Anthem-Cigna breaking: lawyers may talk, but Cigna gets to walk–and it continues in court

May 12, 2017 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/The-End-Pic-typewriter.jpg” thumb_width=”175″ /]Breaking, with a whimper. This evening (11 May), the Delaware Court of Chancery released its ruling denying a 60-day injunction requested by Anthem to prevent Cigna from ending their merger. The original merger agreement had an end date of April 30. Judge Travis Laster stayed the implementation of his ruling until Monday noon to give Anthem a chance to appeal to the Delaware Supreme Court. Reuters

Is this The End? In this Editor’s opinion, yes, the petition to the US Supreme Court for a writ of certiorari notwithstanding. I stand by my Monday observation that “the Chancery Court decision to extend for 60 days–into July– is critical to any SCOTUS hearing, as it is unlikely there would be any merit in a review of a dead deal even if there is a potentially novel issue. 

So Cigna can walk, pass ‘go’ and collect…? The open issue is now Cigna’s. There is a contractually mandated breakup fee of $1.85 bn. In February, their Funny Valentine also claimed over $13 bn in damages, on the grounds that Anthem had intent to harm Cigna’s business. Not so fast though–there will certainly be a fight over the damages. According to Bloomberg, “the judge said there was significant evidence Cigna may have violated the merger agreement by dragging its feet on antitrust concerns, which could entitle Anthem to “potentially massive damages.” The next phase of court actions will be around damages awarded to Cigna, if any; if so how much; and what is the final settlement. Dirty laundry and ‘Who Shot John?’ will fly in this same court, unless the settlement is quick and quiet, highly unlikely with these two noisy protagonists. If it remains substantial, Cigna could be shopping for acquisitions–or be a cash-rich acquisition target itself. More distractions for management.

Other mergers may be more palatable in a changing healthcare landscape…just not this one. Also Fortune. Interested in the previous details? See our coverage here, including our take on ‘whither the policyholders (patients) and corporate buyers’.

The stop-start of health tech in the NHS continues (UK)

May 10, 2017 | by

Continuing their critique of the state of technology within the NHS [TTA 17 Feb], The King’s Fund’s Harry Evans examines the current state of incipient ‘rigor mortis’ (his term). Due to the upcoming election, the Department of Health is delaying its response to Dame Fiona Caldicott, the National Data Guardian for Health and Care (NDG), on her review of data security, consent and opt-outs (Gov.UK publications).

People have significant trust and privacy concerns about their data, which led to NHS England suspending care.data over three years ago. But with safeguards in place, public polling supports the sharing of health data for uses such as research and direct care. But…there’s more. Now there is ‘algorithmic accountability’, which may single out individuals and influence their care, much as algorithms dictate what online ads we’re served. What of the patient data being served to Google DeepMind, IBM Watson Health, and Vitalpac for AI development? Have people adjusted their concerns, and have systems evolved to better store, secure, and share data? And how can this be implemented at the local NHS level? The NHS and technology: turn it off and on again Hat tip to Susanne Woodman of BRE.

A reminder that The King’s Fund’s Digital Health and Care Congress is on 11-12 July. Click on the sidebar to go directly to information and to register. Preview video; the Digital Health Congress fact sheet includes information on sponsoring or exhibiting. To make the event more accessible, there are new reduced rates for groups and students, plus bursary spots available for patients and carers. TTA is again a media partner of the Digital Health and Care Congress 2017. Updates on Twitter @kfdigital17

Hackermania meets The Dark Overlord with 2.3 million 2017 health data breaches

May 10, 2017 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”150″ /]It’s a cage match! Reports are soaring, with a proliferation of data breaches year to date, after a relatively quiet period in 2016.

The Dark Overlord (TDO), in the mainstream news with dumping unseen Netflix program episodes on illegal file-sharing sites and demanding ransom (Guardian), also has been hard at work dumping PHI hacked from various clinics. DataBreaches.net tallied it at 180,000 records from at least nine medical clinics.

Health data security developer/provider Protenus, whose Breach Barometer tracks the numbers, counted 2.1 million breaches in 1st Quarter. March spiked with 700,000 coming from Commonwealth Health Corporation of Kentucky.

Our standby Privacy Rights Clearinghouse counted over 175,000 to date, but 160,000 came from MedCenter Health in Protenus’ total, so their net addition was 15,000. But PRC’s detail illustrates that ransomware is alive, well, and invading smaller healthcare organizations. Other reasons are unauthorized data server access, third-party vendors, email error, and theft.

Thinking about a location for your health tech startup? Consider…’virtual’ Estonia!

May 9, 2017 | by

‘Extreme digital living’ is the norm in the Baltic country of Estonia, which rebuilt itself from the ground up after the formal dissolution of the Soviet Union (and each citizen receiving a distribution of €10) to one of the most advanced online-only countries in the world, far ahead of the US, the UK, and the rest of the EU. Internet access is by law a basic human right in Estonia. Digital signatures are equal in every way to paper signatures, except for marriage and divorce (a nostalgic touch). Everyday living is paperless and programming is taught in early grades. Live in picturesque Tallinn and need a delivery? It may come to your door via Starship robot, founded by one of the former Skype team. (Did you know that former Skypers have funded much of the Estonian tech and investment boom?) They take data security seriously with the Russian Bear growling (and hacking) on the border, so they created a NATO-accredited cyberdefense center in Tallinn and a whole country backup in a Luxembourg ‘data embassy’. Blockchain is a large part of this–and the government is working on using it for mapping the genome data of its 1.3 million citizens and sell it (deidentified) to precision medicine researchers.

So if you are a US, UK, EU, or even Australian-based developer, or already have a small tech company, why is this of interest? Estonia has opened a door for foreigners that is a most attractive one–virtual residency, no matter where you live. Once you’re an e-resident, simply register your company (online of course) and pay a fee of €145. You now can do business in euros–and fully access the EU. Most companies pay monthly administrative and accounting fees in Estonia, providing the country with income. About 1,400 companies have taken advantage of e-residency. It isn’t a tax haven, but if you do have income in Estonia, their corporate taxes are low–20 percent, compared to 19 percent for the UK, 30 percent for Australia, and a shattering 39 percent for the US (at present). Trading Economics And there is that tech and digital-savvy workforce as an additional incentive. Is This Tiny European Nation a Preview of Our Tech Future? (Fortune) Hat tip to TTA Founder Steve Hards

Tender Alerts: Nottingham NHS telestroke, Scotland remote health and care

May 9, 2017 | by

Our Eye on Tenders, Susanne Woodman of BRE, brings to our attention two from UK.Gov’s Contracts Finder and TED, with full information at the links:

  •  Telemedicine Solution for Stroke Services from Nottingham University Hospitals NHS Trust. Nottingham City Hospital requires an immediate replacement for a stroke Telecart which deals with out of hours (OOH) stroke emergencies. This system allows the consultants to remotely interact with patients and staff on the stroke unit. The patient is seen in real time video and audio. Future plans, not in this contract, are for a replacement system in multiple locations. Contact is Niall Fowler of the NUH NHS Trust. Closing 26 May.
  • NHS National Services Scotland Remote Health and Care Monitoring and Communication System. The procurement is intended to support the delivery of home/mobile health monitoring and video conferencing enhanced care. At a later date, this will expand to incorporate future digital telecare or wellbeing solutions. A registration of interest is required for more information, available at the Public Contracts Scotland website. Value is £ 2 million. Note: this listing is a Prior Information Notice with estimated publication 21 June. These are generally released for high-value contracts with usually a compressed application period since information has been previously published.

Better than ‘Dallas’? Anthem and Cigna in Delaware court (updated); Anthem’s SCOTUS appeal

May 8, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/sj8qohs2yc6xbxpx1bmm.jpg” thumb_width=”150″ /]The War of the Payers grinds on. It’s altogether appropriate that this is the 100th anniversary of the US entry into the Great War. It was marked by a costly strategy that stalemated in the trenches and fatally ground into dust over four years men, machines, national treasuries, and ultimately a world order. In this Editor’s view, we are witnessing it writ large in Anthem’s, and to a lesser extent Cigna’s, actions after their merger was put paid to, first by a DC Federal District, then a District Appeals court, in a suit brought by the Department of Justice (DOJ) and 11 states.

Update: In Delaware Chancery Court May 8, Anthem requested a 60-day preliminary injunction to prevent Cigna from ending their merger. This was in a hearing on the February restraining order that Anthem received to block Cigna’s exit, filed in that court, from the merger after the District Court decision. Vice Chancellor Travis Laster said (after five hours of argument) that he would rule as soon as possible. Reuters  New: Even Judge Laster admits it’s a ‘long shot’ that Aetna could find a path to success after two courts turned down the merger. Cigna’s legal spokesperson further amplified that, stating that it was ‘a near impossibility’ and that no “divestiture package would have solved” the merger’s problems. Bloomberg  See the back story below

Watch for fireworks whatever the decision. Antitrust lawyer David Balto rated its potential “more fun than watching an episode of [the television melodrama] Dallas“. CT Mirror

The Chancery Court action is far more important than Anthem’s ‘petition for writ of certiorari’ to the Supreme Court of the US (SCOTUS) for review of the lower court ruling, citing the following:

  1. The 2 to 1 split in the court decision
  2. That the 1960s court precedents relied on by the District Court must be updated to today’s understandings of economics and consumer benefit
  3. And asserting that the loss of the merger “would limit access to high quality affordable care for millions of Americans and deny them more than $2 billion in medical cost savings annually” from the improved bargaining power of the new entity

(What perhaps was not included was that the merger partner, Cigna, wants out, out, out of the merger, which does tend to put a negative cast on the whole affair, as it did for the DC District Court.)

This Editor believes that the Chancery Court decision to extend for 60 days–into July– is critical to any SCOTUS hearing, as it is unlikely there would be any merit in a review of a dead deal even if there is a potentially novel issue. In the Reuters report, Anthem’s attorney mentioned the SCOTUS petition with a decision date by early July (the end of the term). He confirmed their intent to appeal to the DOJ for a ‘negotiation’ once the Trump Administration had its nominated officials in place. In Bloomberg, Cigna’s attorney’s position is that SCOTUS wouldn’t even consider the petition until September, which would put it past the extension and a decision into the next term.

Petitions for writ of certiorari are the Hail Mary pass–the last-ditch move–of court actions. (more…)

d-Lab opens Challenge to transform use, governance of Personal Health Data

May 5, 2017 | by

d-Lab is calling for international healthcare innovators to take a good, hard look at how we can use, secure and increase access to personal health data (PHD). In this Challenge, d-Lab is seeking innovative ideas, projects, and solutions that consider wider uses of PHD for patients and research, such as:

  • innovative modes of PHD governance
  • future use in health and medical research
  • inclusion of new types of data, such as from wearables
  • contribution to wellbeing and aging solutions
  • innovative business models that assure the long-term sustainability of PHD usage and governance

The Challenge opened this past Tuesday and closes on 27 June, with winners announced in September. There will be a maximum of two
winning proposals that will lead to the setting up of a maximum of two partnerships and two pilots. See here for d-Lab’s website and here for the terms and conditions PDF. d-Lab is a program of Mobile World Capital-Barcelona. The Challenge is supported by Clinic Barcelona, Research2Guidance, and TicSalut.

Fitbit reaching out to NHS–but new smartwatch ‘a giant mess’ (updated)

May 4, 2017 | by

There have been sketchy reports of Fitbit’s CEO James Park meeting with the NHS last month to get Fitbits into the ‘big moves’ in wearables and apps promised by Health Secretary Jeremy Hunt. Mr. Park’s interview with the Sunday Times (limited access) indicated that Fitbit’s NHS project, should it happen, would be for exercise and activity monitoring, similar to the partnership with UnitedHealthcare which reduces premiums based on policyholder exercise monitoring. This move towards payers is in line with reports starting last year of Fitbit’s seeking clinical markets and moving away from the fickle B2C market. City AM

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/Fitbit-Watch-FINAL.jpg” thumb_width=”150″ /]Given this week’s leak/reveal and scuttlebutt on the new Fitbit smartwatch, Mr. Park needs to gin up a big payer, quickly. The advance buzz is not positive nor kind. It’s delayed from spring to end of year–in competition with the latest iteration of the Apple Watch. This advance photo of codenamed ‘Higgs’ from Yahoo!Finance indicates a certain clunkiness (and derivation from the panned semi-smartwatch Blaze). It’s pricey, rumored to be priced at around $300. Features include a 1,000nit, built-in GPS, heart-rate monitoring, contactless payments, Pandora and four days of battery life along with connectivity to new Bluetooth headphones. Yet TechCrunch notes “complaints about design, production delays, antenna issues and software problems.” in what they dub “a giant mess”. Forbes notes problems in waterproofing and GPS signal. There are other Android-based smartwatches that do the same for the same price or less. Will this save Fitbit? To be determined….

Update: CEO Park denies delays in the new smartwatch, saying “all new product introductions are on track”, but then again–it hasn’t been officially announced! On the earnings call Thursday, Fitbit stated that new products are now accounting for 84 percent of 1stQ revenue. The company also reported better-than-expected earnings for the first quarter of 2017, reporting an adjusted loss of 15 cents per share on revenue of $299 million. Full year projected at $1.5 – 1.7 bn. Marketwatch, The Verge

A stride ahead in gait analysis for detecting potential health issues

May 4, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/WiGait-wirelessly-measures-walking-speed-MIT-00_0.png” thumb_width=”175″ /]Readers experienced in senior healthcare know that changes in gait can be predictors or a proxy for negative change in physical or mental status, for instance when walking becomes slow or unsteady and the risk of falling rises. We’re familiar with various remote monitoring approaches such as pads, sensor arrays, camera systems such as the VICON tracker, worn sensors, and Fitbits but none so far have proven workable, widespread, or particularly accurate. A research group at MIT’s Computer Science and Artificial Intelligence Laboratory (CSAIL) have designed a system using wireless signals which can measure the walking speed of multiple people with 95 to 99 percent accuracy, the same as clinical measurement and VICON. The WiGait device is the size of a small painting and emits signals at about the level of a smartphone. It analyzes reflected signals off the body and can differentiate through algorithms the type of movement, e.g. walking versus brushing teeth. It can also gauge stride length, since changes in that may indicate progression in diseases such as Parkinson’s. Since the WiGait can be used for longitudinal tracking, gait changes can be further correlated with disease state with the intent of avoiding hospitalization. The researchers built off of previous work on WiTrack, which used signals to track behaviors from breathing and falling to specific emotions.  MIT News, Paper: Extracting Gait Velocity and Stride Length from Surrounding Radio Signals

Blue Cedar releases new security for health apps, built into the app

May 3, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/Blue-Cedar-Logo-Asset-1@3x-100.jpg” thumb_width=”150″ /]For healthcare organizations, device and app developers, one stumbling block for apps has been securing data. The endpoint for security has been to secure and manage the device, which constrains widespread BYOD use and convenient downloading. What if, instead, the apps and the data on them were secured without needing to further secure the device? This is what Blue Cedar, a mobile security developer, has done with what they call a mobile device management (MDM) alternative, with security ‘baked into the app”.

One of their first for the new platform is MedStar Health, the largest healthcare provider in the Maryland and Washington, DC region. Blue Cedar’s MDM enabled them to secure their mobile app for clinicians that contained protected patient information (PHI) yet run securely on personal mobile devices.

Blue Cedar’s Chief Product Officer, Chris Ford, spoke with this Editor and explained that their new platform (V3.14) works through injecting a security code in the mobile app, which enforces policy on encryption and use. Their Enterprise Mobility Management (EMM) can now incorporate support for secure apps on unmanaged devices, security and connectivity for VoIP-based apps, and enforcement of granular controls for HTTP-based apps. This and other features of the new platform will permit healthcare app developers to distribute apps through sites like the Apple Store or Google Play and “trust functionality” that allows control of data sharing between apps on the same device.

Blue Cedar spun off last year from IoT security company Mocana, founded in 2002, and now has over 150 customers in multiple verticals. They believe their MDM alternative is ideal for healthcare organizations and health app/wearable developers, recently adding representation in the UK and Europe. Release (PDF)

Is startup funding actually going to startups? Where are all of them, anyway?

May 3, 2017 | by | 1 Comment

Markus Pohl of Research2Guidance, in two successive blog postings, asks provocative questions on Whither Startup Funding. This Editor will attempt to summarize his key points but read both articles to get the real impact–and surprise.

  • There is $4 bn annually managed by accelerators and incubators that invest in health–over $1 bn in 1st Quarter–but only a portion of this funding goes to startups. (The $4 bn / $1 bn are not footnoted, but they are the Rock Health investment numbers [see TTA 10 Jan and 11 Apr])
  • After subtracting for ongoing investments in portfolio companies, operational costs, and ex-healthcare investments, this funding for startups is realistically closer to $300 million
  • This money will only be spent if there are startups that qualify for the 340+ accelerator and incubator programs
  •  According to the last year’s R2G survey, mHealth App Developer Economics, there are 58,000 mobile health app developers. 15,000 are considered to be in the startup phase (eligible for an accelerator or incubator program). But “The majority of mobile app developers in healthcare tend to struggle on the finance and business side.”
  • The surprise: there are not enough quality startups for the available programs, even though most startups apply to more than one.
  • “Accelerators struggle to build up a high-quality selection funnel.” They suffer from lack of awareness, especially regional accelerators.
  • Accelerators and incubators will be adapting to startup candidate scarcity–or fail–within the next two years. Narrowing their focus to certain healthcare niches and focusing on their target may help. (But there may be a bubble here–Ed.)

More than US$4bn funds raised by accelerators & incubators investing in health. Why is only a small portion landing in the hands of start-ups? and Most digital health accelerator and corporate start-up programs must refocus to survive

For TTA readers, the R2G sponsored 7th Annual mHealth App Developers survey is here. It takes about 10-15 minutes to complete, so grab a cup of coffee or tea, and go! The survey is still open for about two weeks more. It is most applicable to mobile health app developers, project managers, publishers, co-founders, digital health experts, influencers, opinion makers, and investors–in other words, our Readers! Anyone who completes the survey will receive a copy near the end of 2017.

The R2G App Developer Economics Survey is supported by a stellar roster of distribution partners, accelerators, and media partners including Bayer, PCHAlliance, Health 2.0, dhaca…and TTA.

Breaking-The Theranos Story, ch. 41: settling, not fighting, with Partners Fund on fraud

May 2, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/04/The-big-dig.jpg” thumb_width=”150″ /]Breaking News and Updated. Settled–but not settled? Theranos’ May Day celebration was an announcement of a settlement with investor Partner Fund Management (PFM) LP on their two lawsuits alleging investor fraud. PFM’s funds had invested $96.1 million in Theranos’ February 2014 funding round. The amount and terms of the settlement were, as usual, not disclosed.

PFM’s original filing in Delaware Chancery Court in October claiming fraud on various representations that Theranos had made, such as 98 percent reliability on its small sample Edison labs. The second filing in April [Ch. 40] temporarily blocked Theranos’ added equity offer to investors, an offer which had the important condition of blocking further legal action once accepted [Ch. 38]. PFM had powerful and damaging evidence on its side from 22 deposed former employees and directors to bolster its allegations of investor fraud, which was revealed in snippets from unsealed documents last week.

This settlement, according to reports, ends both court actions and permits Theranos to continue their equity offer to investors. According to Theranos, 99 percent of investors were willing to accept it, which neatly heads off additional legal actions. The offer to C-1 and C-2 investors expires 15 May. Theranos release.

Yet the depositions obtained in this case appear to have taken on a life of their own. Digging down into the WSJ report (not yet paywalled if you go in through the ‘What people are talking about’ right-hand sidebar on LinkedIn, or if you have a subscription) is the interesting tidbit that “Federal investigators have obtained depositions taken in the Partner Fund litigation, including those of former Theranos employees and directors, according to a person familiar with the matter.” The WSJ also filed to have the depositions unsealed on Monday (1 May), which an outside entity can request under the rules of the Delaware Chancery Court even after a case is closed.

Despite settlements with PFM, the state of Arizona, and CMS, Theranos still faces a live investigation from the Securities and Exchange Commission (SEC) and the Justice Department (DOJ). There are also major lawsuits from Walgreens Boots seeking to recoup its $140 million investment (and remove the egg on their corporate face) and the Colman/Taubman-Dye suit in California. The latter action has the potential to become a much larger lawsuit, as the US District Court in Northern California has requested a show-cause from the plaintiffs on including third-party sellers (Lucas Venture Group, Celadon Technology Fund, SharePost) as defendants. It also personally charges Elizabeth Holmes and former CEO Ramesh ‘Sunny’ Balwani (ch. 39).

Time and money are running out–and with a Federal investigation in the mix, the future of Theranos still resembles our picture above.

  • In March, Theranos reported $150 million in cash holdings. With another settlement, how much is left in the bank?
  • That equity offer, expiring in two weeks, may be a moot maneuver. After investors do the math and look at the calendar, they may decide that legal action may be a better way of capturing whatever’s left, before it’s all gone or tied up in Chapter 11. Perhaps PFM is smart indeed in moving to settle early.
  • Federal investigations usually do not end happily, unless you are Mayor De Blasio of NYC. Who knows what high-powered maneuvering is going on behind the scenes to prevent Ms. Holmes’ black turtleneck from becoming orange? And where in the world is co-defendant ‘Sunny’ Balwani?

Additional coverage: TechCrunch, Bloomberg  Our index of Theranos coverage is here.

Pulmonary telehealth gets hot: FDA clears MTI’s Bluetooth spirometer for home use

May 2, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/05/GoSpiro.jpg” thumb_width=”150″ /]Monitored Therapeutics, Inc. (MTI) of Dublin, Ohio received FDA 510(k) clearance for a new home spirometer (left) specifically designed to connect via Bluetooth to smartphones, tablets, and PCs. According to Michael Taylor, MTI’s Chief Development Officer, “The GoSpiro is the only spirometer currently on the market that has met the latest and more stringent ISO and FDA device requirements for home use.”

Bill Zimlich, MTI’s CEO, told this Editor more about their market and the reasons for its development. “The GoSpiro is the first to be developed specifically for the home, and also the first to pass the home use FDA requirements. “Slow spirometry” is an added differentiating feature for highly impaired patients with idiopathic pulmonary fibrosis (IPF), amyotrophic lateral sclerosis (ALS), cystic fibrosis and other conditions who would have difficulty with the fast exhalation needed for the FEV test.”

Spirometers collect information on the patient’s inhaling and exhaling air in amount (volume) and speed (flow). The GoSpiro measures forced vital capacity (FVC) and slow vital capacity spirometry (SVC) which are the two main tests used to measure lung function in patients. It connects to MTI’s proprietary platform, CarePortal, based on Qualcomm 2Net, and their GoHome Patient Health Monitor. Specifications are listed here but it appears that MTI will not be selling direct to consumer.

Currently, spirometers are infrequently used in the home, which has been to the detriment of patients with pulmonary diseases such as asthma and COPD, plus associated conditions such as heart disease. Existing units have been expensive (from hundreds to thousands of dollars, excepting some new entrants), bulky, and require manual or cabled input to telehealth platforms. While cost is not disclosed, the MTI GoSpiro appears to be the first FDA-cleared home use device to fully change this picture, and in size and type can be easily bundled with a telehealth kit. Press release. Mobihealthnews.

Others in the now-hot pulmonary game are not far behind. (more…)

ATA 2017: Telehealth 2.0 annual President’s Awards

May 2, 2017 | by

This year’s ATA 2017 President’s Awards, each honoring a company or individual, are:

President’s Award for the Transformation of Health Delivery (supported by Cerner): New York-Presbyterian OnDemand

NYP OnDemand has five services in its app which delivers services from Weill Cornell, NYP, and ColumbiaDoctors: Second Opinion, Urgent Care, Virtual Visit (telemedicine), Express Care (if you’re already in the ER, a virtual visit may shorten wait time), and Inter-Hospital Consult (a collaboration tool within the NYP network). At a recent Health 2.0 NYC Hospital Innovation Programs meeting, Jonathan Gordon (director of NYP Ventures) and Graeme Ossey (innovation manager) discussed its development (see video here, starting at 18:06, about 15 minutes).

Innovation in Remote Healthcare (supported by InTouch Health): Tyto Care

Tyto Care’s portable diagnostic device includes an FDA Class II cleared digital stethoscope, a digital imaging otoscope for ear exams, a throat scope, a skin camera and thermometer swipe. The Tyto home device includes video guidance instructions as part of the smartphone or tablet platform and connects to an online platform to send the information, either in real time or store-and-forward, to a primary care physician the user selects. Currently, they are working with American Well [TTA 2 Dec] and announced in the past month partnerships with Miami Children’s Health System and Allied Physicians Group, a 35-location pediatrics and specialty group headquartered in Melville, NY.

Other awards were: (more…)

Anthem to Cigna: This merger is on, despite the appeals court decision, but the clock is ticking

May 1, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]The War of the Payers continues.

Update: The DC Court of Appeals released its decision Friday 28 April to deny the Anthem-Cigna merger, upholding the District Court’s decision. This was a 2 to 1 vote that was issued immediately prior to the 30 April merger expiration. It cited that the savings would not mitigate the anti-competitive effects in the national, large group, and local markets, mainly in Medicare Advantage. What has been under-reported is that 11 states plus DC originally joined with the DOJ to enjoin (stop) the merger. In the US system, any healthcare merger also has to be approved by the states, and this merger was a failure in this area. Remarkably, even the dissenting judge cited problems with hospitals and doctors due to the combined company’s negotiating power.

In any rational business deal, this would be the final nail in the coffin, especially with one of the merger partners already wanting to leave. Unless Anthem wants to appeal to the US Supreme Court, this merger has reached The End of the Line. Yet publicly Anthem is pursuing, at least for the time being. In a statement, Anthem expressed “We are committed to completing the transaction and are currently reviewing the opinion and will carefully evaluate our options.”  Court decision in full. Healthcare Dive. MedCityNews.

To recap other recent developments: In February, the two insurers were filing and counter-filing each other in Delaware Chancery Court–Cigna to end their merger, Anthem to continue. Last Wednesday (19 April), Anthem filed an injunction to prevent the deal from expiring as per the merger agreement on 30 April. This injunction may be heard by the Chancery Court on 8 May, according to Anthem documents, but the main court documents are still under seal. (Law 360, via Healthcare Dive 24 April)

In prior Federal court actions, the Federal District Court in DC, based on action by the US Department of Justice, first denied the merger on 8 February on antitrust and anti-competitive grounds [TTA 9 Feb]. Unlike the also denied Aetna-Humana merger, it was publicly known, to the point where it was cited in the District Court decision, that the companies had significant disagreements on the merger. After the denial, Anthem wasted no time in appealing for a reversal of the decision with the DC Court of Appeals. Cigna lost no time in initially wanting no part of any appeal of the ruling by Anthem–and filed in Delaware Chancery Court for $13 bn in damages in addition to the contractual breakup fee of $1.85 bn [TTA 14 Feb]. Two days later, Anthem filed in the same court for an injunction to delay the merger agreement’s legal termination [TTA 16 Feb]. In March, Cigna surprisingly filed a brief in support of Anthem’s appeal (Healthcare Dive). Anthem has also denied rumors of an appeal to the Justice Department to save the merger (Reuters), which is now moot if it ever existed.

As the clock winds down, there remain rivers of bad blood and accusations of bad faith between these two organizations which will continue to be fought in court. Was this merger ever really necessary? No, and it never was, and in our 16 February/21 February update (see analysis), this Editor opines on why Anthem’s to-date persistence in pursuing this has been extraordinarily harmful–to their customers and to both companies.

Sustainable transportation models for patient access to care at lower cost

April 26, 2017 | by

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics) returns to the transportation aspect of social determinants of health earlier explored in her article on Veyo [TTA 21 Feb]. New on-demand services provide affordable ‘a to b’ transportation not only which is clean, safe and tailored to the patient’s needs, but also accountable to the health system or provider. A surprise here is that Circulation’s service is not smartphone dependent. 

Circulation, Inc. launched its Non-Emergency Medical Transportation (NEMT) system with just a few hospitals back in September 2016. This game changer company provides on-demand rides with a healthcare transportation platform and an Uber app.  To date, they have expanded significantly with over 30 new clients and ride access in over 25 states. Last week, I had the pleasure to speak with Robin Heffernan, PhD., the co-founder and CEO of Circulation, to learn how they have been able to achieve a successful cost-effective and reliable transportation system for patients and providers. A gently edited version of our conversation follows below.

How has Circulation reduced the cost of a ride with an NEMT system? How will cost savings trickle down?

Heffernan: Our health facility clients are saving costs on the ride component only.  When someone transitions from mostly using taxis to being able to use Uber rides, the cost of that ride is 40 to 50 percent less. We have not yet calculated the bigger total cost savings for our clients. When patients actually make their ride appointment, the savings begin because they are not missing a primary care appointment. Without a scheduled ride, they may decide to take an ambulance the next day to the ER for a basic cough.  I think this is a huge advance for this industry. From day one you are going to achieve significant savings on a pure ride cost basis, get increased patient satisfaction and see your patients actually getting to appointments on time. Health facilities can track for the first time a whole downstream value proposition, and actually tie transportation to appointments to costs like ED utilization. Our solution tracks this component with our clients.

How does Circulation’s transportation model impact value-based care? (more…)