Predictions, predictions, for weekend reading: is telehealth usage shrinking or growing? It depends on your perspective.

crystal-ballTwo very divergent views on the future of telehealth were published this week. Bloomberg Intelligence on the economics side is seeing nothing but blue skies for telehealth for the next five years, while predictive analytics shop Trilliant Health crunches their numbers and sees the opposite picture. Trilliant predicts the downward trend, which they first observed in their mid-2021 [TTA 30 June 2021] healthcare report, will continue except in the select area of mental health. Here are their predictions:

In Bloomberg Intelligence’s Digital Reshaping the Health-Care Ecosystem report, their projection is that telehealth by 2027 will be at minimum $17 billion of healthcare revenue. Their target numbers are $20 billion and 15% of outpatient visits with a three-year compound annual growth of 25%. This is based on claims trends they see (we don’t–see our reports on FAIR Health’s claims data) as well as revenue consensus by public telehealth companies such as Teladoc. However, as the report puts it, it cannot completely account for telehealth acquisitions by larger managed-care companies or the extension of telehealth across existing consumer and patient platforms which if anything would increase the picture. 

  • The ‘flywheel’ effect of the pandemic raised awareness of telehealth by both patients and providers
  • Payers have moved aggressively to incorporate telehealth as their members demand it: CVS Aetna with Teladoc, UnitedHealth with NavigatorNOW, Cigna with Oscar (which has $0 co-pay virtual health plans in many states), Cigna-MDLIVE, and others.
  • The ubiquity of mobile phones, smartphones and apps

From the report: “Virtual care will [increasingly] become the norm, we believe, after the pandemic pushed patients away from in-person visits. A reversion to old practices and business models appears impossible to us after the pandemic forced meaningful change across all the key constituents.”  The rest of the report covers international growth in remote patient monitoring, such as continuous glucose monitors (CGM) ($12 billion) and implantable and wearable cardiac monitors, based on similar corporate projections.

Trilliant Health’s Trends Shaping the Health Economy: Telehealth (e-doc and downloadable PDF) takes the opposite view–that telehealth usage continues to shrink inversely to in-person visits being restored.  It questions whether the “forced adoption” of telehealth over the past two years (March 2020 to November 2021) has actually changed patient and provider behaviors. Patients used it then, will they continue to use it in the future? It’s nowhere near a norm with the exception of growth in behavioral health. Demographically, utilization is uneven. Highlight findings:

  • Even during the pandemic, only 25.6% of Americans used telehealth over the tracking period
  • 46% of telehealth patients used it only once
  • The total addressable market for telehealth is <1% of the health economy and declining, because most prefer in-person care
  • Monthly usage continues to decline even with Covid variants
  • Primary care visits continue to decline as well, but telehealth does not fill that gap
  • The type of telehealth usage hasn’t shifted much, with audio-video leading the way with over 60% share
  • 57.9% of telehealth visits were attributed to behavioral health diagnoses and is growing in share–and this has not changed pre/post-pandemic
  • Between 2020 and 2021, 79% of telehealth patients had between one and four visits. But less than 3% of telehealth patients
    were “Super Utilizers” with 25 or more telehealth visits. And they’re younger–aged 21-36, female (58%), and live in high income areas.
  • The psychographics of telehealth users is interesting. They are not the ‘Priority Jugglers’ of busy moms and hipsters you’d expect, accounting for 15% of users. 30% are “Willful Endurers” who live in the “here and now” and presumably turned to telehealth when they just couldn’t ignore an illness anymore, followed at 25% by their opposites–“Self Achievers” who are very proactive about their health and wellness.
  • Most niche telehealth entrants are targeting the same discrete markets, like women, who will continue to use telehealth
  • Most providers are not equipped to continue to provide telehealth, versus retail suppliers like CVS, Walmart, and Walgreens
  • Public policy calling for permanent expansion of access is inconsistent with actual low telehealth utilization in the past two years, where in-person visits were limited, Medicare and insurance restrictions were put aside, and providers expanded availability

The report looks at all forms of synchronous and asynchronous telehealth modalities–the latter often lost in the shuffle–concentrating on synchronous audio-video and audio-only, plus asynchronous interactions such as email. This is a 69-page report worth your ponder; there are charts and graphs that lighten the load of their conclusions, which directionally seem to fit what this Editor has been seeing in since last autumn. Hat tip to Sanjula Jain, chief research officer of Trilliant. Also Healthcare IT News

Who needs Watson Health? 10 startups using AI (for real) in medical diagnostics, clinical decision making, and more

Our Readers over the years (since 2012!) have been tracking the rise–and fall–of IBM Watson Health. Now sold to Francisco Health [TTA 22 Jan], multiple companies have taken up chunks of their all-too-unwieldy mission, from oncology analytics and diagnostics to clinical decision making, and managing (and, in one case, reversing) chronic conditions. MM+M (Medical Marketing and Media) profiled ten companies–5 in diagnosis and 5 in treatment–in two articles. The first five are closer to the original Watson than the second group.

  1. Heartflow–diagnosis of coronary artery disease
  2. PathAI–machine learning for pathology in bladder and skin cancer detection
  3. Paige.AI–AI and pathology in prostate cancer detection
  4. Exo–medical imaging
  5. Proscia–dermatology diagnosis for melanoma
  6. Atropos Health–converting EHR information for clinical decision making and follow up
  7. Virta Health–prescribing food plans to people to reverse Type 2 diabetes, management via AI to doctors
  8. Sword Health–virtual care for patients with musculoskeletal (MSK) pain, managed by pairing them with digital therapy, monitoring by motion sensors
  9. Omada Health–personal interventions in chronic conditions
  10. Twin Health–sensor based monitoring and machine learning to reverse chronic diseases

Part 1 and Part 2

The shoe dropped: DOJ sues to block UnitedHealth Group-Change Healthcare merger. What’s next?

To nearly no one’s surprise, the US Department of Justice did what was reported back on 17 Jan: block UnitedHealth Group’s (UHG) bid to acquire Change Healthcare on anticompetitive grounds. Earlier today, the DOJ issued their statement in a release on the joint civil lawsuit with the attorneys general of New York and Minnesota. (This Editor finds the New York AG participation interesting, as Change is HQ’d in Nashville, Tennessee with UnitedHealth in Minnesota. The usual grounds are state interest and commerce.)

The reasons cited will also not come as any surprise to our Readers, as these objections were raised from the start in that the acquisition would give UHG an unfair advantage against their payer competition and squelch innovation. These are from the DOJ release and the complaint filed today (24 February) in the US District Court for the District of Columbia.

  • UHG is the US’ largest insurer and also a major controller of health data. Change is a major competitor to UHG/OptumInsight in health care claims technology systems, which was the basis of the American Hospital Association’s (AHA) objections.
  • The acquisition would eliminate a major competitor to UHG in claims processing. Moreover, Change is “United’s only major rival for first-pass claims editing technology — a critical product used to efficiently process health insurance claims and save health insurers billions of dollars each year — and give United a monopoly share in the market.” It would also give UHG the ability to raise competitors’ costs for that technology.
  • Hospital data accounts for about half of all insurance claims. UHG with Change would have effective control of that ‘highway’.
  • Change is also a major EDI clearinghouse, which facilitates the transfer of electronic transactions between payers and physicians, health care professionals, or facilities. UHG would have control of the EDI clearinghouse market.
  • UHG would be able to view competitors’ claims data and other competitively sensitive information through Change. “United would be able to use its rivals’ information to gain an unfair advantage and harm competition in health insurance markets.”

The plaintiffs–DOJ, New York, and Minnesota–conclude with a request of the court to 1) enjoin (stop) the acquisition and 2) award restitution by UHG and Change for costs incurred in bringing this action.

Consider this acquisition one for the books–the one embossed ‘Nice Try, But No Dice’. 

So what’s next? Here’s your Editor’s speculation.

Change is one of the ‘shaggiest’ independent companies in healthcare, in so many businesses (many acquired) that it’s hard to understand exactly what they stand for. It has extensive businesses not only in the areas above that will nix the UHG buy, but also in imaging, data analytics, clinical decision making, revenue cycle management, provider network optimization and related solutions, pharmacy benefits, patient experience in billing and call centers, funding healthcare….and that’s just the surface of a giant list. From the outside, it’s hard to see how all these parts coalesce.

In the industry, Change was long rumored to be for sale. Recently, it’s become unprofitable. It closed its FY 2021 (ending 31 Mar 2021) with a $13.1 million loss and through Q3 FY 2022 with a $24.5 million loss.

At the end of this, Change may be better advised to sell off some of its businesses, retrench, and refocus on its most cohesive and profitable areas. 

Thursday news roundup: Teladoc’s cheery 2021, uncertain 2022; DOJ deadline UnitedHealth-Change Sunday, Cerner’s earnings swan song, Humana feels the activist lash; funding/M&A for WellSky, Health Catalyst, Minded, Automata, MediBuddy

Teladoc closed 2021 on Tuesday with record revenue of $2,032.7 billion, 86% over 2020. Visits were up 38% to 15.4 million with 53.4 million paid members. Q4 revenue was $554.2 million, 45% over Q4 2020, all of which exceeded investors’ expectations. Despite moving to a positive cash flow of $194 million, Teladoc is still not profitable, with full-year losses of almost $429 million and net loss per share of $2.73, somewhat lower than 2020.

The outlook for 2022 is less certain. For the full year, they anticipate a nice rise in revenues to $2.55 to $2.65 billion but a net loss of $1.40-1.60 per share, a little more than half 2021. Paid membership they project will grow to 54 to 56 million. The stock did take a bit of a bath due to market uncertainty with Ukraine-Russia and also a lowered forecast for first quarter. Teladoc earnings release, Healthcare Dive

DOJ has till Sunday 27 February to sue to stop the UnitedHealth acquisition of Change Healthcare. The acquirer and acquiree popped their 10-day notice on 17 February through their 8-K filing with the SEC. They had previously agreed to hold their closing until after 22 February. So if the DOJ is going to block the deal, as has been reported [TTA 17 Feb], they have from today to Sunday to do it–and courts aren’t open Saturday and Sunday. Healthcare Dive, Becker’s Health IT

Cerner’s 2021 swan song kind of… honked. Their net loss for the year was $8.8 million in 2021, compared with a net income of $76.9 million in 2020. Total net earnings topped $555 million in net earnings in 2021, down 29% from $780.1 million in 2020. Cerner release, Becker’s. Meanwhile, Oracle’s acquisition high hurdles continue [TTA 11 Feb] with the Feds, passing the first mark of the Hart-Scott-Rodino Act waiting period as of 11.59pm on 22 February. Still to go is the SEC review of Oracle’s tender offer for Cerner shares.  Becker’s Health IT

Humana joins Centene in insurers forced to change by activist shareholders. Starboard Value, a hedge fund, reached an agreement with Humana that Humana would add two independent board directors backed by Starboard. The first will be named on 21 April with the second to follow. They replace incumbents who will not stand for re-election. Starboard owns 1 million Humana or 0.79% of shares, but is well known for wielding them effectively to leverage change when the business hits a pothole–Humana’s $14 million Q4 loss and Medicare Advantage losses to both traditional rivals and insurtechs.

Humana is standing by its 2022 projection of 11-15%  growth but slowing performance in large areas such as Medicare Advantage. The company has stated that they will funnel funds back into Medicare Advantage through its “value creation plan”, which sounds very much like Centene’s “value creation office”. You’d think they’d come up with cleverer names and less anodyne ‘strategies’ for extracting savings from these lemons wherever possible, including selling off assets and “optimizing its workforce”. Reuters, Healthcare Dive

And quick takes from the US, UK, and India…

WellSky is acquiring TapCloud for an undisclosed amount. WellSky is a data analytics and care coordination automation company in the acute care and home care markets, with TapCloud a patient-facing engagement and communication platform. Release

Another data analytics company, Health Catalyst, is bolstering capabilities with its agreement to buy KPI Ninja, a provider of interoperability solutions and population health analytics. Purchase price and management transitions undisclosed, though from the release it appears that all KPI Ninjas will be onboarded.

Minded, a NYC-based mental health med management company, scored $25 million in seed funding from Streamlined Ventures, Link Ventures, The Tiger Fund, Unicorn Ventures, and private individuals. They provide direct-to-patient behavioral health medications through virtual evaluations with treatment plans without in-person visits, which are still unusual in psychiatry. At the present time, it is available only in New York, New Jersey, Pennsylvania, Florida, Texas, Illinois, and California.

The founders are an interesting mix: David Ronick, who previously co-founded fintech unicorn Stash, Gaspard de Dreuzy, the co-founder of telehealth company Pager, and Dr. Chris Dennis, a multi-state licensed psychiatrist. Their rationale for founding the company does resonate with this Editor, whose brother is a board-certified MD psychiatrist, and who knows well 1) the challenges of remote therapy and 2) the scarcity of psychiatrists in most of the US beyond urban and academic areas. Release, TechCrunch, Mobihealthnews

In the UK, London-based Automata, which automates lab technology to shorten turnaround time and scale up lab capacity, along with deploying automation with contract research organizations, research labs, and blue-chip healthcare institutions, announced a $50 million (£36.8M) Series B raise. The round was led by Octopus Ventures with participation from returning investors Hummingbird, Latitude Ventures, ABB Technology Ventures, Isomer Capital as well as strategic investors including In-Q-Tel. Mobihealthnews

From Bangalore, India, virtual health company MediBuddy $125 million Series C funding was led by Quadria Capital and Lightrock India, bringing their total funding to over $191.1 million, a hallmark of a largely bootstrapped company. MediBuddy uses a smartphone app for 24/7 real-time video doctor consults and at-home lab testing covering the family and in more than eight languages, important in India which has hundreds of languages and local dialects. Great smiles on the founders too! Mobihealthnews

Extending telecare services to 800,000 more people could save the UK £14.5bn: study

An economic analysis by digital connectivity consultancy FarrPoint found that extending telecare and technology-enabled care services to more people aged 75+ could achieve benefits of  £14.5 billion over the next decade. By country, the savings are £12.3 billion in England, £1.1 billion in Scotland, £717 million in Wales, and £370 million in Northern Ireland.  The benefits are improving social inclusion, wellbeing and community resilience, alleviating bed blocking and hospital admissions which are highly quantifiable costs to the healthcare system.

Currently, 2 million people use telecare services in the UK. Based on current take-up rates of 1 in 5 (aged 75+), if this were 1 in 3, an additional 800,000 people could benefit from access to technology-enabled care across the country (eHealth Scot). Over the next decade, that group will likely grow to 1 million, totaling 3 million of the estimated 7.3 million aged 75+ in 2030 (Office of National Statistics estimate)

FarrPoint’s point of view is that the expansion of telehealth is necessary to alleviate the coming demographic crunch in the social care system to prevent a crisis. Their definition of telecare is a modest one: pendants connected to alarm centers and door, bed, and fall sensors.

Their findings are also linked with the first-ever telecare analysis across Wales for TEC Cymru, the program responsible for supporting the shift to technology-enabled care in Wales, where 67% of councils are moving from analog to digital technology for telecare services to their current 77,000 persons, mostly over 65. FarrPoint article

Caveat: we do hope they account for the downsides of VOIP and power outages cutting all telecom off to the vulnerable, all too common in the rural parts of the UK where they live [TTA 21 Dec 21].

Hat tip to Adrian Scaife, who has moved to the ‘Big T’ as Group Product Manager Housing at Tunstall Healthcare (in a smart move on their part!)

The ‘digital premium’ in the future of health, housing, and social care explored in new GGI paper

A new paper by the Good Governance Institute (GGI), Resetting the digital premium, outlines the impact of embracing digital across public services. It is about what the ‘digital premium’ is, why it matters,  and how to move forward with digital technology in the health, housing, and social care areas. For boards in these areas, it provides practical advice and guidance on finding the best ways to provide comprehensive, high-quality digital services. Andrew Corbett-Nolan, CEO of GGI, added that “This paper comes at an incredibly important time, as boards have the opportunity to use digital products with a new approach to support the move forward from the ongoing Covid pandemic.”

Funded by a grant by Legrand Care, the report explores four themes at the heart of the digital premium: place, predictive technology and population health, security and wellbeing at home, and new digital standards. It is the second paper in the series, the first published in 2020 [TTA 26 Feb 2020].

The GGI created this report using multiple methods including desktop research, interviews, roundtables with NHS and other key public, third sector, and private organizations (in the UK and internationally), with an editorial board made up of senior health, housing, and social care leaders. 

Chris Dodd, CEO of Legrand Care, noted that “I welcome this latest whitepaper from the GGI and fully support the premise that connecting digital ‘thinking and doing’ with good governance enables proper stewardship of public assets and the public interest, but in doing so we must continue to tackle the digital divide and ensure we bring all on this transformational journey. This connection grounds strategic digital issues in real accountability, not just in organizations but in new networks, systems, and collaborations between organizations on which the future evolution of health, housing, and social care depends.”

The free five-part report is available for download on the Tynetec website. A tip of our cap to Kathryn Burton of Legrand Care for this news, and Legrand Care and Tynetec for their continued support of Telehealth & Telecare Aware. Their release is here.

DOJ to block UnitedHealth-Change Healthcare buy: report

Change is controversial, at least for UnitedHealth. Healthcare Dive reported today that the Department of Justice (DOJ) is preparing a lawsuit to block UnitedHealth from purchasing Change Healthcare. Their source is a report published on a subscription financial website, Dealreporter, that their sources say that both companies will be meeting with the DOJ for what is charmingly called a ‘last rites’ meeting. Apparently, all the companies’ plans for divestitures [TTA 26 Jan] are not enough to satisfy DOJ on the antitrust issues raised not only by the DOJ, but also strongly by the American Hospital Association and the National Community Pharmacists Association.

Announced in January, the merger approval had been tabled in August and October/November, with the closing delayed accordingly, so the DOJ action resulting from their mandatory review under the Hart-Scott-Rodino Antitrust Act (HSR) was anticipated. Even in August, the delay did not bode well for this $8 billion in cash/$5 billion in debt deal.

What’s at issue here is the consolidation of data and businesses both UH and Change are in–health IT and revenue cycle management–and reduced competition that drives up costs for health systems and providers. As this Editor observed in March, OptumInsight, Optum’s data analytics unit, and Change provide a similar range of services in health IT and revenue cycle management (RCM). As one of the largest independents in these areas, Change contracted with providers and had access to the data of 1 out of 3 patients. Optum’s parent, UnitedHealthcare, is also the largest US payer. These were the factors that made those represented by the American Hospital Association (AHA) very nervous indeed [TTA 25 Mar] regarding pricing of these services–and they expressed their misgivings cogently in a seven-page letter (PDF link) to DOJ on 17 March. In their view, Change integrated into OptumInsight would reduce competition and increase pricing in RCM, claims clearinghouse and payment accuracy services, and clinical decision support services.

In DC, the view of what is anti-competitive is cyclical. The 2020 acquisition of WellCare by Centene was approved with nary a whinny. CVS-Aetna took forever because of a showboating judge, but was finally approved in 2019. Yet only two years before, the Aetna-Humana and Anthem-Cigna mergers were doomed to fail. In this administration, large mergers do not fare well; both Aon-Willis Towers Watson and Lockheed-Aerojet Rocketdyne were canceled.

Expect to hear more by end of month. 

Wednesday roundup: athenahealth acquisition closes, Tyto Care receives lung sound CE Mark, NHS’ elective care recovery plan for 6 million, NSW health secretary to Telstra Health

Bain Capital and Hellman & Friedman completed their $17 billion acquisition of athenahealth on Tuesday. The purchase was from Veritas Capital and Evergreen Coast Capital, which remain minority shareholders along with an affiliate of GIC and a wholly-owned subsidiary of the Abu Dhabi Investment Authority. athenahealth claims over 140,000 ambulatory care providers in the US, which is not much growth considering they had 88,000 in 2017 and reportedly grew to 160,000. Release 

Telehealth diagnostic monitor Tyto Care received CE Mark approval for the Tyto Lung Sounds Analyzer. It is a standalone Software as a Medical Device (SaMD) that alerts to the potential presence of an abnormal breath sound in respiratory recordings that may be wheezing in adults and children. The analysis is based on their database of clinical exam recordings. Release

Whither the 6 million waiting? The NHS intends to reduce the backlog of elective care caused by the pandemic through the Delivery plan for tackling the COVID-19 backlog of elective care. Highlights are the rollout of a new online platform called My Planned Care, as well as plans for 100 community diagnostic centres, new surgical hubs, and increased capacity to offer tests, checks, and treatments–over three years. Healthcare IT News

And in Australia, the revolving door spins. Elizabeth Koff, secretary of NSW Health, will be moving to Telstra Health as managing director effective 1 July. She succeeds Mary Foley, who will continue to be a special adviser and a non-executive director of the board. Ms. Koff has spent three decades in the state health department which manages 228 hospitals and around 127,000 staff. New South Wales was subject to severe lockdowns in 2020 and 2021, which continue to a lesser degree.  Healthcare IT News ANZ

Owlet gets back into the baby zzzzz’s market with Dream Sock and Dream Duo–but now not medical devices!

Without a splash or fuss, Owlet reintroduced its baby monitoring sock as the Dream Sock last month. Formerly known as the Smart Sock, Owlet got into FDA Hot Water in October [TTA 4 Dec 21] with their marketing the Smart Sock, which monitored sleep patterns, blood oxygen saturation, and pulse rate, as a medical device that would fall under 510(k) marketing clearance requirements, including premarket approval (PMA). The Smart Sock and Smart Duo were pulled from market on 22 November.

The Dream Sock, according to Owlet’s product page, is all about baby sleep, measuring sleep quality indicators, including wakings, heart rate, and movement. It provides a sleep quality score via a sleep coaching app. The difference between the old sock and app is that the blood oxygen saturation (SpO2) measuring capability is deleted. The SpO2 monitoring and the claims they were making were likely causes of the FDA’s warning.

The web store listing is for $299 for a Dream Sock fitting up to 18 months, with the Dream Sock Plus, which fits 0-5 years, at $359. The Dream Duo adds the Cam video baby monitor to the system for babies up to 18 months for $399. Sales are restricted to the US at this time. The products can also be found on the usual web stores.

On both the home page and on the product pages, the disclaimer statement is loud and clear:

WARNING: Owlet products are not medical devices. They are not intended for use as medical devices or to replace medical devices. They do not and are not intended to diagnose, cure, treat, mitigate, alleviate or prevent any disease or health condition, or investigate, replace or modify anatomy or any physiological process. [snip]

Digging into the website, Owlet states that they are “actively pursuing submitting a medical device application to the FDA to bring the Smart Sock technology to medical and consumer markets in the future.”

Owlet shares (OWLT:NYSE) have taken a massive value drop since it completed its SPAC with Sandbridge Acquisition Corporation and parked in the Unicorn Lot last July. It opened at $8, crested to over $10 in mid-August, then started to drop precipitously before Labor Day. It closed on Tuesday at $1.83. If only for the Cute Factor, one wishes them luck.

Friday’s really quick takes: Oracle-Cerner starts Federal reviews, Curve Health, Signify buys Caravan, and a gaggle of single name companies!

The long and winding road of Federal scrutiny–and other legal actions–begin for Oracle and Cerner. To be expected, the first hurdle is a review under the Hart-Scott-Rodino Act, by the Federal Trade Commission (FTC) and the US Department of Justice (DOJ). This should conclude by 22 February. The Securities and Exchange Commission (SEC) is also reviewing. As is routine in takeovers of public companies, there are seven civil filings by ‘supposed’ Cerner stockholders in either the District Court for the Southern or Eastern District of New York, their favorite venue, all claiming lack of information. Expect more. Kansas City Business Journal (which may be paywalled), Becker’s Health IT

New York-based newcomer Curve Health scored a $12 million Series A from Morningside Ventures with participation from Alumni Ventures and Recover-Care Healthcare, as well as returning investors Lightspeed Venture Partners, IDEO, Inflect Health, and others. Total funding is now $18 million (Crunchbase). Curve Health specializes in ‘virtual hospital’ telemedicine for skilled nursing facilities (SNFs) and community paramedicine, along with billing and health information exchange. Last July, they partnered with CareConnectMD, a California-based provider group that delivers value-based care for people living in nursing homes via its High Needs Direct Contracting Entity (DCE). Curve’s founder, Tim Peck MD, previously founded Call 9, a telemedicine/onsite service for nursing homes, which closed in July 2019 [TTA 15 May 2020] Release

Signify Health, a senior home care and value-based care provider, is acquiring ACO organizer and management services provider Caravan Health in a $250 million cash/stock deal with contingent additional payments of up to $50 million based on performance. Caravan’s founder and the current CEO will be joining Signify. It’s a move that may bolster Signify, which has had a few valuation challenges, because it expands Signify’s provider base and expands its current narrow episodes of care area (the former Remedy) into additional advanced payment models. Release, Mobihealthnews

Short short takes on single-word company news….

Expressable’s remote speech teletherapy platform closed a $15 million Series A funded by F-Prime Capital and including existing investors Lerer Hippeau, NextView Ventures, and Amplifyher Ventures. The new funding will go towards national expansion. FierceHealthcare  Hat tip to this Editor’s former colleague Amy VanStee, who recently joined them.

Balanced is a new digital platform for exercise coaching targeted to older adults. Users can modify based on assessed fitness level, input injuries, health conditions, and fitness goals. They added to an early seed round to total $6.5 million in seed funding, led by Founders Fund and Primary Venture Partners, with participation from Lux Capital and Stellation Capital. Cost for unlimited use is a gentle $20 per month. Given yesterday’s near-implosion of that expensive must-have of the aggressively fit and heavily dripping, Peloton, is fitness getting real?  Mobihealthnews

AndHealth, founded by the CEO plus veterans from CoverMyMeds, now has $57 million from Francisco Partners, with participation from the American Medical Association’s venture capital arm Health 2047, Kirkland & Ellis and Twofold Ventures. AndHealth specializes in Virtual Centers of Excellence (VCOE) programs for migraine and autoimmune disease reversal programs as an employer-sponsored benefit. Release

Berlin-based Ada extended its Series B by $30 million for a total of $120 million. Ada partners with major pharma for its AI-assisted symptom assessment app. TechEU

Nurx is merging into Thirty Madison. Nurx is primarily a provider of birth control, women’s and sexual health meds via telemedicine, while Thirty Madison specializes in telemedicine for chronic conditions. Thirty Madison was valued at over $1 billion after its Series C round in June. Nurx’s lines will be added to Thirty Madison’s menu which includes Keeps (hair loss) and Evens (GI issues). FierceHealthcare

Wednesday roundup: Amazon Care now (actually) nationwide, Australia’s Eucalyptus telehealth’s A$60M, Withings 2 buys, Glooko buys xbird, HoloLens for nurse-GP comms in Cumbria

Amazon Care, which has compiled a history of playing their news quite close to the vest, coyly dropped another hankie on their website today with a blog post that confirmed that their virtual care platform is now available nationwide. In 2022 they will be adding in-person services to 20 more cities, including San Francisco, Miami, Chicago, and New York City. Companies offering Amazon Care as an employee benefit include Silicon Labs, TrueBlue, and Whole Foods Market (an Amazon company). Back in October, TTA outlined our thoughts on Amazon Care’s structure, offerings, cheap pricing, and our opinion that Amazon’s real aim is to accumulate and own national healthcare data on the service’s users. Then they will monetize it by selling it to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Patients may want to think twice.

On a lighter note, Australia’s Eucalyptus telehealth scored a tidy Series C of A$60 million ($42 million), led by Airbnb and Canva’s early investor, BOND, plus previous investors. Eucalyptus’ telehealth platform markets five services: men’s health-focused Pilot, women’s fertility brand Kin, skincare site Software, sexual health business Normal, and menopause service Juniper. The fresh funds will go towards software development and expanding into the UK. Mobihealthnews

Withings is also on a bit of an acquisition tear, buying Berlin-based nutrition app 8fit on top of last month’s Impeto Medical, which developed a tool for monitoring peripheral neuropathies. 8fit offers efficient workouts, customized meal plans, and self-care
guidance in six languages. While the acquisition cost was not disclosed in the release, Withings plans to invest $30 million to integrate 8fit features into their products. Impeto, a R&D company, developed an FDA cleared technology that measures the ability of sweat glands to release chloride ions in response to electrical stimulus. For those with neuropathy, that sweat gland innervation is reduced and sudomotor function is impaired. Impeto’s tool has already been integrated into Withings’ smart scale, the Body Scan, to be released in the second half of 2022 after FDA clearance. Release, Mobihealthnews

Another Berlin-based company in AI that’s been acquired is xbird. The buyer is Glooko, a diabetes and chronic condition monitoring platform. xbird captures data generated by devices and processes it through algorithms and machine learning models, and will expand expands Glooko’s advanced analytics capabilities and tools. The management and staff will join Glooko GmbH. Glooko release

Closing our update is a Cumbria catchup. Nurses at Kendal Care Home are wearing Microsoft’s mixed-reality HoloLens 2 headset to call GPs through Microsoft Teams. Using the HoloLens, doctors can talk to both the nurses and patients. Kendal Care Home has been working with local GPs, Kendal Integrated Care Community, and University Hospitals of Morecambe Bay NHS Foundation Trust to train staff in the use of the headset, which started use at Kendal in October 2020 and has largely replaced their tablets and smartphones for telehealth consults. In addition to Kendal, the Heart Centre at Alder Hey and Imperial College Healthcare NHS Trust used HoloLens 2 during the pandemic.

The devil is in the (migrated) data: GAO watchdog barks at the VA’s transition from VistA to Cerner

The US Government Accountability Office (GAO) released their “watchdog” report on the Department of Veterans Affairs’ first, failed implementation at Spokane’s Mann-Grandstaff VA Medical Center in October 2020. Their 52-page whopper of a report came to a simple conclusion: the VA didn’t ensure the quality of the data migrating from the EHR warhorse VistA and their Corporate Data Warehouse to Cerner Millenium. Thus clinicians couldn’t use Cerner two ways–one was training in how to use it (as noted in VA’s own analysis) so they could not find the patient information they needed–and the fact that even if they knew how to use it, the data migration apparently was incomplete. The GAO found that the VA did not establish performance measures and goals for migrated data quality based on Federal guidance. The result was inevitable. According to the report, “clinicians experienced challenges with the quality of migrated data, including their accessibility, accuracy, and appropriateness.” 

There is also a method called a stakeholder register which helps to identify and engage all key stakeholders. VA did not use this, so some areas were overlooked in the continuity of reporting and preservation of records. This affects not only patient records, but also scheduling.

The main takeaway is that GAO recommends to VA that they establish performance measures and goals that ensure the quality of migrated data and use a stakeholder register managed by the VA’s deputy secretary to engage all the relevant stakeholders in the migration in reporting needs. VA published its own analysis of its implementation and rollout failures in December. Healthcare IT News

The end of the bubble? SOC Telemed, SPAC’d at $10 per share, acquired for $3 and $300M by Patient Square Capital

SOC Telemed (NASDAQ: TLMD), one of the earliest health tech SPACs [TTA 4 Aug 2020], is going private in a deal with the Sand Hill Road healthcare investment firm Patient Square Capital. Patient Square is paying $3 per share in cash.

Based on the 100,840,000 shares outstanding (MarketWatch), this Editor’s best estimate of the transaction is about $303 million. Holders of 39% of the outstanding shares have already voted in favor of the transaction. The deal includes a 30-day “go shop” period in which SOC Telemed’s board of directors can solicit additional bids. Unless there is a superior bid, the deal with Patient Square is expected to close in the second quarter of 2022. 

According to the release, Dr. Chris Gallagher, CEO since September of 2021 will remain. He was previously co-founder/CEO of Access Physicians, a multi-specialty acute care telemedicine business acquired by SOC Telemed in March of 2021. SOC Telemed claims to be the largest telemedicine provider in the US acute care market, supplying virtual consults in specialty areas such as neurology, psychiatry, and ICU. 

Here is where it gets interesting–and worrisome for telehealth. SOC Telemed’s SPAC in August 2020 started at $10.00 per share and a valuation of $720 million. On 2 February, two days before the announcement, SOC Telemed was trading at $0.64 per share. That is a plunge of 94% from the SPAC, with a 72.6% drop in the prior three months that was only arrested by the buyout. The reality is that the Patient Square offer represents a 368% premium over SOC Telemed’s closing share price on 2 February. It is currently trading in about the $2.75 range. 

The worrisome trend is that since August, the publicly traded and established industry giants, Teladoc and Amwell, have also taken it in the shins on their share prices. Teladoc has tumbled by half and Amwell (American Well) by 60%. Even the private companies like MDLive and Included Health (Grand Rounds + Doctor on Demand) must take note that telehealth consults have plunged to about 4% of claims. SPACs, which had opened up an alternate, less complicated channel of public financing for health tech and had its own role in inflating company valuations, have faded due to a combination of circumstances. Will more cautious investments and fewer IPOs be the trend in telehealth for 2022?

Predictions, predictions for telehealth, digital health, and all those cybersecurity risks

crystal-ballJanuary is the month for predicting what’s ahead, and while this Editor has no pretensions to be Sibyl the Soothsayer despite the picture, let’s look at what others see in their cloudy crystal balls.

Frank McGillin, CEO of The Clinic by Cleveland Clinic, works intensively with telehealth in this joint venture between Cleveland Clinic and Amwell. His prediction: telehealth will evolve towards concierge care, as providers reduce “platform sprawl”, coordinate the virtual care experience, and provide multidisciplinary virtual care.

  • Telehealth is now “a permanent mode of access”, though the pandemic created “platform sprawl” as providers reached for any and all modes and providers which could be implemented quickly
  • Healthcare providers and plans now have to scale back and reconcile all this to “design a digital trajectory with intention”
  • This means developing a personalized approach to telehealth delivery and to provide a seamless, highly coordinated care experience
  • Their approach is to focus on multidisciplinary virtual visits and case analysis for patients with complex conditions, such as their Virtual Second Opinions program for conditions such as brain tumors and prostate cancer.
  • Virtual multidisciplinary support reduces the risk of suboptimal treatment plans and can eliminate long travel times and exposure to COVID-19 for vulnerable patients. For payers and employers, this can add up to better outcomes and reduced cost of care.
  • “Intelligent” remote monitoring also removes another layer of risk in providing the right care at the right time
  • Continuation of relaxed interstate licensure requirements are needed to provide fast access to medical experts, particularly for primary care providers.

Interview with Healthcare IT News 

Healthcare Dive has been running a series on industry trends, and this installment focuses on digital health.

  • Healthcare will become more predictive and proactive, with insights fed by connected devices and analytics (commonly lumped under AI) that enable organizations to collect, analyze, and act on massive amounts of data.
  • But algorithms don’t have judgment and data can have bias, leading to poor decisions, such as the distribution of vaccines. Expect more oversight from the Federal level down on AI research and policymaking, 
  • Virtual care will continue to grow in virtual diagnostics, patient-reported outcomes applications, and digital homecare platforms
  • Telehealth and digital health is integrating into the traditional delivery and payment model–partnerships with health systems, payers, and employers.
  • Virtual care access is booming in niche areas such as women’s health, hospital at home, and mental health, with investment dollars flowing in. Telemental health is moving into consolidation.
  • Cybersecurity will become more of a focal point for healthcare companies in 2021, with hackers finding their way into all these contact tracing apps designed in a hurry, plus digital health systems, many of which are poorly protected. Targeted attacks have skyrocketed.

And speaking of cybersecurity, over at HealthITSecurity, they rounded up the experts to opine on All Those Security Risks that fast implementation of telehealth and moving devices out of the hospital walled garden have created. Remote patient management is now an asset, no longer a ‘nice to have’, for providers, setting up a situation where patients are increasingly both the beneficiaries of more convenient health delivery and victims of security breaches and ransomware.

  • ‘Out of hospital’ care means that data is being transmitted between multiple points. Network security isn’t guaranteed. So attacks can originate at the weak points–either the home or hospital environment.
  • The fast implementation of telehealth during the pandemic meant not only did systems not work together well, it also meant multiple points of vulnerability
  • Over 80% of surveyed healthcare providers globally harbor concerns about data security and privacy (Kaspersky/Arlington Research). And a shocking 70% admitted that their practice used outdated legacy operating systems, exposing them to security vulnerabilities.
  • “A culture of security” means maintaining endpoint security and BYOD policies across the organization’s network, identity management and zero trust tactics, and yes, security consciousness on patients’ parts.
  • Patients should not be responsible for security, providers partly, which leaves the responsibility with the vendor. But healthcare organizations are responsible for evaluating their vendors, and how they are interacting with and storing their data.  

Congress calls to extend PHE telehealth flexibilities; FCC’s $48M telehealth funding boost, telehealth’s shortcomings in pediatric asthma treatment

Permanent telehealth flexibility and expanded use still being debated, and still stuck in Congress. The expansion of telehealth that came with the US public health emergency (PHE) isn’t permanent, despite some expansion plugged into the Medicare Physician Fee Schedule. That can only come with legislation passed by Congress and signed into law–and it is still being debated. A fresh group of 45 Congresscritters (this Editor can’t restrain a certain sarcasm) is now plumping for a more permanent extension for a set–but undefined– time, as part of February funding legislation. This effort is being led in the Senate by Brian Schatz, D-Hawaii, and Roger Wicker, R-Mississippi. Oh yes, the power of a letter to the House and Senate majority and minority leaders (sigh!) Meanwhile, the CONNECT for Health Act and the Telehealth Modernization Act have languished for months in the Senate Finance committee and in House Ways and Means. Healthcare IT News

Over at the Federal Communications Commission (FCC), they’re doling out the sixth and final tranche of $47.89 million to 100 provider and community health organizations that applied to the COVID-19 Telehealth Program. The total FCC funding in this round 2 was $249.95 million that built on funding that was part of the CARES Act. The full list is in the FCC release (PDF). MHealthIntelligence

A combination of in-person care with telehealth as an adjunct may be the best protocol for treating pediatric asthma, a UC Davis Health study found. The first part of the study analyzed EHR records for asthma patients aged 2-24 treated at UC Davis Health in 2020. Of 502 patients, telemedicine usage was significantly lower among:

  • Patients with a primary language other than English (OR = 0.12, 95% CI: 0.025–0.54, p = 0.006)
  • School-aged children (OR = 0.43, 95% CI: 0.24–0.77, p = 0.005),
  • Those who received asthma care from a primary care provider instead of a specialist (OR = 0.55, 95% CI: 0.34–0.91, p = 0.020).

Focus groups are qualitative and should be used for direction and to surface issues, and they did with telehealth. The 12 parents and five young adult patients who were randomly selected and participated stated that:

  • The parents felt that in-person care built better rapport, was more effective in counseling the child and young adult patients on their medication and condition, and more actively engaged their children
  • Parents did not feel confident in correctly using diagnostic tools like peak flow meters and home spirometers on a telehealth visit
  • Scheduling follow-up telehealth appointments was more difficult than in-person 
  • Where telehealth stepped up was convenience–to see their specialist without travel time. The visit also ‘cut to the chase’ by seeing one physician only, not an entire care team. And it was protective of their children during the pandemic. 

Most of the focus group participants agreed that a combination of telemedicine and in-person visits would be preferred when asthma is well-controlled. Published in the Journal of Asthma. Also MHealthIntelligence, which read the study conclusions a bit different than this Editor.

AliveCor releases KardiaMobile ECG in the convenient credit card size

AliveCor, the parent company of KardiaMobile mobile ECG devices, is releasing for sale the KardiaMobile Card, a credit card-sized single-lead ECG. It was FDA cleared in November. It’s mighty for its size, detecting six of the most common arrhythmias: atrial fibrillation, bradycardia, tachycardia, PVCs, sinus rhythm with SVE, and sinus rhythm with wide QRS. The pricing is $149 and includes the $99 annual KardiaCare subscription, which renews after the first year. 

In a price and product comparison, the standard KardiaMobile single lead, which is a strip with two press sensors, remains on sale for $169 and the 6L, which has a slightly bulkier sensor but is clinically equivalent to a six-lead ECG, is $239. KardiaCare includes advanced determinations, cardiologist reviews, heart health reports, and more. Owners of older smartphones should review compatibility before buying, however. Release, Mobihealthnews

As of 1 February, there is no update on AliveCor’s legal actions against Apple on patent infringement in the Apple Watch: April’s patent infringement complaint filed with the US International Trade Commission (ITC) [TTA 29 Apr 21] and their late May Federal antitrust suit in the Northern District of California [TTA 9 July 21].