Ireland’s TASK Community Care launches TASK Connect in Northern Ireland for the UK market

November 30, 2023 | by

TASK Community Care, which was the first personal alarm and telecare company serving Ireland starting (an unbelievable) 45 years ago, has opened a fully-owned UK subsidiary, TASK Connect. It will be located in Lurgan, Northern Ireland. TASK Connect will provide 24/7 alarm services along with GPS location tracking with fall detection devices and monitoring. These can be ordered online, streamlining customer service and user implementation.

TASK Connect recently won a competitive tender with one of Northern Ireland’s eleven councils. The new Lurgan operation will also serve as a base for TASK’s expansion in the rest of the UK. 

Toni Bunting, TASK Connect’s managing director, stated “Our online product range will steadily expand as we solidify our presence in the UK market. Concurrently, our core focus is on refining operations, honed through years of dedicated service to TASK Community Care customers, ensuring an even more streamlined and customer-centric service for all our customers in the UK.” TASK Connect release

Editor’s note: Long-time Readers remember Toni as our Ireland Contributing Editor. She rejoined TASK earlier this year after time out of the industry. Welcome back, Toni! 

A Thanksgiving turkey for hospitals: multiple cyber and ransomware attacks

November 29, 2023 | by | 1 Comment

IT incidents were on the Thanksgiving menu at many US hospitals. It was no holiday for the hospitals experiencing attacks and outages, forcing ERs to divert to other hospitals and resort to downtime procedures. The hospitals reporting them are part of Ardent Health Services, a 30-hospital operator. Ransomware has been reported for some as the cause. Not all Ardent hospitals have been reported as affected.

A rundown of what was attacked, and where:

  • The 10-hospital UT Health East Texas (Tyler, Texas) network reverted to downtime procedures after a security incident, outage, and locked down its systems. Ambulances heading to its ERs were diverted to other hospitals.
  • Lovelace Health System in Albuquerque, New Mexico, affecting six hospitals, 33 health care clinics and seven outpatient therapy clinics. 
  • BSA Health System in Amarillo, Texas 
  • The University of Kansas Health System St. Francis Campus in Topeka 
  • Hillcrest HealthCare System (Tulsa, Oklahoma) 
  • Closer to this Editor’s home, two Hackensack Meridian hospitals in New Jersey served by Ardent were ransomwared starting on Thanksgiving: Pascack Valley in Westwood and Mountainside Medical Center in Montclair. Local reports indicated a ransomware attack. The outage continued through the weekend. Other Hackensack Meridian hospitals are not served by Ardent and were not affected.

Ardent has reported this to law enforcement and in their release, stated they are still determining the full impact of the event, though working with partners to restore access to electronic medical records and operations. 

In addition to the Ardent hospitals, on Thursday the six-hospital Vanderbilt University Medical Center (Nashville, Tennessee) reported a cyberattack that compromised a database and was contained. Ransomwareistas Meow claimed that their information was leaked on the dark web. VUMC is not confirming a ransomware attack and stated that the “compromised database did not contain personal or protected information about patients or employees.”

Becker’s 27 Nov, 27 Nov (Hackensack), Asbury Park Press, News12NJ, Ardent Health release, The Record

‘The Simpsons’ takes on Theranos (by another name, glub glub)

November 29, 2023 | by

Everyone into the ‘LifeBoat’! Episode #754 of the long-running (35 seasons!) series ‘The Simpsons’ is a complete send-up of The Theranos Story in 22 minutes. This episode, which aired in the US on 29 October, transmutes Elizabeth Holmes into Persephone Odair, the young college dropout creator of a can-sized device that converts salt water to drinkable fresh water. The retrospective documentary and ‘news stories’ framing the tale trace Persephone’s and LifeBoat’s rise to fame and riches, then their fall. Set in SimpsonsWorld, the chief financier is the owner of the local nuclear plant, the zillionaire Montgomery Burns, whom she marries. There is an endless supply of in-jokes and jabs, such as Persephone at a TEDtalk saying “The doubters call this goal impossible, but I prefer to say, ‘I’m possible.’” (=”First, they think you’re crazy…”) and the blatant coverup of the technology (=Edison Lab, but here, if anyone drank the water, a competitor could steal the aqua-tech from the urine). The ‘can of oats’ converter, Persephone’s backstory, and the water, of course, are complete fails. Lots of celebrities make guest appearances, but not Judge Edward Davila or John Carreyrou, the author of ‘Bad Blood’. The plotline of “Thirst Trap: A Corporate Love Story” is featured on the WikiSimpsons here and here. It can be viewed on various streamers and can be purchased on YouTube. SFGATE, Entertainment Weekly, Photo from SFGATE screenshotted via Fox. 

New York State drafting proposed cybersecurity regulations for hospitals, allocates $500M for upgrades

November 22, 2023 | by

New York State is imposing new regulations that would establish cybersecurity policies and procedures for hospitals in the state. According to the NYS release, “hospitals will be required to establish a cybersecurity program and take proven steps to assess internal and external cybersecurity risks, use defensive techniques and infrastructure, implement measures to protect their information systems from unauthorized access or other malicious acts, and take actions to prevent cybersecurity events before they happen.” The draft regulations, announced last week, will be published by the Department of Health on 6 December, and will complement existing Federal standards under HIPAA. 

The proposed regulations will mandate:

  • Response plans to a cybersecurity incident
  • Notification to appropriate partners
  • Testing of response plans to ensure continuity of patient care while systems are restored to normal operations
  • Written procedures, guidelines, and standards to develop secure practices for in-house applications
  • Policies and procedures for evaluating, assessing, and testing the security of externally developed applications used by the hospital
  • Multi-factor authentication (MFA) implemented to access internal networks from outside networks
  • Establishment of a Chief Information Security Officer (CISO) if one doesn’t exist presently in order to enforce the new policies, plus annual reviews and updates 

The draft regulations are scheduled to be published on 6 December with a 60-day public comment period ending on 5 February 2024. After the finalization and adoption of the new regulations, hospitals have exactly one year to comply.

Included in the state’s FY24 budget is $500 million in funding for modernization of clinical tech, cybersecurity tools, EMRs and other technological upgrades. They will be part of an upcoming statewide capital program call for applications to improve quality of care, patient experience, accessibility, and efficiency. Given the size of NY state and number of hospitals, plus the time frame, this fund may be spread thin indeed. NYS release, MedCityNews

This Editor attended the Official Cybersecurity Summit New York 2023 last Friday, with a security briefing by NY State’s deputy chief cyber officer for operations, Jesse Sloman. He described the overall strategy of the state agency, the first ever, as building a unified, resilient, and prepared cybersecurity strategy across all agencies in the state, with a single point for operations including law enforcement, military, transportation, and of course healthcare. Certainly, internally instigated breaches, ransomware attacks, DDOS, and nation-state/transnational cyberattacks by Russian ransomwareistes like CLOP are expensive. He quoted a five-year loss of $27.6 billion with 3.2 million complaints–with 2022 alone costing $10.3 billion.

What’s his biggest concern? A multi-state, multi-sector geopolitical event that threatens multiple operations.

News roundup: AstraZeneca’s Evinova to market clinical trial health tech; BehaVR-Fern merge; UpHealth sells Cloudbreak telehealth translation; MedwebX launches; Tunstall-UEdinburgh research partnership; NextGen loses 84 after going private

November 21, 2023 | by

AstraZeneca makes a bet on selling health tech for drug development. Evinova, a separate health tech business within AstraZeneca, will market and develop proprietary technology and sell it to other pharma, biotech, and clinical research organizations (CROs) to optimize clinical trials. According to their release, these technologies have already been used in successful clinical trials in over 40 countries. CROs Parexel and Fortrea have already formally agreed to offer the three-part Evinova ‘drug development suite’ to their customers. Other partnerships include Accenture and Amazon Web Services.

On the buy and funding side:

RealizedCare formed from BehaVR and Fern Health. This interesting combination of virtual reality behavioral health (BehaVR) and chronic pain manager Fern Health promises digital therapeutics for value-based chronic pain care management. RealizedCare’s market is health plans, employers and value-based providers, working with them to identify, assess, and engage their members, employees, and patients with chronic pain. Their advanced care management platform is powered by DTx technology to scale pain management. Fern Health is backed by Aachen, Germany pharmaceutical company Grünenthal which will be a strategic investor in RealizedCare.  The combined company will be US-based in Nashville. Financials and workforce transitions are not disclosed, but two CEOs are listed on their website–Brad Lawson, CEO, Fern Health, and Aaron Gani, founder and CEO. Release, Mobihealthnews

UpHealth sells off telehealth translation services holding Cloudbreak Health to private equity firm GTCR, as part of a complex reorganization. Cloudbreak provides video remote interpreting (VRI) through its Martti (My Accessible Real-Time Trusted Interpreter) tool to aid in simultaneous translation in over 250 languages. Purchase price is $180 million and subject to regulatory and shareholder approvals, with closing anticipated by Q1 2024. Cloudbreak is currently headquartered in Columbus, Ohio. UpHealth has been selling off and putting into Chapter 11 various holdings such as UpHealth Holdings [TTA 29 Sep], Behavioral Health Services (BHS), and Thrasys, Inc., but not the publicly traded UpHealth Inc., which closed today on the NYSE at $0.79 having just resumed trading (Yahoo Finance, UpHealth release). Reportedly UpHealth will be refocusing on addiction treatment services provided in South Florida. More on their complex financials in their Q3 report.  Release

Short takes:

Digital medical imaging and storage company Medweb announced MedwebX, a HIPAA-compliant solution designed for sharing imaging, studies, data, and reports across networks. Release

Oracle’s moves into Music City Nashville [TTA 2 Nov] continue with the announcement of the Oracle Health Summit on 13 February 2024. According to the Nashville Business Journal, it’s a brief one emailed out to save the date and confirm their information when further details are available. The invitation reads in part, “At this daylong event, you’ll network with peers, hear from experts on the latest trends, and learn how leading organizations are using data-driven technology to deliver human-centered experiences.” Wonder if Bill Frist will be invited.

Tunstall Healthcare and the University of Edinburgh signed a Memorandum of Understanding (MOU) on telecare research. Edinburgh’s Advanced Care Research Centre will provide the academic ecosystem for the partnership, including medicine, engineering, informatics, data, and social sciences. Research will center on the development and deployment of digital tools and techniques for telecare, including multi-partner collaborations.  AT Today

And just in time for Thanksgiving…post-going private NextGen Healthcare will be releasing 84 employees at its St. Louis, Missouri location, according to their WARN notice filed with the state. The layoffs are “as a result of staffing optimization efforts” in connection with the company’s purchase by private equity firm Thoma Bravo. Layoffs of management, supervisors, account receivables staff, representatives, and analysts who work onsite, hybrid, and remote will be staggered with some released 16 January with others 1 February and 1 March. Some employees will be remaining in St. Louis, though NextGen is headquartered in Atlanta. Becker’s, St. Louis Post-Dispatch, St. Louis Business Journal

Some final words on Olive AI–what can we learn from its failure? (updated)

November 21, 2023 | by

“To the extent Olive might have sold something, they didn’t deliver – otherwise they’d still be in business.”–Emily Evans, managing director, Hedgeye Risk Management (quoted in Columbus Business Review)

Seeing this article on how Olive AI ‘ran out of time and money’ in Becker’s Hospital Review, this Editor hoped that it would be a final word, a summing up of what was likened to the seismic equivalent of Theranos’ failure in the health IT and ‘changing healthcare’ space. It wasn’t, but a terse summary of a very long article in Columbus Business Journal–Columbus, Ohio being their headquarters city. 

It’s a decade-long story (2012 as CrossChx to 2023). Up to March 2020, it seemed to be a reasonable narrative of a company and entrepreneur, Sean Lane, who built on his USAF background and founding an earlier successful software business (BTS Software) to transform healthcare through automating routine tasks through what they termed ‘AI’ but was more like software programming coupled with machine learning. With General Catalyst’s $52 million in hand and the encouragement of industry experts, he evangelized, hard, at multiple conferences. Some savvy investors and advisers (Ms. Evans above) saw that Mr. Lane didn’t know much about healthcare even during the ‘throw money at anything health tech’ days of 2020-21. But Olive AI easily gained two more 2020 raises totaling over $330 million, plus the capper in July 2021 of $400 million, for a total of over $850 million.

With the funds, Mr. Lane acquired or developed multiple businesses for Olive including prior authorizations, revenue cycle management, population health, business intelligence, and analytics for surgery. He even put $50 million into designing a Medicaid managed care insurer, Circulo Health, which was sold off in 17 months. The pivots came thick and fast, but the sales didn’t follow and the negative client reviews (KLAS) plus non-renewals started to pile up. Come 2022 with healthcare paying the Pandemic Piper and interest rates inflating, the VC funding spigots turned suddenly to ‘OFF’. The grow-at-any-cost early-stage companies found that when it came to VC funding, as they say in New Jersey, they couldn’t get arrested. So the end, as with Pear, Olive, and Babylon, came quickly. (Cue the tinny piano playing ‘Melancholy Baby’ in a dive bar.)

So for your startup or early stage company… A Guide to Avoiding A Train Wreck.

  • Don’t believe your own press releases, no matter how well written. And make sure your marketing people are seasoned pros who say what you do accurately and have been there, done that. (And when the most seasoned gives the raised eyebrow…ask why.)
  • Don’t constantly bang the gong that your solution/s will transform healthcare (memo to Larry Ellison). Stick to solving client problems and do that well, though you may have to evangelize a little. In the end, create ‘raving fans’. 
  • Don’t go it alone. Create strong supplier alliances where you need them. Then treat your partners and their corresponding account managers well and give them the resources they need.
  • Take the absolute minimum of Other People’s Money, even when it’s being thrown at you and everyone else, including your competitors which you will keep a cynical eye on. Stow cash away in the old fashioned way, in a reputable and not overextended bank, for the rainy days that will come.
  • There are certain investors and ‘thought leaders’ to smile at and run away from. (Two of them are mentioned in the article.) Their track records are dubious or they have their own agendas.
  • Get to positive cash flow as quickly as you can. 
  • Hire well, but not too many. And beware of execs with non-competes. They tie up your legal counsel who may also be keeping an eye on your IP, compliance, and finances.
  • Overdeliver and create happy clients who renew and expand your business–but don’t give away the store doing it
  • If you have to buy another company, don’t buy when the streets look paved with gold. Buy when there is some Type A on the pavement. And when you buy, ensure it makes sense in your business model, the acquisition actually does what they claim, their IP is free and clear, and the company owners aren’t overeager to sell (a clue to hidden problems).
  • Don’t, whatever you do, step on Superman’s cape. Avoid getting into conflicts with big guys like Epic, Oracle, or UnitedHealthcare. Especially don’t say that you will put them out of business. (You won’t.)
  • Know that healthcare, no matter what the conferences say, is an entrenched, over-regulated, risk-averse, and thus extremely slow-moving business. The risk level is high, the reward may be incremental, at best. And the big guys–the payers, big health systems, and their vendors, will always have it all over you.

Updated–Some more advice from different points of view:

“Hope is not a business model”–advice from two VCs, with a bit more advice on basic banking

ViVE post-script: VC panel opines in midst of digital health’s new reality (depression?), and extra ViVE from an attendee

Your thoughts on the above and your real-world examples invited as comments!

Primary care provider Forward introduces CarePod kiosks, raises $100 million for deployment–but will it work this time?

November 17, 2023 | by

Forward, a primary care provider that works on a membership model and has practices in 14 markets, announced a line extension to their existing practices. CarePods are self-serve closed kiosks designed for placement in malls, offices, and gyms that deploy a variety of AI-powered health apps for disease detection, biometric body scans, blood testing in disease areas, including diabetes, hypertension, weight management, and mental health (depression and anxiety). The CarePods will be deployed in the San Francisco Bay Area, New York, Chicago, and Philadelphia. Access to CarePods and the app starts at $99/month and $1,639/year–the release is not clear on whether that can include in-office visits. It is not covered by insurance, including Medicare or Medicaid.

The technology is an extension of what’s seen in their offices (this NY-based Editor is bombarded with YouTube ads for membership) that uses body scanning, vital signs monitoring, blood testing, heart monitoring, and corresponding apps for preventative care and condition management. While the ads feature human doctors and clinicians, the impression from the ads and website is that the health exams are technology-driven and while there are clinicians, they may not necessarily be there. It is not for getting updated on your vaccinations or diagnosing a rash or fever. Forward claims 100+ primary clinicians at 19 locations. 

Forward raised a $100 million Series E to deploy the CarePods from Khosla Ventures, Founders Fund, Samsung Next, Abu Dhabi Investment Authority, and Softbank. It consists of equity financing of more than $50 million as well as debt financing. Forward’s total financing is $657 million with its Series D round (Crunchbase). Forward also boasts a blue chip roster of advisers from Eric Schmidt of Google to Robert Wachter, MD.

In viewing this first from their communications representatives, this Editor was immediately reminded of the last time she saw a closed type of health kiosk. I demo’d HealthSpot Station at the CES preview in NYC in late 2012. It officially debuted at CES 2013. Despite decent takeup, HealthSpot was defunct by mid-2016 having placed only 50 or so stations and burned through a substantial $43 million through its entire short but showy life. Its remains went to now-bankrupt Rite Aid which did nothing reportable with it. HealthSpot had key differences with Forward’s CarePods in that HealthSpot was a place to sit down and have a synchronous virtual visit with a doctor (supplied by Teladoc initially), with vital signs monitoring through self-serve tools in the kiosk. Payment was per use and for the doctor visit. Their problems were placement of rather large units, maintenance, and the general reluctance of people to use monitoring tools at that time within a closed area. Based on the available media, the CarePod technology is much more advanced towards a virtual visit with touch screens, AI assists, sophisticated monitors, and an integrated app that generates care plans. It also builds on an established app and in-office technology. Concerns remain in this Editor’s view about maintenance, especially with the CarePod using much more sophisticated technology, cleanliness, and claustrophobia. FierceHealthcare, PYMNTS

This Editor has also taken a dim view of open kiosks placed in retailers such as CVS Health, Walmart, and supermarkets, such as Higi (bought by Babylon Health but evidently not part of the bankruptcy) and Pursuant Health (the former SoloHealth), having seen all too many of them in dusty corners, neglected, and often with Out Of Order signs. The Forward plan to restrict them to malls, offices, and gyms seems to avoid the retail crunch but one wonders what the breakeven is–or if this is a substitute for office expansion.

A commenter with a far dimmer view than this Editor’s is quoted at length in today’s HISTalk. “The target audience seems to be young, worried well people who prefer faceless machines and tons of prevention-focused data or congratulatory test results to interacting with a clinician. That actually is a pretty good business model. Reviews for the company’s in-person clinics are almost all from customers in their 20s and early 30s.” But the commenter–a customer–is dissatisfied with being completely unable to get someone on the phone, everything done through chat, and wait times to see a real doctor upwards of two weeks.

Short takes: Oracle Cerner still has major hurdles, says VA, Congress; One Medical adds Hackensack Meridian to specialist network, HTA to employer benefits; NHS trialing AI tracking of home behavioral patterns for at-risk patients

November 17, 2023 | by

VA’s All Quiet on the EHR Front doesn’t mean nothing is happening. With the House hard at work with a new speaker, negotiating budget extensions, and generally trying to get work done before the Christmas-New Year recess, the work of subcommittees goes on. Rep. Matt Rosendale (R-Montana), chairman of the House Committee on Veterans’ Affairs’ Subcommittee on Technology Modernization, yesterday (15 Nov) in what was titled “Electronic Health Record Modernization Deep Dive: System Uptime” got an update on the status of Oracle Cerner from Kurt DelBene, the VA’s chief information officer. His testimony wasn’t exactly reassuring. “Overall we still think there’s a ways to go. I don’t want to present the system as all set and ready to go.” In a rare show of bipartisanship, ranking member Rep. Sheila Cherfilus-McCormick, D-Florida, said that “[Oracle] training and change management are still woefully inadequate and user satisfaction is still critically low.” And despite being invited by Chairman Rosendale, Oracle’s Mike Sicilia didn’t show up or send regrets, which made Rep. Cherfilus-McCormick a little livid. FedScoop  HISTalk in its recap also pointed out that Rep.Rosendale “cited a report saying that it will take Oracle Health 15 more years to match VistA’s functionality. [VA deputy CIO Laura Prietula] responded that she doesn’t think it will take that long.” Oracle Cerner, in the few VA locations where it is operative, has not had a complete system outage in six months. Hearing and 1 hour 46 min. video (YouTube), hearing documents

Amazon continues to build out One Medical to, perhaps, ubiquity. On the East Coast, Amazon’s One Medical adds a major New Jersey health system relationship, Hackensack Meridian Health. Like its newly inked relationship with CommonSpirit Health, it will add integrated specialty providers to One Medical’s primary care focus. Specific locations based on patient needs are not specified yet nor financials. Implementation timing is unusually long–by the end of 2024. On a faster track may be One Medical’s deal with Health Transformation Alliance (HTA), a consortium of large US employers comprising 67 employers including Coca-Cola, Intel, Boeing, and many others totaling nearly 5 million employees. Timing and financials were not disclosed. This adds to One Medical’s current contracts with 8,500 companies that offer its primary care services as an employee health benefit. Becker’s, FierceHealthcare

NHS experiments with predictive health indicators and AI modeling for at-risk patients to prevent unnecessary admissions. Four GP practices in Somerset will be using an AI system that will flag registered patients who have complex health needs first, and are most at risk of hospital admission or who rarely contact their GP. Monitored in Buckinghamshire, the most interesting part of this is that the AI is linked to electronic sensors on kettles and fridges that spot changes in Somerset patients’ eating and drinking habits, obviously as an indicator of changes in health. (Does this remind anyone of 3rings or QuietCare?) Changes are reported to an Onward Care team of health coaches, nurses, and GPs who speak to patients and ask about any health or living issues. They can provide, based on patient input, deliveries of food parcels, arranging for cleaning or shopping services, home alterations to help to avoid falls, or to link them up with local voluntary groups to reconnect them with community resources or simply to help avoid loneliness. Clinical care can also be scheduled including specialist care. The NHS reports that GP practices can use this system to solve 95% of their issues or escalate anything clinical. Why this is important: hard winter and isolation, even with the holidays, loom after an autumn of wild weather and the persistent shortage of hospital beds and GP capacity/timeliness of appointments.  DigitalHealth.net

Virtual nursing comes to the forefront: Avera Health (SD) launches at two hospitals, Doccla launches ‘virtual wards’ at home with Up Care Derbyshire (UK)

November 15, 2023 | by

The Perspectives article posted today (below) discusses how telehealth for virtual nursing is being used at hospitals. Coincidentally, this Editor had in the ‘virtual file’ for posting today two articles on how virtual nursing is being used in two settings–and in two countries.

In-hospital virtual nursing has been introduced at two Avera Health hospitals in South Dakota, Avera McKennan Hospital & University Center in Sioux Falls and Avera St. Mary’s Hospital in Pierre. This is very much along the lines of adjuncts to bedside nursing in supporting additional care and time-consuming administrative tasks, such as admission assessment, medication reconciliation, pain reassessments, and second RN availability for independent double checks. For Avera, this answers some of their workforce and workflow problems, such as relieving workload and providing second checks. 

An example is intake assessment which in some cases can take up to 30 minutes. The virtual nurses at their stations (left above) work with bedside nurses not only to ask patient questions but also to relieve their anxiety and answer questions. The bedside nurse introduces the virtual nurse, explains the camera/microphone, and then the virtual nurse picks up the assessment from the bedside nurse, who can move on. The camera can also zoom in on equipment such as IVs or vital signs monitors. Virtual nurses can also call bedside nurses when they are needed. No information is recorded.

Avera is a rural health system of 37 hospitals in South Dakota. They introduced virtual nursing in May in the same two hospitals on one metric–reducing in-hospital falls that happen when a patient at increased risk of falling gets out of bed. The virtual nurse uses the camera and speaker to direct the patient to wait for care team assistance or alert staff to help. This 24/7 monitoring program decreased falls with more than 6,800 redirects between May and October. Avera plans to roll out the virtual nursing program eventually to all of their hospitals. Becker’s, Sioux Falls Business (photo credit)

In the UK, Doccla is partnering with Up Care Derbyshire to set up ‘virtual wards’ for at-home care in Derby and Derbyshire. The NHS has a well-known problem with available hospital beds. Much like the US, a nascent hospital-at-home program is attempting to relieve the situation by moving the patient back home faster without skimping on care in five care areas: palliative, respiratory, frailty, cardiology and hematology (haematology). The patient in the program receives a Doccla box with the tools needed for monitoring and coordinating care: a pre-configured smartphone with an easy-to-read large font for the app, plus wearable medical devices to monitor vital signs such as heart rate, respiration rate, body temperature, blood oxygen levels, and blood pressure that are connected to the smartphone. Clinicians monitor the patients at dedicated hubs and call in home health nurses when needed. The program will be at five locations initially within Up Care Derbyshire’s integrated health system (ICS) to enable local NHS hospitals to discharge eligible patients and has a peak capacity at present of 200. One objective is faster patient discharge, but the second is to reduce the need for hospitalization for patients with long-term or chronic health conditions. One area that isn’t apparent is if the camera is used as part of evaluations or contact.

Doccla is now in one-third of integrated care boards (ICBs) and more than 25 NHS Trusts, with a patient compliance rate of over 95% and an independently verified saving for the NHS of £3 for every £1 spent on Doccla. DigitalHealth.net

Perspectives: The Impact of Virtual Nursing on Telehealth

November 14, 2023 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s contribution is from Donna Gudmestad, MHL, BSN, RN, CCRN-K, who is clinical program manager and clinical product owner of mobile technology for Caregility, which provides secure, reliable, and HIPAA-compliant audio and video communication designed for any device and clinical workflow, in both acute and ambulatory settings supporting 1,300+ hospitals across dozens of health systems. Ms. Gudmestad has 30+ years of nursing experience and 14+ years of telemedicine operational and implementation experience. Prior to Caregility, she served as a bedside clinician, clinical manager, director of operations, and director of implementation. Her bachelor’s degree in nursing is from Indiana Wesleyan University and later earned a Master of Health Leadership from Western Governors University.

In this article, Ms. Gudmestad discusses how virtual nursing is not a substitute for in-person nursing, but supports traditional nursing by transcending physical boundaries in specific ways, both in patient care and in clinical workflow tasks, leading to better outcomes.

As healthcare executives, we are witnessing a remarkable transformation in the telehealth and virtual care industry, driven by the emergence of virtual nursing. This innovative approach to patient care, combining the convenience of telehealth with the expertise and empathy of registered nurses, is reshaping the healthcare landscape in profound ways– specifically the role of virtual nursing in clinical workflows and its profound impact on patient care.

Virtual nursing is not merely a digitized version of traditional nursing; it’s a dynamic interaction that transcends physical boundaries. Through video calls and chat interfaces, nurses can provide personalized guidance, address patient queries, offer much-needed emotional support, and provide workflow support for nursing staff. This heightened engagement fosters stronger patient-clinician relationships, resulting in enhanced patient satisfaction and greater adherence to treatment plans.

One of the essential aspects of clinical workflows is efficient patient triage. Virtual nurses excel in this domain, rapidly assessing the urgency of a patient’s condition and determining whether intervention is necessary. This swift and accurate decision-making reduces overcrowding in emergency rooms and clinics, optimizing resource allocation.

Beyond triage, virtual nurses excel in continuous monitoring. They can track vital signs, medication adherence, and symptom management remotely. Adjusting treatment plans and assisting patients in managing their conditions from the comfort of their homes becomes a reality. This proactive approach not only enhances patient care but also minimizes complications and readmissions.

After hospitalization or surgical procedures, patients require diligent follow-up to monitor their recovery. Virtual nursing streamlines this process by enabling nurses to conduct post-discharge check-ins via video calls. This proactive approach minimizes complications and the chance of costly readmission, leading to improved patient outcomes.

By reducing the necessity for in-person visits and hospital readmissions, virtual nursing contributes significantly to cost reduction for both patients and healthcare providers. This multifaceted approach to improving patient care enhances access, efficiency, and cost-effectiveness, positioning virtual nursing as a transformative force in healthcare.

From an inpatient perspective, virtual nursing helps to support bedside nursing staff by performing some of the most time-consuming activities such as admissions and discharges in addition to other supportive workflows. With certain technologies in place such as peripheral devices, virtual nurses can even also perform admission assessments throughout the hospital with the assistance of a bedside nurse tech.

As technology continues to advance and healthcare providers increasingly embrace virtual nursing, we can anticipate continued growth and evolution in the industry. Virtual nursing is more than just a trend; it represents a fundamental shift in the way we deliver and receive healthcare services. It offers a vision of healthcare that is accessible, efficient, and patient-centric.

Virtual nursing is not merely an addition to our healthcare toolbox; it is a catalyst for redefining clinical workflows and patient care. As healthcare executives, we have the privilege of witnessing this transformation firsthand. The future of healthcare is being shaped by innovations like virtual nursing, with benefits that extend far beyond our current understanding. Embracing this shift is not just a strategic choice; it is a commitment to delivering healthcare that is smarter, more compassionate, and more accessible to all.

Roundup: Virgin Pulse, NextGen close fast; Elucid, Eleos, Vida, Neteera funding; One Medical-CommonSpirit; Indian Health $2.5B EHR to General Dynamics+Oracle; losses, layoffs at Cano Health, 15% digital cuts at Mass General Brigham

November 14, 2023 | by

No surprise that some big deals in digital health closed at year’s end before we roll out the turkey and the holiday decorations.

  • The Virgin Pulse-HealthComp merger that adds benefits analytics to Virgin’s employee wellness platform closed last Thursday (9 November). It was announced only in late September [TTA 29 Sep]. This creates what they estimate is a $3 billion company. Ownership is also changing to New Mountain Capital, the owner of HealthComp, now as the majority owner of the new company with Marlin Equity Partners in minority ownership with others including Blackstone and Morgan Health. Other than Chris Michalak becoming CEO of Virgin Pulse and HealthComp, there is no confirmation of financing nor management/employee transitions or headquarters (Virgin is in Providence Rhode Island, HealthComp in Fresno California). Virgin release
  • EHR NextGen closed its $1.8 billion taking-private by private equity firm Thoma Bravo after shareholders approved it the previous Tuesday for $23.95/share in cash. This was announced around US Labor Day and closed in record time on Friday 10 November. As previously noted, this ended 41 years of public trading for a company that was one of the pioneers of EHRs and practice management. In its release, Thoma Bravo will “leverage its operational and software expertise” and “adding new products and capabilities, both organically and inorganically, to continue enabling NextGen Healthcare’s customers to deliver exceptional patient outcomes.” Healthcare Dive, FierceHealthcare (also Virgin Pulse)

Are these lights at the end of the dark M&A tunnel for health tech and related? Or avoiding the oncoming train of FTC and DOJ regulations that collide head-on with M&A with the pending imposition of the Draft Merger Guidelines and the Premerger Notification rules under Hart-Scott-Rodino (HSR)?

It seems like top digital health law firm Epstein Becker Green has caught up with Editor Cassandra [TTA 20 July, 20 June]  in this Diagnosing Health Care Podcast of 10 November. Fun estimate: the time in filing a premerger notification may be increased by 289%. The cloudy crystal ball was clear indeed….

Last week was also a busy time for smaller companies’ fundings–even letter rounds! 

  • Elucid scored $80 million in Series C funding led by led by Elevage Medical Technologies, bringing total funding for this AI-assisted cardiovascular imaging company. They have the “only FDA-cleared non-invasive tool able to accurately characterize arterial plaque, simulating what pathologists would see under a microscope and establishing a histologic ground truth. The company is also pursuing an indication for non-invasive measurement of fractional flow reserve (FFRCT), uniquely derived from its PlaqueIQ technology, to measure coronary blockages and the extent of ischemia.” Release
  • In behavioral health, Eleos Health now has $40 million in Series B funding to add to previous funding of $28 million. The Series B was led by Menlo Ventures, with participation from F-Prime Capital, Eight Roads, Arkin Digital Health, SamsungNEXT, and ION. Eleos has developed AI-assisted solutions for group therapy sessions, compliance automation, case management, concurrent documentation, and value-based care support. They will use the additional funding for further development as well as network expansion and EHR partnerships. Release
  • Vida Health, which offers health coaching for chronic conditions, primarily obesity and diabetes management, gained $28.5 million in an unlettered round led by existing investors Ally Bridge, Canvas Ventures, General Atlantic, Hercules Capital, and others. Vida also announced a change of CEOs. Joe Murad succeeds Stephanie Tilenius, who is stepping down after nine years as founder/CEO, transitioning to an advisory capacity. Mr. Murad joins the company’s board. He was previously with WithMe Health, where he was president/CEO for nearly five years and previously headed PokitDoc before its acquisition by Change Healthcare in 2018. Release  Also Mobihealthnews on Elucid, Eleos, and Vida.
  • Israeli RPM company Neteera now has an additional $6.7 million as part of a Series B extension. Their unique RPM uses sub-THZ radar to monitor vital signs through bedding and clothing, then analyzes the data and produces reports on its platform. Neteera partners with Foxconn on their RPM and currently sells to long-term care facilities in the US.  Pulse 2.0

Amazon’s One Medical announced a partnership with CommonSpirit Health’s Virginia Mason Franciscan Health (VMFH) in the Seattle Puget Sound metro. This will add integrated specialty care in that area to One Medical’s primary care focus. VMFH has 2,000 providers in an integrated network of providers, outpatient facilities, and hospitals. Financials weren’t disclosed, but according to Becker’s, in another One Medical partnership, a health system disclosed that it “reimburses One Medical for providing care on its behalf and collects the fee-for-service revenue from the patient visits. One Medical previously collaborated with Seattle-based Swedish (part of Renton, Wash.-based Providence) in the region.” VMFH release, FierceHealthcare, 

The federal Indian Health System (IHS) is modernizing its EHR and moving to a General Dynamics IT-managed Oracle Cerner system. Its current system is the 40+-year-old Resource and Patient Management System–based on (surprise!) VistA. What is most interesting in the release is that General Dynamics Information Technology (IT) is listed as the primary contractor that will “build, configure, and maintain a new IHS enterprise Electronic Health Record system utilizing Oracle Cerner technology.” One very interesting bit of verbiage! The IHS used an “Indefinite Delivery, Indefinite Quantity” contract structure for this requirement which is explained as “the IHS will issue specific task orders for technical support and services. This gives the IHS the ability to adjust what it purchases, incorporate lessons learned, user input, and availability of new technology.” Reports indicate its ultimate value to General Dynamics IT in the 10-year contract to be close to $2.5 billion. IHS provides healthcare services for 2.8 million American Indians and Native Alaskans belonging to over 570 tribes. IHS release, Healthcare IT News, 

Cano Health continues its hemorrhage. Q3 loss was $497.1 million in Q3, with a cut of 21% of its workforce, or approximately 842 staff. Their loss was 4x times the year-prior Q3 on revenue of $788.1 million. Adding to operating losses, they were hit with a $354 million impairment charge and poor operating results from higher third-party medical costs. 52% of the staff cuts reflect the sales of operating units such as in Texas and Nevada to Humana CenterWell and exits in California, New Mexico, and Illinois. The remaining 48% is from restructuring. Now a Florida-only operation except for Puerto Rico (ending early 2024), they are concentrating on ACO REACH and Medicare Advantage there. Their clinics are now 126, down from 169 at the end of June. Cano is still looking for a buyer, which indicates that they anticipate further rough going. Healthcare Dive, Cano Health Q3 Financial Powerpoint

And winding up the bad news, Mass General Brigham, which is partnering with Best Buy for their Healthcare at Home programs, will be doing it with at least 15% fewer digital staff. They are offering voluntary separation packages to those employees in the hope of finding enough takers. The offer is a not especially generous two weeks of severance for every year of service. If the magic number of 15% is not reached, layoffs will start after Thanksgiving. Reportedly a state agency, the Massachusetts Health Policy Commission, has deemed that MGB’s cost growth is too much. MGB is the largest private employer in Massachusetts with 80,000 workers. The offers were floated starting from 1 November and will close on 15 November, with layoffs if needed to be announced on 4 December. The targeting of digital is claimed to be for modernization. The area is responsible for multiple areas of IT and maintaining patients’ electronic health records. Boston Herald, Healthcare Dive

Breaking: Walgreens lays off 5% of corporate staff; chief medical officer, chief of staff for CEO to depart (updated)

November 10, 2023 | by

The Walgreens shakeup and belt-tightening continues under new CEO Tim Wentworth–starting at the top. The first company memo that was leaked late Thursday 9 November to Bloomberg (paywalled) announced that Kevin Ban, MD, executive VP and chief medical officer, will depart tomorrow (10 Nov). He will be replaced by chief clinical officer Sashi Moodley, MD, not in the memo but according to Bloomberg‘s sources. Luke Sauter, chief of staff to the CEO, will also be leaving. No date was disclosed. In a separate memo, 5% or 267 of Walgreens’ corporate staff will be laid off across multiple departments at their Deerfield Illinois HQ, no notification or effective date disclosed. Bloomberg confirmed the departures with Walgreens, but no further details were provided. The cuts will not affect call centers, micro fulfillment centers, or stores.

Looking at LinkedIn, Dr. Ban joined Walgreens as CMO in January 2022 from Athenahealth. He replaced Patrick Carroll, MD, who left to take the CMO slot at Hims & Hers. Dr. Ban was promoted to global CMO of Walgreens Boots Alliance and added the EVP title in October 2022, a little over a year ago. Dr. Moodley joined in July 2021 from CareMore Health as WBA’s CCO for US Healthcare. Mr. Sauter, the chief of staff, is a long-time (15+ years) Walgreens executive in multiple positions, including VP of strategy and finance officer after multiple finance positions. He was named chief of staff to previous CEO Roz Brewer in July 2022.

It’s perhaps understandable in a cost-cutting situation that the functions of the CMO and CCO overlap to some degree, and the chief of staff to the CEO is an unusual position in today’s companies. It also demonstrates that Wentworth is willing to distribute at least some of the pain of trimming Walgreens staff and projects as part of the previously announced $1 billion cost reduction plan after a steep fiscal Q4 net loss of $180 million [TTA 18 Oct]. Crain’s Chicago Business is also paywalled but readable in part.

This is a developing story and will be updated with additional information when available.

Update: The 5% corporate layoff, which will affect the Deerfield office, is the second this year. There was a 10% reduction in Chicago and Deerfield in May. 393 were released in August at their manufacturing plant in Edwardsville, Illinois, in anticipation of its closing. Yahoo Finance/Chicago Tribune  On Reddit, commenters indicate that marketing and health & beauty departments were the hardest hit. There was also an employee town hall that wasn’t well received.

The Healthcare Dive article published today highlights the 45% drop in share price since January, particularly steep since August, and the struggle to attain profitability in their US Healthcare division, which includes Village MD. The October-announced $1 billion in cost reductions did not buoy stock as hoped, dropping further since then. Walgreens has not replaced the CFO who departed in July.

On Friday 10 November, Walgreens also sold a hefty share of Cencora common stock (the former Amerisource Bergen) in a combination of share repurchase at $250 million and variable prepaid forward transactions starting in Q4 2026 could potentially max out at $675 million. WBA continues to own about 15% of Cencora and remains on its board. Their release explains the financial pretzel, clearly designed to improve liquidity and cash management. 

Editor’s Note/Opinion 10/11: For an employer of this size, the layoffs represent an extreme downsizing that indicates several years of overhiring or wrong hiring in pursuit of corporate goals no longer in sight and strategic mistakes (like Theranos so long ago, but biting back with a $44 million settlement to Arizona patients). Some acquisitions may not be working out. Time will tell whether the majority buy-in of Village MD and financing its further acquisitions was smart or foolish, as already the office co-location scheme is being trimmed after little time in place [TTA 18 Oct]. As is true almost 100% of the time, hard times uncover the numerical and compensation bloat at the C-suite and senior level, and many strategic mistakes.

In short, leaving aside the Cencora stock sale to raise cash, drastic cuts like this usually leave an organization at many levels and the survivors staggering for some time. They have to be done with understanding, not blame, that most of those departing weren’t responsible for corporate strategic sins and, yes, mercy on those affected, beyond one line in a press release or a town hall. Circular firing squads don’t help recovery either.

Short takes: Owlet Dream Sock FDA clearance; Best Buy-Mass General partner for at-home care; Amazon offers Prime members deeper One Medical discount

November 10, 2023 | by

Some really good news for Owlet. The Dream Sock finally got to the mountain top and received de novo FDA clearance for pulse oximetry. To date, it is the only over-the-counter medical pulse oximetry device for the baby market. This adds to the device’s Baby’s Live Health Readings, including pulse rate and oxygen saturation level. The platform also provides Health Notifications, which send alerts to a smartphone with lights and alarm sounds if baby’s readings fall outside of preset ranges. Existing and new Dream Sock buyers will be upgraded to the new features by end of 2023. The Dream Sock is for use with infants 1-18 months and 6 to 30 pounds. Pricing observed for the current Dream Sock is in the $300 range. Owlet release

This follows FDA clearance for the prescription BabySat in June [TTA 21 June]. That is scheduled to be introduced later this year in the US only. The non-prescription Dream Duo, which combines the Dream Sock with a baby cam, will continue to be sold. 

Financially, things have improved a lot since last year. The stock as of 11 July was restored to NYSE listing, but it required a reverse split and an 18 month compliance plan, Currently, it’s trading at about $4.80 which is NYSE compliant, up from well below $1 in June. Also in July, they hired a new president and chief revenue officer, Jonathan Harris, from recently acquired air purification system Molekule. In August, they reported a Q2 adjusted EBITDA loss of $4.3 million, narrowed substantially from prior year Q2’s $16.7 million. This was achieved on lower revenue of $13.1 million versus last year’s $18.3 million. Q1 revenue was $10.7 million. Q3 will be reported on 13 November. Release  Having followed them since the ‘telehealth for the bassinet set’ days of 2012-2013, their continued independence, and their focus on baby health, this Editor continues to wish them bonne chance.

Mass General Brigham’s hospital-to-home and home care programs get a Best Buy boost. Mass General plans to integrate Best Buy’s delivery capabilities for their Healthcare at Home program in several areas. For Home Hospital acute care, Best Buy will supply the Current Health remote patient monitoring program to build out a technology-enabled clinical delivery model that connects patients to nurses, paramedics, advanced practitioners, and physicians. For Home Care, Best Buy will supply Lively Mobile Plus personal emergency response system (PERS) and leverage out capabilities such as Geek Squad to supply Mass General Brigham (MGB) patients with delivery of home-based care and logistics management for the care team. MGB plans to introduce Best Buy as part of Home Hospital in five Boston-area acute care hospitals. The program is for patients with heart disease, chronic obstructive pulmonary disease (COPD) and infections. While their Home Care operation is stated by MGB to be the largest certified provider in New England, the Home Hospital program can presently cover only 33 patients at a time. MGB’s goal is to shift 10% of inpatient care to patients’ homes over the next five years, so expanding capacity and capabilities are critical. FierceHealthcare, Mobihealthnews, MGB release

Get your One Medical now, just $99 per year or $9 a month! It’s an offer hard to refuse for Amazon Prime members. It’s half off the annual membership of $199, with additional members up to five for only $6 a month or $66 annually. What Prime members get is 24/7 virtual care access without further charge through their app that includes video chats with licensed providers plus their “Treat Me Now” service, fast care for common issues like cold and flu, skin issues, allergies, and urinary tract infections. It does not include any One Medical in-office services, if available in the member’s area. The 200 million+ Prime members were briefly offered in February a $144 membership but apparently this new incentive is not only at a deeper discount, but also longer term or permanent.

Time to make that $3.9 billion acquisition pay off. This push is clearly to build up One Medical membership, which stood at only 836,000 members at end of 2022, and build up cash flow. Amazon is not reporting on the success of the earlier discount offer. A question this Editor has–if 1 million Prime members signed up–that’s only a 0.5% rate–does One Medical have the telehealth capacity to serve these patients, especially at peak usage such as cold and flu season?

Prime members are also able to access Amazon Care, which is virtual only, cash-only by medical event asynchronous telehealth services. If a Prime member goes in person to a One Medical practice, they do take insurance. FierceHealthcare, Healthcare Dive, Amazon Prime offer page

Get your goggles on! Augmented and virtual reality finally taking off, from alleviating child pain to astronaut mental health

November 9, 2023 | by

Augmented and virtual reality (AR, VR) back at last.  A few years ago, the future of everything from rehabilitation to PTSD was going to be headsets/goggles and captivating programming. Alas, it went sideways. Now a revival is taking place:

  • The Smileyscope VR platform from Australia recently received the very first Class II FDA clearance for acute pain and anxiety reduction via VR. In September, they received clearance for temporary relief of acute anxiety associated with needle procedures. Using what they term “virtual reality neuromodulation”. their Procedural Choreography technique uses positive virtual stimuli and substitution–for example, replacing a negative real-world stimuli such as a needle, replacing it with a positive virtual stimuli such as a friendly fish. According to their studies submitted for the Class II filing, self-rated pain in children was reduced up to 60% and anxiety of up to 40%. It also achieved reductions of up to 75% in caregiver distress and reduced the use of physical restraints up to 48%. Smileyscope is working with about 50 US hospitals and the NHS. Globally it has been used to reduce pain and anxiety for other procedures such as administering vaccines, bloodwork, wound dressings, anesthetic inductions, cast applications/removals, and medical imaging, thus avoiding sedation especially in children. Smileyscope has partnered with over 50 US hospitals to implement the technology.     Release, Healthcare IT News
  • VR in senior care was explored in a study from Stanford University’s Virtual Human Interaction Lab. The survey of 245 older adults and 39 caregivers in 16 senior care communities across 10 states was highly positive about VR use:
    • 81% of surveyed caregivers reported they enjoyed interacting with residents more using VR than other activities.
    • 94.9% said that using VR was “moderately to extremely beneficial to their relationship” with the patient, while 89.5% of senior care residents reported the same in their relationships with the staff.
    • 74.2% of the caregivers reported that the residents’ moods were improved, while 77.9% of the residents reported feeling more positive.
    • 57.5% of older adults reported feeling less isolated from the outside world after using VR during the study.

Mynd Immersive, formerly MyndVR, AT&T 5G Healthcare, HTC Vive, a maker of 5G products, and a group of rehabilitation and senior living communities, like John Knox Village in Pompano Beach, Florida, collaborated with Stanford on the research. Release (Yahoo Finance), HIT Consultant

  • Clinician training for naloxone (Narcan) has received the VR treatment. Before the pandemic in 2019-2020, University of Pennsylvania researchers found that VR training was as effective as standard in-person training for naloxone administration to treat opioid overdose. The immersive, locally tailored nine-minute video produced by the Penn School of Nursing and the Annenberg Center for Communications was released on 27 October for first use in Camden County New Jersey. Camden has an ongoing naloxone program to train students, staff and school administrators, bus drivers, and other entities that carry Naloxone. Camden County
  • And Space, the Final Frontier, is another place where VR will be tested to improve astronauts’ mental health. A collaboration between XRHealth, Nord-Space Aps, and HTC Vive will use the latter’s Focus 3 headset to deliver “virtual assistance mental balance” to help improve astronauts’ specific mental health needs during their six to eight-month missions. The headset, modified to withstand microgravity, and programs will be used in the upcoming NASA Crew-7 mission. Danish astronaut Andreas Mogensen will be the testing astronaut. Back here on the ground, XRHealth distributed hundreds of virtual reality headsets in Israel to 30 hospitals, assisted living and mental health centers, and nursing homes to assist patients suffering from stress, PTSD, and anxiety. Mobihealthnews

Early news roundup: Envision exits Ch. 11, splits; Walgreens’ new CIO; Philips’ $60M from Gates Foundation; more on Walmart-Orlando Health partnership; Cigna may sell MA business

November 8, 2023 | by

Staffing firm Envision Healthcare exits Chapter 11 bankruptcy, splits off AmSurg clinics. One of the Big Bankruptcies earlier this year has been reorganized, cutting $8 billion in debt by 70% and spinning off its AmSurg surgical clinics to new ownership. The hospital and physician staffing company was hurt as early as 2020 with shortages of available staff, then the pandemic which cut patient volumes, and conflicts with payers around out-of-network billing charges. The last put the company in conflict with the ‘no surprises’ patient protection billing law that took effect this year. One particular legal spat with UnitedHealthcare tied up both companies for years, but was won by Envision after an independent arbitration panel this past spring awarded Envision $91 million, finding that UHC breached its in-network contract. KKR, which had taken Envision private in 2018, lost $3.5 billion in equity, one of their largest corporate investment losses. Henry Howe, the company’s chief financial officer, takes over as interim CEO on 1 December as current CEO Jim Rechtin leaves to join Humana. Healthcare Dive  Background: TTA 12 May, 16 May   

Walgreens fills its chief information officer vacancy with the interim CIO. Neal Sample was appointed last Wednesday (1 Nov) as CIO and EVP, reporting to new CEO Tim Wentworth and joining the executive and IT governance committees. Sample was appointed last month as an IT advisor after CIO Hsiao Wang left suddenly on 2 October. Both Wentworth and Sample worked with each other at Express Scripts, with Sample holding both COO and CIO positions there, then departing for the CIO position at Northwestern Mutual. Walgreens release, Retail Dive

Philips receives an additional $44 million from the Gates Foundation for further Lumify Ultrasound System development. The total of $60 million in grants starting in 2021 was for the development of AI-enabled applications to improve obstetric care in low- and middle-income countries. The Lumify handheld ultrasound system assists frontline health workers, such as midwives, in interpreting obstetric images and identifying possible complications during pregnancy in hours versus weeks of training. The system’s Kenya trial was successful. The additional funding will be used to expand global adoption in underserved rural communities. Philips release  This follows Gates Foundation grants to GE Healthcare ($44 million) and Butterfly Network ($5 million) for easily deployed ultrasound and imaging systems to support low-income countries’ rural maternal health and respiratory scanning. Mobihealthnews

More on Orlando Health’s partnership with Walmart. Briefly noted here last week in Walmart’s release and reporting on Walmart Health’s new partnership with Centene’s Ambetter plan in Florida was the Orlando Health hospital partnership. This will coordinate care for patients admitted to the health system’s hospitals or who need specialty care. It is a first for Walmart as it has not previously partnered with local health systems on specialty and hospital care as an extension of its clinics. Eight of its 48 clinics are in the Orlando area. Becker’s Health IT 1 Nov, 6 Nov

Cigna is exploring a sale of its Medicare Advantage (MA) business. According to the exclusive report by Reuters (may be paywalled), Cigna is in early stages, at this point consulting with an investment bank. Cigna is not much of a player in the difficult state-by-state, county-by-county MA business, with 599,000 members as of 30 September, which is about 3% of their 19 million total insurance members. But it has been problematic, with Cigna recently paying CMS $172 million to settle allegations that it violated the False Claims Act by submitting incorrect data to obtain higher payments. By comparison, UnitedHealthcare and Humana have nearly half (47% or 14.5 million) of the national 30.8 million MA members (KFF). Becker’s

Week-end short takes: payer earnings for Centene, Cigna, Humana; Centene and Walmart partner in FL; Dispatch Health and US Acute Care partner; Amwell widens loss; ProMedica $710M home health sale; AQuity’s $200M sale to IKS Health (updated)

November 2, 2023 | by

On the payer side, buyers of telehealth are trying maintain course:

Challenged Centene beat Wall Street estimates, but clouds loom. For Q3 they reported $38 billion in revenue, but year-over-year profit of $469 million was down 36%. 2014 forecast earnings were already downgraded. Centene is heavily dependent, as some other payers are, on state Medicaid. New Federal guidelines are ending the automatic eligibility redeterminations that took effect during the Covid pandemic. 2024 redeterminations may take millions more off the rolls, though many requalify. The payer contracts with 31 states to offer Medicaid coverage and has lost 1.1 million Medicaid members over redeterminations to date. Their Medicare Advantage (MA) plans were also hit in 2023 with low Star ratings, which reduce desirability and payment status with CMS, but recovered for 2024 with 87% over 3 stars (the minimum) compared to 53%. Layoffs also have bitten into Centene with a known layoff of 2,000 this summer, plus another unannounced layoff terminating staff in December, according to this Editor’s source. Healthcare Dive  Update: Centene is terminating 2,000, or about 3% of workforce, with an end date of 8 December. Becker’s Payer

Cigna also beat Wall Street estimates in a generally upbeat forecast. For Q3, they reported revenue of $49 billion, up 8% year over year. Net income was down 50% to $1.4 billion but understandably as Cigna sold businesses in six countries. Membership are up 9% year over year to $19.6 billion, mostly due to commercial membership. Cigna has little exposure to ACA business, but that grew as well and margins are improving. Healthcare Dive 

Humana saw increased Q3 utilization in its MA plans plus increased Covid hospitalization. This helped to drive its medical loss ratio (MLR) up for 2023. While beating the Street on revenue of $26.4 billion and profit of $1.1 billion and with projected MA growth MA of 19%, or about 860,000 members plus 2024 of 45,000, shares went a bit wobbly. In Star ratings, they did well and maintained a 4.5 Star (out of 5) in its largest contract with 40% of its MA members while the second largest contract improved from 4.5 to 5 stars. Healthcare Dive

A brighter spot for Centene is a partnership with Walmart in Florida on ACA plans. Ambetter from Sunshine Health in Florida is adding Walmart Health Centers to its preferred provider network. This will cover seven counties and focus on care coordination and referral management. Walmart is also working with Orlando Health, a private, not-for-profit network of community and specialty hospitals across Florida, to improve care coordination in the Orlando area initially. Walmart release, Becker’s

In partnerships, Dispatch Health announced today (2 Nov) that will be working with US Acute Care Solutions (USACS) to offer additional support for patients after a hospital stay or when they need hospital-to-home alternative care. Dispatch Health offers same-day, urgent medical care; hospital alternative care; and recovery care. USACS is owned by its physicians and hospital system partners for integrated acute care, including emergency medicine, hospitalist, and critical care services. Dispatch Health release

Back to Big Telehealth, Amwell didn’t have a good quarter. Their net loss of $137.1 million was up 94% year-over-year. This quarter included $78.9 million in impairment charges linked to sustained decreases in its share price and market capitalization. So far in 2023, these impairments have totaled $436.5 million. Another hit was that revenue declined 11% year over year to $61.9 million. Amwell is working to complete the transition of its customers to Converge. On the positive but very long term side, Amwell is partnering with the Leidos Partnership for Defense Health (LPDH) with the US Defense Health Agency as part of the Digital First initiative for the Military Health System (MHS). This will replace the MHS Video Connect system with Amwell Converge, a “comprehensive hybrid care enablement platform designed to power the full continuum of care using digital, virtual, and automated modalities”, and link to MHS GENESIS, the Oracle Cerner EHR. The contract may be worth up to $180 million over 22 months in a prolonged rollout. Healthcare Dive, Amwell release

In sale news, some big numbers are posting:

Ohio-based 12-hospital system ProMedica is selling its home health, palliative and hospice business to Atlanta-based Gentiva Health Services for a tidy $710 million. Gentiva is the largest hospice care company in the US. 4,000 employees will be transitioning. The hospice operations will go under the Heartland Hospice brand by the end of 2023, with home health also joining Heartland Home Health and the palliative care business under Empatia Palliative Care brand between the end of this year and 2024. Becker’s

AQuity selling to IKS Health for $200 million. The sale will add AQuity’s medical-coding, clinical-documentation and revenue-support capabilities to IKS’ technology-backed care enablement platform. This creates a $330 million company with a 14,000 person workforce that includes 1,500 clinicians, 350 medical coders, technology experts, clinical documentation specialists, and revenue integrity specialists. Another example of a larger trend in companies acquiring specific companies to build out their platforms and become more ‘one-stop shopping’, a more attractive proposition at least for now to VCs. Mobihealthnews. More discussion on why VCs are no longer hot on niche or point solutions in MedCityNews.