Healthcare M&A hit a 3 year low in Q2 2023, to the surprise of none: KPMG

August 11, 2023 | by

“Is deal making ready to rebound?”–KPMG tries to find the bright side in their new study of healthcare activity. If Q2 reflects the trend, it won’t be this year. See below for what this Editor sees that KPMG doesn’t.

  • There were 245 deals in Q2 2023, 7% below deal volume in Q2 2022 and 41% below the bull market of Q2 2021.
  • Buyers shifted from the financial buyer (e.g. a long-term investor), now at 29% of deals, to strategic buyers who look to expand or augment their businesses at 71%. This is a complete flip from the prior year, where strategic buyers were 37% (98) of a total of 264 transactions.
  • Sectors have also shifted:  42% of deals included physician groups, 27% were IT/digital health sector, 16% were in post-acute care, and 15% involved health systems. The shift away from digital health is pronounced from the palmy pandemic days of 2021 where 737 deals raised $29.1 billion.

There aren’t many big deals on the board in Q2, mostly announced and not closed: CVS Health-Oak Street (closed), Optum-Amedisys, TPG and AmerisourceBergen-OneOncology, Molina-BrightHealthcare’s CA plans, Froedert Health-ThedaCare, and Kaiser Healthcare-Geisinger (forming Risant Health). The last is still to be structured.

KPMG’s reason why for the paucity of deals were the Fed and the continuance of interest rate hikes to supposedly slow inflation (which hasn’t worked much and instead is depressing the economy), the US political situation (turmoil), and what they politely term “uncertainty about the valuations of potential acquisition targets.” Healthcare Dive, Becker’s

“Uncertainty about the valuations of potential acquisition targets” is an understatement. This Editor looks back at that time of  2020 to perhaps Q1 2022 as a binge of insane proportions and self-reinforcing FOMO. Rivers of free-flowing money for any company in digital health–who can blame founders and funders for grabbing their buckets and filling them? The hangover? Equally insane. Of SPACs alone, which were treated like the future of IPOs, nearly all cracked. Valuations of established telehealth companies plunged 70-90%. The money? The river bed is largely dry except for a few puddles and branches. The call for profitability is late.

Racking up reasons why from this Editor’s POV that aren’t in the KPMG analysis:

  • Investors such as VCs and providers no longer have the money because 1) they spent it and 2) can’t raise it. Those who have ‘dry powder’ are either reserving it for a brighter day, cutting back themselves, or deploying it to what they perceived as safer bets such as fintech and biopharma. The deals being made especially in digital health are small. Private equity, family offices, and high net worth investors are mostly staying out of healthcare, or being extraordinarily cautious about both where they invest and how much. More on this: TTA 5 April.
  • A four-bank collapse–Silicon Valley Bank’s failure most notably was a dagger in the heart of West Coast VCs. Add to it First Republic, Silvergate, and Signature in NYC (a favorite of Silicon Alley), plus Credit Suisse being taken over by UBS, all in fairly short order in late winter, ant that will tend to curb anyone’s enthusiasm. It also affected companies that located their cash, investments, and payables/receivables in these banks.
  • High valuations seem to have an inverse relationship to survival. This past year has seen the total ‘hull loss’ of the following former ‘industry darling’ companies: Pear Therapeutics, SimpleHealth, The Pill Club, Hurdle, Quil Health [TTA 11 July], and now Babylon Health.  Teetering on the edge are Bright Health Group and possibly 23andMe. Insurtechs Clover and Oscar are cleaning up frantically, trying to recover. Established companies such as Teladoc and Amwell have taken it in the shins and talk a lot about profitability after years almost proudly not being profitable. Onetime ‘too hot for their shirts’ telemental health is still trying to survive the scandals around Cerebral and Truepill. What remains isn’t favorable: too many companies chasing the same younger group of people who want virtual mental health, plus DEA confusion around Schedule II medication telehealth prescribing [TTA 14 June]. 
  • Big acquirers CVS Health (Oak Street Health, Signify Health) and Walgreens Boots Alliance (VillageMD) are posting down numbers, retrenching, selling units, closing stores, and laying off staff in a matter of months to a year post-acquisition.

And to wrap…there are six letters may sink any revival of M&A: DOJ (Department of Justice) and FTC (Federal Trade Commission), with a commission relishing their activist role. 

  • Draft Merger Guidelines that update corporate merger guidelines originally from 1968 but updated many times since. The 13 Guidelines drafted by DOJ Antitrust and the FTC have the intent to prevent mergers that threaten competition or create monopolies. But reading them, nearly every merger or acquisition other than in a horizontal or conglomerate model will be in violation of one of the 13. [TTA 20 July] 
  • Earlier, the Premerger Notification changes to the filing process covered under the Hart-Scott-Rodino (HSR) Act for transactions over $111.4 million. Again, it raises the height of the mountain and the time required for all transactions other than the smallest. [TTA 29 June]
  • FTC reviving the 2009 Health Breach Notification Rule to clamp down on ad trackers, fining Teladoc’s BetterHelp and GoodRx millions, and sending letters to 130 hospitals and health systems to put them on notice that they are on the radar [TTA 27 July].

This Editor is shocked that this concatenation of Federal actions have not gained the attention they deserve, especially the first–or maybe the legal departments are just working verrry verrry qwietly to register their objections.

Perhaps there will be a bounce in M&A–companies moving to acquire under the wire of both the merger guidelines and the premerger notification changes–akin to what Wall Street calls a ‘dead cat bounce’ (apologies to felines). After they’re in effect, watch for another dead stop in M&A and investor exits until everyone adjusts to the new rules and figures out new workarounds. No one wants to be the first out of the gate in this situation.

(Edited for clarifications)

Babylon Health shuts US operations, goes into UK receivership

August 10, 2023 | by

Babylon reached the end of the runway, smack into the lights and barriers. In the US, Babylon Health shut its Austin, TX headquarters on Monday 7 August, the same date as the announcement of the termination of their merger with AlbaCore Capital and their MindMaze business [TTA 8 Aug]. The required filing of a closure notice with the Texas Workforce Commission came to light late yesterday. The layoff of 94 employees left in the office was immediate and the closure permanent. 

As of this writing, there is no change to their US website, but LinkedIn has many posts from the now laid-off. There are no statements from founder and CEO Ali Parsa.

No transition in the US for users. With the US office closure, there is no service for current contracts such as with Ambetter’s (Centene) commercial exchange product nor with other payers or value-based providers and plans, mainly in Medicaid, which have been using Babylon apps. According to the Forbes article published yesterday, users have found that their Babylon 360 app no longer works and have been redirected to their health plan for assistance.

“When Linda, a patient in New York who requested her last name not be used for privacy reasons, went to login for a scheduled therapy appointment today, she received the following message on her Babylon app, according to a screenshot. “Babylon’s clinical services and appointments are no longer available. For details about your health plan benefits and to find a new provider, contact your health plan.”

It appears that Babylon is putting the responsibility of the “transition” on patients and their insurance companies. An email Linda received from Babylon at 11:02 am ET said: “We know you may have questions about this change. Your health plan’s dedicated Member Services team can assist you. You can find your health plan’s contact information on your ID card.”

In the UK, Babylon has entered UK administration (=US bankruptcy). Its main product is GP At Hand which is still active and up for sale in the dissolution of the company. Last year, it exited its three contracts with NHS Trust hospitals two years into ten-year contracts [TTA 24 Aug 22, Wired], leaving Reading and Birmingham controversially [TTA 24 Aug 2022] but may have had a fourth continue with Hammersmith and Fulham in London, one of its earliest users back to 2018-19. GP At Hand is still active in London with about 100,000 users reported by Pulse but is only enrolling patients in Fulham (West London). No further information on the administration filing but that would likely be with the High Court in London as previously disclosed by Babylon.

It is quite stunning that a company that the UK’s Health Secretary Matt Hancock lauded as the future of healthcare in 2018 and plumped for at every turn, survived a beatdown on BBC Two’s Newsnight in February 2020, successfully went public in a US SPAC two years ago (Oct 2021) at a value of $4.2 billion/$272 per share, that entered the US and bought two large US medical practices, had operations in 16 countries and as of last December had 1,895 employees with 35% (660 people), in the US, has collapsed so completely and thoroughly. As of 4pm EDT today, their market capitalization was just above $425,000.

As to the non-US/UK operations and multiple user services in places like Rwanda and India–their fate is unknown. Perhaps another reason why Babylon, like its Biblical namesake, eventually collapsed.

FierceHealthcare, Computing (UK–may require free signup), BMJ, The Telegraph (via Yahoo Finance)  Our Babylon Health file here.  This story is developing. If you were a Babylon employee, you may email Editor Donna in confidence or leave a public comment below.

Mid-week short takes: Amwell lowers 2023 outlook, DocGo goes up, Imprivata + PFH win Ireland HSE contract, Oracle Health’s Nashville move, layoffs at 23andMe, Doximity

August 10, 2023 | by

Amwell missed Wall Street earnings analyst estimates and lowered its 2023 outlook. Q2 revenue of $62.4 million was a 3% drop versus prior year. Net loss was $93.5 million, added to a nearly $400 million net loss in Q1. Both quarters included goodwill impairment charges totaling nearly $400 million to reflect losses in stock value and market capitalization. Amwell is projecting downgraded revenue between $257 and $263 million compared with earlier guidance of $275 million to $285 million. Their adjusted EBITDA range for the year was also downgraded to lose $160-165 million from $150-160 million. Much of this is due to payer and provider migrations to their new platform, Converge, which will consolidate its offerings plus third-party tools, in a process that is losing providers and reducing visits. Release, Healthcare Dive

DocGo, a telehealth and medical transportation provider, upped its outlooks. First, they reported a tidy bump in Q2 revenue of $125.5 million, up from $109.5 million in prior year. Once known for mass Covid testing which has largely disappeared, which was $28 million in Q2 2022, non-testing revenue grew 53% versus prior year. Revenue is split between transportation ($45 million) and mobile health ($80 million). Adjusted EBITDA was $9.1 million for Q2, rising from $5.6 million in Q1. With $325 million in contracts not fully rolled out and wins with the NYC Department of Housing, their full-year 2023 revenue guidance is now projected to increase from $500-$510 million to $540-$550 million and monitoring over 50,000 patients. Release, Mobihealthnews

Ireland’s Health Service Executive (HSE) awarded a national framework contract to Imprivata and regional partner PFH Technology Group. Imprivata OneSign is a single sign-on (SSO) enterprise access solution for clinicians logging into various systems which eliminates repeated username/password entries. Logins will be via entering their password once per shift and reauthenticating with a tap of their ID badge, potentially saving 50 minutes per shift. Initial rollout will be to the following: Tallaght University, Beaumont, Rotunda, Galway University, Cork University Maternity, National Forensic Mental Health Service, and National Rehabilitation Hospitals. Imprivata release

Oracle Health on the move. Apparently Oracle Health, largely the former Cerner, will be moving to Nashville, Tennessee. This is a commitment that Oracle made in 2021 before purchasing Cerner. Oracle is building a $1.35 billion facility at a riverfront site, planning to locate 8,500 jobs in Nashville by 2031. Nashville has become a southeastern hub of healthcare companies and development. Oracle Health chair David Feinberg, MD and Seema Verma, a SVP there, were at a healthcare meet and greet there last week.  This adds to the de-Kansas City-ing of Oracle and perhaps more attrition among long-time employees. Becker’s

Two healthcare companies reported layoffs and revenue rethinks this week:

  • Genetic tester and data merchandiser 23andMe announced layoffs of 11%. This affects 71 employees primarily in their therapeutics segment, a cut of 47% in that segment and 11% of the company’s workforce. The staff downsizing reflected the end of a five-year partnership in therapeutics development with GSK and adds to April cuts of 75 jobs. The new cuts will be in Q2 of their 2024 fiscal year ending 31 March 2024 which will be by September this year. Revenues also fell in the quarter ending 30 June (their Q1) 6% to $60.9 million from $64.5 million in prior year, with a net loss of $104.6 million. Interestingly, 70% of their revenue is from direct-to-consumer services in genetic testing, subscriptions, and telehealth.  StreetInsider, GenomeWeb
  • Doximity also is laying off 10% of staff, or about 100 people. A digital platform for medical professionals with online networking tools, scheduling, CMEs, secure messaging and telehealth for consults, it is facing slowing growth and renewals among paying customers that include hospitals, health systems, pharmaceutical companies, and medical recruiting firms that purchase subscriptions for services on Doximity. The company adjusted its FY2024 (March end) financials downward to $452 to $468 million and $468 million from $500-$506 million, with adjusted EBITDA for the year to $193-$209 million from $216-$222 million. Release, FierceHealthcare

 

Living to fight another day: insurtechs Bright Health, Clover Health, and Oscar Health report improved Q2s, H1s (updated)

August 10, 2023 | by

Have the upstart payers turned a corner–even if that means exiting the business? ‘Insurtech’ is the term given to the tech-enabled, health tech-friendly US payers which were supposed to deliver health insurance plans more efficiently (buy online!), more conveniently using apps and telehealth, lead in value-based care through strong networks, provider software, internal automation tools, and wrap it up with a ribbon of lower delivery cost to consumers, from those who needed individual exchange plans to Medicare Advantage. This utopian model cracked like the SPACs of Bright Health and Clover Health, and the IPO of Oscar Health, as this Editor noted last month, perhaps to the glee of traditional payers. But when survival is at stake, some surprising things can happen. All three are Not Dead Yet.

Bright Health Group succeeded last month in selling its remaining plans to ‘pure payer’ Molina Healthcare–their California Medicare Advantage plans Brand New Day and Central Health Plan. The deal: purchase 100% of the issued and outstanding capital stock of the two plans in a deal structured to be about $600 million. The Catch-22: stay solvent and absorb plan operational costs and losses (which are many) until Q1 2024 when the Molina deal will close. [TTA 6 July]

Last Friday (4 August), Bright secured a life preserver and line just as the waves started to crash–$60 million through a credit facility with an investment partnership of New Enterprise Associates (NEA). They also entered into a permanent waiver of default on its existing credit facility, which expires in February 2024. This has to refer to their prior $500 million credit facility with JP Morgan which was long overdue and now waived until the Molina close, apparently. Bright also is issuing penny warrants to NEA to purchase up to 1,656,789 shares of the Company’s common stock to the lenders under the new credit facility, approved by the board without the usual shareholder approval. This leaves an open question about who is really controlling the company. Release, Healthcare Finance, FierceHealthcare

There seems to be an even brighter (sic) picture in that their adjusted EBITDA for Q2 and H1 were actually in the black: $6.4 million for Q2 and $670,000 for H1. Even more bullishly, they project a full-year profitable adjusted EBITDA.

  • Reduced Q2 and H1 net losses: Q2 was $125 million versus $284 million in prior year. For H1 2023, the losses were $312 million and $488 million respectively.
  • Their other businesses in consumer care delivery, value-based care with providers in shared risk including ACO REACH (NeueHealth), and enterprise seemingly perform well. Their 2023 totals: consumer care $250-275 million, care solutions $900-925 million, and enterprise $1.15 -$1.2 billion.
  • Lives covered in value-based care are up to 371,000, an increase of 214% over last year’s 118,000–excluding any covered under their now exited commercial plans. Release,  Healthcare Finance

Looking at Clover Health, it was revealed this week that they survived a delisting off Nasdaq, which happens when the minimum closing share price requirement falls below $1 for at least 10 consecutive days. Now with closings for 10 days over $1, they are in Nasdaq’s good graces for now. They are exploring a reverse stock split or authorized share reduction, to be discussed at the 30 August shareholder meeting.

Clover then followed this up with a cheerful lead in their Q2 results that they had adjusted profitable EBITDA of $10 million versus last year’s $83.9 million loss. This is also remarkable as their revenue fell by over $333 million to $513.6 million due to a drop in non-insurance revenue of $384 million. Insurance plan revenue made up some of it by growing 17% to $314.4 million. In total, Clover recorded a net loss of $28.8 million. But for the year, adjusted EBITDA is projected to remain in the red between $70 and $120 million. Mobihealthnews, FierceHealthcare, release

Clover provides both Medicare Advantage (MA) plans in eight states plus a tool for practices, Clover Assistant, which assists in patient chronic care management through machine learning and aggregated data. They also entered value-based care in 2021 in the Medicare Direct Contracting (now ACO REACH) model which was a major loss generator in 2022 (Healthcare Dive) and has been cut back. Clover also survived an epically cracked SPAC out of the gate in January 2021 with the news that the Department of Justice (DOJ) had been investigating the company on investor relationships and business practices starting in fall 2020. A little over a month ago, the company finally settled seven shareholder lawsuits over its non-disclosure of the DOJ investigation at the time of the SPAC [TTA 28 June]. 

Now to NYC-based Oscar Health reporting its Q2, the first under its new CEO Mark Bertolini [TTA 30 March]. Their adjusted EBITDA went from red to in the black with a Q2 of $35.6 million, an improvement of $111.4 million versus prior year, and the second profitable quarter in a row with H1 adjusted EBITDA of $86.6 million, improving by $198 million from 2022. Revenue for Q2 was $1.5 billion with H1 at $3 billion. Net loss narrowed substantially to $15.4 million, an improvement of $96.7 million versus prior year, with H1 loss at $55.3 million, reduced by 70% from last year’s $187.3 million. The year will still be in the red with projected EBITDA loss of $75 to $175 million. The reasons for this gap–two profitable quarters, but an overall disappointing year–are not clear.

Bertolini touted factors such as improved medical loss ratios and rate increases. Oscar also pulled out of unprofitable Affordable Care Act marketplaces in Arkansas, Colorado, and California, as well as trimming MA plans in New York and Texas. On the earnings call, they announced that they were given state approval to resume MA enrollments in Florida and that they were relaunching +Oscar with help from ChatGPT to build automation tools in its Campaign Builder platform. In other news, their CFO is stepping down on 13 August, but remains on the board. He will be replaced internally by the chief transformation officer. Other staff are reportedly changing. Release, Healthcare Dive, FierceHealthcare

Update: you may also want to read Ari Gottlieb’s comments on these three companies on LinkedIn from the view of an expert financial analyst. Further comments on Bright’s perilous situation and Clover’s ‘legitimately good quarter’ here.

Babylon merger with AlbaCore and MindMaze collapses, selling UK and transitioning US businesses, bankruptcy anticipated

August 8, 2023 | by | 2 Comments

Babylon running out of runway, likely to hit the barriers and lights at the end unless there’s a miracle. On 7 August, Babylon, in a tersely written announcement, stated that their 23 June agreement to execute the ‘Take Private Proposal’ with AlbaCore Capital to merge with another of their holdings, MindMaze Group SA, has fallen through and will not proceed. No reasons were given for this surprising development six weeks later.

The release is headlined in the usual guarded terms of being “in discussions of new strategic alternatives” for their US and UK businesses but the reality is in the release copy.

  • Babylon is selling its UK businesses. The company is pursuing the divestiture of its UK business to third parties to provide financing to assure the continuity of Babylon’s operations. There is non-surprising coverage language in the release that “it cannot provide assurance that any of these initiatives will result in Babylon entering into a definitive agreement for or completing a divestiture” which means that the UK businesses may close without a transition. 
  • Babylon will be transitioning its US business to other providers. It is exiting its core US business. As to the transition, no providers are disclosed as of this time.
  • The sale of the Meritage Medical Network IPA is still pending.
  • After the bridge financing by AlbaCore Capital that was provided in May along with AlbaCore’s interim funding proposal of $34.5 million, Babylon is out of money. It is actively seeking additional financing but cannot assure that it will fund continued operations or that a third party sale will be executed in time.
  • This anticipates a complete shutdown of operations, not a reorganization. “The applicable entities of the Group will file for bankruptcy protection or implement other alternatives for an orderly wind down and liquidation or dissolution, which may include commencing Chapter 7 proceedings under the U.S. Bankruptcy Code and/or a UK administration for the applicable entities of the Group in the near term.” For American readers, UK administration for insolvent companies is similar to US bankruptcy procedures in equivalents of US Chapter 11 reorganization and Chapter 7 asset sale and closing. Administrators for Babylon would be appointed by the High Court in London.

Any sales to third parties for any of the above are subject to AlbaCore approval. The proceeds will go to AlbaCore to settle Babylon’s indebtedness to them. As before, common shareholders of Babylon will be shut out as their shares are near worthless today at $0.28. 

Babylon is headquartered in Jersey (Channel Islands) along with Austin, Texas. The company was once a leader in the UK telehealth scene with remote consults and cooperative deals with GPs that received considerable criticism, then expansion to the US after their SPAC with Alkuri Global Acquisition in October 2021. Shares reflected the telehealth bull market of the time with a share price of $272 per share. The SPAC cracked like so many others, deflating shares to double then single digits to around $6 in May. Despite some success in the US market with payers, developing chronic care management programs for high-risk patients, reorganizing as a foreign private issuer to a domestic one, and the reverse share split on 15 December 2022, this last ‘rabbit out of hat’ didn’t work and apparently AlbaCore’s deal with a forced merger with a very different company, MindMaze in neurotherapeutics, didn’t work either. ‘Wicked Tuna’ indeed.

At present, there are no further announcements or changes on the website, nor any confirmed layoffs, a situation which undoubtedly will change.

Also Mobihealthnews, Healthcare Dive, Sifted (UK/EU), and UKTN

More details on the HIMSS-Informa partnership on HIMSS24-Global Health Conference & Exhibition

August 8, 2023 | by

HIMSS has confirmed to this Editor additional information on the open items in our 2 August article, as well as on the update produced by HIMSS for their media arm. As previously confirmed, the name of the conference for 2024 will remain the HIMSS Global Health Conference & Exhibition.

  • The partnership with Informa is only for the Global Health Conference at this time. HIMSS will continue to fully manage its international shows, such as the upcoming September APAC Conference and any planned European conferences.
  • When asked specifically about Informa managing HIMSS-branded international conferences, they emphasized the focus being on HIMSS24, with potential to grow the HIMSS brand.
  • Informa will fully manage the HIMSS24 show, including registration and travel arrangements, while HIMSS will provide the content for the conference. As previously noted, HIMSS is already soliciting speaker proposals for HIMSS24.
  • The contact at Informa for the show will be Ken McAvoy, president, South Florida Ventures at Informa Markets and at HIMSS, Elli Riley, VP Events & Exhibitions at HIMSS. However, as noted by HIMSS’ CEO Hal Wolf in the HIMSS Media interview was that their conference organizing people will be moving over to Informa.
  • HIMSS leadership started to seek a partner for the Global Conference more than a year ago. The discussions with Informa were ongoing for the past several months.
  • Of great interest to exhibitors who have already booked or are about to book for Orlando in 2024, they do not anticipate any significant changes to the logistics arrangements for HIMSS24, nor to any booked exhibition spaces. They are looking for ways to improve the onsite experience and create more value for customers.
  • At this time, HIMSS is not planning to revisit or revive regional conferences or Health 2.0.
  • HIMSS will continue to be a mission-driven nonprofit focused on a vision to realize the full health potential of every human, everywhere. An interesting statement was that “Governments are selecting HIMSS to do their analyses, and the largest employers of healthcare turn to HIMSS to help make the right operational decisions. HIMSS will continue to grow its thought leadership and take on initiatives and issues that are vital to health and healthcare.” which indicates growth in their consultancy area.
  • No financials were disclosed.

This is a developing story and will be updated.

Short takes: CVS’ $1.12M Q2 net income loss, forecast spurs 5,000 layoffs; Signify’s in-home kidney exams; Indonesia’s Halodoc $100M D; FeelBetter raises $5.9M; Medicare breach hits 612,000 beneficiaries

August 3, 2023 | by

A mixed picture for CVS Health. Their Q2 reporting was almost schizophrenic, depending on whose reporting you read. Healthcare Finance highlighted their $1.12M net income loss–tiny when compared to the size of the company– but apparently one of the factors driving a layoff of 5,000 corporate, non-customer facing staff. From FierceHealthcare, CVS is still quite profitable at $1.9 billion, but that is down 36%. Revenue of $88.9 billion was up 10% from prior year. The results beat Wall Street analyst estimates of $2.12/share with adjusted earnings of $2.21/share. 

Despite the overall good picture of Q2, financial projections trended down for the full year. CVS in Q2 started a restructuring plan which cost $496 million in pre-tax income, expected to be completed by year’s end. 2023 is projected to have increased Medicare Advantage costs, higher drug utilization, and lower consumer spending expectations affecting retail operations. Added to their acquisition binge of Signify Health and Oak Street Health, which together totaled $18.6 billion, their 2024 earnings per share projections for 2024 fell from $9 to a range of $8.50 to $8.70. Timing was not disclosed for the 5,000-person reduction among corporate staff. It is not known whether this will affect Aetna and CVS Caremark (pharmacy benefit). CVS has 300,000 employees (75% full time) including part and full-time retail workers. They are also reducing corporate travel, plus the use of consultants and vendors. (CVS is known to have extremely low contractor rates already.) The restructuring is projected to save $700 to $800 million next year, but cold comfort to the 5,000 who won’t be there.  FierceHealthcare. We’ll see.

One of those CVS purchases, Signify Health, is moving forward with an in-home option for evaluating kidney function as part of in-home exams of Medicare Advantage members. This evaluation will include urinalysis and estimated glomerular filtration rate testing which are relatively simple and cost-effective to administer in-home. It fits within their in-home exam protocols and will support early detection and diagnosis of kidney disease plus management of those with chronic kidney disease for earlier and better treatment. End-stage renal disease (ESRD) costs $37.3 billion to Medicare. FierceHealthcare

Going far, far East to Indonesia, virtual health provider Halodoc scored $100 million in a Series D funding round. Lead investor was Astra International with Openspace and Novo Holdings. This brings their total funding to $245 million. Halodoc provides online and app-based health services for 20 million active platform users claimed. Services include telehealth, medicine ordering, lab test, and doctor appointment booking. They also manage third-party health insurance purchase and at-home health testing. Their network includes more than 20,000 medical practitioners, 3,300 hospitals, and 4,900 pharmacies. On the website, there are a wide variety of services, including wellness. Unfortunately, to read it, you’ll have to know Indonesian (Malay)–and there are some pictures of intriguing recipes there! Mobihealthnews

Contrasting this to an exceedingly modest raise by a new Boston/Tel Aviv medication management company, FeelBetter. Their $5.9 million unlettered raise was led by Firstime Ventures and Shoni Health Ventures, with participation from Random Forest VC, The Group Ventures, and previous investor Triventures for a total of $8 million. FeelBetter uses AI tools to create what they call Pharmaco-Clinical Intelligence to identify patients at risk and deliver insights on gaps in care to personalize medication management to change the risks of polypharmacy. Release, Mobihealthnews  They also issued a study on how FeelBetter could be used to effectively risk stratify emergency department use and hospitalizations among patients 65+ with multiple chronic conditions and complex medication regimens to avoid the 10-30% of hospitalizations that include medication issues. Release

No week seems to pass by without a data breach of some sort, but it’s unusual when Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) are attached to it. A contractor to the Medicare program, Maximus Federal Services, Inc. (Maximus), used a vendor, Progress Software, and their MOVEit Transfer software, which is a popular file transfer software for transmitting sensitive data. There was a vulnerability in this software that has previously been exploited by Russian ransomwareistes CLOP with Johns Hopkins currently being sued for their breach [TTA 19 July]. Maximus detected the unusual activity, an outside entity copying files, from 27 to 31 May. CMS is reporting that about 612,000 Medicare beneficiaries may have been affected by the breach which may have exposed personally identifiable information (PII) and/or protected health information (PHI). CMS and Maximus are notifying the beneficiaries this week and offering 24 months of free credit monitoring service. CMS release, Federal News Network, Progress page,  Deep Instinct backgrounder on MOVEit’s zero-day vulnerability

House appropriates $1.9B for Oracle Cerner VA EHR modernization, $5.2B for telehealth, plus other technologies; Oracle lays off more Cerner staff

August 3, 2023 | by

House appropriations for the VA in FY 2024 were passed last week, including requirements for the VA/Oracle Cerner EHR Modernization program. The House allocated $1.9 billion in total for VA’s Oracle Cerner EHRM program. According to the report in FedScoop, the topline amount is broken down as follows: $1.2 billion for the Oracle Cerner-operated contract, $424 million for infrastructure readiness, and $253 million for program management. 

The budget is part of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Bill 2024 (full bill). The bill goes to the Senate after the summer recess. See pages 53 and 54 for the EHRM.

Key points:

  • This appropriation is the sole source of funding for the EHR modernization program. “No authority is provided for funds from other VA accounts to be transferred into this account nor for funds from this account to be transferred out to other accounts.”
  • Reaffirms “quarterly reporting of obligations, expenditures, and deployment schedule by facility and the Office of Deputy Secretary to administer the initiative”
  • There is also a 25% contingency upon the VA Secretary to report any outstanding issues impacting the stability and usability of the system, certifying and detailing any changes to the deployment timeline, certifying the status of outstanding issues, and whether
    the system is ready and optimized for further deployment at VA sites. 
  • ” The Government Accountability Office is directed to continue quarterly performance reviews of EHRM deployment and to report to the Committees each quarter.”

Reports will start within 30 days of the enactment of the appropriations bill looking back on “each new requirement and customized interface added in fiscal years 2022 and 2023, including the cost of each, reasons for inclusion, and whether they were outside of the scope of the contract within 30 days of enactment of this Act.” At 45 days, the bill requires a briefing on how the Department plans to set enterprise standards. The bill also confirms that no new deployments are scheduled for FY2024 and the 25% of funds set aside for FY2023 in deployment will not be released. Also EHR Intelligence

The bill also allocates $5.2 billion for telehealth and connected care (page 42). This covers services in home telehealth, home telehealth prosthetics, and clinic-based telehealth. The bill encourages expanding telehealth capacity to address backlogs for disability exams and healthcare appointments when appropriate. Our top story on 9 June was the award of Home Telehealth monitoring contracts to incumbent Medtronic and newcomers Cognosante, Valor Healthcare, and DrKumo.

Included in other budget lines are healthcare technologies (pages 33-34) such as bioelectronic medicine/AI, early detection diagostics, focused ultrasound therapy, medical image exchange, migraine prevention and treatment, and respiratory illness diagnostics using 4-dimensional images of lung function. 

Meanwhile, Oracle is laying off more Cerner employees. Your Editor is basing this on a Reddit 1 August thread that has no totals but indicates that employees were told yesterday (1 August), given two weeks notice to 15 August, and that the layoffs hit areas such as revenue cycle, 10% of CernerWorks, and properties. CernerWorks hosts, manages, and monitors client systems by providing data center hosting services for Cerner EHRs and other SaaS. Whether any of this affects the VA is to be determined, but their Federal service area had 500 to a rumored 1,200 layoffs in June. This was not much of a surprise with the near-completion of the DOD Military Health System EHR implementation and the holdup save one of the VA’s implementations (except the joint VA-MHS Lovell facility in Chicago). Our Readers have heard this here first.

Done (and split) deal! Informa to “manage” HIMSS Global Health Conference & Exhibition (updated)

August 2, 2023 | by

Gimlet EyeIt’s now a “landmark partnership”. From a non-announcement announcement by Informa in its H1 financials to today (seven days), we have gone from Informa’s “exclusivity to acquire the HIMSS Global Health Exhibition/Conference” to a “partnership” as follows:  Informa will manage the HIMSS Exhibition, while HIMSS will oversee the content and programming. This will expand the combined conference and exhibition. (Informa taking over conference logistics aren’t specified, but assumed from later on in the release.)

No transaction costs are disclosed. The word ‘acquire’ is not used once.

It may be the best possible deal for both. The press release (on Yahoo Finance) and identically in the news section on HIMSS.org content is masterful in saying very little in a lot of words. Here’s this Editor’s view of the deal:

  • It avoids the biggest problem–without HIMSS content, the conference would lack a strong reason why to go and spend money on participation and exhibiting. (This Editor guessed right on that.) Minus HIMSS, it would be easy for exhibitors and participants to walk away from it or say ‘maybe next year’. A lot of what has driven HIMSS is FOMO.
  • It would lose 50+ years of Society legitimacy, continuity, and goodwill as an unaffiliated conference
  • This gives HIMSS, as a society, an annual conference as part of member value (Guessed right on this too)
  • Informa would be hard-pressed to organize the conference content by year’s end, as there’s basically less than eight months to March
  • It absolves the HIMSS organization of being responsible for venue negotiations, expo design, logistics, travel arrangements, and all the messy expenses such as Freeman. Their vulnerability showed in the last-minute cancellation in 2020. It’s now in professional hands. 
  • It may generate some needed cash for HIMSS in this FY (not disclosed) 

HIMSS24 will be taking place in March in Orlando as originally planned, managed by Informa’s South Florida Ventures unit. Informa promises “improved digital features, enhanced registration processes, marketing tools, and cutting-edge product discover applications”. One would also hope improved travel arrangements.

There is no information in the release about Informa involvement in the 18-21 September APAC conference (too soon?) nor mention of any future international conferences, though Informa is certainly capable of staging and managing them.

Open issue–HIMSS Media is not mentioned in the release. Media tie-ins and merchandising are a substantial source of revenue for that division. But the lack of mention is not a ‘no’ and if HIMSS is generating the conference content, it’s likely that HIMSS Media will do the merchandising.

Surprisingly, the press ‘break’ is not yet up on HIMSS Media (Healthcare IT News, Mobihealthnews, Healthcare Finance News). Update–an 18 minute video hosted by editor Mike Miliard is up on Healthcare IT News 3 August.

  • The name will not be changed.
  • HIMSS has been considering bringing in an outside organization to manage the conference for some time and had been speaking with Informa over the past year.
  • Mr. Wolf of HIMSS stated that their conference organizing people will be moving over to Informa.
  • Mr. McAvoy of Informa touted the tools that HIMSS will now be able to access–enhanced tools that Informa has developed and amortized over multiple conferences.
  • More to come

A new day for HIMSS in a competitive conference market. Except the link to the conference page at the end of the release, https://www.himss.org/global-conference.–does not open the conference page but goes to a ‘page not found’. Oops! Hint: it’s misconfigured to include the period in the URL.

Previous coverage: More thoughts 2 August, Informa to acquire 27 June    Follow up 8 Aug, answers to questions:

 

More thoughts on the pending sale of the HIMSS Global Conference

August 2, 2023 | by

In the absence of a real announcement, speculation has been everywhere on the not-yet-done deal between HIMSS and Informa. As reported last week [TTA 27 July], HIMSS will be selling the annual Global Conference to Informa PLC, the largest B2B trade show operator on the Planet Earth. There has been no communication as of this writing from HIMSS to members or chapters, nor any announcements in HIMSS Media. The only corporate confirmation came through Informa PLC’s H1 financial report.

From LinkedIn, Tom Foley, who is the head of GenieMD telehealth and also hosts a podcast called The Virtual Shift via HealthcareNOWRadio and Answers Media Network (headed by Roberta Mullin and Carol Flagg, with whom this Editor worked some years back) had two posts on the pending ‘exclusivity to acquire’. In the later post, he addresses the fact that HIMSS has already been booked by most exhibitors as HIMSS, not as a ‘third-party conference’, and asks for market responses. The earlier post is about the ‘announcement’ and is largely the same as his comment on TTA’s original article. Other than these and spinoff posts from other commenters, Other than we Happy Few, LinkedIn posts have been on the QT and very hush-hush on the subject. Interesting as so many on LinkedIn are HIMSS, HLTH, ViVE and other health conference exhibitors and attendees.

Which leads this Editor to turn to the pointed, yeasty HIStalk where their Editors have dug around HIMSS and turned up some interesting things. This Editor encourages Readers to go to the source articles linked below for their analysis. I will add some points and commentary to each, especially on the Form 990s:

  • Monday Morning Update 7/31/23 speculates on HIMSS’ financials reported in their Form 990 as a 501 (c)(6) non-profit. Their last FY filing is for fiscal 2020. Since HIStalk does not, here is the link to that Form 990 2020 in Candid, a public database on non-profits (the former Guidestar and Foundation Center). On the organization page, click on the Form 990 tab for the first 2020 dropdown, which is for their FY starting 1 July 2019 to 30 June 2020. In 2020, HIMSS had total revenue of $28.7 million, a severe drop from 2019 where revenue was over $111.9 million (line 12). Their expenses were over $82.6 million for an operating loss of over $53.9 million. This represents the effects of the cancellation of the 2020 conference, which in 2019 ‘conferences and meetings’ reported $42.8 million in revenue and in 2020 only $1.9 million. Using this information and from Informa’s track record, HIStalk does some calculations on projected sales prices.
  • This Editor also examined the second 2020 dropdown, which is a six-month first-half report from 1 July to 31 December 2020. Revenues rose to $65.1 million with expenses of $42.6 million for an operating profit of $17.9 million. Conference revenue was a tiny $8.7 million but higher than the full year. HIMSS under a joint Health 2.0 banner had a Middle East-based virtual conference in November and HIMSS Media promoted some ‘HIMSS20’ content as digital sessions.
  • News 8/2/23 has reader comments on a HIMSS initiative for vendors called Accelerate, which has apparently been inactive for some time, executive salaries, and speculation on why the delay on the Form 990s.

What remains problematic is HIMSS’ future involvement, if any, in a conference that has been branded as HIMSS for over 50 years and has already been sold into as HIMSS’. How will Informa handle that? Invite HIMSS to sponsor it? Then again, what will be HIMSS’ future as a member-based society without a conference and with a subsidiary, HIMSS Media, that makes money off sponsorships both pre and post and content during the conference? It seems that both buyer and seller would benefit from a shared relationship.

This is a developing story and will be updated.

Amazon Clinic announces 50-state rollout 1 August. Were the privacy issues fixed?

August 1, 2023 | by | 2 Comments

At least the disclaimers are new and improved. Amazon today, on its news page, announced that Amazon Clinic was being rolled out to all 50 US states from the previous 33. You will be paying in cash (no insurance accepted) for services, which now include live 24/7 telehealth (via two ‘white-labels’, Wheel and SteadyMD) in addition to asynchronous (messaging) telehealth, for treatment of about 30 common mild and chronic conditions such as rosacea, gout, eczema, UTIs, and the ever-popular erectile dysfunction and hair loss. Access is provided through the Clinic website or the Amazon app. Providers set fees on a one-time and ongoing basis. Prescriptions can be filled individually or through Amazon Pharmacy. The service is not available to those below 18 or above 64, which is a mystery as those 65+ are perfectly capable of paying in cash and suffer from the same maladies. (Age discrimination, anyone?)

As to the reported delay from 27 June on the service expansion [TTA 27 June], an Amazon spokesperson denied that privacy concerns expressed by two US senators (Warren and Welch) and in the Washington Post had any effect and in fact, denied that there was any delay.  FierceHealthcare.

It is unknown whether Amazon replied to the senators’ letter that cited where consumer information went, that it may be redisclosed, and denial of service (inability to complete registration) if a user during registration did not agree to waive HIPAA and give Amazon access to the patient’s personal information file.

Looking at the news, website and privacy disclosures, there are multiple disclaimers wherever one looks that seem to address these concerns.  On the news release, there is a link labeled Read more about how privacy is built into Amazon Clinic’s core. Excerpts below (main points in red):

We do not sell customer information.

Amazon doesn’t sell customers’ personal information. Amazon Clinic also doesn’t use a customer’s personal health information to market or advertise other products in the Amazon.com store.

We ask for HIPAA authorization to make things easier for customers.
One of the complaints we hear a lot about traditional health care is how many times customers are asked to fill out forms over and over again. To solve this problem, Amazon Clinic asks customers for permission (through the HIPAA authorization) to allow us to save their information and patient records if their health care provider leaves Amazon Clinic. This supports continuity of care and makes it easier for customers to work with different provider groups, because they won’t have to fill out the same form multiple times or lose access to their visit history. Customers have the option to accept or decline the HIPAA authorization before getting treatment—customers who decline can still receive care from Amazon Clinic.

Privacy disclosure on the Amazon Clinic site is the same in consumer-oriented language and with a revocation notice:

What we do (and don’t do) with your information
We use your information to make your healthcare experience easier. We send it to your healthcare providers and pharmacies when you’re being treated, and we save it so you won’t have to fill out the same forms over and over again—even if your healthcare provider were to leave Amazon Clinic. We’ll never sell your information to anyone and we don’t use your personal health information to market or advertise other products available on Amazon.com.
We respect your preferences
If you don’t want us to save your health information, you can still get care through Amazon Clinic. However, you should know that if the healthcare provider(s) you’ve used leave Amazon, we’ll be required by law to delete your health information and you’ll have to re-enter it if you visit us again.
You can change your mind
If you give us permission to save your health information, then change your mind, that’s OK. To revoke your HIPAA Authorization, just email your request to clinic.privacy@amazon.clinic. Make sure to include your name, date of birth, address, and phone number, or download the HIPAA revocation form, fill it out, and send it as an attachment to your email.

Unless this is not operating reality, Amazon may have come to its senses and installed proper guardrails on this service. Amazon is making a massive bet on healthcare by building Clinic, Amazon Pharmacy, and paying $3.9 billion for One Medical which is currently unprofitable. They are betting that to their captive audience, basic healthcare can be delivered like merchandise and that more complex primary care can be folded into the Amazon continuum. In Amazon Clinic, it’s betting that it can one-up established players like Ro and Hims as well as Teladoc and Amwell.

A hard look at Amazon reveals that the strategy compensates for losses in other areas, such as their basic businesses with layoffs of 27,000, including Amazon Pharmacy and the Washington Post, and shuttering Amazon Care last year. Technology hasn’t been much of a winner, with Halo terminated yesterday and with privacy concerns (again) around Alexa, Kindle, and Ring security cameras. AWS is no longer the cash cow mooing in the meadow that subsidizes various ventures, with growth down by half and plenty of competition [TTA 16 June]. Amazon has few friends in DC, not even at the Washington Post. The Federal Trade Commission (FTC) and the Department of Justice (DOJ) have held up their $1.7 billion buy of iRobot for one year as of this month, and are still scrutinizing One Medical.

If the guardrails are made of Silly Putty and there are consumer complaints, Senator Warren, who has a long history of sparring with Amazon, will be issuing more letters. She will huddle with FTC and DOJ, where there’s a dartboard with Amazon’s name on it. Note to Amazon: Senator Warren is up for reelection in 2024, and she needs a high-profile issue.

Legal roundup: Dorsata sues athenahealth, provider group on trade secret theft, Nevada terms Friday Health Plans

July 28, 2023 | by

Dorsata, a women’s health-focused EHR, filed a lawsuit on 19 July against athenahealth and provider group Unified Women’s Healthcare. The suit has nine counts that allege unfair and deceptive acts and practices, breach of oral contract, breach of fiduciary duty, common law fraud, unjust enrichment, theft of trade secrets, tortious interference with current customers, breach of nondisclosure agreement, and commercial disparagement. 

A joint venture that went very sideways. After Unified purchased Women’s Health USA in 2021, an existing customer of Dorsata, athenahealth approached Dorsata to create a joint solution to pitch to Unified. According to Dorsata, which signed a non-disclosure agreement, Dorsata provided trade secrets to athenahealth and the two made oral agreements to approach Unified as a joint venture. Dorsata developed a software product for this, vU, but to finance it had to borrow $6 million from athenahealth. Unbeknownst to Dorsata, athenahealth created its own version of vU using Dorsata’s information to sell into Unified, cutting out Dorsata. Provisions in the promissory note prevented Dorsata from competing with athenahealth. Unified is also named as a defendant as it aided athenahealth’s actions and failed to act while athenahealth cut Dorsata out of their business. 

The suit has been filed in the civil court of Suffolk County, Massachusetts and is searchable here. Dorsata is seeking damages incurred from a loss of expected profits, the value of injury to reputation, a loss of company valuation, the value of future lost business as well as damages for unlawfully gained commercial marketplace advantage. “We’ve been severely damaged, and we hope the court will rectify the situation,” David Fairbrothers, cofounder and CEO of Dorsata, told Mobihealthnews in an email. athenahealth has stated that the suit is ‘without merit’. Becker’s

Friday Health Plan’s last state, Nevada, shuts down their plans. The Nevada Division of Insurance is terminating all Friday plans effective 31 August. After the liquidation on 1 September, Nevada Life and Health Insurance Guaranty will pay provider claims through 31 August. Approximately 2,000 members of Friday’s plans will have to scramble to find coverage on Nevada’s Silver State Health Insurance Exchange (NevadaHealthLink.com) during the special enrollment period (SEP) ending 31 October. The Nevada exchange offers six different health plan carriers with 100 different options. Nevada, like Colorado, had hoped that the plan might survive until the end of the year. Earlier this month, Colorado terminated Friday Health Plans [TTA 20 July]. Friday leaves behind a lot of members in the lurch, providers who are wondering if their states will pay them, over 300 former employees, state insurance departments having to guarantee hundreds of millions in payments in seven states, and embarrassment by the state regulators and by CMS. FierceHealthcare, Nevada DOI release

Close of week short takes: Q2 earnings up for GEHC, Talkspace; UnitedHealth invests $11M in SDOH; fundings for two AI startups, K4Connect, UpLift, Family First

July 28, 2023 | by

Winding up this week on nothing but positive news.

GE Healthcare was up smartly on revenue. For Q2, GEHC reported revenue of $4.8 billion, up 7% versus Q2 prior year, and a 9% organic revenue growth.  The adjusted earnings before interest and taxes (EBITDA) was $711 million versus $719 million prior year, with net income slightly down at $418 million versus $485 million prior year. Adjusted earnings per share was $0.92. Orders were up 6%. GEHC is adjusting its earnings upward by one percentage point for the full-year guidance on organic revenue growth and 10 cents in adjusted EPS at the midpoint. GEHC spun off from GE in January. Mobihealthnews

Talkspace had a far more mixed picture. Their Q2 revenue climbed 19% versus prior year to $35.6 million. This was due to an 82% increase in B2B revenue partially offset by a 41% consumer revenue decline. The other good news was that they narrowed net loss to $4.7 million from the prior year’s $23 million. Adjusted for EBITDA, the loss was $4 million. Another positive factor was that operating expenses were reduced 32% to $24.2 million. They are seeing an increase in revenue for 2023 to $137 million to $142 million and moving towards breakeven by end of Q1 2024. Another entrant in the crowded telemental health space, Talkspace went public in 2021 through a SPAC, trading as high as $11.95. Late last year, it flirted with delisting on Nasdaq, but is currently trading at $1.70. Mobihealthnews

UnitedHealthcare’s big bet on social determinants of health (SDOH) involves $11.1 million in grants to 66 nonprofits across 12 states. Part of their Empowering Health initiative, the grants help organizations that aid uninsured individuals and underserved communities in areas such as food insecurity, nutrition, social isolation, memory loss, behavioral health issues, health literacy efforts, and more. Since its start in 2018, UnitedHealthcare invested $62 million in grants that serve more than 11 million people in 30 states and the District of Columbia. MedCityNews, UnitedHealthcare news

Digital health and AI fundings are also ramping up–a little–in the $9-15 million range:

  • Two generative AI startups, Hippocratic AI and GenHealth AI, had early funding rounds in the $15 million range. Hippocratic AI is a safety-focused large language model (LLM) for healthcare competing with GPT-4, outperforming it on 105 of 114 healthcare exams and certifications. Their second seed round funding of $15 million from Cincinnati Children’s and HonorHealth adds to their May $50 million seed. GenHealth AI raised $13 million in a venture round from Obvious Ventures and Craft Venture. Their form of generative AI they call a large medical model (LMM) trained on medical-event data called DOOG-E. Two Washington veterans joined their board: Dr. Don Rucker, former national coordinator for health IT in the Trump administration and currently on the 1upHealth board, and Aneesh Chopra, the first chief technology officer of the US in the Obama administration.
  • Senior housing focused K4Connect received a venture round of $9 million from AXA Venture Partners and Bryce Catalyst with existing investors Forté Ventures, Intel Capital, the Ziegler-LinkAge Fund, and Topmark Partners, for a total of $41 million. K4Connect is positioned as an operating system (FusionOS) that integrates multiple senior living technologies. Mobihealthnews
  • Telementalhealth provider UpLift raised $10.7 million in Series A funding from Ballast Point Ventures with participation from Front Porch Ventures, Kapor Capital, and existing investor B Capital for a total raise of $22 million. UpLift is a direct to consumer therapy model which promotes both insurance coverage, affordable rates, and medication management. Another Series A funding of $11 million went to Family First, a technology platform for enterprises that supports caregivers’ mental health and wellbeing, The round was led by RPM Ventures and Eos Venture Partners.  Mobihealthnews

Informa PLC to acquire HIMSS Global Health Conference and Exhibition (updated)

July 27, 2023 | by | 1 Comment

HIMSS to exit ‘HIMSS’. For more years than most of us care to remember, the five letters have meant more than the association (Healthcare Information and Management Systems Society). It’s been all about the annual conference in (usually) Las Vegas or Orlando. Prime expo booth locations are so prized that usually one member of the team is negotiating and pre-booking the next year at the conference. Thus it came as a major surprise to the industry that HIMSS plans to sell the Global Health Conference to Informa PLC. Transaction cost is undisclosed as it is “exclusivity to acquire” the conference and the deal is not closed. The news was buried in Informa’s half-year financial report (PDF, see page 5 under ‘Market Specialisation: Further depth in Healthcare Technology’ and isn’t even on Informa’s news page as of mid-afternoon EDT 27 July, nor on HIMSS’ website (Ed. note–neither as of mid afternoon 28 July). Hat tip to HIStalk today

It is not known if the deal will affect the upcoming HIMSS23 APAC conference in Jakarta on 18-21 September, nor how it will affect the 2024 Conference in Orlando 11-15 March which is already requesting speaker proposals.

HIMSS the Conference is the largest healthcare conference in the world and except for the off years around the pandemic, attracts on average 35,000 healthcare professionals from more than 90 countries to over 200 educational sessions and 1,200 exhibitors. Informa is a trade show powerhouse as the largest in B2B conferences grouped under Informa Markets, Informa Connect (including life sciences), and Informa Tech. Their recent Tarsus acquisition includes healthcare (Health Connect Partners) and anti-aging & aesthetics (A4M Spring Congress) plus a joint venture, Tahaluf, with the Saudis in the burgeoning Middle East conference market.

What will be left of HIMSS after the conference divestiture? It will be the society itself with a mission of reforming the global health ecosystem through the power of information and technology. The basics are benefits for members around professional development, where the conference originally started, and public policy/advocacy. HIMSS has an extensive series of initiatives such as Accelerate Health and Gravitate Health (list here). Not on the main website is HIMSS Media, which includes Healthcare IT News, Mobihealthnews, Healthcare Finance, and HIMSS TV, though losing the conference reduces a major link to advertisers and cash flow as part of a package and content, plus content syndication, custom webinars, and data/lead generation packages.

There is no mention of any continuance of HIMSS ties to the conference and content at this time, though as mentioned neither HIMSS nor Informa have announced the conference acquisition via the usual press releases–or HIMSS Media. The association with ‘the’ society for IT executives, CIOs, and technology was its ace card for over 50 years. Will HIMSS completely walk away, as CHIME did, bolting to ViVE in 2022, or lend its presence and prestige? Trade Show Executive, FierceHealthcare, Healthcare Innovation

Perhaps, and this is only your Editor’s speculation, the merchandising and lift around the HIMSS Conferences were so labor-intensive that HIMSS lost focus on its mission as a member organization. Their handling of the 2020 conference cancellation mere days before the event then not refunding registration and booth fees until 2021 and 2022 under duress was an unforced error that left a bad taste. Other large conferences such as HLTH and its digital health spinoff ViVE in the past two years have peeled off attendees, exhibitors, and ‘buzz’ in a way that other smaller conferences in the past did not. HIMSS the Conference was increasingly tagged as overly tied to Big Med Device and Big HIT, coming off as ‘stodgy’ and “awkward” post-pandemic. (That wasn’t supposed to happen with buying Health 2.0’s conferences squarely based among digital health innovators, but that was killed off even before the pandemic, as were HIMSS’ regional conferences.) With marketing cutbacks at many companies affecting booths and attendees, needing to pick where to spend your trade show dollars, that this was the time to sell could have been obvious. Informa could very well reinvigorate the conference as something new and different.

This is a developing story and will be updated.

Mid-week news roundup: $105M senior debt to Headspace; Nextech bought for $1.4B; Teladoc’s Better(Help) Q2 boosts 10%; Peppermint’s online ‘clubhouse’ for seniors, PathAI lays off 87

July 27, 2023 | by

Mostly good news this midweek…

Headspace gained some needed cash–a $105M senior debt facility–from Oxford Finance. The company can use it. Their more recent headlines were for layoffs (15% earlier this month) and the telemental health space, which boomed during the pandemic, now can best be described as challenged. Headspace expanded to the UK in January. As noted with the layoffs, Headspace never SPAC’d but after acquiring Ginger for a $3 billion valuation back in the crazy days of 2021, hasn’t had an easy time of it. Their financing will be used for expansion and for opportunities. The problem is that telemental health has too many lookalike/soundalike competitors including the 9,000 lb. elephants (see Teladoc) all going after the same targets–direct to consumer, enterprise, and health plan markets. It’s a rocky road to that cliché, a path to profitability. Business Wire, FierceHealthcare

Nextech was bought by TPG for a tidy $1.4 billion. Nextech is a healthcare IT company with cloud-based specialty EHRs, analytics, and practice management systems. Specialties they cover are dermatology, ophthalmology, orthopedics, plastic surgery, and med spa. TPG is investing in Nextech through TPG Capital, its US and European late-stage private equity platform. The exit was made by Thomas H. Lee Partners. TPG has previously invested in Lyric (formerly known as ClaimsXten), WellSky, and IQVIA. TPG release, FierceHealthcare

Teladoc had good Q2 news for investors, with a 10% boost aided by BetterHelp’s performance.  TDOC beat The Street ever so slightly with a 10% quarterly revenue boost to $652 million. They also narrowed net loss to $65 million, or a loss of 40 cents per share. BetterHelp’s performance was up 18% in revenue, with $292 million in Q2, hardly dented by their $7.8 million FTC settlement in March. Integrated care was up 5% for $360 million in revenue. In Q2 2022, Teladoc took a $3 billion impairment charge as the second part of writing off its Livongo buy [TTA 30 July 2022]  and their Q1 wasn’t much better with a $6.6 billion writeoff [TTA 4 May 2022]. It showed in TDOC’s share price which has been up about $5 since the announcement on 25 July.  On the investor call, CEO Jason Gorevic is betting on BetterHelp and weight management [TTA 21 April] being introduced this quarter, though for the latter recent health concerns on Ozempic as a weight loss drug, insurers increasingly refusing to pay for it (Medicare does not, and it costs upwards of $1,000/month), and substantial competition from other weight loss players may cloud the outlook. FierceHealthcare, Q2 earnings

Peppermint appealing to older adults with online ‘clubhouses’. Out of NYC-based VC/developer Redesign Health , Peppermint’s purpose is to address senior loneliness through virtual clubs. Older adults can practice hobbies or contribute their knowledge as ‘experts’. Peppermint is kicking off with $8 million in seed funding partly out of Primetime Partners and partnering with senior centers affiliated with the Massachusetts Council on Aging (MCOA). This Editor wonders if $9.99 per month (nearly $120/year) with a 30-day free trial is a sustainable model for those minding their dollars in this inflationary time. Release, MedCityNews

AI pathology company PathAI is releasing 87 employees, according to a Massachusetts-filed WARN notice. Of the 87, 51 live in the Bay State with 36 mainly remote workers outside it. It’s considered to be one of Massachusetts’ largest health tech companies with an estimated 600 employees. The layoffs are effective 31 July. The company has had over $255 million in funding through a 2021 Series C including General Atlantic and Labcorp. (Crunchbase) One month ago, they added a new president of biopharma and chief business officer, Matt Grow (release).  BostInno (paywalled), Becker’s

FTC, HHS OCR scrutiny tightens on third-party ad trackers, sends letter to 130 hospitals and telehealth providers

July 27, 2023 | by

If you’ve checked on your legal department, they may resemble Pepper (left). Hospitals and telehealth companies have been put on notice by letter agencies HHS Office for Civil Rights (OCR) and the Federal Trade Commission (FTC) that personal health information–not just protected health information (PHI) covered by HIPAA–that can be transmitted to third-parties by ad trackers like Meta Pixel is now forbidden, verboten, not permitted. In the joint statement by OCR and FTC, hospitals, providers, and telehealth providers were explicitly told that use of these online trackers is being equated with violations of consumer privacy. Their release specified “sensitive information” such as health conditions, diagnoses, medications, medical treatments, frequency of visits to health care professionals, and where an individual seeks medical treatment. Hospitals and telehealth companies also cannot plead ignorance of what their developers did, as the responsibility is being put squarely on them to monitor the data going to third parties out of websites and apps. 

“The FTC is again serving notice that companies need to exercise extreme caution when using online tracking technologies and that we will continue doing everything in our powers to protect consumers’ health information from potential misuse and exploitation.” Samuel Levine, Director of the FTC’s Bureau of Consumer Protection, said. At OCR, which historically had its hands full with HIPAA violations and data breaches, their scope has broadened. “Although online tracking technologies can be used for beneficial purposes, patients and others should not have to sacrifice the privacy of their health information when using a hospital’s website,” said Melanie Fontes Rainer, OCR Director. “OCR continues to be concerned about impermissible disclosures of health information to third parties and will use all of its resources to address this issue.” Both HHS and FTC can take action without the time-consuming legal actions that DOJ must undertake.

True to FTC’s renewed use of the 2009 Health Breach Notification Rule, the letter sent to 130 hospital systems and telehealth providers came down hard on anything that could be interpreted as personal health information. Even for health organizations not covered by HIPAA, the letter is explicit on their obligation to protect against disclosure to third parties and to monitor the flow to third parties even if not used for marketing. Without explicit consumer authorization, it can “violate the FTC Act as well as constitute a breach of security under the FTC’s Health Breach Notification Rule.” Previous TTA coverage on third-party trackers and FTC actions here. Health IT Security

Between the DOJ and FTC alone, with actions on ad trackers and changes to antitrust guidelines, they have made the spring and summer of 2023 a most interesting and busy one for hospital and healthcare company legal departments. It’s even more amazing that given this background and on notice, Amazon just keeps flouting basic regulations about health information usage, such as for Amazon Clinic–which to date has not rolled out. TTA 27 June