News roundup: dogs sniffing out COVID, CVS rolling out OTC COVID tests, Hydrogen Health launches, Alcidion UK acquires ExtraMed

April 24, 2021 | by

Woof! A trained dog can sniff out COVID-19 with 96 percent accuracy. Based on a study by the University of Pennsylvania’s School of Veterinary Medicine, their trained dogs could recognize the unique odor signature of infection from saliva and urine samples. From the study: “Dogs successfully discriminated between infected and uninfected urine samples, regardless of the inactivation protocol, as well as heat-treated saliva samples.” The specially trained dogs were all Labrador retrievers ranging in age from 1.5 to 2.5 years, along with a six-year-old Malinois. The training took three weeks. However, the length and expense of the training, plus the dogs consistently treating as positive two samples where donors were negative in PCR testing but with one person recently recovered and the other exhibiting symptoms, may limit canine detection. FierceHealthcare, PLOS One.

But without a trained dog, you might be relieved to know that CVS is carrying in-store COVID rapid tests, rolling out in various states:  the Ellume COVID-19 Home Test, the Abbott BinaxNOW COVID-19 Antigen Self Test, and the Pixel by LabCorp PCR Test Home Collection Kit. All three tests have received FDA Emergency Use Authorization (EUA) which means they are not FDA cleared, but they don’t require a prescription and can be used by those with or without symptoms. CVS is placing them in-store initially in different and limited numbers of states, with the Abbott test set to be most widely available, plus online ordering. Healthcare Finance

Hydrogen Health launches a joint venture between Anthem, K Health, and Blackstone Growth. Its purpose is kind of the usual–improve care and care access at a lower cost. K Health combines a symptom checker with telemedicine–a $19 flat visit charge to see a clinician, including pediatricians. The release is a model of forward-thinking opacity as to what “innovative, digital-first healthcare solutions” might emerge, but they will target consumers, employers, and health plans. K Health’s CEO Allon Bloch will also serve as the CEO of Hydrogen Health. There is a put-and-call agreement between Anthem and Blackstone as part of the financials regarding the selling and buying of shares in the company. FierceHealthcare, Healthcare Dive

In the UK, Alcidion Group, a hospital software provider in interoperability, workflows, and clinical decision support with the Miya product suite and Patientrack, is acquiring ExtraMed. ExtraMed’s software provides real-time visibility of patient flow for NHS trusts. According to the release, ExtraMed will be purchased from current owner Hospedia, a bedside communication and entertainment unit provider. ExtraMed currently has nine customers in the NHS, including involvement as a partner in a 10-year Digital Control Centre project at Salford Royal NHS Foundation Trust. Alcidion works with 40 hospitals across the UK and is headquartered in South Yarra, near Melbourne, Australia. Alcidion news page

‘Insurtech’ Oscar Health adds +Oscar tech platform to market health plan and member engagement services

April 24, 2021 | by

Oscar Health putting $1.4 bn in IPO cash to work. Oscar Health announced the formation of a stand-alone platform, +Oscar, to provide healthcare partners with a range of services to benefit providers, payers, and patients/members. The new unit will be headed by Meghan Joyce as COO and EVP. There is no website yet for +Oscar nor mention of a start of business date but an email contact for the unit.

+Oscar will offer a range of services to enable partners to:

  • Lower costs through an efficient, full-stack platform and health plan infrastructure–integrated, end-to-end health plan services. Oscar is claiming they can achieve the administrative efficiency of far larger health plans, targeting provider-sponsored and regional health plans.
  • Create member experiences that are marketable and can drive growth and retention; that catch the attention of brokers and members plus enables flexible plan designs that can save money for members. Oscar is also hiring out Care Teams.
  • Power effective medical cost management and deliver on value-based care by closing care gaps, improving quality scores, enhancing value capture, and more.
  • Empower providers to manage care at scale: bi-directional integrations with existing electronic medical records and workflow tools.  

Why it’s important. It’s an interesting and fast redeployment of assets developed to run Oscar’s plans and services, repackaged to sell to smaller health plans. Large insurers took years to realize that they could package and sell their systems to other health plans and employers; independent companies do the same (for instance, network management and provider credentialing). Oscar is also partnering with Cigna on co-branded California health plans. Selling the technology can create real revenue (ask UHG’s Optum), even more so than health plans. It also might help their profitability problem [TTA 9 Feb]. Release, FierceHealthcare, Becker’s.

Mayo Clinic creates AI-powered clinical decision/diagnostics support platform, two digital health portfolio companies

April 23, 2021 | by

“Changing the nature of healthcare from episodic to continuous”. Mayo Clinic announced the launch of the Remote Diagnostics and Management Platform (RDMP) that will connect data to artificial intelligence (AI) algorithms and create a ‘next generation’ of clinical support tools, diagnostics, and care protocols for faster diagnostics and more continuous care. According to Mayo Clinic Platform president John Halamka, MD, “clinicians will have access to best-in-class algorithms and care protocols and will be able to serve more patients effectively in remote care settings.” Patients will be able to access information to take better control of their health and make more informed decisions.

Mayo Clinic, with partners, is also organizing two portfolio companies to support RDMP:

  • Anumana, Inc. With nference, a synthesizer of biomedical data, Anumana will bring to market digital sensor diagnostics to decipher electrocardiograms (ECGs). The objective is to more effectively spot heart disease at the pre-symptomatic stage, enabling early treatment that saves patients and costs. Their first project will be to develop neural network algorithms based on billions of relevant pieces of heart health data contained in Mayo’s Clinical Data Analytics Platform, including millions of raw ECG signals. nference with Mayo in the past year has released COVID-19 molecular research based on Mayo data. Anumana completed a Series A of $25.7 million funded by the partner companies plus Matrix Capital Management, Matrix Partners, and NTTVC.  nference release.
  • Lucem Health Inc. With Commure, a General Catalyst portfolio technology company that accelerates healthcare software development, Lucem will develop the platform for connecting remote patient telemetry devices with AI-enabled algorithms. Lucem is kicking off with a jointly funded $6 million Series A. 

We noted back in 2019 Dr. Halamka’s move to Mayo to head up a machine learning/AI initiative which took a while (during a pandemic year) but is moving quickly. The Mayo release includes a YouTube video of Drs. Halamka and Friedman explaining Anumana’s objectives in early diagnosis reading ‘those invisible signals’ well ahead of an event, especially needed with heart disease as the first symptom may be devastating or deadly. Hat tip to HISTalk, which also amusingly notes Dr. Halamka’s sartorial changes.

 

A new event–and not all virtual! HLTH and CHIME to launch ViVE in March 2022.

April 21, 2021 | by

Does it seem like forever that there’s been a new digital health conference, fully in-person–and not labeled HIMSS? HLTH, a relatively new entrant to the big healthcare event calendar starting in 2018 in Las Vegas, and CHIME, The College of Healthcare Information Management Executives, will launch ViVE on 6-9 March 2022 at a location (TBD) in Miami Beach. They are positioning it as an annual event for digital health leaders innovating across the spectrum of health and care. 

The event will incorporate CHIME’s spring forum, a full plate of networking events and presentations, matchmaking, the ViVE Expo, and a gala. For more information on the event or to register interest as a sponsor or partner, see the ViVE page. Release. 

(This Editor admits that the thought of a new and in-person conference is exciting. It’s nice to contemplate normality!)

CHIME is a 5,000-member association of C-level and senior healthcare IT leaders across 56 countries. The organization parted from the annual HIMSS event this year in Las Vegas 9-13 August, which will be a hybrid in-person and virtual conference [TTA 4 Feb]. Registration and information on the event have been updated.

The HLTH 2021 next event is in Boston 17-20 October. Like HIMSS, it’s scheduled to be a combination in-person and virtual event. HLTH is more broadly inclusive of healthcare care models and consumer health issues. The in-person portion will be at the Boston Convention & Exhibition Center, located in the Seaport District. 

Good news! Eight software functions no longer classified as medical devices under FDA.

April 21, 2021 | by

Good news for medical device designers. FDA is amending classification regulations as a result of changes made by the 21st Century Cures Act to the Federal Food, Drug, and Cosmetic Act (FD&C Act). These remove certain software functions from the definition of a device  “including software functions that are solely intended to transfer, store, convert formats, or display medical device data and results, including medical images or other clinical information.” The changes apply to software in the following devices and systems:

Calculator/Data Processing Module for Clinical Use
Continuous Glucose Monitor Secondary Display
Automated Indirect Immunofluorescence Microscope and Software-Assisted System
Medical Device Data Systems
Home Uterine Activity Monitor
Medical Image Storage Device
Medical Image Communications Device
Picture Archiving and Communications System (PACS)

Read more in the Federal Register. Hat tip to HISTalk Monday Morning Update

News and deal roundup: Microsoft’s $20B deal for Nuance; Cigna Evernorth finalizes MDLive; GoodRx buys HealthiNation; Papa’s $60M Series C

April 21, 2021 | by

Our Big Deal is Microsoft’s acquisition of Nuance Communications, a cloud and AI-based speech recognition company which has been a leader in healthcare for a few decades. Most recognizable are their Dragon and PowerScribe trade names. Microsoft is paying $56.00 per share, a 23 percent premium to the closing price of Nuance on 9 April, an all-cash transaction valued at $19.7 bn. Closing is projected to be end of 2021 as subject to regulatory and final shareholder approvals.

Nuance and Microsoft have closely worked together for some time with Microsoft Cloud using Nuance speech recognition and Nuance clinical speech recognition offerings built on Microsoft Azure. Nuance claims that in the US, 55 percent of physicians, 75 percent of radiologists, and 77 percent of hospitals use their products. It’s a big but expected bet for Microsoft in healthcare against Apple that is expected to double Microsoft’s total addressable market (TAM) in the healthcare provider space to nearly $500 billion. It also adds enterprise AI expertise and customer engagement solutions in Interactive Voice Response (IVR), virtual assistants, and digital and biometric solutions for companies outside of healthcare. Microsoft release, Becker’s Health IT

Cigna closed its purchase of telehealth provider MDLive on 19 April. Purchase price and management transitions were not disclosed. MDLive will be part of Evernorth, Cigna’s health services portfolio. That portfolio includes Accredo, Express Scripts, Direct Health, fertility health, and more. Earlier coverage 27 February. Evernorth release, FierceHealthcare. 

GoodRx closed its purchase of health education video producer HealthiNation. Sale price was not disclosed. HealthiNation’s video library will reinforce GoodRx’s consumer information on prescription prices for better consumer decisions. Release, Mobihealthnews  

Senior services and socialization ecosystem Papa now has a brand new Series C of $60 million, via Tiger Global Management. Papa connects seniors with Papa Pals, a ‘family on demand’ that appear to be heavily college students. Papa Pals visit with them and provide in-person and virtual companionship, assist with house tasks, technology training, and transportation to doctors’ appointments. Scheduling is done via a smartphone app. The company added Papa Health last year, connecting in ‘Papa Docs’ (an unnerving term for those who recall ‘Papa Doc’ Duvalier of Haiti) for primary care, chronic care management, and urgent care. Papa works extensively with Medicare Advantage plans such as Humana, Reliance, Florida Blue, and Aetna. Founded in Miami in 2017 with now total funding of over $91 million and available in 50 states, earlier round funders include Comcast Ventures and Canaan Partners. Release, Crunchbase, FierceHealthcare

‘Most Reputable’ healthcare technology companies ranked

April 21, 2021 | by

RepTrak has a mission–quantifying reputation, brand, and ESG (environmental, social, and corporate governance) performance for their clients. Their product is software and algorithms that monitor real-time perception data for companies to increase reputation intelligence. A way to market themselves is to issue a Top 100 list (PDF link) of top-scoring companies primarily in mass-market and luxury brands, plus automotive, retail, financial, media and entertainment, and technology companies. Becker’s Health IT picked out health tech-related companies as follows:

Bosch (#4)
Microsoft (#10)
Philips (#13)
Google (#15)
3M (#20)
Apple (#46)
Hewlett Packard Enterprise (#49)
IBM (#54)
Salesforce (#89)
Amazon (#92)

These companies in the Top 100 averaged 74.9 in Global Reputation Scores, a composite of products and services, innovation, workplace, governance, citizenship, leadership, and performance. 

This Editor was surprised that Becker’s missed Samsung (#17), in medical imaging monitors, dedicated smartphones, monitors, and in many of the tablets that are used in remote patient monitoring and telehealth; LG (#67) in the same lines of business; Dell (#72) in computing, cloud, and monitors; and Honeywell (#77). 

Pharma and related companies were in the lower-ranked group: Lilly (#82), Roche (#87), BristolMyers Squibb (#94), and BASF (chemicals for pharmaceuticals and vitamins).

Notably, healthcare service companies such as health plans were not included in the ranking. Are they RepTrak clients? (Do they dare?)

The top three companies? Lego, Rolex, and Ferrari. The last only before the repairs come needing replacement parts!

Short takes 9 April: Doro phones to elderly isolated; funding to Vesta Healthcare, Zedsen; Anthem partners with Canvas EMR, Health Metrics (AU) new owner

April 9, 2021 | by

Today’s News from all over roundup….

Doro in the UK is participating in the ‘Do Good’ initiative with the mobile network giffgaff. Doro is donating 500 Doro phones to isolated elderly people across the UK, as part of their efforts in other countries such as Germany, France, and the Nordics. The tie with giffgaff came about after their announcement of ‘goodybank’ to help those in UK communities facing hardship. Release

Vesta Healthcare raised $65 million in a venture round, bringing its financing since 2018 to $105 million (Crunchbase). Vesta connects a network of caregivers to at-home care and clinical care management. This round was led by Deerfield Management with participation from existing investors Oak HC/FT, Kaiser Permanente Ventures, Lux Capital, Generator Ventures, Nationwide, CareCentrix, and Epstein Partners plus K2 HealthVentures. Vesta is HQ’d in New York City and provides services in five states, which will be expanded with the new funding. Release. Hat tip to HISTalk

London-based Zedsen raised $12 million (£8.7 million) in a Series B which apparently is its first reported financing. Also joining them is Dr. Caroline Hargrove CBE, former CTO of Babylon Health, as Chief Technology Officer. Zedsen provides non-invasive skin biosensor-based monitoring of human body functions to create personalized insights about health, fitness, diet, and emotional wellbeing. The investors include: Joseph R. Grano, former Chairman and CEO of UBS Financial Services Inc; Nasser Kazeminy, Investor, Founder of NJK Holding and Chairman of the Ellis Island Honor Society (EIHS); Tony Rice, Former CEO of Cable and Wireless; Bonnie Mcalveen Hunter, Chairperson of the Red Cross; and Jim Harpel, Investor at Palm Beach Capital. Release, Mobihealthnews

Health payer Anthem is constructing an interesting partnership with a physician-targeted EMR, Canvas. Canvas will integrate Anthem member information into their EMR workflows as part of Canvas Payer SDK (software development kit). The company is leveraging this function as in primary care, usually health insurance claims data are a reliable source of patient data. They also gained a brand new Series A of $17 million funded by Inspired Capital and IA Ventures after seed and venture rounds. Becker’s Health IT, TechCrunch 

And Down Under, Tanarra Capital acquired a majority stake in Health Metrics, a software provider that supports Australia’s residential aged care, retirement living, community, and disability sectors.

Google’s Care Studio patient record search tool to pilot at Beth Israel Deaconess Medical Center

April 9, 2021 | by

A cleaned-up Project Nightingale? Beth Israel Deaconess Medical Center (BIDMC) in Boston announced their participation in a pilot with Google of Care Studio, described in the BIDMC press release as “a technology designed to offer clinicians a longitudinal view of patient records and the ability to quickly search through those records through a single secure tool.” In other words, it’s like Google Search going across multiple systems: the BIDMC proprietary EHR (WebOMR), core medical record system, and several clinical systems designed for specific clinical specialties. All the clinician need do is type a term and the system will provide relevant information within their patient’s medical record from these systems, saving time and promoting accuracy. (See left)

The BIDMC pilot will use a limited group of 50 inpatient physicians and nurses, to assess the tool’s quality, efficacy, and safety of its use. Technical work starts this month.

At the end of the BIDMC release, it’s carefully explained that the tool is “designed to adhere to state and federal patient privacy regulations, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and industry-wide standards related to protected health information. BIDMC and Google Health have entered into a Business Associate Agreement (BAA) to ensure that both parties meet patient privacy obligations required under HIPAA. BIDMC patient data will be stored and maintained in a protected environment, isolated from other Google customers.” (Editor’s emphasis) The BAA was inked in 2018.

Without referring to it, it addresses the controversy surrounding Google’s Project Nightingale and Ascension Health, a major privacy kerfuffle pre-COVID that broke in early November 2019. From the TTA article, edited: “Google’s BAA allowed them apparently to access in the initial phase at least 10 million identified health records which were transmitted to Google without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names and dates of birth.” Ascension maintained that everything was secure and Google could not use data for marketing or other purposes not connected to the project, but handling was under wraps and Google employees had access to the data. Ascension’s core agreement was about migration of data to Google Cloud and providing G Suite tools to clinicians and employees. But apparently there was also a search tool component, which evolved into Care Studio.

Health and Human Services (HHS) Office of Civil Rights, which governs privacy, announced at the time an investigation. The only later reference this Editor was able to locate was in HIPAA Journal of 5 March 2020 regarding the request of three Senators from both sides of the aisle demanding an explanation on the agreements and what information Google employees accessed. The timing was bad as then COVID hit and all else went out the window. In short, the investigations went nowhere, at least to the public.

It would surprise this Editor if any questions were raised about Care Studio, though BIDMC’s goal is understandable and admirable. Also Becker’s Hospital Review, FierceHealthcare

Deal and news roundup: Therapy Brands’ big KKR investment, AppliedVR’s non-painful $29M Series A; Akili tests cognitive-boosting games; Firefly Health lights up $40M; Mastercard-b.well partner, two big IPOs filed, more

April 8, 2021 | by

Behavioral health stays on the bubble. Therapy Brands, a Birmingham, Alabama-based company with a suite of mental and behavioral health practice tools for providers, announced (7 April) that major investment firm KKR will take a majority interest in the company. Existing investor PSG will participate. Exiting are current investors Lightyear Capital LLC, Oak HC/FT, and Greater Sum Ventures. Neither expected closing nor financial terms were disclosed. Previous investment was private equity and is not available (Crunchbase).

Therapy, founded in 2013, has a suite of practice management, telehealth, and data collection tools encompassing practice management; software tools for substance, psychotherapy, and rehab treatment; two HIPAA-compliant telehealth/e-prescription platforms; billing; and staff performance evaluation. It’s remained under the radar yet boasts leadership from Greenway Health–their CEO, Kimberly O’Loughlin–Community Brands, Advance Publications, ADP, and Henry Schein. 

Virtual reality and its effects on the brain are growing warm as an approach to pain management. LA-based AppliedVR announced a $29 million Series A with F-Prime Capital, JAZZ Venture Partners, Sway Ventures, GSR Ventures, Magnetic Ventures, and Cedars-Sinai. Their EaseVRx was the first VR-based prescription therapeutic to receive FDA Breakthrough Device Designation late last year to care for treatment-resistant fibromyalgia and lower back pain. VR is used to modulate the brain’s perception of pain through cognitive behavioral therapy, mindfulness, and biofeedback, reducing it in intensity and emotional effect. Total funding is $35 million since 2016. While still in clinical trials for other types of pain management (recent release), EaseVRx is being used by 200 provider groups and 60,000 patients. This Editor noted their inclusion in a Louisville Thrive Center showcase back in 2017 when Care Innovations was there; they are still listed under Social Engagement. Release. FierceHealthcare includes AppliedVR with a roundup of March deals.

Related in brain management is therapy for a long-term effect of COVID-19 infection recovery–cognitive impairment. An emerging long-term effect of COVID-19 illness in some individuals has been ‘brain fog’. Akili Interactive of Boston is collaborating with Weill Cornell Medicine, NewYork-Presbyterian Hospital, and Vanderbilt University Medical Center to evaluate their video game-based digital therapeutic AKL-T01 as a treatment for patients with cognitive dysfunction following COVID-19. Their EndeavorRX has also been used with therapy for children with ADHD and includes a behavior tracking app. Release

Boston-based startup Firefly Health scored a luminescent Series B of $40 million. Their current platform provides integrated in-person and virtual primary health along with specialist referrals and behavioral support in what they term a ‘digital Kaiser’. The raise will be used to launch a targeted health plan offering. Firefly already works with Aetna, Anthem, Tufts Health Plan, and UnitedHealthcare, among others, but at this time is pretty much limited to Massachusetts and does not accept Medicare nor Medicaid. Jonathan Bush, former CEO of athenahealth, joined back in 2019 as executive chairman a year after his departure. FierceHealthcare

And in other news…

Two IPO filings plus a SPAC:

  • Privia Health, a national physician platform furnishing management services to providers such as group formation (ACOs) and technologies for coordination and value-based patient care, announced their S-1 with the SEC. No share offering information was disclosed. Lead managers are Goldman Sachs and JP Morgan, so it will be sizeable.
  • Agilon Health, another management services company organizing community physicians for Medicare Advantage in their ‘Total Care Model’ value-based care for 65+, announced their S-1 for 46.6 million shares priced between $20 to $23 per share. At the low price, this would be a raise of $932 million. JP Morgan, Goldman Sachs, and BofA Securities are leads. Hat tip on both to HISTalk Morning Headlines.
  • Better Therapeutics, a digital therapeutics/cognitive health platform addressing type 2 diabetes and cardiovascular disease, will be merging with a SPAC, Mountain Crest Acquisition Corp. II, closing by late summer for listing on NASDAQ. Projected: $113 million of cash proceeds, including a fully committed $50 million PIPE and up to $57.5 million of cash held in the Mountain Crest II trust account assuming no redemptions, for a valuation of about $187 million. Release, Mobihealthnews

Mastercard and b.well Connected Health, a consumer health management platform via employers, health systems, and health plans, are launching a patient identity verification tool for mobile phones. FierceHealthcare

And a health tech entrepreneur turns towards the payer side, for now. Karl Hess joins Texas Health Aetna, a joint venture between Arlington-based Texas Health Resources and Aetna, as interim CEO. Mr. Hess is better known to health techies on LinkedIn as principal of OnDigitalHealth Consulting, Kalico Partners in population health management, Welltok, and Collain Healthcare. Becker’s Payer Issues

A smash Q1 for digital health funding–but the SPAC party may be winding down fast

April 7, 2021 | by

An Overflowing Tub of Big Funding and Even Bigger Deals. The bubble bath that was Q1 deals and funding is no surprise to our Readers. Your Editor at one point apologized for the often twice-weekly roundups. (Better the Tedium of Deals than COVID and Shutdown, though.)

Rock Health provides a bevy of totals and charts in its usual quarterly summary of US digital health deals.

  • US funding crested $6.7 bn over 147 deals during January through March, more than doubling 2020’s $3.1 bn in Q1 over 107 deals.
  • Trending was on par through February, until it spiked in March with four mega-deals (over $100 million) over two days: Clarify (analytics), Unite Us (SDOH tech), Strive Health (kidney care), and Insitro (drug discovery). These deals also exceeded 2020’s hot Q3 ($4.1 bn) and Q4 ($4.0 bn).
  • Bigger, better. Deals skewed towards the giant economy size. $100 million+ deals represented 66 percent of total Q1 funding
  • Deal sizes in Series B and C were bigger than ever, with a hefty Series B or C not uncommon any more. Series B raises were on average $49 million and C $77 million. One of March’s megadeals was a Series B–Strive Health with a $140 million Series B [TTA 18 Mar].
  • Series A deal size barely kept up with inflation, languishing in the $12 to $15 million range since 2018.
  • Hot sectors were a total turnaround from previous years. Mental health, primary care, and substance use disorders, once the ugly ducklings which would get their founders tossed out of cocktail parties, became Cinderellas Before Midnight at #1, #2, and #3 respectively. Oncology, musculoskeletal (MSK), and gastrointestinal filled out the Top 6 list.
  • M&As were also blistering: 57 acquisitions in Q1, versus Q4 2020’s 45

Given the trends and nine months to go, will it blow the doors off 2020’s total funding of $14 bn? It looks like it…but…We invite your predictions in the Comments below.

Les bon temps may rouler, but that cloud you see on the horizon may have SPAC written on it. A quick review: Special Purpose Acquisition Companies (SPACs) typically are public companies that raise money through their own IPOs for the express purpose of buying other companies. Often called a ‘blank check’, they have no purpose other than buying one or two other companies–in the latter case, merging them like the announced Cloudbreak and UpHealth last November–and converting over to the company’s identity and business. The timeframe is usually two years. Essentially, the active company goes public with a minimum of the messy, long, expensive, and revelatory process of filing directly with the SEC (in the US). This quarter, Rock Health’s stat on SPACs was that they raised $83.1 bn this quarter, exceeding by $0.5 bn all SPAC activity in 2020, mainly late in the year. Their count was two SPACs closing in Q1 and 8 more announced but not yet closed (counting Cloudbreak/UpHealth as one).

As an exit door for investors, it’s worked very well–but is dependent on private equity and public investors having confidence in SPACs. One thinning of the bubble may be the scrutiny of Clover Health’s SPAC by the SEC [TTA 9 Feb] over not revealing that they were under investigation by the Department of Justice (DOJ). Certainly this was a material circumstance that could dissuade investors, among other dodgy business practices later unveiled. Mr. Market tells a tale; Clover went public 8 Jan at $15.90 and closed today at $7.61. Their YahooFinance listing has a long list of law firms filing class-action lawsuits on behalf of shareholders.

Clover may be the leading edge of a SPAC bust. SPACs are losing their luster because there are too many going through, jamming bandwidth at the bank and law firm level. As time ticks by and deals are delayed, the private funders of SPACs are growing squeamish, according to this report in National Review’s Capital Note (yes, National Review has a finance newsletter). “In the past two weeks alone, four blank-check deals have been halted, with SPAC shares declining significantly from their highs early this year. The slowdown follows an influx of short-sellers into the opaque financial vehicles and a sell-off in high-profile SPACs such as Churchill Capital Corp IV.” Reasons why: lower quality of companies available to go public via SPAC–the low hanging ripe fruit has been picked–and the last mile in SPACs, which is PIPE funding (private equity-investment-in-public-equity financing) is getting skittish. The last shoe to drop? The SEC in late March announced an investigation into SPACs, making inquiries into several banks seeking information on their SPAC dealings, which is alluded to near the end of the Rock Health report. CNBC  (Read further down into the NR article for a Harvard Business Review dissection of the boom-bust dynamics of ‘controversial practices’ like reverse mergers as a forecast of what may happen to SPACs. Increased popularity led to increased negativity in reverse mergers.)

And speaking of SPACs...Health tech/digital health eyes are upon what Glen Tullman and the ‘late of Livongo’ team will be doing with their SPAC, Health Assurance Acquisition Corp., which is backed by Hemant Taneja’s General Catalyst, also a former Livongo funder. Brian Dolan, who is now publishing Exits and Outcomes. His opinion is their buy will be Color, formerly Color Genomics: opinion piece is here. Messrs Tullman and Taneja are also leading Transcarent, a company that brings together employers, employees, and providers in a seamless, app-driven integrated care model. Forbes

The cool-off in SPACs may burst a few bubbles in the bath–and that may be all to the good in the long term.

Zipnosis, health system telemedicine/triage provider, acquired by insurtech Bright Health Group

April 6, 2021 | by

Breaking: Zipnosis, a telemedicine/telehealth company that provides telehealth and diagnosis triage for large health systems, had a stealthy announcement of its acquisition by Bright Health Group late yesterday. The announcement is not on either corporate website but was made by Zipnosis’ financial advisers in the transaction, Cain Brothers/KeyBanc. Neither the value of the transaction, the transition plans for Zipnosis management and staff, nor operating model, were disclosed. Both Zipnosis and Bright Health are HQ’d in Minneapolis. Release

Why This Is Verrrry Interesting. Zipnosis developed an interesting niche as a relatively early starter in 2009 by providing white-labeled telemedicine systems to large health systems. They made the case to over 60 health systems across the US, including large systems like Allina Health with a ‘Digital Front Door’ that provided initial triage for a claimed 2 million patients, moving them into synchronous or asynchronous care fully integrated with hospital EHRs. They were named as the ‘Hottest Digital Startup from Flyover Country’ by Observer.com, once upon a time in this Editor’s wayback machine an actual print weekly newspaper and, as is obvious, NYC-centric. Release Their funding to date is, surprisingly, limited: under $25 million from seven investors, including Ascension Ventures, Safeguard Scientifics, Hyde Park Ventures, and Waterline Ventures, with the last round back in 2019. Crunchbase

Bright Health Group, on the other hand, is an insurance provider in both the exchange and Medicare Advantage (MA) markets in 13 states and 50 markets, covering 500,000 lives. Their model integrates both technology like web tools and apps with their insurance plans to be an ‘insurtech’ like Oscar Health and Clover Health. They claim to be the third-largest provider of the highly specialized type of Medicare Advantage plans called Chronic Condition Special Needs Plans (C-SNP) for those with severe and/or disabling chronic conditions. Bright Health operates in 13 states and 50 markets. In January, they announced the acquisition of Central Health Plan in California with 110,000 MA members.

However, what is verrrry interesting about Bright’s model, compared to other ‘insurtechs’, is that they own or manage a care delivery channel–40 advanced risk-bearing primary care clinics delivering in-person and virtual care to 220,000 members. The ‘risk-bearing’ is also interesting as it leads one to believe that some of these practices may participate in Center for Medicare and Medicaid Services (CMS) value-based care models such as Primary Care First, the Medicare Shared Savings Program, or End-Stage Renal Disease (ESRD).

Bright Health is also extremely well funded now–and may be even better funded in the near future. Last September, they raised $500 million in a Series E led by New Enterprise Associates with Tiger Global Management, T. Rowe Price Associates, and Blackstone, as well as existing investors including Bessemer Venture Partners and Greenspring Associates (Crunchbase and Mobihealthnews). The purpose stated at the time was new market expansion both geographically and to small groups. Last week’s rumor was that they are preparing for an IPO in the $1 bn range with a valuation between $10 and $20 bn, which is Big Hay indeed. No paperwork has been filed yet with the SEC. Twin Cities Business, YahooFinance.

As an acquisition for Bright Health, Zipnosis brings in large healthcare systems with a unique triage platform that could be modified for primary care practices. It seems like a snack-sized acquisition that doesn’t require Federal approval but can be operated stand-alone–as health systems may be leery of an insurer’s ownership–with technology that can be integrated into other parts of the Bright Health business. This will be updated as additional news develops.

Weekend reading: the strange reasons why Amwell doesn’t consider Amazon a competitor; ground rules for the uneasy marriage of healthcare and technology

April 2, 2021 | by

Yahoo Finance interviewed co-CEO/founder of Amwell Ido Schoenburg, MD on the company’s 2020 results and forecast for 2021. It makes for interesting but convoluted reading on their growth last year in what is a consolidating field where Amwell was once one of the undisputed two leaders. They now compete against payers acquiring telehealth companies (MDLive going to Optum) and mergers like Doctor on Demand-Grand Rounds that are taking increasing market shares. Then there are specialty providers like SOC Telemed and white-labels like Bluestream Health. However, there are a couple of whoppers in the happy talk of growth for all. Dr. S pegs the current run rate of telehealth visits at 15-20 percent. The best research from Commonwealth Fund (October) and FAIR Health (August) tracked telehealth at 6 percent of in-office visits. Epic Health Research Network measured 21 percent at end of August. [TTA summary here] 

Then there’s the tap dance around Amazon Care. His view is that telehealth companies all need a connective platform but that each competitor brings ‘modular components’ of what they do best. What Amazon excels at is the consumer experience; in his view, that is their contribution to this ‘coalition’ because healthcare doesn’t do that well. There’s a statement at the end which this Editor will leave Readers to puzzle through:  

“And Amazon and others could bring a lot of value to those coalitions, they should not be seen as necessarily competing unless you’re trying to do exactly what they do. And there are some companies, including some telehealth companies, that that’s what they do. They focus on services. They try to sell you a very affordable visit with a short wait time and a good experience. They should be incredibly concerned when someone so sophisticated as Amazon is trying to compete in that turf.”

The last time this Editor looked, none of these companies were non-profit, though nearly all are not profitable.

Gimlet EyeLooking through her Gimlet Eye, Amazon Care is a win-win, even if the whole enterprise loses money. In this view, Amazon accumulates and owns national healthcare data far more valuable than the consumer service, then can do what they want with it, such as cross-analysis against PillPack and OTC medical shopping habits, even books, toys, home supplies, and clothing. Ka-ching!

A ‘bucket of cold water’ article, published in Becker’s Health IT last month, takes a Gimlety view of the shotgun marriage of healthcare and technology. Those of us laboring in those vineyards for the better part of two decades might disagree with the author in part, but we all remember how every new company was going to ‘revolutionize healthcare’. (The over-the-top blatherings of ZocDoc‘s former leadership provide a perfect example.) The post-Theranos/Outcome Health/uBiome world has demonstrated that the Silicon Valley modus operandi of ‘fake it till you make it’ and ‘failing fast and breaking things’, barely ethical in consumer businesses, are totally unethical in healthcare which deals in people’s lives. Then again, healthcare focused on ‘people as patients’ cannot stand either. Stephen K. Klasko, MD, President and CEO, Thomas Jefferson University and Jefferson Health in Pennsylvania, advocates for a change–far more concisely than Dr. Schoenburg. You may want to pass this along.

Deals and news roundup, April Fool’s Edition: SOC Telemed’s $196M acute care telehealth buy, HIMSS takes over SCAN Health, Livongo’s Burke joins Owlet board, CirrusMD text app raises $20M

April 2, 2021 | by

(We’ve gone bug-eyed for 1 April!)

SOC Telemed ponies up a Spritely $196 million for competitor Access Physicians. The completed combination forms, according to SOC, the largest acute care telemedicine provider in the US serving 1,000 facilities, including over 700 hospitals, across 47 states. The deal is cash and stock. No transitional information other than the CEO of Access Physicians joins the SOC Telemed board. Both companies are in the enterprise acute care telemedicine area, facilitating virtual consults between specialists and to patient bedsides. In its SEC 10-K filing released earlier this week, SOC Telemed reported $59 million in 2020 revenue, up from $66.2 million in 2019. Q4 was a mixed bag: a 95 percent increase in Q4 bookings but a 13 percent revenue decline due to reduced hospital visits. Losses are limited–a net loss per share of $3.55 which is light for like telehealth companies (more in SOC release). For 2021, the projection is $107 to $113 million in pro forma annual revenue. SOC Telemed was one of the first digital health companies to use a SPAC to go public (amazingly) less than one year ago and with substantial assets at formation [TTA 4 Aug 20]. The combined company connects specialists in neurology, psychiatry, critical care, infectious disease, cardiology, maternal-fetal medicine, and nephrology. SOC Telemed release, Mobihealthnews, Becker’s Hospital Review 

HIMSS assumes the operations of SCAN Health, a networking and events company concentrating on best practices in the healthcare supply chain. SCAN was founded by the Canadian government out of the University of Windsor’s Odette School of Business. Their events are held with over 100 partners in North America and Europe, and will transfer to HIMSS effective immediately. SCAN’s founder, Dr. Anne Snowdon, launched the Clinically Integrated Supply Outcomes Model, a supply chain infrastructure strategic roadmap, with HIMSS Analytics in 2019. HIMSS release, Healthcare IT News.

Zane Burke, former CEO of Livongo, has joined another board–this time, with ‘sock’. Mr. Burke joins the board of Owlet, the baby monitoring sock company. In February [TTA 17 Feb], Owlet announced their SPAC estimated at $325 million. The transaction is expected to complete in Q2. Becker’s Health IT

CirrusMD, an on-demand text-first telehealth app, raised $20 million for its Series C led by The Blue Venture Fund and 7wire Ventures. Total funding to date is $47 million. Visits cover primary or urgent care, chronic condition management, women’s health, pediatrics, and behavioral health with text first then connection to a board-certified physician within one minute. Release, Mobihealthnews

US Department of Justice decides additional scrutiny needed of $13bn Optum acquisition of Change Healthcare

March 30, 2021 | by

Change, so to speak, will not be fast for Optum. On Friday, Change Healthcare filed with the Securities and Exchange Commission (SEC) a Form 8-K (PDF link) that confirms that the Department of Justice (DOJ) has asked for additional information pertinent to their proposed acquisition by UnitedHealthcare Group and integration into their Optum unit. On 24 March, both received a request from the DOJ for additional information and documentary materials (called a “Second Request”) as part of DOJ’s review of the merger under the Hart-Scott-Rodino Antitrust Act (HSR). The Second Request extends the waiting period for 30 days after UHG and Change comply with the review, unless either the DOJ shortens it or it is extended by the two companies (para. 3).

The integration of Change Healthcare into Optum already had significant competitive concerns for DOJ to consider. OptumInsight, Optum’s data analytics unit, and Change provide a similar range of services in health IT and revenue cycle management (RCM). However, Change is one of the largest independent companies providing these services to major providers, with access to the data of 1 out of 3 patients. Optum’s parent, UnitedHealthcare, is the largest US payer. These were the factors that made those represented by the American Hospital Association (AHA) very nervous indeed [TTA 25 Mar] regarding pricing of these services–and they expressed their misgivings cogently in a seven-page letter (PDF link) to DOJ on 17 March. In their view, Change integrated into OptumInsight would reduce competition and increase pricing in RCM, claims clearinghouse and payment accuracy services, and clinical decision support services.

Why it’s important. The closing of the $13 bn deal, originally forecast as second half 2021, now has a decent likelihood of being postponed. As CVS and Aetna found between 2017 and 2019, once the objections start in the flashpoint called US Healthcare, they tend to snowball into delays, even if it can be managed to a successful conclusion. (Extreme examples: the doomed to fail Aetna-Humana and Anthem-Cigna mergers) While RCM and data analytics are not as high profile as health plans and retail health, industry groups have a lot of clout in the DC Swamp when the cause is higher cost and DOJ, in this administration, is likely to be more activist. Another reason: if UHG or Change have to divest themselves of too much (UHG set a boundary of $650 million), they may Call The Whole Thing Off. Also Healthcare Dive and FierceHealthcare. 

Deals and news roundup: Ginger’s $100M, myNEXUS to Anthem, Everlywell snaps up PWN, Amwell’s banner year for revenue–and loss, VA reviews Cerner rollout, voice visits for MA, GE’s vScan goes wireless, uBiome founders indicted

March 27, 2021 | by

Deals–and news–are piling up like Easter eggs before the hunt. Mental health and cognitive digital therapy scored another raise with Ginger‘s $100 million Series E to fund expansion into health plan and government partnerships. Blackstone Growth led the round. Total funding to date is $220 million. It’s entered unicorn status with a valuation just north of $1 bn. Ginger to date has concentrated on corporate mental healthcare. From being an ugly duckling only a few years ago, digital mental therapies are this year’s ‘it’. But competition is fierce: the traditional telehealth companies such as Teladoc, Doctor on Demand, and Amwell are closing in on the early entrants such as AbleTo. Direct-to-consumer models like Talkspace; UK/Ireland’s SilverCloud Health; and Lyra, Spring Health, and Happify, which just closed a $73 million Series D, all step out with slightly different ‘differentiators’ but target the same companies, health plans, and health systems. FierceHealthcare, Ginger release. 

Home health is also another former ugly duckling transformed into a swan. Anthem is acquiring home health/nursing management company myNEXUS, which manages home-based nursing services for 1.7 million Medicare Advantage members across 20 states. Their digital authorization and visit management couples with a nationwide network of providers and nursing agencies for local care. Exiting myNEXUS are private equity investors led by New York’s WindRose Health Investors, after four rounds and a conservative $31 million in funding (Crunchbase). Neither terms nor management transitions were disclosed. myNEXUS will join Anthem’s Diversified Business Group. FierceHealthcare, release.

Home testing+telehealth company Everlywell (not connected with the Everly Brothers) has a different take on home health. They are now integrating their self-test kits with fully owned lab testing. New acquisitions PWNHealth and its subsidiary Home Access Health Corporation will join Everlywell in Everly Group. PWN was Everlywell’s main telehealth partner and diagnostic testing partner since 2016. It will become Everly Health Solutions with their testing data kept separate from Everlywell’s. Home Access was PWN’s self-collected lab test company. Everly Health now will support more than 20 million people annually in all 50 U.S. states, Canada, and Puerto Rico. Acquisition terms were not disclosed. PWN’s CEO will take a seat on the Everly Group board to assist integration. Valuation is now estimated at $2.9 bn.  Mobihealthnews, Everly release, Bloomberg News

And in other news…

Amwell reported a Very Good Year in their telehealth services, with visits growing to 5.9 million from 2019’s 1.1 million. Total revenue was up over 65 percent to $245.3 million. However, profitability continues to be elusive, with net loss almost equaling revenue. Release

The Department of Veterans Affairs (VA) finally announced a review of the Cerner-Leidos EHR integration. Back in February, VA was hanging tough on the rollout after the GAO report questioning its wisdom and recommending postponement until high severity issues were corrected. Secretary Denis McDonough, new VA head, has directed the undertaking of a 12 week strategic review without pausing the project. Taking bets on that 12 weeks! Healthcare Dive

Payers and their lobbyists are supporting a newly reintroduced House bill that would permit telephonic-only telehealth visits to be reimbursed for their Medicare Advantage plans after HHS closes the pandemic period. There is considerable information that video/audio virtual visits still have limitations with the 65+ group, clustered around high-speed internet or good data connections, smartphones, and computers with cameras, making video visits difficult or impossible. Which begs the question about continuing coverage for those on Original Medicare. Healthcare Dive

Those readers with long memories will recall GE Healthcare’s heralded introduction of the VScan handheld clinical-grade ultrasound device–back in 2010, complete with Eric Topol rave and demo. Not much has been heard from GEHC since till this month, and other competitors, such as the Butterfly IQ from 4Catalyzer, have made handheld ultrasound common and affordable. GEHC announced Vscan Air, a fully wireless version that connects to iOS or Android. It was FDA cleared in November 2020 and will be shipping its dual-headed probe and accessories starting 1 April for a US-listed target price of $4,495. GEHC page (with the cute domain vscan.rocks), Mobihealthnews

And in our Scandal Sheet section, a Federal grand jury in the Northern District of California has indicted the founders of now-bankrupt uBiome on 40-odd counts encompassing conspiracy to commit securities fraud, conspiracy to commit health care fraud, money laundering, and identity theft. Separately, the Securities and Exchange Commission (SEC) also filed charges. Between 2016 and 2018, uBiome had raised $100 million through a Series C, and was likened to Theranos, after its fall, in the Big Claim (‘inventing the microbiome industry’). Its business was analyzing the DNA of fecal and other biological matter to sequence the bacteria of the body’s microbiome. Starting with low-cost, limited data comparison for at-home tests, the founders progressed to claiming to doctors that their diagnostic tests were clinical-quality and would be reimbursed by payers. Payers did–for awhile–and the investors piled in. By 2019, the wheels fell off their scheme and the FBI came knocking at their Silicon Valley offices after the founders cashed in. Chapter 7 followed in late 2019. The Register reports that the two married founders are on the run, whereabouts unknown. US Attorney’s Office release, SEC filing (PDF)