A spooky ‘good news’ roundup: AtlantiCare rolling out Orbita AI, Health Wildcatters Pitch Day, RapidSOS, HealthJoy fundings and more

This Editor has noticed the gloomy tone of the past few weeks’ postings. She has decided to ‘accentuate the positive, eliminate the negative” (in Johnny Mercer’s words) using the last few hours of Halloween (boo!) with nothing but Good News.

A health system is actually implementing an AI platform! AtlantiCare, which is based in southern New Jersey, will be rolling out the Orbita virtual artificial intelligence platform across its system, which includes more than 100 locations across Southern New Jersey. Orbita’s capabilities can link patients with virtual assistants and AI to streamline routine tasks such as scheduling, patient reporting, medication adherence, and care management. It also recognizes and translates more than 100 languages. According to Becker’s, Orbita’s functions will be rolled out in stages with the digital ‘front door’ going live in September and patient outbound communication capabilities in 2023.

Dallas’ Health Wildcatters finishes up its 2022 cohort with an evening Pitch Day at their new HQ on Thursday 10 November. Their 11 startups will present starting at 4pm in two sessions. With two networking sessions, the festivities start at 3:30 and go to 8pm. Health Wildcatters has relocated to a 23 acre campus, Pegasus Park, targeted to entrepreneurs and startups in biotech and healthcare to encourage development and collaboration. More information and registration links

And fundings are actually happening–for companies with an established success story + track record–and those at a very early stage where there’s promise, the risk is shared, and the investment is modest. 

  • RapidSOS raised $75 million in a venture round. It developed an emergency response platform that provides first responders with real-time health and location data from connected devices, apps and sensors. It supports 5,200 Emergency Communications Centers, protecting 95%+ of people in the US, across 150 million emergencies annually. Night Dragon Security led 11 other investors. Funding to date is over $280 million.
  • HealthJoy, a digital employee benefits platform for healthcare, raised $60 million in Series D funding from nine investors led by Valspring Capital. Their app bundles telemedicine, wellness, dental, advocacy, medical bill review, EAP, prescription savings, behavioral health, price transparency, MSK, chronic care, mental health, and others. FierceHealthcare
  • Pediatric telehealth provider Hazel Health closed a Series C1 of $51.5 million led by Bain Capital. Hazel partners with school districts to offer virtual care clinics inside the school nurse’s office. It claims to be the only company in school-based telehealth.
  • Others: Navina (AI, $22 million), Galen Robotics ($15 million), Midi Health (menopause virtual clinic, $14 million), and Lumata Health (virtual practice management for ophthalmology, $4 million seed)  Mobihealthnews

Also:

  • Valera Health raised $44.5 million in a growth equity financing round led by Heritage Group. Additional participants are Horizon Healthcare Services and Cigna Ventures, joined by seven previous investors. Total funding is over $71 million. Valera is a specialized virtual mental health platform for high-acuity patients with serious mental illness and severe depression with live health coaches to find a therapist or doctor, and creates a team with multiple clinicians. Their services can be used by adults (18+) and children, adolescents, and teens (6-18)  Mobihealthnews

VillageMD considering $5-$10B merger with Summit Health provider group: reports

Two large provider groups, VillageMD and Summit Health, reportedly are considering a merger. VillageMD, which now is majority owned (62%) by Walgreens Boots Alliance, has 342 total primary care clinics in 22 southern and northeastern markets covering 15 states, with 152 co-located with Walgreens eventually increasing to 200. Summit Health has 370 locations in five states, including specialty practices and CityMD urgent care locations. Summit Health is majority owned by Walburg Pincus.

This reinforces a trend of cross-healthcare sector buys, consolidations, and control. VillageMD’s move from a co-location deal with Walgreens to majority ownership (but controlled by an independent board) was one step starting during the pandemic in July 2020 [TTA article series here].

  • Amazon agreed to acquire OneMedical (1Life) for $3.9 billion at the end of July, and abandon Amazon Care, though now running into FTC/DOJ review headwinds with a second request for information [TTA 15 Sep].
  • CVS Health has made no secret of its desire to acquire primary care, provider enablement, and home health companies (Signify Health, also under DOJ scrutiny), but apparently has abandoned or put on hold a deal with Cano Health [TTA 21 Oct].
  • Walmart continues to go direct by opening full-service clinics, announcing the expansion of 16 based in the Tampa, Jacksonville, and Orlando areas in 2023 (Healthcare Dive, Healthcare Finance News).

Valued at $12.9 billion and with Walgreens’ backing, VillageMD has the ‘go big or go home’ resources to execute Walgreens’ version of this strategy.

Why this very well may happen. The two do not overlap (except in NJ) on markets. VillageMD is primarily owned and affiliated primary care practices; Summit Health specialty practices (neurology, chiropractic, cardiology, orthopedics, dermatology) and CityMD urgent care. VillageMD has successfully mastered value-based care models in Medicare and entered advanced Medicare ACO models early and vigorously (Editor’s information); Summit Health primarily is fee-for-service with some participation in value-based programs. More to come. Bloomberg, Becker’s, and a very big hat tip to research from Jailendra Singh of Truist Securities  (paper here)

Is there a way out of the digital health funding black hole? Can it rebound to…2020?

The latest CB Insights report tracking global health funding isn’t cheery reading for VCs and their young analysts, associates, and principals. CB’s tracking of Q3 spending, like Rock Health’s [TTA 5 Oct], indicates it’s Back to 2019–not even 2020–with funding of $4.6 billion snapping back to Q1 2019.

In CB Insights’ tracking, 2022 Q1 had funding of $16.1 billion with Q2 slumping to $7.2 billion. Q3 funding was a 36% drop from Q2. (Editor’s note: CB Insights tracks global funding, while Rock Health is US only, with lower totals.) The most affected sectors: clinical trials tech, telehealth, and health IT, though the last two still have high levels of funding.

Unlike Rock Health’s analysis, mental health funding is struggling with 72 deals, a small gain after two straight quarters of decline. CB also identified only three new unicorns (over $1 billion) in Q3: health startup accelerator Redesign Health (which since September has had some reverses), nurse staffing platform Incredible Health, both with $1.7 billion, and UK-based Spectrum Health, with $1.2 billion. M&A/exits have also slumped to 48, the lowest level in five years. IPOs were also down to seven.

It doesn’t look bright for Q4, especially when you look at the miseries of healthcare-related companies like Philips, which reported a €1.3 billion operational loss this past quarter and immediately moved to reduce its global workforce by 4,000. For the young analysts and associates who were just starting or advancing their careers in the VC field, it snapped shut with a suddenness that would make a crocodile envious.

Healthcare Dive, CB Insights (paywalled)

Telehealth-only follow up increased repeat ED visits by 2.8%, return admissions by 1.1%: JAMA Network study

Not good news for telehealth using the ‘lower healthcare utilization’ talking point, if this study is confirmed by others and not an outlier. A study published this week in JAMA Network Open could be dismaying for those advocating a ‘straight line’ view of telehealth as a complete substitute for the in-person visit. The researchers from University of California, UCLA, and the Wharton School – University of Pennsylvania (Leonard Davis Institute for Health Economics) found that telehealth follow-up was “associated with 28.3 more repeated ED encounters and 10.6 more return hospital admissions per 1000 patients compared with in-person follow-up.” In percentage terms, they are 2.8% and 1.15 respectively.

The retrospective study was based on 2 in-system EDs of a single integrated urban academic integrated health system in Los Angeles from 1 April 2020, to 30 September 2021. They sampled over 12,000 patients with close to 17,000 ED encounters who were discharged home, then obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days).

Based on postdischarge follow-up visits:

  • In-person: 1865 (16%) were followed by an ED return visit and 438 (4%) with a hospital admission within 30 days
  • Telehealth:  937 (18%) were followed by an ED return visit and 238 (5%) with a hospital admission within 30 days

The percentage is small in this study, but there, for which there is no substitute for in-person follow-up visits. The study conclusion addressed this with the following points:

  • “Patients with telehealth follow-up who return to the ED might have greater illness severity when they arrive or possibly other medical or social circumstances that prevent ED physicians from being able to discharge them home.”
  • Patients in the study who used telehealth follow-up lived farther from the ED than in-person patients
  • “A potential mechanism to explain increased health care utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms.” There is additional discussion of how the lack of a physical examination during telehealth may hamper clinicians in fully evaluating evolving illness or deterioration.
  • “Telehealth is not well suited to evaluate specific concerns, such as chest pain, abdominal pain, or shortness of breath, which represent a large proportion of post-ED follow-up visits” based on two other qualitative studies.
  • “The association of telehealth with increased health care utilization warrants further study to evaluate its appropriateness as modality for post-ED follow-up.”

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department (JAMA Network Open–PDF, online link)

Smartwatches lead wearables, adoption now at 29%: Parks Associates study

Health tracking and users are leading the way into smartwatch adoption and wearables popularity. In just one year, (Q2 2020 to Q2 2021), smartwatch ownership increased 13 points from 16 to 29% of US households. Fitness trackers, which once predominated, increased five points to 23%, while GPS sport watches grew four points to 11% in US households.

Overall:

  • Smartwatches are dominated by the Apple Watch (1st left), with Samsung’s devices a distant second.
  • Smartwatch owners are particularly likely to own and use other connected health products, with these consumers reporting owning an average of 6.8 devices (including their smartwatch)
  • Most people buy their smartwatches through ecommerce channels–42%–but 30% still use traditional retail. (15% are gifts!)
  • Intent to purchase in the next six months has rocketed from 18% to 45%
  • Apple and Samsung lead all wearable brands under consideration. Curiously, pioneers Fitbit and Garmin are ranked below LG and Sony, which no longer offer wearables. (Fitbit–2nd left–and Garmin need to do some marketing)
  • Fitness trackers/bands hold their own, but GPS sport watches are the weakest of the three categories. Current owners are most likely to seek a new model, with 88% of owners reporting intention to purchase.
  • Most of the intenders are “very likely” to purchase add-on subscriptions for their watch, such as cellular plans (69%) and at-home fitness programs (47%), as long as they are at $10/month. This overlaps into cellular phone providers who need to keep these subscriptions inexpensive.

Parks Associates surveys every quarter 10,000 U.S broadband households, with additional surveys throughout the year. The results represent the national demographics for US broadband households, which are 88% of all US households. To read the full survey results, go to Parks Associates’ survey page.

Pre-weekend short takes: Teladoc posts much smaller Q3 loss, 17% revenue boost; is telehealth threatening disability care quality; $2.8M for Australian wearables; more healthtech layoffs at Antidote, OrCam, Ada Health

Teladoc today (27 Oct) beat Wall Street consensus in reporting revenue of $611.4 million, a 17% increase versus prior year. It also reduced its per-share losses to 45 cents per share ($73.5 million) versus last year’s Q3 loss of 53 cents ($84.3 million) and Q2’s stunning $3.1 billion loss due to goodwill impairments from the Livongo acquisition [TTA 30 July]. Powering today’s stock bump (6.5% to $28.47) was primarily loss reduction from the prior quarter zeroing out the goodwill impairments and lower net interest expense. Motley Fool, Mobihealthnews

Disability groups are expressing concern that incentives to promote telehealth may be discriminatory. The concerns are primarily around the need for in-person care.  Groups such as the American Association of People with Disabilities admit that telehealth can benefit the disabled, but are wary of a swing towards telehealth as a cost-saving measure versus in person. Federal data confirms that Medicare beneficiaries due to disabilities use telehealth at about twice the rate of age-eligible Medicare beneficiaries. There’s also concern about how the disabled can access and use telehealth platforms, as well as the quality of assessment during the virtual visit. POLITICO.

The Australian government is funding three five-year projects using wearable sensors for activity and diagnostics. The US$2.8 million will go to Curtin University for monitoring activity in children with cerebral palsy who are unable to walk (US$950,000), University of New South Wales for a cuffless blood pressure for hypertension monitoring (US$1.2 million), and Bond University for a project combining data from wearable devices and medical records for Type 2 diabetes patients (US$700,000). Mobihealthnews

More healthcare tech layoffs confirm that VC Elvis has left the building. The tech downturn has hit Israel-based startups particularly hard, but Europe is also affected. This is despite fundings for two of them earlier this year.

  • Pinkslipping over a third (23) of its employees is telehealth platform Antidote Health. Based in Tel Aviv and New York, the layoffs hit primarily R&D staff in Israel. Antidote in March closed a $22 million Series A, bringing total funding to $36 million (Crunchbase). Antidote offers telehealth primary care, mental health, and hypertension chronic care as well as featuring sinus, tick bite, and UTI treatment on its website. The platform connects users to a network of about 100 doctors with a smart chatbot and through video calls. Their target audience is uninsured and underinsured people. Calcalist CTECH, Mobihealthnews   
  • Larger OrCam in Jerusalem is laying off about 16% (62) of staff, again primarily in Israel, as part of a reorganization. OrCam develops devices to help blind or visually impaired people read and navigate daily life more easily via AI. OrCam has over $86 million in funding through a Series A and three venture rounds (Crunchbase), the last in 2018. A planned 2020 IPO valuing the company at $3 billion never happened. The company also has offices and staff in New York, London, and Cologne. Calcalist CTECH, Jewish Business News

Berlin, Germany-based Ada Health also pinkslipped 50 people. According to a spreadsheet linked on Layoffs.fyi, most of the layoffs are in Europe and the UK in tech and product development, with others in marketing and medical. Ada has a medical assessment app that claims 10 million users and 25 million assessments. Employees are based in the US, London, and within Germany. Most recent funding was in March from a $30 million Series B, adding to a 2021 Series B of €74 million funded by Bayer (Crunchbase).

Oracle talks to banks to increase loans funding Cerner buy; VA delays Cerner deployments to June 2023

Oracle’s Cerner buy proving to be more expensive–and complicated–than expected. Oracle is reportedly going to its banks to increase their term loan against the Cerner purchase from the current $4.4 billion. The increase would refinance short-term debt and reduce refinancing of the existing bridge loan into longer-term bonds and loans. According to reports, the bridge loan, originally $15.7 billion of debt, was reduced to about $11 billion by the term loan. The bridge loan was originally used to finance the Cerner purchase.

Under the existing agreement, the term loan can be extended up to a maximum of $6 billion. This avoids the dicey situation the bond market is currently in with yields and access by companies.

According to Bloomberg Intelligence, Oracle’s over $90 billion in debt is one of the largest debt loads in tech. Oracle’s credit rating by S&P Global Ratings places it two steps above junk (Baa2/BBB/BBB+) but it may sidestep a downgrade by this action. Yahoo!Finance (Bloomberg), Becker’s 

Oracle announced last week modernizations to Cerner which would have greater interoperability and introduce more cloud-based features. This follows on Larry Ellison’s pronouncements during their September Q1 2023 earnings call. During the Oracle Cerner Health Conference last week, four were announced: Seamless Exchange (eliminating duplicate patient health information), Advance (dashboard), virtual models of care (virtual nurses capturing information), and RevElate (billing). Becker’s

Will the modernizations help Oracle’s VA migraine with the Cerner Oracle Millenium implementations? The prior week (13 Oct), the VA announced that deployments are being pushed from January to June 2023. The release cites the multiple problems with technical and system issues that were uncovered in August (outages), discussed extensively in Senate hearings in July, and the OIG report released in July on the ‘unknown queue’ and more.

Deputy Secretary of Veterans Affairs Donald Remy stated that “VA will continue to work closely with Oracle Cerner to resolve issues with the system’s performance, maximize usability for VA health care providers, and ensure our nation’s Veterans are served by an effective records system to support their healthcare. During this “assess & address” period, we will correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers.” VA will also concentrate on the existing five facilities already deployed on fixing the multiple issues they have. Veterans treated at these sites will receive letters asking them to call the VA if they experienced delays in prescription filling, appointments, referrals, or test results. One wonders if all the steps Oracle’s Mike Sicilia said Oracle is taking [TTA 28 July] to fix the performance, design, and functionality issues are achievable even in the longer time frame–and certainly in the five live systems.

News updates: Theranos’ Holmes goes ‘mental’ in last ditch defense; troubled Cerebral telemental health fires another 400

Blood out of a rock? The Holmes’ defense goes ‘mental’ with Dr. Adam Rosendorff. Reduced to a limited hearing before Judge Edward Davila and the US District Court in San Jose, where Rosendorff not only reaffirmed his testimony but also explained the circumstances around his visit to the home, the Holmes defense filed a motion on Monday, citing an obscure interview published in September by the South African Jewish Report to cast doubt about the veracity and credibility of his testimony. Rosendorff, who was born in South Africa, recounted to the interviewer that the stress from blowing the whistle on Theranos led to a “breakdown, medication, hospitalization, and health problems.”

Rosendorff also stated in the interview that by the time the trials (Holmes and Balwani) were scheduled in early 2020, he was off medication. The trials finally took place in 2021 (Holmes) and this year. When questioned last week by defense lawyer Lance Wade about his mental state, his response was that “I’m finding this line of questioning to be invasive.” and that his “mental state was solid” when he drove to Holmes’ home wanting to speak with her. The prosecution objected to the questioning and Judge Davila upheld it.

The prosecution’s response to the defense filing is that the court record “contains no indication whatsoever that Dr. Rosendorff suffered from a mental health issue that affected his ability to serve as a reliable witness,” and that “newly raised and uncorroborated insinuations about Dr. Rosendorff’s mental health do not justify discounting his testimony or granting a new trial.”

The Mercury News’ money quote from New York defense lawyer Jennifer Kennedy Park: “I think the judge already made the decision that this is not relevant.” Another lawyer quoted, former Santa Clara County prosecutor Steven Clark, said that the stress can be difficult but that it apparently didn’t affect Rosendorff’s capacity to testify–and that he was consistent across two trials.

Unless Judge Davila decides to delay–not likely given the above and the pending sentencing for both Holmes and Balwani–or there are additional magic ‘rabbits out of hats’, Holmes’ sentencing remains scheduled for 18 November, Balwani’s later this year.

And speaking of mental health, beleaguered telemental health provider Cerebral let go of 400 more staff, or another 20% of their remaining workforce. This follows a layoff of ‘hundreds’ of contractors, including nurse practitioners who did counseling and support staff, at end of May. Cerebral is ‘restructuring’ under a new CEO, David Mou, who replaced CEO and co-founder Kyle Robertson  forced out by the Cerebral board after the first round of investigations by the Department of Justice (DOJ) on over-prescribing of controlled substances and the subsequent defection of CVS Health and Walmart, as well as Truepill on mail fulfillment. Their statement cites “operational efficiencies while prioritizing clinical quality and safety across the organization.” Cerebral had at its peak in the spring 4,500 employees.

In addition to the DOJ investigation, the FTC is investigating Cerebral for deceptive advertising [TTA 1 June] and a former VP of product and engineering, Matthew Truebe, is suing for wrongful dismissal, further exposing the inner workings of the company [TTA 16 June]. Employees have gone public with tales of pushing prescriptions to 95% of patients, disregarding state regulations, and generally Running Wild over any semblance of clinical probity [TTA 29 June]. Certainly Softbank cannot be delighted at the rolling crackup of their once-valued $4.8 billion baby for which they’ve led funding of over $426 million. TechCrunch, Healthcare Dive.

Meta Pixel ad tracker collects another 3 million data breaches at Advocate Aurora Health; Zuckerberg getting Senate scrutiny

The Pixel ad tracker continues to be a Big Problem for Meta and Facebook. Advocate Aurora Health, a large health system in Illinois and Wisconsin, this week informed 3 million patients of a potential data breach connected to the use of Meta Pixel. The Meta Pixel snippets of JavaScript code were used within their Epic MyChart and LiveWell websites and applications, as well as on some of their schedulers.

As we have previously noted (below), ad trackers like the Meta Pixel are used to target website visitors and also to track ads placed on Facebook and Instagram. Developers routinely permit these snippets of code as trackers for better performance and website tracking, but the problem here is that sensitive patient information (PHI) is being sent back to Facebook where it violates patient privacy and can be misused.

Advocate Aurora cited that Meta Pixel may have collected “IP address; dates, times, and/or locations of scheduled appointments; your proximity to an Advocate Aurora Health location; information about your provider; type of appointment or procedure; communications between you and others through MyChart, which may have included your first and last name and your medical record number; information about whether you had insurance; and, if you had a proxy MyChart account, your first name and the first name of your proxy.” It did not collect social security number, financial accounts, credit cards, or debit card information. At this point, there is no reported misuse of information. Bleeping ComputerHealthcareITNews

That this is at all problematic is being vigorously denied by Facebook. But in an unusual move, Senator John Warner (D-VA) sent a letter yesterday to Meta CEO Mark Zuckerberg, containing seven fairly rigorous questions based on The Markup’s articles to be answered by 3 November. This follows on Sen. Jon Ossoff’s request via the Senate Homeland Security Committee (below)  (Editor’s opinion: to be written by Meta’s lawyers, and don’t hold your breath for any rending of garments or mea culpas.) HealthcareITNews, The Markup

Our previous articles on The Markup‘s research and Meta Pixel:

Breaking: Hospitals sending sensitive patient information to Facebook through website ‘Meta Pixel’ ad tracker–study

Facebook Meta Pixel update: Nemours Children’s Health using 25 ad trackers on appointment scheduling site

Let the lawsuits begin: Meta sued by health system patient for Meta Pixel info gathering

Novant Health notification 

Meta facing some Senate scrutiny on Meta Pixel’s health data collection–and how it’s used

Breaking: CVS’ Signify Health buy under DOJ scrutiny in ‘second request’

Not unexpectedly, the US Department of Justice (DOJ) is taking a hard look at the Signify Health acquisition by CVS Health. The two companies were notified Wednesday on DOJ’s Second Request for information. This was disclosed on an SEC Form 8-K. The DOJ now has 30 additional days to investigate antitrust aspects of the merger, once that additional information is received. 

The timetable goes like this:

  • 19 Sept: CVS filed its premerger notification and report with the DOJ and the Federal Trade Commission (FTC) under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 (HSR). This initiates a 30-day waiting period.
  • 19 Oct: At deadline, the request for additional information initiated by the DOJ was received by both CVS and Signify (Second Request)
  • The Second Request extends the waiting period under the HSR Act by 30 days after both CVS and Signify have substantially complied with the Second Request. The DOJ can terminate the waiting period earlier, or move it to an agreed-upon later date. 

CVS continues to affirm closing the deal by first half 2023 as planned, which is a fairly wide window.

The current government’s DOJ and FTC have made no secret of their policy-driven yen for using antitrust in the name of lowering healthcare costs (even favored pharma). The crashing failure of DOJ’s antitrust motions against UnitedHealthGroup and Change Healthcare [TTA 20 Sept] must have smarted. What this usually initiates is the search for a quick and easy win to put said embarrassment behind them. CVS Health is certainly a high-profile target, though Signify even at $8 billion, like Change, is not except in the industry. 

Signify’s competitive overlap with CVS/Aetna isn’t as large or obvious as UHG’s Optum with Change, but there is some: home health management and (in this Editor’s view), ACO management services with Signify’s Caravan, which participates in multiple Federal shared savings models where Aetna also is. One wonders if some divestment will be demanded by DOJ. Even before the auction, Signify started the complicated and long exit from the failing Bundled Payments for Care Improvement (BPCI) programs inherited from the Remedy Partners buy.

Could the DOJ action have played a role in CVS’ sudden cold feet in acquiring Medicare/Medicaid primary care provider Cano Health? [TTA 20 Oct] The timing is certainly close. 

DOJ is not working alone. The FTC also has a yen for Amazon in their 2 September second request for information on their acquisition of OneMedical, which also added 30 days to the Hart-Scott-Rodino (HSR) clock after compliance. Amazon is already going through this with their iRobot acquisition [TTA 15 Sept]. Reuters, FierceHealthcare, Home Health Care News

News roundup: CVS abandons (?) Cano Health buy; Signify adds home RPM; BioIntelliSense RPM acquires AlertWatch; GE Healthcare, AMC Health partner; Viome raises $67M, other fundings

CVS Health apparently backs away from a strategic primary care buy. Earlier this week, both Barron’s and DealReporter (via FactSet) reported that CVS Health is no longer pursuing an acquisition of Cano Health, a primary care provider group in Florida, Texas, Nevada, California, Illinois, New Mexico, and Puerto Rico that concentrates on senior health, Medicare Advantage patients, and value-based care. Cano has 4,000 employees and 280,000 members. Reasons why were not disclosed by either CVS or Cano. Cano shares listed on the NYSE fell on the news from Monday’s open of $8.22 to $4.50 today (20 Oct). An alternative buyer may be Humana, which has a right of first refusal on a sale dating back to 2019, but Humana has been quiet on the acquisition front of late.

Walking away seems contrary to CVS’ stated strategy of pursuing deals in primary care, provider enablement, and home health, but CVS can afford to be choosy. There’s speculation that CVS has a different provider/VBC enablement target in mind.  Jailendra Singh of Truist Securities identified ACO management services organization Privia Health as a potential buy that would fit well with CVS’ pending buy of Signify Health, which includes competitor Caravan Health (more on this here). But who knows if this ‘walk away’ is final? Healthcare Finance, FierceHealthcare

CVS’ pending deal, Signify Health, announced the addition of spirometry testing to evaluate patients for COPD. This will be added to their existing suite of in-home diagnostic testing and tracking, In-Home Health Evaluation, targeted to Medicaid and Medicare Advantage members. Mobihealthnews

If there’s a Cinderella this inflationary, recessionary year, it’s remote patient monitoring (RPM). BioIntelliSense has been in RPM since 2020 with on-body/stick-on sensors such as the BioButton and the BioSense 30-day monitor. Their latest addition through acquisition is the AlertWatch clinical intelligence and triage system. AlertWatch will join BioIntelliSense’s product group within Medtronic’s HealthCast portfolio in US hospital patient monitoring as part of their existing partnership. In the past ten years, AlertWatch achieved four FDA 510(k) clearances for its specialized product offerings for the operating room, intensive care unit, and labor and delivery unit.  BioIntelliSense release

Veteran RPM company AMC Health will be partnering with GE Healthcare (GEHC) for post-discharge in-home care monitoring. This will extend GEHC’s hospital-based monitoring into post-acute patient needs and anticipate future care needs, potentially reducing unnecessary readmissions. It’s also planned that eventually both hospital and home data will be integrated into GE’s Edison Health database. GEHC also announced additional details about its spinoff, due to happen in early 2023. [Also TTA 12 Nov 21 and 20 July] Mobihealthnews

Healthcare/health tech raises haven’t entirely disappeared. Viome, which uses AI to test the oral and gut microbiome to prevent, diagnose, and treat chronic diseases and cancer, just raised a $67 million Series C led by Bold Capital Group with participation from Khosla Ventures, West River Group, Glico, Ocgrow Ventures, and Physician Partners, for a total raise since 2017 of over $169 million (Crunchbase). Viome recently launched the CancerDetect test for oral and throat cancers under the FDA Breakthrough Device Designation. Last year, they expanded their partnership with GlaxoSmithKline to research and potentially develop interventions for some cancers and autoimmune diseases. Viome release  

Mobihealthnews rounds up several other financings from genomic tester Variantyx’s $20 million in debt financing to mental health app Mindful Care’s modest $7 million Series B and dataset research collaboration platform Rhino Health‘s $6.7 million seed round extension for an $11 million total.

Rosendorff stands pat on Theranos’ Elizabeth Holmes: “She needs to pay her debt to society”

Monday’s limited hearing in US District Court on Adam Rosendorff’s Mysterious Visit to Casa Holmes is likely to be a Defense Dud. Rosendorff walked Judge Edward Davila through the circumstances of his visit, what he said–which differed from Holmes’ partner Billy Evans’ recollection–and reaffirmed his testimony in the Holmes trial plus his sworn declaration given prior to the hearing.

  • He recounted his feelings of distress that Holmes’ and Evans’ son would “spend his formative years” without his mother in prison. The surprise contained here is his testimony that “It’s my understanding that Ms. Holmes may be pregnant again.” Follow-up by reporters outside of court was not answered by either Dr. Rosendorff or Evans.
  • Rosendorff reaffirmed that he testified “truthfully and honestly” on Theranos. “At all times the government has encouraged me to tell the truth and nothing but the truth.” 
  • Regarding telling Evans that the prosecution made the situation at Theranos sound worse than it was, Rosendorff did not recall that. He reconfirmed that he didn’t believe the prosecution did that. Rather, the prosecution “was trying to paint an accurate picture of Elizabeth Holmes.” 
  • As to another Evans statement that Rosendorff regretted that the prosecutors made people at Theranos look bad, he countered that “to the extent that other people looked bad, it was because of their association with Elizabeth.”
  • Overall, “I don’t want to help Ms. Holmes. At this point she needs to pay her debt to society.”

For anyone who has been through a legal process, Dr. Rosendorff’s all-too-human reactions after the extraordinary strain of two trials as well as the destruction of his career, his wanting to square things with, and confront, the cause of years of tsuris is understandable. That, of course, was ill-advised in the extreme. One only hopes that he has family and friends to comfort, counsel, and help him in moving toward a satisfying future, perhaps well away from California. He can also reflect that the four counts for Holmes and 12 for Balwani were on fraud, proved by the testimony of others who certainly aren’t running to Casa Holmes banging on her door.

Barring any other defense rabbits out of hats, Holmes is scheduled to be sentenced by Judge Davila on her four counts on 18 November to begin paying her debt to society. Mercury News

Theranos’ Holmes sentencing now 18 November, defense wants to expand hearing scope; Balwani can’t join in

Elizabeth Holmes will be receiving a limited hearing concerning The Mysterious Visit of Dr. Adam Rosendorff and her defense is attempting to expand the hearing. But Sunny Balwani won’t be joining in. The highlights of their recent District Court activities under Judge Edward Davila:

  • Holmes’ sentencing on her four counts has been reset to 18 November at 10am PT. This is despite the limited hearing on 17 October to determine whether Adam Rosendorff was really regretful about his testimony (as the Holmes defense maintains) and what he said and did. 
  • In a separate order, Judge Davila rejected Balwani’s defense move to join in the hearing. Rosendorff’s statements to Evans “related exclusively to his testimony during Ms. Holmes’ trial, not Mr. Balwani’s trial,” and provide “no basis for Mr. Balwani to examine” Rosendorff at the hearing.
  • In a filing, Rosendorff’s legal team asked Judge Davila to quash a subpoena sent by Holmes’ defense to obtain additional information from Rosendorff to use in next week’s hearing. “(Holmes) has sought to transform that limited inquiry into a free-for-all in which Dr. Rosendorff would be required to search through more than a year’s worth of sensitive emails, text messages, and other communications with family, friends, and others so that (Holmes) can try, yet again, to make him look like a liar.”
  • In that filing, the legal team also provided explanations of Dr. Rosendorff’s actions on that day. Driving around the area, he saw that the Theranos building had been torn down and a residential development complex built in its place, and the Palo Alto Walgreens where the first pilot took place had been replaced by a rug store. He wanted to “forgive her for the pain and suffering her actions have caused in his life” and to express his condolences on the child growing up without a mother. Unfortunately, he didn’t stop there on Memory Lane but took a drive up to the well-known location of her rental house, where recollections do differ and increased his tsuris as a result. 

Mercury News, Palo Alto Online

News roundup: CVS sells bswift; Babylon puts Meritage IPA up for sale, financially realigning to prevent delisting; Redesign Health sheds 20%, Noom 10%

Companies shedding ancillary businesses, and more than a few of their people that make them go. 

CVS Health is selling bswift to Francisco Partners. Bswift, a benefits technology and HR services company, was acquired by Aetna in 2014 for $400 million. It became part of CVS Health in 2018 after CVS acquired Aetna. Based on the website, it was operated independently. Francisco Partners, an investment group specializing in tech, recently acquired IBM Watson (now Merative) [TTA 7 July] and added it to 400-odd portfolio companies. Acquisition cost and management transitions were not disclosed, but expected to close by Q4 this year. The company will continue to partner with CVS Health and Aetna. Francisco Partners/bswift release, Mobihealthnews, FierceHealthcare, HealthcareFinanceNews

Babylon Health exiting the provider business, transitioning to US financial reporting requirements, and reversing stock to boost price. Babylon has put on the block Meritage Medical Network, an independent physician association (IPA) based in Northern and Central California with 1,800 providers in six counties serving 90,000 patients. The sale was announced 12 October and is expected to complete in early 2023. Babylon’s rationale is “to focus on its core business model through further investment in its digital-first contracts”. It was a short-lived foray, as Meritage was bought only last year along with First Choice Medical Group [TTA 7 Oct 21], which is not mentioned, and completed prior to their SPAC.

Babylon is also financially realigning.

  • On 12 October they also announced conversion to US financial reporting and GAAP accounting from reporting as a foreign private issuer. This will be effective in January 2023.
  • In September, shareholders approved a reverse share split to take place in Q4 to consolidate shares within the approved range of 15:1 to 25:1. All shares will be converted to Class A ordinary shares from a previous A/B structure.

These address a major problem that threatened Babylon’s listing on the New York Stock Exchange (NYSE). In September, Babylon received notice that it violated NYSE rules in not maintaining an average closing share price of at least $1 over 30 consecutive days. Today’s close (12 October) was $0.42. A reverse split will boost the stock price and prevent Babylon from being delisted. Babylon release, Mobihealthnews

After a brief break, healthcare layoffs continue even at richly valued companies with recent raises.

  • Redesign Health is releasing 20% of its workforce, or 67 people from its NYC-based workforce. This is one month after a $65 million Series C raise in late September from General Catalyst, CVS Health Ventures, and other investors, and a valuation in the $1.7 billion range. According to a company spokesperson, these had nothing to do with the Series C or financially driven, but according to the CEO, part of a “ongoing evolution, and given the need to prioritize in a challenging market”. Departments affected in the ‘restructuring’ are engineering, product, marketing, and recruiting. Redesign is unusual in that it creates startups from its own research, assembles management teams, brands, and funds them. To date, it has created about 40, including a few that have had layoffs of their own (Calibrate). Redesign had planned to create more than 25 new companies by the end of 2022, which apparently will not happen. Fast Company, Mobihealthnews
  • The heavily advertised weight loss app Noom reportedly will be laying off 10% of their staff, or 500 people primarily in coaching. Noom currently has a valuation around $3.7 billion and a cumulative funding of $650 million. Apparently there is also a change in direction from the original (and successful) concept of nutrition, behavioral, and exercise coaching via live chat to scheduled video consults as part of a mind and body platform with a higher degree of personalization, including mental health. The company CFO is also departing for TripAdvisor, according to the Wall Street Journal. TechCrunch

Perspectives: How joined-up communications can enable connected patient care across healthcare Trusts

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Dave O’Shaughnessy, Avaya’s Healthcare Practice Leader for EMEA and APAC. The subject is NHS England’s transition to an integrated care system and where a cloud-based communications system helps in patient engagement and care team coordination.

Interested in being a Perspectives contributor? Contact Editor Donna

Photo courtesy of Avaya

The new NHS’ integrated care system (ICS) aims to support patients across England with health and care that is ‘joined-up’ in its delivery from local councils, the NHS, and other partners. The aim is to remove the existing silos that separate hospitals, GPs, physical health, mental health, and council services from each other.

As each ICS region starts to prepare their 5-year plan, there is an opportunity for modern communications and collaboration technology solutions to play an important role in helping to address healthcare Trusts’ challenges as they work to deliver joined-up services across their ICS.

Connected Challenge

As part of a successful ICS, a Trust will need to deepen its relationship with a number of other stakeholders, including local councils, the voluntary community and social enterprise sector. This can be greatly facilitated by leveraging communications and collaboration services to improve experiences at both a local level as well as scaling the solution across the region. In this way, what were previously isolated pain points can be solved across the whole ICS.

Four Areas for Improvement

There are four key practice areas where cloud-based communications and collaboration solutions can help maximise the positive transformation of the patient and key worker experience – patient access to care, patient experience, team member experience, and collaboration across an ICS. Let’s add some details to these four areas:

  1. Improving patient access to care includes managing healthcare appointments, prescriptions, payments, and other everyday administrative tasks in a way that works effortlessly for all parties, constructive access to healthcare specialists where control of access is maintained by support staff, enabling more complex remote treatments and monitoring whilst maintaining a high quality of care; and effective, non-repetitive, digital data capture and organisation to reduce the administrative burden on both patients and staff.
  2. Creating an engaging patient experience includes integrating digital therapeutics to enhance and modernise traditional care, creating scalable, even automated on-demand patient health services to help avoid overwhelming hospital staff; ensuring these digital services are intuitive, easy to learn, and practically accessible to all patients and staff; creating more personalised and therefore meaningful care experiences cost-effectively and rooted in scientific and behavioural understanding.
  3. Enabling beneficial care-team coordination, to help staff focus on delivering healthcare services, will include being able to contact and communicate with the required staff resources (e.g. on-call specialists, hospital orderlies) with the minimum of effort or time-wasting steps; making best use of scarce specialist resources to tackle the elective backlog without adding to burnout, and leveraging the best features from communications and collaboration services to help remove frustrating siloes and operational complexities.
  4. Collaboration with healthcare providers across the ICS includes creating consistent, beneficial experiences across regions despite variations in age and quality of infrastructures; removing duplication or confusing patient treatments across Trusts and other care providers; maintaining compliant data governance and security to create ‘joined-up’ care without adding to staff burnout, reduction in hospital alarm notifications and messaging fatigue, and maintaining clear roles and responsibilities for transformation projects to prevent delays.

When collaboration and communications services are connected across the entire patient journey from before a visit, during a visit, and then after a visit, they become integral to the improvement of the total experience for patients, clinical staff, and back-office staff. It can be a good idea to start off by using a benchmarking tool to measure against industry standards, and so get a good idea of a healthcare provider’s innovation readiness.

Q3 digital health funding craters nearly 50% to $2.2B: Rock Health

Returning to 2020 and prior trends? The recession and expensive money have hit quite comprehensively in digital health, with Rock Health’s quarterly/YTD tracking that Q3’s digital health funding of $2.2 billion declined to a little over half of Q2’s $4.1 billion. It is the lowest quarter in funding since Q4 2019’s $2.1 billion. Q3’s performance is also reflected in the number of deals completed, tracking at a scant 125 deals.

Are we returning to a prior norm? In looking at YTD 2022 funding ($12.6 billion, 458 deals), it is trending very close to the full year of 2020 at $14.7 billion and 481 deals which in turn was a decent increase from 2019. Allowing that it was kickstarted by carryover from 2021 (Q1 of $6.1 billion), it puts 2021 in sharp relief as a Covid-driven and (in this Editor’s estimation) ‘silly money’ outlier since Rock Health’s tracking started in 2012.

Reviewing Rock Health’s numbers:

  • They project that 2022 will not even attain half of 2021’s funding levels
  • Average deal size YTD is $27 million, $3 million less than 2020 and $12 million less than 2021
  • Raises of Series C and above nearly vanished: only 6, accounting for less than 5% of total funding. Q2, by contrast, had 19 Series C+ raises. And there were only two digital health mega raises of $100M or more compared to 2021’s average of 22 per quarter. Rock Health speculates on the reasons why, including that some were diverted into other funding types such as round extensions and venture debt.
  • Mental health continues to lead the composition of funding by clinical indications, with oncology and cardiovascular moving into the #2 and #3 spots YTD versus 2021, with diabetes moving back to #4. In value propositions, non-clinical workflow jumped to #1 with on-demand healthcare holding on to the #2 spot. R&D fell back to #3 from last year’s #1 spot.

Certainly for those seeking funding, this confirms that the open wallet days for anything labeled digital health are over and not returning.