One more from our Eye on Tenders, Susanne Woodman, is from NHS South West which is reviewing their currently in-house delivery of TECS, including monitoring, in Torbay. The Torbay and South Devon NHS Foundation Trust is seeking a fresh look at innovative services from providers who are interested and able to provide the full service from equipment, installation and monitoring, as well as bench-marking information. To review their current services and equipment (Tunstall), they helpfully provided this link. This was posted today (15 Aug) and closes 1 September, so there’s only a short window. Refer to the Gov.UK Contracts Finder page for contact information and (importantly) document attachments.
Inhealthcare Ltd is part of Intechnology plc, owned by Peter Wilkinson, who has developed several UK internet and technology companies at scale–Planet Online, Freeserve, and Sports Internet (now Sky Betting and Gaming). Tunstall release
We start the New Year off we hope in the right way with some good news on telecare expansion and media coverage, traditional and social, versus the gloominess that dominated 2016.
Welbeing, which has become one of the larger telecare providers in the UK from its Eastbourne and Wealden Council roots, was the subject of a feature on Nick Conrad’s breakfast show on BBC Radio Norfolk. This focused on their East Anglia expansion to 4,500 new customers acquired from Flagship Home, with phone-ins by an operator from their new call center in Dereham, a local Welbeing customer and a representative from Norfolk County Council. Welbeing has been on a recent tear with acquisitions in East Sussex, Cumbria, Stonewater and with Muir Housing, cresting their total users to more than 70,000. Of late there’s been a lot of downbeat feelings about the fate of telecare in the UK, so it’s refreshing to hear an upbeat local story for a change. News release. Hat tip to Charlene Saunders, marketing manager of Welbeing.
Tunstall in UK has also developed a smart home type test bed in a sheltered housing flat to showcase how existing TECS kit, Tunstall’s and others, can be combined in everyday living. Smart home demos to interested parties may be old news, but Tunstall is cleverly using social media marketing to build it up. It’s hashtagged #MarysVIPHome with updates on Twitter. There are also has five demo videos on YouTube which show how a family can observe activity/ADLs without intrusion, plus connect the resident to care, improve their socialization and remotely control the home environment. This Editor saw it on a LinkedIn post before the holidays from Tunstall’s Adrian Scaife thanking their visitors and wishing us a Mary Christmas. Now we hope to see more of a narrative about a real Mary living there and using all that TECS. It’s a nice start to what we hope is an innovative 2017.
And we were having such a good time! UPDATED Having ridden a few hype curves (in health tech and out–remember airline deregulation?) and with the bruises to prove it, this Editor believes that she can spot a Cracking Market at forty paces. The hands on the clock appear to be near closing time, even as we party on. After all, DTC telehealth is forecast to be $25 bn in the US by 2025 (GrandView Research), if we make it that far!
Where are the sharp noises coming from?
- The continuing fail of unicorns like Theranos [TTA 4 May and prior], now resorting to bullying the Wall Street Journal and negotiating with the alphabet (SEC, DOJ, FDA, CMS…), and the troubles of Zenefits.
- Another notable unicorn, the doctor booking site ZocDoc, being called out at last on their customer churn, low margins, and high customer acquisition costs. (As well as an irritant to doctors and office managers) New York Business Journal
- Extremely high and perhaps insane rounds of funding to young companies with a lot of competition or a questionable niche. Higi is an odd little kiosk + consumer engagement program located in primarily Rite Aid drugstores–odd enough to score $40 million in its first venture round. (Ed. note: I shop at Rite Aid–and have never seen one.)This is after the failure of HealthSpot Station, which burned through approximately $43 million through its entire short but showy life. The low-cost, largely exchange plan insurer Oscar Health raised $400 million this February ($727 million total) while UnitedHealth and others are dropping money-losing plans in most states. Over 50 percent of exchange co-ops went out of business in 2015, leaving doctors, health systems and patients holding their baggage. Again, low margins, high cost and high customer acquisition costs.
- We’ve previously noted that funders are seeking ‘validation in similarity’–that a few targeted niches are piling up funding, such as doctor appointment setting, sleep trackers and wellness engagement [TTA 30 Dec 15]
- Tunstall’s continuing difficulty in a sale or additional financing, which influence the UK and EU markets.
- NEW More patent fights with the aim of draining or knocking out competition. We’re presently seeing it with American Well litigating Teladoc over patent infringement starting last year, which is only now (March) reaching court. It didn’t stop Teladoc’s IPO, but it publicly revealed the cost: $5 million in previously unplanned lobbying and legal costs, which include their fight with the Texas Medical Board on practicing telemedicine–which is beneficial for the entire industry. (But I would not want to be the one in the legal department explaining this budget line.) Politico, scroll down. But these lawsuits have unintended consequences–just ask the no-longer-extant Bosch Healthcare about the price of losing one. (more…)
In technology, over-use of the term “groundbreaking” is common. However it takes some nerve to use the term to describe “Home Assist”, a push-button pendant-based telecare service now being sold by Boots (provided by Tunstall). Whilst TTA can only applaud the arrival of another high street offering, we would counsel a more realistic service description for a telecare service already offered by many.
Research via Boots’ own website reveals that in addition to the advertised push-button pendant, a falls detector is available as well. This site gives price details too, which look quite competitive at the basic level with non-subsidised local authority telecare schemes, though of course without the linkages to local services, including response services in the event eg of a fall, that some of these schemes also offer. Downloading the in store leaflet gives yet further information, for example that the pricier ‘advanced’ package includes a smoke detector (surely for older people almost as important as a basic pendant, and ideally one/floor of your house?) and bogus call detector, as well as falls detector etc.
Meanwhile in a far off land (Los Angeles to be precise) Active4Pets are busy recruiting to accelerate the US rollout of their “innovative” telehealth communication platform for pets. The (admittedly far-fetched) thought of pets regularly reporting vital signs electronically conjures up all sorts of bad, (though unavoidable) puns such as: (more…)
Tunstall Healthcare Group in UK outlined today their five-year public, global strategic vision, along with a fresh investment of £100 million during this timeframe (~£20 m per year) to transition their connected care systems over to IP and cloud technology. The initiative, dubbed Connected Healthcare 2020, is centered on:
- Leading the switch to IP infrastructure–transitioning away from analogue (analog) services and devices to connected digital and mobile (cellular, Wi-Fi, Bluetooth)
- Extending managed services–offering a wide variety of services end-to-end including full outsourcing
- Developing new consumer propositions through innovation–tapping into demand, often private pay, for high quality home care not provided by carers (caregivers)
- Developing new models of care in the home through integration–coordination of social care and healthcare
The Yorkshire Post article also points out, through their separate comments with CEO Paul Stobart, that prospective markets include developing nations with aging populations such as Mexico, South Korea and Turkey. Tunstall claims market leadership in UK, Germany, France, Spain, the Netherlands, Belgium, Sweden, Denmark, Finland and Australia, as well as fourth position in the US. The TECS (technology enabled care services) initiative will create about a dozen jobs per year at the Whitley HQ, adding to their present 650 there and their total globally of 3,500. Tunstall release
We wonder if in the US we will see more of Tunstall at events like the mHealth Summit. Tunstall Americas has a refreshed website and communications as ‘The voice of connected health’, is more strongly promoting their call/contact services and its HQ location in New York City. We’ve previously noted their recent home care acquisitions and partnership with QMedic.
Tunstall Americas’ monitoring providers will have something new to distribute: the QMedic activity tracker. The QMedic bracelet (alternatively pendant) has an alert button and a base station like a conventional PERS, but also tracks sleep quality and activity levels. It has two way monitoring and also generates alerts and texts to loved ones if the bracelet isn’t worn or no wake-up is detected, plus recurring wellness reports on activity, sleep, and safety in the home. Fall detection presumably is inferred Tunstall’s reseller agreement includes all its local healthcare service providers. This Editor also observes that after a very long period of quiet, Tunstall in the US is demonstrating its own activity. Release. Earlier in TTA: Tunstall Goes Hawaiian with Kupuna Monitoring acquisition
Editor Charles has treated you to a look back on his 2014 predictions, daring Editor Donna to look back on hers. Were they ‘Decidedly so’, ‘Yes’, ‘Reply hazy, try again’ or ‘My sources say no’? Read on…
On New Year’s Day 2014, it looked like “the year of reckoning for the ‘better mousetraps’”? But the reckoning wasn’t quite as dramatic as this Editor thought.
We are whipping past the 2012-13 Peak of Inflated Expectations in health tech, diving into the Trough of Disillusionment in 2014.
There surely were companies which turned up ‘Insolvent with a great idea’ in Joe Hage’s (LinkedIn’s huge Medical Devices Group) terms, but it was more a year of Big Ideas Going Sideways than Crash and Burns.
Some formerly Great Ideas may have a future, just not the one originally envisioned. (more…)
- In the 2014 FY ended 30 September, revenues were £215 million. FY2013 was £221 million, a decrease of £6 million (2.7 percent).
- A corresponding but greater EBITDA (earnings before interest taxation depreciation and amortization) drop to £43.0 million. FY 2013 was £52.7 million, a decrease of £9.7 million (18.4 percent).
- The good news: revenues up 6.8 percent in the Nordics, Southern Europe, Central Europe, and Australasia; Spain’s Televida as a market leader also a bright spot [TTA 19 Dec].
- No such good news in UK and the US (more…)
One of the surprises for this Editor, and for others attending the mHealth Summit, was to see the sizable presence of Qualcomm Life on both the exposition floor and during the sessions. From a near-nil presence at ATA 2014 and gone dark on news, the floodlights snapped on last week with new partners and a new emphasis: coordination of chronic and transitional (hospital to home) care management (CCM/TCM).
On the show floor, the spotlight was on the partner companies which mixed the established with (mostly) the early and mid-stage. Readers will recognize names such as AliveCor, Telcare, OMRON, Nonin and Airstrip; not so well known are Vaica, Orion Health, Monitored Therapeutics, IMPak Health, Vital Connect, Care Connectors, toSense (CoVa), Dexcom, InteliChart, TruClinic, ForaCare, VOXX, vitaphone (outside of Europe), Propeller Health and Noom Health (a NYeC Digital Health Accelerator 2014 graduate). The partners occupy different parts of the management continuum, integrating communications, record sharing, population health management, sensor-based monitoring, traditional and non-traditional vital signs monitoring, medication management, behavioral change methodologies and PHRs. The 2net Hub is still present for data transmission, sharing and storage, but more prominent is Qualcomm Life’s HealthyCircles platform which provides the clinical management ‘glue’: secure communications, record sharing and care team coordination. HealthyCircles was purchased in mid-2013. Founder James Mault, MD, FACS joined Qualcomm Life as VP/Chief Medical Officer.
We had some post-mHealth Summit reflection time by telephone this Wednesday while Dr Mault was in Boston. (more…)
If you are in the Eccles/Greater Manchester area on 11 September (and not attending the Kings Fund International Digital Health and Care Congress or Medical Engineering Centres Annual Meeting and Bioengineering14, both in London), Contour Homes is sponsoring a free, full day North West Telecare Event at AJ Bell Stadium. It will give an overview and showcase latest technologies in telecare for professionals involved in supporting independent at home living. There are talks including Alyson Bell, Managing Director of the TSA, Dawn Thomber of Contour Homes and Tahir Idris of TeleMagenta plus an exhibition. This Editor notes the Tunstall logo (but no speakers); Contour Homes is one of the ‘my world’ introductory sites. PDF with complete information and registration.
Tunstall Healthcare UK last week announced the addition of an advisory service to help commissioners (CCGs, borough councils) and providers better understand, design, deliver and deploy what they’ve coined ‘telehealthcare’, which is plain ol’ telehealth to The Rest of Us. The Advisory Service will be managed by a team of specialists with clinical, technology, training, implementation and business intelligence expertise. The illustration to the left indicates their ‘swirl of disciplines.’ An interesting quote from the release: “According to NHS England, nearly a third of patients aged 75 or over have two or more long-term conditions; the overall cost of care for a person with multiple conditions is £2,500 per year.” (In US terms, that seems vanishingly small, except when you start multiplying…Ed.D.) In the UK system, commissioners are supposed to stay vendor-neutral so to this Editor there is a question on the objectivity of the advice given. On the clinical side, how many doctors and nurses will be engaged by the Advisory Service? The release also implies that the service will be available internationally, but materials are UK only. Website, release, brochure.
Another indication that Tunstall is trying to broaden itself beyond frameworks, fees and NHS funding is their organization of a European Symposium in Barcelona a few weeks ago. Hot topics were integrating services, enabling self-care and self-management for people with long-term health and care needs, increasing awareness of these service among carers, and of course cost management. Tunstall blog.
According to this GP article, GPs are not impressed by telehealth. They “have expressed doubts over the potential of telehealth to improve patient care, and studies have questioned whether the health-tracking technologies are value for money for the NHS.” Thus the Department of Health will encourage commissioners to use telehealth by surveying telehealth and telecare users, as well as developing a set of metrics for commissioners which will demonstrate their impact on health outcomes. The Telehealth Service Association (TSA) estimates are that 1.37m people in 2011 used telehealth, telecare and telecoaching services in England. Certainly Tunstall’s move in this area is designed to take advantage of Government action in this area and commissioners’ increased accountability.
A ‘slipped under the radar’ story (in this Editor’s judgement, based on the lack of news references) is Bloomberg News’ exclusive on last week’s (12 May) meetings between Tunstall Group Ltd and its creditors over the company’s recent performance. According to Bloomberg’s sources, the meeting was called “after income plunged and management changed following a refinancing in September.” In a statement from Charterhouse that cleverly tap-danced past the reason for the meeting, “Tunstall continues to be a successful, profitable, cash-generating business and comparable to many other organizations, experiences short-term fluctuations in performance.” and “The group has been impacted by a number of factors including specific market factors and the continued strength of sterling against the major-trading currencies.” The business has also been hurt by delays in awarding major contracts, according to the statement.
From the Bloomberg article:
As Tunstall’s profits have declined, its ratio of debt to earnings before interest, taxes, depreciation and amortization increased to 5.6 times as of March, from 4.7 times in September, the people said. The loan terms in the March test dictated that the leverage ratio shouldn’t exceed 6.3 times, they said.
Lenders are expecting the company to give a new profit forecast today for the 12 months to September 2014, according to the people. The company didn’t comment on earnings targets or leverage in its statement.
AND: Its 350 million pounds ($590 million) of loans dropped to as little as 77 pence on the pound, according to broker quotes, from 99 pence in September. (Ed. note: these loans are publicly traded and a lowered value is highly significant as to the debt quality.)
The outcome of the meeting is not yet known.
As our readers know, private equity firm Charterhouse Capital Partners LLP acquired Tunstall Group in 2008 from Bridgepoint Capital for £514 million (US$ 1 billion), funded in part with over £242 million in debt and with Bridgepoint and management retaining small shares (FT.com). The September 2013 refinancing was for £350 million ($590 million). This paints a picture of a highly leveraged company beholden to many beyond its owners and its contractors in local authorities and housing associations. Tunstall and Charterhouse also received negative publicity when the Guardian did an exposé on their use of the (wholly legal) ‘Quoted Eurobond Exemption’, where they pay loan interest at high rates to their parent companies through a mechanism via the Channel Islands Stock Exchange.
Management changes over the past six months have also rocked the top layers of the company. (more…)