2021’s bubbly $14.7 billion in digital health funding–six months that beat all of 2020

Rock Health’s roundup for the first half of 2021 definitely floats that rubber ducky. $14.7 billion in funding went to digital health companies in the US, breaking through full year 2020’s $14.1 billion, itself a record. However, the year to date is skewed by mega deals that may proved to front-load the year.

The first half boasted:

  • 372 deals and an average deal size of $39.6M
  • 48 mega deals which accounted for 59% of total H1 2021 funding
  • 11 closed IPOs and SPACs, with another 11 SPACs expected to close in 2021
  • Tripling prior year in the final month: June 2021 $3.1 billion versus $1.1 billion June 2020

It was no surprise that mental health continued in the lead for the second year, with cardiovascular, diabetes, primary care, and oncology following. Rock Health also tracks ‘value propositions’ which are led by research and development, plus on-demand healthcare neck-and-neck.

Size and stage of deals continued to enlarge. 

  • Average deals per week in 2021 totaled 11 and $548 million, compared to 2020’s seven deals and $285 million
  • The funding shift to Series D and higher levels was profound–$76 to $131 million for about the same number (51 to 54) deals. Series A through C had positive gains but relatively flat
  • Private equity firms and growth funds were more active in digital health venture investment versus venture capital
  • $100+million rounds are becoming ‘average’, comprising 59% of total funding–prompting one to think that the definition of ‘mega’ needs to be upscaled

The mix of businesses is also changing towards B2C. Direct to consumer (B2C) digital health is gaining and now is 27% of all investment, with B2B/B2C and B2B-only declining. This change was driven by big B2C players Noom ($540M), Ro ($500M), and Capsule ($300M).

Consolidation is real. Providers with broad scope are buying niche startups to fill gaps, as well as giants like Microsoft snapping up a Nuance medical transcription. To be expected when there’s pressure to acquire and sell, but often these acquisitions don’t integrate well into large parents. (Ask Philips how Lifeline worked out for them.)

One company–New York City-based Tiger Capital or Tiger Global Management–is a name that popped up repeatedly this year. Their strategy is ‘blitz-funding’: participating in 14 funding rounds totaling $1.8 billion–12% of digital health funding in first half and generally at C or D. OODA, Hinge Health, Komodo Health, and ACO organizer Aledade (not digital health) received investments from Tiger. This isn’t unprecedented, but may scare off other investors except in earlier rounds.

And SPAC salad days are likely over. The easy pickings are over, as investment funding flows in, IPOs remain attractive, the SEC’s increased scrutiny, plus SPAC investment insurance premiums are more costly.

No forecast yet for the year though. (A mistake from a few years ago they won’t repeat!) But if July is any indication, not much is cooling down unless COVID really hits again. Rock Health H1 2021 Report

The Roy Lilley-Sir Simon Stevens ‘Health Chat’ interview

Sir Simon Stevens, NHS England’s chief executive who leaves this post on 31 July after seven years, was interviewed by Roy Lilley (nhsManagers.net) for his recurring Institute of Health and Social Care Management Health Chat. This Editor has found a summary of the interview and it makes for interesting reading.

Sir Simon started with the NHS out of their graduate training program. Assigned to run a mental health facility in the North East, he introduced himself to some people on the drive by the facility and asked what they were doing. “Scattering the ashes of your predecessor” they said. From that macabre start, he went on to craft public policy under two very different Labor governments, the first ‘The NHS Plan’ in 2000 and then returning after stops at Downing Street and United Health to take over a ‘traumatized’ NHS in 2012. “The NHS was out of New Labour’s money, facing rising demand from an ageing and increasingly unequal society, and struggling to pick up the pieces from a broken social care system. It needed a new approach, and Sir Simon provided one with the ‘Five Year Forward View’ and its successor the ‘NHS Long Term Plan’” that controlled demand and improved efficiency by introducing population health management and integrated care. He was also able to secure funding, more than other agencies. Sir Simon was then expected to leave with the change of government, but then Covid-19 hit.

About halfway down, you’ll read some tart comments about the mix of digital health in the total picture of the NHS and whether digital first will stick.

With deputy Amanda Pritchard taking over, only weeks from the appointment of the new health secretary Sajid Javid replacing Matt ‘Man in a briefcase’ Hancock, the snapback in care demand, and apparently another round of a virus which should get the Henry VIII treatment (‘Will no one rid me of this meddlesome virus’?), it will surely be interesting times. Hat tip to Highland Marketing which is the strategic communications partner for the Institute of Health and Social Care Management and the Academy of Fab Stuff, and article writer Lyn Whitfield. 

News and deal roundup: another big mental health app funding, Happify Health’s prescription therapy app debuts, Alcuris approved by Scottish Digital Telecare for cybersecurity

It does seem that behavioral health apps are falling from the trees and into pots of gold. Unicorns have become so…everyday. The latest is SonderMind, a Denver-based therapist matchmaking site for both video telehealth or in-person sessions. With a $150 million Series C round, it is claiming a valuation ‘well north’ of $1 billion. Main funders were Drive Capital and PremjiInvest. Previous funding was $32 million since 2017. The new funding will support expansion from the current 10 states to national. SonderMind first asks the prospective patient to complete a short questionnaire on care needs, insurance, and payment information, then connects them to a licensed mental health professional within a day or two. For their approved therapist group, they work with them to determine the types of patients they’d like to treat. FierceHealthcare

Another behavioral health company, Happify Health, announced Ensemble, its first prescription app. Formally called a PDTx (Prescription Digital Therapeutic), it will be for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). It’s a cognitive therapy with ‘Anna’, an intuitive support app with a patented dialogue flow. Ensemble is classified as an investigational medical device at this point. Happify plans to seek a 510(k) clearance in the future. It is designed to be used in support of other mental health treatments and can be integrated into a physician’s EHR.

The app’s development was facilitated by a recently renewed FDA guidance issued in April of 2020 that lets digital health companies go to market without clearance for digital health treatments for eight psychiatric disorders including those in Ensemble. Chris Wasden, head of DTx at Happify Health, was interviewed by Mobihealthnews. We note that Happify has been around since 2012 when mental health wouldn’t get you more than one free drink at a digital health conference. In March, they scored a $73 million Series D.

And in the UK, social alarm system Alcuris announced that their Memo Hub, Memo App and the Connec+ platform have been added to the list of Scottish Digital Telecare security-assessed suppliers. They were reviewed as part of cybersecurity for third parties which process personal data. Digital Telecare is part of the Scottish Local Government Digital Office and evaluates suppliers on their business processes as well as requiring independent Penetration testing (PEN testing). In their statement, “Alcuris welcomes the Digital Offices’ “Once for Scotland” approach and recognises the value it provides across Scotland. We would like to see a “Once for the UK” approach adopted and today we have written to the Telecare Services Association (TSA), to ask if they can collaborate with the Digital Office to enable the benefits of their security assessment programme to be available across the rest of the UK.”  Hat tip to Adrian Scaife of Alcuris for the release.

Telehealth Wars: Amwell’s raises game with buys of SilverCloud and Conversa Health (updated); Teladoc’s slow member, hospital growth lead to $133M Q2 loss

Updated. Amwell’s announcement today (28 July) of the twin acquisitions of SilverCloud Health and Conversa Health for the tidy total sum of $320 million in cash and stock was, if not quite a ‘see ya and raise ya’ move, a confirmation that Amwell was going to raise its game, at long last, versus Teladoc. SilverCloud provides digital telehealth programs for common behavioral health conditions. A spinoff of Trinity College Dublin, it counts as US clients Kaiser Permanente, Optum, and Providence Health, plus over 80 percent of NHS’ mental health service. Conversa is a StartUp Health portfolio company that developed a scalable care management triage system for at-risk patients that provides automated patient outreach and engagement tools that can move them to higher levels of care where needed. Clients include Northwell Health, UCSF Health, UNC Health, Merck, MedStar Health, and Prisma Health. 

For Amwell, this expands their capabilities in the hot behavioral health area and, with Conversa, into a care management platform targeted to providers, pharma, and payers. They see digital workflows, patient engagement, a longer-term relationship with their consumer base through the continuum of care, through these two companies’ hospital, health system, health plan, and employer clients.

The wrinkle? Neither company is all that far along–SilverCloud has total funding of only $26 million but is more established with 750,000 clients and 300 organizations. Conversa’s Series B was a tiny $8 million for total funding of $34 million. Amwell also paid a premium price. According to Healthy Skeptic, a blog written by long-time UnitedHealth Group senior healthcare executive Kevin Roche, their combined revenue was $15 million–more than a 20x multiple of the purchase price. The other challenge for Amwell? Making all the systems work together in a meaningful way–and to market what can be a confusing picture properly. Amwell press release, Mobihealthnews

Update 2 August. The Irish Times, undoubtedly working a local contact at Silver Cloud, ascertained that Silver Cloud was purchased by Amwell for a price in excess of $250 million. That means a tidy payday of €23 million ($27.3 million) for the company’s founders – Ken Cahill, James Bligh, Karen Tierney, Dr John Sharry, and Gavin Doherty. If that is so, Conversa was bought for $70 million or less. One wonders why a shell game tactic was used, as Conversa is known to be an early-stage company. Hat tip to HISTalk today.

For Teladoc, growing beyond urgent care, plus integrating the former Livongo and InTouch Health, presents difficulties. Telehealth usage continues to shrink as in-person visits rebound save for behavioral health, which is also bad news for the payers as utilization goes up. Teladoc now struggles to add new members after last year’s pace. Their hospital business that came with last year’s acquisition of InTouch Health is growing more slowly than expected [TTA 16 July]. The expected cross-sales traction with the former Livongo hasn’t caught fire yet, but that may change with myStrength Complete and the myStrength app going live with health plans or employers starting this month. The first enterprise customers are a major Blues plan (likely HCSC) and a Fortune 100 employer. [TTA 14 May]. Teladoc is also growing into other areas with more continuous user engagement, such as chronic care, weight management, and primary care. That program, Primary360, is in “very very late-stage” discussions with multiple payers. Teladoc, which has never been profitable, lost $133.8 million for Q2.   Healthcare Dive

Cerner execs to VA Congressional committee: “We are committed to getting this right”

Two Cerner executives had their say in testimony to the Senate Veterans Affairs Committee last week, and they hung on by, presumably, their fingernails in their commitment to having working tests and a workable rollout of the Cerner Millenium system. This will replace the warhorse VistA system in use for decades in the VA, but incompatible with the Department of Defense’s Cerner MHS Genesis and earlier EHRs in use in military care facilities.

The EHR implementation, which is at last report costing $16 billion, failed miserably at Mann-Grandstaff VA Medical Center in Spokane, Washington in late 2020 into this year. The three-month review of the program “raises more questions than it answers,” said Committee Chair Frank Mrvan, D-Indiana. Other members concurred in being less than impressed by Cerner. Ranking Member Matt Rosendale, R-Montana, wasn’t interested in “shoveling more money into a flawed program just to keep the paychecks flowing.”

However, Brian Sandager, senior vice president and general manager of Cerner government services, pointed out that wait times at Mann-Grandstaff, with nearly 70% of veterans seen within 15 minutes of their scheduled appointment time, with urgent care patients seen within 13 minutes of arrival. Opioid treatments were flagged for alternative treatments. HealthcareITNews   Our earlier coverage here.

Cerner Government Services has a great deal riding on the successful implementation of the VA contract, including their extensive government work with DOD on MHS Genesis and other healthcare organizations within the US Government, including those listed on their website: the US Coast Guard, CDC, HHS, and CMS. 

Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care

430 telehealth and remote care companies, along with major health providers and associations, have organized to petition Congress to make permanent the changes instituted by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for the duration of the COVID-19 public health emergency (PHE). These changes will expire this year unless the pandemic emergency extends into 2022.

Like the Senate Telemental Health Care Access Act of 2021 that would extend telemental health Medicare coverage to patients without a prior in-person visit [TTA 16 June], the extension of CARES Act coverage would require Congressional action to amend the Social Security Act: for telemental health, Title XVIII; for telehealth, Section 1834(m). While the Telemental bill is actually in the Senate, the permanent expansion of telehealth and remote care would require its own and far more complicated bill and corresponding regulations.

Based on the letter (PDF link), these changes would include:

  1. Remove Obsolete Restrictions on the Location of the Patient and Provider. This is the rural geographic restriction.
  2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and
    Modalities for Telehealth. This would expand the list of practitioners, services, and also expand telehealth in some cases to audio-only consults.
  3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics
    Can Furnish Telehealth Services After the PHE. These are the ‘safety net’ providers for underserved and rural areas.
  4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services
    Offered Through Telehealth. This covers much the same ground as the Telemental bill.

What is unclear, of course, it being Washington, is how quickly Congress will bestir itself to enact these changes to existing law before the end of 2021 and the expiration of the CARES Act window with, presumably, the end of the PHE. American Telemedicine Association (ATA) releaseHealthcareITNews, FierceHealthcare

Softly, softly: GPDPR comes to screeching halt, indefinitely, to be reworked

UK GPs and offices can now take an August holiday. The entire process of GPs extracting their data for the NHS GP Data for Planning and Research (GPDPR) database and patients opting out has been halted–or “deferred” per the letter from Parliamentary Under Secretary of State Jo Churchill. Formally, the Data Provision Notice was withdrawn on 19 June–and quietly. That means no more deadline of 1 September–or, in fact, any deadline, right now. 

According to the letter to GPs:

Instead, we commit to start uploading data only when we have the following in place:

  • the ability to delete data if patients choose to opt-out of sharing their GP data with NHS Digital, even if this is after their data has been uploaded [This is a significant feature that is expanded on later in the letter–Ed.]
  • the backlog of opt-outs has been fully cleared
  • a Trusted Research Environment has been developed and implemented in NHS Digital [Security based on OpenSAFELY and the Office for National Statistics’ Secure Research Service best practices–Ed.]
  • patients have been made more aware of the scheme through a campaign of engagement and communication

The revised scheme will be created in collaboration with the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA). One wonders why these logical steps weren’t taken before deadlines were set, moved, and about five medical associations plus at least one MP excoriated the NHS publicly. Undoubtedly more tap dancing to come. Our most recent and previous coverage here. Also Pulse and HealthcareITNews EMEA.

News and deals roundup: Owlet’s $1B SPAC, Carbon Health’s $350M Series D, Series Bs by Woebot Health and b.Well, digital health rakes in $15bn

Baby monitoring system Owlet closed its SPAC late last week with Sandbridge Acquisition Corporation. It is now trading on the NYSE (OWLT) for around $8 per share. With Sandbridge’s investment and the concurrent private placement (PIPE), Owlet now has $135 million and a valuation of over $1 billion, far exceeding the $325 million estimated [TTA 17 Feb]. Owlet started in 2013 with a ‘Smart Sock’ (right) at $299 using pulse oximetry to monitor baby heart rate, oxygen levels, and sleep patterns with readouts via their app, but has expanded to include an Owlet Cam and a Dream Lab to encourage good baby sleep, which parents will be the first to appreciate. Mobihealthnews

Carbon Health, which is certainly an odd name for a primary care provider plus virtual health with a streamlined patient record/EMR system and makes insurers happy because they charge only Medicare rates, received a hefty $350 million Series D raise. Led by Blackstone Horizon Partners with Atreides, Homebrew, Hudson Bay Capital, Fifth Wall, Lux Capital, Silver Lake Waterman, and BlackRock participating, along with returning investors Dragoneer Investment Group and Brookfield Technology Partners along with a slew of private investors, it follows on last November’s Series C of $100 million for a total raise since 2016 of $522 million. Valuation is what used to be an eye-blinking $3.3 billion. Carbon’s locations are a bit strange–concentrated in California and SF area with outposts, many of which are limited service or ‘pop-ups’, in Florida, Arizona, Kansas, and NYC. Unlike the recently covered One Medical, it does not require any kind of annual concierge fee. The model is an interesting one in positing high service and low cost. The founders are also staking out becoming the largest US primary care provider, which Village Medical or UnitedHealth Group would not be delighted about. One wonders if all this staking out will work, or is to attract payer investment when the VCs decide to exit. FierceHealthcare, Mobihealthnews (referring to them as multimodal, which sounds like ocean/rail transport or articulated lorries), Forbes

Also in the Mobihealthnews article: a Series B $90 million raise by Woebot Health, developer of a mental health chatbot (ok, relational agent), and the $32 million Series B raise of b.well Connected Health, a patient-facing health management platform that will get a big boost from interoperability around patient records required under the Cures Act. Woebot’s twee infographic about their therapeutic bond study in the JMIR is woeful, though, as large parts are unreadable.

No surprise that digital health funding hit a $15 billion high in the first half of 2021, up 138%, driven in large part by telehealth investment. This is based on a report from Mercom Capital Group. FierceHealthcare

Oh, MAMA! The Medical Alert Monitoring Association meeting, 28-29 September, Chicago

If you are in the medical alert business in the US or are looking at investing here, you’re likely a member of MAMA. This year, the two-day members-only MAMA Annual Conference will take place in-person and virtually at the Park Hyatt Chicago for two days, 28-29 September. There are special rates for first-time participants upon advance application.

  • Day 1 includes a deep dive into the industry, technology trends, as well as an overview of the annual industry survey. Also on Day 1 is the Medical Alert Financial Summit. It’s included with the Annual Conference, but if you only want to attend the financial summit, a separate registration is required. With major deals such as the sale of Philips Lifeline to Connect America and VRI being on the market, it will be interesting!
  • Day 2 is for MAMA members only and includes strategic round table discussions on supply chain, the 3G to 4G conversion, government funding, remote patient monitoring, and telehealth.

Information, hotel booking, and registration page here. Hat tip to PERS Insider (free subscription here) which will be covering the conference.

Three healthcare startup events: MedStartr NYC Thursday 21 July, Dallas Startup Week starts 1 August–and apply now for UCSF Health Awards

The startup events return….

Move fast–this one is tomorrow! MedStartr (a/k/a Health 2.0 NYC) is returning to NYC with a pitch event that is both live and video. Six startups are listed to be participating: Emedevents, Pelex, Beam, Gravitas Labs, Umbrosys, and ShereHealth.co/BrooklynMinds.com. If you would like to attend live at the location in Midtown, registration and tickets are here through Eventbrite. However, do note that proof of vaccination in advance must be sent in. For the unvaccinated and vaccinated without cards, a rapid test will be performed and those with a positive test will be sent home. Negatives may stay, masked if unvaxed. (So much for the indoor removal of same!) You may feel more comfortable opting for the video version which will be presented on MedStartr.TV or on Clubhouse (app requires installation). Hat tip to our old compadre Alex Fair 

And Hubert Zajicek and the Health Wildcatters have their Dallas Startup Week kicking off on Sunday 1 August with a full five days, with 21 tracks plus special events and summits. It will both in-person at the Southern Methodist University Cox School of Business and live-streamed on Brushfire. Registration is here (and reasonable).

Health Wildcatters is also collaborating with UCSF Health Hub for the 3rd annual UCSF Health Awards. There are 18 selected award categories, including telehealth, remote and hospital diagnostics, patient cost savings and life sciences. Applications are due on 31 July. Those making it to the quarterfinal will be notified by 16-20 August, with semifinalists notified 13-17 September. Final awards are 7 October at a live ceremony in Mission Bay, San Francisco. 

IBM Watson Health’s stumble and possible fall

This Editor hadn’t thought about or seen news about IBM Watson Health in over a year…and likely, neither did you. Granted, our minds have been Otherwise Engaged, but for the company that was supposed to dominate AI and health analytics, it’s notable that TTA’s last two articles mentioning Watson Health was 25 April 2019, on a report that its Drug Discovery unit was being cut back as the latest in a series of executive cutbacks and lawsuits (MD Anderson on a failed oncology initiative), and 14 Feb 2020 on 3M’s lawsuit on unauthorized use of their software.

The New York Times in an investigative piece (may be paywalled or require signup for limited access), brings us up to date on what is happening at IBM Watson, and it’s not bright for Watson Health. IBM, like so many other companies, badly underestimated the sheer screaming complexity of health data. Their executives believed they could translate the big win on the “Jeopardy!” game show in 2011, based on brute computing power, into mastery of healthcare data and translation into massive predictive models. The CEO at the time called it their ‘moon shot’. Big thinkers such as Clayton Christensen chimed in. IBM managers sang its praises to all in healthcare who would listen. This Editor, on a gig at a major health plan in NJ that was ‘thinking big’ at the time and used IBM consultants extensively, in 2012 was able to bring in speakers from Watson for an internal meeting.

But we haven’t been on the moon since 1972 (though probes have visited Mars). Since the big push in 2011-12, it’s been one stumble after another. According to the Times:

  • The bar was set much too high with oncology. Watson researchers knew early on in their research at the University of North Carolina School of Medicine that their genetic data was filled with gaps, complexity, and messiness. The experience was similar with Memorial Sloan-Kettering Cancer Center. The products growing out of the UNC and MSKCC research, Watson for Genomics and Watson for Oncology, were discontinued last year. These were in addition to the MD Anderson Cancer Center initiative, Oncology Expert Advisor for treatment recommendations, that was kicked to the curb [TTA 22 Feb 2017] after $62 million spent. At the same time, IBM’s CEO was proudly announcing at HIMSS17 that they were betting the company on multiple new initiatives. 
  • Watson Health, formed in 2015, bought leading data analytics companies and then didn’t know what to do with them. TTA noted in August 2018 that Phytel, Explorys, and Truven Health Analytics were acquired as market leaders with significant books of business–and then shrank after being ‘bluewashed’. HISTalk, in its review of the Times article, noted that along with Merge Healthcare, IBM spent $4 billion for these companies. IBM’s difficulties in crunching real doctor and physical data were well known in 2018 with revealing articles in IEEE Spectrum and Der Spiegel

Six years later, Watson Health has been drastically pared back and reportedly is up for sale. Smaller, nimbler companies have taken over cloud computing and data analytics with AI and machine learning solutions that broke problems down into manageable chunks and business niches.

What’s recoverable from Watson? Basic, crunchy AI. Watson does natural language processing very well, as well as or better than Amazon, Google, and Microsoft. Watson Assistant is used by payers like Anthem to automate customer inquiries. Hardly a moonshot or even clinical decision support. For business, Watson applications automate basic tasks in ‘dishwashing’ areas such as accounting, payments, technology operations, marketing, and customer service. The bottom line is not good for IBM; both areas bring in a reported $1 billion per year but Watson continues to lose money. 

Saturday summer morning fun: treat yourself (or your boss) to a Dead Startup Toy

Making Lemonade Out Of Lemons. Most of our Readers have seen startups come and go. Some this Editor has profiled were regrettable. Some had Cute Factor, but still tanked. Others were high in Stonato Factor. And a few, like Theranos, had Major Fraud Factor, augering in taking hundreds of millions of OPM with it (not including legal fees).

But entrepreneurial hope springs eternal, and why not memorialize these College Trys with a toy? MSCHF of Brooklyn has style, enough to go viral with a unique spin on swag. You can go on eBay, Poshmark, or Etsy to grab a Theranos poster or mug, but you can’t get a Theranos mini MiniLab to put on your shelf as a memento mori. Or a toy Jibo [TTA 18 July 2014]  to remind you to not go up against Google and Amazon. There’s also CoolestCooler, a Kickstarted cooler/speaker/blender that never delivered the goods but burned through $14 million, Juicero, an $400 IoT juicer that laid waste to $120 million in one year, and One Laptop Per Child, a Nick Negroponte-headed $100 laptop full of clunkiness that didn’t make it past the Seven Year Itch of Reality.  (The last two are sold out)

Have some fun reviewing–and shoppingHat tip to Reader Dave Albert of AliveCor (KardiaMobile), who definitely has a sense of humor!

Volte-face: VA now puts their Cerner EHR implementation on hold

The US Department of Veterans Affairs has pulled a 180° on the Cerner EHR implementation. In a move worthy of the old-time moonshine runners, VA Secretary Denis McDonough went before the Senate Veterans Affairs Committee on Wednesday to announce that the deployment of the Cerner system in the VA is on hold. This is after maintaining two weeks ago [TTA 2 July] that they were sticking with Cerner and the implementation, pending a further review.

In the interim, the VA Office of Inspector General (OIG) issued two reports that criticized the unreliable estimating process for various upgrades to the system, including lack of complete documentation, and the implementation of the Cerner EHR at Mann-Grandstaff VA Medical Center in Spokane, Washington, starting in October 2020. HealthcareITNews

In a classic ‘falling on one’s sword’ in the Wednesday hearing, Secretary McDonough told the committee that the project review found multiple “governance and management challenges” as well as patient safety concerns and system errors. He attributed them to VA and Cerner leadership, or lack thereof. For instance, VA clinicians couldn’t easily find help from Cerner on the initial rollout at Mann-Grandstaff VA Medical Center. The clinician using it called the help desk, reaching a Cerner employee there but a week. The Cerner EHR also generated duplicate prescriptions and confused patients.

The approach to implementing the modernized Cerner EHR approach will be ‘reimagined’ (DC-speak for redoing what should have been done right the first time, which started in 2017). This will start with a new, enterprise-wide governance structure to manage the project and integrate it with other modernizations, according to the Secretary. He admitted that the original plan to roll out the EHR by geographic area was a mistake. It will also not be synchronized with the Department of Defense rollout, which has proceeded without serious hitches. Go-lives will now be based on evidence of readiness, such as training, infrastructure, and management.

The Deputy Secretary has been designated to be directly in charge of the project. Acting undersecretary for health Richard Stone, MD, who had been in charge of the Cerner implementation, resigned in June after not being considered for the deputy secretary post. Secretary McDonough pitched the senators on quickly confirming nominee Donald Remy, with whom he will be speaking on big decisions. (One would hope. Mr. Remy, who was confirmed on 15 July. )

The final straw for the senators was budget. HISTalk summarizes: “The cost of the project, which was originally estimated at $10 billion when Cerner was awarded a no-bid contract in 2017, has risen to over $20 billion. McDonough has ordered a new budget estimate for the entire project, which will include the several billion dollars of infrastructure upgrades that the original estimate missed.”

Looks like the Old Gray Mare of EHRs, VistA, will be lingering for awhile. This Editor lays even money that the senators will be discussing the same issues, such as revenue cycle management, in 2025. Becker’s Hospital Review, Federal News Network

The King’s Fund annual conference returns in November, virtually

The King’s Fund has been able this year to maintain a virtual event schedule, of conferences, one-hour free events, and three-hour workshops. Thus it was good news that one of those conferences will be their annual conference 29 November-2 December, but not in person quite yet. It will be full virtual, first live then on demand through the end of the year. Content will center around:

  • the role of the NHS and the wider health and care system in tackling health inequalities
  • what the new health and social care Bill means for the system in England
  • how the recovery from the impact of the Covid-19 pandemic is being managed and plans to meet the backlog challenge
  • how to meet the needs of the health and care workforce.

For more information, registration, and sponsorship opportunities, check their conference page here.

The implications of Teladoc’s integration into Microsoft Teams

The Big News this week was the terse announcement by Microsoft and Teladoc that Teladoc’s Solo application for hospitals and health systems will be integrated into Microsoft Teams applications. The integration includes workflows and through Solo, integration into EHRs while remaining in Teams.

During the pandemic, many health systems resorted to Microsoft Teams to communicate internally and one-on-one with patients. Integration means that while on the Teams consult, a clinician can securely access clinical data included within the EHR and workflows via Teladoc Health Solo without leaving it. It can also connect care teams on the consult. The release also mentions the magic words artificial intelligence and machine learning, without giving examples. 

As of now, with telehealth receding to perhaps 5% of visits based on claims [TTA 9 July], it’s a strategic win for Teladoc to integrate with a part of the Microsoft suite widely used by providers. It also builds on an existing relationship between the companies, as Teladoc already uses Azure as one of its cloud providers. Health systems still have to license Teladoc Solo if they do not already, and engineering work is yet to be done. Teladoc has a substantial foothold in this market due to its July 2020 acquisition of InTouch Health. InTouch’s hospital-to-home telehealth is now Teladoc Solo, with a separate line of business into the specialty telehealth consult market through its portable wheeled telehealth carts for in-hospital use. It’s notable that the InTouch brand remains, albeit visibly transitioning to Teladoc.

According to Credit Suisse’s analysis (page 3), 46% of C-Level executives from hospitals and health systems (combined representing 563 hospitals) said that they currently work with Microsoft Teams as a telemedicine vendor. 11% said they already work with Teladoc/InTouch Health.

As for telehealth already used by providers, such as Zipnosis’ ‘white label’ triage/telehealth system (now owned by insurtech Bright Health) and Bluestream Health, can they compete? Also FierceHealthcare

UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’

UnitedHealthcare and its parent UnitedHealth Group (UHG) have been busy in the past few weeks. Of most interest to our Readers with an interest in data analytics is UnitedHealthcare’s pilot of a social determinants of health (SDOH) initiative that uses de-identified claims data to identify members at high health risk due to social factors. UnitedHealthcare call center staffers then contact members to further determine needs and to assist them with appropriate community resources. These can include assistance with childcare, obtaining internet access, financial assistance with medical bills, healthy food options, and local support groups. Staffers are also trained to extend the conversation beyond the first call.

SDOH factors can impact up to 80% of a person’s health, according to research performed by the Robert Wood Johnson Foundation.

The predictive analytics model for SDOH was developed with Optum from data gathered from 300 markets and across 100 metrics. Call center staff are also clued to members with needs through keywords or phrases that indicate a need for assistance: “I’m hungry” or “I’m struggling to make ends meet”. The initiative also allows employers to design interventions for their employees.

The pilot is for two employer products, Advocate4Me Elite and Advocate4Me Premier. About half of the contacted members in the pilot have accepted assistance. UnitedHealthcare plans to roll the program out to other fully insured employer plans later this year. Release, FierceHealthcare

UnitedHealth Group, the parent of UnitedHealthcare and Optum, published its annual corporate Sustainability Report. where SDOH has a considerable part. It’s a roadmap for transformation into a high-performing health plan that is part of a modern, high-performing health system–a very high bar for UHG as the largest US health plan. This builds on six points detailed on page 9, most of which SDOH affects:

  • Expanding access to care
  • Improving health care affordability
  • Enhancing the health care experience
  • Achieving better health outcomes
  • Advancing health equity
  • Building healthy communities

SDOH has become significant enough to become the subject of a House bill, HR 2503, the Social Determinants Accelerator Act of 2021, to support community groups in coordinating health and social services through grants, technical assistance, information exchange. It, of course, would not be complete without a federal inter-agency technical advisory council. There is a similar bill in a Senate committee and funding made available to the Centers for Disease Control and Prevention’s Social Determinants of Health Program. FierceHealthcare