TTA’s Spring Debut: CMS’ big telehealth expansion, conferences vaporize to virtual, Cera’s $70M raise, news from RxHealth, TeleDentists; Caravan buys Wellpepper, more

 

 

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.

(Our Alert is a day late because your Editor’s Fios internet went on the fritz (C-19?) for the second time in 10 days. But it is now fully recovered–we hope!)

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)

It’s hard to move beyond the coronavirus talk permeating everything in healthcare to other news, but there is some. American Well’s rename, a Senate look at Project Nightingale, and a $16 million digital health Series A surfaced in the sea of spread and conference cancellations. And there’s more on how telehealth can be very useful in both diagnosis and treatment of the virus–even if the consulting doctor is quarantined or sick.

News roundup: Kompaï debuts, Aging Tech 2020 study, Project Nightingale may sing to the Senate, Amwell, b.well, Lyft’s SDOH, more on telehealth for COVID-19 
Update: healthcare/digital health conferences canceled/postponed due to COVID-19 include SXSW, Naidex, EPIC (updated 13 Mar). (The busiest season for meetings suddenly isn’t)

The only real news this week is around the effects of the coronavirus on the business of healthcare–HIMSS20 and other conferences are casualties–and on population health. The US is funding public health, NIH research, telehealth and more with an additional $8.3bn. Let’s hope that the last weeks of winter and (in US) springing forward on the clocks presage the end of its spread.

$8bn COVID-19 supplemental funding House bill waives telehealth restrictions for Medicare beneficiaries (US) (Passed and now to the Senate)
Breaking News: HIMSS20 canceled; Naidex update; what is the outlook for other major conferences? (updated) (The business effect of COVID-19 hits healthcare. Hard.)

How does one celebrate a Leap Year? Certainly not with a trip to China, as you may not have to go that far to have a coronavirus adventure. But digital health is going to the rescue in several significant ways, including treatment. Symptom checkers are much in the news, not only with COVID-19, but also with K Health’s big raise and Babylon’s profile on Newsnight with @DrMurphy11’s reveal. GGI and Legrand debut their study on digital tech’s potential to deliver more efficient health services. NYC events abound. And if you’re in London, leap to DHACA Day on 18 March! 

Digital health on the front lines of coronavirus checking, treatment, and prevention (What wasn’t around during the SARS and swine flu epidemics may make a big difference)
Symptom checker K Health gains $48 million Series C (NY/Tel Aviv) (A big bet made, and not on Babylon)
Babylon Health fires back at critic @DrMurphy11; Dr. Watkins–and Newsnight–return fire (UK) (Why can’t they just get along? Watch the video and find out.)
A potpourri of upcoming NYC events (HITLAB and Columbia University)
Unleashing the Digital Premium’ for health in the public sector (UK) (Good Governance Institute and Legrand study) 

The consumer DNA/genetics biz is frosty, IBM certainly isn’t feeling the love from 3M, and malware’s worse than rain you have to shovel. VA’s Cerner debut won’t be till the daffodils bloom. But Hollywood tech is helping stroke rehab, and it’s warming up around post-surgery telemedicine usage and physician telehealth use. Plus Yorkshire & Humber AHSN’s back with their Propel accelerator.

News roundup: stroke rehab uses Hollywood technology, 3M sues IBM Watson Health on analytics software misuse, AI-based skin cancer detection apps fail, Dictum’s successful telemed use post-pediatric surgery, malware attacks Boston practice network 
Is the bloom off the consumer DNA business? It’s past time for a Genomic Bill of Rights. (Ancestry, 23andme’s declining fortunes)
100% increase in physician telehealth and virtual care usage in three years: AMA study (Progress in this market, especially for chronic care)
Propel@YH opens again for 2020 accelerator candidates (Yorkshire & Humber AHSN’s 2nd year)
VA running at least one month late on Cerner implementation launch (Not unexpected after last week’s turmoil)

February is here, can Spring be far away? It might be an early one for Mark Bertolini, booted from the board of the company he worked so hard to put together. Ashik Desai of Outcome Health may be looking at a Club Fed ‘vacation’. And James Byrne of the VA got an early furlough from Washington for that Florida holiday. So we can take a Mid-Winter’s nap courtesy of NHS, dream of digital health investments for 2020, and won’t buy into a company paying a $1 million monthly rent.

But do wake up in time for DHACA Day on 18 March! A good reason to be in London….

Considering 2019’s digital health investment picture: leveling off may be a Good Thing (Less froth, more quality)
Outcome Health’s Desai reaches settlement with DOJ, SEC (Another cautionary tale of Young Entrepreneurs Gone Wrong–somewhat like Theranos)
Comings and goings, wins and losses: VA’s revolving door spins again, NHS sleep pods for staff, Aetna’s Bertolini booted, Stanford Med takes over Theranos office

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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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

Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations

Following on last week’s announcement of Tyto Care‘s partnership with Novant Health, Sioux Falls SD-based telemedicine provider Avera eCARE will be introducing Tyto Care’s professional version, TytoPro, into its telemedicine service using high-definition video for virtual consults. What TytoPro will add is remote diagnostic capability and collection via the TytoVisit platform, using the TytoApp and Clinician dashboard. Avera will use TytoPro’s hand-held device with exam camera, thermometer, otoscope, stethoscope (with volume, bell, and diaphragm filters), and tongue depressor adaptors.

In a test of Avera eCARE plus Tyto Care in an assisted living community, the pairing of the two systems reduced emergency department transfers by 20 percent, with 93% of residents treated in place.

Avera eCARE, a part of Avera Health, provides telemedicine services to medically underserved populations via local healthcare systems, rural hospitals, outpatient clinics, skilled nursing facilities, assisted living communities, schools, and correctional facilities. It has over 400 providers in its comprehensive virtual health network across the US. A ‘white paper’ on the Avera/Tyto Care partnership is here. Release 

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner

Appello telecare acquires RedAssure Independent Living from Worthing Homes. A 20-year provider of telecare services to about 700 homes in the Worthing area in West Sussex, the acquisition by Appello closed on 1 October. Previously, Appello provided monitoring services for RedAssure since 2010. Terms were not disclosed. Release.

Another NHS Digital departure is Rob Shaw, deputy CEO. He will be leaving to pursue a consulting career advising foreign governments on national health and care infrastructure. He is credited with moving the NHS Spine in-house and establishing NHS Digital’s cybersecurity function. The Digital Health article times it for around Christmas. Mr. Shaw’s departure follows other high-profile executives this year such as former chief digital officer Juliet Bauer who controversially moved to Kry/LIVI after penning a glowing article about them [TTA 24 Jan], Will Smart, Matthew Swindells, and Richard Corbridge.

One initiative that NHS Digital has lately implemented is passwordless, biometric facial or fingerprint-based log in for the NHS App, based on the FIDO (Fast-Identity Online) UAF (Universal Authentication Framework) protocol (whew!). NHS Digital’s most recent related announcement is the release of two pieces of code under open-source that will allow developers to include biometric verification for log in into their products.

Babylon Health’s GP at Hand plans Manchester expansion. The formal notification will likely be this month to commissioners of plans to open a Manchester clinic as a center for GP at Hand’s primarily virtual consults. This follows on their recent expansion into Birmingham via Hammersmith and Fulham CCG which will be notified. How it will work is that patients registering in Manchester would be added initially to a single patient list for GP at Hand located at Hammersmith and Fulham CCG. Babylon is now totalling 60,000 patients through GP at Hand.  GP Online

Singapore’s Verita Healthcare Group has acquired three digital health startups. The two from Singapore are nBuddy and CelliHealth, in addition to Germany’s Hanako. Verita has operations in Singapore, the US, Asia-Pacific and Europe, with 35 alliance partnerships with medical clinics and hospitals across Australia, Southeast Asia and Europe. Mobihealthnews APAC

Novant Health, a 640-location health system in North Carolina, is introducing Tyto Care’s TytoHome integrated telehealth diagnostic and consult device as part of its network service. Webpage, release

Can a smartphone camera, app, and device detect viruses at low cost?

A team of researchers led by the University of Tokyo’s Yoshihiro Minagawa has developed a mobile-based portable viewing and diagnostic platform for viruses, which may be a breakthrough in diagnostics for rural and underserved global areas. The viewer is about the size of a standard brick and performs the digital enzyme assay using cavities lit with an LED to create light spots detectable by the camera.  The smartphone camera fits on top of a lens on the top of the box. Right now it detects only about 60 percent of what can be detected by a fluoroscopic microscope, but its speed and portability are major assets in these early tests, as well as versatility in possibly detecting other biomarkers. Mobile imaging platform for digital influenza virus counting (Lab On A Chip–Royal Society of Chemistry) Supported by the ImPACT Program of Council for Science, Technology, and Innovation (Cabinet Office, Government of Japan) Also Mobihealthnews APAC.

Oral health: more than a public health challenge, an opportunity for telehealth?

Untreated caries in permanent teeth was the most prevalent health condition in 2010, affecting 35% of the global population, or 2·4 billion people worldwide. In 2010, severe periodontitis was the sixth-most prevalent health condition, affecting 10·8% of people, or 743 million, worldwide.

Worldwide in 2015, dental diseases accounted for US$356·80 billion in direct costs and US$187·61 billion in indirect costs.

Is oral health the next big SDH (Social Determinant of Health)? A focus in this month’s Lancet is the neglect of global oral health. Most of our Readers know that oral self-care can be a challenge with older adults due to physical limitations, finances, and access, but oral  and periodontal disease affects nutrition, is a source of pain, tooth loss, consequent low self-regard, low quality of life, and can lead to other diseases such as sepsis and undiagnosed cancers.

The Lancet’s two articles, Oral diseases: a global public health challenge and Ending the neglect of global oral health: time for radical action (open access, registration required on these links) point out the current allopathic model does not fit the wider societal need,  and come down hard on the social and economic origins (very hard on Western dental practice, the sugar industry, and food providers). However, the articles are light on solutions other than universal health care and community based dental practice. Even in less-developed countries like India and Brazil, practitioners don’t migrate to poor, rural areas. It is true, however, that much of dentistry, at least in the US, has an increasing focus on cosmetic restoration.

Here is a wide-open area for telehealth development. Some areas to explore:

  • Creating wider access to dentistry that treats immediate problems
  • Greater access to proactive dental care, whether dental checkups and to encourage better self-care
  • Connecting rural fixed or mobile clinics staffed by technicians or locally trained staff with dentists for remote screening and scheduling care. 

Hat tip to Leah at The TeleDentists for these articles. The articles are also attached as PDFs here and here.

FCC’s $100M Connected Care Pilot Program for rural areas up for July vote

Finally, a big boost for rural telehealth comes to the ‘yea or nay’ stage. The Federal Communications Commission’s (FCC) Connected Care Pilot Program, which was approved to proceed last August [TTA 9 Aug 18] with comments on the creation of the program, now moves to the next stage with a formal FCC vote on 10 July on the program itself. The FCC vote was announced by FCC Commissioner Brendan Carr, the co-proposer of the program with Mississippi’s Senator Roger Wicker, during a visit on Tuesday to a rural health clinic in Laurel Fork, Virginia.

The three-year program increases support for telehealth efforts aimed at low-income Americans in underserved regions and who are veterans, to increase their access to health technologies. Providers would be assisted in securing both technology and broadband resources needed to launch remote patient monitoring and telehealth programs. 

Commissioner Carr quoted, in his rural health clinic visit, stats from multiple studies including the VA‘s long experience (since the early 2000s) with remote patient monitoring:

  • A study of 20 remote patient monitoring trials found reductions of 20 percent in all-cause mortality and 15 percent in heart failure-related hospitalizations.
  • A remote patient monitoring initiative (not attributed) reduced ER visits by 46 percent, hospital admissions by 53 percent, and in-patient stay length by 25 percent.
  • The Veterans Health Administration’s remote patient monitoring program had reductions of 25 percent in days of inpatient care and a 19 percent in hospital admissions.
  • In savings, a diabetes trial run by the University of Mississippi Medical Center (UMMC) saved nearly $700,000 annually in hospital readmissions. This extrapolated, based on 20 percent of Mississippi’s diabetic population, that Medicaid would save $189 million per year.

HealthLeaders Media also noted that at the July meeting, the FCC will vote on a notice of proposed rulemaking to seek comment on funding to defray the cost of healthcare providers joining the telehealth initiative and innovative pilot programs aimed at responding to critical health crises including diabetes management and opioids. Also mHealth Intelligence

Tyto Care telehealth integrates with Epic EHR MyChart patient app

Tyto Care announced today the addition of their remote diagnostic device and app to Epic’s app marketplace, AppOrchard. The addition enables health organizations to adopt the Tyto Care app and offer TytoHome service to their care providers and patients. The data is integrated into Epic’s MyChart patient portal, delivering patient exam data to Epic EHRs used by providers.

The remote visit can work two ways.

  • Launched from within MyChart, the patient can initiate a live or scheduled telehealth visit
  • From Epic’s HyperSpace desktop app, a care provider can remotely join a telehealth visit with the patient.

During the visit, the provider can control the TytoCare device to capture temperature readings, skin images, heart and lung auscultations, and recordings of the throat and ears for a remote diagnosis.

Sanford Health, a health system in the Midwest and West, is one current Tyto Care user which also uses Epic as their EHR. Meghan Goldammer, a senior vice president and chief clinical officer at Sanford Health, commented that “Epic has been our electronic patient record standard of care for years and now we have adopted Tyto Care. The integration will allow for a coordinated patient experience and give our providers the information they need to deliver great care.”

Based in Netanya, Israel and New York City, Tyto Care’s ‘all-in-one’ device incorporates a camera, stethoscope, otoscope, tongue depressor, basal thermometer, and smartphone app for an extensive video exam which can be integrated with an EHR or other telehealth systems. It includes visit scheduling capability, a cloud-based data repository with analytics, and built-in user guidance with machine learning algorithms for accurate use. Tyto Care is now retailed at Best Buy in select markets [TTA 17 April]. Tyto Care release

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

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

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

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

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

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

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

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

International news roundup: ATA dispatches, compete for funding in Helsinki, Spry FDA-cleared for COPD, Merck acquires ConnectMed Kenya

There’s not much news so far from the just-wrapped ATA 2019 conference in New Orleans, but POLITICO Morning eHealth highlighted a drop-by by Sen. Bill Cassidy from Louisiana, urging attendees to demonstrate to their local politicos that telemedicine is safe and effective–and be ready to answer questions about fraud or misuse. Louisiana’s Ochsner Health System is branching into retail with the O Bar, cleverly designed to look like an Apple Store to merchandise wearables and other health tech devices. For Ochsner patients, they can enroll into RPM programs and have their data directly input into their Epic EHR. American Well released a survey of 800 doctors, with the unsurprising finding that 22 percent have used telehealth to treat patients, but this is up 340 percent since 2015; also that the doctors finding telehealth most attractive to practice are also reporting high levels of burnout. Looking for more substantiative news from NOLA.

It’s Helsinki for pitching your digital health idea in June. The 11th edition of the interestingly named EC2VC Investors Forum and Pitch Competition is now part of HIMSS/ Health 2.0 Europe 2019. Healthcare startups and SMEs looking for funding can apply, with 12 companies to be selected to present before a jury panel of digital health investors. The format is a four-minute pitch, followed by six minutes of Q&A. More information and to apply by 6 May, with finalists selected by 13 May. The event is 11 June from 13:00 to 16:00 at Messukeskus Helsinki Expo & Convention Centre. 

Spry Health’s Loop wearable device gained FDA clearance. Spry is a RPM device company with a wrist-wearable device that measures pulse oximetry, respiration, heart rate, and blood pressure (research only) through optical sensors. While users can receive reports on the display and alerts, it is primarily meant for clinical monitoring by physicians in healthcare systems. The RPM is meant to detect signs of patient deterioration and exacerbations early so that actions can be taken. For the present time, the company is focusing on the device’s use in COPD patients. Certainly there is a large market in the US–there are 12 million diagnosed patients, with COPD the third leading cause of death with over 120,000 deaths per year. Mobihealthnews, BusinessWire, MDDIOnline

Merck acquires Kenyan digital health startup ConnectMed. The pharma company is purchasing ConnectMed’s telehealth applications in Kenya serving about 8,000 consumers, as well as related management systems. Merck will use the platform in conjunction with its Curafa point of care clinical and pharmaceutical services. Started in September of last year, these are run by local independent pharmaceutical technologists, clinical officers and nurses for underserved populations in Kenya. ConnectMed will cease operations. During its lifetime, it developed three DTC digital health services in Kenya and South Africa. WT/Startup Africa

Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)