TTA’s Week: pointing forward to ‘virtual care’, non-BG glucose monitoring, The King’s Fund and Parks summer event updates

 

A study that points the way forward in markets, tech, and investment for virtual care. The non-blood glucose monitoring race. Updates on The King’s Fund and Parks Associates’ summer conferences.

‘Deconstructing the Telehealth Industry’ positively, focusing on ‘virtual care’ of older adults (Major investor study looks forward and deeply)
The race to develop a blood glucose skin patch monitor speeds up with UCSD pilot (Another approach in measuring sweat vs. blood glucose)
The health tech events of summer: The King’s Fund (London) and Parks Associates (San Diego) (Updated)
UK-developed non-invasive skin patch monitors blood glucose; a ‘slow-mo’ injection to regulate it (Measuring interstitial fluid, adding gel to GLP1 treatment) 

Two private health tech solutions in the UK can’t wait for the NHS. DARPA developing a passive monitor out of your smartphone for warfighter readiness and health.

UK health grassroots programs not waiting for the NHS: VR for COPD patient exercise, Now Patient app for chronic care management (Health tech not waiting for NHS Digital)
DARPA’s $5.1M contract with Kryptowire to develop passive smartphone health monitoring, predictive analytics (A breakthrough in monitoring–just carry around your phone)

JPM’s Jamie Dimon delivers a windy healthcare lecture to his shareholders. Theranos winds down to startup size and its last few million. But you can wind up in London and San Diego at two events this summer.

The health tech events of summer: The King’s Fund (London) and Parks Associates (San Diego) (Here sooner than you realize! Speaking proposals still open with Parks)
The Theranos Story, ch. 48: down to 24 employees in a last ditch before bankruptcy (The Incredible Shrinking Theranos, only $900 million later)
Soapbox: JPM’s Dimon takes the 50,000 foot view on the JP Morgan Chase-Berkshire Hathaway-Amazon health joint venture (Trailing a fog of generalities, but don’t worry–the experts will fix it all)

Digital health funding concentrates on the already successful. Less ‘wild’ breaches in healthcare, but spreading to fitness devices. ‘You’re Fired’ plays out at VA. A therapy robot’s price limits its needed use. And three London events coming up.

2017’s transition in digital health funding: is it maturity or a reconsideration? (Investors taking a breath–or the Theranos Effect creating a damper?)
Breached healthcare records down 72% but incident numbers steady. Then there’s MyFitnessPal’s 150 million… (No one should be relaxing)
Shulkin out, Admiral Ronny Jackson MD nominated for VA head (Not getting job done means You’re Fired)
PARO: The robotic therapy seal that benefits so few (Founding Editor Steve laments PARO’s pricing as limiting its use)
Upcoming London events–a few suggestions (Editor Charles fills your UK calendar with RSM and other events)

The Amazon Effect may not be as cheap & cheerful as promoted. Inexpensive ultrasound in the pocket may change how imaging is used. 3rings calls up Amazon Echo. And who’s next at VA?

Is the Amazon Effect good or bad for consumers–and health tech? (Unintended–or intended–consequences)
Butterfly IQ handheld ultrasound offers clinical-quality body imaging for under $2,000 (Changing how imaging is used)
News roundup for Tuesday: room at the top at VA? (updated), Philips integrates teleradiology. 3rings Care premieres Amazon Echo service (Dr. Shulkin had less than two days to go at VA–whether fired or resigned, here’s the topline and the about to-be-confirmed replacement here.)

The Theranos post-mortem begins, and the company’s not even dead. Looking again at drug delivering contact lenses and PARO. Who’s hiring?

PARO therapy robot tested, cleared by NHS for — hygiene (The long road for this robot’s acceptance with geriatric dementia patients)
The Theranos Story, ch. 47: the post-mortem, blaming–and ghost chasing–begin (Digging into what happened–Mr. Balwani as Casper?)
Contact lenses as a drug delivery system take home MIT Sloan Healthcare prize (Commercialization nearing?)
The Theranos Story, ch. 46: “F for Fake.” SEC’s fraud charges force Elizabeth Holmes out (finally). (She settled, but lost the company. Balwani–he’d rather fight.)
Who’s hiring? Buddi seeks Sales Account Manager. (Your new situation? With our compliments…see below.)

Editor Steve maps the way through the hypey fog of blockchain and healthcare. And more of continued interest….

Blockchains, EHRs, roadblocks and baby steps (Founding Editor Steve cuts through the fog and hype to a realistic picture of blockchain in healthcare)
MediBioSense partners with MRIGlobal for Department of Defense health monitoring system (A new partnership for a somewhat ‘spooky’ DOD project)
Is Uber fit to deliver healthcare transport? Healthcare organizations may want to check. (Uber’s recent business practices against organizations’ codes of conduct)
Lyft and Uber’s big tech twists on a Social Determinant of Health–medical-related transportation (The big shared ride services enter the NEMT game)

CVS sets it up for Aetna with $40 billion in the third-largest bond sale ever (One more step to beating Amazon at the Retail Health Delivery Game, and the analysts like it.)

Digital health is not here. Or it is. Or it’s still “the future” and we’re waiting for the ship to come in. (Where are we on the Hype Curve anyway?)


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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

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‘Deconstructing the Telehealth Industry’ positively, focusing on ‘virtual care’ of older adults

A Big Study must-read. Just published is healthcare-specialized investment banking firm Ziegler’s 28-page update on their 2016 survey of the telehealth industry. Unlike some industry observers who believe that health tech has been ‘next year’s Big Thing’ far too long, with unproven effectiveness and savings, Ziegler believes it’s about to substantially ramp up in investment spending and tech integration.

The study looks forward and goes deeply into the markets. In their view, “We believe the next generation of successful virtual care companies will be those who understand the critical marriage between chronic care management, behavioral health, and social determinants.” Their focus is on the aging (50+) population and their higher risk for developing chronic conditions and the 50 percent/5 percent spread (50 percent of the spending is generated by 5 percent of the population). Their picture is that virtual care will ‘meet patients where they are’ in their daily lives.

The study sees trend confirmation in the adoption of virtual care by health systems (the widest–telestroke and tele-ICU), low-acuity care, and 2019 expansion of Federal reimbursement in Medicare Advantage Plan B with ACOs having more flexibility in telehealth-supported services. Ziegler promotes a change in terminology–‘virtual care’ as the ‘naturally integrated tool used to streamline the complex healthcare ecosystem.” Another difference: they place virtual care in the ‘smart aging continuum’ including its effect on decision makers, payers, care options, aging in place, and residential care.

A strong reference paper our Readers will be referring to for months to come. Deconstructing the Telehealth Industry, Part II (option for printable and viewable PDFs).

A tipping point in consumer acceptance of health apps, AI, and virtual care? Accenture thinks so.

Accenture’s 2018 Consumer Survey on Digital Health indicates that the tipping point may be here, sort of. Some key findings:

  • Consumers had high rates of favorable acceptance and likeliness to use AI-enabled clinical services: home-based diagnostics (66 percent of respondents), virtual health assistants (61 percent), and virtual nurses to monitor health conditions, medications and vital signs at home (55 percent), which may be good news for the future of telehealth services.
  • The 2,301 respondents already are using mobile and tablet health apps (48 percent). 44 percent are using patient portals for to fetch their health records, primarily to get information on lab and blood-test results (67 percent), to view physician notes regarding medical visits (55 percent), and their prescription history (41 percent).
  • Wearables are being used by 33 percent and favorably viewed by over 70 percent as beneficial in understanding their health condition (75 percent), engaging with their health (73 percent), and monitoring the health of a loved one (73 percent). 

Virtual care seems to be leading the way over wearables and remote patient monitoring–and after-hours care, patient follow-up, and patient education are leading virtual care.

  • 25 percent had received virtual care services in the previous year, up from 21 percent in last year’s survey. 16 percent are taking part in remote health consultations, compared with 12 percent in 2016. 14 percent are participating in remote monitoring, up from 9 percent in 2016.
  • 47 percent state that given a choice, they would prefer a more immediate virtual medical appointment over a delayed in-person appointment.
  • For after-hours care, 73 percent said they would use virtual care for after-hours (nights and weekend) appointments.
  • 71 percent said they would use virtual care for taking a class on a specific medical condition. 65 percent would use virtual care for a follow-up appointment after an in-person visit.
  • Most respondents said they would also use virtual care for a range of additional services, including discussing specific health concerns with medical professionals (73 percent), in-home follow-up after a hospital stay (62 percent), participating in a family member’s medical appointment (59 percent), and being examined for a non-emergency condition (57 percent).

Accenture release and report.

UK roundup: CCIO Simon Eccles warns against ‘shiny objects’, NHS Liverpool CCG award to Docobo, 87% concerned with NHS info security

click to enlargeNHS Digital CCIO doesn’t like ‘shiny objects’. Dr. Simon Eccles used his first NHS Digital board meeting as national CCIO to encourage delivering the current agenda first and not getting distracted by the ‘shiny objects’ of new innovations which also divert funding. “It is our collective challenge to make sure that doesn’t happen to things that are valued by the NHS – to do what we said we’d do and not be too distracted by new and shiny things.” This seems to be at odds with non-executive director Daniel Benton, who “suggested that NHS Digital needed to become more flexible as an organisation so that it was in a better position to roll with the punches in future.” Digital Health News

Docobo announced their win of the NHS Liverpool Clinical Commissioning Group‘s scale up of telehealth as part of the Healthy Liverpool program. The three to five-year contract has a maximum value of £11.5 million. The current Mi Programme (More Independent) partly funded by the Innovate UK dallas initiative and using Philips equipment is at 900 patients with 5,300 total patients since 2013. The plan is to scale up the program to 4-5,000 patients a year and support new clinical pathways and conditions including lung conditions, heart failure, and diabetes. Docobo’s platform is Doc@Home which uses patient information from the CarePortal device or their own digital devices. Docobo release. NHS Innovation Accelerator, Digital Health News

A survey of 500 British adults conducted by UK IT VAR Proband found that perceptions of public sector information security are poor. 87 percent were concerned about the security of their information with the NHS. Of that 87 percent, 34 percent were ‘very concerned’ about their cybersecurity. Taking this with a grain of salt, 80 percent distrusted security at the Driver and Vehicle Licensing Agency (DVLA) and 78 percent on data held by the police. The General Data Protection Regulation (GDPR) can’t come too soon [TTA 17 Feb] — but are you ready? More in Proband’s Online Security Audit (PDF).

Telehealth policy and reimbursement changes summarized by Center for Connected Health Policy (US)

A significant barrier to the adoption of telehealth (defined here as video consults, store and forward imaging, and remote patient monitoring) is the issue of reimbursement gaps. Basic Medicare (the Federal program for those over 65) pays for video and store and forward only under certain conditions (primarily under rural telehealth programs) but does pay for RPM as part of chronic care management (albeit under a maze of codes and procedures). Medicaid (the state low-income insurance program) is far more lenient, and private pay in states varies widely, with 36 states having some form of parity payment legislation. However, Medicare is planning expansion beyond what is covered in private plans (Medicare Advantage) by 2020. Some Federal programs such as the advanced Next Generation ACO program and the bundled payment Comprehensive Care for Joint Replacement model have telehealth waivers.

The always-helpful Center for Connected Health Policy (CCHP) has published a five-page guide to where these programs stand. Becker’s Hospital Review. CCHP PDF 

Telemedicine’s still-sluggish adoption in health systems revealed in survey of health system executives

Sage Growth Partners, a Baltimore Maryland-based healthcare research and strategy firm, released a study surveying US C-level executives and service line leaders at a variety of larger health systems (integrated delivery networks (IDNs), academic medical centers (AMCs), community hospitals, and specialty hospitals) on their telemedicine use. It combined initial/exploratory qualitative interviews (total N=65) with online quantitative surveys (completed N=98) taken 2nd Quarter 2017.

Have we reached a tipping point? The findings indicated that just over 50 percent (56 percent) had developed in-house telemedicine systems or were already working with vendor/s on implementing telemedicine in their organizations. The study’s definition of telemedicine was broad, inclusive of any technology and programs that connect providers and patients not physically at the same location when care is provided. 

But many of the findings are dismaying:

  • Budgets–limited at best. Most (66 percent) had budgets under $250,000 per year 34 percent committed over $250,000 with most under $100,000, but three-quarters believe those budgets will increase next year. 
  • What it’s used for: Emergency use (29 percent), remote patient home monitoring (21 percent, and non-emergency cases (20 percent). 
  • How many vendors do they want to deal with?: One is quite enough–54 percent prefer a single telemedicine solution across the continuum of care (however defined), with 31 percent accepting two solutions. 
  • Has it changed the ‘standard of care’?: Yes for stroke, according to 70 percent surveyed. 75 percent believe it will potentially change the standard of care for behavioral health/psychiatry, followed by neurology (53 percent), primary care (52 percent), and cardiology (48 percent).
  • What about direct-to-consumer telemedicine?: The top must-haves are EMR integration, appointment scheduling, and store-and-forward messaging (60+ percent). What’s surprisingly not so desired: store-and-forward of images (47.9 percent–so much for home wound management) and vitals capture (45.9 percent–so much for connecting devices to telemedicine).

Perhaps it’s this Editor looking at the ‘glass half-full’ with a ‘Gimlet Eye’, but here we are in February 2018 still having this discussion at the executive and service line levels. The progress has been glacial at best on starvation budgets, yet telemedicine vendors are multiplying. What is also not promising: these executives’ preference for enterprise solutions which preclude small, innovative companies from getting past the pilot or trial phase. Another barrier: the insistence upon EMR (EHR) integration, which sounds appropriate except that Cerner and EPIC are ‘walled gardens’. Defining Telemedicine’s Role: The View from the C-Suite (PDF, free download from Sage). Also Clinical Innovation + Technology and Global Healthcare 

Rounding up what’s news: LindaCare, TytoCare funding; Medicare telehealth parity, Norway’s big cyberhack, Virta reversing diabetes, DARPA’s 60th birthday

click to enlargeYour Editor’s been away and then largely out of pocket over the past two weeks. Here’s our roundup/catchup beyond the bombshells:

In remote patient monitoring for chronic disease, Philips, PMV, and other investors invested €7 million ($8.6 million) in Belgium’s/Hartford CT’s LindaCare. The Series B funding will accelerate its US expansion of OnePulse for remote monitoring of chronic heart failure and cardiac arrhythmia patients with Cardiac Implanted Electronic Devices (CIED). It is in use in major European hospitals and in US trials, though there is no mention in the release or on their website on CE Marking or FDA clearance/clinical trials. Previously from its 2013 founding, it had €1.6 million in funding. Also Mobihealthnews.

TytoCare, a remote monitoring telehealth/video consult platform which integrates peripherals for a virtual physical exam, raised $25 million in a Series C round led by large Chinese insurer Ping An via their Global Voyager Fund plus Walgreens, Fosun Group, OrbiMed, LionBird, and Cambia Health Solutions. Release. Their total raise is $45.6 million since 2012 (Crunchbase). Their most current partnership is with Long Island-based Allied Physicians Group which is featuring at-home telehealth visits at its pediatric practice in Plainview.

More favorable Medicare reimbursement for telehealth is the subject of four US Congressional bills. The one furthest along is the ‘Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017’ (S.870), which aims to improve at-home care, increases Medicare Advantage flexibility, gives ACOs more options and expands telehealth capabilities for stroke and dialysis patients. It passed the Senate in September and now goes to the House Subcommittee on Health of the Committee on Energy and Commerce. The effect of all four is on Medicare payment parity with in-office visits, which does not currently exist and is not affected by the various state parity bills on insurance for those below 65. American Well touts a 10-fold growth in revenue, but the likelihood of any of these four bills being signed into law is small, particularly with a pending report from the Medicare Payment Advisory Commission. Becker’s Hospital Review

Norway released at end of January news on an “advanced and persistent” 8 January cyberattack on Health South East RHF. This has both a health breach and military twist.

(more…)

InTouch Health launches a three-way collaboration on virtual acute care with Jefferson Health, Mission Health

Telehealth provider InTouch Health announced a five-year joint partnership with Asheville, North Carolina-based Mission Health and Philadelphia-based Jefferson Health to develop 10 new models in virtual acute and outpatient care. These use cases are not “typical telehealth” and include stroke, sepsis, and acute heart failure.

It’s an interesting expansion of the telemedicine/telehealth acute care model, especially if it extends to outpatient care. InTouch is building upon several years of separate work with each health system. In this joint development arrangement, the health systems will share information and with InTouch Health. What is also interesting that working with both systems allows InTouch to test virtual care access and whether it increases care coordination in diverse settings. Jefferson is an urban university hospital based in Center City Philadelphia, while Mission serves an economically mixed suburban and rural area. According to the release, this is to “ensure the care pathways and supporting technologies improve patient access and quality of care and are applicable across markets and geographies.”

Jefferson Health has worked with InTouch for nearly a decade, using the InTouch telestroke program for its 30 hospitals in the Jefferson Neuroscience Network. Mission Health is using their telestroke, telepsychiatric, tele-hospitalist, and tele-neonatology programs. The InTouch programs include virtual platforms, clinical workflow solutions, and software.

There is no mention here of using new telehealth partner Vivify Health [TTA 19 Dec] for their Managed Kit and BYOD, but to this Editor the most likely place for their systems would be integration into outpatient care. Outpatient service could also be furnished by their new home-based video consult services acquired through their purchase earlier this month of TruClinic.

Since 2003, InTouch has rounded up over $26 million in funding through a 2010 $6 million Series D. The fact that their funding has been conservative (compared to the over $158 million Practice Fusion raised in a dozen years before their acquisition earlier this month by Allscripts) and have managed to make several acquisitions in that time either indicates excellent cash flow from existing business or undisclosed sources of private financing. Release. Mobihealthnews.

Iron Bow’s uncertain future with $258 million VA Home Telehealth contract

Iron Bow Technologies’s setback with their VA contract confirmed. Iron Bow, which partnered last year with Vivify Health to provide telehealth services to the US Department of Veterans Affairs, received an unfavorable ruling on the US country of origin of the Vivify Health system that essentially stops the contract implementation.

Under Title III of the Trade Agreements Act of 1979, Federal suppliers must produce their products in the US or substantially transform the components in such a way that it becomes a product of the US. US Customs and Border Protection (CBP), Department of Homeland Security (DHS), makes this determination. Vivify Health contended that their Vietnam-produced tablet, because of their US-produced Vivify Health Pathways software and further US-based modifications to convert it into an FDA-regulated medical device, was transformed into a US product. In August, the CBP determined that the end product did not meet the transformation standard based on decades of precedent and the country of origin remained Vietnam. Transformation, yes, but not enough or the right kind for the CBP. Federal Register 8/22/17

An interesting Federal regulatory disconnect is that the FDA considers the Vivify tablet a regulated medical device. CBP considers it a communications device as the tablet transmits data from other medical devices but does not take those measurements itself. 

Vivify Health has publicly used in implementations with health organizations Samsung tablets. It is not known if the tablet reviewed by the CBP is manufactured by Samsung.

Both Iron Bow and Vivify Health were asked by this Editor for comments. Iron Bow’s response:

We have received an unfavorable ruling from United States Customs and Border Protection (“Customs”) regarding our proposed solution for the Home Telehealth contract. We respectfully disagree with the findings by Customs and have appealed the matter to the United States Court of International Trade. We are currently in discussions with our customer regarding the possible options for a path forward.

Vivify has not responded to date. 

Certainly, this is a sizable financial loss to both Iron Bow and Vivify if they cannot go forward with the VA, whether through a court decision or a different procurement process for the tablet to qualify it as US origin. Last February, we reported that the VA awarded the billion-dollar five-year Veterans Health Administration (VHA) Home Telehealth contract to four providers: incumbent Medtronic, Iron Bow, Intel Care Innovations, and service-disabled veteran-owned small business 1Vision. The award amount for each was $258 million over a five-year period, re-establishing the VHA as the largest telehealth customer in the US. All four awardees had in common that they were prior Federal contractors, either with the VA or with other Federal areas [TTA 1 Feb 17].

Medtronic and Care Innovations had long-established integrated telehealth systems but Iron Bow and 1Vision, as telemedicine and IT service providers respectively, did not have vital signs remote monitoring capability. In the solicitation, Iron Bow partnered with Vivify [TTA 15 Feb 17]. For 1Vision, it took nearly one year to announce that their telehealth partner was New York-based AMC Health, an existing provider of VA health services. It was also, for those in the field, a Poorly Kept Secret, as AMC Health had been staffing with VA telehealth veterans from the time of the award. (The joint release is on AMC Health’s site here.) The reason for the announcement delay is not known. AMC Health does not use a tablet system, instead transmitting data directly from devices or a mobile hub to a care management platform. They also provide IVR services.

Vivify has moved forward with other commercial partnerships, with the most significant being InTouch Health, which itself is on a tear with acquisitions such as TruClinic [TTA 19 Dec 17].

Hat tip to two alert Readers who assisted in the development of this article but who wish to remain anonymous.

Babylon’s ‘GP at hand’ has thousands of London patients in hand

click to enlargeApparently Babylon Health’s ‘GP at hand’ is a hit with Londoners, despite the requirement to shift GP practices. The Evening Standard reports that the Lillie Road Surgery in Hammersmith, one of the five London practices in the program (plus Victoria, Poplar, Euston, and Fulham), increased its patient list by nearly 7,000 (4,970 in November to 11,867 last month). (Was it the Tube adverts?–Ed.) No information is available on increases at the other surgeries. 

Helping matters may be the UK flu epidemic, where the incentive to stay at home and have a video consult would be great (and helpful in stemming the spread). These consults on average are available 2 1/2 hours after booking, which to us Yanks used to independent services seems a great delay. One-third are reportedly out of office hours. Duration of the visit is about 10 minutes, which is standard for in-person. What is suspected is that many do not realize that the GP at hand signup also changes your GP to the program. The GP partner quoted in the article claims that homeless people, those with mental health and multiple chronic conditions–not just the young and mobile-savvy–have signed up. 

This Editor will concur with others that it’s time for telehealth to be integrated into the NHS, but the tying of it to specific practices which alters capitation is a large wrinkle which needs ironing out. Our earlier coverage here. Hat tip to Roy Lilley.

Deals of the day: American Well partners with Philips for global telehealth apps, gains $59 million partnership with Allianz

The large partners with the large, adding a global dimension. Telemedicine provider American Well and Philips announced today a global alliance to integrate American Well’s patient-doctor video consults with a range of Philips’ healthcare monitoring program. First up will be adding American Well consults to the Philips Avent uGrow parenting app. This is an Apple/Android app that presently tracks baby feeding, weight, and sleeping patterns, tying into Philips baby monitoring products such as an ear thermometer and babycam. The second stage with American Well involves their mobile telehealth software development kit (SDK) to integrate video consults into other Philips’ digital health solutions and the Philips HealthSuite Digital Platform. Philips also announced that uGrow will include voice activation with the ever-trendy Amazon Echo and the Philips Avent smart feeding kit to automatically monitor the time, volume and duration of a baby’s feeds. Philips release

American Well’s second global deal of the day is with insurer Allianz’s digital investment fund, Allianz X.  The latter, funded with a $59 million investment, creates another partnership dedicated to developing a digital product that combines wearable sensors, remote monitoring, and virtual visits. The goal is to widen patient access, lower cost and improve healthcare quality. As part of the deal, Allianz X will be joining American Well’s Board of Directors. Allianz is not well known as a health insurer in the US, but is active in the international health insurance area for individual expats and employers with international employees.  Release, Mobihealthnews

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

click to enlargeOur 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. 

click to enlargeLove 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…)

2017 wrapup: state telehealth reimbursement policies and progress made

click to enlargeOur first 2017 wrapup is from the Center for Connected Health Policy at the National Telehealth Policy Resource Center which has helpfully organized the state of telehealth reimbursement policies in the 50 US states into an interactive map. 2017 state legislative actions are available in a summary sheet cross-referenced with linked bill numbers. 63 pieces of legislation focusing on telehealth or telemedicine were approved by 34 state legislatures this year.

True policy wonks will want to peruse on their holiday time the 262-page full report of policies as of October.

Based on the report, one of the major changes is in private payer reimbursement: “36 states and DC have laws that govern private payer reimbursement of telehealth. This number has increased by two since April 2017, although additional states have made modifications to their private payer law. Some laws require reimbursement be equal to inperson coverage, however not all laws mandate reimbursement.” The rest of the findings are highlighted in the infographic (left above) and the CCHP release.

Becker’s Hospital Review also surveyed the changes this year, as did mHealth Intelligence.

Far from a tipping point: only 18 percent of consumers using telemedicine. An expectation gap? (US)

When will we get there? And what needs to happen? Telemedicine provider Avizia surveyed both consumers and healthcare professionals earlier this year, and the results are not encouraging. For the huge investments made by telemedicine and telehealth companies, along with providers and payers, the key finding here is that only 18 percent of the 403 consumers surveyed in March had even used telehealth.

Of that 18 percent (N=72), it’s been a positive experience:

  • On a 1 to 10 scale, with 10 signifying a “great experience,” 62 percent of consumers who used telehealth ranked their experience a 10, 9, or 8.
  • Consumers who used telehealth appreciated time savings and convenience (59 percent), faster service and shorter wait times to see the doctor (55 percent), and cost savings due to less travel (43 percent)

Modern Healthcare also sponsored the outreach to healthcare professionals who are subscribers, locating 444 respondents whose organizations currently use telehealth or telemedicine.

  • They are most interested in telehealth’s ability to expand access or reach to patients (72 percent). Barriers are reimbursement (41 percent), program cost (40 percent), and clinician resistance (22 percent)
  • Their #1 use cases are for stroke and neurology (72 percent), followed by behavioral health (41 percent) and intensive care (20 percent).

What’s unsaid in this write-up? Consumers and clinicians clearly have differing expectations on how they want to use telemedicine. Consumers are largely using it as an alternative to an in-person visit for less serious medical needs. Clinicians use it for very serious situations–stroke, neurology, mental illness, ICU. Perhaps this is why the takeup of telehealth among consumers is low.

Mike Baird, CEO of Avizia, is quoted in the release as saying “Health systems are investing in telehealth, even as uptick is slow among consumers, because they understand the potential of the technology to impact patient care in a profound way.” But as a Grizzled Pioneer in this field said to this Editor in confidence, how many of these companies have the revenues and patient investors to enable them to stay alive till they get to the Promised Land–and how far is it? Closing the Telehealth Gap (white paper requires free registration and download)Becker’s Hospital Review

OnePerspective: VA shows how technology can improve mental health care

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

click to enlargeBy: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

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VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill