Weekend roundup: telehealth claims ticked up again in January, Walmart opens Florida health ‘superstores’, Blue Shield California partners with Walgreens’ Health Corners

April 8, 2022 | by

Telehealth now above 5% of January claims. Perhaps Omicron, winter weather, or the post-holiday blues, but telehealth visits after a long drop have risen to 5.4% of January medical claim lines. It’s also the third month in a row of increase: November was 4.4%, up from October’s 4.1%; December was 4.9%.

As a percent of the total, claims increased in November and December for acute respiratory and Covid-19, but leveled off in January. The numbers remained in single digits compared to the leading diagnosis code group, mental health conditions, which rose in January:

MonthMental healthAcute respiratoryCovid-19
January 202258.93.43.4
December 202155.06.04.8
November 202162.24.51.4

February and March claims will be the proof, but telehealth is leveling off to a steady 4-5% range of claims with seasonal rises, barring any mass infectious diseases. The FAIR Health monthly map also enables drill-down by region. Healthcare Dive

Walmart Health ‘superstores’ open in Florida, finally. The concept, which had gradually spread to 20 locations in Arkansas, Georgia, and Illinois starting in 2019, now has two locations in the Jacksonville area. Three additional locations will be opening by June in the Orlando and Tampa area. Openings were delayed from 2021 so that Walmart could debut their Epic EHR and patient portal in those locations. Plans for expansion in Florida, filled with areas with aging populations, have been hinted at but coyly not confirmed by Dr. David Carmouche, senior vice president of Omnichannel Care Offerings.

After a few false starts and retrenching, Walmart is leveraging its strong physical point in delivering health–retail supercenters–against competitors such as CVS, Walgreens, and Amazon. The centers provide primary and urgent care, labs, X-rays and diagnostics, dental, optical, hearing and behavioral health and counseling for a checkup priced around $90, with most under contract with payers. Walmart has not announced expansion beyond Florida or in current states, but prior statements have indicated their desire to open Walmart Healths across the country. Walmart release, Healthcare Dive, Miami Herald

And Walgreens is not far behind the curve with 12 Health Corners in California. Walgreens’ joint model with Blue Shield of California in the San Francisco Bay and Los Angeles areas is designed to boost community health, especially in areas with low health coverage or ‘health deserts’. Health advisers can provide simple in-store care along with guidance on preventive screenings, chronic care management and medications. Select health screenings, such as blood pressure checks and HbA1c tests will be available. 

Both in-person and virtual services through the Health Corner app are available at no additional cost to members enrolled in Blue Shield’s commercial PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) plans, who live within 20 miles of a Walgreens Health Corner location. It is part of both Walgreens’ enlarging of patient care offerings, including telehealth at a local level, and Blue Shield’s health transformation goals.

Their release promises an additional eight locations by mid-year. Healthcare Finance, FierceHealthcare

Thursday roundup: UHG/Optum, Change extend merger deadline to 31 Dec, buys Kelsey-Seybold; $2B Tivity Health sale; General Dynamics enters derm AI diagnostics; MobileHelp PERS sold to Advocate Aurora

April 7, 2022 | by

UnitedHealth Group’s Optum unit and Change Healthcare, to no one’s surprise, have cast the die and extended their merger deadline to 31 December. Originally, the acquisition was to be completed at end of 2021 and later pushed to 5 April.

In a joint release, they touted their shared vision for a “simpler, more intelligent and adaptive health system for patients, payers and providers”. Backing this up is a break fee of $650 million from Optum to Change Healthcare in the event the court scuppers the deal.

On 25 February, the US Department of Justice filed a lawsuit in US District Court in Washington, DC to stop the acquisition on anti-competitive grounds [TTA 25 Feb]. UHG/Optum and Change, despite divestitures, could not evade DOJ’s reasoning that Optum was buying its only major competitor in areas such as hospital claims data, claims processing, claims editing, and EDI clearinghouse, which facilitates the transfer of electronic transactions between payers and physicians, health care professionals, or facilities. Less than a month later, Optum and Change responded, contesting the charges in that same District Court, and contending that it would be ‘economic suicide’ for Optum to be anti-competitive, since Optum’s business model is dependent on payers other than UnitedHealth. Fighting rather than switching off the deal, it’ll be heard on 1 August [TTA 23 March]. FierceHealthPayer, 

As noted last week, Optum is writing big checks for LHC Group home care/management services and Refresh Mental Health. This week’s jumbo buy is the Kelsey-Seybold Clinic of Houston. This is a multi-faceted operation with multiple multi-specialty care centers, a cancer center, a women’s health center, two ambulatory surgery center locations, and a 30-location specialized sleep center. It also has a highly regarded ACO and KelseyCare Advantage, a 5 Star Medicare Advantage plan, in addition to partnering with insurers on commercial value-based health plans. If it closes, Optum will be more than likely well over its goal of owning or controlling over 5% of US providers. Terms were not disclosed, but TPG’s private equity arm made a minority investment in Kelsey-Seybold two years ago. At the time, the valuation was rumored to be $1.3 billion.

Tivity Health is being acquired by funds managed by Stone Point Capital for $2 billion. The $32.50 per share is a 20% premium to the 90-day price average, which reflects its 40% financial share growth in the past year. Having sold its original name of Healthways and a sizable chunk of its original business to the digital health conglomerate Sharecare, it rebranded in 2017 as Tivity and concentrated on fitness businesses: senior-targeted SilverSneakers, gym chain Prime Fitness, and alternative/complementary medicine WholeHealth Living. Closing is anticipated to be Q3. CEO Richard Ashworth will remain with the company, and headquarters stay in Franklin, TN. Release, Becker’s

A palate cleanser: a division of defense/aerospace giant General Dynamics, General Dynamics Information Technology (GDIT) has developed an AI diagnostic for remote dermatologic use for the active service/veteran market. It classifies images of skin lesions, determines if they are indicative of skin disease, and will recommend follow-up care. According to the GDIT release, “the GDIT skin lesion classifier tool won third place in the VA National AI Tech Sprint 2020-2021, a competition organized by the Department of Veterans Affairs (VA) National Artificial Intelligence Institute (NAII) to match private sector talent with veterans, VA clinicians and other experts to brainstorm AI-based solutions that can improve veteran health and well-being.” Also Healthcare IT News

MobileHelp, one of the earliest mobile PERS, and sister company Clear Arch Health, a remote patient monitoring provider, have been purchased by Advocate Aurora Enterprises. Terms were not disclosed, but management will remain in place in Boca Raton. MobileHelp was private, so estimates of valuation are difficult, but their private equity backing included ABRY Partners and Topmark Partners (Crunchbase). Their PERS market claimed 300,000 households. Clear Arch had a separate clinical base with provider care management of chronic condition patients connected to EHRs. For AAE, a division of Advocate Aurora Health systems in Illinois and Wisconsin, MobileHelp’s acquisition will complement their recently acquired home health provider Senior Helpers and Xhealth clinical digital solution ordering. The traditional PERS and call center business continues to be of interest, but blending into other businesses. Release, Healthcare IT News

Digital health funding’s Q1 hangover from 2021’s bender–and Q2 is a question mark, even for Rock Health

April 6, 2022 | by

Chug the Pedialyte and pickle juice, down those milk thistle caps for the liver. It’s a morning after quarter that we knew was coming. After 2021’s mighty year for health tech investment, doubling 2020’s, capped by a $29.1 billion total across 729 deals [TTA 29 Jan], the slump we knew would arrive, did. Rock Health’s tracking of 2022’s Q1 proved to be a less than stellar $6.0 billion across 183 deals. It mildly lagged 2021’s Q1 but was still 75% more than 2020’s depressed Q1 at the start of the pandemic.

Even in January, the 2022 projections were iffy. Silicon Valley Bank projected, based on anemic post-IPO performance, that there would be ‘massive consolidation’ and even acquiring companies to hire talent [TTA 14 Jan]. Rock Health and Silicon Valley Bank noted the waning of SPACs as an easy way to IPO for a variety of reasons, including SEC scrutiny. A combination of both was SOC Telemed. which IPO’d via a SPAC at $10, and was taken private seven months later at $3 per share–after trading at $0.64. SOC was not an outlier–larger telehealth brothers Amwell and Teladoc had taken major share price kicks in the head at 50% and more by February [TTA 8 Feb].

The rest of the story is mixed as the economy continues to open up with the pandemic over, but the stock market is wobbly, inflation soars as does a Russia-Ukraine war. 

  • Average deal size was $32.8 million, again below 2021
  • January was a cheerier month than the following two, with companies raising $3.0 billion. Some of this was carryover from 2021 deals that didn’t quite make it past the post. February slumped to $1.4 billion while March ticked up to $1.6 billion, not a good trend going into Q2.
  • Rock Health’s Digital Health Index (RHDHI), a composite of publicly traded digital health securities, fell 38%, far below the S&P 500’s 5% dip over that same time period.
  • SPACs tumbled along with the market, continuing their fall since 2021. Deals were canceled, taken private (SOC Telemed), and companies sued for misleading investors (Talkspace).
  • Late stage deals continued to roll: mega Series D+ deals in Q1 2022 included TigerConnect ($300M), Lyra ($235M), Alto Pharmacy ($200M), Omada Health ($192M), and Ro ($150M). D and above deal size fell by $16 million. But average deal size fell off at every Series, less so for B and C.
  • Lead clinical investment areas were mental health continuing far in the lead, followed by oncology, cardiovascular, and diabetes. Oncology rose from the fifth spot in 2021 to #2 in Q1, displacing cardio. In value proposition, the top three were on-demand healthcare, R&D, and clinical workflow–this up from the 11th spot.

A weak start for 2022, but only compared to 2021. Q2 and maybe even Q3 will be the test in this mid-term election year. Rock Health Q1 report

Wisconsin’s $5M for child psychiatry, community telehealth; FQHC patients prefer audio-only telehealth–Rand

April 5, 2022 | by

The state of Wisconsin is granting $5 million to telehealth vendors, equally split between child telemental health and community telehealth delivery. Governor Tony Evers announced the grant series which was funded by the American Rescue Plan, the third COVID stimulus round of 2021 as part of the State and Local Fiscal Recovery Fund to bolster rural telehealth plus mental health. With COVID fading, the funds are being redeployed by states for related health initiatives.

Applications are due 6 May for:

  • Up to five one-year grants of approximately $500,000 will be provided to Wisconsin hospitals and health systems to expand and improve child psychiatry telehealth services
  • Between 25 and 50 providers to partner with community organizations to establish neighborhood telehealth access points at food pantries, homeless shelters, libraries, long-term care facilities, community centers, and schools. These are targeted to reach people with limited access to technology and reliable internet service. These are also one-year grants of up to $100,000 each.

While big telehealth funding for mental health grabs the headlines, at the local level, it is these state initiatives that often keep both providers and smaller telehealth companies going. State of Wisconsin release, mHealth Intelligence

RAND Corporation’s study of telehealth in Federally Qualified Health Centers (FQHCs) found that audio-only telehealth was used more frequently during the pandemic, and continued to be used by patients for behavioral health even when primary care shifted back to in-person visits. The study group was the California Health Care Foundation (CHCF)’s 45-center Connected Care Accelerator (CCA) program started in July 2020. These centers serve rural, low-income, and underserved populations, common in places like Wisconsin (this Editor worked with a successful FQHC ACO there) and in California.

Audio and video telehealth was problematic for both the patient population and the clinics. Those with limited English proficiency participated in a significantly lower percentage of video visits. Behavioral health centers also had difficulties. Centers that coordinated efforts to replace audio-only with video visits had specific promising practices.

According to the RAND study, “key facilitators of telehealth implementation were leadership support, patient willingness to use the technology, platforms that were easy to use and access, a sense of urgency within clinics, changes in reimbursement policy, and training opportunities for staff.” Another recommendation was to retain centers to serve as distant telehealth sites (and to be reimbursed). Also mHealth Intelligence

Weekend wrapup & reading: Amazon Health on talent hunt, Practice Fusion fined $200K for violating $145M prosecution agreement, and must-read studies and articles on older adults tech

April 2, 2022 | by

Resumes and networking up! A writer at Becker’s Hospital Review tired of their usual diet of healthcare departures, ‘alarming’ rises of COVID rates by state, and cyber-attacks on hospitals to publish six top-level jobs opening up in Amazon’s healthcare areas. The lead is Head of worldwide health technology solutions to lead strategy in that area at the C-level. Two are in UX and software development at Alexa Health, a senior solutions architect, health artificial intelligence , a principal of behavioral health for digital health benefit programs, and a health information exchange specialist. So if your spring brings a yen for change….

Physician EHR Practice Fusion, now Veradigm owned by Allscripts, got another $200,000 spanking from the Feds. Back in January 2020, right before Pandemic Hell really broke loose on the world, the Department of Justice successfully resolved both criminal and civil charges against the EHR company. Practice Fusion was charged with “soliciting and receiving kickbacks in return for embedding electronic prompts in its electronic medical record (“EMR”) to influence the prescribing of opioid medications” as part of the platform’s clinical decision support (CDS) alerts. The kickback was $1 million from an unnamed ‘opioid company client’, The deferred prosecution agreement (DPA) was accompanied by 1) a $145 million fine and 2) maintenance of an Oversight Organization based on three specific requirements. DOJ in the District of Vermont found that Practice Fusion did not comply with the terms of the latter, charges that Practice Fusion denied. They settled with the DPA extended by 11 weeks with a fine of $200,000. Release, US Attorneys Office, District of Vermont 29 March, US DOJ release 27 January 2020

Weekend Reading. Laurie Orlov of Aging and Health Technology Watch has been hard at work, recently updating her Market Overview Technology for Aging and releasing The Future of Smart Homes and Older Adults. No time with spring cleaning to tackle long-form? Try three tart short takes on PERS smartwatches (not getting the ‘why’), did ‘voice first’ technologies meet their 2018 promises (not quite), and what she sees as the Seven Top Trends for tech to reach older adults–with the first being hospital to home (Optum and Humana have voted ‘yes’). 

What do physicians really think about telehealth, now that they’ve used it? Lower use, substantial frustrations remain.

April 2, 2022 | by

Optum finds a part-rosy, part-jaundiced picture. Not much notice was taken of a survey on behalf of UnitedHealth Group’s Optum survey of 240 physicians, 75% of whom were in primary care with the remainder in specialty or urgent care. Most (65%) hadn’t used telehealth prior to the pandemic, yet shifted to 74% heavy to moderate use during it. Good times for telehealth providers of all types, secure and non-secured platforms. The problem, despite Optum’s optimistic headline in the release? Telehealth use predictably rolled back; doctors aren’t sticking with it–86% project now rare (<10%) to moderate (10-49%) usage in future. 

Telehealth in use was primarily synchronous (real-time), and almost equally audio/video (88%) and phone only (80%). 30% used secure messaging. Patients also preferred phone to online, 86% to 51%, for scheduling. Most providers saw telehealth as convenient (69%), efficient (35%), and timely (29%). For patients, the convenience factor soared to 90%, with 47% happy they could have telehealth from home.

But provider frustrations were found to be substantial, with dissatisfaction over 50% in three key areas. 58% felt that they could not provide the level of care they want (58%), meet patient expectations (55%), or were frustrated with telehealth audio/video technology (50%). As to the last, 40% wanted better technology and 35% wanted EMR integration. Only 23% wanted a mobile app. 47% wanted training–for their patients. Only one in four said that job satisfaction and patient health improved.

A picture that needs some improvement for telehealth to succeed. Optum release, Provider Telehealth Use and Satisfaction Survey. Hat tip to EPTalk by Dr. Jayne on HISTalk.

Friday roundup: LetsGetChecked buys Veritas Genetics, Everly Health adds CMO, Babylon sends chatbot to Higi, ConcertAI’s $150M Series C, AmplifyMD’s $23M, and two ‘Brights’ raise $155M

April 1, 2022 | by

Home health testing company LetsGetChecked is buying Veritas Genetics and Madrid-based Veritas Intercontinental for an undisclosed sum. Veritas specializes in whole genome sequencing. For LetsGetChecked, they can now build out genomic testing as part of their broad range of at-home test kits and app reporting for a wide variety of wellness, sexual health, and men’s/women’s health. It also opens up targeted panels and tests such as Pharmacogenomics (PGx), cancer screening, carrier screening, and maternal-fetal testing.

LetsGetChecked, based in Dublin and NYC, has raised $263 million to date through a 2021 Series D from investors such as Casdin Capital, HLM Venture Partners, and Optum Ventures. Veritas Genetics and Veritas Intercontinental are very early stage companies HQ’d near Boston with $61 million in funding through several venture rounds. Veritas was founded by Harvard and MIT genomics experts to make genetic testing more available and affordable. The release implied that Veritas principals would be joining LetsGetChecked. The acquisition is expected to close shortly. Release, Mobihealthnews

New CMO at Everly Health.  Liz Kwo, MD will lead their clinical strategy as chief medical officer. A competitor of LetsGetChecked, Everly Health is the parent of direct-to-home testing Everlywell, enterprise-focused Everly Health Solutions, and recently acquired Natalist in the fertility and pregnancy testing area. Comparing the two, LetsGetChecked occupies a more clinical and condition-specific space (e.g. thyroid antibodies, hormones), while Everlywell is positioned in the general wellness testing area, e.g. allergies. Dr. Kwo previously was with Anthem as Deputy Chief Clinical Officer and is an interesting combination of clinician and digital solutions/advanced data analyst. Release, FierceHealthcare

Babylon Health’s recently acquired Higi mobile app now has Babylon’s well-known AI-enabled symptom checking chatbot. Higi’s main business are in-store health ‘stations’ that measure blood pressure, pulse and weight, plus diabetes and heart disease risk through symptom checkers. The integration with the Babylon app also demonstrates for other Babylon partners how their chatbot can be used. Mobihealthnews

ConcertAI, the former Concerto HealthAI, raised $150 million in Series C funding from Sixth Street for a total $300 million and boosting its valuation to $1.9 billion. ConcertAI specializes in life sciences and healthcare enterprise AI and RWD SaaS solutions for use in precision medicine. It has partnered with Pfizer, Bristol-Myers Squibb, and has begun a collaboration with lab-testing giant Labcorp to launch precision oncology studies. Its parent is SymphonyAI, a larger AI company in other areas such as retail. Release, Mobihealthnews, 

AmplifyMD, a telemedicine platform for medical facilities to connect to specialist doctors, raised a $23 million combination Series A/seed round from F-Prime Capital, with the seed co-led by Forerunner Ventures and Greylock. Their target market? Over 3,300 medical institutions with a lack of specialty access, which are often in rural or small regions of the US. Their specialties are cardiology, neurology, psychiatry, pulmonology/critical care, infectious disease, nephrology, and hematology/oncology. Release 

Two mental health ‘Brights’ raise a total of $155 million. Brightline Health, a pediatric mental health company for at-home therapy targeted to kids and teens, raised a $105 million Series C for a valuation of $705 million. The round was led by KKR with current investors GV, Optum Ventures, Oak HC/FT Partners, Threshold Ventures and Blue Cross Blue Shield of Massachusetts. It was co-founded by Livongo veteran Naomi Allen who left Livongo shortly before the Teladoc acquisition. The funding will be used for staffing and to broaden its offerings. Mobihealthnews, Bizjournals, Bloomberg

The other ‘Bright’ spot in mental health company funding is Brightside Health, which raised a $50 million Series B financing round led by ACME Capital and Mousse Partners, for a total of $81 million. Brightside is for adults combining an app-driven mental health assessment, therapist match and connectivity, and automated matching to medication if needed. They market membership to payers, providers, and employers as a benefit. Mobihealthnews, FinsMes

 

UnitedHealth Group makes two jumbo buys for Optum: LHC Group home health for $5B, Refresh Mental Health

March 31, 2022 | by | 2 Comments

In two jumbo acquisitions that further diversify UnitedHealth Group (UHG)’s Optum into the hot sectors of home and mental health (and are bright spots of this so-far somewhat dim M&A year), UHG is acquiring LHC Group, a major home health and hospice provider, for $5.4 billion or $170 per share. After the buy closes in second half 2022, after the usual regulatory approvals, UHG will put LHC under Optum Health to integrate their services into their provider network and health plans, especially Medicare Advantage where home health utilization is part of value-based care and costs are increasingly scrutinized. LHG serves 960 locations in 37 states, with 30,000 employees and revenue of $2.2 billion last year. The management team based in Louisiana will be coming over to Optum Health. Interestingly, co-founders Keith and Ginger Myers will personally invest $10 million in UHG following the acquisition close. FierceHealthcare, Healthcare Dive, LHC release

Little noted–through LHC, Optum is acquiring Imperium Health, a good-sized ACO, population health, and management services company. It’s another fit as Optum is a major physician group owner, many of whom are also in ACOs. LHC acquired Imperium in 2018. According to their website, Imperium now manages 16 ACOs and is in partnership with a large ACO group. 

Also coming Optum’s way is Refresh Mental Health which owns and operates US mental health practices with specialized programs in psychiatry and substance abuse treatment. Optum is acquiring it from private equity firm Kelso & Company. Terms were not disclosed, but Kelso bought Refresh in December 2020 at a valuation of around $700 million with earnings of about $40 million. Refresh has 300 practice locations in 37 states. FierceHealthcare, AxiosPro (which broke and confirmed the story).

Meanwhile, UHG will be slugging it out this summer to convince a US District Court judge that their super-jumbo Change Healthcare acquisition isn’t anti-competitive in about a dozen ways, as the Department of Justice lawsuit maintains. TTA 23 March

Short takes for Thursday: TimeDoc’s timely $48M, Glooko buys France’s DIABNEXT, Jio Health’s $20M, Pear’s Tokyo sleep-wake, Antidote’s $22M, and Centene’s new, young CEO signals big changes

March 24, 2022 | by

TimeDoc Health, a Chicago-based virtual care management platform that enables doctors to manage their patient populations between visits, has raised $48.5 million in a Series B funding round led by Aldrich Capital Partners.  This follows on a modest $5.7 million Series A round and equally modest seed rounds (Crunchbase). (This Editor notes that funding is becoming more modest this year anyway.) TimeDoc provides remote patient monitoring (RPM), chronic care management, and behavioral health monitoring, plus about 150 care coordinators who do it. The funding will be to add 20-40 new hires to the care coordinator group monthly and undoubtedly build out within and without its present 35 state coverage. The 2025 goal stated by their CEO is to serve one million patients monthly. Axios, Mobihealthnews

Palo Alto meets Paris, with Glooko buying DIABNEXT. The French company, which had been marketing its own diabetes management app, will be rebranding as GlookoXT, use the Glooko platform and continue to market its established app and remote monitoring products. Terms were not disclosed, but the DIABNEXT team will be joining the Glooko team. Glooko’s been hitting the European capitals, since last month they acquired Berlin-based xbird.  Release, Mobihealthnews

In Asia-Pacific news, Jio Health, based in Vietnam, now has $20 million in a Series B funding led by Singapore’s Heritas Capital. The startup is an interesting blend of telemedicine and e-prescribing via app, physical “smart” clinics, 300 branded pharmacies, and on-demand home care. Mobihealthnews

Sleepless in Tokyo? In Japan, Pear Therapeutics and SoftBank are teaming up to develop a digital therapeutic treating sleep-wake disorders. Pear has an FDA-approved prescription product for chronic insomnia, Somryst, and is pursuing a strategy of marketing sleep treatments in countries outside the US. Pear went public via a SPAC at end of 2021. Mobihealthnews

Telehealth is still captivating investors, with a $22 million Series A raise by the interestingly named Antidote Health. This tops off $12 million in seed funding by iAngels, Group 11, and Flint Capital. Their virtual consults are pitched as affordable either on a one-time or subscription basis. The raise will go towards adding chronic and primary care services, plus R&D activity, which includes advanced AI screening and clinical decision support system capabilities built on a claimed 20 year database.

And for those of us who are survivors of US health plans, top payer Centene, after 25 years of one man at the top, now has a new CEO, effective immediately. To no one’s great surprise, the pick is Sarah London, formerly vice chair of the Centene board of directors, one-third of their ‘value creation office’, and part of the Office of the Chairman. London previously headed Centene’s non-plan, primarily technology-based businesses. In 2020, she joined Centene from Optum Ventures, UnitedHealth’s VC arm, and prior to that was chief product officer of Optum Analytics. She fits a picture of Centene being a technology company for value-based care that also owns health plans, once sketched out by their now former CEO, Michael Neidorff.

Neidorff was a casualty of December’s shakeup by activist investor Politan Capital Management, along with three board members over the now-mandatory age 75 limit [TTA 18 Dec 21]. Since February, Neidorff has been on medical leave of absence from the BOD chairman’s position, with James Dallas, formerly of Medtronic, now acting chair. Neidorff is now 79 so would not be able to remain on the board unless an exception is made. He remains one of Centene’s largest individual shareholders, though he has sold millions of dollars of shares in recent years. We wish him a speedy recovery and a quiet retirement.

London’s youth at 41 and fast rise is a seismic change for Centene, and this Editor predicts a lot of changes to come quickly from top to bottom, including holdings, location, organization, and culture. Centene release, Healthcare Dive  Disclosure: this Editor worked for a division of WellCare that was acquired by Centene, and remained with the company for six months after the closing.

The Theranos Trials, ch. 3: Sunny and Elizabeth were in it together, all the way

March 23, 2022 | by

“Partners in everything, including their crimes” was part of the prosecution’s opening statement in today’s start of Ramesh ‘Sunny’ Balwani’s trial. Delayed by a week by a Covid-19 exposure, the former chief operating officer of Theranos is on trial for the same charges as Elizabeth Holmes–10 counts of wire fraud and two counts of conspiracy to commit wire fraud. Their trials were severed when her defense charged him with emotional abuse. The trial is taking place in the same US District Court in San Jose, with Judge Edward Davila and with the same prosecution team, for the next 12 weeks.

Prosecutor Robert Leach brought Holmes into the picture repeatedly with their personal and professional partnership, adding that while Balwani “skewed the medical decisions patients were making and put them at risk”, he laid the financial and technical fakery at both their feet. “The defendant and Holmes knew the rosy falsehoods that they were telling investors were contrary to the reality within Theranos.”  Leach also contended that Balwani had absolutely no background in healthcare technology and was unqualified to lead the company.

His defense, which is led by Stephen Cazares of Orrick–a former Federal prosecutor and enforcement attorney at the SEC–contends that Balwani was not a founder, nor a controlling executive, or had final decision-making authority–Holmes was. If anything, Balwani was blinded by his belief in the technology, to the extent of putting up his own $10 million to guarantee a loan for Theranos before investing another $5 million for a stake in the company. And others, such as Safeway and Walgreens, had reviewed and invested in Theranos. Like Holmes, he never cashed in his stake.

A new piece of the defense is quoted from the very thorough article in tech website Protocol: “…the government was to blame for not doing its due diligence. Theranos handed over a hard drive to the Department of Justice with encrypted test data for more than 9 million Theranos patients back in 2018. The DOJ didn’t analyze that database, and therefore, Cazares argued, the government cannot definitively say how well or not well Theranos’ technology worked.” It’s an interesting limb but given the Holmes convictions, feels to this Editor like one that’s easily sawed off.

The first witness called was Erika Cheung, the Theranos lab associate who became a whistleblower. Court ended before she got to any statements, but in the Holmes trial she stated the Edison lab results were about as accurate as a coin toss, which was devastating. More to come through Thursday. The Guardian, NBC Bay Area, and Mercury News (annoyingly paywalled).

DOJ lawsuit to block UnitedHealth-Change Healthcare’s acquisition now set for 1 August trial

March 23, 2022 | by

UnitedHealth Group isn’t giving up. Last Thursday (17 March) UHG filed with the US District Court in Washington, DC, responding to the US Department of Justice’s (DOJ) suit to stop their acquisition of Change Healthcare and folding into its Optum unit. Essentially, their argument in their public statement is that the acquisition would have multiple consumer benefits and big savings as the ‘healthcare system of the future’, including:

  • We can increase efficiency and reduce friction in health care, producing a better experience and lower costs
  • Helping health care providers and payers better serve patients by more effectively connecting and simplifying key clinical, administrative and payment processes
  • Improve the quality of health care delivery, automate claims transactions, and accelerate payment between provider and payer
  • Patients get a simplified consumer experience, lower costs, and get better point-of-care delivery due to improved adherence to best clinical evidence

In their view, it would be ‘economic suicide’ for Optum to be anti-competitive. UHG states that Optum’s business model is dependent upon their external customers, and if their competitively sensitive information is misused, they would stop using Optum’s services and turn to competitors.

The DOJ does not agree, of course. As to competition, they contend that Change is the only significant competitor to Optum in claims processing. The merger would be anti-competitive in other ways as well:

  • Change is “United’s only major rival for first-pass claims editing technology — a critical product used to efficiently process health insurance claims and save health insurers billions of dollars each year — and give United a monopoly share in the market.” It would also give UHG the ability to raise competitors’ costs for that technology.
  • Hospital data accounts for about half of all insurance claims. UHG with Change would have effective control of that ‘highway’.
  • Change is also a major EDI clearinghouse, which facilitates the transfer of electronic transactions between payers and physicians, health care professionals, or facilities. UHG would have control of the EDI clearinghouse market.
[More–TTA 25 Feb] 

It moves to the District Court and Judge Carl J. Nichols on 1 August. The trial will be 12 days–seven for DOJ, five for UHG/Change. With the delay, analyst Jailendra Singh of Credit Suisse expects Change to press UHG to sweeten the deal, such as a termination fee, versus an increase in purchase price. It’ll be an interesting summer for a bevy of lawyers! Forbes, Credit Suisse note

This Editor holds to her previous opinion that this merger is ‘one for the books–the ones marked ‘Nice Try, But No Dice’.  No matter what, Change will have to change.

Friday short takes: ElliQ companion robot launches, Tunstall pilots chronic condition support in Ireland, Walmart Better(s)Up, TytoCare surveys virtual primary care, Microsoft closes $19B buy of Nuance

March 18, 2022 | by

ElliQ, a small size companion robot, was officially launched this week by its developer, Intuition Robotics. From the release, it’s a national launch but concentrated in senior-rich south Florida. ElliQ responds and ‘learns’ by voice commands and through a connected tablet. It has gained some notice for its unusual shape (like a small lamp), animation in place, and initiating conversation that resembles chit-chat. Behind this is interactivity–the companion part–checking in to say “good morning,” pointing towards sleep, but also informing family or friends that you’re OK and helping track appointments and medications. We noted at the end of January that Michael Cantor, MD, JD is their chief medical officer, as well as CMO of Uber Health. Intuition release, Fast Company profile of an ElliQ beta tester, aged 81.

It’s a day late for St. Patrick’s Day, but Tunstall Healthcare piloted with several agencies in County Wexford, Ireland, in a 12-week proof of concept test of remote monitoring support of 50 patients with three chronic conditions: heart failure, diabetes, and chronic obstructive pulmonary disease (COPD). The 2021 telehealth intervention measured the impact on the patient’s clinical condition and wellbeing; in-person use of health services; ascertaining patient and clinician perceptions of the intervention and technology; and an analysis of the cost-effectiveness of the intervention. The trial used the myMobile patient app and the triageManager clinical management software platform. Participating in the pilot: Age Friendly Ireland, Integrated Care Programme in the HSE, Wexford General Hospital, Tunstall Emergency Response and Wexford County Council-Age Friendly Programme. THIIS. Also in the same publication is a Tunstall take by Gavin Bashar, Tunstall UK & Ireland managing director, on aging in place with technology support.

In another expansion of Walmart into healthcare, they’re partnering with behavioral health-coaching platform BetterUp in a program dubbed ‘BetterUp for Caregivers’. The app will be offered exclusively through Walmart’s Wellness Hub. Caregivers can access support via BetterUp’s live group coaching circles hosted by a BetterUp coach. Release, Mobihealthnews

TytoCare’s quick survey found that their 300 users via a major insurer preferred more access to virtual primary care, which isn’t much of a surprise. Going through the numbers:

  • 67% felt they would be more likely to stay with their health insurer long-term as a result of being offered remote physical examinations (always catnip to insurers!)
  • 66% of users would consider a digital-first plan
  • 87% of respondents indicated they are pleased by health insurers who offer technology for remote visits
  • Much of this is a reaction to delayed in-person primary care: 90% of members wait an average of six days to see their primary care physician. Over 45% wait between 1-2 hours or more. 

And in the It’s About Time Department, Microsoft’s $19 billion purchase of Nuance Communications closed after the UK cleared the acquisition. It was our Really Big Deal of 21 April 2021. Nuance is a cloud and AI-based speech recognition company with well-known brands Dragon and PowerScribe. Becker’s. 

NHS Digital roundup: £200M allocated for research, COVID-19/cancer cross-research using the new Trusted Research Environment (TRE)

March 18, 2022 | by

NHS Digital has awakened with recent news around funding and research using data in the new Trusted Research Environment (TRE).

  • Of the government’s commitment of £260 million for life sciences manufacturing and health research, £200 million will go toward research into diagnostics and treatment. The NHS data will be deployed through Trusted Research Environments (TRE) and digital clinical trial services, with the intent that the data will be made available to researchers faster and more securely. Of the remaining funding of £60 million, it will be distributed through the new Life Sciences Innovative Manufacturing Fund (LSIMF). The committing agencies are the Departments for Business, Energy & Industrial Strategy (BEIS) and Health and Social Care (DHSC). Release
  • The TRE provides approved researchers from trusted organizations with timely and secure access to health and care data. According to NHS Digital’s information page, the TRE is a “secure data platform with the analytical and statistical tools to support researchers in conducting their work. Their findings can then be exported safely, ensuring the formats and analyses are approved and sent to authorised users.”
  • The first new TRE project announced is a cross-research project to discover the impact of COVID on cancer patients and services with DATA-CAN, the UK’s Health Data Research Hub for Cancer, curated by NHS Digital’s National Disease Registration Service. The TRE datasets have de-identified data that is available for analysis without being downloaded, which secures data for analysis and research. NHS release

Thursday news roundup: Walmart hiring 50K workers including health, Anthem name-changing, GE Healthcare-AliveCor partner, IPO for Komodo Health amid slowdown?

March 17, 2022 | by

In the midst of war, inflation, and the contradiction of a tight labor market, it’s somehow reassuring that Walmart needs to hire 50,000 new workers–and fast, by end of April. According to reports, some of those new hires will be bolstering the health and wellness areas. In the past, Walmart has hired heavily in their in-store pharmacies. Many of these jobs are lower-end–delivery drivers for direct-to-fridge InHome groceries, in-store workers, and supply chain staff. One higher-level worker area that points to health is global tech, creating offices in Toronto and Atlanta, with Walmart planning jobs for 5,000 engineers, data scientists, analysts, and tech experts. Additional hires will go to increasing its advertising business which is based in the New York metro area. Especially for those high-skill positions, six weeks is not quite plausible in this market. But you have to admire them for trying. CNBC, Becker’s

Anthem changing its name–again. Health insurer giant Anthem, Inc. has announced a renaming to Elevance Health. According to the release, the name is a combination of elevate and advance, presumably for health but as they say in their release, vaulting beyond healthcare into the rarefied air of ‘whole health’. It also reflects vaulting beyond the health plan business, as they fully savor the rarified air of healthcare diversification like fellow giants UnitedHealth Group, Centene, and CVS Aetna.

The parent company of Anthem Blue Cross Blue Shield plans, Anthem owns non-Blues Amerigroup, Integra Managed Care in NY,  pharmacy benefits manager IngenioRx, plus a $25 million investment in digital health hub Sharecare. Plan and product names, along with organizations will not change at this time–these are major changes that usually require state department of insurance approvals.

To this Editor’s Gimlet Eye, the coined name Elevance feels pharmaceutical and not in a good way–it’s very close to an old anti-depressant, Elavil. A return to WellPoint, a name the company had up to 2014, would have accomplished the same ends. But there’s always the shock of the new, the opportunity to change the tired signage, and behind this, someone making a point for themselves. Undoubtedly the shareholders will agree at the 18 May annual meeting, since they always do, and it will start to be used–presumably with a logo and new graphics they don’t have now–at end of Q2. Another gimlety view–it takes a certain myopia to announce a name change given what’s happening in the world. Healthcare Dive

In time for HIMSS, GE Healthcare and AliveCor, developer of the KardiaMobile ECG, announced their partnership to transmit KardiaMobile 6L data directly into GE Healthcare’s MUSE Cardiac Management System for clinical evaluation. MUSE is used by 87 percent of the top cardiac hospitals in the US. The direct integration of KardiaMobile 6L data that is taken anywhere into the MUSE workflow and then into an EMR, targeting atrial fibrillation but also other cardiac monitoring, is a big validation and win for AliveCor. Release

Analytics software company Komodo Health is preparing an IPO as early as this summer. Goldman Sachs and SVB Securities are rumored to be the lead bookrunners. Timing will depend on markets and financing. Komodo completed last March a $220 million Series E for funding to date of $314 million [TTA 25 Mar 2021]. With a valuation now topping $3 billion, Komodo may be the ‘IT’ company of healthcare IPOs in a market much tamer than last year’s Wild West Rodeo. What they do isn’t easy to explain, but they feed their 325 million patient encounter database drawn from EHR, pharma, lab, and government data into proprietary software to map patient journeys, providing analytics on more than 325 de-identified, real-world patient insights. These are used to drive better health outcomes across therapeutic areas. The primary markets for their data are life sciences and pharma for R&D, clinical trials, and medical affairs, but are seeking to expand to providers and payers.

Other IPOs rumored to be on tap are Included Health (the former Grand Rounds/Doctor on Demand) [TTA 20 Oct 2021] and Tempus Labs in precision medicine.

Weekend short takes, UK edition: Tunstall acquires Germany’s BeWo, AWS UK healthtech accelerator launches, Fidgetbum bed sleep aid gains US patent

March 11, 2022 | by

Tunstall Healthcare has acquired BeWo Unternehmensgruppe (BeWo), a German call center services, social alarm, and device technology and management company, effective 1 March. Terms and management transitions were not disclosed. The BeWo operation, which had previously worked with Tunstall in Germany, will initially be using its call center operations combined with Tunstall Cognitive Care, which uses advanced artificial intelligence (AI) in combination with technology in the home to monitor changes in condition that could be predictive of changes in health. Their information also indicates expansion into social care applications in hospitals and care homes. InsiderMedia, IoTNow, Yorkshire Post

Amazon Web Services (AWS) has named its 12 finalists in its first-ever UK healthtech accelerator. 

  • Dr Julian, a telemental health platform
  • C the Signs, AI for early identification of cancer
  • Infinity Health, a software-as-a-service (SaaS) task management tool for planning and coordinating care
  • Dignio, which connects patients and professionals through a digital platform
  • Sapien Health, a digital clinic to help patients prepare for surgery through sustainable lifestyle changes
  • WYSA for stress management through AI
  • DDM Health using digital therapeutics to improve patient health outcomes
  • PEP Health, which uses AI to help patients share their thoughts in real time
  • Remedy Rx, capturing around 95% of the data that sits outside the healthcare system to link doctors and patients
  • Birdie, a tech platform for home care providers
  • Abtrace, which uses data to detect, monitor, and treat long-term disease
  • Thymia, which analyses speech, video, and behavioral data gathered via video games to assess patients’ mental health conditions

The four-week accelerator programs will help the startups in business models, regulatory pathways, clinical validation, electronic health record integration, specialized AWS training and promotional credits, mentoring from healthcare domain and technical subject matter experts, business development, go-to-market guidance, and investment guidance. The group was selected in partnership with govtech accelerator Public, from a pool of over 100 applicants. ComputerWeekly

The interestingly named Fidgetbum is on the face of it, off our normal healthtech beat. It’s meant to help transition young children from crib to bed and sleep through most of the night through a stretchy wrap-around device that snugly holds the covers in place without restricting the child. The sensory effect is being hugged, without the heaviness and heat generation of a weighted blanket, and has been used successfully with children who have sensory needs, such as autism and epilepsy, or simply feel insecure. Founder Melanie Wood was recently granted a US design patent, which will open up the US market for the company. It’s perhaps this Editor’s recent sleeplessness, but this sounds like a natural cross-promotion with Owlet’s new Dream Sock Plus that fits up to 5 years [TTA 16 Feb]. THIIS

Friday news roundup: CVS filing for metaverse patents; Orbic-Verizon smartwatch debut, Amwell and LG partner for hospital digital health–and what *doesn’t* make for a good partnership

March 11, 2022 | by

What’s a metaverse anyway? It’s a bright, shiny piece of jargon meaning the virtual reality or 3D virtual world. And CVS is rushing right to the US Patent Office to patent its goods and services–including their clinic services and telehealth–in the metaverse. While it’s hard to imagine prescription drugs, healthcare, wellness, beauty and personal care products being wholly virtual, shopping for them can be and obviously CVS doesn’t want to miss out on a world where we’re all wearing 3D headsets and ordering our healthcare in VR and AR. CNBC, USPO filing  

Orbic, a US-India manufacturer popular for being one of the more budget-friendly makers of mobile phones (including flips), tablets, laptops, routers, and accessories, has debuted a smartwatch in partnership with Verizon, the SmartWrist. It has monitoring features such as pulse oxygen levels, body temperature, heart rate, and sleep. It also sets and keeps track of fitness goals and, for those who need it, fall detection, autodial emergency services or contacts in event of emergency, and geofences safe zones. The watch face is 1.78” AMOLED, dock charging, and Android Go 8.1. All for an affordable $199. Our contact Erin Farrell Talbot tells TTA that the SmartWrist is integrated with EHRs plus currently going through FDA approvals that when completed will enable it to be prescribed for patients with medical issues or chronically ill.

Amwell goes into the hospital to connect with LG on TVs and monitoring devices. LG is the leading provider of smart TVs in the hospital market, and where Amwell will initially partner is with Converge, its unified provider-patient platform, inputting information from LG peripheral devices already in or being introduced into acute care. Amwell and LG are also looking beyond the hospital setting into home or sub-acute care. As Healthcare Dive noted, this is not Amwell’s first fling with TV-based care–they demonstrated at last April’s Client Forum a TV-based hospital-to-home integration with Solaborate. LG release (Yahoo)

Sometimes digital health partnerships start at a low level–and auger in from there. Becker’s Hospital Review quizzed three hospital executives, including one from Geisinger Health, an early adopter, on three signs that your digital health partner is not one for the long haul:

  1. It doesn’t have a genuine mission. The mission that hospitals are interested in are about patient outcomes and interest in the hospital partner’s business, not the digital health company’s funding or press.
  2. It hasn’t earned your trust. It seems obvious, but do your due diligence on how the company has handled other partnerships. Red flags include inadequate funding and the terms of the partnership fluctuating.
  3. It lacks responsiveness. This is a big one that this Editor has experienced as both a vendor and buyer. It’s a willingness to listen to and address pain points in “the never-ending troubleshooting” that’s across the board.

As a digital health company, the first is attitude, the second is performance, but #3 is generally the grind point where internal frustrations build and relationships go south.