Tender Alert: Oxfordshire County Council, Housing & Care 21 Birmingham

December 18, 2017 | by

Our Tender Watcher, Susanne Woodman, has two more before we break for the holiday season–which may make your 2018 brighter!

  • Oxfordshire County Council: This is for a comprehensive telecare service for call monitoring of telecare alarms, a 24/7 emergency response service for telecare alarms, plus the installation, assessment and review of telecare and associated equipment. The Service Provider(s) will work closely with the Equipment Service Provider. This starts in April 2018 for five years with option to extend for two; value not correctly posted (£1?). Closing 15 January 2018. Gov.UK 
  • Housing and Care 21: This is an open future opportunity for providers to indicate interest in providing a new warden call supplier to maintain the existing stock of warden call products across the estate. The contract will be for one to five years with funding of £500k per year. This includes bridging equipment from analogue to digital. The approach to market date is 9 April 2018 with a start date of 1 July. More information at Gov.UK.

The ‘health kiosk’ idea is alive and kicking from New York to France

December 15, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Kiosk1.jpg” thumb_width=”200″ /][Photo: NYP] The $40 million+ failure of HealthSpot Station last year [TTA 14 June 16] might have signaled the demise of the health kiosk (telemedicine + multiple vital measurement devices) concept. Basic stations with consumer engagement/mobile tie-ins such as Higi have been gaining traction at retail locations [TTA 30 Mar] such as RiteAid (which bought the assets and IP of HealthSpot) and Publix supermarkets. CVS MinuteClinics in northeast Ohio and Florida have allied over the past two years with Cleveland Clinic and American Well to integrate records and telemedicine. But the kiosk model is gaining a second life with these recent iterations.

  • NewYork-Presbyterian, Walgreens (Duane Reade) and American Well: Kiosks located in private rooms at select Duane Reade drugstores (left above) connect to NYP OnDemand using American Well telemedicine and Weill Cornell Medicine emergency medicine physicians. In addition to the live consult, the patient can send select vital signs information to the doctor using a forehead thermometer, a blood pressure cuff, a pulse oximeter, and a dermascope for a high-resolution view of skin conditions. Pediatric emergency physicians are available through NYP OnDemand weekdays between 6 – 9pm. Prescriptions are e-prescribed to the patient’s preferred pharmacy. The first kiosk opened this week at 40 Wall Street with additional locations to open in 2018. NYP OnDemand telemedicine consults are also available to NY area residents through the Walgreens website. American Well release, Healthcare IT News, MedCityNews
  • H4D (Health for Development): French doctor Franck Baudino wanted to reach those who live in what the French term ‘health deserts’ in their rural areas. Over the past nine years, he developed a booth-type kiosk connecting to a live doctor and with vitals instrumentation. The Consult Station is fully equipped with a wide range of vitals instrumentation, including vision, audio, eye, and blood glucose, functioning almost as a remote doctor’s office. In France, to gain access, all users need do is pop in their carte vitale. Reportedly the kiosks can treat 90 percent of common illnesses. Prescriptions are printed out in the booth. Consult Stations are now in France, Italy, Portugal, Philippines, Canada, Belgium, UAE and were recently cleared by FDA as a Class II device. ZDNet  

Tender/PIN Alert: NHS North of England, Highlands & Islands Enterprise NHS Market Ready

December 15, 2017 | by

Susanne Woodman, our Eye on Tenders, is still scanning the skies for opportunities. Here are two important ones:

  • NHS North of England (NOE): The Commercial Procurement Collaborative (CPC) is seeking to appoint providers to a framework agreement for the provision of a range of healthcare consultancy services for use by the NHS and other eligible bodies. The new framework starts 1 March, extending for four years with a value of £10m. The agreement has six Lots with different requirements and awards will be to six providers per Lot. Documents can be requested until 19 January 2018. Tender information is located at the CPC page–detailed information can be seen by clicking on the ‘View New Contract Notice’ button. 
  • Highlands and Islands Enterprise (HIE)-NHS Market Ready: HIE leads the Northern Innovation Hub (NIH). The relevant part for healthcare technology is NHS Market Ready, to benefit small and emerging businesses and social enterprises which want to present, test and trial products and services and secure commercial opportunities with the NHS. This is a PIN so applicants can obtain descriptive documents and demonstrate interest at Public Contracts Scotland–click on the tabs. Also Scottish Business News Network on  the NIH’s £16 million initiative for businesses in the Highland Council Area

A basket of reflections, considerations on CVS-Aetna: Epic, Cerner, the model, and hospitals’ role

December 14, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]With the holidays and the end of the year coming in a little over two short weeks, there’s plenty of room for thoughts, reasoned speculation, and some unusual takes on the CVS-Aetna merger. This Editor remains in her belief that among us, there’s a bit of exhaustion and an attitude of ‘wait and see’ around the topic among us. The canaries have a case of the vapors….

Let’s sort through some of the more interesting POVs expressed of late by our fellow pressies, which Readers can consider in between cups of good cheer and bites of All That Food. Bear in mind that this merger has a long road to go on a hard road, with potholes marked DOJ and (in this Editor’s opinion) HHS, before it’s a done deal in 2018.

  • A big win for Epic. Currently the EHR for CVS’ MinuteClinics and most recently the care management programs of CVS Specialty, Epic is bullish on the opportunities in what their VP of population health termed the ‘gray space’ in the patient experience outside of the traditional sites of care. In October, CVS added Epic’s Healthy Planet population health analytics platform to learn more about drug dispensing patterns and medication adherence–this Editor believes in preparation for merger talks. The open question this Editor has after all the glow in this article is how Aetna’s varied systems (e.g. ActiveHealth, Medicity, and others) would integrate into Epic, and the price of poker, because with Epic it’s never free. Ask any hospital. Healthcare IT News.
    • Certainly, their main competitor Cerner is feeling the heat after a slowdown in its VA plans, the single largest EHR implementation ever. Congress has held up initial funding making the contract effective (Washington Technology). It is geometrically more complicated than their simultaneous DoD implementation, with $10 billion estimated over 10 years (FCW). Other wrenches in the works: a fresh CliniComp lawsuit against Cerner based on infringement against their 2003 patent on remote hosting, and their appeal of the no-bid award to Cerner [TTA 23 Aug] against VA. Kansas City Business Journal, Healthcare IT News
  • Is it going to increase cost? It might. And what about info sharing with providers? A Harvard Medical School professor opined to Marketplace that instead of self-treatment at home for a cold, the patient might actually traipse to a MinuteClinic for care, thus driving up healthcare costs. This resembles the RAND logic around telemedicine consult expense we deflated in a series of articles back in the spring. Information sharing with regular providers is a bigger issue which urgent cares, telemedicine, and clinics already are dealing with. The paradox is that integration with a payer, with a retailer’s ability to track ancillary purchases such as OTC meds and DME purchases, might actually help that issue. But will it? Will a combined CVS-Aetna share information or hoard it, further disempowering patients? This Stat article calls on Mark Bertolini to promote shared information, engagement, and accountability to balance the scales.
  • Do we really need hospitals? If they don’t change, we might need a lot less of them except for highly specialized treatment. And this is likely a good thing. The HBR points out that CVS-Aetna is hardly the only threat to the traditional hospital–there’s Johns Hopkins’ Hospital at Home program for older adults, UnitedHealthcare’s growing network of providers under OptumCare, including the recent deal for DaVita dialysis centers, and free-standing, low-cost “neighborhood” hospitals, almost like pop-up stores. The article doesn’t mention ‘consult stations’ like Europe’s H4D, which is proving that the kiosk idea isn’t dead. 

The reality is that we won’t know what this merger entails until it actually happens, if it happens–and its final shape will take years to mold. Related: CVS-Aetna: the canary says that DOJ likely to review merger, Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?, CVS’ bid for Aetna–will it happen, and kick off a trend? (what will Amazon and other retailers, including supermarkets, do?)

Tender Alert: NHS England, London South Bank, Univ. of Leeds, NHS Digital, Halifax, Healthy New Towns

December 12, 2017 | by

We have a specially wrapped and large present from Susanne Woodman, our Eye on Tenders. Some are high value, all have short deadlines, so read up!

  • NHS England: This is through the NHS South, Central and West Commissioning Support Unit and is for a Dynamic Purchasing System (DPS) for the procurement of online consultation systems. It is for a little over two years starting January 2018 and valued at £45 million. Closing is 29 December. Details at Gov.UK.
  • London South Bank University: This is for a Summative Assessment (Evaluation) of Simulation for Digital Health (SimDH). This would result in three reports to delivered electronically to be reviewed by the project team (LSBU) and project funders (GLA & ERDF). This is deadlined on Thursday 14 December, but an inquiry on this might invite further dialogue. Value is £13k. Gov.UK
  • University of Leeds: This is for an app specification and design, to engage participants in clinical trials, to thank and build relationships with these 600,000+ people in the UK. Again, an early close of 20 December, valued at £100k – £500k. Gov.UK
  • NHS Digital: The De-identification Project will implement a strategic approach to de-identifying data flowing into or out of NHS Digital or requiring linkage with NHS Digital data. Status is ‘open early engagement’ which means they are judging interest from potential suppliers. Another early closing of 18 December. Gov.UK
  • Borough of Calderdale, Halifax: Seeking provision of a community alarm and mobile response service; comprising of a community alarm – call monitoring centre, mobile response, and the installation of various pieces of assistive technology, carbon monoxide detectors and smoke detectors. The contract is for 36 months with extension up to 24 months. Value excluding VAT: £2,250, 000. Deadline is 10 January 2018. TED
  • NHS England–Healthy New Towns: This program is to support a vision of healthcare in a Healthy New Town. Responses should include: rationale for system transformation, key challenges and priorities for the healthcare sector, barriers to implementation and overcoming them, and the role of the Healthy New Towns programme in NHS England’s Five Year Forward View and Business Plan. This NHS England link may not work, so see attached PDF for requirements (thanks Susanne!). Deadline is 19 January 2018. Here’s more on it: 

    • As set out in the Specification of Requirements, the desired outcomes of the Healthy New Towns programme and the guidance are that: (A) Neighbourhoods, town and cities built in England after 2019 have:
      • populations with reduced levels of preventable disease;
      • communities with improved health and wellbeing; and
      • health and social care provision that is more effective and better for users
      (B) The guidance that this commission helps deliver has played a major role in achieving the above, because:
      • the guide and the process of developing it have built momentum and support; and
      • the guide collates good practice and shares it in a compelling, highly useable way.

      In a context of pressure on the NHS caused by preventable disease and changing demographics, how, in your role as New Care Models support partner for the Healthy New Towns programme, will you help us achieve these outcomes?

Babylon Health: correcting our NW London CCG report; objects to concerns raised by CQC report (latest updates)

December 11, 2017 | by

Correcting and commenting on our earlier report. This Editor had earlier published on 11 Dec, as follow up to the extensive coverage on Babylon Health’s ‘GP at hand’ pilot activity in London, summarizing a report in Digital Health stating that the North West London Collaboration of Clinical Commissioning Groups (CCG) ended plans for expanding a test of the Babylon video consult/symptom checker app for GP practices in that area and that the app could be ‘manipulated’ to secure GP appointments faster and would not reduce demands on GPs. The original article was first corrected at an NHS England‘s representative’s request to reinforce that this was a local CCG project and that NHS England was not involved. The second request we received last Friday was from Babylon Health’s PR representative, Giles Kenningham, principal at Trafalgar Strategy. It was certainly strong and quoted here, edited as indicated to remove the link to the original article and Mr. Kenningham’s signature:

Your recent article on Babylon is factually wrong and misleading (link removed):
You claim the babylon app was dropped after being manipulated by patients. The term ‘manipualtion’ has been removed from the board papers and is wrong. Similarly the planned pilot had never begun so there so nothing to roll out.
This story is based on incorrect board papers which have now been corrected.

Please find a spokesman quote below. (closing signature removed)

A spokesperson for Babylon said:

“No pilot was ever carried out, nor any agreement signed with Babylon for such a pilot.

“Discussions were held after Babylon was selected in a competitive procurement exercise as the best technology to trial in GP practices across North West London. Subsequently, a decision was taken not to fund the pilot.”

This Editor then checked on the Digital Health article and found it had been removed without any follow-up or correction. Thus on Friday 8 Dec, this Editor removed the article, thanked Mr. Kenningham for bringing it to attention, and added that our report cited Digital Health as the source. I also requested a reference or third-party confirmation of his corrections. (This last request was not received as of the time of this writing.)

Wanting to get to the bottom of this for our Readers–and as a marketer who’s corrected more than a few inaccurate reports, your Editor has located the CCG’s report which is here published 22 November. It corresponds with Mr. Kenningham’s full note. The CCG report appears to have been revised (the URL indicates a v3), there never was a Babylon pilot, this version does not use the word ‘manipulation’, and the end result was that the CCG decided not to proceed to the pilot stage. In short, it appears to this Editor that the Digital Health report was based on an earlier and incorrect version of the report (perhaps as early as 25 Oct) and we are of course happy to correct. My fault and apology to our Readers and to Babylon in that I should have located the 22 Nov revised report prior to publishing the article and essentially provided a correction to Digital Health‘s report.

However, the CCG’s report on their Babylon evaluation contains two findings that were included in Digital Health‘s now-deleted article and give some pause. The CCG used focus groups of potential users, which surfaced that, in the CCG’s words, “The focus groups had also commented that there is a risk of some people gaming the symptom checker to achieve a GP appointment. The insights gathered therefore revealed that the symptom checker in particular was unlikely to reduce demand for GP services.”

Our Editor Chrys has pointed out the Pulse article which also comments on this and was corrected for the CCG’s revised report. The comments here by practicing GPs are worth reading. Scroll down and you’ll see that  ‘gaming the system’ has happened using direct triage in practices using personal phone consults–no app required. Can this even work?

Focus groups are highly subjective, but they are great ways of surfacing the flaws that developers and companies have gone blind to.

We hope that Babylon Health does take this feedback seriously. This Editor makes no secret of her advocacy of technology that can speed the obtaining of care, but based on her experience with early-stage companies, every critique, every hole that can be kicked in a service, delivery, and logistics, exposing a weakness should be appreciated–and ruthlessly scrutinized for flaws that need solutions. This becomes harder to do when you’ve achieved Big Funding. Babylon is typically burning a hole through it (The Times, 1 Oct–hat tip to Chrys). The pressure on now to find The Road to Breakeven must be stunning.

Important updates: Speaking of finding solutions, Babylon differs strongly with the findings of the Care Quality Commission (CQC)(not to be confused with the CCG), in the CQC report on their service published on Friday 8 December. 

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CVS-Aetna: the canary says that DOJ likely to review merger–plus further analysis and developments

December 8, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]The canary is still tweeting. News reports indicate that the US Department of Justice (DOJ) will be in the lead reviewing the CVS acquisition of Aetna. This should be no surprise to our Readers. This Editor’s first analysis noted regulatory necessity and earlier this week, more explicitly predicted either the Federal Trade Commission (FTC) or the DOJ would be reviewing.

The New York Post’s Beltway sources (for ex-US readers, it’s the mass market News Corp. paper/site) are talking up DOJ:

President Trump’s Department of Justice appears to be the agency that will review CVS Health’s $69 billion merger with Aetna, sources tell The Post. While the decision is not yet final, the move would not be good news for the merging parties, sources said. “I think they would prefer it to be at the Federal Trade Commission,” one Washington, DC, source said.

The article explains that it’s a tossup as to bailiwicks–FTC reviews retail and drugstore mergers, DOJ insurance mergers. A sound but (by CVS) unwelcome reason for DOJ to review the merger is their familiarity with Aetna after DOJ opposing its failed merger with Humana in Federal court less than a year in the past. Their expertise would be wasted and politically, a cup that FTC would wish to pass inasmuch they are also short on commissioners.

As the Third Century Greek philosopher Sextus Empiricus stated, ‘The mills of the gods grind slowly, but they grind small’ (or ‘exceeding fine’ in more modern citations), which means that justice, at least in the Federal definition, will be served eventually.

  • The Trump Administration has let DOJ question the AT&T/Time Warner merger on antitrust reasons up, down, and sideways, to the point where it is nearly derailed. Much the same can be expected here.
  • The businesses create a new type of healthcare system. Expect HHS to have a say.
  • Congress is already demanding hearings, which given the short time to Christmas break will likely be January. 
  • What may help Aetna’s cause is that the merger with Humana was a friendly one; the decision, at least in the press, was accepted with grace. 

But as wags have said for at least two centuries, you can always tell the pioneers by the arrows in their back. When you’re redesigning the Conestoga Wagons, it has to be expected–which is why the experts gathering here in NYC over the past week have had not much to say about it to date.

Certainly it has been a downer for investment pickers, though both companies had significant profitability challenges facing them in the future. We refer here to several articles in Seeking Alpha where it’s predicted that the acquisition will boost CVS’ growth, but saddle it with huge debt: $45B in new debt, $21B in new equity, plus using $4B in available cash. Are they overpaying? Will it reduce internal cost and boost profitability? Will it do what they say they’ll do, which is to bend the cost curve down by start-to-finish engagement with customers? What pieces are missing? And time is a critical factor–how long this will take to realize is not projected. If you like stock and value charts and graphs, here’s the place. Seeking Alpha (by author): Ciura, Arnold, Ward

Other retailers will have their say. We’ve noted earlier that the vast supermarkets like Publix, Wegmans, Shop Rite or Ahold (Stop & Shop, Giant) are likely looking at opportunities with logical alliances or buy-ins to insurers like Oscar, Clover, Bright Health, or the smaller Blues. Target is already allied with CVS for their in-store drugstores. And then there is retail/online giant Walmart. The Wal-Martians need plenty of healthcare and Humana, based on local Louisville-area reports, is in play after not merging with Aetna.

Looming over all this is Amazon. A little-noticed report in Becker’s from July indicated that their 1492 unit has set about extracting data from legacy EHRs and to build a telehealth platform on Amazon hardware such as Echo. Already noted has been their buying of pharmacy licenses in various states. None of which can make any of the usual healthcare suspects happy.

Analysis of the CVS-Aetna merger: a new era, a canary in a mine–or both?

December 6, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]This Editor has been at two healthcare conferences in the last four business days (with tomorrow being a third). They should be abuzz about how the CVS-Aetna merger may transform healthcare delivery. To her surprise, there’s been a surprising lack of talk. There is a certain element of ‘old news’, as the initial reports date back five weeks but the sheer size of it ($240bn combined future value, $69bn purchase, an estimated $750 million in near-term synergies), being the largest health insurance deal in history, and the anticipated effects on the health delivery model normally would be a breaking news topic. To this Editor, it is a sign that no one truly knows what to make of it, and perhaps it’s too big–or threatening–to grasp for provider and payer executives especially.

For an overview of what we saw at the time as reasons why and possible competitor reaction, Readers should look back to our original article [TTA 28 Oct]. It’s being presented by both companies as a vertical merger of two complementary organizations, which already were moving towards this model, integrating their different services into “America’s front door to quality health care” (CVS CEO Larry Merlo)–a lower cost setting that saves premium dollars and brings integrated care to consumers’ doorsteps.

CVS brings to the table huge point of care assets: 9,700 pharmacy locations, 1,100 MinuteClinics, Omnicare’s senior pharmacy solutions, Coram’s infusion services, and the more than 4,000 CVS Health nursing professionals providing in-clinic and home-based care. Aetna has about 23.1 million medical members, 14.5 million dental members, and 15.2 million pharmacy benefit management (PBM) services members. Aetna also has a wealth of advanced data analytics capabilities through two subsidiaries, ActiveHealth Management and  Medicity’s health information exchange technology.

Seeking Alpha has an intriguing POV on this entry into a ‘new era’: that both CVS and Aetna consider this to be a long-term reshaping of their business model under the threat posed by Amazon, and are willing to do this despite little short-term financial benefit for either company. The problem as the writer sees it: execution. This is re-engineering care on a national scale, and its benefits are based upon combining intangibles, a murky area indeed especially in healthcare. Time is also a factor, as Amazon is getting pharmacy licenses in multiple states, and is rather an expert at combining intangibles.

Does it signal that the approach to a ‘new era’ in healthcare is accelerating? If this is a preview, 2018 will be extremely interesting. Our ‘canary in the coal mine’ may tweet–or fall over on its perch, asphyxiated.

Some additional points to consider: (more…)

#MedMo17: the conference, winning startups, Bayer, blockchain, and more

December 6, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/MedMo-header-crop.png” thumb_width=”150″ /]MedStartr Momentum‘s conference last week was extremely well attended, with 260 registrations over the two days at PricewaterhouseCooper’s NYC HQ. It jumped! (Disclaimers: your Editor is one of the hosts and co-organizers; TTA is a media partner) #MedMo17 had about 50-60 total speakers, presenters, and panelists in fast-moving sessions, most 10-15 minutes, with panels clocking under one hour.

What’s always unusual about MedStartr conferences is the mix of topics and people, and not just from NY. There were startups just getting going, successful startups sharing their stories, patient advocates, providers, and investors sharing what they want to see (and not see) before they fund. There was Deborah Estrin from Cornell Tech describing how they nurture graduate student tech entrepreneurs and Maria Gotsch from the Partnership Fund for NYC discussing how they accelerate, partner, pilot, and fund companies coming to market. One sponsor was nearby Newark NJIT’s NJ Innovation Institute–and one of the presenting companies was Uniphy Health (formerly PracticeUnite) that they’ve worked with and helped make successful over five years. Who would have expected a wild discussion about blockchain? Well, here, hosted by media personality/entrepreneur Ben Chodor (HealthTechTalk Live) with panelists ranging from a digital asset hedge fund founder to a patient advocate. For two panels, questions came from ‘the field’ via a Reddit ‘Ask Me Anything’.

Notably, Bayer G4A Generator, coordinated in the US by Aline Noizet, came on board as a sponsor. They came to the right place as they are seeking early-stage companies for Bayer Grants4Apps. In the US, they are seeking new companies developing self-care products: nutritionals/wellness, therapeutics (pain management, seasonal health), personal care (skin, sun, footcare), and self-care in general. Bayer also runs similar programs in Berlin (Accelerator and Dealmaker), Barcelona, Tokyo, Moscow, Singapore, Shanghai, and Italy.

Of the 18 Grand Challenge finalists competing for financing and guidance, the winners were: Population Health–Valisure (online pharmacy pre-screening meds); Wearables/Medical Devices–Alertgy (non-intrusive continuous blood glucose monitoring); Clinical Innovations–eCaring (at-home senior care monitoring), and in Killer Apps, a product that actually kills bad bacteria on the skin–Xycrobe (good recombinant bacteria for dermatological use). Special awards were given to Check with Ellie (breastfeeding questions answered, Momentum Award for growth) and MedAux (patient ed and HIPAA compliant messaging–Crowd Choice Award).

The full conference (Thursday and Friday) is up on video at Medstartr.tv. And in 2018, it will be 29-30 November, so put it in your calendar. Kudos to the MedStartr team, especially Alex Fair. Hat tip also to the NOLA (New Orleans) Health Innovation Challenge 

Health Care Homes – treating chronic diseases in Australia

December 2, 2017 | by

The second tranche of the so called “Health Care Homes” (HCHs) trial started enrolling and providing services [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Health-Care-Homes.png” thumb_width=”150″ /]yesterday (1st December 2017) in Australia according to Australia’s Department of Health.

HCHs are existing General Practices (GPs) or Aboriginal Community Controlled Health Services providing a more systematic, coordinated care for people with chronic conditions such as diabetes, heart disease and respiratory problems. Patients who have been assessed as eligible can choose to enrol on the programme at a HCH and a care plan is then developed covering care to be received from their GP/ Aboriginal health worker and nurses at the GP practice as well as specialists and allied health workers.

Australia has seen a rise in chronic diseases with 50% of the population now having at least one chronic illness and 25% having at least two. The Australian Government believes that the GP led Primary Care system does not deal well with chronic diseases where patients often need services from multiple professionals working in different parts of the healthcare system. The HCH model is expected to reduce the confusion, delays and costs by using a team based coordinated delivery of care.

A key element of the HCH model is that the patient and all members of the care team (within the HCH and outside) have access to the care plan. A minimum requirement for software tools for creating and sharing the care plan have been defined and several companies have already produced software for this purpose. There has been some criticism of the way the software tools market has developed and the lack of independent guidance on choosing such software.

On the whole this trial is of interest not just to Australia but also to all other countries since chronic disease care is a key issue around the world. HCH model is considered consistent with the models used in the UK and New Zealand.

The stage one trial is due to run until November 2019 and has around 200 HCHs, of which the first tranche of 22 started in October 2017.

A brochure on the HCH produced by the Australian Dept of Health is available here.

OnePerspective: VA shows how technology can improve mental health care

December 2, 2017 | by

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Gigi-Sorenson-GlobalMed.jpg” thumb_width=”150″ /]By: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

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VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

November 27, 2017 | by

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill 

Mayo Clinic’s Victor Montori MD calls for a ‘patient revolt’ for ‘careful and kind care’

November 27, 2017 | by

Have a listen…This Editor has kept an eye on Dr. Victor Montori’s concept of ‘minimally disruptive medicine’ which seeks to fit the medical treatment to what the patient can handle through shared decision making, reducing the burden on both doctor and patient. He has recently published a book titled ‘Why We Revolt: A patient revolution for careful and kind care’. ‘Careful’ and ‘kind’ don’t immediately come to mind in this force-fed world of HEDIS quality scores, 31 ACO quality measures, HCAHPS hospital surveys, patient compliance, Ezekiel Emanuel, and the drive to measure every pill, footstep, and mouthful you take via your smartwatch or -phone–then ‘big data’ it.

Dr. Montori makes the case for balancing the agendas between doctor and patient, bringing back empathy, kindness, and respect in that relationship, with the goal to ensuring that “care fits into life and does not demand more than is sensible.” This 15-minute interview journeys from the medical privations Dr. Montori witnessed in his native Peru to his current work as an endocrinologist at the Mayo Clinic. You’ll want to buy the book after you listen. (And he should have included doctors in that revolt as well.) Podcast at Health News Review/Health News Watchdog.

Previously in TTA on Dr. Montori’s contrarian views: Patient non-compliance=toxic healthcare system? and Is how we are treating patients for chronic diseases (and pre-diseases) all wrong?

HeyDoctor! Come and get your diagnosis via text here!

November 27, 2017 | by

An app that makes this semi-grizzled pioneer feel…not quite on board the wagon. HeyDoctor is not for horses, but for those who Text to Live. Yes, all you need to do if you feel under the weather is to download the app, text the doc, get your diagnosis, and prescription. Like that. No need to comb your hair and wash your face for that video visit. According to the website, you can get anything from a UTI to acne to erectile dysfunction diagnosed and treated. Out of birth control? Handled. You can get tests ordered up for blood typing, HIV, and metabolic analysis. Not happy with your lash thickness and growth? Here’s the topical med for you! Trying to quit smoking? Done. All you need do is text one of their in-house board-certified physicians and live in one of 19 states where it’s offered.

For our UK Readers, this is a service with similarities to Babylon Health‘s chatbot service but without the decision support ladder–it goes straight to the doctor.

They claim on the website that most visits are five minutes and under $20 in cost, plus affiliations with leading medical centers like UCSF and Georgetown, although this Editor doubts that Amazon Web Services (AWS) is a ‘healthcare organization’ in the same category.

MedCityNews confirms their playbook, for now, is B2C, but the San Francisco-based founders are considering partnering with health systems. According to Crunchbase, funding so far is seed from the two founders, Brendan Levy, MD, a SF-based family medicine practitioner, and Rohit Malhotra, an attorney. LinkedIn counts three employees.

So why not on board the Conestoga? While the convenience is very attractive, there’s also the opportunity for misdiagnosis–the kind of thing we used to worry about with telemedicine. Does the app secure the texts for privacy? Many of these conditions aren’t hangnails–HIV and UTIs come to mind. Oddly, photo upload isn’t mentioned–important with acne. Testimonials point to convenient prescription renewals, but that information can be falsified–easy to do with text. Identity too with smartphones can be faked. A video consult also permits the doctor to see the patient and pick up at least some physical signs of illness. Also not inspiring confidence: a website that crashed when I looked for FAQs and had a chatbot named Brendan (same face as Dr. Levy’s) constantly popping up after X’ing him out. To this Editor, it feels like some verification and diagnostic layers are…missing.

NHS, Public Health England testing multiple digital health devices for obesity, diabetes

November 22, 2017 | by

NHS England, Public Health England, and Diabetes UK launched a pilot, announced on World Diabetes Day on 14 November, to test various digital health approaches to controlling obesity and Type 2 diabetes. Approximately 5,000 patients will be recruited for a test period of up to one year. Multiple apps, gadgets, wristbands, and other digital devices to measure their results against goals will be tested,  combined with health coaching and online support groups. NHS is also offering to some wearable devices which record activity levels and receive motivational messages and prompts. 

The test will use products and services from five companies and the patients will be recruited from eight areas of the country. The companies, programs, and tools are:

  • Hitachi – Smart Digital Diabetes Prevention program combines an online portal + coaching
  • Buddi Nujjer – a wristband which monitors the user’s activity, sleep patterns and eating frequency, paired with a smartphone application
  • Liva Healthcare – 12 months of a dedicated coach starting with a personal face-to-face meeting. The Liva platform and patient app supports the patient with smart goal setting and plans, lifestyle tracking, video communication, and online peer to peer support.
  • Oviva – An eight-week intensive lifestyle intervention with an experienced dietitian providing personalized advice and support.
  • OurPath – A six-week mobile and desktop digital program with structured education on healthy eating, sleep, exercise and stress management.

The pilot builds on Healthier You: The NHS Diabetes Prevention Programme, launched last year to support people who are at high risk of developing Type 2 diabetes. This adds digital tools to a coaching-intensive, educational, and activity-oriented program. Public Health England also has the Active 10 app, which encourages at least 10 minutes of daily brisk walking. NHS press release, Digital Health

MedStartr Momentum ’17 this Thursday–50+ speakers, 20 pitches, $2M in prizes! (NYC)

November 21, 2017 | by

MedStartr Momentum (#MedMo17), 30 Nov-1 Dec, PwC HQ, 300 Madison Avenue (@42nd) NYC

Now that you’ve finished off the last of the Thanksgiving leftovers, leave some room for this year’s MedMo17. You’ll feast on over 50 speakers and panelists in two full days of talks, networking, and real discussion on how to improve healthcare. There will be plenty of ideas served piping hot on innovation, adoption, and investment in the future of healthcare. Highlights:

  • Nine Momentum Talks on Healthcare innovation from inspirational leaders like Deborah Estrin of Cornell Tech,  Maria Gotsch of the Partnership Fund for NYC, Jack Barrette of WEGO Health, Jay Helmer of Livongo, Stuart Hochron MD of Uniphy Health, Jim Lebret MD of NYU,  and George Mathew, MD of DXC Technologies and CarePredict.
  • Four panels with thought leaders and CEOs on healthcare innovation and investing, reviewing the hottest topics for 2018, such as blockchain, smart cities, empowered patients and digital health for the rest of us.
  • Four Grand Challenge pitch contests covering wearables/ IoT, hospital solutions, clinical innovations, pharmatech, patient connectivity, AI, precision medicine, and more. (Rumor has it that this Editor will be on one judging panel!)

Join 200 attendees who are leading the healthcare innovation drive. There’s a great team that puts this all together, with Alex Fair of MedStartr the real spark plug behind it all. Much credit is due to generous sponsors and supporters like PricewaterhouseCoopers, DataArt, SparkLabs, HealthTechTalk Live, Moses & Singer, CohnResnick, McCarter & English, Epion Health, WEGO Health, Chardan Capital Markets, NJ Innovation Institute/NJIT, and others. 

TTA has been a supporter of MedStartr/Health 2.0 NYC since early days (2010). We’ve been able to obtain this special offer for our Readers–25% off a regular $299 ticket. Use Code TTA25. It’s an unbeatable deal for two full days with lunch and coffee breaks–conferences of this type are usually three to five times more. (And if you fall into certain special categories, like student or a pre-revenue startup founder, it’s even less; though our discount isn’t available on these ‘specials’, you won’t need it.) For our UK and EU Readers, it makes it worthwhile to catch an inexpensive NY flight, attend, and get started on your holiday shopping! See the action on Twitter #MedMo17, updates on @MedStartr.