New Tunstall Americas CEO Oscar Meyer announced today (6 Sept) the acquisition of Providence Lifeline Medical Alert Service from parent Providence Health & Services, a division of Providence St. Joseph Health, a nonprofit Catholic health system with 50 hospitals and over 800 clinics in seven Western states. Terms were not disclosed. The sizing was also not disclosed beyond ‘thousands of customers’. Evidently from its statement, Providence Health will continue to contract with Tunstall and expand PERS health monitoring for its clients: “Providence looks forward to a collaboration that will help people stay safe and independent at home.” Another interesting affirmation is that Tunstall is resuming its collaborating or acquiring “highly regarded regional, state, and local providers of telecare, medical alarms, and medication management services.” Release (PR Web)
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Breaking News, even though it happened in March! See updates below. The Sunday Times (UK–sign up for limited access) broke news over the weekend that Charterhouse Capital Partners, the main investor in Tunstall Healthcare, along with other shareholders, have been forced to relinquish nearly half the equity in the company to senior lenders and management. According to their annual report on page 65, section 31**, this happened on 17 March after the close of the FY, but only now has come to light through the Sunday Times report.
The article is light on details, but our Readers who’ve followed Tunstall’s history since the Charterhouse purchase in 2008 for £530 million will not be surprised, only that this development took so long. The cold facts are that the company has been wrestling with a stunning debt burden that grew from £1.2bn in 2015 [TTA 15 Apr 16] to the Times report of £1.7bn at the end of last September, with £300m owed to lenders and £1.2bn to investors. Debt service drove their financials to a £391m pre-tax loss last year.
The highlights of the deal as reported in the Sunday Times:
- Senior lenders (not disclosed) received 24.9 percent of Tunstall’s shares. Management received 25 percent.
- Charterhouse with other shareholders now have a razor-thin controlling balance of 50.1 percent. Prior to this, Charterhouse alone had 61 percent of Tunstall’s shares.
- In return, the lenders agreed to relax covenants on their debt, termed a ‘covenant reset’.
- Tunstall also spent £18.5m last year on an abortive attempt to sell itself for up to £700m. We noted reports in April 2016 that they rejected a £300 million (US$425 million at the time) buyout offer from private equity investment firm Triton Partners.
**For those who wish to dig deeper, Tunstall’s hard-to-find annual report through last September (but not filed until 29 March 2017) is available through Companies House. Go to their index here and select the “Group of companies’ accounts made up to 30 September 2016” which currently is the first listing.
This will be updated as other sourced reports come in, if they do–for now, it appears that the Sunday Times has the exclusive ‘dig’. It is unfortunate since Tunstall is responsible for millions of customers and employs thousands worldwide, and has been aggressively investing in the company and technology while having a fair amount of churn in executive and director positions. Regrettably, they never capitalized on a established position in a big market when they bought AMAC in 2011, then estimated as the US’ third largest PERS company. But as this Editor closed her 2016 article, the whole category of healthcare tech, while becoming more accepted and with a few exceptions, regrettably is still mired in ‘too many players, too many segments with too many names, all chasing not enough money whether private or government.’ I will add to that equation ‘too few users’–still true among older adults and the disabled–and ‘technology that moves too fast’ to make it even more confusing and unsettled for potential buyers (obsolescence on steroids!). And ‘gadgets’, to use the Times’ wording, are among the worst culprits and victims of these factors.
Updated: Equity capital. A cautionary tale was Editor Emeritus and Founder Steve Hards’ prescient analysis of the risks that Tunstall and Charterhouse undertook in acquiring so much debt. After you read it, note the year it was published. More recent commentary on Tunstall’s financial deteriorata dating back to 2013 can be found here.
We haven’t heard much from Tunstall Healthcare in the past two months, but Tunstall Americas has announced that the belle PERS unit has been added to the US line of products which now . The belle is on the AT&T GSM cellular network for two-way voice communication with their 24/7 call center and GPS location technology. The pendant has a rechargeable battery that can last up to 30 days on a single charge, and can be either worn or carried in pocket or purse. Also new in the line is the Tunstall flood detector which signals the call center through the Vi+ and CEL. Release, Tunstall Americas website.
Tunstall Healthcare has been, quite untypically (for years) and aseasonally, burning up the newswires with press. The first we’ll mention is from Tunstall Americas announcing the availability of smoke detection sensors as part of their their newly introduced Vi+ and the CEL mobile PERS. The units when triggered by heat or smoke sound an audible alarm and generate an alert over to the 24/7 monitoring service. Like last week’s announcement of ambient temperature sensing, there’s nothing revolutionary here but these add-on features are extremely helpful to older people who use these systems. It also is a bit of sales upsell for their growing network of local home monitoring monitoring dealers/services [TTA 3 Aug]. Tunstall release.
We’ve also noted a new surge of activity in Australia (the Staying Strong telehealth pilot) with vital signs monitoring using the myclinic telehealth hub in the homes of older Aboriginal and Torres Strait Islander peoples. In the UK there is the PegasusLife new Malt Yard assisted living development for care alarms, Wakefield District housing and providing extra care services at Hare Hill-Rochdale Boroughwide Housing (RBH). Roundup here on their press page. For their LTC work at Tameside Hospital NHS Foundation Trust Community Services, Tameside and Glossop Clinical Commissioning Group (CCG) and Tameside Metropolitan Council (TMBC), Tunstall UK won the HealthInvestor Technology Provider of the Year Award. Tunstall telehealth solutions reduced hospital admissions by 38 percent or £2.7m where mymedic was used. Release
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Tunstall Healthcare Group’s release for 1 June’s Telecare Awareness Day was a virtual tour of their Innovation Centre physically located at their Whitley, Yorkshire head office. It’s divided into five TECS-related ‘zones’: integrated care, connected home, development room, app bar and workshop. There are explanatory comments below, which help because the virtual tour has a measure of clunkiness. The marketing purpose of the Innovation Centre? It “provides a unique, dedicated space to define the challenge and help accelerate the development and design process to evolve the next generation of digital connected healthcare, create new innovations and service models that genuinely meet the needs of commissioners and consumers.” (Whew!) It’s also kind of a cool space to get feedback from customers, users and partners, which this Editor suspects is the real reason why it was developed. But overall, both the Centre and the virtual tour are good ‘showcase’ ideas that demonstrate both product and thought leadership.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Breaking News. Some long-awaited updates on the ongoing rumors regarding Tunstall Healthcare and a potential sale surfaced on Bloomberg late yesterday. Citing ‘people familiar with the matter’, Charterhouse Capital Partners, the owner and main investor, rejected a £300 million (US$425 million) buyout offer from private equity investment firm Triton Partners and reportedly will seek refinancing as an option if a buyout offer cannot be accomplished. However, the same sources state that talks are ongoing including with Triton and other potential investors and that no decisions have been made.
Triton is an investment firm registered in St Helier, Jersey and with locations through Europe, China and New York. It represents around 100 institutional investors and concentrates in investments in medium-sized businesses in northern Europe, Italy and Spain. In looking at their sector mix on their website, health is a small slice of their interests under consumer. This Editor speculates that they were seeking to expand this area, and perhaps sensed a bargain, because Tunstall by no stretch could be considered ‘medium-sized’.
Another interesting tidbit is that the cited sources indicated that before a refinancing, the company might need to be deleveraged. There is about £230 million in debt excluding shareholder loans and bank debt, which if included would bring the total to an eye-blinking net debt of £1.2 billion. Charterhouse purchased Tunstall in 2008 for £530 million. Current sales are £212 million for the fiscal year ending in September 2015, down from £215.2 million in 2014 according to a filing with Companies House (see 4 Dec 15 PDF in the filing history tab).
Tunstall’s statement: “Tunstall’s turnaround plan is well advanced and we are seeing improved performance,” the company said in an e-mailed statement. “Our focus is on delivering for our customers and helping them exploit the possibilities that new digital technologies present.”
This Editor’s reflection is that Tunstall is in the situation that nearly every company in telehealth and in health tech is in–a confusing market with segments as fine as a garlic clove sliced with a razor, too many players, too many segments with too many names, all chasing not enough money whether private or government.
Certainly more to come. Hat tip re the article to a Reader with long-standing experience in the telehealth field.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/03/Boots-Main-Logo.jpg” thumb_width=”150″ /]Boots has entered the direct-to-consumer PERS business with Home Assist, supplied by Tunstall Healthcare. It’s a conventional (non-mobile) base unit and pendant with 24/7 response to Tunstall’s call center and a temperature sensor that will alarm at cold temperatures. The basic PERS is priced at £34.79 ($49) inclusive of VAT for the unit and a £19.99 ($28) monthly charge. Adding fall detection, the prices rise to £46.79 and £25.19. The most expensive option adds a smoke detector, reassurance calls and a bogus caller alarm for £58.79 and £31.19. Some end users may qualify for VAT-free pricing due to a qualifying disability or long-term illness, which lowers rates by £7-9. According to our former Editor and occasional contributor Mike Burton, this is a first for any High Street chemist and ups the game for all PERS and alert systems. It’s also a natural move, given that the US outpost of the Walgreens Boots Alliance has direct sold Tunstall (and earlier, AMAC) PERS units for 10 years. (Walgreens’ base monthly rate is about the same at $29.99 monthly for the same unit, but no unit cost on an annual contract.) Home Assist website (Tunstall UK/Boots). The in-store leaflet link on the Boots website features Boots locations in London and Leeds only, along with a full application.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”120″ /]Tunstall Americas has made a second acquisition of a home monitoring service and distributor in Hawaii, Lifeline Hawaii Services. Based in Honolulu and providing monitoring throughout the Islands, it appears from a statement by CEO Casey Pittock that the 15-year-old company will be merged with an earlier acquisition, Kupuna Monitoring Systems. Monitoring services will be provided on the mainland in New York City and Rhode Island. This marks the eleventh acquisition of local monitoring services Tunstall has made since late 2014. A caution to Mr Pittock: Editor Donna having some experience with a mainland company managing a significant Hawaii presence, albeit in a different industry (Avis car rental), the kama’aina (local) market prefers on-island presence and service, the more personal the better. One of the biggest challenges will be when that Hawaii emergency call comes in, to understand local expressions and to know that on the Big Island, Hilo is not around the corner from Kona but nearly two hours away; even on Oahu outside of Honolulu, help can get far away quickly. Hawaii News Now (Tunstall release)
Down Under, Tunstall maintains a steady level of activity unlike their US brethren who are hard to find at industry events. They began distribution before Christmas of the latest version of the wander alerting Find-Me Carers Watch for the cognitively impaired which just received a AU $3 million investment from local VC OneVentures. Retirement community Living Choice has also contracted with Tunstall to update their emergency call systems for five villages. Since last July, they have transitioned and customized 700 units across five villages. Residents now can access the National Home Doctors Service and 24/7 monitoring by Tunstall’s centers in Australia and New Zealand. Australian Ageing Agenda Technology Review
TTA Situations Wanted poster succeeds! Back in August, Hannah Lowish, an experienced project manager formerly with one of the UK’s leading remote monitoring health providers, asked this Editor to run a listing posting her background in our ‘Who’s available?’ section (above). It was our pleasure to do so (and also revive this section under Jobs.)
Hannah has now written us advising that she has now started a new position with Tunstall Healthcare in their programme delivery team. Congratulations Hannah! And thank you for advising us.
And if you are seeking a new situation, or have a position to fill, we are listing–free as a service to our industry. Please write Editor Donna. We will post both confidential and identity revealed contacts.
Tunstall Healthcare in Australia is adding an unusual (for telehealth) market with the National Home Doctor Service (NHDS), which provides after-hours home visits for urgent, episodic care. The NHDS’ 600 doctors provide one million patient visits in home, including calls on those living in residential aged care (assisted living), older adults and those with disabilities. Home visits (US=house calls) have the aim of reducing ED/ER visits which may require ambulance calls. NHDS coordinates records with the patient’s regular GP. Tunstall’s role is to provide on-call care consultants who coordinate NHDS services; they also match NHDS with the needs of current Tunstall clients. Australian Ageing Agenda Technology Review. Tunstall Australia release.
A familiar debate raged at the Connect Expo Future Health Summit in Melbourne this week [TTA 15 Apr]. Is lack of digital health adoption due to lack of political push, as Lyn Davies, managing director at Tunstall Healthcare, maintained? Australia continues to back the Personally Controlled EHR (PCEHR) to the tune of AU$1.1 billion so far, yet it is still not integrated into the healthcare system. Are clinicians allergic to technology qua technology projects, and need to be approached differently to adopt digital health, as Donna Markham, advisor to chief executive affairs at Monash Health, said? Is it people–the patients– not seeing any benefit to things like PCEHR, a lack of demand filtering down to the practice level, per Toby Hall, Group CEO of St Vincent’s Health Australia? There is a certain comfort in the issues not being much different in a smaller, centralized health system (as the US is not–and as we’ve learned from ISfTeH, in Germany telehealth adoption is low). What seems to be missing is a perspective on what individuals are doing with their own health management and tracking outside the system. TechRepublic Hat tip to David Trainor of Belfast’s Sentireal on David Doherty’s mHealth LinkedIn group (signup required).
If you caught the recent Wired article entitled Wearables Are Totally Failing the People Who Need Them Most, you may have felt a sense of deep depression that a sector growing as strongly as it is is apparently delivering so little real health benefit (you may also be depressed to see the world of apps developers described as “From Silicon Valley and San Francisco to Austin and MIT…” although remember the North American-based Major League Baseball is called the World Series). The thrust of the article is that young people are developing wearables for people like them, who are then stopping using them within a few months, whereas those with long term conditions (LTCs) who are not the target customers are actually the ones using wearables consistently. As they say: (more…)
Tunstall Healthcare is partnering with Canadian mHealth developer Tactio Health Group in what is a distinct first for them: creating a mobile care management system that is 1) smartphone-based for the patient and 2) prominently integrates non-Tunstall apps and devices. The patient uses the smartphone and the Tactio-developed mTrax app to collect a wide spectrum of data–everything from activity, sleep, pregnancy, body fat and mood tracking to the traditional constellation of vital signs. This uploads to the care provider’s tablet mPro Clinical App which overviews, details and reports the data for each patient and patient groups in care. The data comes from well-known mHealth apps outside the Tunstall world: BodyMedia, Fitbit, Fitbug, Garmin, Jawbone UP, Medisana and Wahoo Fitness, as well as connected (presumably Bluetooth) medical devices from A&D Medical, Mio, iHealth, Telcare, Withings and Nonin. Tunstall has also added two-way patient coaching and health journal features.
Tunstall’s positioning for what they call Active Health Management or AHM is “supported self-management” and “shift(ing) from reactive care to cost-effective active care.” (more…)
Technology enabled care services (TECS) are the key, according to this study headed by the Good Governance Institute (GGI) and supported by Tunstall Healthcare. Whatever your thoughts are about the latter, the problem pointed out in the study is valid; that TECS (another acronym to be added to the arsenal encompassing both telecare and telehealth; not a ‘telehealthcare’ in sight) is thought of as ‘too difficult’ and because the system has not changed, people are being denied life-changing support and technology. GGI surveyed healthcare professionals in its networks plus organized a workshop with the Tunstall Clinical Advisory Group for more qualitative information.
According to the report, 85 percent of respondents said that telehealth was “very important” (50 percent) or “important” (35 percent) in developing pathways for patients with long-term conditions and better management of their care in the community. The overwhelming majority (79 percent) responded by saying they would be prepared to contribute to some or all of the costs, or introducing telehealth from their own budgets. (more…)