Alertacall receives Queen’s Award For Enterprise: Innovation

One of the items that whizzed by this Editor while she was in Pepper the Robot mode was the highly prestigious Queen’s Award For Enterprise: Innovation, awarded to one of the pioneering companies in UK telecare, Alertacall Ltd.  Their CEO and founder, James Batchelor, is an old friend of TTA from early days with Editor Emeritus Steve. (Editor Donna hadn’t even thought of marketing health tech at that time.)

Alertacall provides tablet touchscreen connectivity to the housing, care markets, and personal markets, from OKEachDay checkins to smart home systems controlled by the touchscreen.

Alertacall was founded in 2004 by James, the original inventor of the “I am okay” button. Like many of us in those days, he had a personal inspiration for being engaged with creating a better way to support older adults in their home–Eveline, his own staunchly independent grandmother. She was, in James’ words “a shop keeper for much of her life, and a B+B operator up until her early eighties. After the death of 2 husbands – the first of whom was detained as a Prisoner of War in WW2, she learned to drive in her late 50s, travelled the world on her own and was an inspiration to many with her grit and determination to live on her own, and under her own terms for as long as possible.”

Also, James’ gracious note from LinkedIn, posting on the Queen’s Award:

We won this Queen’s Award because of the great technology we have created for sheltered and supported housing to help independent older people, women fleeing domestic violence and people who are disabled – to feel safe, connected and informed.

This award really is testimony to that innovation, but more so to the incredible team I have the joy of working with each day. This is an award for them and their phenomenal care of our customers.

In July I’ll be attending a winners reception at Buckingham Palace with HRH The Prince Of Wales – on behalf of those team members. My grandma, Eveline, who was the inspiration for Alertacall would have been pretty excited by that I think.

A lot of you run your own businesses, and some of you might have started those from scratch. So you’ll understand that external, independent validation is rare, and a great feeling when it comes.

Many of you have also been a positive part of our journey – and if so thank you, sincerely.

Dame Esther Rantzen DBE, the well-known British journalist and TV presenter of That’s Life! on the BBC for 21 years, who was instrumental in the founding and popularization of both ChildLine and The Silver Line helplines, is a supporter of Alertacall. Her statement is attached here.

Our warmest congratulations to James and the Alertacall team!

Alertacall announcement.

Weekend news and deals roundup: Allscripts closes sale of hospital EHRs, closing out CEO; DEA scrutiny of Cerebral’s ADHD telehealth prescribing; more telehealth fraud; Noom lays off; fundings; and why healthcare AI is only ML

That was fast. Allscripts closed its $700 million March sale of its hospital and large physician practice EHRs to Constellation Software Inc. through N. Harris Group. The Allscripts EHRs in the transaction are Sunrise, Paragon, Allscripts TouchWorks, Allscripts Opal, and dbMotion. They reported their Q1 results today. According to HISTalk earlier this week, CEO Paul Black will be stepping down, with President Rick Poulton stepping in immediately. Update–this was confirmed on their investor call Thursday and the transition is effective immediately. No reasons given, but there were no effusive farewells.  Healthcare Dive

A damper on telemental health? Online mental health provider Cerebral, which provides talk therapy, audio/video telehealth, and prescriptions for anxiety, depression, insomnia, ADHD, and other conditions, is finding itself under scrutiny. This week, its main mail fulfillment pharmacy partner, Truepill, stopped filling prescriptions for Adderall, Ritalin, Vyvanse, and other controlled Schedule 2 pharmaceuticals. Cerebral is redirecting current patients with these prescriptions to local pharmacies and as of 9 May, will not prescribe them to new ADHD patients.

Based on reports, the Drug Enforcement Agency (DEA) is looking at Cerebral in particular as part of a wider scrutiny of telehealth providers and pharmacies filling telehealth-generated prescriptions due to allegations of overprescribing. It also didn’t help that a former VP of product and engineering plus whistleblower claims in a wrongful dismissal lawsuit that Cerebral execs wanted to prescribe ADHD drugs to 100% of diagnosed patients as a retention strategy. Bloomberg Law. Unfortunately, Insider is paywalled but you may be able to see a report in the Wall Street Journal. Becker’s Hospital Review, FierceHealthcare

Also troubling telehealth is recurrent fraud, waste, and abuse cases involving Medicare and Medicaid. Back in 2020 the National Healthcare Fraud Takedown took down over 80 defendants in telemedicine fraud [TTA 2 Oct 20, 30 Jan 21]. The Eastern District of NY based in Brooklyn has indicted another physician, an orthopedic surgeon, in a $10 million fraud involving durable medical equipment (DME). In exchange for kickbacks from several telemedicine companies, he allegedly prescribed without examination and with only a cursory telephone conversation DME such as orthotic braces. DOJ release

Some fundings and a sale of note–and a big layoff at a well-known digital health leader:

  • Blue Spark Technologies, an RPM company with a patented Class II real-time, disposable, continuous monitoring body temperature patch good for 72 hours, TempTraq, raised a $40 million intellectual property-based debt solution (??) to fund growth led by GT Investment Partners (“Ghost Tree Partners”) with support from Aon plc (NYSE: AONRelease
  • Specialty EHR Netsmart acquired TheraOffice, a practice management platform for physical therapy and rehabilitation practices which will be added to its existing CareFabric platform. Neither terms nor management transitions were disclosed in the release.
  • ‘White label’ telehealth/virtual health provider Bluestream Health is implementing its systems in Mankato Clinic, with 13 facilities across southern Minnesota. It’s a rarity–physician-owned and led–and in business since 1916. This also fits into a new telehealth trend–providers working with ‘white label’ telehealth companies and not with the Big 5. Release
  • Ubiquitously advertised (in US) weight-loss app Noom is laying off a substantial number of employees–180 coaches plus 315 more employees. Reportedly they are pivoting away from on-demand text chat to scheduled sessions that don’t require so many people. While profitable in 2020 ($400 million) and with Series F funding of over $500 million in 2021, it’s come under criticism that while its pitch heavily features easy behavioral change achieved through cognitive behavioral therapy (CBT), their real core of weight loss is severe calorie restriction. Engadget
  • Element5, an administrative software provider for post-acute facilities, raised a $30 million Series B from Insight Partners. They claim that their software is AI and RPA (robotic process automation) based. ReleaseMobihealthnews

And speaking of the AI pitch in healthcare, a VC named Aike Ho explains why she doesn’t invest in healthcare AI companies because there’s no such thing in healthcare–it’s just machine learning. On that, Ms. Ho and your Editor agree. She also makes the point that the market they address is ancillary and not core services, plus they have difficulty clinching the sale because they don’t relate well to achieving or can’t prove at this stage improved clinical outcomes. Ms. Ho’s looooong series of Tweets is succinctly summarized over at HISTalk (scroll down halfway).

Some thoughts on Teladoc and the Week That Was in telehealth

Yes, your Editor has, for the past few weeks, felt like Pepper the Robot, moving at two speeds–crazed and off. (‘Off ‘ to the left. Now cart me off.) Home renovations, with strangers tramping through your abode, noise, dust, and the corresponding moving of furniture, packing and unpacking, pre- and post-cleaning, then trying to put things right and get your life back will do that. Add to that an unexpected gushy kitchen sink that took three ‘fixes’ to get actually fixed. Then there were technical problems with our email sender that Editor and Administrator Emeritus Steve had to work through. One becomes more appreciative of order, routine, and Peace and Quiet.

Speaking of Peace and Quiet, there is little to be found in telehealth. Instead, there is a lot of Feeling Off. The Big News of late last week, of course, was Teladoc’s troubles. In the words of Seeking Alpha, they had one horrific quarter. The horror show started with writing off the Livongo acquisition– a noncash goodwill impairment charge of $6.6 billion, for a massive loss of $41.11 per share for a total of $41.58 per share. To compare, last year’s Q1 loss was $1.31 per share. While revenues were up almost to projection (25%), it was still a $3 million miss and in context, it was the cherry on a very nasty sundae. After rosy projections last year, Teladoc lowered their 2022 revenue guidance from $2.6 billion to $2.45 billion.  

Moving forward from the questionable Livongo acquisition at the absolute peak of the market, CEO Jason Gorevic admitted some hard truths to investors that deepened the hole: much more competition, particularly in telemental health; the rising cost of paid search advertising and the keywords driving towards direct-to-consumer telehealth driving up the cost of acquisition; and difficulty closing B2B deals. This creates, in the terms of analyst SVB Leerink’s Stephanie Davis quoted in FierceHealthIT, “a direct-to-consumer air pocket that business-to-business sales (and their inherently longer cycles) are too slow to fill” at least, in her view, until the end of the year.

Teladoc’s difficulties, as this Editor has noted, started after a peak in early 2021 as the pandemic started its protracted wind-down and telehealth volumes plunged to well below 5% of claims as practices reopened. The stock value is down over 90% from last February, not helped by a volatile market triggered by war and inflation. Similar difficulties are plaguing Amwell (down 92% since February 2021), Talkspace (down to a paltry 16 cents and in court for misleading investors), SOC Telemed (taken private at a 70% drop in value, TTA 8 Feb), and other health tech companies. For our Readers, this is no surprise: the telehealth bender is ovah.

One industry leader in a post-ATA conversation with this Editor cited a less obvious factor–that hospitals and other health providers are now putting together their own telehealth/triage packages tied into population health and case management software, with and without ‘white label’ providers such as Bluestream Health and Zipnosis (acquired by insurtech/payvider Bright Health a year ago). Teladoc is a late entry to this provider/payer market with Primary360, where they also compete with Babylon Health [TTA 7 Oct 22]. And health retailers have joined the primary care telehealth game. Walmart last week announced a virtual health diabetes care program for employers through their recently acquired MeMD.

Big Telehealth’s troubles may depress investment in related earlier stage companies–or help those in niches such as telemental and population health, or remote patient monitoring (RPM) systems that have telehealth features (e.g. TytoCare), as VC investment seeks a brighter home. Right now, this Editor’s Magic 8 Ball is saying ‘outlook, cloudy”. 

Tunstall Healthcare announces new group CEO, Emil Peters

The Guard Changeth. Emil Peters will be joining Tunstall Healthcare as group CEO, effective 16 May. Mr. Peters is departing Cerner Corporation, having come up through the ranks over 25 years through international directorates and markets, leaving only briefly for a seven-month sojourn at TriZetto in 2012. For the past five years, he has been president of Cerner Global, managing all territories outside of the US from London, and previously general manager of Cerner Europe and Latin America. With the acquisition of Cerner by Oracle pending the usual approvals and then the usual restructuring, this is likely to be a fortuitous move on both sides.

Mr. Peters will succeed Gordon Sutherland, who held the position from September 2016 and oversaw many changes, but most significantly the change of ownership and company restructuring finalized in April 2020 from Charterhouse Capital Partners to a lender group led by Barings and M&G [TTA 10 April 2020 and 30 October 2020].

Peter Nicklin, chairman of the Tunstall board, who himself joined the company in March 2021, commented: “As we move forward past our 65th year anniversary and continue to expand our digital technology capabilities, I am thrilled to have Peters leading the charge. His leadership experience is perfectly placed to empower the Tunstall team to deliver products and services that, ultimately, save and prolong lives.”

This is the third high-profile change at Tunstall in the past year. In August, Gary Steen came from TalkTalk as Group Chief Technology Officer (CTO) Yorkshire Times.

LaingBuissonNews, HealthInvestorUK, Tunstall release   And a hat tip to a UK Reader who wishes to remain anonymous.

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

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

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

Month Mental health Acute respiratory Covid-19
January 2022 58.9 3.4 3.4
December 2021 55.0 6.0 4.8
November 2021 62.2 4.5 1.4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What can be the long-term drivers of remote patient monitoring growth?

Is it as simple as getting simpler to use devices to collect long-term data that picks up trends and provides feedback that motivates to users? That is the surprise at the very end of this pre-HIMSS Healthcare IT News interview with Dr. Waqaas Al-Siddiq, chairman, CEO, and founder of Biotricity, a biometric monitoring and telemedicine company incorporating devices into monitoring systems for cardiac and pain management. Those of us who have worked for RPM companies know the variety of devices typically used by those monitored for chronic conditions can be stunning–and most of them aren’t easy to use for those with sight difficulties or mobility problems. Pain monitoring is especially tricky and subjective. Gaps in use are to be expected, even as these systems have become more mobile and smartphone connected. The popularity of continuous glucose monitoring (CGM) monitors such as the Dexcom G6 and Abbott’s Freestyle Libre system is a predictor–make it simple, eliminate something unpleasant, provide easy feedback, and you have a winner.

Dr. Al-Siddiq points out that we are at the early stages of monitoring for chronic disease. People with COPD, sleep apnea, and atrial fibrillation right now don’t have CGM level monitoring. There are also patients who are sent home from the hospital with no monitoring devices at all and won’t (or can’t) visit a doctor’s office. RPM organized at discharge, set up with a nurse, and connected to a doctor’s office would be ideal if the offices adopt a cohesive monitoring approach. But Dr. Siddiq adds the feedback to the user to trigger motivation, which to this Editor has been a missing element. 

So much of this is dependent on device and system design–clinical quality monitoring that’s easy to use and almost forgettable in everyday life, that provides feedback (reward experience), and that provides quality data that doesn’t overwhelm the clinician. A familiar trio to those of us who’ve been in the RPM Wars. 

Congress may extend emergency telehealth flexibilities for Medicare, high-deductible plans for five months in spending bill

The quaintly titled 2,741 page $1.5 trillion omnibus bill to fund the US government for the remainder of fiscal 2022, rolled out in the wee hours of Wednesday, includes an extension of telehealth flexibilities established under the COVID-19 public health emergency (PHE). The flexibilities extend full geographic coverage (versus rural only), location (home and medical facilities), and full payment for beneficiaries and providers, including some audio-only visits. This will apply, however, only to Medicare beneficiaries and providers, members of high deductible health plans (HDHP), and patients of rural health clinics (RHCs), and Federally Qualified Health Clinics (FQHCs). This is a five-month stopgap into 14 September. (The Federal fiscal year 2023 starts 1 October.)

The telehealth rule extension includes:

  • Practitioners such as physical therapists, occupational therapists, special therapists, and audiologists 
  • Originating sites can be anywhere in the US including the home and medical facilities
  • 1,400 Federally Qualified Health Centers (FQHCs) and 4,300 Rural Health Clinics (RHCs) can continue providing telehealth services including mental health visits
  • Waiving in-person initial visit requirement for mental health as well as postponing the in-person visit six months after receiving a telehealth visit
  • Audio-only allowed for Medicare
  • HDHPs have a continued ‘safe harbor’ to offer members telehealth services pre-deductible for the remainder of the 2022 plan year 

The vote is scheduled for the House today (9 March–still not finalized as of this writing), and to the Senate 11 March, with a concurrent short-term funding extension to give the Senate the usual time through 15 March. As of this time of writing, the floor wrangling continues with COVID-19 funding dropped and $13.6 billion in emergency non-defense aid to Ukraine added. The inclusion was cheered by ATA and ATA Action in their release; also Becker’s Hospital Review and Roll CallUpdate: the House passed the domestic portion of the bill 260-171 late Wednesday 9 March evening, and it moves on to the Senate.

Thursday news roundup: Cigna deploys over $12B for investment, Cerner’s Feinberg to Humana board, Teladoc on Amazon Alexa, admitting Livongo problems, and XRHealth VR therapy scores $10M

Cigna’s opportunity piggybank just added $12 billion+. It’s a combination of selling off non-core businesses, share repurchasing authorization, and redeploying funds to areas such as capital investment and Cigna Ventures. This includes:

  • $5.4 billion after-tax from the sale of its international life, accident, and supplemental benefits businesses in seven countries
  • $450 million invested in Cigna Ventures, its innovation investment arm
  • An expected $7 billion for share repurchase this year from a $10 billion authorization. To date this year, Cigna has already repurchased $1.2 billion of shares.

The Cigna Ventures funding will go towards three announced areas: insights and analytics; digital health and experience; and care delivery and enablement. Originally formed in 2018 with $250 million, they now have seven VC partners and 15 direct investments, including Arcadia, Babyscripts, Cricket Health, Ginger, Omada, and RecoveryOne. 

Buried in the release is this: “…the company is not currently contemplating large-scale mergers or acquisitions” which would seem to put a tight lid on the long-rumored acquisition of parts or all of Centene [TTA 28 Jan]. (Too much wake turbulence?) But following on this, “The company intends to continue making strategic investments in innovation through targeted bolt-on or tuck-in acquisitions” which fits sell-offs, as well as investment in early-stage companies through Cigna Ventures. Also FierceHealthcare

Insurer Humana’s board expands to 14 with the addition of David Feinberg, MD, the current CEO of Cerner and future executive of Oracle, provided the merger is approved. He joins the current seven independent directors on the Humana board. Last week, Starboard Value LP, an activist investor hedge fund, reached an agreement with Humana to appoint two Starboard-backed board members starting next month and retire two incumbents. Humana limped through last year with a $14 million Q4 loss and Medicare Advantage losses to both traditional rivals and insurtechs. With over 25 years in healthcare management including CEO positions at Geisinger Health System and three divisions of UCLA Health, it’s a smart move. Release, FierceHealthcare

“Alexa, I want to talk to a doctor”–and that doc will be through Teladoc. Amazon customers with supported Echo devices, such as an Echo, Echo Dot, and Echo Show, will now be able to access Teladoc and a virtual care session 24/7. Initially it will be voice-only with audio/video to come. The release states that visits may be free through insurance or $75 direct pay. It did give a much-needed lift to Teladoc shares, which have been hammered by 76% in the past year, on the announcement and in the past few days, feeding the usual rumor mill that Amazon may be writing a check for Teladoc shares.

Teladoc has finally admitted via its annual report (SEC 10-K) that the Livongo acquisition has not been all beer and skittles. It impacted its indebtedness (page 35) and on page 52, significant insecurities on the integration of the two companies, well over a year after the acquisition.

Our failure to meet the challenges involved in successfully integrating the operations of the two companies or to otherwise realize any of the anticipated benefits of the merger, including additional cost savings and synergies, could impair our operations. In addition, the overall integration of Livongo post-merger will continue to be a time-consuming and expensive process that, without proper planning and effective and timely implementation, could significantly disrupt our business.

Healthcare IT News and HISTalk

VR physical therapy has remained a “we try harder” area of telehealth for several years, with a lot of initial promise in treating returning veterans with PTSD in de-escalating symptoms but having a hard time getting takeup. XRHealth, an early-stage company offering VR-driven physical, occupational, and speech therapies, gained a $10 million venture round backed by HTC, Bridges Israel impact investment fund, AARP, and crowdfunding on StartEngine.com and existing investors. According to Crunchbase, this is par for their course since 2016; their total of $35 million has been in pre-seed, seed, grant, crowd, and venture funding. Based in Brookline, Massachusetts with R&D in Israel, it is good to see them progress, having ‘been there and done that’ with two early-stage health tech firms.

However, their release does them a great disservice. It is, frankly, 90% nonsense in trying to position them out of the gate as “the gateway to the healthcare metaverse” and “growing the open ecosystem and providing greater access to care while reducing costs. Interoperability is key…”. This Editor had to go to their website to find out what they do. As a marketer and reporter, the First Rule of Press Releases is say what the news is, what the company does, and why it’s important in the first two paragraphs. The rest is reinforcement and expansion, with the spokesperson quote part of that and never in paragraph #2. Additional advice: don’t pick up a word now branded by Facebook (Meta). Hat tip to HISTalk