10 reasons for a new trial? Elizabeth Holmes’ legal team files appeal, delay in prison start (updated)

December 15, 2022 | by

Elizabeth Holmes and her legal team continue their campaign to keep her out of Federal prison. On 2 December, on the deadline from two weeks of sentencing but just made public, her three-page appeal was filed with the US Court of Appeals for the Ninth Circuit.  She has until 3 March to file legal briefs in the 9th Circuit Court of Appeals in California. In addition, her legal team has requested from Judge Edward Davila that she remain free until her appeal is concluded due to not being a flight risk, citing close family ties and pregnancy. Holmes was scheduled to report to Federal prison (still to be determined by the US Bureau of Prisons) on 27 April 2023.

The 10 reasons for a new trial are not fully enumerated in the SiliconValley.com article, but include purported errors by Judge Davila during the trial. These include allowing the jury to hear about regulatory action against Theranos and the company’s voiding of all test results from its Edison lab machines. The filing argues that those events took place after she made any “relevant” statements to investors. Another reason was the sudden visit by former lab director and key prosecution witness Dr. Adam Rosendorff to her home [TTA 26 Oct, 20 Oct]. Dr. Rosendorff reaffirmed in the court hearing that he testified truthfully and honestly, the visit took place during a moment of distress, and that he continued to believe that Holmes needed to pay her debt to society. 

Legal experts mostly agree that Holmes presents little to no flight risk, as she is known everywhere, and is no threat to her community. Where they are split on whether she will remain free during the full process of the appeal, which could be a year or even more. Appeals have low rates of success at the Federal level. To these observers, Judge Davila has been scrupulous–‘bent over backwards’–to be fair to both prosecution and defense during the trial. He has already heard and rejected defense arguments for new trials and acquittals. He did not permit the prosecution to run wild or overcharge either. The decision of another jury on COO Sunny Balwani on all 12 counts, the same as Holmes, also conducted by Judge Davila, may very well factor into an appeal to the judges, unfavorably for the defense. One wild card factor is that the jury convicted her on but four out of 11 counts (acquitting or deadlocking on the rest; Count 9 was dropped due to a prosecution error). The jury for her trial proved 1) difficult to select and 2) difficult to retain, going through three alternates of the five.

Still pending are monetary damages. Updated: checking Judge Davila’s calendar, this will take place after January as his calendar is filled.

It does look like Holmes may enjoy freedom through 2023–but her chances of reversing her conviction and going free are as small as that nanotainer she is modeling. FoxNews, Ars Technica

Mid-week roundup: Wisconsin’s Marshfield Clinic zeros out telehealth staff; Komodo Health lays off 9%; epharmacy Medly’s Ch. 11, PharmEasy layoffs; OneStudyTeam releases 25%

December 15, 2022 | by

Year-end brings reckonings and reorganizations….and may leave you feeling like Pepper.

Marshfield Clinic, located in rural north central Wisconsin, eliminated its 18-person telehealth department on 1 December. It is not clear from reports whether telehealth is being eliminated (HISTalk) or whether this is being maintained by current IT staff. This follows news of ongoing financial difficulties in this network of 12 community and rural hospitals and 65 clinics. In August, they renegotiated some loans in the wake of losing $25 million that month–and their CFO departed. The health system is also in the throes of replacing a 30-year-old homegrown EHR with Cerner. Like most rural hospital systems, Marshfield has been keelhauled between increasing wage and supply costs plus the ending of CARES Act subsidies. It has had ongoing merger discussions with Minnesota’s Essentia Health. WSAW-TV 7 (Wausau WI)

Recently fast-growing Komodo Health is laying off 9%, or 78, staff.  The layoffs were positioned as a ‘restructuring’ to remaining employees. Interestingly, Komodo has about 40 positions recently posted and listed as open on LinkedIn, not including its CFO who is departing at end of this year.

Komodo is reportedly planning to IPO in 2023. In early November, it completed a structured equity infusion of $200 million from Coatue and Dragoneer. Reportedly, Komodo’s annual recurring revenue is $150 million but is not yet profitable. Last March in its Series E, it was valued at a rich $3.3 billion. 

Komodo is in the complex analytics business of creating data maps out of de-identified patient data. From this, they create software applications that reveal patient behaviors, can guide treatment, highlight care gaps, and, in their words, ‘reduce the global burden of disease’. Like mapping patient health journeys, everyone agrees it is valuable, but then debates on how to apply it. Is it the whole truth and nothing but? Or are my patients different? Whether strapped health systems and health plans see that Komodo’s applications are necessary, given their in-house data, with the knock-on cost of integrating it into their systems, is entirely another question that influences Komodo’s growth. TechCrunch, FierceHealthcare, Mobihealthnews  

Two epharmacy operations have run into significant financial difficulties.

  • Brooklyn’s Medly filed for Chapter 11 bankruptcy reorganization on 9 December, closing 20 stores. A scrappy upstart founded in 2017 that grew from a storefront in Brooklyn to over 20 physical locations in New York, New Jersey, and Philadelphia plus four same-day prescription delivery centers, they went through a cash crunch in August that derailed their filling prescriptions for close to one month. Precipitating this was their purchase of Boulder-based integrative pharmacy Pharmaca in late 2021 to add 21 locations in 20 markets across nine states, first-half losses of $35 million, and failure to obtain over the summer a $100 million loan. Medly owes about $121 million plus $47 million in trade debt, unpaid salaries, and other unsecured debt. A bidder, MedPharmaca Holdings Inc., will have an opening bid of $18.5 million at a bankruptcy auction for almost all of Medly’s assets, including the Pharmaca stores.

A complication–employees are also suing the company in a class action lawsuit for mass layoffs. 1,100 of 1,900 employees were not given up to 90 days written notice, as required by Federal and NY State Worker Adjustment and Retraining (WARN) Acts. WARN act notices were posted after the layoffs, according to the lawsuit. Employees also lost salary, commissions, bonuses, accrued holiday pay, and 401(k) contributions. Oddly, their website lists about 20 open positions, but this Editor is sure that is due to the website manager also being laid off.  FierceHealthcare, Boulder Daily Camera, Digital Health Business

  • Nearly 8,000 miles away, PharmEasy of Mumbai, India has laid off an undisclosed number of people in a second round of layoffs, primarily in product technology, quality analytics, and support verticals. Their problems, reported in India’s Inc42, center on mounting losses, a funding crunch, and a shelved IPO. India’s Business Standard reported that the layoffs will go into the hundreds. PharmEasy is an online store covering most of India that delivers everything from medications and lab tests to doctor referrals and Dettol. 

And last in this (depressing) roundup is Boston’s OneStudyTeam’s 25% layoff of 160 employees with the usual “restructure our team going into 2023” and “streamline operations” statements, despite being used by 70% of biopharma companies.  OneStudyTeam has a clinical trial workflow platform that enrolls and manages patients. As part of clinical trials holding company Reify Health, it is a sister company to Care Access, a decentralized research organization (DRO). In April, Reify added $220 million in Series E funding for $479.6 million in total, increasing its valuation to $4.8 billion. Mobihealthnews, Crunchbase

Theranos’ Balwani gets an unlucky 13 year sentence, restitution to come

December 8, 2022 | by

Today, in the US District Court, Northern District of California, Ramesh ‘Sunny’ Balwani, the former president of Theranos, was sentenced to 155 months, or 12.9 years, in Federal prison. Balwani had been convicted on all 12 counts of fraud and conspiracy, including two for patient fraud, in July. The prosecution had asked for 15 years, as they had with Elizabeth Holmes, who was sentenced by Judge Edward Davila to 11.25 years on four counts. Balwani will be required to surrender on 15 March. None of the coverage indicates that he will appeal. 

The hearing today was about six hours and was far less of a media ‘event’ than Holmes’ hearing. 

Like Holmes, Balwani’s defense requested a sentence of home confinement of four to 10 months, citing that Balwani was an investor ($5 million), was not CEO but COO for six years to May 2016 before the company went out of business, wasn’t involved in key decision-making by Holmes, and gave money to charitable causes. The probation officers’ recommendation was, also like Holmes, nine years. Judge Davila again went with standard sentencing guidelines to produce a result that was far less than most observers, including your Editor, expected given the 12 counts and his direct management of the Theranos lab.

US Attorney Jeff Schenk, who spoke for the prosecution, said “Mr. Balwani knew that Theranos was not generating, and would not generate, any meaningful revenue by being honest with people. So he chose a different path.” The opposite view from his defense attorney, Jeffrey Coopersmith: “Mr. Balwani never wanted anyone to be harmed. He would never harm a fly. Instead, he wanted to give…He’s deserving of a lenient sentence. He’s not Ms. Holmes. He did not pursue fame and fortune.”

However, Balwani was key in making deals and withheld what was really happening in the lab. According to TechCrunch, “During the trial, a Walgreens executive testified that he worked closely with Balwani on the deal. The prosecution also displayed evidence of a text from Balwani to Holmes stating that he deliberately didn’t tell Walgreens that they were using different machines.” He did not testify in his own defense or speak at the hearing on his own behalf.

According to reporter Dorothy Atkins, covering for Law 360, Judge Davila “won’t give Balwani a tougher sentence for leading the conspiracy, but he found Balwani recklessly put patients at risk, since he led the lab.” By his own text to Holmes, “I am responsible for everything at Theranos.” and had, according to the judge, “significant autonomy” in the lab–where the machines did not work. In the judge’s words, as she reported, “Defendant chose to go forward with deception, I’ll call it, and continued to perpetuate the fraud….” After sentencing, his defense requested that he serve in a minimum security prison. At the end, “Balwani packed his things and whispered something to his family members. He didn’t get any hugs, and there were no visible tears in the courtroom.”

On restitution, the prosecution wants Balwani to pay $804 million to defrauded investors, which happened to be the same amount requested bu the prosecution as Holmes. Judge Davila calculated total investor loss as $120 million. A final determination will be made at a later date to be determined.

Balwani is 57, which means that if he serves the typical 85% of his Federal sentence, he will emerge from Club Fed aged 68.  Washington Examiner, NBC, NBC Bay Area, Scott Budman of NBC’s Twitter feed

AliveCor loses Patent Office ruling with Apple; three patents invalidated

December 8, 2022 | by

Apple prevails in the patent infringement suit by AliveCor–and got three AliveCor heart monitoring patents invalidated as ‘unpatentable’. In the duel of patent infringement claims dating back to May 2021 between AliveCor and Apple, the US Patent and Trademark Office’s Patent Trial and Appeal Board (PTAB) not only ruled that Apple did not infringe on AliveCor’s patents, but also threw out the AliveCor patents that were the basis for the infringement. AliveCor had sued Apple for patent infringement on their ECG technology in three US patents: No. 10,595,731 (“the ’731 patent”); No. 10,638,941 (“the ’941 patent”); and No. 9,572,499 (“the ’499 patent”) in their Apple Watches 4, 5, and 6. [TTA 29 Apr 21, 9 July 21] 

The term ‘unpatentable’ is used when the PTAB deems the patent, even when granted in the past, too obvious or too general. When the PTAB finds that, they throw out the patent and it is no longer valid.

Apple of course crowed that they developed their own patents fully on their own, and not from the time when AliveCor’s ECG monitoring was incorporated into earlier Apple Watches. Apple is up to the Series 8. AliveCor has already announced it will appeal and await the pending ruling from the International Trade Commission (ITC) to block the import of Apple Watches. The ITC’s initial determination in June was positive [TTA 28 June] and AliveCor of course is ‘cautiously optimistic’ on the Final Determination due in a few days (12 December). With the PTAB’s finding, it is far less likely that the ITC will impose an import block when AliveCor’s patents have been invalidated.  9to5Mac, Mobihealthnews

AliveCor has moved forward with its KardiaMobile series, including a credit card-sized device (left), and has enjoyed substantial investment, with an August Series F (amount undisclosed) round led by GE Healthcare. 

Patent invalidation is a danger in any patent infringement lawsuit. In 2015, Bosch Healthcare, which had bought HealthHero, an early RPM platform marketed as Health Buddy, and ViTelNet, was a serial patent challenger. They went after Philips, Viterion (while owned by Bayer), both to a draw, and won against a slew of barely-out-of-the-cradle companies forgotten by nearly all of us such as Alere Health, MedApps, Waldo Health, and Express MD Solutions. Then they sued Cardiocom in 2012 with the same expectation. Except that a year later, Cardiocom was acquired by Medtronic. Deep-pocketed Medtronic fought back hard–and by 2015, the PTAB invalidated most of Bosch’s key patents. Bosch withdrew from the US market abruptly in 2015. TTA 19 June 2015, 7 September 2015 primarily about the ongoing Teladoc-Amwell dustups

Given their funding and device development, AliveCor will likely not face Bosch’s fate, but such invalidations have consequences yet to be determined and litigated. 

News (and robot) roundup: ElliQ companion robot upgrades, named to 2022 TIME list; Robin the Robot introduced for older adult care; Utilita acquires Canary Care (UK)

December 7, 2022 | by

ElliQ, a desktop companion robot targeted to older adults and those with assistive needs, announced an upgrade to their software, a new 2.0 edition of their hardware (left), and a communication app for caregivers. In March, when Intuition Robotics launched it, this Editor noted its unusual shape, versatile small size, controlled by a small tablet with a simplified interface, and its ability to combine both chat interactivity and wellness tracking, including appointments and med reminders.

  • The new software enhances interactivity with deeper conversations, and more content, such as museum exhibit tours, virtual travel, and the recording of memories to send to loved ones. The software upgrades are supported on ElliQ 1.0 and the new 2.0 hardware.
  • The 2.0 hardware is at a significantly larger scale with improvements such as simpler tablet charging, a better screen, and higher quality far field microphone performance. 
  • The new companion app for family members, friends, and caregivers expands capabilities into video calls, text/image/video messages, remote reminder setting, and updates on wellness changes. The free app is available shortly on the Apple Store and Google Play.

ElliQ was also named to TIME’s 2022 list of Best Inventions in the Accessibility category, for innovation in helping seniors live happier and healthier with the use of easy-to-use AI and technology.

In May, ElliQ entered a partnership with the NYSOFA (New York State Office for the Aging) program with 800 older adults in care. Based on their impact study from the first six months of distribution, ElliQ has had some impressive results, such as reducing loneliness in 80% of users and helps 82% stay mentally active. Release (PDF)

Another TIME winner in 2021 for robotics, Robin the Robot, has been introduced in care for older adults at Riverwalk Post-Acute in Riverside, California. Robin’s design is child-sized at 4 feet and mimics a child of about seven years. Most of the Robin pilots are in pediatric hospitals such as UCLA Mattel Children’s Hospital, augmenting care through interacting with the child, providing social support through telepresence and unobtrusive patient monitoring. This new initiative in older adult post-acute care not only monitors emotional state by observing patient facial expressions, but also provides companionship and mental stimulation through playing games and conversation at a ‘grandchild’ level. Expper Technologies, a seed-stage company also in California, in October won a $2 million round led by Starta VC with its co-investing platform Liqvest and Formula VC. HealthLeadersMedia  More on Robin’s use in this type of care is in this blog post.

In the UK, Canary Care has been acquired by energy ‘challenger’ provider Utilita. Oxfordshire-based Canary Care expands Utilita’s home services area into assistive technology with wireless sensors that monitor activity, temperature, and portal accessible by family and caregivers. Transaction cost is not disclosed. Canary Care will continue as a separate entity, but will be working with Utilita’s tech arm, Procode, on research and development. Utilita supplies energy and also energy control such as smart meters and monitoring apps. Release (PDF). 

Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand?

December 6, 2022 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Adam Hunter, CCO at Phlo Connect, an API-driven pharmacy infrastructure platform to deliver enhanced patient and clinician experiences. Phlo Connect integrates with prescribing technologies and digital health platforms used by the NHS and by private healthcare providers, from the initial consult and prescribing, and processes the request through to patient delivery. This article discusses how Vertically Integrated Micro-Providers (VIMPRO) can work in partnership to streamline NHS services using technology and telehealth.

Interested in being a Perspectives contributor? Contact Editor Donna. 

The NHS is in crisis: with staff vacancies currently exceeding 130,000, elective care waiting lists are predicted to exceed 10 million by March 2024, and up to 22,000 appointments are cancelled every single day.

Speaking at a King’s Fund conference in London earlier this month, NHS Chief Executive Amanda Prichard told delegates that demand on national health and care providers is rising so quickly that patients are not always getting the level of care they deserve. Highlighting a projected £7bn NHS budget shortfall, she went on to emphasise that “We’ve got to shift the model of care from one that does late diagnosis and expensive treatment to one that does faster diagnosis, better treatment and better value for the taxpayer in the process.”

Such a model, where all patients can access timely, preventative care without exorbitant cost, is one that every developed national healthcare system aspires to adopt. Navigating the practicalities and finding the capacity for transformation has to date stalled the full realisation of this. However, gathering pace in the past decade has been the VIMPRO model of healthcare delivery, which is increasingly proving to be a successful way of meeting the needs of underserved patient groups and alleviating pressures. At this time of critical need, could this model save struggling public systems from drowning in demand?

The VIMPRO model explained

A Vertically Integrated Micro-Provider (VIMPRO) is a telehealth provider focused on delivering an end-to-end service to a specific patient group. VIMPROs are characterised by excellent user experience and personalised clinician-led care, and are increasingly entering into partnerships with national healthcare providers (including the NHS) to help bridge gaps in service delivery.

One example of a successful existing VIMPRO model operating in partnership with the NHS to meet a previously unmet patient need is Leva Clinic. They are UK leaders in chronic pain management and medical cannabis treatment. The majority of their users pay to use their digital platform, where they access psychology consultations, nurse appointments, physiotherapy advice, prescription and direct-to-door medication delivery.

This is a big step in the right direction towards meeting the needs of the UK’s underserved pain patients, many of whom have spent years with inappropriate support owing to a shortage of pain specialists and lack of personalised treatment options.

Patient and system benefits

From the perspective of NHS leaders, the benefits of the VIMPRO model are multiple. Firstly, they provide an alternative point of access to care for patients who’d otherwise need to be seen by GPs and referred on to NHS consultants. This frees up system capacity and cuts wait times and workloads. Secondly, VIMPROs provide the education and information that their specific patient group needs to manage their condition and improve their outcomes. This reduces the burden of ill health on the NHS further down the line. And thirdly, when VIMPROs are integrated properly with NHS systems, all the information about the patient’s care can be tracked in their electronic record without adding to practitioners’ admin burden. 

The VIMPRO model also offers multiple benefits to patients. Convenience and timeliness of access to healthcare are primary amongst these, as they remove the barriers of geography and waiting lists that obstruct care in the NHS. Patients can be quickly connected to leading specialists and prescribers anywhere in the county, and don’t even have to leave their homes to collect their medication. In addition, accessing remote care through a VIMPRO model means that patients who are reluctant to engage with local services for support – perhaps because of stigma around their condition – are offered an alternative source of care that’s entirely virtual and distinct from other NHS services. Finally, VIMPROs often take on the responsibility of creating education materials and championing the needs of their patient vertical. For example, men’s health VIMPRO Numan hosts a medically-reviewed blog delivering advice on weight management, erectile dysfunction, hair loss, mental health and other under-discussed men’s health issues.

The future of NHS care delivery?

There is no single solution that can fix the problems facing the NHS and other public health systems around the world. Replacing the core of NHS services with a network of VIMPROs is an unrealistic proposition that would be extremely difficult to achieve. However, carefully planned VIMPRO partnerships have already proven to be effective at redirecting patient demand to where it can be successfully dealt with.

If the right streamlined system integration and tailored digital infrastructure is put in place, patients and clinicians can enjoy seamless and convenient experiences. This means no clunky transition between platforms and service providers: from first consultation to the arrival of medication on the doorstep of the patient. 

Global health needs, and our expectations of healthcare, are constantly evolving. Only by constantly evolving the models of care delivery will we be able to keep up, and right now, that means embracing the opportunities of the VIMPRO model and making it work as well as we possibly can.

Optum Labs creates and funds digital health research hub at Cornell Tech NYC

December 6, 2022 | by

Optum Labs, the research and development arm of Optum/UnitedHealth Care, is allying with Cornell University to create a collaborative health research hub at the university’s NYC-Roosevelt Island campus, Cornell Tech. The initiative, funded by Optum Labs, is targeted to develop precision behavioral health and advance equity. According to the release, it will drive innovative research in precision behavioral health, extended reality for aging in place, and equitable human and algorithmic decision-making. A large part of this is incorporating new types of health data from wearables and IoT devices, Also this joint venture will seek to create new types of remote intervention and care delivery using augmented reality and virtual reality actuation technologies with computational techniques. (Whew!)

The digital health hub will be led by Deborah Estrin, an Associate Dean and a Robert V. Tishman ’37 Professor at Cornell University, and Tanzeem Choudhury, Ph.D., Senior Vice President at Optum Labs, and a Roger and Joelle Burnell Professor in Integrated Health and Technology at Cornell University. The funding amount is not disclosed. To this Editor, this seems like an effort to restore the New York area as a digital health hub and regain momentum lost since 2020. Cornell release, 

Optum has been reaching out on multiple fronts. The RVO Health joint venture brought over media and Healthgrades doctor ratings [TTA 14 July], UHG inking a 10-year deal with Walmart Health starting with Florida locations, and of course the Change Healthcare wrap into OptumInsight [TTA 20 Sept, 4 Oct] though still being contested by DOJ post-closing. All a part of Keeping Up With the CVS Health/Aetnas, Walgreens/VillageMDs, Amazons, and fellow payers like Cigna and Elevance. HealthcareFinanceNews

Who’s buying, selling, funding wrapup: athenahealth IPO deux?, NextGen EHR buys reseller TSI for $68M, Cloudwave buys Sensato; fundings for Lumen, UpStream, Aide Health

December 3, 2022 | by

athenahealth may go public a second time. This was teased by CEO Bob Segert in the Boston Globe (paywalled) earlier this week. He claimed in the article that since the company went private in 2019, they have added nearly 2,000 clients each year of the past three and that revenues are in the billions. Healthcare IT News recaps some of their moves from going from public to private and downsizing to today. Their other news is that they have instituted a clinical advisory board of 30 members (!) to provide feedback and guidance on clinical features and direction to athenahealth’s product team. One hopes that the sharper members advise a change in the first letter of their name from the oh-so-twee lowercase to an uppercase ‘A’. 

NextGen Healthcare, an EHR/EMR and revenue cycle management software provider for medical/dental practices, is acquiring reseller partner TSI Healthcare. The agreement is for $68 million in cash upfront, with a contingent consideration of up to $22 million in cash if TSI meets certain goals by March 2025. TSI has been a NextGen reseller for 16 years. The acquisition will enable NextGen to expand in key specialties including rheumatology, pulmonology, and cardiology. No mention is made of management or staff transition, nor of SEC review as NextGen is a publicly traded company on Nasdaq. Hat tip to HISTalk 2 Dec. Release, BusinessJournals Triangle

Massachusetts-based Cloudwave is acquiring Sensato Cybersecurity to increase cybersecurity capabilities. Cloudwave provides cloud services hosting with cybersecurity capabilities exclusively to healthcare organizations. Sensato adds cybersecurity-as-a-service (CaaS) to manage security needs, determine where security gaps are, and threat intelligence. Transaction price and details were not disclosed, but Sensato’s founder John Gomez will join CloudWave as chief security and engineering officer. Healthcare IT News  Cybersecurity continues to be top-of-mind for healthcare organizations. The latest Big Data Breach at CommonSpirit Health system hospitals got even worse, with the third-party breach of an undisclosed number of patient records at their Franciscan Health hospitals in September and October. This followed the ransomware attack on other CommonSpirit system hospitals’ EHRs in October. Healthcare IT News

As we near the end of the year, funding is wrapping up with a flurry in some surprising areas such as optimizing metabolism and care coordination for chronic conditions, reducing burden on primary care practices/GPs. One is for an early-stage company in the UK for the latter.

  • Lumen’s $62 million Series B was led by Pitango Venture Capital with Hanwha Group and Resolute Ventures.   Lumen measures metabolism via a handheld, breathalyzer-like device equipped with a CO2 sensor that analyzes whether the body is burning fats or carbs for fuel which can promote weight loss, energy for fitness, and sleep. With that data, the app delivers to users personalized meal plans and nutrition along with when to eat. The new funding will be used to expand these nutrition and lifestyle coaching services. The device is sold direct to consumers, with the app services sold on a SaaS basis: three yearly plans with a range of services from $249 to (on sale) $349.  Mobihealthnews, MedCityNews
  • Another Series B raise of $140 million went to UpStream, for total funding of $185 million. UpStream is in the decidedly unsexy area of care coordination, workflow, and financial platform technology for groups of advanced primary care practices enrolled in value-based full-risk care models, most of which are centered around Medicare and Medicare Advantage. They also deploy pharmacist-led care teams into primary care practices. Their platform and services are free to the practice, with a risk-sharing agreement that pays UpStream through savings (upside risk) but also holds them accountable if savings are below the benchmark (downside risk). Practices are paid on quality during the performance year versus having to wait for CMS to pay in Q3-4 of the following year. This is an MSO (management services organization) ‘in a box’ versus organizing ACOs that is mainly technology-based, a new wrinkle for this Editor who used to be in marketing this area. MedCityNews, Mobihealthnews
  • Aide Health is a clinician-to-patient platform for better management of chronic conditions now bolstered with £1 million in pre-seed funding. Founded by Ian Wharton, CEO, and Brian Snyder, COO, the platform measures physical, mental, and social wellbeing markers for more proactive care. Aide is piloting with the NHS for asthma or Type 2 diabetes with a cohort aged 18 to 75.  Funding was led by Hambro Perks through its EIS fund, with participation from Fuel Ventures, 1818 Ventures, and APX. BusinessCloud (UK)

“Big Story” update: where Elizabeth Holmes will spend 11 years, Cerebral sues former CEO Robertson, Amwell buying Talkspace?

November 30, 2022 | by | 1 Comment

Where will Elizabeth Holmes serve her sentence, whatever it is? A story that got lost in the Thanksgiving shuffle was Bloomberg News’ (paywalled) report that Judge Edward Davila recommended that she be remanded to a minimum security Federal women’s prison in Bryan, Texas, outside of Houston. What has previously been mentioned in the press and by legal commentators is that she would likely serve her time in a northern California minimum security prison about an hour from her present home, the Federal Correctional Institution in Dublin, California. According to commentators, the larger Bryan facility may be better than Dublin, which is a satellite camp. Bryan  “…compared to other places in the prison system, this place is heaven. If you have to go it’s a good place to go,” Alan Ellis, a criminal defense lawyer, told Bloomberg. The final say will be made by the Federal Bureau of Prisons. The selection is important because Federal inmates typically serve a minimum of 85% of their time, unlike time served in state prisons. Gizmodo reports on Bloomberg’s reveal

Holmes’ reporting to prison is scheduled for 27 April 2023. Her appeal to the Ninth Circuit Court of Appeals must be filed within two weeks of sentencing, which by this Editor’s calendar is 2 December but may be later due to the holiday. Holmes may be permitted to stay out of custody pending appeal if it extends beyond the surrender date if the judge permits. 

Editor’s commentary: One wonders whether Holmes’ appeal will be successful. One factor is what Judge Davila acknowledged: “What is the pathology of fraud? Is it the inability to accept responsibility?” Even in her personal statement during the sentencing, there is evasion. Holmes did admit some sorrow about patients and investors relating to her own failings (back to her again), but sorrow is not responsibility. Moreover, Holmes did not refer to making amends for that sorrow created by the Fraud That Was Theranos. Her defense continues to blame others, like Sunny Balwani, former president and live-in. Even the 130 character letters, many from others who knew her only briefly, blamed others including Balwani, almost tracking to the defense’s talking points. The case proved conspiracy with Balwani, who will likely be sentenced on 7 December for what is expected to be something close to the full 20 years as convicted on all 12 counts.

The tables are turned by Cerebral on co-founder/former CEO Kyle Robertson. Only a week or so ago, Robertson (through his attorneys) reportedly sent a letter to Cerebral management demanding access to documents detailing “possible breaches of fiduciary duty, mismanagement and other violations of law.” [TTA 18 Nov] Now Cerebral is suing Robertson for his default on a $49.8 million loan taken this past January to buy 1.06 million shares of common stock in the company. According to the filing in New York Supreme Court, he is personally liable for $25.4 million, plus interest and attorney’s fees. After his dismissal 18 May, he had six months to repay the loan or direct Cerebral to repurchase or cancel the shares. According to the lawsuit, “Robertson repeatedly asserted that he would not repay the loan.” The troubled company laid off 400 or more in October and is now valued at a fraction of last year’s $4.8 billion valuation.  Stay tuned. HealthcareDive, Mobihealthnews

A cracked SPAC may get itself sold. Talkspace, which has had a year of challenges since its SPAC, apparently is in talks to be acquired by Amwell. According to Calcalist, an Israeli business publication, Amwell is in advanced talks to acquire it for $1.50 per share, or about $200 million. This is quite a comedown from when Talkspace was valued in January 2021 at $1.4 billion. It executed its SPAC in June [TTA 25 June 2021] and hit Nasdaq at $8.90 per share. Today it closed at $0.88, so Amwell’s offer would be close to double. It would also remove another problem. Nasdaq notified Talkspace on 18 November that they were on the verge of delisting their stock, as it was trading for over 30 consecutive business days at under $1.00 per share.

The ‘advanced’ term is interesting because this past June, reports indicated that Talkspace rejected overtures by Amwell and Mindpath. The amount bandied about at that time was $500 million and a sale was expected during the summer. (What a difference six months of economic uncertainty makes.) 

In November 2021, founders Roni and Oren Frank stepped down and their COO resigned shortly thereafter on a conduct-related allegation. Shareholders started to sue starting then. YTD results have also been dismal, with losses of $61 million on revenues of $89 million.

Talkspace would bolster Amwell’s mental health capabilities in telepsychiatry with a DTC and enterprise product. If the company hung on to most of their $184 million in cash reported in June (of the SPAC’s $250 million), for Amwell it also would be a deal that almost pays for itself. HealthcareDive, FierceHealthcare

Mid-week news briefs: House members’ ‘grave concerns’ on two deaths tied to Oracle Cerner VA rollout; care.ai’s $27M funding; Clear Arch’s new mobile RPM platform; digital health investment in rough times

November 23, 2022 | by

A pre-Thanksgiving news roundup in this short week.

More miseries for Oracle Cerner’s VA rollout. This week, three House members sent a letter to the Department of Veterans Affairs (VA). After a 2 September visit to the Chalmers P. Wylie VA Ambulatory Care Center in Columbus, Ohio and interviewing the staff, they determined that the Cerner Millenium EHR as currently in use possibly led to the deaths of two veteran patients. The deaths were due to 1) hypoxia after an antibiotic ordered for mail delivery was never tracked nor received, leading to a decline in the patient’s condition; and 2) alcohol withdrawal symptoms after a patient’s missed appointment was lost in the EHR and not rescheduled, leading to his decline and death several months later. The three Representatives are asking Denis McDonough, the Department secretary, for answers on the processes and problems that led to this, and more. They are Mike Bost, R-Ill., Mike Carey, R-Ohio, and Troy Balderson, R-Ohio. Becker’s

care.ai, a system that uses sensor-based AI for care facilities, secured $27 million in venture funding from Crescent Cove Advisors. care.ai’s sensors and their Smart Care Facility Platform are currently used in 1,500 facilities in the US to automate, monitor, and streamline clinical and operational workflows in hospitals, skilled nursing facilities, and assisted living facilities. care.ai plans to use the funding from Crescent Cove Advisors to build on their ongoing operations and deliver ambient intelligence to healthcare. Release, Mobihealthnews

Clear Arch Health is introducing a new RPM mobile app, Clear Arch Mobile, as an alternative to its current tablet-based system. It connects via Bluetooth to devices and is based on the LifeStream Clinical Monitoring Dashboard by enhancing security (with two-factor authentication) and simplifying the collection and transmission of patient data for clinician assessment and intervention, as needed. LifeStream was acquired by Clear Arch earlier this year with their buy of Life Care Solutions. Clear Arch is a division of MobileHelp. Both were acquired by Advocate Aurora Enterprises in April. Release (PDF)

How to cope with the transition from easy funding to showing investors that they are squeezing every dime? That was the topic of a roundtable of investors at HLTH last week. One major problem was that the 2020-21 influx of capital boosted valuations to unrealistic and unsustainable levels, leading to unrealistic expectations for growth and moving into businesses that weren’t core. The advice was bracing from investor luminaries such as Glen Tullman of 7Wire Ventures/Transcarent, Emily Melton of Threshold Ventures, Andrew Adams of Oak HC/FT; and Krishna Yeshwant of Google Ventures.

  • Don’t focus on valuation. Focus on how much capital your enterprise needs to the next phase of inflection, minimize dilution, and set yourself up for the next up round.
  • Refocus and reprioritize, making the most of cash resources on hand
  • Have a plan to get to profitability, not just growth
  • Even more depressing news: the downturn is expected to continue through 2023 into 2024 — make cash last into 2025

Growth areas in healthcare they identified will be familiar: mental health, senior care and primary care –one is not, the Medicaid space. Mobihealthnews

News roundup: Babylon Health Q3 revenue up 3.9x; surprise–DOJ to appeal UHG-Change buy approval; Walmart loses senior health exec Pegus to JPM

November 22, 2022 | by

Earlier this month, Babylon Health announced its Q3 financials. Both revenue and value-based care membership grew. Losses also grew but the margins narrowed considerably. Highlights of their release:

Comparing Q3 2022 to Q3 2021

  • Revenue increased by $288.9 million versus $74.5 million, an increase of $214.4 million or 3.9x. This was largely driven by a 285% increase in Medicare membership.
  • Losses were there but margins improved due to aggressive cost reductions. Q3 loss was $89.9 million, or a 31.1% loss for the Period Margin (percent of revenue). Last year’s loss was $66 million, or 88.6% Period Margin. This represented an improvement of 57 points. When looking at EBITDA, Adjusted EBITDA totaled $(54.3) million, an (18.8)% Adjusted EBITDA Margin. This compared to last year’s $(47.5) million Adjusted EBITDA, or (63.7)% Adjusted EBITDA Margin, an improvement of 45 points.
  • Value-based care membership grew 2.7x to approximately 271,000
  • They acquired Medicare Advantage members in New Mexico, and commercial members via a digital-first product for Centene’s Ambetter plans in six states
  • In the UK, their Bupa partnership was extended for three years. Bupa has 2.3 million health insurance customers.

For year 2022, Babylon is updating its revenue guidance from $1.0 billion or greater to $1.05 billion to $1.1 billion.

Babylon is selling Meritage Medical Network, an independent physician association (IPA) based in Northern and Central California with 1,800 providers in six counties serving 90,000 patients, advised by  a major investment bank. They will also comply with SEC reporting requirements for a domestic issuer versus previously as a foreign private issue. Babylon will report its Q4 and 2022 yearend results under U.S. GAAP. They are also proceeding with a 25-to-1 reverse stock split to boost share price and prevent a NYSE delisting [TTA 13 Oct]. Mobihealthnews

The Department of Justice (DOJ) wiped egg off its face Friday, appealing the District Court of the District of Columbia approval in late September of UnitedHealth Group’s acquisition of Change Healthcare. The two companies closed on the buy in early October. DOJ was joined in the appeal by New York and Minnesota. The surprising appeal, after six weeks and the closing, is unusual but not unprecedented. At the time, the DOJ statement was written so that industry observers expected an appeal.

While the merger is closed, an appealed decision, if favorable to the DOJ, would force a separation of the businesses. Of course, UHG believes that “the appeal is without merit.” Stay tuned to see if this goes anywhere. Becker’s, Healthcare Dive

Walmart loses another healthcare exec. Cheryl Pegus, MD, will be departing Walmart as EVP of health and wellness and joining Morgan Health as a managing director. At Morgan, she will be focusing on population-based health initiatives and bringing clinical expertise to mental health, diabetes, and other chronic diseases. She is also joining Atria, a physician-owned organization of heart specialists.

During two years at Walmart, Dr. Pegus helmed development of a low-cost private brand analog insulin, expanded Walmart’s retail health center network across major markets, and the company’s pandemic response. Morgan Health was set up in 2021 to improve the quality, affordability, and equity of employer-sponsored healthcare. It has opened advanced primary care centers in Ohio. JPM a few weeks ago opened a Life Sciences Private Capital group [TTA 2 Nov]. Becker’s, Healthcare Dive

Walmart, despite their size, has had a certain wobbliness in their strategy. Aggressively starting out of the gate in 2018 with high-profile exec Sean Slovenski leading and plans to open up 1,000 clinics, he departed in 2020 and that put the brakes on the clinic strategy for awhile. In 2021, they bought privately held telehealth provider MeMD. Earlier this year, they announced the opening of more health ‘superstores’ in Florida, having established 20 in Arkansas, Illinois, and Georgia starting in 2019. Meanwhile, Walgreens is going big with VillageMD and its acquisition of Summit Health, and CVS Health is snapping up Signify Health to expand into value-based care and home health.

Breaking–The Theranos denouement: Elizabeth Holmes sentenced to 11.25 years with an investor loss of ~$121 million

November 18, 2022 | by

Elizabeth Holmes received her sentence today by Judge Edward Davila of the US District Court of Northern California, in an over four-hour court proceeding.

The sentencing was based on Federal guidelines for four counts of a Class C (non-violent) felony, as well as the recommendations of probation officers. Your Editor watched this in real time from the NBC Bay Area feed and reporter Scott Budman’s Twitter feed from the courtroom (cameras are excluded). This started at 10am PT with last arguments made by prosecution and defense and victim statements. The actual reading of the sentence in his summation by Judge Davila took a little more than 20 minutes, delivered in a silent courtroom, concluding after 2pm PT.

The decision:

  • Prison sentence: 11.25 years (11 years, three months), to be followed by three years of supervised release. Holmes will be required to self-surrender on 27 April 2023. This is likely after her delivery date. This was less than the 15 years requested by the prosecution (in turn less than the 20 years maximum), more than the nine years recommended to the judge by the probation officers (what is called a downward deviation), but entirely based on the sentencing manual. Judge Davila obviously did not believe that he could justify that downward deviation.
  • The investor loss. Judge Davila estimated the total loss by 10 investors at $384 million, not $804 million. A ‘reasonable total loss’ is only $121 million. This winnowing down is a big win for Holmes. While she will never be able to pay it, below $500 million it takes down her possible sentencing, according to NBC’s legal commentator, former prosecutor Dean Johnson. The total and final amount will be settled at a later date at a restitution hearing.

Scott Budman’s tweets included the jousting between both prosecution and defense on multiple points.

There were victim impact statements directed to Holmes, which include the father of whistleblower Tyler Shultz, Alex Shultz, whose grandfather was investor, board member, and enabler George Shultz. “There’s a lot of talk about Sunny and Elizabeth. From my family’s perspective, Elizabeth is their Sunny Balwani. She took advantage of my family.” Theranos lawyers burst into their home (average for the bare-knucks tactics of one David Boies) with no chance for Tyler to defend himself. It also pitted the senior generation (now departed) versus son and grandson, ripping apart the family.

A cancer patient testified; the judge gently said he read her letter.

Holmes presented her own statement as the last word. “I am devastated by my failings. I have felt deep pain for what people went through, because I failed them. To investors, patients, I am sorry.”

Judge Davila’s formal sentencing of Holmes was well under 30 minutes. A judge’s summation must primarily justify the sentencing. It is where he speaks at length. It must detail his logic, discretion, reasoning, and thought process based on the information presented at trial and by precedent. The quotes are from Scott Budman’s play-by-play tweets:

“This case is troubling on so many levels. What went wrong? This is sad because Ms. Holmes is brilliant.”
“Failure is normal. But failure by fraud is not OK.”
“We know by the texts with Mr. Balwani that there was conspiracy.”
“What is the pathology of fraud? Is it the inability to accept responsibility? Perhaps that [is] the cautionary tale to come from this case.”

This Editor will reflect on this, with more information, next week. Will there be a genuine Silicon Valley impact in the middle of a downturn or has this all been factored in? There is the implosion of bitcoin/crypto FTX in the headlines–2022’s equivalent of the early 1930s’ fall of Swedish Match/Ivar Krueger and Ivan Boesky’s stock fraud of the Big ’80s.

Certainly there will be appeals by the defense and by the Feds. A defense appeal, for instance, may lengthen the time before she will serve her sentence.

Sunny Balwani’s attorneys will not be having a Palm Springs Weekend, either, now knowing the thought process of Judge Davila. 

With deep appreciation to the NBC Bay Area team coverage, the analysis by Dean Johnson, and warmly to Scott Budman.

Ousted Cerebral CEO may sue company, accuses management of scapegoating on Schedule 2 prescribing

November 18, 2022 | by

Troubled telemental health provider Cerebral may face a lawsuit from former CEO Kyle Robertson. Ousted in May when the company’s prescriptions for ADHD patients started to be excluded from pharmacies such as Truepill, CVS, and Walmart for Schedule 2 (potential for abuse and misuse) medications such as Adderall, Ritalin, and Vyvanse [TTA 6 May], Robertson has written a letter to Cerebral demanding access to documents. The types of documents requested, according to (paywalled) Insider, include “possible breaches of fiduciary duty, mismanagement and other violations of law.” Usually, these are a setup to determine whether others on the company board and leadership were the real culprits in business mismanagement, and a prelude to a legal filing.

CBS News obtained a copy of the Robertson letter, in which “Robertson says he was pressured by the company’s investors to “sell more stimulants” and believes his ouster was an effort to “scapegoat” him as these investigations arose.  He was urged by one board member  that “the easier you make it for people to get stimulants, the better for the business and its customers.” and also claimed that an investor told Robertson’s partner the company’s “ADHD business is crushing and it’s a cash cow … Kyle’s got to push this thing further.” Other documents obtained by CBS allegedly detail clinical safety issues, staff “practicing with expired (or) suspended license(s),” and duplicate accounts which could set the stage for overprescribing. Other documents allege lack of training, pushing prescriptions to 95% of patients, and disregarding state regulations putting licenses at risk. [TTA 29 June] The current management, led by David Mou, has denied this all.

Multiple investigations are proceeding. From May on, Cerebral came under investigation by the Federal Trade Commission (FTC) on deceptive advertising and marketing practices, the Drug Enforcement Agency (DEA) as part of increased scrutiny of telehealth providers and pharmacies possibly overprescribing telehealth-generated prescriptions, and most significantly, the Department of Justice (DOJ) subpoenas on allegations of overprescribing. A prior wrongful dismissal lawsuit by Matthew Truebe, Cerebral’s former VP of product and engineering, alleged that the company put growth before patient safety, including prescribing ADHD drugs to 100% of diagnosed patients as a retention strategy. The concatenation of evidence from multiple sources makes a lawsuit by Robertson, who also cites other factors, probable–unless this is being used as a tablespoon to sweeten his severance.

Prior to that, Cerebral was one of the leaders in the still-hot digital mental health category. In December 2021, their $300 million Series C raise led by Softbank boosted their valuation past $4.8 billion, employed 4,500, and had 210,000 patients. In October, they released 400 staff but other reports indicate far more. Also FierceHealthcare

The Theranos denouement: ‘Humble, hardworking’ Elizabeth Holmes sentencing Friday; prosecution and defense paint different pictures (updated)

November 17, 2022 | by

Elizabeth Holmes finally faces the music and perhaps the mercy of Judge Edward Davila on Friday, 10 am PT. Convicted on four felony counts of 11 and defrauding investors of over $144 million, the prosecution has called for Holmes to go to Federal prison for 15 years of the maximum 20, plus three years of supervised release. Restitution of $804 million would go to investors plus a fine of $250,000 for each charge. In US Attorney Stephanie Hinds’ 46-page pre-sentencing memo to Judge Davila, the prosecution states that she was blinded by ambition. “She repeatedly chose lies, hype and the prospect of billions of dollars over patient safety and fair dealing with investors. Elizabeth Holmes’ crimes were not failing, they were lying—lying in the most serious context, where everyone needed her to tell the truth.” They called her crimes “extraordinarily serious, among the most substantial white collar offenses Silicon Valley or any other district has seen.” and that her actions damaged the trust and integrity that is needed for Silicon Valley investors to trust companies to fund ideas before profits are seen. The cut: “She stands before the Court remorseless. She accepts no responsibility. Quite the opposite, she insists she is the victim.”

In all fairness, her defense has relentlessly painted Holmes as exactly that, from young, naive, battered, psychologically and sexually abused Trilby to Sunny Balwani’s Svengali. Their argument in their 82-page sentencing memo argues for mitigation to the point of no sentence at all, or a minimal sentence of no more than 18 months in home confinement plus her continuing service work. Supporting her character as a ‘humble, hardworking, and compassionate woman who deeply wants to give what she can to the world” and not motivated by greed or personal gain were character testimony letters from Billy Evans, her partner, as one would expect, but also from some unexpected places: the Senator from this Editor’s home state of New Jersey, Cory Booker, who knew her starting in 2012, and a former EPA head, William Reilly, who worked with Holmes’s father back in the George H.W. Bush administration. Their memo cited 130 letters.

Also revealed by the defense: Holmes is not only the mother of a year-old son but also pregnant. Evans’ letter contains another heartbreaking fact. Her beloved ‘wolf’ of a husky dog, Balto, was tragically killed by a mountain lion while she and Evans were living in seclusion in a rural area. While they lived in San Francisco, according to him, they were harassed by reporters, ordinary people, and threatening letters, so they hit the road for at least 6 months living in a camper.

Holmes’ ability to pay $804 million to the likes of Safeway and Walgreens seems to be a bit of a reach, as Holmes never cashed out of Theranos stock–at its peak valued at  $4.5 billion–is unemployed with no prospects, and is widely assumed to be, as they say, flat broke as are her parents. As to her sentence, what is widely expected is a multi-year sentence. If that happens, the defense will request that she remains free on bail (a motion for stay) while the filing to the Federal Appeals Court is made, a process that can take a year or more from filing to a decision. 

Judge Davila’s record has been to take in all the circumstances and to be measured in sentencing. After several years, he is intimately familiar with Theranos to the likely point of dreaming about it at night. Factors he may consider in sentencing, start of her term, where it will be served, restitution and fines: lack of flight risk, Holmes’ young child, and her current condition both physical and financial. Savvy court watchers have noted that if Federal law enforcement is in the courtroom, Holmes may initially be taken to prison and held, then freed on bail pending appeal. The jury convicted her on only four out of 11 counts (and threw out the 12th), but it remains that the prosecution proved and the jury decided that she was fully capable of engineering fraud, not once but several times, leaving Balwani’s Mesmerizing Influences aside.

Balwani’s own sentencing on 12 charges, with the same maximum of 20 years in Federal prison, is scheduled for 7 December, Pearl Harbor Day, at 10 am PT.

The Mercury News articles, while thorough, are paywalled: 11 November (defense memo), 11 November (Billy Evans letter), 14 November (prosecution filing). FierceBiotech, MedCityNews

The US Attorney, Northern District of California summary: U.S. v. Elizabeth Holmes, et al.  District Court documents here.

NBC Bay Area will cover the sentencing live here at 10 am PT, 1 pm ET, 6 pm GMT.

News briefs: ResMed-Verily’s Primasun sleep solution; Maven Clinic’s $90M Series E; Mount Sinai genomics spinoff Sema4 lays off additional 500, exits women’s health

November 16, 2022 | by

The large conference HLTH is underway in Las Vegas and like pre-Covid, conferences are a platform for announcements. Verily, which is Alphabet’s (Google’s) life sciences and health skunk works, and ResMed, a large company in respiratory medical devices for sleep apnea and sleep disruption treatment, have formed a joint venture, Primasun. Their target market is employers and providers to identify patients at risk for sleep disorders, particularly obstructive sleep apnea. About 75% of those in the US experience some form of sleep disruption at least a few times a week, leading to behavioral and physical problems. Mobihealthnews has the basic information on the launch but also some side information on Verily. Back in September, alongside a $1 billion raise to fund precision health, controversial founding CEO Andy Conrad announced he was stepping down effective in January 2023, replaced by current president Stephen Gillett. Dr. Conrad survived a brace of bad press back in 2016 [TTA 6 Apr 2016] and multiple ups and downs in the past six years.

Maven Clinic, a virtual care company targeting women and families, bucked the trends and locked up a $90 million Series E financing. Led by General Catalyst, there are nine other investors including La Famiglia, CVS Health Ventures, and Intermountain Ventures, bringing total funding to just under $300 million (Crunchbase) and unicorn valuation last year. Maven focuses on women’s health journey from fertility through menopause. The company claims to host 15 million members through primarily companies and health plans, and has contracts with half of the Fortune 15. Recently, they launched a menopause and ongoing care program with 1.2 million lives covered across 150 employer clients.  Release, Mobihealthnews  Notably, General Catalyst has been a bullish funder of both US and UK health systems such as Banner Health, Cincinnati Children’s Hospital Medical Center, Hackensack Meridian Health, HCA, and Intermountain Health, along with Guy’s and St Thomas’ NHS Foundation Trust in the UK. Mobihealthnews

Unfortunately, Mount Sinai spinoff Sema4 continues to cut back and restructure. Their latest round of layoffs affects 500, or 32.5% of its workforce. Sema4 will be exiting its reproductive and women’s health testing business and shuttering operations located in Stamford, Connecticut by end of Q1 2023. Going forward, they will concentrate operations in Maryland. In August, they discharged 250 staff, about 13% at that time, including its founder from both the president and director slots. With this latest restructuring, their workforce has been reduced to 1,100. Their release states that they will concentrate on their high growth, high margin pediatric and rare disease business using whole exome/genome diagnostic testing, achieve annual revenue growth in excess of 20%, and reach profitability by 2025. MarketWatch, Becker’s, Mobihealthnews

Yes, Virginia, there is an Amazon Clinic, after all; stripped down, non-face-to-face consults for common conditions

November 16, 2022 | by

On the move while Care is shutting down and OneMedical is not yet onboard as awaiting Federal approvals, Amazon Clinic’s premature leak generated press for the service’s formal debut on Tuesday. The leak was remarkably accurate [TTA 11 Nov] in describing it for the New York Minute it was up. According to their introductory blog, Amazon Clinic will operate in 32 US states (not specified, but a quick check indicates it’s not available in Alaska and New Hampshire). It provides message-based virtual care for more than 20 common health conditions, such as allergies, acne, eczema, UTIs, and hair loss. (The website lists conditions covered and prescription renewals for previously diagnosed conditions such as asthma, hypothyroidism, high cholesterol, and migraine.)

What it is: a stripped-down, questionnaire-driven provider referral platform, enabling a non-face-to-face telehealth consult or prescription renewal. It’s not clear from available information whether the messaging is synchronous, asynchronous (delayed), or a combination of both. This certainly sounds less ambitious than the home-based delivery/enterprise membership model of Amazon Care. How Clinic works:

  • Select your condition
  • Pick your preferred provider from a list of licensed and qualified telehealth providers. Costs and if available in your state are disclosed in the selection process.
  • Complete intake questionnaire
  • Connect with clinician through a secure message-based portal
  • After the message-based consultation, the clinician sends a personalized treatment plan via the portal, including any necessary prescriptions to the customer’s preferred pharmacy including Amazon Pharmacy. Here, costs may be covered by insurance.

As Care was, payment is upfront as Amazon doesn’t accept insurance. The cost of consultations will vary by provider and condition but tend to be in the $40 – 50 range. This includes ongoing follow-up messages with the clinician for up to two weeks after the initial consultation. Some conditions, such as rosacea, require a prior diagnosis.

In addition, the services provided are available only to those aged 18-64, which strikes this Editor as discriminatory for those 65 and over who can well pay cash and might prefer a ‘visit lite’.

No mention of whether those laid off at Amazon Care or through the rest of Amazon (10,000 announced) can apply for jobs with this new service; it sounds largely referral, highly automated, manageable, and not requiring heavy oversight. The last can be a problem all its own. TechCrunch, Mobihealthnews, CNBC