Thursday’s short takes: Walmart’s delivery drones expand, AWS lands Geisinger for AI and cloud, UHG-Kaia Health partner for virtual MSK therapy

May 26, 2022 | by

Look, up in the sky! If you live in Arizona, Arkansas, Florida, Texas, Utah, and Virginia, you might be seeing a Walmart delivery drone sooner than you think. By end of 2022, the DroneUp delivery service will be expanding to 34 sites in six states, including Orlando and Tampa, covering 4 million households. What stores in those states will fill these orders between 8am and 8pm haven’t been disclosed, but Walmart estimates that delivery may reach 1 million packages. They will be limited in weight to 10 lbs, promise a 30-minute turnaround, and the delivery fee will be a modest $3.99. “Certified pilots” will be flying these drones. A side business for DroneUp is aerial photography for city and state governments’ construction projects. Color this Editor skeptical, as she wonders how many packages will be dropped and drones shot at. Also, they need to stay clear of restricted airspace. Walmart release, Epoch Times, The Verge

Amazon Web Services (AWS) continues its foray into healthcare with a prime partnership with Geisinger Health, a regional (PA) integrated health system.  They will be transitioning to AWS as their strategic cloud tech provider including their EHR, over 400 applications, plus workflows, after a multi-year review. Geisinger has estimated that post-implementation, they will save several million dollars. Their EHR migration will be one of the largest AWS migrations to date. AWS for Health is rivaled by Microsoft with Teams, Azure IoT, and chatbots for clients such as Humana, plus Google’s partnerships with healthcare giants such as Mayo. FierceHealthcare, Geisinger release

UnitedHealthcare and Kaia Health are partnering for a musculoskeletal (MSK) virtual therapy program. United Healthcare members recovering from surgery or injury will be assessed and referred to the Kaia program when appropriate. These members will then be able to download the Kaia app for physical therapy, tailored to them via “artificial intelligence”. Progress is monitored by that person’s smartphone camera to record motion in real-time and offer suggestions via coaches either 1 to 1 or through the app’s chat feature. At this point, UHG will offer it only to their self-funded employer clients. FierceHealthcare

ElliQ companion robot, NYSOFA partner for NY older adult assistance

May 25, 2022 | by

In a step to move robotics more widely into the home, the recently launched ElliQ voice-controlled small-size companion robot from Intuition Robotics will be offered in a pilot program to about 800 seniors in a NYSOFA (New York State Office for the Aging) program. NYSOFA and Intuition Robotics will work with over 830+ case managers to nominate the best candidates for the program. The NY state office is the company’s first state government partner. This is the second initiative in robotics for NYSOFA, the first being an animatronic pet program from Ageless Innovations/Joy for All that reportedly reduces self-reported loneliness by 70 percent.

As we noted in March, ElliQ responds and ‘learns’ by voice commands and through a connected tablet. It is unusually shaped like a small lamp, is animated in place, and initiates conversation that resembles chit-chat after a learning period. Behind this is interactivity–the companion part–checking in to say “good morning,” pointing towards sleep, but also informing family or friends that you’re OK and helping track appointments and medications. ElliQ release

Wednesday news roundup: Oracle-Cerner reportedly OK’d by EU, VitalTech RPM raises $14.1 M, Aging 2.0 interoperability challenge, what do rough times mean for investors and startups, employees cause 39% of healthcare IT breaches

May 25, 2022 | by

One regulatory hurdle down for Oracle’s $28 billion Cerner acquisition? The EU has reportedly given an unconditional EU antitrust clearance to Cerner, three sources informed Reuters. The formal announcement will be made 1 June. In the US, the long and winding road of Federal antitrust scrutiny and review began in February by the usual alphabet agencies–DOJ, FTC, and SEC–that show no sign of wrapping up [TTA 11 Feb]. Cerner continues to run into headwinds in its VA EHR implementation including spotty interoperability with the Military Health Service DOD version [TTA 18 May].

In a small confirmation that RPM is on the rise, Texas-based VitalTech raises $14.1 million in a Series B equity raise. The company offers an app-based remote patient monitoring platform for vital signs, med and nutritional reminders for use by home and hospital/acute care. Investors were not disclosed and the total offering has about $2.1 million remaining in unsold equity. Their undisclosed Series A funding dated back to 2019 and funded by Concord Health Partners and Stanley Ventures. SEC filing

The international Aging2.0 organization announced the Global Innovation Search (GIS), an opportunity for innovators around the world to showcase innovations that enable and promote a system-level approach to improving quality, continuity, and efficiency of care through interoperability. The eight finalists will participate in a Care Tech Pitch at OPTIMIZE, Aging 2.0’s annual conference on 21-22 September in Louisville, Kentucky. Applications close 12 June. The GIS is associated with the Louisville Healthcare CEO Council (LHCC) and will require the winner to relocate to Louisville. More information here.

What does this mess of a market mean for healthcare investors, startups, and companies looking for equity or VC investment? Industry figure Lisa Suennen, who has been to this rodeo before, has a POV in her Venture Valkyrie blog that HISTalk has summarized neatly, if not cheerfully. Major points: the downturn in funding will lag the market by 3-6 months, VCs will stuff the cash and wait for deals at lower valuations, few exits mean that portfolion companies will be burning through cash and dependent on existing investors, and there will be less-well-funded companies and funds which will go belly-up. This Editor’s disagreement is only that VCs lag downturns. In 2008, heading marketing in an early sensor-based monitoring company running out of funds, funding became scarce months ahead of the downturn.

39% of healthcare data breaches are caused by employees, according to Verizon’s latest cybersecurity Data Breach Investigations Report–more than any other industry at 18%. Incidents hit an all time high in healthcare, with 849 incidents and 571 breaches last year. 76% of breaches centered on basic web application attacks (attacks against a web-facing app–30%), system intrusions (malware, hacking–26%), and miscellaneous errors (mostly unintentional–21%).  Personal data was nearly 60% of the data compromised, while 46% was medical. Much more in the report. Healthcare Dive

To white coat, or not to white coat? That is the telehealth doctor question.

May 25, 2022 | by

A light but thoughtful take on the protocols of the white coat, and how the clinical dress translates to telehealth consults. Dr. Jayne, who writes the weekly ‘Curbside Consult’ column for HISTalk, discussed how wearing a white coat on a telehealth visit may very well be passé. Some companies require it, others don’t, but what’s in those pockets anyway? And in telehealth, does this garb turn off patients? 

Dr. Jayne’s practice, based on her columns, is a mix between office and telehealth, but she has previously worked in the ER/ED. Where the white coat comes from is hospital culture, where the differentiators were short white coats for the medical students and longer white coats for the degreed physicians–except in surgery where short coats were worn by interns (remember interns?) and first-year residents. Men wore ties, and the dress was uniformly professional under those white coats. The white coats descended from laboratory coats. As everyone changed into scrubs during the pandemic and ties were ditched (long ago in the UK, along with long sleeves), who is who in a hospital became even more confusing to outsiders, thus requiring even larger nametags.

Perhaps the precedent for telehealth is psychiatry, where most of the telehealth consults occur at the present time. In my brother’s clinical practice, and at the community hospital where he admitted patients, he and his colleagues didn’t wear white coats over their jackets and ties (or dresses/suits for the women). It was offputting to patients, even if they were already in the psych ward. One concession–short sleeves in summer. He did wear a white coat as a locum tenens in a much larger hospital’s psychiatric ER, mainly to protect his clothing from ER mayhem which was prevalent on the night shift. 

As Dr. Jayne put it, it’ll be interesting to see how the protocol evolves. Curbside Consult with Dr. Jayne 5/16/22

Crime Does Not Pay–especially when defrauding Medicare of nearly $1 billion

May 20, 2022 | by

Ocean’s 11 (or 13) It Ain’t. Back in October, the Department of Justice (DOJ) and other Federal agencies had what was dubbed the  National Health Care Fraud and Opioid Takedown. Many of the takedownees were ‘telemedicine’ fraudsters. Of the over $6 bn of fraud identified, $4.5 bn was specified as relating to ‘telemedicine’ with more than 86 criminal defendants located in 19 judicial districts [TTA 2 Oct 20].

The sentences are now rolling in for this and earlier actions. Becker’s seems to be the only outlet tallying those who will be fined and having a stay in Club Fed. The three ‘telemedicine’ convictions noted by this Editor to date, totaling $958 million, are:

  • Genetic testing fraud: The owner of Scott Global, an Orlando telemarketing call center, was convicted of eight counts and a $2.8 million fraud. Telemarketers would call Medicare beneficiaries soliciting their information for expensive cancer screening genetic testing, or CGx, telling them that it would be covered by Medicare. Mr. Scott then paid bribes and kickbacks to ‘telemedicine’ companies to get physician’s orders authorizing the tests. Becker’s Healthcare 12 Jan   DOJ release
  • Pharmacy fraud: Larry Smith, a Florida resident owner of two pharmacies and a related company, defrauded pharmacy benefit managers of $931.4 million by submitting bills for fraudulent prescriptions purchased from a telemarketing company. The telemarketers improperly solicited patient information, then got approvals from ‘telemedicine’ prescribers, and finally sold the prescriptions to pharmacies like Mr. Smith’s for a kickback. Mr. Smith faces up to 10 years in prison. DOJ Release 21 Jan 21 

(Updated April 2024) In a 2018 related action, HealthRight, a ‘telemedicine’ company, and its CEO Scott Roix pleaded guilty to conspiracy to commit healthcare fraud for their roles in the scheme and agreed to pay $5 million in restitution. Subsequently, other defendants and related companies were sentenced for their parts in the conspiracy. The DOJ release of 20 May 2022 details involvement and sentencing.  DOJ release May 2022

  • The absence of telemedicine–prescribing medication without a patient consult–was what landed New Jersey physician Bernard Ogon, MD, to 33 months in prison, pay restitution of $24.3 million, and forfeit an additional $75,000. He signed preprinted prescriptions and then sent them to specific compounding pharmacies involved in the conspiracy. Becker’s Healthcare 28 Jan  DOJ release

Certainly more to come. This Editor has also checked for any further actions in Humana’s suit against telehealth/telemarketing company QuivvyTech as reported last August, and there are none. Our original report here.

Thursday legal news roundup: Oscar Health accused of IPO securities fraud; Venezuelan cardiologist moonlights as cybercriminal, faces slammer; Change Healthcare sues former employee now at Olive AI

May 19, 2022 | by

To use a cliché, what a difference a year makes. In March 2021, insurtech Oscar Health successfully raised $1,4 billion in its IPO with shares at $39. Heady times didn’t last long, with shares tumbling to $5.67 as of this writing. Now the shareholder lawsuits have begun, with the complaint stating that negative effects of COVID-19 on Oscar’s business were not disclosed, specifically the growing cost of the pandemic on testing and treatment costs they would cover, and “Oscar would be negatively impacted by an unfavorable prior year Risk Adjustment Data Validation (RADV) result relating to 2019 and 2020 [and] that Oscar was on track to be negatively impacted by significant SEP membership growth”. The lack of forward-looking disclosure at an IPO is a violation of the Securities Act. The initial lawsuit has been filed in the US District Court for the Southern District Court of New York by shareholder Lorin Carpenter. Multiple law firms have invited shareholders to join in the suit — example from PR Newswire. Also named in the suit are Oscar Health co-founders CEO Mario Schlosser and Vice Chairman Joshua Kushner, plus several investment banks.

Oscar started the year with a Q1 loss of $0.36 per share versus an estimate of a loss of $0.40, but this is less than half of last year’s loss of $0.98 per share. They are also exiting the Arkansas and Colorado markets in 2023. Healthcare Dive

Cardiologist, master cybercriminal, a new Dr. Mabuse? Accused of the creation, use, and sale of ransomware is one Venezuelan doctor and practicing cardiologist, Moises Luis Zagala Gonzalez, a dual citizen of Venezuela and France. The charges by the Department of Justice (DOJ) in the Eastern District of New York also detail his “extensive support of, and profit sharing arrangements with, the cybercriminals who used his ransomware programs.” SaaS can’t hold a candle to the RaaS–ransomware-as-a-service–operation he created to sell what he dubbed ‘Thanos,’ allegedly named after a fictional cartoon villain responsible for destroying half of all life in the universe. Turns out that Iranian state-sponsored hackers and fellow ransomware designers really liked it too. If convicted, he faces 10 years in Club Fed–five years for attempted computer intrusion, and five years for conspiracy to commit computer intrusions. Designing criminal software really does test the limits of moonlighting. DOJ release, TechCrunch

Change Healthcare sues former employee at competitor Olive AI. While their merger with UnitedHealthcare is tied up in the US District Court in DC [TTA 23 Mar], Change Healthcare is not letting any courtroom grass grow under their feet. They are suing a former employee, Michael Feeney, with violating the non-compete clauses of his employment contract. The suit was filed in Tennessee Chancery Court, its HQ state. Mr. Feeney has countersued in his state of residence, stating that the non-compete violates Massachusetts law. He was VP, strategy and operations at Change handling physician revenue cycle management. At Olive AI, he is currently SVP, provider market operations. Information is a bit scarce on this and the free article this Editor has found reads machine-translated. If you have access to the Nashville Post or Modern Healthcare it’s probably more decipherable.

As to the lawsuit affecting non-competes due to the tight labor market–don’t count on it. It’s a conflict between the state the company is in enforcing non-competes, versus a state which restricts (or negates) them that is the former employee’s state of residence and work. What wins out will be the interesting part and affect many of us in the US.

Cerner EHR implementation with both DOD and VA running into interoperability, other problems: Federal audit

May 18, 2022 | by

DOD, VA Cerner implementations stumbling on their raison d’être–interoperability. Those of us with pre-Covid memories recall that the Department of Defense and the Department of Veterans Affairs had separate and ancient EHRs that didn’t speak well with each other. Going back to the Federal FY 2008 National Defense Authorization Act (NDAA), both DOD and VA had to become interoperable. Thus Cerner became the one-stop-shopping solution for both, after attempting to modernize their warhorse systems (AHLTA and VistA, respectively). DOD went first in 2015 and rolled it out through the Military Health System (MHS). The VA awarded it in 2018 and started to roll it out in 2020. (No one said that the US government works quickly.) This would also include the US Coast Guard, which is under the Department of Homeland Security.

Earlier this month, a joint VA and DOD audit by their respective Inspectors General (IG) found that both departments, plus the FEHRM (Federal Electronic Health Record Modernization) Program Office established by DOD and VA to oversee the process, as well as the joint health information exchange (HIE) established in 2020 by the FEHR, did not ensure interoperability between their systems. Specifically, they did not:

  • Consistently migrate patient healthcare information from the legacy electronic health care systems into Cerner to create a single, complete patient EHR
  • Develop interfaces from all medical devices to Cerner Millennium so that patient healthcare information will automatically upload to the system from those devices
  • Ensure that users were granted access to Cerner Millennium for only the information needed to perform their duties

Most of the audit pointed responsibility at the FEHRM for not taking an active role in the program, instead acting as a facilitator. The IGs recommended a review by DOD and VA of FEHRM’s procedures, develop processes and procedures to ‘comply with its charter’ and the recommendations of the audit, as well as the NDAA.

VA’s problems with the first implementation at Mann-Grandstaff VA Medical Center in Spokane, Washington in late 2020 blew up embarrassingly last year before the Senate Veterans Affairs Committee [TTA 28 July 2021]. GAO further barked at them in a ‘watchdog’ report published in January. It followed VA’s own “mea culpa/go forth and sin no more” reorganization plan in December. Healthcare IT News, Healthcare Dive

Perspectives: Where next for technology-enabled care after 2025?

May 17, 2022 | by | 1 Comment

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Adrian Scaife, Global Product Manager at Tunstall Healthcare Group. Can telecare save the UK more than £14bn over the next 10 years, as FarrPoint projected–or is that an underestimate based on the past? Can we do better than this?

Interested contributors should contact Editor Donna. (We like pictures and graphs too)

FarrPoint recently published a report showing how extending telecare services to more people could save the UK more than £14bn over the next decade. While £14bn is no small sum, it is based on the evidence of hindsight and importantly through current models of reactive service provision.

In a LinkedIn post I boldly suggested that this should be an underestimate of the benefits that Technology-Enabled Care, associated with a wider transformation of care, could deliver over the next decade.

With increasing demand for care and support combined with finite resources for provision, the statutory care system is facing a perfect storm. The cracks have been appearing for some time but have become apparent to a much wider audience during the Covid pandemic. To be blunt, the current model of care provision is unsustainable in the medium term. (And many would argue today!)

By moving to more preventative, personalised, joined up and proactive service models, supported by communities as well as statutory services, the benefits are potentially much bigger across the whole care ecosystem. (The care ecosystem includes health care, social care, housing, the third sector and, the largest group of all, informal family carers.)

Source: Social Care Future  

This new vision is being discussed by many people and organisations across the care ecosystem and has been referenced, in whole or part, in a host of reports over the last couple of years. What is most encouraging is the consensus around the direction of travel.

The real challenge is the transformation of services from purely reactive, one size fits all, to a preventative and person-centred approach across housing, social care, health care, and the third sector, supported by families, friends, and communities, while still retaining a reactive safety net.

There are important questions around the how? Enabling and underpinning these new service models will be technology using data, information, and actionable insight. New technology has already created dramatic changes in many other sectors across the UK. There is a huge demand for a new set of tools that can, for example, flag everything is OK today or when an early intervention may be required. These tools will work on an individual personalised basis and all the way up to the population level. Joining up data and using insight provided by analytics will enable new high value timely personalised interventions and provide improved outcomes for all stakeholders. 

The good news is that there are a huge variety of companies already working on these challenges from start-ups to SME’s, larger companies, and even global players. The real challenge will be around people (e.g., new working practices) and processes (e.g., new models of commissioning), and of course, culture. Part of the new story will be about enabling working across all stakeholder groups and indeed recognising families as equal partners.

Finally, this is not a transformation that will take place overnight or even within a year but a journey that will take five or more years before it reaches any type of maturity. The green shoots already exist if you look for them, they may be a little tender and frost sensitive, but they are growing! It reminds me of the early telecare journey in the late 90s and early 00s when many could not see how it would scale to where we are today!

While £14bn from traditional reactive services would be welcome, the real opportunity for improved outcomes for all stakeholders across the care system is much greater and not just in an economic context. Personally, I am enormously excited to be playing a part in enabling those tender shoots to grow, thrive, and become the norm over the next few years.

Further reading:

News roundup: telehealth claims drop 9% in February; Amwell’s good news, bad news Q1; tech-enabled practice Crossover Health growing; NowRx and Hyundai test semi-self-driving delivery

May 17, 2022 | by

FAIR Health’s February monthly tracker is pointing downward again. After a brief post-holiday rise to 5.4% of claims in January, it dropped to 4.9% in February, a 9% drop. Mental health claims seized the lead again by a country mile at 64.2% of claims. COVID-19 fell off the list of top 5 claim areas, though only 3.4% in January compared to 58.9% for mental health. This month lists categories of specialists delivering telehealth, and social workers topped the list at over 31%, which fits the telemental health picture. 

Amwell’s shaky opening to 2022. It should not come as any surprise to our Readers that Amwell, the Avis to Teladoc’s Hertz, didn’t have a good Q1. Most of their key indicators around total revenue, providers, and visits grew smartly. Unfortunately, their losses did too. Comparisons are to Q1 2021 unless noted:

Revenue grew to $64.2 million [$57.6 million], up 11.5%
Gross margin: 42.8% [38.0%], up 12.6%
Total active providers grew 12% from Q4 to approximately 102,000 [91,000] Total visits also grew 20% from Q4 to 1.8 million [1.5 million]

But there’s no turning the corner on losses this quarter, despite Converge, their unified platform, shifting over telehealth visits as planned, and adding SilverCloud, Conversa, and specialty telehealth with musculoskeletal (MSK) and dermatology programs to the totals.

Net loss was ($70.3) million, compared to ($39.8) million, an increase of 77%
Adjusted EBITDA was ($47.1) million, compared to ($26.4) million, an increase of 78%

Amwell’s projected 2022 is the same–growth mixed with financial losses: revenue between $275 and $285 million, adjusted EBITDA between ($200) million and ($190) million.

Inquiring investors may very well ask when Teladoc and Amwell, now smaller by a factor of just over 9, will ever be profitable. Mr. Market had its say over the past year, from a high of $14.26 in early June 2021, to today’s close of $3.09, an enterprise valuation loss of $11.17 or 78%, just a little better than Teladoc’s 81% in the same period. It will likely be no time soon. But the shares may be an excellent opportunity at a low cost. Yahoo Finance, FierceHealthcare, Becker’s 

Crossover Health, a hybrid virtual/in-person primary care practice group, announced that they would be opening new centers in Seattle, Austin, and another one in New York this year. Their virtual care operates in all states, while their in-person footprint consists of 41 health centers in 11 states which are generally about 5,000 square feet. They have 33 on-site clinics for employers, which are a combination of exclusive to one company and shared, and in total cover 400,000 eligible employees and dependents including for 115,000 Amazon employees and dependents. In addition to corporate clinics, Crossover offers individual membership plans in a concierge, under one roof type model. FierceHealthcare

In another tech area, med delivery company NowRx is partnering with Hyundai for a limited test of their self-driving cars in the LA area. Hyundai will be using slightly modified Hyundai Ioniq 5 electric vehicles with some autonomous capability, but using a driver. The purpose of the test is to simulate and gather data on autonomous vehicle delivery, such as delivery statistics, dispatch and customer interactions, and feedback. NowRx offers free same-day prescription delivery in the San Francisco Bay area, Orange County, and Los Angeles areas. FierceHealthcare

Alertacall receives Queen’s Award For Enterprise: Innovation

May 12, 2022 | by

One of the items that whizzed by this Editor while she was in Pepper the Robot mode was the highly prestigious Queen’s Award For Enterprise: Innovation, awarded to one of the pioneering companies in UK telecare, Alertacall Ltd.  Their CEO and founder, James Batchelor, is an old friend of TTA from early days with Editor Emeritus Steve. (Editor Donna hadn’t even thought of marketing health tech at that time.)

Alertacall provides tablet touchscreen connectivity to the housing, care markets, and personal markets, from OKEachDay checkins to smart home systems controlled by the touchscreen.

Alertacall was founded in 2004 by James, the original inventor of the “I am okay” button. Like many of us in those days, he had a personal inspiration for being engaged with creating a better way to support older adults in their home–Eveline, his own staunchly independent grandmother. She was, in James’ words “a shop keeper for much of her life, and a B+B operator up until her early eighties. After the death of 2 husbands – the first of whom was detained as a Prisoner of War in WW2, she learned to drive in her late 50s, travelled the world on her own and was an inspiration to many with her grit and determination to live on her own, and under her own terms for as long as possible.”

Also, James’ gracious note from LinkedIn, posting on the Queen’s Award:

We won this Queen’s Award because of the great technology we have created for sheltered and supported housing to help independent older people, women fleeing domestic violence and people who are disabled – to feel safe, connected and informed.

This award really is testimony to that innovation, but more so to the incredible team I have the joy of working with each day. This is an award for them and their phenomenal care of our customers.

In July I’ll be attending a winners reception at Buckingham Palace with HRH The Prince Of Wales – on behalf of those team members. My grandma, Eveline, who was the inspiration for Alertacall would have been pretty excited by that I think.

A lot of you run your own businesses, and some of you might have started those from scratch. So you’ll understand that external, independent validation is rare, and a great feeling when it comes.

Many of you have also been a positive part of our journey – and if so thank you, sincerely.

Dame Esther Rantzen DBE, the well-known British journalist and TV presenter of That’s Life! on the BBC for 21 years, who was instrumental in the founding and popularization of both ChildLine and The Silver Line helplines, is a supporter of Alertacall. Her statement is attached here.

Our warmest congratulations to James and the Alertacall team!

Alertacall announcement.

CMS telehealth pandemic waivers boosted usage among disadvantaged, urban patients

May 11, 2022 | by

Broadening telehealth usage areas when in-person visits are restricted boosts–telehealth usage. Beyond the tautology, the surprising finding here is that it benefited two groups that telehealth hasn’t done well with prior to the pandemic: those living in the most disadvantaged neighborhoods and in metropolitan areas. It also increased usage among women and those of Asian and Hispanic heritage.

The Johns Hopkins study, published in Health Affairs (abstract only, restricted access), reviewed 30 million Medicare fee-for-service claims to quantify outpatient telemedicine use before and after the Medicare telemedicine coverage waiver that took effect on 6 March 2020. Prior to the waiver, Medicare beneficiaries were covered very narrowly for telehealth, in designated rural areas and specific designated facilities, using synchronous audio/video only–a total of 0.42% with one outpatient visit. After the waiver, this grew to 9.97% of patients with at least one outpatient telemedicine visit. Medicare had previously reported that Medicare beneficiary telehealth usage had grown to over 40% during the pandemic.

According to the study abstract, “After adjustment [for demographic variables], our data suggest that the coverage waiver increased access to telemedicine for all Medicare populations, including people residing in the most disadvantaged neighborhoods, although the odds of use were persistently lower with increasing age.” Other studies had found disparities based on demographics such as race, income, and residential location, with higher status pointing to greater telehealth usage, but this study indicates that the loosening of restrictions did not contribute further to these disparities. Thus the logic points to more availability (access) powering increased usage, or at least the odds of use, in this disadvantaged/minority population. 

It is certainly an argument for retaining most of the telehealth waivers–which will require Federal legislation for Medicare after the 90-day Public Health Emergency renewal expires in mid-July, if not renewed. Healthcare Finance, FierceHealthcare

DOJ investigates telemental Cerebral on over-prescribing of controlled medications

May 10, 2022 | by

DOJ dropped an anvil on Cerebral’s head Friday night. Last week’s reports on the Drug Enforcement Agency (DEA) investigation of telemental health provider Cerebral were confirmed on Friday with the official notification that the US Attorney’s Office for the Eastern District of New York had subpoenaed the company as part of their investigation into possible violations of the Controlled Substances Act. According to the Wall Street Journal, the subpoena was issued to Cerebral Medical Group, the corporation it uses to contract with clinicians and provide healthcare services. The company is fully cooperating with the investigation by the Department of Justice, which includes turning over records pertaining to their prescribing of controlled substances such as Adderall and Xanax. This has been reported by FierceHealthcare which is citing (paywalled) Insider.

Last week, Cerebral announced that it would stop prescribing controlled substance prescriptions for new ADHD patients as of 9 May. However, they would continue prescribing controlled substances for other mental health conditions, according to a memo from their chief medical officer to their clinician network.

Cerebral’s Saturday statement in response to the subpoena maintains (from FierceHealthcare):

“To be clear, at this time, no regulatory or law enforcement authority has accused Cerebral of violating any law”

and

“Cerebral has dedicated significant time, energy, and resources to ensuring that its policies and procedures regarding the prescription of controlled substances and other medications both are medically appropriate and comply with all applicable state and federal law,” the statement also said. “As a responsible company, Cerebral is continuously improving its systems and practices. The foundation of this company is built on evidence-based, ethical, and compliant practices so that our patients can receive the highest quality of care and achieve the best clinical outcomes.”

The company has done well with the increased demand for mental health services provided via telehealth including remote evaluating and prescribing. In December, their $300 million Series C raise boosted their valuation past $4.8 billion.

Darkening this rosy picture is, as TTA noted last week, that a former VP of product and engineering, Matthew Truebe, has sued Cerebral for wrongful dismissal. According to him, the company put growth before patient safety, including overprescribing medications for ADHD. Other reports indicate that the DEA interviewed other former Cerebral nurse practitioners who felt pressured to prescribe ADHD medication after a short video call. The Verge

Cerebral has also gained notoriety for dodgy advertising claims pertaining to ADHD and other conditions. In January, advertising on TikTok and Instagram was pulled for claims that obesity is “five times more prevalent” among adults with ADHD, and stated that getting treatment for the mental health disorder could help patients “stop overeating.” These followed inquiries by Forbes and NBC News. Also pulled was their Facebook advertising around prescribing Type 2 diabetes medications, GLP-1 agonists, as a “wonder drug” for weight loss. 

Will this put a damper on the burgeoning area of telemental health and remote prescribing? Stay tuned. Also Becker’s. 

Weekend news and deals roundup: Allscripts closes sale of hospital EHRs, closing out CEO; DEA scrutiny of Cerebral’s ADHD telehealth prescribing; more telehealth fraud; Noom lays off; fundings; and why healthcare AI is only ML

May 6, 2022 | by

That was fast. Allscripts closed its $700 million March sale of its hospital and large physician practice EHRs to Constellation Software Inc. through N. Harris Group. The Allscripts EHRs in the transaction are Sunrise, Paragon, Allscripts TouchWorks, Allscripts Opal, and dbMotion. They reported their Q1 results today. According to HISTalk earlier this week, CEO Paul Black will be stepping down, with President Rick Poulton stepping in immediately. Update–this was confirmed on their investor call Thursday and the transition is effective immediately. No reasons given, but there were no effusive farewells.  Healthcare Dive

A damper on telemental health? Online mental health provider Cerebral, which provides talk therapy, audio/video telehealth, and prescriptions for anxiety, depression, insomnia, ADHD, and other conditions, is finding itself under scrutiny. This week, its main mail fulfillment pharmacy partner, Truepill, stopped filling prescriptions for Adderall, Ritalin, Vyvanse, and other controlled Schedule 2 pharmaceuticals. Cerebral is redirecting current patients with these prescriptions to local pharmacies and as of 9 May, will not prescribe them to new ADHD patients.

Based on reports, the Drug Enforcement Agency (DEA) is looking at Cerebral in particular as part of a wider scrutiny of telehealth providers and pharmacies filling telehealth-generated prescriptions due to allegations of overprescribing. It also didn’t help that a former VP of product and engineering plus whistleblower claims in a wrongful dismissal lawsuit that Cerebral execs wanted to prescribe ADHD drugs to 100% of diagnosed patients as a retention strategy. Bloomberg Law. Unfortunately, Insider is paywalled but you may be able to see a report in the Wall Street Journal. Becker’s Hospital Review, FierceHealthcare

Also troubling telehealth is recurrent fraud, waste, and abuse cases involving Medicare and Medicaid. Back in 2020 the National Healthcare Fraud Takedown took down over 80 defendants in telemedicine fraud [TTA 2 Oct 20, 30 Jan 21]. The Eastern District of NY based in Brooklyn has indicted another physician, an orthopedic surgeon, in a $10 million fraud involving durable medical equipment (DME). In exchange for kickbacks from several telemedicine companies, he allegedly prescribed without examination and with only a cursory telephone conversation DME such as orthotic braces. DOJ release

Some fundings and a sale of note–and a big layoff at a well-known digital health leader:

  • Blue Spark Technologies, an RPM company with a patented Class II real-time, disposable, continuous monitoring body temperature patch good for 72 hours, TempTraq, raised a $40 million intellectual property-based debt solution (??) to fund growth led by GT Investment Partners (“Ghost Tree Partners”) with support from Aon plc (NYSE: AON)  Release
  • Specialty EHR Netsmart acquired TheraOffice, a practice management platform for physical therapy and rehabilitation practices which will be added to its existing CareFabric platform. Neither terms nor management transitions were disclosed in the release.
  • ‘White label’ telehealth/virtual health provider Bluestream Health is implementing its systems in Mankato Clinic, with 13 facilities across southern Minnesota. It’s a rarity–physician-owned and led–and in business since 1916. This also fits into a new telehealth trend–providers working with ‘white label’ telehealth companies and not with the Big 5. Release
  • Ubiquitously advertised (in US) weight-loss app Noom is laying off a substantial number of employees–180 coaches plus 315 more employees. Reportedly they are pivoting away from on-demand text chat to scheduled sessions that don’t require so many people. While profitable in 2020 ($400 million) and with Series F funding of over $500 million in 2021, it’s come under criticism that while its pitch heavily features easy behavioral change achieved through cognitive behavioral therapy (CBT), their real core of weight loss is severe calorie restriction. Engadget
  • Element5, an administrative software provider for post-acute facilities, raised a $30 million Series B from Insight Partners. They claim that their software is AI and RPA (robotic process automation) based. Release, Mobihealthnews

And speaking of the AI pitch in healthcare, a VC named Aike Ho explains why she doesn’t invest in healthcare AI companies because there’s no such thing in healthcare–it’s just machine learning. On that, Ms. Ho and your Editor agree. She also makes the point that the market they address is ancillary and not core services, plus they have difficulty clinching the sale because they don’t relate well to achieving or can’t prove at this stage improved clinical outcomes. Ms. Ho’s looooong series of Tweets is succinctly summarized over at HISTalk (scroll down halfway).

ATA conference roundup: a new board chair, a digital app review pilot, and company announcements

May 5, 2022 | by

The American Telemedicine Association (ATA) 2022 conference and expo is a wrap, after starting on Sunday through to Tuesday. While your Editor could not attend due to other commitments that precluded a trip to Boston, one industry insider who visited the expo–his first in-person event in two years–reported that after a slow start on Sunday, the floor busied up on Monday. Business was being done, finally and not virtually. What were the busy booths and what was ‘hot’? Companies in the areas of telemental health and remote patient monitoring (RPM). (Did you attend? What was your impression? Leave comments below.)

ATA had two major announcements of its own during the conference:

  • Kristi Henderson, DNP, NP-C, FAAN, FAEN, has been named as Chair of the ATA Board for a two-year term. Henderson is the CEO of Optum Everycare, where she leads a team building digital and virtual health solutions to improve quality outcomes and experiences for patients and providers. She has served on the board since December 2020. As Chair, she is succeeding Joseph Kvedar, MD and Professor at Harvard Medical School among other positions. Dr. Kvedar will become Immediate Past Chair and Senior Advisor to the ATA. Announcement
  • ATA, the American College of Physicians (ACP), and ORCHA, the Organization for the Review of Care and Health Applications,  announced a framework for the assessment of professional and consumer digital health technologies, including mobile apps and web-based tools. ACP and ORCHA, which has experience assessing compiling libraries of apps, will be piloting a test of the framework against a database of digital health tools. The goal of the pilot is to “determine how the library can be useful to physicians in recommending high-value digital health tools to their patients, and what other barriers to wider adoption of digital health tools may exist.” Announcement

Quite a few company announcements were made during ATA–a selection:

  • Johns Hopkins Bloomberg School of Public Health highlighted the publication of a major scientific study (full text) documenting telehealth outcomes in JAMA Network Open. This Johns Hopkins-based research was partially supported by the ATA. The study followed a national cohort of 40.7 million commercially insured persons from July to December 2021 and included 21 chronic and non-chronic conditions. Fourteen-day follow-ups for persons with an initial telehealth visit were compared to persons receiving in-person care. On average, patients participating in an initial telehealth consult for a new health condition did not require more unplanned hospitalizations or follow-up ED visits within 14 days of their initial consult compared with patients making an initial in-person visit. The exception was respiratory conditions. Release
  • BioIntelliSense, which last year scored $45 million in funding for its on-body sensors, announced two major collaborations for remote patient monitoring (RPM) with UC Davis Health and Houston Methodist.
  • CDW Healthcare and Caregility announced a strategic partnership to expand their virtual care capabilities, including Caregility’s new Inpatient Virtual Engagement solution (IVE), also launched during ATA. 
  • Connect America, which snapped up Lifeline last year, launched Connect America Home, a single health and safety platform connecting (PERS) and remote patient monitoring (RPM) with supporting services, including AI-enabled virtual health assistance and Social Determinants of Health (SDoH) support, along with analytics. Release.
  • AliveCor announced the launch of KardiaComplete, a comprehensive heart health enterprise solution designed to drive improved health outcomes and reduce the cost of cardiac care. The service will be available through self-insured employers, health insurance plans, and health systems to those diagnosed with hypertension and arrhythmias, like atrial fibrillation.
  • Withings launched Withings RPM, the company’s most advanced remote patient monitoring solution designed to enhance the patient experience. It is a single platform that enables clinicians to order and send Withings RPM devices, manage data from multiple patients with automated alerts and reminders, communicate via SMS, phone, and in-app video calls, billing, sleep tracking, and more. 

TTA was a media partner of ATA 2022.

Some thoughts on Teladoc and the Week That Was in telehealth

May 4, 2022 | by

Yes, your Editor has, for the past few weeks, felt like Pepper the Robot, moving at two speeds–crazed and off. (‘Off ‘ to the left. Now cart me off.) Home renovations, with strangers tramping through your abode, noise, dust, and the corresponding moving of furniture, packing and unpacking, pre- and post-cleaning, then trying to put things right and get your life back will do that. Add to that an unexpected gushy kitchen sink that took three ‘fixes’ to get actually fixed. Then there were technical problems with our email sender that Editor and Administrator Emeritus Steve had to work through. One becomes more appreciative of order, routine, and Peace and Quiet.

Speaking of Peace and Quiet, there is little to be found in telehealth. Instead, there is a lot of Feeling Off. The Big News of late last week, of course, was Teladoc’s troubles. In the words of Seeking Alpha, they had one horrific quarter. The horror show started with writing off the Livongo acquisition– a noncash goodwill impairment charge of $6.6 billion, for a massive loss of $41.11 per share for a total of $41.58 per share. To compare, last year’s Q1 loss was $1.31 per share. While revenues were up almost to projection (25%), it was still a $3 million miss and in context, it was the cherry on a very nasty sundae. After rosy projections last year, Teladoc lowered their 2022 revenue guidance from $2.6 billion to $2.45 billion.  

Moving forward from the questionable Livongo acquisition at the absolute peak of the market, CEO Jason Gorevic admitted some hard truths to investors that deepened the hole: much more competition, particularly in telemental health; the rising cost of paid search advertising and the keywords driving towards direct-to-consumer telehealth driving up the cost of acquisition; and difficulty closing B2B deals. This creates, in the terms of analyst SVB Leerink’s Stephanie Davis quoted in FierceHealthIT, “a direct-to-consumer air pocket that business-to-business sales (and their inherently longer cycles) are too slow to fill” at least, in her view, until the end of the year.

Teladoc’s difficulties, as this Editor has noted, started after a peak in early 2021 as the pandemic started its protracted wind-down and telehealth volumes plunged to well below 5% of claims as practices reopened. The stock value is down over 90% from last February, not helped by a volatile market triggered by war and inflation. Similar difficulties are plaguing Amwell (down 92% since February 2021), Talkspace (down to a paltry 16 cents and in court for misleading investors), SOC Telemed (taken private at a 70% drop in value, TTA 8 Feb), and other health tech companies. For our Readers, this is no surprise: the telehealth bender is ovah.

One industry leader in a post-ATA conversation with this Editor cited a less obvious factor–that hospitals and other health providers are now putting together their own telehealth/triage packages tied into population health and case management software, with and without ‘white label’ providers such as Bluestream Health and Zipnosis (acquired by insurtech/payvider Bright Health a year ago). Teladoc is a late entry to this provider/payer market with Primary360, where they also compete with Babylon Health [TTA 7 Oct 22]. And health retailers have joined the primary care telehealth game. Walmart last week announced a virtual health diabetes care program for employers through their recently acquired MeMD.

Big Telehealth’s troubles may depress investment in related earlier stage companies–or help those in niches such as telemental and population health, or remote patient monitoring (RPM) systems that have telehealth features (e.g. TytoCare), as VC investment seeks a brighter home. Right now, this Editor’s Magic 8 Ball is saying ‘outlook, cloudy”.