News roundup: Phreesia’s IPO, Chiptech enters UK telecare market, PatientsLikeMe goes to UHG, Medopad-Tencent UK Parkinson’s pilot, Oxford VR goes to HK, Cigna Singapore’s telehealth intro, HIMSS exiting Cleveland

June 27, 2019 | by

Patient check-in tablet Phreesia is preparing for an IPO, filing of its S-1 form this week. The number of shares and pricing is not yet announced. Phreesia, which specializes in patient intake in the office via a rugged PhreesiaPad tablet and software that integrates with major EHRs such as Epic, Cerner, and Allscripts, has survived not only 14 years, but also in New York City. Phreesia has enjoyed a relatively low profile on the health tech scene, yet it has raised close to $100 million through a Series D (Crunchbase) and maintained much the same founding leadership (Chaim Indig, Evan Roberts, Michael Weintraub). Their business includes 1,600 health firms and 70 million patient intakes annually, for $100 million in revenue in its last fiscal year, up 25 percent from previous. Timing of the IPO is not yet forecast. Mobihealthnews, Business Insider.

Coming to the UK and Europe markets are New Zealand’s Chiptech telecare systems. Chiptech has both traditional in-home and mobile monitored PERS, pill dispensers, and a smartphone-based lone worker alert device. According to their website, they are the leading provider of monitored personal alarms in Australasia. Chiptech also announced a new CEO, veteran David Hammond, whose background includes leadership roles at UTC and Chubb. 

In M&A news, UnitedHealth Group bought the contested PatientsLikeMe, which runs an online service that helps patients find people with similar health conditions. PatientsLikeMe had raised $100 million in 2017, selling a majority stake to Shenzhen-based iCarbonX, backed by Chinese giant Tencent. That investment put the company under scrutiny by CFIUS–Committee on Foreign Investment in the United States. CFIUS is especially looking at Chinese investment in companies that deal with sensitive data, trade secrets, and national security–and coming down hard. Companies like Tencent are working with the Chinese government to amass millions of patient records and data points, with no regard for consent, and to build massive medical databases [TTA 17 Apr].

Tencent has multiple strategic investments in data-driven health companies, including an interesting Parkinson’s clinical trial in the UK with London startup Medopad, which developed an app that tests cognitive abilities across a series of tasks and captures it into what’s dubbed the Markerless Motion Capture and Analysis System (MMCAS). It is being tested on about 40 patients at a private mental health clinic in London called (appropriately) Dementech Neurosciences. Forbes

Mental health is hot, and Oxford VR, a spinout of Oxford University, is pairing with AXA HK and the Chinese University of Hong Kong (CUHK) to develop treatments for common mental health conditions such as social avoidance, anxiety and depressive symptoms. ‘Yes I Can’ uses virtual reality (VR) sessions over three to six weeks. In the true Chinese model (it’s free, but you don’t control where your data goes), it will also be offered to AXA’s corporate customers as part of their employee benefits services to drive better mental health outcomes in Asia. Mobihealthnews

Elsewhere in Asia-Pacific, Cigna Singapore launched a telemedicine service, Cigna Virtual Clinic, where users can access real-time doctor consults via a mobile app. Cigna is using Doctor Anywhere for the service. Telemedicine in Singapore is supervised by the Singapore Ministry of Health’s Licencing and Adaptation Programme (LEAP), “a regulatory sandbox initiative that allows the safe development of new and innovative healthcare models to be piloted in a controlled environment”. Insurance Business Asia

Back in the US, HIMSS is exiting its 30,000 square foot bricks-and-mortar office in downtown Cleveland’s Global Center for Health Innovation (a/k/a the Medical Mart). The exit will be over the next year. This is after a three-year extension of its lease inked in 2018. According to Crain’s Cleveland Business, their sources “described the move as a shift in strategy by the nonprofit that has gone through a leadership change.”

VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk

June 27, 2019 | by

The Department of Veterans Affairs (VA) has been using artificial intelligence and patient data as part of a suicide prevention program for veterans–a top clinical priority for VA. The REACH Vet program, started in 2017, uses predictive algorithms to identify risk factors for suicide in millions of veteran patient records for medications, treatment, traumatic events, overall health, and other information. It then uses the information to determine the top 0.1 percent of veterans at any facility at the highest risk for suicide in the next year. Clinicians then call these veterans for about an hour’s conversation, offering to help them create a mental health care plan.

In its first year (2007-8), the program reached more than 30,000 veterans and identified about 6,700 active VA users a month. According to the short article on findings published by the Suicide Prevention Resource Center in 2018, “veterans who engaged with REACH Vet were less likely to be admitted to an inpatient mental health unit, and more likely to attend mental health and primary care appointments compared to those not in the program. REACH Vet infrastructure includes a coordinator at every VA facility and a national team of clinicians who provide overall program support.”

There are pros and cons to this proactive approach–the pros being a reduction in veteran suicides and evidence of higher suicide risk in the three-to-six months of starting–and ending–an opioid prescription; and the cons being that some of the algorithms may be inaccurate–a veteran could be inaccurately ‘dinged’ for risk or a traumatic involuntary hospitalization. VA is still refining its algorithms in areas such as changes in medication dosage (including opioids) and clinical notes for mention of negative personal issues. POLITICO Health Care

SNF emergency telehealth provider Call9 shuts down most operations, after $34M raise (updated)

June 26, 2019 | by

Is it a symptom of a bubble’s downside? In an interview with CNBC, Dr. Timothy Peck, the CEO of Call9, profiled in TTA only a month ago, confirmed that his company will be shutting down operations. Call9 provided embedded emergency first responders in skilled nursing facilities (SNFs) on call to staff nurses. The first responders not only could provide immediate care to patients with over a dozen diagnostic tools, but also would connect via video to emergency doctors on call. 

Headquartered in Brooklyn, the shuttering of the four-year-old company has laid off over 100 employees as it winds down operations. They claimed 142,000 telemedicine visits and 11,000 patients who were treated via its services. In the past few months, Call9 had inked deals with Lyft for patient transportation and was expanding to Albany NY. They also operated a community paramedicine division utilizing their emergency doctor network.  

This Editor can now reveal that through a reliable industry source, I was informed of Call9’s difficulties earlier this month. Not wanting to ‘run with a rumor’, I contacted Dr. Peck. He confirmed to me information that later appeared in the CNBC article: that the company was refining its model in the face of a change in previous funders and working with some new partners to stay in a model with embedded clinical care specialists in nursing homes. While they would scale back, they still had current contracts. However, the changes in their model would mean that the company would be in a ‘bit of a stealth mode’. After we discussed the business situations that most early-stage health tech companies have faced with funding, we agreed to touch base in a few weeks when things developed.

CNBC, with a different source, had essentially the same information from Dr. Peck on the winding down of the company but in this case also confirmed layoffs, including a ‘pivot’ of the company into a different model around technology in nursing homes. They also confirmed that a part of the company, Call9 Medical, will remain in operations.

Update: Skilled Nursing News had additional detail on Call9’s partnerships which included SNF providers Centers Health Care, CareRite, and the Archdiocese of New York’s long-term care arm, ArchCare. Their first client was Central Island Healthcare, where Dr. Peck lived for three months testing the model. The article goes on with Central Island’s executive director explaining that he is now seeking a telemedicine provider, as they adjusted their services to Call9’s capabilities.

Payer providers included Anthem, Blue Cross Blue Shield, and Healthfirst, plus some Medicare Advantage plans, splitting the savings from avoiding unnecessary ER admissions. Another appeal made by the company for its services was to keep in place higher acuity–sicker–patients in SNFs who would otherwise have to go into the hospital.

As our Readers know, these pages have covered the comings and goings of many health tech and app companies. Some succeed on their own, are acquired/combined with others and go on in different form, or are bought out at their peak, leaving their founders and some employees cheerful indeed. On the other hand, and far more common: the demise of some is understandable, others regrettable, and nearly none of them are cause for celebration in our field–Theranos and Outcome Health being exceptions. This Editor has been a marketing head of two of them (now deceased except for their technology, out there somewhere), and has discussed marketing, funding, and business models with more startups and early-stage companies than she can count.

If anything, investors have less patience than they did back in the Grizzled Pioneer period of the early 2000s, when a $5 million round put together from a few personally (more…)

Best Buy enlarges health tech footprint with Tyto Care expansion, connected fitness products (updated)

June 25, 2019 | by

Best Buy is dramatically increasing its wellness profile with two announcements around digital health. The first is today’s announcement of a further rollout of retailing Tyto Care’s TytoHome device and platform in select Best Buy stores in California, Ohio, North Dakota, and South Dakota. This adds to the previously announced Minnesota locations [TTA 17 Apr] for a total of 30, as well as nationwide via BestBuy.com. In Minnesota, North and South Dakota, Tyto Care connects to Sanford Health doctors 24/7. In California and Ohio, as well as for online sales, Tyto Care partners with LiveHealth Online, part of American Well, except for users in Louisiana and Mississippi who will be covered by Ochsner Health System. Each visit is a maximum of $59, which may be less depending on the patient’s insurance plan or the type of visit. Tyto Care is also offering the plan through LiveHealth Online to select employers. Release.

Tyto Home is a handheld examination device with attachments that can examine the heart, lungs, skin, ears, throat, and abdomen, plus body temperature. The captured information can be sent or examined live by a primary care provider.

Best Buy is also betting that people also will flock to their stores to sample connected fitness, most with virtual classes and coaching. Last week they highlighted five: Flywheel Sports, an indoor cycle with online classes; Hydrow, a rowing machine with virtual classes on real-life bodies of water; NordicTrack, with a line of treadmills, bikes, rowers and strength training machines with virtual classes; NormaTec, a digital compression recovery system; and Hyperice, which produces a range of recovery tools like massagers. The digital fitness market is massive–estimated by Piper Jaffray at around $5 billion today, over double from 2016’s $2.1 billion. Mobihealthnews, CNN Business

This adds to a Best Buy digital health profile that includes the Big Buy of GreatCall last year and Critical Signal Technologies monitoring last month to add senior remote monitoring devices to their portfolio. This is not without pitfalls. Earlier this month, Best Buy was sued for a defect found in its GreatCall Lively MobilePlus mobile PERS that in action failed to detect falls as described, after GreatCall discontinued the device in mid-May in what a letter from their CEO David Inns described as an “important safety recall,” offering buyers a Jitterbug flip phone or a full refund. But Best Buy is hedging its bets on tech with higher price-point connected fitness exercise machines and wearables which will attract higher end buyers into stores and online.

News roundup: The state of Finland’s health tech, American Well-Cisco team for TV consults, Tech for Quality Care in Manchester 9 July

June 20, 2019 | by

Finland shows its sisu in health tech startups. It’s a country you wouldn’t think of readily as hospitable to startups, but they’ve leveraged their tech skills (think the pivots that Nokia has accomplished) to create patient outcome and remote patient monitoring companies that are making an impact in Europe. Some which are making an impact are Meru, Kaiku, and Navigil. Venture capital is ‘thinnish’ which leads to companies seeking seed and development funding from government sources and later on, foreign investors. Mobihealthnews is profiling these companies in conjunction with Business Finland, a government entity. HIMSS and Health 2.0 also had their European conference in Helsinki, and this article discusses how their national health service, Kanta Services, leverages digital health in e-prescribing, they have a national database called the Patient Data Repository that collect patient data records to make them accessible to providers and patients, and the My Kanta patient portal.

Back to the 1990s? Tech device maker Cisco is teaming up with American Well to convert TVs to a video portal via a set-top unit. This is targeted to older adults and those with multiple chronic conditions who may not be comfortable with laptops, tablets, or smartphones, but wouldn’t mind using their TV to connect to a doctor. How it work seems to require a ‘smart TV’–the patient would activate the device on the TV, connect it to Wi-Fi, and initiate the video consult with the doctor and caregiver. No information on timing, markets, or pricing at this time. CNBC. Why does this sound like a klutzy non-starter to this Editor, who went through the fad of interactive TV in the Mad ’90s? It seems to need more than just consults.  Mobihealthnews notes that Quil Health, a Comcast-Independence Blue Cross joint venture, is targeting pre- and post-care support through the TV. Comcast is also rumored to be working on an Alexa-like ambient sensor based device to monitor basic vital signs and fall detection.

Using Technology for Quality Care on 9 July is a free half-day conference/workshop at Kings House Conference Centre, Manchester. It is the first of a series of regional workshops in the North West region to learn from local areas where councils, care providers, and suppliers work together using technology to support care. More information is on this PDF and on the Local Government Association website. Hat tip to Reader Adrian Scaife who just recently joined Alcuris Ltd. as Business Development Manager.

FCC’s $100M Connected Care Pilot Program for rural areas up for July vote

June 20, 2019 | by

Finally, a big boost for rural telehealth comes to the ‘yea or nay’ stage. The Federal Communications Commission’s (FCC) Connected Care Pilot Program, which was approved to proceed last August [TTA 9 Aug 18] with comments on the creation of the program, now moves to the next stage with a formal FCC vote on 10 July on the program itself. The FCC vote was announced by FCC Commissioner Brendan Carr, the co-proposer of the program with Mississippi’s Senator Roger Wicker, during a visit on Tuesday to a rural health clinic in Laurel Fork, Virginia.

The three-year program increases support for telehealth efforts aimed at low-income Americans in underserved regions and who are veterans, to increase their access to health technologies. Providers would be assisted in securing both technology and broadband resources needed to launch remote patient monitoring and telehealth programs. 

Commissioner Carr quoted, in his rural health clinic visit, stats from multiple studies including the VA‘s long experience (since the early 2000s) with remote patient monitoring:

  • A study of 20 remote patient monitoring trials found reductions of 20 percent in all-cause mortality and 15 percent in heart failure-related hospitalizations.
  • A remote patient monitoring initiative (not attributed) reduced ER visits by 46 percent, hospital admissions by 53 percent, and in-patient stay length by 25 percent.
  • The Veterans Health Administration’s remote patient monitoring program had reductions of 25 percent in days of inpatient care and a 19 percent in hospital admissions.
  • In savings, a diabetes trial run by the University of Mississippi Medical Center (UMMC) saved nearly $700,000 annually in hospital readmissions. This extrapolated, based on 20 percent of Mississippi’s diabetic population, that Medicaid would save $189 million per year.

HealthLeaders Media also noted that at the July meeting, the FCC will vote on a notice of proposed rulemaking to seek comment on funding to defray the cost of healthcare providers joining the telehealth initiative and innovative pilot programs aimed at responding to critical health crises including diabetes management and opioids. Also mHealth Intelligence

Comings & goings: The TeleDentists go DTC, gains Reis as CEO; University of Warwick spinoff Augmented Insights debuts (UK); a new CEO leads GrandCare Systems

June 19, 2019 | by

The TeleDentists leap in with a new CEO. A year-old startup, The TeleDentists, has announced it will be going direct-to-consumer with teledentistry consults. This will permit anyone with a dental problem or emergency to consult with a dentist 24/7, schedule a local appointment in 24-48 hours. and even, if required, prescribe a non-narcotic prescription to a local pharmacy. Cost for the DTC service is not yet disclosed. Currently, the Kansas City-based company has provided their dental network services through several telehealth and telemedicine service providers such as Call A Doctor Plus as well as several brick-and-mortar clinic locations.

If dentistry sounds logical for telemedicine, consider that about 2 million people annually in the US use ERs for dental emergencies; 39 percent didn’t visit a dentist last year. Yet teledentistry is just getting started and is unusually underdeveloped, if you except the retail tooth aligners. Several US groups are piloting it to community health and underserved groups, with Philips reportedly considering a trial in Europe (mHealth Intelligence). This Editor notes that on their advisory board is a co-founder of Teladoc.  Release

The TeleDentists’ co-founder, Maria Kunstadter, DDS, last week announced the arrival of a new company CEO, Howard Reis. Mr. Reis started with health tech back in the 1990s with Nynex Science and Technology piloting telemedicine clinical trials at four Boston hospitals, which qualifies him among the most Grizzled Pioneers. He also was business development VP for Teleradiology Specialists and founding partner of The Castleton Group, a LTC telehealth company, and has worked in professional services for Accenture, Telmarc and SAIC/Bellcore. Most recently, he started teleradiology/telehealth firm HealthePractices. Over the past few years, Mr. Reis has also been prominent in the NY metro digital health scene. Congratulations and much success!  

In the UK, the University of Warwick has unveiled a spinoff, Augmented Insights Ltd. AI will be concentrating on machine learning and AI services that analyze long term health and care data, automating the extraction in real time of personalized, predictive and preventative insights from ongoing patient data. It will be headed by Dr. James Amor, whom this Editor met last summer in NYC. Long term plans center on marketing their analytics services to tech providers. Interested parties or potential users may contact Dr. Amor in Leamington Spa at James@augmentedinsights.co.uk |Congratulations to Dr. Amor and his team! 

And in more Grizzled Pioneer news, there’s a new CEO at GrandCare Systems who’s been engaged with the company since nearly their start in 1993 and in its present form in 2005. Laura Mitchell takes the helm as CEO after various positions there including Chief Marketing Officer and several years leading her own healthcare and marketing consulting firm. Nick Mitchell rejoins as chief technology officer and lead software developer. Founders Charlie Hillman remain as an advisor and Gaytha Traynor as COO. Their offices have also moved to the Kreilkamp Building, 215 N Main Street, Suite 130, in downtown West Bend Wisconsin. GrandCare remains a ‘family affair’ as this profile notes. Congratulations–again!

Best Buy buys Critical Signal Technologies, increasing telehealth footprint

June 13, 2019 | by | 3 Comments

Late last month, Best Buy with little fanfare bought Critical Signal Technologies (CST) of Novi, Michigan. CST is a device-agnostic telehealth monitoring and social work services platform through its Care Center, covering services such as PERS monitoring, medication management, and remote patient monitoring. Terms were not disclosed for this private company founded in 2006, but CST cares for 100,000 patients and has partnerships with 1,500 payers, including many Medicare Advantage plans. 

For those seeking the sunnier uplands of digital health, it’s surprising but gratifying to see Best Buy place another sizable bet in the home health area. The recent acquisition of GreatCall for $800 million is larger, but GreatCall is a turnkey, profitable company. The partnership with Tyto Care [TTA 17 April] to retail their system is relatively low risk, limited in scope, and follows their Midwest intro pattern (followed over 12 years ago with, believe it or not, QuietCare when owned by Living Independently).

Best Buy has gained kudos for moving into specialty areas in healthcare when its fellow retailers have been falling by the wayside. It covers both their bricks-and-mortar–where older adults still like to shop–and online, delivering a large slice of health tech directly to consumers. One asset, the tech-oriented Geek Squad, is a ready made unit for installing and walking older adults through using home tech. MedCityNews, MarketWatch

CVS-Aetna merger will run off the tracks in Federal court: reports

June 13, 2019 | by

Reports emerging this past Monday after the close of last week’s DC Federal District Court hearings in indicate that the CVS-Aetna merger may be nixed by Judge Richard Leon. This may result in the full unwinding of the already-closed merger, a derailing of the settlement which involved selling the Aetna Medicare Part D business to government-plan insurer WellCare, or something in between.

The original report was in Monday’s New York Post. A source working with CVS and Aetna stated “I think Leon rules against us. If he rejects the settlement, we would have to figure out the next steps.” That settlement is significant because it represents the only major overlap between the CVS and Aetna businesses. In other words, there’s nothing left to divest or concede.

Judge Leon, based on reports, was consistently irritated with the Department of Justice, questioning everything from the Part D divestiture to the effects of adding 21 million Aetna customers to CVS’s pharmacy benefits management (PBM) business not being revealed in DOJ documents to him. Conversely, the sale of the Part D business to WellCare was batted one way–as not enough to reduce CVS’ market control and not competitive–and then the other, as WellCare remains a CVS PBM customer for 2.2 million members in its health plans. What was also clear from his selection of expert witnesses that Judge Leon was more interested in the anti-competitive effects of the merger than any of the benefits.

It is obvious both from Judge Leon’s in-court actions (such as not permitting DOJ attorneys to cross-examine any witnesses), assorted remarks, and delay for now over six months, that this merger is coming to a pre-ordained conclusion, at least by this judge. This is already a first under the Tunney Act enacted in 1974. A negative decision will certainly be appealed by CVS-Aetna and DOJ, which will drag out any finalization even if successful–and the sale of the Part D business, important to WellCare as part of its own pending acquisition by Centene–to the end of the year and possibly beyond.

With this background and oral arguments delayed until 17 July, according to Judge Leon, the legal teams on all sides won’t have much of a summer.  Also Barrons, video on NBR.

Digital health: why is it a luxury good in a world crying for health as a commodity?

June 5, 2019 | by

Why digital health still struggles to find its stride. Those of us in the healthcare field, especially Grizzled Pioneers, have been wondering for the past decade why Digital Health’s Year is always Next Year. Or Next Decade. 

Looking back only to 2000, we’ve had 9-11, a dot-com bust, a few years in between when the economy thrived and the seed money started to pollinate young companies, a prolonged recession that killed off many, and now finally a few good economic years where money has flooded into the sector, to good companies and those walking the fine line of mismanagement or fraud. We’ve seen the rise/fall/rise of sensors, wearables, and remote monitoring, giants like Google and Microsoft out and back in, the establishment of EHRs, acceptance by government and private payers, quite a bit of integration, and more. All one has to look is at the investment trends breaking all records, with funding rounds of over $10 million raising barely a notice–enough to raise fears of a bubble. Then there’s another rising tide–that of cyberattack, ransomware, insider and outsider hacking.

Is it this year? It may not be. Despite the sunshine, interoperability holds it all back. Those giant EHRs–Cerner, Epic, Athenahealth, Allscripts–are largely walled gardens and so customized by provider application that they barely are able to talk to their like systems. There are regional health exchanges such as New York’s SHIN-NY, Maryland’s CRISP, and others, but they are limited in scope to their states. The VA’s VistA, the granddaddy of the integrated system, died of old age in its garden. Paul Markovich, CEO of Blue Shield of California cites the lack of interoperability and being able to access their personal health data as a major barrier to both patients and to the large companies who want to advance AI and need the data for modeling. (China and its companies, as we’ve noted, neatly solve this problem by force. [TTA 17 Apr]) Apple is back in with Health Records, but Mr. Markovich estimates it may take 10 years to gather the volume of data it needs to establish AI modeling. Some wags demand that Apple buy Epic, as if Epic was up for sale. BSC, like others, is testing interoperability workarounds like Notable, Ooda Health, and Manifest MedEx. Mr. Markovich cites interoperability and scaling as reasons why healthcare is expensive. CNBC

And what about those thriving startups? Hold on. During the Google Cloud/Rock Health 3 June event, one of the panelists–from Partners HealthCare, which works both side of the street with Pivot Labs–noted that hospitals have figured out their own revenue models, and co-development with hospitals is key. Even if validated, not every tech is commercially ready or lowers cost. And employers are far worse than hospitals at buying in because they ultimately look at financial value, even if initially they adopt for other reasons. In addition, the bar moved higher. The new validation standard is now provider-centric–workload, provider satisfaction, and implementation metrics, because meeting clinical outcomes is a given. Mobihealthnews

And still another barrier–data breaches and cyberattack–is still with us, and growing. Quest Diagnostics’ data breach affects nearly 12 million patients. It was traced to an individual at a vendor, American Medical Collection Agency, and it involved Optum360, a Quest contractor and part of healthcare giant Optum. The unauthorized person had access to the network for eight months – between 1 August 2018, and 30 March 2019–and involved both financial and some health records. Quest now is in the #2 slot behind the massive 79 million person Anthem breach, which, based on a Federal grand jury indictment in Indianapolis in May, was executed by a Chinese group in 2015 using spearfishing and backdoors that gathered data and sent it to China. There were three other US businesses in the indictment which are not identified. Securing health data is expensive — and another limitation on the cost-lowering effects of interoperability. Healthcare IT News

Digital Health’s Year, for now, will remain Next Year–and digital health for now will remain fractional, unable to do much to commoditize healthcare or lower major costs.

The CVS-Aetna hearing is on the move–finally

June 5, 2019 | by

The train that is the CVS-Aetna hearing, in the courtroom presided over by Judge Richard Leon of the US District Court for the District of Columbia, is at long last chugging down the tracks. And Pauline is still tied up. Tuesday 4 June was Day 1 of this hearing. Early reports are just being filed. The issue is whether Judge Leon will authorize the Department of Justice’s approval of the merger or dissolve a closed merger, based on his authority under the Tunney Act and his own repeated intent to search for harm that the merger might do to the public. 

Today’s hearing focused on Aetna’s divestiture of its Medicare Part D business as a prelude to the merger, and whether it was quite enough. Much of the discussion was on the relative strength of the buyer, WellCare (itself in the early stages of being acquired), and whether it could be truly competitive in the Part D market. The other factor is that CVS as a dominant pharmacy benefits manager (PBM) could undermine WellCare in several ways. PBMs operate opaquely and are highly concentrated, with CVS, Optum (UnitedHealthcare), and Cigna-Express Scripts accounting for 70 percent of the market. Modern Healthcare

Other issues for Days 2 and 3 will cover the effects on competition in health insurance, retail pharmacy and specialty pharmacy.

Healthcare Dive discusses how these hearings are already setting precedent on how Tunney Act hearings are conducted, their scope (Judge Leon has ruled against every attempt by CVS-Aetna to limit it), and the unprecedented live testimony.  There is the good possibility that Judge Leon will decide to dissolve the merger for competitive reasons, which DOJ likely would appeal. Add to this the cost of the delayed integration and the precedent set by the District Court on scrutiny of any healthcare merger, and this tedious hearing along with Judge Leon’s actions leading to it hold major consequences.

IBM gives sensor-based in-home behavioral tracking a self-driving car ‘spin’ in the UK with Cera Care

May 30, 2019 | by

In-home behavioral tracking of older adults, which was a significant portion of telecare circa 2007 up until a few years ago, may be getting a new lease on life. The technology in this round is the same as what guides self-driving vehicles–LiDAR or Light Detection and Ranging, which uses laser light pulses to map images of movement and surroundings. 

In this model, IBM Research will use the LiDAR information and their machine learning to establish normal patterns and also to observe behaviors that may indicate a potentially dangerous condition or situation. The LiDAR pilot will be in 10-15 households in the UK starting in June. IBM is partnering with early-stage UK home care company Cera Care on the reporting and linking with care staff on alerts on changes in behavior that may predict a more acute condition. 

Many of the privacy issues that dogged predictive behavioral telemonitoring via networked infrared motion sensors, as well as in-home cameras, are present with LiDAR monitoring. Unlike 2007, five states have ‘nanny cam’ laws that prohibit cameras within skilled nursing facilities without patient consent (Senior Housing News) Another issue: expense. LiDAR sensor setups cost up to $1,000 each, and at least one per room is needed. Far cheaper setups are available from the Editor’s long-ago former company, QuietCare, if one can still purchase them for the home from Care Innovations; Alarm.com, UK’s Hive Link, and Google may get into the act with their Nest connected home tech.

Senior housing may open up a new market for LiDAR, which is wilting in the autonomous vehicle (AV) area as it’s proven to be rather buggy on real roads with real drivers. Certainly the housing and care market is growing and destined to be huge, with over-60s growing from 900 million in 2015 to 2 billion worldwide in 2050, while for-hire caregivers are shrinking by the millions.  Business Insider, Reuters

Call9 and an ’embedded’ approach to emergency response in nursing homes

May 29, 2019 | by

Back in March, this Editor noted the substantial $34 million raise over the past three years by Call9. The Brooklyn-based company has pioneered an innovative approach filling a non-glamorous but badly needed gap in care–providing in-facility emergency care in SNFs and rehab facilities. Embedded in-facility first responders summoned by SNF nurses provide immediate care at a higher level than nursing home staff, married to telehealth capability that connects to remotely located emergency medicine doctors via a video cart and diagnostics.  The goal is to provide care immediately, avoid unnecessary and potentially harmful ER/ED admissions (estimated at 19 percent of ambulance transports), and generally keep SNF patients healthier while on site.

The numbers are there. Call9 reported in their studies a 50 percent reduction in ER admissions and a savings of $8M per year for a 200-bed nursing facility. Even if these numbers are high, a reduction is welcome news to SNFs, payors, Medicare, and one would think nursing home patients and families. Hospital readmissions within 30 days are also a CMS quality measure important to SNFs–the lower the better.

The Hunter College Center for Health Technology in their blog reported that one Call9 feature is special training for staff at their in-house Call9 Academy in the unique emergency care demands present in a SNF. These were initally learned first hand by the founder, Dr. Timothy Peck, who lived three months in a Long Island SNF’s conference room in order to better understand staff and patient needs.

It not only saves money, but fills other gaps in care and social determinants of health. Part of the Academy training covers the gap in palliative care with residents, and can facilitate Medical Orders for Life-Sustaining Treatment (MOLST) preparation with families. Last year, Call9 partnered with Lyft to provide transportation for family members of nursing home residents who have had a change in condition. Other partnerships serve the needs of community paramedicine services to connect with telehealth services as part of CMS’ ET3 model. The company currently covers over 3,700 beds in New York State, recently expanding to Albany, its third city.

A similar company, Third Eye Health, based in Chicago, covers about 15,000 beds but is a ‘lighter’ system that concentrates on remote care without the embedded staff and purely tablet based remote consults initiated by staff nurses. Both indicate through their growth and funding a surge in realization that both improved care and major savings to healthcare can be realized here.

Global news roundup: Italy’s digital health summer school, GSK Impact Awards, Propel@YH for Yorkshire & Humber digital health, Aging 2.0 engages seniors

May 23, 2019 | by

Smart Homes for Healthy Ageing, 24-27th June 2019, Artimino, Florence (Italy) might be just the thing as an learning adjunct to enhance your summer holiday. The four-day conference concentrates on supporting people living with dementia (PLwD). It is designed for early career researchers and delegates who are focusing on the research and development of smart homes and health services for PLwD. Registration deadline is 31 May. 2.5 ECTS equivalency and conducted in English. See the attached PDF for session information and the website for more detail on the conference. Hat tip to Cristiano Paggetti of the Medea Project via Editor Steve.

The King’s Fund, which is having its Digital Health and Care Congress as your Editor is writing this, announced on 16 May the outcome of one of its projects: the GSK IMPACT Awards to ten charities which have improved health and wellbeing. Each company receives a £30,000 donation, two places on a free training and development program, and an invitation to join the GSK IMPACT Awards Development Network with free meetings and events. The overall winner, Suffolk Carers, as the lead receives a bonus £10,000 to use in its work supporting unpaid carers of all ages across Suffolk. The other awardees are: The Children’s Sleep Charity,East Surrey Domestic Abuse Services,Grassroots Suicide Prevention, Healthy Minds, Off the Record Youth Counselling Croydon, Positive Life, Rape Crisis South London, Refugee and Migrant Centre Black Country and Birmingham, and Support in Mind Scotland. Nine runner-ups received a £3,000 donation. Congratulations to all!

Yorkshire & Humber AHSN (Academic Health Science Network) announced their first-ever digital health accelerator, Propel@ YH, at the ‘Transforming Lives Through Innovation’ Annual Conference 9 May in Leeds. It targets building a relevant business case for the NHS. The six finalists are DigiBete, Healthcare Engineering, HeteroGenius, Medicsen, Medicspot and Scaled Insights. The Leeds-based program is in partnership with mHabitat, an NHS-owned specialist and expert in the application of digital to health and care.

And closer to home, Aging 2.0 Atlanta and Kansas City are conducting a free webinar on Driving Senior Engagement with Education & Socialization on 30 May, 11am-12.30pm ET. From their notice, “Social isolation, loneliness, lack of engagement, a shrinking world and a diminished sense of purpose are all issues effecting (sic) seniors today.” Presenters are Lynne Beachner of Senior Learning Network and Amber Carroll of COVIA Well Connected.  More information here. Registration direct link. 

Bayer 2019 G4A Partnerships now open for applications through 31 May

May 23, 2019 | by

Alex Fair of Medstartr has alerted us to Bayer’s G4A Partnerships for their accelerator to develop and scale breakthrough solutions anchored in behavioral science. The program now covers 35 countries to collaborate with startups and healthcare technology companies that are developing innovative solutions in health and care.

Health areas include Cardiovascular, Digital Therapeutics, Global Health, Oncology, Ophthalmology, Pulmonology, Radiology and Women’s Health.

G4A has two tracks for companies based on development stage: 

Growth Track: for companies in the pre-product launch stage. Ideal candidates are seed-stage startups with a Minimal Viable Product validated through acquisition of patents and in publications. Funding is €50-100K to partner + co-create products and solutions with Bayer, plus co-working space in Berlin.

Advance Track: a mature company with a product in the market. Companies will be working jointly with Bayer experts to drive a commercial partnership, co-funded by G4A. There’s a €50-100K initial investment followed by incremental milestone-based payments.

Since 2013, G4A has supported over 150 digital health companies, resulting in 30 direct collaborations, the most recent award being in January: KinAptic (US), Agamon (Israel/UK), and Cyclica (Canada). To apply, see the Partnership page and click on Apply Now. Finalists will be notified in August for the formal announcement in Berlin in early October. But you have to move quickly. as it closes 31 May!

Tyto Care telehealth integrates with Epic EHR MyChart patient app

May 22, 2019 | by

Tyto Care announced today the addition of their remote diagnostic device and app to Epic’s app marketplace, AppOrchard. The addition enables health organizations to adopt the Tyto Care app and offer TytoHome service to their care providers and patients. The data is integrated into Epic’s MyChart patient portal, delivering patient exam data to Epic EHRs used by providers.

The remote visit can work two ways.

  • Launched from within MyChart, the patient can initiate a live or scheduled telehealth visit
  • From Epic’s HyperSpace desktop app, a care provider can remotely join a telehealth visit with the patient.

During the visit, the provider can control the TytoCare device to capture temperature readings, skin images, heart and lung auscultations, and recordings of the throat and ears for a remote diagnosis.

Sanford Health, a health system in the Midwest and West, is one current Tyto Care user which also uses Epic as their EHR. Meghan Goldammer, a senior vice president and chief clinical officer at Sanford Health, commented that “Epic has been our electronic patient record standard of care for years and now we have adopted Tyto Care. The integration will allow for a coordinated patient experience and give our providers the information they need to deliver great care.”

Based in Netanya, Israel and New York City, Tyto Care’s ‘all-in-one’ device incorporates a camera, stethoscope, otoscope, tongue depressor, basal thermometer, and smartphone app for an extensive video exam which can be integrated with an EHR or other telehealth systems. It includes visit scheduling capability, a cloud-based data repository with analytics, and built-in user guidance with machine learning algorithms for accurate use. Tyto Care is now retailed at Best Buy in select markets [TTA 17 April]. Tyto Care release