Short takes: Walgreens now majority share of VillageMD, CareCentrix; Lark Health lifts $100M, UnitedHealth Group’s profitable Q3 and Change delay

October 14, 2021 | by

Walgreens has ‘gone big’ with its VillageMD primary care practice investment, putting on the table $5.2 billion. It’s now t the majority owner with 63% of the company, up from 30% last year. Their projected number of co-located full-service Village Medical practices is projected to grow to 600 by 2025, up from a current 52. VillageMD is still planning an IPO in 2022, making for a potential great ROI for Walgreens. Walgreens Boots Alliance also invested $330 million in CareCentrix, a post-acute and home care provider, for 55% of the company. CareCentrix was a recent investor in Vesta Healthcare [TTA 9 April]. Wrapping it all up is their new Walgreens Health, for tech-enabled consumer-directed primary care, post-acute care, and home care.

Weight loss and chronic conditions app Lark Health flew into a $100 million Series D, led by Deerfield Management Company, with PFM Health Sciences and returning investors Franklin Templeton, King River Capital, Castlepeak, IPD, Olive Tree Capital, and Marvell Technology co-founder Weili Dai. Their total funding since 2011 is over $195 million (Crunchbase). Lark claims an AI-based platform for individual coaching in weight loss along with related conditions such as diabetes, pre-diabetes, diabetes prevention, cardiovascular, and behavioral health. The platform logs and provides immediate feedback on food and tracks data from sources like Apple Health. The new funds will be used for R&D and to expand its virtual care integrations to more payers. Current payer partnerships include Anthem, Highmark BCBS, and Medical Mutual. Release, MedCityNews, FierceHealthcare

UnitedHealth Group, parent of UnitedHealthcare and Optum, reported $4.1 billion in profit for Q3, notching $72.3 billion in revenue for the quarter, a tidy gain over year prior’s $65.1 billion. The mega-acquisition of Change Healthcare to fold into OptumInsight is further delayed, being worked towards a closing of early 2022, having hit more than a few strong regulatory headwinds and the rocks of DOJ [TTA 14 Aug].  Becker’s Payer Issues, FierceHealthcare 

What’s next for telehealth? Is it time for a correction?

October 14, 2021 | by

crystal-ballThe boom may be over, between shrinking visit volume and a pileup of providers. Is a correction in the cards? The flood of funding that started in 2020 and has not abated was kicked off by the pandemic and a massive shift to telehealth visits in March/April 2020 from a barely-above-plant-life number in January/February.

Post-pandemic, the shift corrected.

  • The peak of 69% of visits tracked by Epic in April had tailed off to 21% as early as May 2020 [TTA 2 Sept 20].
  • National commercial claims data via FAIR Health was lower. They tracked its peak also in April 2020 at 13%, falling continuously monthly: May to 8.69%, 6.85% in June, 6% in August, and 5.61% in October [TTA 9 Jan].
  • By mid-year 2021, the claims numbers continued to lose altitude: June 4.5%, July 4.2% (FAIR Health monthly report).

Despite the numbers, telehealth companies raised $4.2 billion of a total $15 billion in digital health funding in the first half of 2021, according to Mercom Capital Group, a global communications and research firm. So…what’s the problem with les bon temps rouler?

CB Insights notes the increased specialization of new entrants and, as this Editor has noted previously, the blending and crossing of business lines.

  • Companies like Heal, Dispatch Health, and Amazon Care will send a clinician to your house for a checkup–no running to your urgent care.
  • Kidney disease? Monogram Health. Musculoskeletal pain? Hinge Health. Child with an earache or fever? Tyto Care. Check symptoms first? Babylon Health.
  • Telemental health has gone from cocktail party repellent to the belle of the ball, concentrating on cognitive remote therapies. For the past year, it moved to more than half of all telehealth claims, with currently over 60% of procedure codes–and it’s consolidating. AbleTo was bought by Optum, Ginger bought by Headspace, SilverCloud by Amwell.

So for the Major League–Teladoc, Amwell, Doctor on Demand, Grand Rounds, and MDLive–what does this mean? If this interview with Teladoc’s CIO is an example, they plan to segue to a ‘hybrid’ model of virtual quick response plus integrating providers into a continuing care model with patients, creating a relationship with history and familiarity. A model that’s very much dependent on IT, analytics, and connecting with willing providers. But in this free-floating sea of verbiage, it didn’t come into misty focus till the very end, when he mentions Primary360 [TTA 7 Oct] and a virtual primary care team. (And let’s not forget Babylon360 along similar lines.) He finally sketches a view of all the connections to conditions coming together on a very far horizon. 

One can say it’s a cloudy crystal ball, indeed. FierceHealthcare, HealthcareITNews (Teladoc CIO interview)

News and deal roundup: Babylon’s $200M raise, Best Buy buys Current Health, Virgin Pulse-Welltok, Devoted Health’s $1bn raise, Withings watch gains FDA ECG clearance

October 13, 2021 | by

Babylon Health adds $200 million to the accounts–in advance of its SPAC. Babylon’s raise of $200 million (€173M) in a ‘sustainability-linked investment’ came from the strategic capital investment firm, Albacore Capital Group. With the SPAC and PIPE, Babylon will now have access to over $800 million in capital [TTA 7 Oct]. Whew! Mobilhealthnews, Babylon release 

A score for Edinburgh. Current Health, a biosensor-based monitoring and home care management/remote patient monitoring system based in Edinburgh and Boston, sold itself to US retailer Best Buy. The company recently raised $43 million in an April Series B, which makes its quick sale somewhat unusual. Terms were not disclosed other than it was a cash deal and that Current’s CEO Christopher McCann will be remaining with the company. Best Buy extends its reach into digital home health, following on their 2019 buys of GreatCall, Critical Signal Technologies for RPM, and partnership with Tyto Care.

Current had achieved FDA Class II clearance in early 2019 [TTA 7 Feb 2019], had piloted with Mount Sinai Brooklyn and in the UK, Dartford and Gravesham NHS Trust for a post-discharge monitoring program, and recently had created a “Community” initiative to build diverse longitudinal datasets for decentralized clinical trials [TTA 18 Feb]. Current Health announcement, Best Buy release, Mobihealthnews, Healthcare Dive

The wellness app-employee/health plan engagement program area continues to consolidate with Virgin Pulse’s acquisition of Welltok. In recent years, Welltok has concentrated more on data analytics and predictive capabilities in its member experience and patient acquisition/retention platforms for health plans and systems, after a start in employee wellness programs. Virgin Pulse, which exited the Richard Branson universe (despite the logo) when sold to Morgan Equity Partners in 2018, is now backed by Marlin Equity Partners. Terms and leadership were not disclosed. Virgin Pulse release, HISTalk

‘Insurtech’ Devoted Health raised a hefty $1.15 billion Series D led by Uprising and Softbank Vision Fund 2, along with a long list of returning and new investors. Icing on the cake is that they are closing in on an additional $80 million in funding to accommodate an investor. Devoted is led by former athenahealth and government IT leaders Ed and Todd Park. It’s one of the smaller in footprint tech-based Medicare Advantage providers but combines their plans with health coverage via Devoted Medical, a telehealth and in-home care provider, and partner providers. FierceHealthcare

The ECG monitoring space is now a little more crowded. Withings finally received FDA clearance for their ScanWatch’s ECG and SpO2 monitoring, nearly two years after its introduction in January 2020. It received clearance in Europe a year ago. The cleared features are atrial fibrillation detection alerts, which advises users to take a 30-second ECG readings, and SpO2 blood oxygen monitoring for detection of respiratory issues. Withings joins the Apple Watch, Fitbit, Samsung, and the grandaddy of them all, AliveCor’s KardiaMobile, for ECG monitoring–but packs this monitoring into a good-looking watch. Mobihealthnews

Theranos, The Trial of Elizabeth Holmes, ch. 3: Safeway, Walgreens execs testify to deception, frustration with Holmes, failed pilots and labs (updated)

October 13, 2021 | by

It’s Tuesday, and it’s another court day in Silicon Valley’s Big Trial, this time with the former C-level executives of Safeway and Walgreens who did the partner deals with Theranos–and rued the days Elizabeth Holmes walked in their doors. Updated for additional Tuesday testimony reports.

Former Safeway (supermarket) CEO Steve Burd returned to the stand for more prosecution questions and a turn with the defense. Mr. Burd had formed Safeway Health to introduce Theranos in 2010, after Ms. Holmes personally negotiated a deal with Safeway without attorneys. Ms. Holmes definitely wove a spell on Mr. Burd. “There are very few people I had met in the business that I would actually say are charismatic. She was charismatic, she was very smart, and she was doing one of the hardest things you can do in a business, and that’s to create an enterprise from scratch.” Always decisive, ‘she owned the room’.

From that point, and after an unusually high 100 hours of due diligence (updated, ArsTechnica 13 Oct), it was full speed ahead. But the potholes turned up fast after Ms. Holmes had convinced Safeway to invest in the company, claiming that they could run 95% of tests on one cartridge and that they could handle the volume from hundreds of store testing sites. During a pitch to the Safeway board, board member Michael Shannon offered his blood draw for a PSA test, the screening test for prostate cancer. The Theranos Edison machine “made a bunch of noise,” but never delivered a result, even after Ms. Holmes said something about getting it later (updated, ArsTechnica 13 Oct).

By the time the pilot started with regular blood draws, from the testimony, “there were results that didn’t make any sense. Samples were lost and samples were not properly cooled. He also said tests took days to come back when other companies could deliver in 24 hours. In an email to Holmes, Burd wrote: “I am genuinely concerned that Safeway’s lab reputation gets worse by the day.” By 2012, Safeway had built out 98% of 960 planned stores to hold Theranos testing sites, but had long since blown past the $30 million estimate. Multiple launch dates were missed over two years. By November 12, Mr. Burd had reached the end of his tether. “I can only recall having been discouraged once in the last 62 years. That said, I am getting close to my second event. ” and “This does not feel like a partnership, I’ve never been more frustrated.”

Theranos never rolled out to the public with Safeway. Mr. Burd retired from Safeway after a long career in May 2013.

Apparently the defense cross conducted by Kevin Downey is concentrating on The Big Chance that Safeway took with Theranos, after all a ‘startup’ that never built out their technology for consumer use, and all the regulatory hurdles the company faced. Mr. Burd confirmed it but he and the board reviewed the agreement and included requirements such as a CLIA waiver to operate the lab devices, negotiating preferred network status with commercial health plans, and a network of partners. Most of all, Safeway negotiated the right to terminate the agreement if the pilot failed and Theranos did not obtain FDA clearance. On the redirect, the government maintains that Theranos started in 2003 and purported to be making money (!!).

Up next for the prosecution was Wade Miquelon, former CFO of Walgreens. Walgreens was the only Theranos partner to put Theranos centers in their store. He testified to the presentation he received in 2010 which was similar to those received by investors. It included claims that Theranos’ technology could “run comprehensive blood tests” from a finger stick in real time and that it had partnerships with major pharmaceutical companies and military organizations–some of which were semi-true, the rest fictional. Apparently, some of the validation reports from pharmaceutical companies were false–while they had logos, there was one from Schering-Plough where its name was misspelled and never noticed by anyone at Walgreens. The prosecution had already established to the jury in opening arguments on 8 September that the Pfizer report endorsing the technology had also been faked. It had been written by Theranos, with a Pfizer logo added. 

Mr. Miquelon testified that he was never told that third-party labs were being used.“My understanding is, the blood would be tested on the [Theranos] Edison device,” adding later, “My understanding was that the base level testing would be able to do 96 percent of the testing done at labs.” He stated that third-party testing would be to check calibrations and accuracy. Relying on such testing would be beside the point of cost and time savings. 

Mr. Miquelon’s testimony will continue on Wednesday.

KTVU2’s coverage is nearly all tweets so it’s assembling a picture from many fragments. Ars Technica on Mr. Burd.  Updated: Additional information on Mr. Miquelon: Fortune, Washington Post

Walgreens sued Theranos in 2016 for $160 million invested [TTA 9 Nov 2016]. The company was one of the few able to claw back substantial funds, a paltry $25 million, in August 2017. Safeway settled in June 2017 for an undisclosed amount. They had built out 800 centers and cost the company $360 million before the agreement was axed (updated for cost, ArsTechnica 13 Oct).

If you have access to the WSJ, their coverage details a trail of forged documents, massive fundraising–and losses, and partner deception. The NY Times ran an interesting ‘color’ article on the atmosphere in the San Jose courtroom. The trial is settling into a groove. Two court artists (complete with art) have interesting impressions of Ms. Holmes and the participants. The spectators appear to be primarily retirees with the time to line up for the 34 seats in the courtroom and 50 in an overflow room, though the testimony goes over the head of many. Ms. Holmes’ family and partner accompany her daily. And two jurors have departed, one a Buddhist who became uncomfortable with the idea of punishing Ms. Holmes. Judge Davila has already extended trial hours one hour to get through the stack of witnesses a little faster.

Our previous coverage: Chapter 1, Chapter 2

To be continued….

Telehealth’s primary care wars heat up: Teladoc’s Primary360, Babylon 360

October 7, 2021 | by

The new fronts in the Telehealth Wars continue to expand, with this week Teladoc announcing that their virtual primary care offering, Primary360, is now available for health plans, employers, and other payers. Babylon Health, in its push into the US market and their upcoming SPAC, also announced that their similar program, Babylon 360, is also being offered to health plans.

Both these services connect the patient users with an assigned doctor and primary care team for ongoing care. They emphasize building a relationship with a doctor and team, not just a random selection previously typical of telehealth. Both Teladoc and Babylon are fully virtual in exams and checkups, sending equipment where needed, ordering lab tests and prescriptions, and accepting your prior health records, plus have 24/7 coverage for urgent situations. Babylon’s service also offers a symptom checker and connection to social determinants of health (SDOH) community services.

It’s obvious that the payer-provider walls are coming down in all directions–telehealth is one more. Babylon, as we noted earlier, acquired two California-based practice groups. Payers like lower-cost, more convenient visits, and after a fractious start, have for some time. Many of the insurtechs either have close relationships with providers or have bought practices (Bright Health’s NeueHealth)–copying the Optums which have affiliations with or ownership of practices all over the US. It’s also another pressure on primary care practices around reimbursement. Often the answer is to either sell out or enter into value-based care arrangements.

For the patient/member, there’s the benefit of convenient care, and a relationship with a team, albeit not with an in-person option right now–if these services are consistent in their promise and steady in their physician/clinician groups. Mobihealthnews (Teladoc)

Babylon Health’s SPAC closing later this month at $4.2 billion value, buys California medical practices

October 7, 2021 | by

Ali Parsa, CEO of Babylon Health, confirmed to FierceHealthcare yesterday that Babylon Health will be going public later this month via a SPAC. This is proceeding as closed in June with blank-check Alkuri Global Acquisition Corp., led by former Groupon CEO Rich Williams [TTA 1 June].

The pro-forma equity valuation is estimated as $4.2 billion, with Alkuri providing $575 million in gross proceeds to Babylon, including $230 million in a private placement from investors such as AMF Pensionsförsäkring and Palantir Technologies. The new Babylon Holdings Limited will be listed on the New York Stock Exchange under the ticker symbol BBLN.

After developing its GP in Hand triage service with the NHS starting in 2017, now claiming 102, 000 users, it has weathered controversies from clinical commissioning group (CCG) reservations to gender bias in its chatbot (‘Heart Sister’ Carolyn Thomas) to a litany from @DrMurphy11 to the BBC Two’s Newsnight treatment [TTA 9 Jan 20, 27 Feb 20]. However, Mr. Parsa believes that their value proposition (technically, a written document) is sound and that they are now poised for growth.

Newly developed products include Babylon 360, a digital-first value-based care service that includes the option for telehealth visits, and Babylon Cloud Services, a suite of digital self-care tools for patients and doctors, including an AI-enabled symptom checker. Expansion has been as far flung as Rwanda and the US, although in the crowded US telehealth market, Babylon has found it difficult to make a strong  impression versus Teladoc and Amwell, though they cover three million lives and has licensed providers in all 50 states.  They recently bought two California-based medical practices, Meritage Medical Network and First Choice Medical Group, opening an office in Palo Alto. Babylon also optioned to buy Higi health kiosks after a $30 million investment [TTA 30 May 20], which may close after the SPAC. Still, Mr. Parsa is staking the future on the US, where over 40% of global healthcare money is spent. 

Babylon has been growing 400% year to year for a few years with $79 million in 2020 unaudited revenue, a 394% year-over-year increase, and a projected $321 million in 2021, $710 million by 2022, and $1.4 billion by 2023. Hampering this sunny picture are Babylon’s continued losses: $76 million first half of 2021, less than their PY net loss of $91 million. 

Theranos, The Trial of Elizabeth Holmes, ch. 2: the lab director’s contradictions, competence questioned

October 6, 2021 | by

The grilling of former Theranos lab director Adam Rosendorff continued Tuesday, with the defense hammering Dr. Rosendorff about his activities there prior to his departure in August 2014, catching him on contradictions in his testimony, painting him as self-serving and, through his actions there and with later companies, essentially incompetent.

Lance Wade, the defense attorney handling today’s redirect, returned to Dr. Rosendorff’s testimony about the lower-than-normal HDL levels recorded by the Edison lab machine. Earlier, he had testified about his major issue with it, urging Ms. Holmes and COO Sunny Balwani to discontinue the test but got “pushback”. Using a long trail of emails, Mr. Wade continued what’s proving to be a theme at this trial–that the government is showing only limited information to witnesses and the jury, that Holmes and Balwani addressed problems, and that Dr. Rosendorff often used his own judgment to resolve problems without discussion with Holmes or Balwani. Dr. Rosendorff admitted, contradicting his earlier testimony, that Balwani and others “jumped” on the HDL readings right away, and that the real problem was with a Siemens machine.

Mr. Wade also got Rosendorff to admit that in a civil case, he testified that complaints about Theranos “weren’t more common than what usually sees in … some labs with high volume” and, even more specifically, that “I don’t think I had a greater number of tests that were anomalous that I had to review at Theranos than at other places I’ve been like University of Pittsburgh.”

Dr. Rosendorff, according to reports, kept commenting on his earlier testimony to reinforce that decisions made at Theranos were ‘not good solutions’, no matter what he believed or how he acted at the time. Mr. Wade tried to have these comments struck from the record, but Judge Davila ruled that both should move on.

Finally, Mr. Wade brought up as confirmation of Dr. Rosendorff’s incompetence his subsequent employment and termination at now out of business uBiome, charged with health fraud (but not fraudulent lab tests) but was not permitted to go beyond basic statements. He was permitted to ask about Dr. Rosendorff’s current employer, PerkinElmer, which has also violated CMS (Centers for Medicare & Medicaid Services) regulations by the same inspectors who audited Theranos, and which may cause the loss of his license for two years. NBCBayArea, CNBC, Ars Technica

(Editor’s note: unfortunately the Mercury News, Bloomberg, and WSJ coverage are heavily paywalled after one or two views. The WSJ focused on text messages between Holmes and Balwani, and the Mercury News added color coverage of Holmes’ lifestyle with Balwani and vegan diet.)

To be continued…

Theranos, The Trial of Elizabeth Holmes: ch. 1

October 1, 2021 | by

“The company believed more about PR and fundraising than about patient care”, from Tuesday’s testimony by former lab director Adam Rosendorff, could be the prosecution’s strategy in the proverbial nutshell. Mr. Rosendorff, who quit in November 2014 after a long struggle to get Ms. Holmes and Theranos management to address persistent problems in patient lab results and to implement a legally required verification process, was a witness for the prosecution. The defense tried to paint his testimony in cross-examination as inconsistent and self-serving in accounts of Ms. Holmes’ state in hearing concerns about three particular blood tests, the launch date of public blood tests, proficiency tests versus ‘precision tests’, when the California Department of Public Health audited the lab, and exactly why he quit Theranos 18 months after hire. The questioning twice grew so heated that District Circuit Court Judge Edward Davila deemed it inappropriately argumentative. One example from Lance Wade to Mr. Rosendorff was that supervising quality control tests and making sure laws were followed was “why you get the big bucks, right?” “Not as big bucks as you get paid,” Mr. Rosendorff replied. Mr. Rosendorff did get caught up in an email trail and on narrowing the proficiency testing to FDA-approved devices versus the Edison labs. The cross and the bickering went on into Friday and probably will resume on Tuesday next week (@doratki).

Also on Tuesday was brief testimony from Celgene manager Victoria Sung, who drew a picture of more Theranos fabrications around how pharmaceutical companies (Celgene owned by Bristol Myers-Squibb) had not  “comprehensively validated” Theranos technology. 2012 results showed that Theranos labs performed “out of range” versus standard tests, and other tests were not run. Last week, Theranos employee Surekha Gangakhedkar in her testimony stated that she did not think GSK’s report validated Theranos’ tests. Mercury News, The Verge

Today, John Carreyrou, who broke la scandale Theranos in The Wall Street Journal and authored the book Bad Blood, filed a motion to stop being barred from court. Cleverly, La Holmes’ defense put him on the witness list but not subpoenaed him. Being on the witness list, however, means he cannot attend any part of the trial or publicly discuss his testimony, if given, without permission from Judge Davila. “Placing Carreyrou on the witness list was done in bad faith and was designed to harass him,” the motion claimed, calling his placement on the list “a cynical ruse” that violates the First Amendment. Also cited in the motion were the company chant about him and various text messages between Ms. Holmes and Sunny Balwani. Mercury News  Mr. Carreyrou and six years before the Theranos mast, interviewed in The Verge in an interview that diverges fascinatingly into the psychiatric drives of the players….

And earlier in September (Wednesday 22nd), General James Mattis, Ret. testified about how he initially wanted to pilot the Theranos labs on ships and remote locations, where space and swiftness are at a premium. The Verge article does take liberties in the psychology between the two (bachelor general, young female CEO), including his joining the board after retirement, sticking around despite his growing doubts until he was named secretary of defense in 2016. The defense drew out that he was confused about his compensation package ($150,000 per year plus a stock option purchase).

The Mercury News (which has a minimum of free articles before the paywall goes up, the WSJ (paywalled), local TV KRON4, The Verge, and CNBC have been covering the past weeks of the trial. Dorothy Atkins of @Law360 is also tweeting in real time on it (@doratki).

To be continued….

Walgreens may acquire Evolent Health: report

October 1, 2021 | by

Walgreens in another ‘go big or go home’ move. Bloomberg reported yesterday that Walgreens Boots Alliance is considering an acquisition of Evolent Health, a Washington DC-based healthcare management and administrative services company. It’s another move that indicates that their growth plans continue to be in technology-based services, provider services, and diversifying away from brick-and-mortar pharmacy. 

An acquisition of Evolent would add to Walgreens a suite of management services around total cost of care for payers and providers through Evolent Care Services (administrative, operations), provider management services in value-based care models such as ACOs through Evolent Care Partners, and specialty care management for oncology and cardiology through New Century Health. Notably, Walgreens would grow ever closer to primary care providers through Evolent Care Partners, a 1,000 provider, six-state ACO network covering 90,000 lives. 

Last week, Walgreens bolstered its pharmacy operations through a majority investment of $970 million in specialty pharmacy company Shields Health Solutions, also a fit with the proposed Evolent acquisition with their specialty care management area.

Should this go through, it further differentiates Walgreens from rival CVS Aetna as a services provider.

Evolent is a public company trading on the NYSE with a current valuation of $2.71 billion, so it won’t come cheaply. Reuters

Mental health apps Headspace, Ginger to merge into $3B Headspace Health

August 27, 2021 | by

Two acquisition prospects, Headspace and Ginger, decided to beat the heat and merge. The two companies, currently headquartered in Santa Monica and San Francisco, will combine into Headspace Health. From the context of the release, the Ginger brand will be sunsetting. The merger is expected to close in Q4 subject to the usual regulatory and financial approvals. Financial terms were not disclosed. The combined company claims a valuation of $3 billion.

Leadership will combine from both companies. Russell Glass, Ginger’s present CEO, will be CEO of Headspace Health. CeCe Morken will remain CEO of Headspace and take on the additional role of President for the combined entity. 

Digital mental health continues to be hot in a hot August. Headspace, which started as a mindfulness and meditation app in 2010, then sidled into behavioral coaching to mitigate stress and aid in sleep, to date raised $216 million through a Series C (Crunchbase). Ginger, a cognitive therapy service with both self-guided coaching and psychiatric video consults, was founded in 2011 and raised $220 million through a Series E. Headspace has a direct to consumer focus with business partnerships with Google, Roche, and employers, while Ginger has developed into a benefit for payers like Cigna and Amerihealth Caritas. The combined company claims it will cover 100 million lives direct-to-consumer and through its more than 2,700 employers and health plan partners.

It is obvious from the management setup and the overpadded release (sorry, but it’s true!) that the lead company in this is Headspace. Can an IPO be far away? Release, Healthcare Dive

Another Google termination: Google Streams clinical support app used by NHS

August 27, 2021 | by

Now that Google Health has been scattered within the Google Puzzle Palace like so many marbles, it should come as no surprise that its Deep Mind-created clinician support app, Streams, is being ‘decommissioned’. The terminology, used for military ships and basis, is quite odd. Termination, or terming, would be more accurate.

The users were concentrated in the UK: University College London NHS Trust, Imperial College Healthcare NHS Trust, Taunton & Somerset, and London’s Royal Free. But all contracts had expired with the exception of the Royal Free. It’s still active there and no definite date has been published for the service’s end.

Deep Mind, Google’s AI skunk works until it was also smushed into Google, started up the Streams app with the Royal Free in 2016 or 2017 and announced plans to integrate AI into it which never came to fruition. The predictive modeling came from the NHS. In the midst of five-year contracts with various Trusts, Streams was handed off in 2018 to Google Health, requiring 1) new contracts because Google was now handling patient data, and 2) dealing with the security and NHS restrictions. Still, the Trusts sustained the app till earlier this year, except for Royal Free’s continuance.

What they will do now that Streams is heading off to Google’s Box of Forgotten Toys? Well, they could adopt Care Studio, currently piloted with Ascension and Beth Israel Deaconess Medical Center (BIDMC). Care Studio also came in for some bad publicity in 2019 when Care Studio’s predecessor, Project Nightingale, piloted at Ascension, accessed 10 million identified patient records without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names, and dates of birth [TTA 9 April].

Google has become a perfect example of how Big Tech stumbles and misunderstands healthcare, whether in the UK or in the US [TTA 24 Aug]. Dropping it like another Google experiment, Google+, just doesn’t cut it. TechCrunch

Amazon’s Chime telehealth solution rang Beth Israel Deaconess Medical Center’s bells–case study

August 25, 2021 | by

A short case study that shows what Big Tech–and attuned clinical IT people–can do under pressure. Beth Israel Deaconess Medical Center (BIDMC), a Harvard Medical School affiliate, had at the start of the Covid pandemic limited and multiple telehealth systems for 1,400 physicians. They quickly adopted systems such as SnapMD, Google Meet, Zoom, Doximity, and Doxy.me. They were not interoperable nor did they interface well with their EHR. While this was going on and in parallel, BIDMC’s tech team developed and deployed a new integrated telehealth system using Amazon Chime on the existing AWS platform. This integrated video conferencing into workflows with telehealth tools such as multiple participants, security, EHR integration, live translation, and chat equipped with Google Translate. Despite this, BIDMC physicians at the virtual peak of 66% in March-April 2020 were still conducting 73% of visits telephonically. By June 2021, video visits as a percentage of total telehealth were 50% in June, with 65% of the video visits done on the new platform. HealthcareITNews.

Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package.

August 24, 2021 | by

With Google scattering Google Health to the four winds of the organization--the heck with what employees recruited for Health think of being reorg’d to, say, Maps or YouTube and falling through the corporate rabbit hole–more detail has leaked of Apple’s struggles. This time, on the scaleback list (a/k/a chopping block) is Health Habit. It’s an app in the Apple Store that connects users with AC Wellness, a doctor’s group in Cupertino, California. The ‘eligible participants’ are restricted to Apple employees. From the app site, they can check weight, nutrition, blood pressure, and schedule wellness checks. It seems to be the typical ‘skunk works’ project that’s not ready for prime time, but its public fate seems to be poorly timed and simultaneously, overblown because they are–well–Apple. 

Bottom line, is healthcare once again proving rather resistant to being leveraged by technological solutions? Those of us who go back to the Stone Age of health tech, or those of us who joined in the Iron and Bronze Ages, remember when you couldn’t get into a conference cocktail party without a “wellness” app. (You say you’re in behavioral and remote patient monitoring for older adults? Oh, look! A squirrel!)

Microsoft was going to dominate consumer health with their HealthVault for personal health records (PHRs). We know how that turned out–dead apps, Fitbit an also-ran bought, Pebble and Misfit going to the drawer of failed toys, Jawbone t-boning plus Intel and Basis written off in 2017, and HealthVault unlamentedly put out with the trash at the end of 2019. Oh yes, there was an earlier Google Health for PHRs, which died with a whimper back in 2012 or so.

The press releases crow about Big Tech’s mastery of complexity, yet going off on their own without partners–or even with partners–never seems to work. In the industry, it makes for a few good articles and the usual rocket launching at places like Forbes, but the pros tend to treat it with a shrug and pull out a competitive plan. Glen Tullman, founder of Livongo who will never have to worry about paying for chateaubriand for two for the next billion years or so, stated the obvious when he said that patients cared about the overall experience, not the tech.

Speaking of experience, Amazon Care promises the best for its employees and enterprise accounts–a one-minute telehealth connection, a mobile clinician if needed within the hour, and drugs at the door in two hours. All with direct pay. This has met with skepticism from telehealth giants like Teladoc and Amwell with established corporate bases. There’s also CVS Health and Walgreens. The Editor has opined that care isn’t Amazon’s game at all–it’s accumulating and owning national healthcare data on Amazon Care and Pharmacy users that is far more valuable than whatever is spent on providing care and services [TTA 16 June]. Will Amazon really be able to pull it off?

Paddy Padmanabhan, the author of Healthcare Digital Transformation, lists a few more reasons It’s Too Hard For Big Tech In Healthcare in his HealthcareITNews article here….

  • Healthcare is a part-time job for Big Tech
  • Big tech firms want to solve the healthcare problem by themselves
  • Selling technology is not the same as selling healthcare services

…but holds out some hope that the initial success of “digital-first and virtual-first providers of healthcare emerging as challengers” will point the way for them.

And speaking of Google Health and former employees, Cerner’s necessary SEC disclosure today of new CEO and president David Feinberg, MD’s compensation package was sure to create some talk in Googleville among his now-scattered team. $34.5 million over the next 15 months is structured as follows:

  • $900,000 base salary
  • a target cash bonus of $1.35 million
  • a one-time cash bonus of $375,000 stock
  • $13.5 million in Cerner’s restricted shares for 2022
  • $3.375 million in stock shares for the fourth quarter of 2021
  • a new hire award of $15 million in restricted stock shares to offset his equity loss with Google. 

Whew! Becker’s HealthIT

Breaking: Google Health shutting down, most employees scattered to other divisions (updated)

August 21, 2021 | by

Breaking  Google Health is disbanding, according to an ‘insider’ report in the (paywalled) Business Insider, reported secondarily in Becker’s Health IT and in specialized websites such as Apple Insider. This comes on the heels of the departure of Google Health head and Google VP David Feinberg MD after two years on 1 Sept. He will become CEO and president of Cerner starting 1 October. Healthcare IT News, Healthcare Dive

Reports about the internal memo sent to Google employees from what Apple Insider calls “Google research whiff” (?) Jeff Dean indicates that the teams working on various health projects will be split up to other areas. For instance, Google Health’s clinical group including the EHR tool team will now report to Dean. Based on 2020 numbers, 500 employees will be affected. 

Google Health’s track record since its founding in 2018 hasn’t been superlative, despite the prestigious name and bankroll. They bought a failing Fitbit for $2.1 billion closing only in January, after a bouncy romance starting in 2019  with more than the usual share of controversy, with scrutiny from DOJ to EU regulators. Becker’s reports that Google’s CMO, Karen DeSalvo, MD, leader of clinical initiatives, will now report to the chief legal officer. The AI team on medical imaging will report to Google’s search and AI team. The memo also noted relocation of staff to Search, Maps, and YouTube. 

(updated) In June, Google Health reorganized to shed its consumer focus and focus more on clinical applications such as its controversial Care Studio and health AI, including projects moved from sister company Verily. Even losing 130 or so employees to other areas of the company from a unit high of 700, this apparently was not enough to justify its separate existence. TTA 18 June, FierceHealthcare 

Healthcare ain’t beanbag, as they say in New York, and even Apple with its Watch and innumerable apps has found it rough going. Reports this week stated that Apple is scaling back a specific health team that was focused on an internal health app.

For Dr. Feinberg, former CEO of integrated health regional Geisinger and CEO at UCLA Health, the Cerner position is ‘top of the world’. He is being hired as Cerner’s third CEO in 42 years and will be combining both the CEO and president positions which previously were separately held. He reportedly has been hired to be a strategic CEO, which is a change for the company reflecting its directional change to be a software-as-a-service (SaaS) business rivaling Amazon Web Services, marking a transition away from legacy EHRs. Cerner has had some significant challenges, with the VA implementation sidelined until sometime in 2022, and quite a few executive changes, with the current CEO and chairman departing immediately after three years without an expected transitional period, and a new chairman coming from the board of directors.

As for Google, Dr. Feinberg might agree with “amar99”, one of the commenters on Apple Insider, who said in part: “Great, now can Google please leave Google?”

Deal and news roundup: Humana closes $5.7B Kindred at Home buy, Unite Us SDOH buys Carrot Health for data, Carrot Fertility raises $75M, Maven Clinic at $1B value, Privia partners with Babyscripts for moms, Tyto Care and Prisma Health

August 20, 2021 | by

Home care continues to rock with the third move in two weeks. Payer giant Humana closed its acquisition of home care giant Kindred at Home, completing the acquisition of the approximately 60% Humana did not already own for $5.7 billion. Kindred provides home health, hospice, and personal care services to over 550,000 patients annually, making it the largest US home health company. Humana will integrate Kindred into their Home Solutions business, sunsetting the Kindred name for CenterWell Home Health starting in 2022. CenterWell is payer-agnostic, which is a fancy way of saying that they sell to other payers. An interesting nugget in the release is that Home Solutions has an interim president, Greg Sheff. FierceHealthcare

While planned since earlier this year, the shakeup in the sleepy home health segment in usually dozy August has been substantial, and at premium prices. Honor’s acquired Home Instead [TTA 14 Aug] with a valuation of $2.1 billion and the Sharecare conglomerate bought CareLinx for $65 million [TTA 19 Aug].  

In another hot area, social determinants of health (SDOH), NYC-based care coordination platform Unite Us acquired Carrot Health for an undisclosed sum. Carrot Health is a consumer data and health data set that powers over 500 proprietary predictive models. Carrot’s team will be absorbed into the Unite Us current structure. Both products will be sold together and separately as Unite Us positions the company as the only national company to integrate health and social care. Back in March, Unite Us closed a $150 million Series C. This follows on the Wellsky acquisition of SDOH provider Healthify earlier this month to bolster its community care platform [TTA 4 Aug]. Release, FierceHealthcare, Mobihealthnews

Women’s and family health gaining popularity and funding. Another Carrot, Carrot Fertility, raised a $75 million Series C funding, led by the deep-pocketed Tiger Global Management. Their current funding totals $115 million. Carrot Fertility, based in San Francisco, provides fertility benefits for generous companies like Peloton, Box, Slack, and Eventbrite in more than 55 countries. FierceHealthcare

And while we are on women’s health, Maven Clinic, a women and family health-oriented digital health provider, reached unicorn ($1 billion) valuation status with a $110 million Series D fund raise led by a female partner at Lux Capital with backing from Oprah Winfrey. Maven pitches itself to employers and health plans as a virtual clinic for women’s and family health, offering care and support for fertility, pregnancy, and parenting. This Editor looks forward to the day where specialized women’s and family health services are part of routine care, and news about a provider wouldn’t need this type of spin to get noticed. (It’s like US car companies in the 1950s bringing in women designers to make cars that appealed especially to women. Buick and Jordan figured that out in the 1920s.)  FierceHealthcare, TechCrunch, plus a loquacious blog post from founder Kate Ryder

And speaking of babies, Privia Health, one of the larger management services organizations (MSOs) for physician practices, is partnering with virtual maternity care Babyscripts for pregnancy and post-partum care. The Babyscripts services will be integrated into Privia’s Women’s Health provider group. DC-based Babyscripts is small with only about $20 million in funding through Series B (Crunchbase) but addresses the big problems of maternal and post-pregnancy mother and baby care, including maternal deaths. Privia providers will be able to access Babyscripts’ remote patient monitoring for mental health, hypertension, preeclampsia. and gestational diabetes, as well as apps for educational content.  Mobihealthnews

Diagnostic monitor Tyto Care is partnering with Prisma Health, the largest healthcare system in South Carolina, for remote diagnostics and treatment during video consults. Their physician network will be equipped to provide their patients and Prisma employees with convenient, secure, and clinic-quality diagnostics using the Tyto Care kit during telehealth visits. Release, Mobihealthnews

Sharecare expands health education capabilities, acquires CareLinx home care for $65M (updated)

August 19, 2021 | by

Sharecare, a free/paid app platform that enables users to consolidate and manage all their health and wellness data, is adding to its health management platform additional tools for patient engagement, including more health education. These four will be available on the Sharecare platform in Q4 this year, based on their release:

  • “All Together Better” social aggregator – a dynamic, curated collection of social media content containing relevant conversations, influencers, and news.
  • Condition-specific chatbot – this lets users explore their condition-specific questions through a range of questions and topics related to their health concerns
  • Condition-specific virtual assistant – a virtual assistant to help navigate questions, answers, and resources
  • Interactive data visualization and mapping – this new mobile- and web-based experience takes users on a highly interactive data-driven health education journey with animated graphics and national- to community-level maps.

Interestingly, both care management and health education are converging in services such as Emmi Wolters Kluwer, Milliman HealthIO, and even apps such as Wellframe which have added biometric alerts and RPM. Release, Mobihealthnews

Last week, Sharecare had its own ‘shake’ of the home care market with the acquisition of CareLinx, a home care provider with a network of 450,000 caregivers. The CareLinx platform facilitates care team management and delivery of a wide variety of home support services. Sharecare acquired it from Europ Assistance for $65 million–$54.6 million in cash and $10.4 million in Sharecare common stock. Another shakeup of the otherwise sleepy home care market, in size smaller than the Honor-Home Instead deal that also took place last week. Release

Earlier this year [TTA 18 Feb], Sharecare went the SPAC route with Falcon Capital Acquisition Corp., trading on NASDAQ under SHCR as of 2 July. Sharecare received $571 million in gross proceeds and is reported to have a valuation of $3.9 billion. Management is staying in place. Release, Capital 

Speaking of aggregation, in the past two years, Sharecare has become an aggregator, or perhaps a conglomerate, of multiple digital health companies that operate separately or are integrated within the company. Their recent purchases include two AI platforms–doc.ai.in capturing data; WhiteHatAI, which is now Sharecare Payment Integrity; MindSciences (DrJud.com) in behavioral health and smoking cessation; and value-based care gap closer Visualize Health into their provider dashboard.