Week-end roundup of not-good news: Teladoc’s Q2 $3B net loss, shares down 24%; Humana, Centene, Molina reorg and downscale; layoffs at Included Health, Capsule, Noom, Kry/Livi, Babylon Health, more (updated)

July 30, 2022 | by

Teladoc continues to be buffeted by wake turbulence from the Livongo acquisition. The company took a $3 billion goodwill impairment charge in Q2, adding to the $6.3 billion impairment charge in Q1. The total impairment of $9.3 billion was the bulk of the first half loss of nearly $10 billion. While their revenue of $592.4 million exceeded analyst projections of $588 million, adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) of $46.7 million were barely up from projections and were down from $66.8 million year prior. Losses per share mounted to $19.22, versus $0.86 in Q2 2021.

Another weak spot is their online therapy service, BetterHelp, which in the US is pursuing a substantial TV campaign. CEO Jason Gorevic in the earnings release pointed out competitors buying the business at low margins and consumer spending pullbacks. Teladoc’s forward projections are bolstered by Primary360 and Chronic Care Complete. Projected revenue for Q3 is $600 million to $620 million. Shares on Thursday took a 24% hit, adding to the over 50% YTD drop misery. At best, Teladoc will muddle through the remainder of the year, if they are lucky. MarketWatch, Mobihealthnews, FierceHealthcare

Health plans are also presenting a mixed picture. 

  • Humana announced a healthy earnings picture for the quarter and YTD. It earned $696 million in profit for Q2, up nearly 20% year over year. For first half, Humana earned $1.6 billion, an increase of 14.8% from 2021’s $1.4 billion. Cited were growth in their primary care clinics, Medicaid membership, and investment in Medicare Advantage. Earnings surpassed Wall Street projections and Humana increased its guidance to $24.75 in earnings per share. At the same time, they announced a reorganization of its operating units that separates their insurance services (retail health plans and related) and CenterWell for healthcare services including home health. Some key executives will be departing, including the current head of retail health plans who will stay until early 2023, ending a 30 year Humana career. FierceHealthcare, Healthcare Dive
  • Under new leadership, Centene posted a Q2 loss of $172 million which in reality was a significant improvement over Q2 2021’s $535 million and looked on favorably by analysts.
    • Their ‘value creation plan’ has sold off its two specialty pharmacy operations to multiple investors, using third-party vendors in future, and agreed this week to sell its international holdings in Spain and Central Europe — Ribera Salud, Torrejón Salud, and Pro Diagnostics Group — to Vivalto Santé, France’s third-largest private hospital company.
    • Medicaid, their largest business line, has been growing by 7%.
    • Centene is continuing to divest much of its considerable owned and leased real estate holdings, which marks a radical change from the former and now late CEO’s* ‘edifice complex’ to house his ‘cubie culture’. As a result, it is taking a $1.45 billion impairment charge.  Healthcare Dive. [* Michael Neidorff passed away on 7 April, after 25 years as CEO, a record which undoubtedly will never be matched at a health plan.)
    • A cloud in this picture: Centene’s important Medicare Advantage CMS Star quality ratings for 2023 will be “disappointing” which was attributed to the WellCare acquisition (accounting for most of the MA plans), two different operating models between the companies, and the sudden transition to a remote workforce. For plans, WellCare operated on a centralized model, Centene on a decentralized one, and the new management now seems to prefer the former. (Disclosure: your Editor worked over two years for WellCare in marketing, but not in MA.) Healthcare Dive
  • One of the few ‘pure’ health plans without a services division, Molina Healthcare, is also going the real estate divestment route and going full virtual for its workforce. Their real estate holdings will be scaled down by about two-thirds for both owned and leased buildings. Molina does business in 19 states and owns or leases space across the US. Net income for the second quarter increased 34% to $248 million on higher revenue of $8 billion. Healthcare Dive

Many of last year’s fast-growing health tech companies are scaling back in the past two months as fast as they grew in last year’s hothouse–and sharing the trajectory of other tech companies as well as telehealth as VCs, PEs, and shareholders are saying ‘where’s the money?’. 

  • Included Health, the virtual health company created from the merger of Grand Rounds and Doctor on Demand plus the later acquisition of care concierge Included Health, rebranding under that name, has cut staff by 6%. The two main companies continued to operate separately as their markets and accounts were very different: Grand Rounds for second opinion services for employees, and Doctor on Demand for about 3 million telehealth consults in first half 2020. As Readers know, the entire telehealth area is now settling down to a steady but not inflated level–and competition is incredibly fierce. FierceHealthcare
  • Unicorns backed by big sports figures aren’t immune either. Whoop, a Boston-based wearable fitness tech startup with a valuation of $3.6 billion, is laying off 15% of its staff. (Link above)
  • Digital pharmacy/telemedicine Capsule is releasing 13% of its over 900 member staff, putting a distinct damper on the already depressed NYC Silicon Alley.  FierceHealthcare also notes layoffs at weight loss program Calibrate (24%), the $7 billion valued Ro for telehealth for everything from hair loss to fertility (18%), Cedar in healthcare payments (24%), and constantly advertising Noom weight loss (495 people). Updated: Calibrate’s 150-person layoff was reported as particularly brutally handled with employees. Many were newly hired the previous week, given 30 minutes notice of a two-minute webinar notice, then their laptops were wiped. Given that the company makes much of its empathy in weight loss, facilitating prescription of GLP-1 along with virtual coaching, for a hefty price of course. HISTalk 8/3/22
  • Buried in their list are layoffs at Stockholm-based Kry, better known as Livi in the UK, US, and France, with 100 employees (10%).
  • Layoffs.fyi, a tracker, also lists Babylon Health as this month planning redundancies of 100 people of its current 2,500 in their bid to save $100 million in Q3. Bloomberg

Weekend investment/divestment roundup: 3M to spin off Health Care, Cleerly’s $223M Heartbeat, Elation’s $50M Series D, Health Note’s $17M Series A, Galen bought by RLDatix

July 30, 2022 | by

3M to spin off its Health Care operation by the end of 2023. According to their release, the Health Care spinoff will be focused on patient care as a diversified healthcare technology leader in wound care, oral care, healthcare IT, and biopharma filtration. The larger part of the present 3M, called a New 3M in the release, will concentrate on global material science and technology innovation, with manufacturing, global capabilities, and “iconic brands”. Currently (FY 2021) what will be New 3M will be far larger, with $26.8 billion in sales. Health Care currently has about $8.61 billion in sales. New 3M will retain a 19.9% stake in Health Care. Somehow, 3M has engineered it to be tax-free for US federal income tax purposes. How this will affect current shareholdings is not disclosed–yet.

Despite the wet blanket of a developing recession, there are smaller health tech companies scoring decent funding rounds and buying each other.

Cleerly Health, which has developed an AI-based cardiac diagnostic tool for coronary artery disease, has scored an exceptionally healthy and oversubscribed $223 million (from $192 million) Series C. Lead investors are Fidelity Management and Research Company and T. Rowe Price, returning investors Vensana Capital, LRVHealth, New Leaf Ventures, Cigna Ventures, and DigiTx Partners, plus seven others. Cleerly uses machine learning to evaluate coronary computed tomography (CT) angiograms, allowing physicians to more easily identify, characterize and qualify atherosclerosis (plaque) buildup in the walls of the heart arteries to more accurately predict the risk of heart attack. Release, Mobihealthnews

Primary care-focused EHR Elation Health doubles current funding with a $50 million Series D. Total funding is now $108 million. In the still-crowded EHR field, Elation focuses on independent primary care practices and claims a base of 20,000 practices. In 2021, the company was invited to work with the American Academy of Family Physicians (AAFP) on technology to ease the administrative burden on physicians. The funding round was led by Generation Investment Management and Ascension Ventures, joined by Threshold Ventures, Ascend Partners, and individual investors including Fay Rotenberg and Jonathan Bush. Elation release, Mobihealthnews

Health Note closed a $17 million Series A. SignalFire led the round with participation from UnityPoint Health, Northwell Holdings (Northwell Health), and Cedars Sinai Health Ventures. Health Note is a pre-clinical visit automated intake platform that prepares clinical notes for providers ahead of patient visits. Current seed funding was about $6 million. The funding will go towards market expansion, expanded EHR integration, and further R&D. Release, Mobihealthnews, SoCalTech, MedCityNews 

And to close with a specialized acquisition in the IT and data governance areas, Galen Healthcare Solutions has been acquired by RLDatix. Terms and management transitions were not disclosed. RLDatix specializes in governance, risk, compliance (GRC) and workforce management technology for healthcare organizations. Galen adds health IT expertise in data migration and archival solutions. Release This is on top of RLDatix’s acquisition of UK-based Quality Compliance Systems (QCS) in May.

Oracle’s ‘new sheriff’ moving to fix Cerner EHR implementation in the VA: the Senate hearing

July 28, 2022 | by

Last week’s (20 July) hearing on the VA’s increasingly wobbly EHR transition from VistA to Cerner showcased Oracle’s executive vice president for industries Mike Sicilia. His testimony to the Senate Committee on Veterans’ Affairs had a heaping helping of ‘the new sheriff has arrived in Dodge City’.  As of six weeks ago, after the Transformational Big Vision kvelling faded, Cerner’s painful stumbles became Oracle’s VA Migraine [TTA 21 July, 21 June]. Cerner is now part of the Oracle Global Health business unit that falls under him.

First, the pledge made in his statement: “Unlike Cerner alone, Oracle brings an order of magnitude more engineering resources and scale to this formidable challenge.” After outlining the work that Oracle has done for CDC and NIH on Covid-19, he testified:

You should consider that in effect the VA, the Department of Defense (DoD) and the Coast Guard obtained a new, vastly more resourced technology partner overnight to augment Cerner. We also strongly believe in this mission and consider it not only a contractual obligation but a moral one to improve healthcare for our nation’s veterans and their caregivers. We intend to exceed expectations. 

Of the list of 36 issues detailed by the committee to VA Deputy Secretary Remy, Sicilia condensed them into three main areas: performance, design, and functionality. The concrete moves are:

  • Oracle will move the implementation to the cloud and rewrite Cerner’s pharmacy module, completing both tasks within 6-9 months
  • They have set up a ‘war room’ consisting of Oracle’s top talent of senior engineers and developers, working on the entire DoD/VA EHR systems as priority #1, with the first order of work a top-to-bottom analysis. While integrating with the Cerner team, the statement makes it clear that Oracle “brings an order of magnitude larger engineering team than Cerner”.
  • The Cerner EHR system is currently running on a dated architecture with technology that is in some cases two decades old and thus will be moved within 6-9 months to Oracle’s Generation 2 cloud. (That must be reassuring to thousands of hospitals and practices!)
  • Shortly after the closing, Oracle fixed a database bug that caused 13 of the last 15 outages, and as of last week there were no further outages. 
  • Testifying on the status of the “unknown queue”,  he stated it was designed to account for human error rather than to mitigate it, so it will be redesigned–it will be automated more on the front end and on the back end will have a better process.
  • Oracle will “start over” with the Cerner pharmacy module, rebuilding it as a showcase of a cloud-optimized web application.

VA’s EHR leaders also testified at the Senate hearing. Terry Adirim, Executive Director of the Electronic Health Record Modernization Integration Office at the VA, confirmed that unsurprisingly, Cerner’s next rollouts scheduled for the Boise VA Medical Center and other centers have been postponed indefinitely due to multiple ongoing system stability issues: change control and testing; challenges with increased capacity; basic functionality; its resilience design, and its response in last resort disaster situations. These specific issues overlapped but were more specific than those covered in Sicilia’s statement, which focused on the actions that Oracle would take.

Adirim and Kurt DelBene, the VA’s CIO, were roasted by the senators as painting a “very rosy picture”. The OIG report itemized at least 60 recommendations before going further. Adirim, to his credit, noted that DoD had similar stability issues in its system which was a warning, but the VA’s system is far more complex and care oriented than DoD which presumably exacerbated those issues. FedScoop and especially HISTalk’s Monday Morning Update 7/25/22

Amazon moves to acquire One Medical provider network for $3.9B (updated)

July 27, 2022 | by | 1 Comment

Amazon joining the in-person provider network space for real. Amazon Health Services last week moved beyond experimenting with in-person care via provider agreements (Crossover Health, TTA 17 May) to being in the provider business with an agreement to acquire One Medical. Earlier this month, news leaked that One Medical as 1Life Healthcare was up for sale to the right buyer, having spurned CVS, and after watching their stock on Nasdaq plummet 75%.

  • The cash deal for $3.9 billion including assumption of debt is certainly a good one, representing $18 per share, a premium to their $14 share IPO in January 2020. (The stock closed last Wednesday before the announcement at just above $10 per share then plumped to ~$17 where it remains.)
  • The announcement is oddly not on One Medical’s website but is on Amazon’s here.
  • The buy is subject to shareholder and the usual regulatory approvals. The IPO was managed by JP Morgan Securities and Morgan Stanley. It is primarily backed by Alphabet (Google).
  • One Medical’s CEO Amir Dan Rubin will stay on, but there is no other executive transition mention.
  • Also not mentioned: the Iora Health operation that serves primarily Medicare patients in full-risk value-based care models such as Medicare Advantage (MA) and Medicare shared savings, quite opposite to One Medical’s membership-based concierge model. However, Iora’s website is largely cut over to One Medical’s identity and their coverage is limited to seven states.

There is a huge amount of opinion on the buy, but for this Editor it is clear that Amazon with One Medical is buying itself into in-person and virtual primary care for the employer market, where it had limited success with its present largely virtual offering, and entree with commercial plans and MA. One Medical has over 700,000 patients, 8,000 company clients and has 125 physical offices in 12 major US markets including NYC, Los Angeles, Boston, and Atlanta. It has never turned a profit. Looking at their website, they welcome primarily commercial plans and MA (but not Medicare supplement plans).

Amazon, with both a virtual plus provider network, now has a huge advantage over Teladoc and Amwell, both of which have previously brushed off Amazon as a threat to their business. There is the potential to run two models: the current Amazon Care pay-as-you-go model and the One Medical corporate/concierge model. This puts Amazon squarely in UHC’s Optum Health territory, which owns or has agreements with over 5% of US primary care practices, is fully in value-based care models such as Medicare shared savings through its ACOs, and is aggressively virtual plus integrating services such as data analytics, pharmacy, and financial. Becker’s

What doesn’t quite fit is Iora Health and the higher cost/higher care needs Medicare market that is less profitable and requires advanced risk management, a skill set that Amazon doesn’t have. This Editor will make a small prediction that Iora will be sold or spun off after the sale.

This Editor continues to believe that the real game for Amazon is monetizing patient data. That has gained traction since we opined that was the real Amazon Game in June and October last year, To restate it: Amazon Care’s structure, offerings, cheap pricing, feeds 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. This opinion is now shared by those with bigger voices, such as the American Economic Liberties Project. In their statement, they urged that the government block the buy due to Amazon’s cavalier attitudes towards customer data and far too much internal access, unsecured, to customer information (Revealnews.org from Wired). Adding PHI to this is like putting gasoline on a raging fire, and One Medical customers are apparently concerned. For what it’s worth, Senator Bernie Sanders has already tweeted against it.   MarketWatch

Whether this current administration and the DOJ will actually care about PHI and patient privacy is anyone’s guess, but TTA has noted that Amazon months ago beefed up its DC lobbying presence last year. According to Opensecrets.org, they spent $19.3 million last year. In fairness, Amazon is a leading Federal service provider, via Amazon Web Services. (Did you know that AWS stores the CIA’s information?)  One Medical is also relatively small–not a Village MD/Village Medical, now majority owned by Walgreens Boots. This is why this Editor believes that HHS, DOJ, and FTC will give it a pass, unlike UHG’s acquisition of Change Healthcare, especially if Amazon agrees to divest itself of the Iora Health business.

Treat yourself to the speculation, including that it will be added as an Amazon Prime benefit to the 44% of Americans who actually spend for an Amazon Prime membership. It may very well change part of the delivery model for primary care, and force other traditional providers to provide more integrated care, which is as old as Kaiser and Geisinger. It may demolish telehealth providers like Teladoc and Amwell. But as we’ve also noted, Amazon, like founder Jeff Bezos, deflects and veils its intents very well. FierceHealthcare 7/25, FierceHealthcare 7/21, Motley Fool, Healthcare Dive

Week-end news roundup: Fold Health launches OS ‘stack’; admin task automator Olive cuts 450 workers; 38% of UK data breaches from cyber, internal attacks; hacking 80% of US healthcare breaches; does AI threaten cybersecurity?

July 21, 2022 | by

Startup Fold Health launched this week. It’s developed a suite of modular tools that are interoperable with existing EHRs or platforms to enable them to work better, together. Fold’s main claim is to “move primary care beyond the constraints of a 15-minute visit and provide a revolutionary consumer first experience through micro, automated workflows and campaigns of care.” There is an athenahealth connection, in that the founders were from Praxify, a virtual assistant/patient engagement app bought by athenahealth for $65 million in 2017. It has a $6 million seed investment from athenahealth. FierceHealthcare

On the other side of the funding mountain,  Olive, an AI-enabled data cruncher that automates routine administrative healthcare processes such as revenue cycle management, has pink-slipped 450 employees, about one-third of its staff. In a letter to employees excerpted in Axios, Olive cites ‘missteps’ and ‘lack of focus’. It follows hiring freezes, major staff departures, and overpromising/underdelivering, including not using AI or machine learning for automating tasks, featured in an April Axios investigation. Olive has gone through over $850 million in nine rounds of funding (the last July 2021, Series H–Crunchbase). FierceHealthcare

Cyber attacks with internal breaches account for 38% of UK organizations’ (of all types) data losses in 2022. This is based on the Data Health Check survey of 400 IT decision makers compiled by Data Barracks, a cloud-based business continuity organization. The second and third reasons for data loss are human error and hardware failure. Of those surveyed, over half have experienced a cyber attack, most commonly caused by ransomware. 44% paid the ransom, 34% didn’t and used backups. Their recommendations include frequent backups and keeping track of how many data versions–both will minimize downtime and data loss. Release, full report

By contrast, returning to the US and healthcare, malicious hacking activity accounts for nearly 80% of all breaches. Fortified Health Security’s mid-year report on the state of healthcare cybersecurity, reviewing HHS Office for Civil Rights (OCR) data,  noted that in first half 2022:

  • Healthcare data breaches primarily originated at providers– 72%. The remainder were at business associates at 16% and health plans at 12%.
  • The number of records affected was 138% higher than the first half of 2020 at over 19 million records
  • Breaches were concentrated in relatively few organizations: Seven entities experienced breaches of more than 490,000 records each, in total 6.2 million records or 31% to date.  
  • OCR’s data breach portal recorded 337 healthcare data breaches that each impacted more than 500 individuals, a small decline from 2021’s 368
  • Hacking incidents rose to 80% from 72% in 2021. Unauthorized access/disclosure incidents totaled 15%; loss, theft, or improper disposal accounted for only 5 percent of breaches.
  • AI and ML-enabled security offerings can bolster cyber infrastructure. Organizations should also look at how IT staff shortages impact their planning and security.    HealthITSecurity

Can AI (and machine learning-ML) lessen breaches–or open the door to worse problems, such as algorithmic bias, plus data privacy and security concerns? Vast quantities of data pumped through AI or ML algorithms are harder to secure. If the algorithms are built incorrectly–such as eliminating or underrepresenting certain populations–what comes out will be skewed and possibly misleading. In the Healthcare Strategies podcast, Linda Malek of healthcare law firm Moses & Singer, who chairs their healthcare, privacy, and cybersecurity practice group, discusses the problems. She suggests some best practices around transparency, security, privacy, and accuracy when developing an AI algorithm, including collecting as much data as possible, and as diverse as possible, for accuracy. Additionally, the design should incorporate privacy and security from the start. HealthcareExecIntelligence

VA’s final, troubling OIG ‘unknown queue’ report on Cerner Millenium rollout; Oracle’s Sicilia to testify before Senate today

July 21, 2022 | by

The Office of the Inspector General (OIG) report on the troubled rollout of Cerner Millenium at the VA continues to reverberate. The final report, revealed last month in draft [TTA 21 June], detailed a flaw in Cerner’s software that caused the system to lose 11,000 orders for specialty care, lab work, and other services – without alerting health care providers that the orders (also known as referrals) had been lost. This was the infamous ‘unknown queue’. The final report identified 149 adverse events related to the lost orders, including a homeless veteran at risk of suicide whose follow up appointment was lost, threatened to kill himself, but fortunately was helped (and hospitalized) outside the VA system. None of these problems surfaced before the go-live at Mann-Grandstaff VA Medical Center, but did four days later–and apparently other end users weren’t informed of the problem until a year later.

In FierceHealthcare’s update published today, “The OIG called it “troubling” that the deputy secretary [Donald Remy] “appears to absolve Oracle Cerner for its failure to inform VA of the unknown queue while placing the blame for outcomes from the unknown queue on VHA end-users.”” and “In a second report (PDF) released last week, the federal watch agency says VA project executives misrepresented its EHR training program” starting with Mann-Grandstaff. Two VA senior staffers responsible for training employees there gave inaccurate data to inspectors.

Cerner Millenium and the VA implementation (and other problems around the DOD implementation) are now Oracle’s headache. Executive Vice President Mike Sicilia was scheduled to testify Wednesday afternoon at a Senate hearing this afternoon to answer the many questions raised about the EHR rollout and safety problems. 

Herts Careline marks 40th Anniversary

July 21, 2022 | by

Some news to applaud. Stephanie Bevan, the marketing and relationships officer for Herts Careline, shared with us that the Careline has just marked 40 years of providing in-home supportive services and technologies to Hertfordshire residents. Starting with the north part of the county four decades ago, Herts Careline now covers the full county, providing 16,000 residents with 24/7 support. From the days of analogue phones and paper records, their services include pendant alarms, fall detectors, door sensors, smoke detectors, and epilepsy monitors. Phones are not forgotten, with a volume of up to 1,500 calls a day handled by 30 operators.

David Coolbear, Strategic Lead for Assistive Technology at Hertfordshire County Council, noted that “The assistive technology that Herts Careline provides plays a vital role in helping residents live safely and independently in their own homes. We’re thrilled to celebrate 40 years of this innovative support service. We are also working closely with Herts Careline to pilot new digitally enabled assistive technology to enable our residents to remain in their own home for longer, provide added reassurance for family carers and support safer hospital discharges. The move to a more digital support offer provides an exciting opportunity to be able to support our residents in a more preventative manner as well as increasing resident choice over their care needs.”

We at TTA congratulate Herts Careline on four decades of keeping older adults independent in their homes. This Editor especially likes their gift to new clients during July and August of a bird food treat, Suet Love Hearts. This attracts birds with needed food and promotes relaxing backyard bird watching (a/k/a The Bird Show). But make sure you keep that bird bath full during this hot weather! Release

Midweek heat wave roundup: GE Healthcare’s new name, hospital-to-home health trending big, over 2 million patient records hacked

July 20, 2022 | by

GE’s breakup into three public companies, announced last November [TTA 12 Nov 21], has been formalized with brand names. No surprise, the healthcare business has but a teeny tiny change to GE HealthCare (logo left) and after the spinoff will be trading sometime in early 2023 under GEHC on Nasdaq because “GE HealthCare will benefit from the exchange’s profile and track record as a market for innovative, technology-led public companies, particularly in the healthcare sector. The heritage ‘meatball’ (as we called it in marketing internally, but formally the Monogram) will be retained but the color will change from poison green to “compassion purple” to reflect more humanity and warmth and achieve greater distinction”. The hardest hit part of GE, the energy businesses, will be spun off as GE Vernova and key color an ‘evergreen’. What is left will be GE Aerospace, retaining its name and change its color to an ‘upper atmosphere’ blue that is almost black. Outer space, anyone? GE release, interview on YouTube

Au courant is hospital-to-home (H2H) and home health, digitally enabled mais bien sûr.

  • Mass General Brigham (MGB) is reportedly expanding its current 25-bed program to 200 in the next 2.5 years. Since 2016, MGB has treated nearly 1,800 H2H patients. By end of 2023, they plan 90 hospital-at-home beds managed across Massachusetts General Hospital, Brigham and Women’s Hospital, Newton-Wellesley Hospital, and Salem Hospital. Their new head for home-based care will be Heather O’Sullivan, who comes from EVP and chief clinical innovation officer spots at Kindred at Home, acquired by Humana in 2021. FierceHealthcare
  • Out in rural Wisconsin, Marshfield Clinic is rolling out a H2H program with DispatchHealth, to coordinate medical care for injuries and illnesses including viral infections, COPD exacerbations, congestive heart failure, and more. The goal is to reduce non-emergency ED visits. DispatchHealth can also perform services such as onsite diagnostics, mobile imaging, and CLIA-certified labs for kidney function, electrolytes, and urinalysis. In March 2021, they closed a $200 million Series D bringing their funding to unicorn level. HealthcareITNews
  • UHG’s Optum has moved closer on its $5.5 billion acquisition of LHC Group home health and hospice [TTA 31 Mar] with shareholder approval on 21 June. Once closed later this year, LHC will be integrated into Optum Health. LHC operates in 37 states and the District of Columbia, employing about 30,000 individuals. Home Health Care News, Becker’s

And what would a week with a heat wave that melts runways at RAF Brize Norton and Luton be without a couple of big data breaches to heat up things? Stolen: an iPad chock full of 75,000 Kaiser Permanente patients’ PHI from Kaiser’s Los Angeles Medical Center’s COVID-19 testing center. While the information on the iPad included first and last names, dates of birth, medical record numbers, and dates and location of service (but not SSN or financial information), Kaiser was able to remotely erase the data. At this point, there is no evidence of theft or misuse. NBC Los Angeles, Becker’s   An even larger breach of 2 million records came via a February hack attack on health provider debt collector Professional Finance Company (PFC). Hackers got into PFC’s computers and accessed patient names, addresses, SSN, health insurance, and medical treatment data. Among the 650 client companies affected were Banner Health and Nevada physician network Renown Health. Healthcare Dive

Cerner’s business now consolidated under Oracle Health

July 19, 2022 | by

The internal memo doesn’t say so but doesn’t really have to. The sunsetting of the Cerner brand (logo left) has begun. HISTalk this evening reported on Friday 15 July’s Cerner internal announcement posted on Reddit, vetted by the Kansas City Business Journal (paywalled), and it’s not all that surprising:

  • The business unit is now called Oracle Health Global Industry Unit (GIU) or Oracle Health
  • The chairman of Oracle Health will be David Feinberg, MD, late CEO of Cerner and previously of UCLA Health, Geisinger Health, and Google’s last effort at Health. 
  • Travis Dalton is being promoted to run the Oracle Health GIU as General Manager from running Cerner Government Services as Client Services Officer
  • Cerner’s engineering and product executives will be reporting to Oracle’s Don Johnson who runs all Oracle engineering for all applications and platform services. This includes former CTO Jerome Labat who received a stay deal along with Dr. Feinberg [TTA 21 Jan, 26 Jan]. Mr. Labat has at least 11 million good reasons (and Dr. Feinberg 22 million) to stay for the next year and a day from the closing on 8 June.
  • Cerner’s corporate functions, such as IT, finance, legal, and HR, will move into Oracle’s centralized, global teams, which typically means that pink slips will be the order of the day if they haven’t already been received
  • More disclosed to employees at a town hall on that Friday 
  • No external announcement has been made as of 1845 19 July (Eastern Time)

Our Readers who have been following the acquisition and personally been through acquisitions know the stage was set by Larry Ellison’s Big Pronouncements on Healthcare Transformation at the closing [TTA 14 June]. It was all about what Oracle would be doing in building a national health record database and more, with nary a mention of Cerner. The eventual elimination of the Cerner name should thus be no surprise to industry observers. Cerner was a pearl bought at a great price ($28 billion) to make Oracle the Visionary Leader In Healthcare and provide Mr. Ellison with a Grand Finale.

How this will be received by health system and provider customers–including DOD and the ever-troublesome VA–is anyone’s guess. This Editor has previously speculated that health systems with Cerner EHRs were not going to be enthusiastic about replacing Cerner’s current third-party vendors with Oracle services and technology, especially if they worked well or if Oracle costs more. If the move to OCI–Oracle Cloud Infrastructure–doesn’t go as smooth as brand new glass, another black mark in the copybook. The other would be resentment of Oracle’s announced and completely expected hard sell on other services to make up the cost of the pearl. [TTA 15 June]

Almost an ideal scenario for Epic to sell against, one would think. As for the VA, Oracle needs to fix the Cerner Millenium rollout now under heavy scrutiny–fast and right.  

Home-based remote monitoring for Covid reduced hospitalizations, hospital length of stay: JAMA study

July 15, 2022 | by

Activation of remote patient monitoring (RPM) in this study is associated with lower hospitalization, intensive care use, and if hospitalized, length of stay. Conducted by Froedtert & Medical College of Wisconsin Health Network with Covid-19 positive ambulatory patients who accepted RPM in the home (N=9,378), the study’s purpose was to evaluate the implementation of a large-scale daily RPM program for patients who were managing symptoms from home. They compared those who activated their RPM (N=5,364, 57%) versus those who did not (N=4,014, 43%). The mean age was 46 and 58% were women.

  • 878 patients  (16.4%) had at least one RPM alert
  • 2.4% (128) of the activated patients were hospitalized, compared to 3.9% (158) of inactivated patients

A weighted regression analysis, adjusted for demographics, comorbidities, and time period, compared RPM-activated to the tracked but inactivated patients:

  • Lower odds of hospitalization (odds ratio, 0.68; 95% CI, 0.54-0.86; P = .001)
  • Greater time between test and hospitalization for RPM-activated patients 6.67 [3.21] days vs 5.24 [3.03] days)
  • Shorter length of stay (4.44 [4.43] days vs 7.14 [8.63] days)
  • Less intensive care use (15 patients [0.3%] vs 44 patients [1.1%])

The study excluded patients younger than 18 years, those with asymptomatic tests (because these were often scheduled before procedures or other planned admissions), patients who were admitted within 24 hours of a positive test, and those who already had internal PCPs to reduce the chance of missing hospitalizations. The RPM provider was GetWellNetwork using the GetWellLoop monitored by a centralized team of Froedtert & Medical College of Wisconsin nurses. Patients used the web or a mobile app to record their symptoms, temperatures, and pulse oximetry readings. Hospitalization Outcomes Among Patients With COVID-19 Undergoing Remote Monitoring (abstract and downloadable PDF)

Weekend reading roundup: Amwell’s Schoenberg opines to Politico; Teladoc’s new CMO also opines, SPACs are done, done, done

July 15, 2022 | by

If Teladoc’s Jason Gorevic [TTA 1 July] and new CMO Vidya Raman-Tangella (below) are suddenly available to the health press, can a Schoenberg brother be far behind? This brief Q&A with Politico is with Roy Schoenberg of Amwell and covers the state of telehealth, obstacles, abortion, consolidation, and automation. He stays pretty much on message with no surprises as the questions are short and, as is the practice, pre-submitted:

  • Telehealth is a distribution arm of healthcare, not just videoconferencing
  • The biggest war in telehealth remains state licensure–as it was pre-pandemic, past the ‘jumping in’ stage
  • Telehealth will not be a ‘pill mill’ for abortion pills (abortifacients) or controlled substances–it will be based on clinician professional judgment. (In the Editor’s opinion, this ‘hot potato’ was pre-written by the legal department.)
  • Consolidation as a question is not answered. We will see telehealth delivered by large healthcare organizations and telehealth that works with multiple brands. (What is not addressed is what telehealth services large healthcare organizations will go forward in using–the ‘high-priced spread’ of all-inclusives or the white-labels)
  • His opinion around automation is that it will be split between the camps of replacing clinicians, or augmenting them plus giving patients the opportunity to manage their health reality. (One wonders for what reality Amwell is preparing)

Teladoc’s new chief medical officer Raman-Tangella is also on the healthcare charm offensive with a Healthcare Dive interview on strategy and new products. She discusses enterprise clinical strategy and whole-person care, which echoes the Gorevic interview. There’s a diversion to ‘health equity’ which is first defined as a continuum [Editor’s term] of gathering data, taking solutions to customers, and seeking outcomes that validate the first two. She then moves on to closing care gaps through this information, especially in musculoskeletal and physical therapy, and returning to health equity, disparities and then (what we used to define as) proactive care based on all this patient information.

Forget the fork. SPACs as an IPO method are burnt and heading to the trash bin. Again [TTA 9 June] we have PrivCo’s Daily Stack addressing their demise, this time quantifying the crack of the full SPAC market (in and outside healthcare):

  • From one in 2009 to 248 in 2020
  • 2021: an estimated 50% of the total US IPO market in Q1 with 299 listings valued at $98.3 billion
  • 2022: 18 registrations this entire 2022 year and still in the process of raising $2 billion. (This Editor noted that the only healthcare SPAC apparently in progress is VSee and iDoc Telehealth with Digital Health Acquisition Corporation to close in Q3.)

As we’ve previously noted, SPACs are under attack by the SEC and by perpetual hair-on-fire for the press Senators such as  Elizabeth Warren. According to Bloomberg (sign-in needed), 30 SPACs have been called off this year. And as we’ve noted, there are healthcare SPACs like SOC Telemed which went private at a fire sale discount. Others like Owlet, Headspace, and Talkspace are struggling. Watchful eyes are on late SPACs such as Pear Therapeutics and Babylon Health. It’s a less-than-grand finale to what was touted as a low-muss way to IPO.

Weekend UK news roundup: NHS England’s growing bed shortage as backlog hits 6.6M, Inoapps software for US health vans, Data Driven Healthcare Birmingham 1 Aug, Oto raises £2.8M, WeWALK £1.7m in funding

July 15, 2022 | by

A study by the Health Foundation’s REAL Centre is sounding the alarm over a growing shortage of hospital beds within NHS England. Their estimate is in order to maintain pre-pandemic standards of care, 23,000 to 39,000 extra beds could be needed by 2030/31–a 20–35% increase that will cost in current monetary terms between £17 and 29 billion. The study cites the factors of a larger, aging population, with more complex conditions. In the past 30 years, as in most countries, England’s hospital bed capacity has been reduced by half as care has shifted to outpatient facilities and now telehealth. Where this puts England–like the US in a different management model–is that there is little excess to meet extraordinary demand with only two beds per person, near the bottom. England’s 89.6% acute bed occupancy rate is lower only than Ireland at 90.7%, perpetually strapped Canada (which offloads to the US) at 91.7%, and Israel at 92.3%. (The US is surprisingly just above 64% though there are 2.5 beds per person.) The study does advocate solutions such as RPM and hospital-to-home, identifying four areas:

  1. Increase hospital bed supply – provide additional hospital beds that are suitably staffed to meet demand.
  2. Do things faster – continue to reduce the average time each patient spends in hospital.
  3. Do things differently – for instance, by expanding potential substitutes for hospital beds such as expanding virtual wards or nursing home beds.
  4. Do less – either by better meeting patient need, for instance by investing in primary care to reduce unnecessary emergency admissions, or by delivering less of some services, either explicitly by changing thresholds or implicitly by reducing supply.

Knocking on to all of this is the staffing shortage which REAL Centre has chronicled which is a key factor in treatment, affecting patient backlog which rose to 6.6 million at end of May. HealthcareandProtection

The REAL Centre study is available for download here. A good summary with plenty of charts to peruse is provided by the Daily Mail. Health Foundation release

Scotland and US-based Inoapps announced that it developed a guest registration application for TeleHealth Network, a Los Angeles-based (literally) mobile health provider. Over 40 5G equipped TeleHealth Vans travel to underserved areas of Los Angeles to deliver community-based virtual health services. The vans provide health services to primarily homeless, veterans, and low-income communities, and have reached 550,000 people to date. The application is based on Oracle APEX on Oracle Cloud Infrastructure (OCI) to connect people with services efficiently, using the smallest amount of personal data possible which seems to be a key driver (sic). Inoapps release.

Data Driven Healthcare is the theme of a 1 August meeting in Birmingham during the Commonwealth Games. It is sponsored by UK House: The Commonwealth Business Hub and takes place at the University of Birmingham’s Exchange Building. The meeting will address healthcare challenges faced across the world and the critical issues governments, industry and communities must work together to address, as well as how the Midlands is driving innovation in translational medicine, clinical trials, and regulatory innovation. More information and registration here.

Tinnitus management app Oto raised £2.8 ($3.3) million in seed funding from Octopus Ventures. It follows a £510,000 pre-seed round from Y Combinator in January for a total of four pre-seed rounds since 2020 (Crunchbase). The app helps sufferers (and boy, do they suffer) habituate to the incessant ringing and buzzing, better manage it, and use positive relaxation and sleep techniques. The small London-based company was founded by two doctors who developed it in their 20s. UK Tech News  Also in London, WeWALK raised £1.7 million in funding from UK Research and Innovation (UKRI) for its “smart cane”. It uses ultrasonic sensors to help those with visual impairments and can be paired with a mobile app to give voice-guided navigation. About 2 million in the UK have some form of severe visual impairment. According to their website, they are currently crowdfunding on Crowdcube and offering the app separate from the smart cane. UK Tech News

Thursday news roundup: RVO Health JV combines Optum-RV Health consumer health assets; Holmes sentencing for Theranos fraud delayed

July 14, 2022 | by

Red Ventures, Optum combine consumer savings, digital health coaching, education assets into RVO Health. Quietly announced via Moody’s Investor Services (PDF) and appearing on LinkedIn, this offloads media holding company Red Ventures’ RV Health, consisting of Healthline health news/education media (Healthline, Medical News Today, Psych Central, Greatist, and Bezzy), plus the Healthgrades doctor rating, FindCare doctor locator and PlateJoy meal planner services. Optum contributes their Perks prescription savings card, Store shopping service, and coaching platforms Real Appeal, Wellness Coaching, and QuitForLife. For Red Ventures, this moves 20% of their company earnings into the JV, leaving media such as Bankrate.com and CNET. For Optum, this expands their coaching and consumer savings capabilities into an established digital audience–Red Ventures claims 100 million monthly users of its health media and other services. For Red Ventures, it opens up new solutions available through Optum’s parent, UnitedHealth Group.

According to Moody’s analysts, this is part of Red Ventures’ de-leveraging: “Under the terms of the JV arrangement, in exchange for the contributed assets, RV received cash proceeds, which were used to pay down the term loan. UHG will consolidate the financials of RVO Health in its future financial statements.” Based on LinkedIn, it will be located in Charlotte, North Carolina. Unannounced is who will be managing RVO Health.  FierceHealthcare, Becker’s 

Ironically, Healthline Media’ main competitor, WebMD, bought the former data analytics part of Healthgrades, Mercury Healthcare, on 29 June (release).

Elizabeth Holmes gets a three-week extension on her freedom. Her sentencing, originally scheduled for 26 September at the US District Court, Northern District of California, in San Jose has been moved to 17 October. No reason was given by the court for the extension. Judge Edward Davila will be presiding over the sentencing on four of the original 11 Theranos wire fraud charges [TTA 4 Jan]. Each one of these charges carries a penalty of up to 20 years, but generally in financial fraud, sentences are carried out concurrently. Judge Davila, known as a tough sentencer according to the Mercury News (mercifully not paywalled) may be considering factors such as that Holmes was, after all the founder and CEO but that Theranos did not start as a scam, proceeding to fraud when the technology was oversold and financially started to go under; and that she is a mother of a child not yet out of diapers. (This Editor will add the smoke around Sunny Balwani’s emotional abuse.) She will also be in a Federal facility for women likely located not far from San Jose. It is expected that she will appeal the verdicts and the sentences.

There is also the Balwani Factor. Sunny Balwani was convicted on 12 wire fraud charges and as Theranos’ president, was depicted as the ‘enforcer’. That book, when thrown after Holmes’ sentencing, will not be a paperback. Although he will want to stock up on reading for his expected long stay in Club Fed. Also CBS News.

The clunk continues: Q2 2022 digital health funding fades to $4.1B in Q2, down 50% from 2021

July 13, 2022 | by

Digital health funding continues to take a plunge. Knocked about by the hangover from the pandemic, a grinding war between Russia and Ukraine, gasoline prices jacked up worldwide, and knock-on inflation and looming stagflation, funding continues to slide. The decline in Q2 digital health deals and funding to $4.1 billion more truly reflects the downturn than Q1’s relatively buoyant $6.1 billion, which benefited from the carryover of deals negotiated during 2021’s boom and closing then [TTA 6 April]. Year over year, it was half of 2021’s high of $8.3 billion.

  • 2022’s first half (H1) total of $10.3 billion was down 31% from 2021’s $15 billion. Despite this, it is 63% above the pandemic-stricken 2020’s H1 $6.3 billion. 
  • Average deal size has dropped to $31.2 million from 2021’s full-year $39.5 million and even 2020’s $30.6 million, accounting for inflation in the past two years. Looking at funding size by series year over year, Series A funding is flat but funding for Series B, C, and D+ have dropped substantially.
  • No startups went public but four digital health companies announced plans to go public or were reported to be planning public exits. One SPAC was announced in June to close in Q3, that of VSee and iDoc Telehealth with Digital Health Acquisition Corporation. SPACs, as this Editor has noted, have gone from Funding Hero to Zero under 2022’s economics, causing many SPACs to crack (Owlet, Talkspace) and increased scrutiny by the Feds [TTA 9 June]. SOC Telehealth, an early SPAC, went private after a 90% share price drop [TTA 8 Feb].
  • Average monthly M&A has dropped substantially. 2021’s monthly average of 23 has dropped to 20 in Q1 and 13 in Q2, for a H1 average of 16.
  • Most popular funding areas are mental health (a far ahead #1 at $1.3 billion), oncology, and cardiovascular. Diabetes dropped from #2 to #4, skewed last year by Teladoc’s acquisition of Livongo. Oncology rose to #2 from #6 in 2021. For mental health, given increased Federal scrutiny and legal problems of companies like Cerebral plus the expansion of Teladoc and Amwell into the area, this Editor does not expect telemental health companies to continue to attract this level of funding but may be attractive for M&A.
  • Disease monitoring (a/k/a RPM) as a value proposition moved from #8 to #3 in investment at $1.4 billion. R&D and on-demand healthcare remained in their #1 and #2 positions.

As TTA has noted previously, this was all to be expected. Will 2022 funding perk up like 2020’s did through Q3 and Q4, or fall off like in 2019 as money sits on the sidelines? Rock Health does try to put a rosier shine on the retrenchment in its roundup, as has venture capital–reality can be good for you. Another depressive factor is regulatory uncertainty in multiple areas and Federal involvement, which some companies can work to their advantage. The Rock Health summary discusses this at length. Also Mobihealthnews. 

Weekend news roundup: Teladoc adds to Primary360; Novartis, Medtronic support UK digital cardiac startups; Bluestream adds PrimaryOne Health; NoKo ransomware threatens healthcare; more Fed scrutiny on telehealth Rx, billed time may be coming

July 8, 2022 | by

Teladoc had some positive news this week with additions to Primary360, its new primary care service for the provider/payer market. It added in-network referrals and care coordination capabilities, free, same-day prescription delivery from Capsule, and in-home, on-demand phlebotomy from Scarlet Health. The release notes that about half of patients fail to pick up their prescriptions. In addition, Priority Health, a nonprofit health benefits company serving Michigan, has added Primary360 to its fully insured virtual first plan design for employers. FierceHealthcare

Some good news from the UK in a time of government upheaval. Novartis is supporting cardiac digital health startups through the Novartis Biome UK Heart Health Catalyst 2022. This investor partnership is to identify and scale innovations for non-invasive lipid testing and at-home blood pressure testing using software as a medical device. Partners in support are Medtronic, RYSE Asset Management and Chelsea and Westminster Hospital NHS Foundation Trust and its official charity CW+. Successful applicants will receive support from partners during the competition process, the opportunity of investment up to £3 million provided by RYSE Asset Management, subject to due diligence at RYSE`s discretion, access to the Novartis Biome UK eco-system located in White City, and opportunities to work with our NHS partners to set up and deliver a pilot evaluation of the winning innovation. Applications must be in by 31 August–form is here. FierceBiotech

Bluestream Health adds PrimaryOne Health. Bluestream provides a white-labeled customized virtual care service that will be integrated into PrimaryOne’s services. This medical group of 11 community healthcare facilities across central Ohio serves 48,000 patients with primary care, OB-GYN, pediatric, vision, dental, behavioral health, nutrition, pharmacy, physical therapy, and specialty care.  Release

North Korea’s Maui Ransomware is no Hawaiian vacation. The threat has built enough since May 2021 for the Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and the Department of the Treasury (Treasury) to release a joint Cybersecurity Advisory (CSA) on Thursday warning healthcare and public sector health organizations. It is state-sponsored North Korean malicious cyber activity. The CSA provides a sample of how it executes, what it targets, how it encrypts files, and how to respond. Hackermania, NoKo Style, is Running Wild with breaches piling up [TTA 7 July], and not only in healthcare. Healthcare Dive, Healthcare IT News

And in Dog Bites Man News, a former US assistant district attorney for Massachusetts predicts that Federal entities such as the Department of Justice (DOJ) may not stop with telemental prescribing. They will not only be ramping up their scrutiny of telemental health companies–but also telehealth billing. For Cerebral and Done Health that facilitate the prescribing of Schedule 2 drugs, this assumption of scrutiny has become a no-brainer. What it also is: a caution for mainstream telehealth providers such as Teladoc and Amwell charging into psychiatric telehealth.  But the former ADA, Miranda Hooker, now a health sciences area partner with Troutman Pepper in Boston, makes a broader prediction. Prosecuted telehealth fraud, as this Editor has noted, has grown in other areas, such as prescriptions for durable medical equipment (DME) billed to Medicare [TTA 6 May] and cardiologists moonlighting as Dr. Mabuse, Master Cybercriminal [TTA 19 May]. But the next frontier may be time-specified telehealth consults billed to Medicare under various CPT codes (e.g. 994XX). A 15-minute consult billed as a more lucrative 30-minute consult can be considered fraud. The Cerebral investigation, according to Hooker, marks a shift by the DOJ into investigating the actual provision of telehealth services and whether they are being billed properly. FierceHealthcare

Two telehealth case studies: St. Luke’s University Health, CommonSpirit Health

July 8, 2022 | by

Telehealth effectiveness measured in two different US health systems. Some of our Readers are marketers like your Editor, who are always searching for references on program effectiveness. Healthcare IT News in recent days has presented two, one using Amwell and the other using Teladoc:

St. Luke’s University Health is a small health system with 14 hospitals and multiple clinics covering eastern Pennsylvania and western New Jersey. They were addressing several problems:

  • Network coverage expansion and time to consult reduction
  • Integration with EHR and multiple systems
  • Maintaining high privacy standards
  • Introducing behavioral telehealth for both patients and employees, especially during the Covid pandemic

The case study is primarily about the implementation of Amwell Psychiatric Care for 24/7 coverage and the SilverCloud Health platform, part of Amwell. This accelerated at the start of the pandemic. St. Luke’s instituted a Virtual Remote Monitoring Center (VRC) that monitored more than 6,000 patients supported by a 24/7 operations team.

With SilverCloud, they custom-built a support program for employees that included a self-paced program for stress, anxiety, and depression with support from a social worker and app-based 24/7 coaching interventions. If needed, the employee could be referred to an Employee Assistance Program or a St. Luke’s therapist. 

For the mental health programs, using the PHQ-9, comparing results between in-person and virtual visits from July 2021 to March 2022, results were close to identical in 6-point reductions in both virtual (96%) and in-person (90%) populations. In overall telehealth visits, between March 2021 and March 2022, they had over 205,000 unique patients use telehealth. Another metric that telehealth affected was outpatient care. St. Luke’s reduced no-show rates from 14% to 6%. Article

CommonSpirit Health is the largest Catholic and second-largest non-profit health system in the US.  The problem they were attempting to solve was primarily onboarding patients in crisis in the shortest possible time, well within the four hours recommended by the Joint Commission. They expanded their use of Teladoc in the CommonSpirit Telehealth Network to include behavioral health, instituting a.”round and respond” model to improve access to behavioral health specialists in several hospital emergency departments (EDs) and quickly assess patients as mild, moderate or severe based on patient risk. They also added services such as geropsychiatric and crisis intervention with medication-assisted treatment as consultation-liaison services. Results were:

  • Decrease in length of stay, cost; increased satisfaction and expectations of care met
  • 1,200 telebehavioral health consultations per month, through three states and across 25 hospitals
  • Establishing a standard of care of response within 60 minutes to all ED consult requests, have actionable recommendations within 90 minutes, and an ED disposition plan within the first four hours
    • 61% of cases seen within 30 minutes, 79% within 60 minutes with average response 42 minutes
    • 65% rate for discharge recommendations and a 35% rate for transfer at specific locations.

Article