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

November 17, 2023 | by

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

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

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

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

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

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

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

November 17, 2023 | by

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

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

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

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

November 15, 2023 | by

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

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

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

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

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

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

Perspectives: The Impact of Virtual Nursing on Telehealth

November 14, 2023 | by

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

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

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

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

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

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

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

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

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

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

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

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

November 14, 2023 | by

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

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

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

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

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

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

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

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

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

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

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

November 10, 2023 | by

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

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

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

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

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

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

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

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

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

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

November 10, 2023 | by

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

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

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

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

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

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

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

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

November 9, 2023 | by

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

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

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

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

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

November 8, 2023 | by

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

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

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

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

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

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

November 2, 2023 | by

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

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

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

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

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

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

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

In sale news, some big numbers are posting:

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

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

This ‘n’ that: HHS settles *2017* ransomware breach, Carbon Health lays off 114 in restructuring, why oh why VC General Catalyst wants a $3B health system, when Larry Met Billy, a lexicon of workplace terms

November 2, 2023 | by

It only took five years to levy a $100,000 fine. Doctors’ Management Services, a Massachusetts-based medical management company, had a ransomware attack back in 2017 that exposed 206,695 individuals to personal health information violations. The Health and Human Services (HHS) Office for Civil Rights (OCR), which is charged with actually enforcing penalties and remedies for data breaches, decided that Doctors’ management hadn’t done quite enough to protect their patients. The cyberattack was identified in December 2018, but Doctors’ didn’t report the breach to OCR until April 2019. Their network had been infected with GandCrab ransomware. After determining various protection failures, HHS put them on a three-year corrective plan to protect their data and collected the $100,000 fine, their very first. But still, nearly four years later? And with breaches, ransomware, and hacking going on every day?  Healthcare Dive

Another Covid unicorn comes down with a bang. Carbon Health, a 13-state network of primary care clinics along with virtual care in areas such as mental health, says ‘bye’ to 114 or 5% of its staff. It grew and got funded big during Covid as it set up testing and vaccine initiatives, achieving a valuation of $3 billion. In 2021, Covid accounted for 60% of their revenue, but as it waned in 2022, so did their revenue by 23%. To date, their funding has been over $622 million, with $100 million in January in a Series D funded by CVS Health Ventures. This isn’t their first big layoff–200 staffers said goodbye in January as well as 250 in mid-2022 which was about 8%. Becker’s

General Catalyst’s newest venture into Health Transformation Land, HATco, The Health Assurance Transformation Corporation, is in the market for a health system in the “$1 billion to $3 billion” range. Not too small to not have an impact in their communities, and large enough to have capabilities around value-based care plus a track record of excellence. This is to create their ‘blueprint’ for healthcare transformation. Interested parties should contact CEO Marc Harrison, MD. Their other plans to get there were announced at HLTH. As to why…General Catalyst has had a lot of experience with companies, and perhaps they feel they have a Better Way to Get There. Becker’s, TTA 10 Oct.

Of Note…The second wealthiest executive in healthcare, Oracle’s Larry Ellison, wasn’t too busy to hang out with the third wealthiest on Forbes’ list, former senator and HCA honcho Bill Frist, in Nashville at the inaugural Frist Cressey Ventures Forum. Ellison is also investing in a 70-acre, $1.35 billion campus on Nashville’s riverfront. It’s always nice to make nice with the neighbors, especially when they have major holdings in a large health corporation. Becker’s

To wrap up This ‘N’ That, Becker’s has a useful article that will keep you au courant on those workplace terms you see on places like LinkedIn. ‘Quiet quitting’, so popular in 2021-2, has had its day with layoffs leading to real ‘quitting’, leaving behind ‘grumpy stayers’ who try to get away with ‘Bare Minimum Mondays’. ‘Coffee badging’ was a new one on your Editor. The rest are catchy phrases for things as old as time in the workplace.

Catching up on Oracle Cerner and the VA, plus the AI ‘tech sprint’

November 1, 2023 | by

Since Congress passed appropriations for the VA in September/October [TTA 3 Aug on House bill] after a busy and acrimonious summer, things have been very, very quiet. The appropriations require multiple mandatories around reporting by Oracle and the VA, which have kept them busy. Prior to this, VA screeched to a halt any further implementations of the Cerner EHR until the five current ones are fixed. The exception–the Captain James A. Lovell Federal Health Care Center in Chicago, the only fully-integrated VA and Department of Defense (Military Health System) healthcare system, with a projected go-live of March 2024.. As MHS, a much smaller and focused system, is just about completed with Cerner and the VA implementation is now postponed, Oracle decided to lay off former Cerner staff in fairly substantial numbers–500 to a rumored 1,200 layoffs in June.

Additional updates:

  • As of a September report on FedScoop, VA and Oracle Cerner plan to resume implementations during the summer of 2024, according to Dr. Neil Evans, acting program executive director of the VA’s EHRM Office, during a House Appropriations Oversight hearing on implementation of the VA’s EHRM initiative with Oracle Cerner that included Oracle’s Mike Sicilia.
  • At that hearing, VA reported that the first round of fixes were completed on the EHR on 31 August in the first round of three-month increments.
  • But during the Appropriations Oversight hearing, leaders of the VA medical facilities already using the Oracle-Cerner EHR testified that productivity is still less than when they were on VistA. Workers are putting in longer hours to cover the workload. Overal, the five the medical centers have hired on extra staff to compensate and have reported “exhausted, sometimes tearful, and frankly distressed” staff in dealing with multiple errors.
    • Robert Fischer, director of the flashpoint Mann-Grandstaff VA medical center in Spokane, Washington, testified that they hired 20% more staff and 15% more clinicians to handle the same workloads. “I would say one of the root causes is related to Oracle-Cerner’s lack of appreciation for the complexity of VA operations,” Fischer said.
    • Since implementation, employees have investigated 1,600 Oracle-Cerner-related patient safety events, 15,000 “break-fix” IT help tickets, and 28,000 medical orders that “did not execute successfully as anticipated.
    • Example: at the VA Ambulatory Care Center in Columbus, Ohio, “Imagine being a doctor in Columbus, and receiving a critical message about a patient you have never seen, who’s been admitted to a Department of Defense site thousands of miles away, because his provider has a similar name,” Meredith Arensman, their chief of staff, testified. “Imagine being an optometrist and finding an eyeglass prescription that has your signature, that you know you never signed … These are not possibilities. It has been the reality.” Federal News Network
  • Perhaps as a backup, the VA inked a deal made public today (31 October) with 13 community hospital systems for data sharing.  The stated intent is by data sharing, they will improve veterans’ care in or outside the VA system, facilitate veterans taking advantage of VA and community resources, and connect veterans with VA benefits, including new benefits for toxic exposure-related conditions under the PACT Act. However, it’s also well known that VA offloads to community health systems. The systems are listed in the VA release. Work has already started and proof-of-concept is due in early 2024. FedScoop

VA also has to cover the now executive-ordered (EO’d) $1 million ‘tech sprint’ for healthcare innovation to 1) reduce staff burnout and 2) create AI-centered tools to save time for clinicians, such as clinicians’ note-taking and integration into veterans’ medical records. This one will consist of two three-month AI Tech Sprint competitions. More distraction. FedScoop

The Cerner blues, VA and health system driven, are affecting the Oracle share price. But Oracle chairman’s Larry Ellison need not worry. His net worth of $130.9 billion makes him the second wealthiest person in healthcare, topped only by Jeff Bezos of Amazon and followed by Thomas Frist and family, according to Forbes. Becker’s

Olive AI selling rest of business to Waystar Health and Humata Health, winding down: reports (several updates)

October 31, 2023 | by | 3 Comments

The final reorganization is to sell everything. Today’s report in Axios states that Olive AI’s remaining business has been sold to revenue cycle management/payments software Waystar Health and to Humata Health, a startup (see update below). Olive’s Clearinghouse and Patient Access business units went to Waystar and its Prior Authorization business unit to Humata. Sale prices and staff transitions were not disclosed. OliveAI’s business lines centered on automating routine tasks in healthcare so that more time could be spent on patient care and higher value tasks.

Olive’s statement was simple and brief, in part reading “These products represent the heart of Olive’s business and we believe this decision will provide important stability and a bright future for these customers. With the sale of our core business units, Olive will wind down the remainder of its business.” Other than this message, their website was almost totally disabled except for a customer login on a product named Lighthouse. In the message, there is no information on handoffs nor on the fate of remaining staffers.

This follows on our reporting of Olive AI’s slow bleed starting July 2022 when they pink-slipped 450 employees, or one-third of staff, followed by additional layoffs of 35% of staff (215 workers) this past February, then the sale of various businesses to an undisclosed sister company, business intel to BurstIQ, and its utilization management tool to Availity all between February and June. They had a lot to sell in refocusing on core business. Since its founding in 2012, Olive had pivoted its business model 27 times according to its CEO, which sounds to this Editor more like a constant pirouette. The final layoff reported was in July of another 450 staff, another one-third. An Axios report in April 2022 demolished much of their credibility with examples of overpromising on their technology producing savings and efficiencies, then underdelivering, an assessment echoed by KLAS. HISTalk

OliveAI’s demise as it reaches the end of the runway for near-total hull loss is almost in the Theranos class as a Unicorn Fail. They were valued at one point at $4 billion and burned through over $850 million in nine rounds of funding up to a Series H, including from top VCs General Catalyst, Tiger Global, and Vista Equity Partners. General Catalyst is now moving into the transformation business with the awkwardly named HATco,  The Health Assurance Transformation Corporation, announced at HLTH earlier this month and defined as “a more affordable, accessible and proactive system of care”.  As this Editor noted then, HATco’s promise is a song we’re heard before. (The Gimlet Eye would say it should be played on a tinny, out-of-tune piano.)

One of the remaining business buyers, Waystar Health, filed only two weeks ago to be the first IPO in digital health in over a year, for an estimated valuation of $8 billion. Mr. Market’s bad behavior though is delaying its roadshow till December at the earliest due to weakness. The IPO will be 2024. Sometime. [TTA 26 Oct] The cycle begins anew.

Even so, yet another demise of a once-promising company is sad news. This is developing and will be updated.

Update on Humata Health (see comment below). Turns out it is a startup that will be headed by a former Olive president for their payer business, Jeremy Friese, MD. According to his LinkedIn profile, Dr. Friese had that position November 2020 to September 2022 after the sale of Verata Health, where he was co-founder and CEO from 2017 until they sold their prior authorization business to Olive AI. Three former Olive employees contacted the author of Axios’ coverage, Erin Brodwin, after she published the original article on 31 October. So Dr. Friese, who lists a ‘stealth startup’ from April 2023 in his profile, is apparently taking back his prior authorization business. Does this seem reminiscent of Pear Therapeutics’ CEO, Corey McCann, obtaining backing to acquire many of Pear’s assets out of bankruptcy for a paltry $2.03 million [TTA 24 May]?

Was Olive AI a scam? HISTalk has an interesting discussion today on whether it met the definition, as some have claimed. Their POV is that it was not, but investors and customers didn’t do their due diligence despite poor KLAS reviews (except for prior authorization) and especially in the hothouse of 2020-2021 did not see past the hype. For those evaluating companies, whether to take them on as a vendor or to go work for them, there are three cautionary points that stood out in their seven lessons:

  • Companies can be wheezing their last even as they pay big money for impressive exhibits and sponsored events at conferences.
  • Rapid company expansion, acquisitions that look like an attention-diverting shell game, and a product line that is too confusing to summarize in a single “what does your company do” sentence are reasons for skepticism.
  • All companies and investors look smart when the economy is booming.

HISTalk’s Curbside Consult columnist Dr. Jayne takes on Olive AI, which in her health IT world is being much talked about. She and this Editor are on the same page about these running-out-of-funding runway startups which she summarizes so well:

In talking with friends who know the industry well, most are in agreement that it’s time for a lot of companies to pay the proverbial piper since they can’t deliver on the promises they made in exchange for startup funding. They forecast that many more companies will be trying to reinvent themselves over the coming months. Those that are successful may live to fight another day, but others may become the stuff of fire sales or ultimately closures.

News roundup: Walgreens & CVS pharmacy staff 3 day walkout, DOJ ramping up healthcare acquisition scrutiny, Cantata Health sold to TT Capital, Lancashire County Council chooses Progress Lifeline for TECS (UK)

October 31, 2023 | by

Kicking off the week, a walkout. Pharmacy staff at both Walgreens and CVS locations are participating in a three-day walkout that started today (30 October) and will go through Wednesday (1 November). The scope is limited–organizers are urging pharmacists to call in sick on those days and the actions appear to be somewhat scattered by state. This follows an earlier mid-October three-day walkout [TTA 11 Oct]. The Walgreens action, according to organizers, will end on Wednesday with  Wednesday with a planned demonstration outside Walgreens’ headquarters in the Chicago suburb of Deerfield, Illinois.

The organizer quoted by MedCityNews and CNN, Shane Jerominski, a former Walgreens pharmacist and now with an independent pharmacy, stated that the issues are over short-staffing and overwork. In addition to their main tasks of accurately filling prescriptions, he said that they also deal with requests for administering vaccinations, testing, setting up auto-refills and other tasks. Mr. Jerominski claims that 2,500 Walgreens pharmacists and technicians will participate, which is coming as a surprise to Walgreens management. He also claimed to CNN 25 store closures.

Pharmacy workers are not currently unionized, but both the United Food and Commercial Workers International Union (UFCW) and the Service Employees International Union-United Healthcare Workers West (SEIU) are interested and support the walkouts. The American Pharmacists Association (APhA) also issued a statement of support from their CEO including issues such as patient harassment, burnout, quotas, and additional fees imposed by pharmacy benefit managers (PBMs) such as Express Scripts and Optum. Becker’s

Meanwhile, the Department of Justice (DOJ) continues its warning shots over the bow to Big Healthcare. POLITICO, the daily broadsheet of the political class, reported that Andrew Forman, a deputy assistant attorney general in the DOJ’s antitrust division, warned that DOJ would be 1) closely scrutinizing all deals for antitrust and 2) stepping up post-merger investigations. This is all about “monopoly’ of healthcare markets as deemed by DOJ–and the Federal Trade Commission (FTC), currently ax-tossing at Amazon. Mr. Forman cited national economic data, blame-gaming among health care providers, insurers and drug makers, and economic analysts–as well as the public comments registered as part of DOJ’s draft merger guidelines. Hiding behind value-based care isn’t going to help as DOJ is questioning whether payer/provider consolidation actually delivers on VBC, but instead “delivers on increased power and conduct that increases barriers and otherwise harms competition”. A far more complete summary of his remarks at the Health Care Competition Conference of The Capitol Forum is at Medical Economics. 

Our backgrounders on both DOJ and FTC actions around antitrust and mergers are summarized on 24 August (lead item) including our 20 July analysis of the Draft Merger Guidelines and this Editor’s educated guesses on the cloudy future of M&A. Also Becker’s

Slipping in under the DOJ radar is Cantata Health’s majority sale to a private equity group, TT Capital Partners (TTCP). Cantata developed and markets the Arize EHR and revenue cycle management platform for behavioral health, human services, acute and post-acute care. Arize is in 280 healthcare facilities across 45 states, as well as Canada, the Bahamas, Puerto Rico, and Guam. Investment amount nor percentage are disclosed, nor who exited or management changes. However, a look back at a 2017 release about Cantata’s formation states that another PE, GPB Capital, acquired NTT DATA’s healthcare software assets for acute and long-term care. TTCP release

In Lancashire, the County Council has chosen a new preferred provider for technology enabled care services (TECS), Progress Lifeline, in a competitive bid. The Council currently provides personal alarm button pendants, wristbands, and wireless home sensors and detectors to local residents for a monthly fee. A significant factor in these new bids is enabling a smooth analogue-to-digital changeover, a critical issue for UK telecare providers. Progress release   Hat tip to Diane Gannon of Progress

UHG’s Optum UK closes £1.24B buy of EMIS Group

October 31, 2023 | by

UHG and Optum wasted no time. A year after their bid yet less than one month after approval by the Competition and Markets Authority (CMA), EMIS Group is now part of Optum Health Solutions (UK) Limited. The £1.24 billion transaction became effective on Friday 27 October when shares were suspended from trading on the London Stock Exchange. The sale was formally to Bordeaux UK Holdings II Limited, an affiliate of Optum Health Solutions UK Limited.

As we noted on 2 October, EMIS is the leading EHR system used by NHS GPs throughout the UK. EMIS also has systems for business intelligence, pharmacy, EDs and urgent care, and to identify patients for clinical trials.  It started as Egton Medical Information Systems by two Yorkshire physicians, back when IT was called MIS 35 years ago. In their statement, EMIS will remain HQ’d in Leeds and remain primarily a UK-based company. “…there will be no material changes to our existing operations or locations. Optum UK intends to continue EMIS’s technology development investments, such as EMIS-X, without any material changes to our focus on the key areas of interoperability, elite partners, community pharmacy and data analytics.” There is no indication in the statement about changes in management, more about reassurance in continuity of operations. MarketScreener

Weekend reading: new study finds lack of GP and healthcare access driving 55% of UK patients to online/apps, desire for prescribed apps

October 27, 2023 | by | 1 Comment

A new 26-page study from Swiss ‘innovation service provider’ Zühlke found that 55% of UK adults in the past six months have self-diagnosed their health problems online or with an app, versus seeing a medical professional. Driving it is lack of access, reported by 43% of UK adults in Zühlke’s 1,000-person May sample.

App and online use for self-diagnosis peaks among those 30-39 (72% strongly/somewhat agree), with 67% 18-29 and 65% 40-49, dropping off sharply in the two oldest age groups. The fairly consistent positivity of the 30-39 age group versus the 18-29 group is surprising to this Editor.

According to the study, UK adults are also reaching out to the NHS to vet apps in higher numbers. 49% strongly agree/agree, with the remainder rather lukewarm. in four descending neutral to strongly disagree categories. But by age, those who feel comfortable with healthcare providers prescribing apps range from 41% in the 60+ cohort to 58% in the 30-39% group. The increased acceptability apparently has been driven by the Covid-19 experience with remote health.

55% also feel comfortable with a prescribed app to monitor mental health, with the same strength (69%) in the 30-39 group.

The study also covers price tolerances for paid health apps, with 25% in the 30-39 group willing to pay over £20 monthly for an app, and preferred types of conditions to be managed with an app. The NHS is far and away the #1 preferred provider for prescribed health apps. Full study (link to PDF), press release