become a hackfest, with all sorts of alerts from mobile providers like Verizon on how to secure your phone. (An organization of which this Editor is a member had a panel this week completely disrupted by a hacker in five minutes.) Skype’s problems are well known. The winners here will be telehealth platforms that integrate well with EHRs, population health platforms (or may be part of population health platforms), and have robust security.
  • Primary care practices and specialists, who’ve been surviving on non-F2F visits, will be adjusting their practices to patient demand, and integrating telehealth with physical visits in a way that their patients will prefer. This means a search for integration of EMRs/EHRs with secure platforms and reconfiguring areas such as care coordination. If planned correctly, this could create better management of patients with multiple chronic conditions.
  • Actual physical visits will rebound, creating financial pressure on Medicare, hospitals, and private payers. How many people’s health has declined in two-three months is key. Small practices, who may see this first, will see another level of pressure, because they will be held to their Medicare quality metrics in value-based models even if adjusted. Hospitals will also rebound–if they are able. The dark side: private payers may run the numbers and scale back on benefits for the 2021 year especially if COVID is projected to make a return.
  • Behavioral health may benefit, yet drive individual practices and a wave of retirements, or a consolidation into clinic or group settings. There’s a reason why Optum is buying out AbleTo; we may see a wave of competitor acquisitions in this area with the emphasis will be on cognitive health and short courses. Why retirements? Many psychiatric practices are still independent, concentrated geographically, and the average psychiatrist is over 50. Psychiatric EHRs are both costly and not particularly suited to practices. If faced with technological challenges, a lot of MDs and senior clinical psychologists may very well exit–threatening clinics which need MDs to legally operate.
  • Rural health’s failure accelerated. USA Today’s analysis pinpointed at least 100 rural hospitals to close within the year. They already operated on thin margins, but with COVID expenses for additional equipment, the closing down of more profitable elective procedures and dependence on Medicaid, the over 1,100 unprofitable hospitals, over half of which are the only hospital in their county, have received a body blow. HHS allocated $10 billion to rural hospitals and clinics of the $100 billion aid package, but it may be too little and too late. Becker’s Hospital Review continues to track the bankruptcies and closures. Here there are no easy solutions from the digital health area.
  • A culture of cleanliness should accelerate. If the genie pulls this out of the bottle, one major benefit will be that hospital-acquired infections will decline. Effective sanitization methods that reduce human application and scrubbing will be the ones to look at: disinfecting foggers and UV full room or area systems–or combinations of same. Cleanliness and lack of virii and bacteria may become a new metric. Look and bet on companies that can provide this, from rooms to computers/mobile tablets and phones.

Readers can help with these prognostications and especially how they will play out not only in the US, but also in the UK, Europe, and worldwide.

FCC opens application window for $200 million telehealth cost reimbursement program

In more COVID related news, the Federal Communications Commission (FCC) will be administering the $200 million allocated by the CARES Act to fund telehealth related expenses for providers to furnish connected care for patients. The program will fully fund practices and health systems in telecommunications services, information services, and devices necessary to provide critical connected care services. Funding will continue through the national health emergency or until the program funds have been fully spent out.

The application period opened on Monday 13 April. Applicants can download a fillable PDF form linked to the FCC’s program web page, but before they do that, there’s several pre-requirements typical of any Federal program:

  • Obtain an FCC Registration Number (FRN) from the Commission Registration System (CORES), as well as a CORES username and password at that link. An FRN is a 10-digit number that is assigned to a business or individual registering with the FCC and is used to identify the registrant’s business dealings with the FCC.
  • Obtain an eligibility determination from the Universal Service Administrative Company (USAC) by filing FCC Form 460 through My Portal on USAC’s webpage. (Filers do not need to be rural health care providers in order to file Form 460 for this program.)
  • Register with the federal System for Award Management (SAM)

When approved, the program operates as a reimbursement program where approved providers will have to submit invoices and supporting documentation which are also subject to audit.

FAQs are linked here. Also HISTalk.

Cigna launches dental telehealth with Dental Virtual Care–including The TeleDentists

In the US, most insurance payers have been responding to the COVID-19 pandemic by waiving cost-sharing, such as deductibles and co-pays, for coronavirus treatment–and also waiving co-pays for medical telemedicine/telehealth visits for any reason. A medical area that hasn’t been considered previously, but is becoming more important as restrictions continue, is dental treatment. Nearly all dental practices have been shut or open for emergency treatment only since mid-March.

Cigna is possibly the first payer to innovate a Dental Virtual Care program for emergency care using its own dental network and that of The TeleDentists [TTA 19 June 19]–and at no cost through 31 May. (For instance, The TeleDentists’ average consult cost is $69.) Cigna’s 16 million members of their employer-sponsored insurance plans are eligible for the program. 

Teledentristry is designed for urgent situations, such as pain, infection, and swelling, and to avoid an initial visit to the ER. The visit is done through a video consult plus chat (TeleDentists uses the VSee platform) to evaluate the plan member, then to guide on next steps. If necessary, the dentist will prescribe medications, such as antibiotics and non-narcotic pain relievers.

The program will continue later than 31 May subject to state regulations and benefit plans as part of Cigna Dental Health Connect. Cigna release. Hat tip to CEO Howard Reis.

After the COVID Deluge: a Topol-esque view of what (tele)medicine will look like

A typically cheery view by Eric Topol, MD of what medical practice will look like after COVID is over. With the full court press to go remote in hospitals and practices worldwide, telehealth and telemedicine has gone fast forward in a matter of under two months. But what will it look like after it’s over? Most of what the good doctor is prognosticating will be familiar to our Readers who’ve followed him for years–certainly he was right on mobile health overall and especially AliveCor/Kardia Mobile— but not so on point with mobile body scanners (anyone remember VScan?)

When the high tide recedes, what will the beach look like?

  • “Telemedicine will play the role of the first consultation, akin to the house-call of yore.” (Terminology note–interesting that Dr. T still uses ‘telemedicine’ versus ‘telehealth’–Ed.)
  • Chatbots will serve as screeners–once they are proven to be effective (a ways to go here, as the Babylon debate rages on)
  • Smartphones will be the hub, connecting with all sorts of monitoring devices (the ‘connected health’ Tyto Care and Vivify Health model–which makes the Editor’s former company, the late Viterion Digital Health, even more of a pioneer that died crossing the Donner Pass of 2016)
  • Smartwatches are also part of this hub (this Editor remains a skeptic) 
  • Now is the time to harness technology by both health systems and individual practices, but multiple barriers remain. (This Editor can speak to the difficulties for both primary care and specialty practices in not only practice but also reimbursement–and acceptance by patients.) Device expense is also a problem for the non-affluent.

As to the rest, it is pretty much what we’ve heard from Dr. T before.  The Economist

Your Editor will add:

  • Easy to use, secure platforms that don’t put users through multiple security steps remain a concern for users. This Editor’s concern is that easy to use = insecure. Skype and Zoom are inherently insecure–Skype’s user unfriendliness and insecurity outside enterprise platforms and Zoom’s major security problems on its platform and user flaws are well-known (ZDNet).
  • Reimbursement, again! CMS has done a creditable job in broadening reimbursement for telehealth a/v and telephonic services, but coding remains a nightmare for practices struggling to remain open and with some lights on. After COVID, will CMS and HHS get religion, or put it right back in its rural bottle? Covered in the CARES Act passed at the close of March, $200 million sounds like a lot from the FCC to bankroll telecom equipment for providers, but these funds will go quickly. At least they are not delayed in endless rule making, as the Connected Care Pilot Program has been for two years. Mobihealthnews 

Tyto Care telehealth diagnostics raises $50 million in venture round

Tyto Care today (7 April) announced a venture round investment of $50 million by Insight Partners, Olive Tree Ventures, and Qualcomm Ventures LLC plus previous investors. The new investment will pay for commercialization throughout the US, Europe, and Asia as well as to introduce new advanced product capabilities including AI and machine learning-based home diagnostics solutions and other patented technologies. 

Tyto’s timing could not be better for the raise. In the US, led by CMS with private payers following in near lockstep, the past month has seen the rapid unrestricting of payment for telehealth services like virtual visits of the audio-visual type and short asynchronous and synchronous image and audio/telephonic short visits. Tyto’s remote medical exams of the lungs, heart, throat, ears, abdomen, and body temperature fits into the current and likely future need. Both live exams and asynchronous forwarding of data are part of a platform that integrates with EHRs and third party exam tools.

Tyto Care works with hundreds of hospitals and over 100 health organizations including health systems, payers and strategic partners, primarily in North America, Europe, and Israel. In 2019, they had over 200,000 examinations.

If, like your Editor, you believe that the tidal wave of telehealth has changed the office visit model for keeps, adding remote diagnostics can be a winner–if Tyto can navigate the tricky shoals of a largely consumer-based marketing strategy (Best Buy) and gain adoption by health systems and payers, as they have in Israel with Sheba Medical Center [TTA 28 Feb]. Release, FierceHealthcare

Virus-(almost) free news: Cera’s $70m raise, Rx.Health’s RxStitch, remote teledentistry to rescue, Alcuris responds, Caravan buys Wellpepper, and Teladoc’s heavy reading

Keeping calm and carrying on (but taking precautions, staying inside, and keyboarding with hands that resemble gator hide), yes, there IS some news that isn’t entirely about COVID-19:

This Editor had put aside the $70 million funding by the UK’s Cera at end of February. What is interesting is that Cera Care is a hybrid–specializing in both supplying home-based care, including dementia care, and providing tech-enabled services for older adults. The funding announcement was timed with the intro of SmartCare, a sensor-based analytics platform that uses machine learning and data analytics on recorded behaviors to personalize care and detect health risks with a reported 93 percent accuracy. It then can advise carers and family members about a plan of action. This sounds all so familiar as Living Independently’s QuietCare also did much the same–in 2006, but without the smartphone app and in the Ur-era of machine learning (what we called algorithms back then).

The major raise supports a few major opportunities: 50 public sector contracts with local authorities and NHS, the rollout of SmartCare, its operations in England and Wales, and some home healthcare acquisitions. Leading the round was KairosHQ, a US-based startup builder, along with investors Yabeo, Guinness Asset Management, and a New York family office. Could a US acquisition be up next?  Mobihealthnews, TechEU

Located on NYC’s Great Blank Way (a/k/a Broadway), Rx.Health has developed what they call digital navigation programs in a SaaS platform that connect various programs and feed information into EHRs. The interestingly named RxStitch engine uses text messages (Next Gen Reminder and Activation Program) or patient portals to support episodes of care (EOC), surgeries, transitions of care (TOC), increasing access to care, telehealth, and closure of care gaps. Their most recent partnership is with Valley Health in northern NJ. Of course they’ve pitched this for COVID-19 as the COVereD initiative that supports education, triage, telehealth, and home-based surveillance as part of the workflow. Rx.Health’s execs include quite a few active for years in the NY digital health scene, including Ashish Atreja, MD.

Teledentistry to the rescue! Last summer, we focused on what this Editor thought was the first real effort to use telemedicine in dentistry, The TeleDentists can support dentists who are largely closing shop for health reasons to communicate with their own patients for follow up visits, screen new patients, e-prescribe, and refer those who are feeling sick to other telehealth providers. For the next six weeks, patients pay only $49 a visit. More information in their release. Hat tip to Howard Reis.

What actions are smaller telehealth companies taking now? Reader and commenter Adrian Scaife writes from Alcuris about how their assistive technology responds to the need to keep in touch with older people living alone at home. Last week their preparations started with giving their customers the option to switch to audio/video conferencing with their market teams. This week, they reviewed how their assistive technology and ADL monitoring can keep older people safe in their homes where they may have to be alone, especially after discharge, yet families and caregivers can keep tabs on them based on activity data. A smart way for a small company to respond to the biggest healthcare challenge of the last 30 years. Release

Even Caravan Health, a management services company for groups of physicians or health systems organizing as accountable care organizations (ACOs) in value-based care programs, is getting into digital health with their purchase of Wellpepper. The eight-year-old company based in Seattle works with health plans to provide members with outpatient digital treatment plans, messaging services, and an alert system to boost communication between care teams and patients. Purchase price was not disclosed, but Wellpepper had raised only $1.2 million in debt financing back in 2016 so one assumes they largely bootstrapped. Mobihealthnews

And if you’re stuck at home and are trying to avoid chores, you can read all 140 pages of Teladoc’s Investor Day presentation, courtesy of Seeking Alpha

CMS clarifies telehealth policy expansion for Medicare in COVID-19 health emergency, including non-HIPAA compliant platforms (US)

Today (17 March), the Center for Medicare and Medicaid Services (CMS) issued a Fact Sheet and FAQs explaining how the expanded telehealth provisions under the Coronavirus Preparedness and Response Supplemental Appropriations Act and the temporary 1135 waiver will work. The main change is to (again) temporarily expand real-time audio/video telehealth consults in all areas of the country and in all settings. The intent is to maintain routine care of beneficiaries (patients), curb community spread of the virus through travel and in offices, limit spread to healthcare providers, and to keep vulnerable beneficiaries, or those with mild symptoms, at home. Usage is not limited to those who suspect or already are ill with COVID-19.

Previously, only practices in designated rural health areas were eligible for telehealth services, in addition to designated medical facilities (physician office, skilled nursing facility, hospital) where a patient would be furnished with a virtual visit. 

The key features of the 1135 telehealth waiver are (starting 6 March):

  • Interactive, real-time audio/video consults between the provider’s location (termed a ‘distant site’) anywhere in the US and the beneficiary (patient) at home will now be reimbursed. The patient will not be required to go to a designated medical facility.
  • Providers include physicians and certain non-physician practitioners such as nurse practitioners, physician assistants and certified nurse-midwives. Other providers such as licensed clinical social workers (LCSW) and nutritionists may furnish services within their scope of practice and consistent with Medicare benefit rules.
  • Surprisingly, there is ‘enforcement discretion’ on the requirement existing in the waiver that there be a prior relationship with the provider. CMS will not audit for claims during the emergency. (FAQ #7)
  • Even more surprisingly, the requirement that the audio/visual platform be HIPAA-compliant, as enforced by the HHS Office of Civil Rights (OCR), is also being waived for the duration (enforcement discretion again), which enables providers to use Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype–but not public-facing platforms such as Facebook Live, Twitch, or TikTok. Telephones may be used as explicitly stated in the waiver in Section 1135(b) of the Social Security Act. (FAQ #8) More information on HHS’ emergency preparedness page and OCR’s Notification of Enforcement Discretion.
  • On reimbursement, “Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.”

Concerns for primary care practices of course are readiness for real-time audio/video consults, largely addressed by permitting telephones to be used, as well as Skype and FaceTime, and what services (routine care and COVID-19 diagnosis) will be offered to patients.

This significant expansion will remain in place until the end of the emergency (PHE) as determined by the Secretary of HHS.

In 2019, CMS also expanded telehealth in certain areas, such as Virtual Check-Ins, which are short (5-10 minute) patient-initiated communications with a healthcare practitioner which can be by phone or video/image exchange by the patient. This could be ideal for wound care where this Editor has observed, in one of her former companies, how old phones are utilized to send wound images to practices for an accurate ongoing evaluation via special software. E-Visits use online patient portals for asynchronous, non-face-to-face communications, initiated by the patient. These both require an established physician-patient relationship. Further details on both of these are in the Fact Sheet, the FAQs, and the HHS Emergency Preparedness page with links.

The American Medical Association issued a statement today approving of the policy changes, and encouraged private payers to also cover telehealth. The American Telemedicine Association didn’t expand upon its 5 March statement praising the passage of the Act but advocated for increased cross-state permission for telehealth consults.

Additional information at HISTalk today and Becker’s Hospital Review.

$8bn COVID-19 supplemental funding House bill waives telehealth restrictions for Medicare beneficiaries (US)

The House of Representatives, which controls appropriations, has passed H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act. The bill provides $8.3 billion in new funding that includes a significant telehealth waiver for Medicare. From the bill summary on Congress.gov:

Within the Department of Health and Human Services (HHS), the bill provides FY2020 supplemental appropriations for

the Food and Drug Administration,
the Centers for Diseases Control and Prevention,
the National Institutes of Health, and
the Public Health and Social Services Emergency Fund.

In addition, the bill provides supplemental appropriations for

the Small Business Administration,
the Department of State, and
the U.S. Agency for International Development

The supplemental appropriations are designated as emergency spending, which is exempt from discretionary spending limits.

The programs funded by the bill address issues such as

developing, manufacturing, and procuring vaccines and other medical supplies;
grants for state, local, and tribal public health agencies and organizations;
loans for affected small businesses;
evacuations and emergency preparedness activities at U.S. embassies and other State Department facilities; and
humanitarian assistance and support for health systems in the affected countries.

The bill also allows HHS to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.

Sponsored by retiring Rep. Nita Lowey (D-NY), it was introduced and passed in the House 415-2.

In the text of the bill, the telehealth-pertinent portion permitting CMS to waive restrictions on telehealth for Medicare beneficiaries during this emergency is Division B, Sections 101-102. This cost is estimated at $500 million by The Hill.

The bill went to the Senate yesterday (4 Mar) for final approval. There is already an amendment proposed by Senator Rand Paul (R-KY) to offset the $8 bn of the bill with unobligated, non-health related foreign aid funds (FreedomWorks). Whether this is the ‘offset’ for telehealth that is mentioned in The Hill as under negotiation is not revealed.

The American Telemedicine Association (ATA) approved of the waiver. Ann Mond Johnson, the ATA’s CEO, urged “CMS to implement its waiver authority as soon as possible to ensure health care providers understand any requirements and help speed the deployment of virtual services” and pledged “The ATA and its members will continue to work with federal and state authorities, including HHS and the CDC, to address the COVID-19 outbreak and ensure resources are appropriately deployed for those individuals in need of care and help keep health care workers safe.” ATA press release, Hat tip to Gina Cella for the ATA heads-up

Consolidation crunch time in telehealth: Teladoc acquires InTouch Health for $600 million

Announced on Sunday just in time for Monday’s start of the annual, breathlessly awaited JP Morgan healthcare conference where ‘middle America’ ‘flyover’ companies are now the hot thing, was the acquisition by decidedly not-flyover Teladoc (Purchase, NY) of InTouch Health (Santa Barbara CA). InTouch is a mid-sized company for primarily hospital and health system-based telehealth. The purchase price was $150 million in cash and the remainder in Teladoc common stock, scheduled to close next quarter.

InTouch had made acquisitions of its own in 2018: REACH Health (enterprise telehealth) and TruClinic (DTC telehealth). Unusually, it also came fairly unencumbered by outside funding–only $49 million to date.

Telehealth and telemedicine are both rapidly consolidating and growing horizontally into payers (Teladoc and Aetna), corporate, and health systems.

An analysis over at Seeking Alpha emphasizes InTouch’s enterprise business as the charm for Teladoc, leading to a purchase price 7.5x revenue based on InTouch Health’s 2019 revenue of $80mm. InTouch had, with TruClinic, built itself up into a comprehensive system for over 450 hospitals reaching to the patient, but also developed specialty telehealth areas in stroke, behavioral health, critical care, neonatology, and cardiology. In their view for investors, the news is quite positive for Teladoc as–returning to JP Morgan–40 percent of hospitals expect to increase their telemedicine budgets. Release, MedCityNews

Babylon Health to enter US market with two large strategic partners: report

An apparently exclusive report in Mobihealthnews confirms the recent speculation that Babylon Health is entering the US market starting next month with its smartphone-based chat and triage service. Kurt Blasena, Babylon’s senior managing director of commercial strategy and revenue growth, said at the October Digital Health Innovation Summit in Boston that there are two current partners and a projected additional one to three more in 2020. The hints were that they were two “very large” strategic partners and one implementation will be for the state Medicaid market. The partners were not named, which leads this Editor to guess that the Medicaid implementation hasn’t been cleared with its state yet.

Babylon is experienced at international rollouts but not the US market. According to Mr. Blasena, they been busy localizing the service for the US by adapting the chatbot’s natural language processing system and hiring US-based staff. Part of the US difference is negotiating through how local healthcare is delivered, plus the thicket (this Editor is being kind) of Federal, state, and local regulations.

Right now their US operations are in a Prospect Heights, Brooklyn NYC apartment and in a WeWork in Austin, Texas. Mr. Blasena, according to his LinkedIn profile, is resident in San Diego.

Babylon Health has abundant cash on hand from a $550 million August Series C led by the Saudi Arabia Investment fund along with previous investors Kinnevik AB and Vostok plus new investor Munich Re. The stated intent was to expand into the US and other international markets in addition to presently being in Rwanda and Canada. Release  Stay tuned….

Cleveland Clinic, American Well extend partnership to high-acuity telehealth services with ‘The Clinic’

Proof that the realm of virtual consults is growing more competitive and specialized than ever is the announcement of a joint venture between the Cleveland Clinic and American Well. Dubbed The Clinic, the partnership will give patients access to comprehensive and high-acuity care services by integrating Cleveland Clinic’s specialists with American Well’s platform. 

While Cleveland Clinic and American Well have worked together in telehealth for non-emergency and specialty care since 2014, this new partnership takes it a giant step further to the care and management of complex conditions. Cleveland Clinic has also stated that telehealth is a key part of their growth strategy to double the number of patients served in the next five years. The Clinic will provide both national and international reach beyond their physical locations that include Abu Dhabi and London, according to a quote in the press release from Tom Mihaljevic, MD, their CEO and president. 

Cleveland Clinic reported that in 2018, the number of annual virtual visits grew 68 percent, anticipating that in five years, 50 percent of their outpatient visits will be virtual.

No timing for a go-live of The Clinic has been announced. Release, Mobihealthnews