Thursday legal news roundup: Oscar Health accused of IPO securities fraud; Venezuelan cardiologist moonlights as cybercriminal, faces slammer; Change Healthcare sues former employee now at Olive AI

May 19, 2022 | by

To use a cliché, what a difference a year makes. In March 2021, insurtech Oscar Health successfully raised $1,4 billion in its IPO with shares at $39. Heady times didn’t last long, with shares tumbling to $5.67 as of this writing. Now the shareholder lawsuits have begun, with the complaint stating that negative effects of COVID-19 on Oscar’s business were not disclosed, specifically the growing cost of the pandemic on testing and treatment costs they would cover, and “Oscar would be negatively impacted by an unfavorable prior year Risk Adjustment Data Validation (RADV) result relating to 2019 and 2020 [and] that Oscar was on track to be negatively impacted by significant SEP membership growth”. The lack of forward-looking disclosure at an IPO is a violation of the Securities Act. The initial lawsuit has been filed in the US District Court for the Southern District Court of New York by shareholder Lorin Carpenter. Multiple law firms have invited shareholders to join in the suit — example from PR Newswire. Also named in the suit are Oscar Health co-founders CEO Mario Schlosser and Vice Chairman Joshua Kushner, plus several investment banks.

Oscar started the year with a Q1 loss of $0.36 per share versus an estimate of a loss of $0.40, but this is less than half of last year’s loss of $0.98 per share. They are also exiting the Arkansas and Colorado markets in 2023. Healthcare Dive

Cardiologist, master cybercriminal, a new Dr. Mabuse? Accused of the creation, use, and sale of ransomware is one Venezuelan doctor and practicing cardiologist, Moises Luis Zagala Gonzalez, a dual citizen of Venezuela and France. The charges by the Department of Justice (DOJ) in the Eastern District of New York also detail his “extensive support of, and profit sharing arrangements with, the cybercriminals who used his ransomware programs.” SaaS can’t hold a candle to the RaaS–ransomware-as-a-service–operation he created to sell what he dubbed ‘Thanos,’ allegedly named after a fictional cartoon villain responsible for destroying half of all life in the universe. Turns out that Iranian state-sponsored hackers and fellow ransomware designers really liked it too. If convicted, he faces 10 years in Club Fed–five years for attempted computer intrusion, and five years for conspiracy to commit computer intrusions. Designing criminal software really does test the limits of moonlighting. DOJ release, TechCrunch

Change Healthcare sues former employee at competitor Olive AI. While their merger with UnitedHealthcare is tied up in the US District Court in DC [TTA 23 Mar], Change Healthcare is not letting any courtroom grass grow under their feet. They are suing a former employee, Michael Feeney, with violating the non-compete clauses of his employment contract. The suit was filed in Tennessee Chancery Court, its HQ state. Mr. Feeney has countersued in his state of residence, stating that the non-compete violates Massachusetts law. He was VP, strategy and operations at Change handling physician revenue cycle management. At Olive AI, he is currently SVP, provider market operations. Information is a bit scarce on this and the free article this Editor has found reads machine-translated. If you have access to the Nashville Post or Modern Healthcare it’s probably more decipherable.

As to the lawsuit affecting non-competes due to the tight labor market–don’t count on it. It’s a conflict between the state the company is in enforcing non-competes, versus a state which restricts (or negates) them that is the former employee’s state of residence and work. What wins out will be the interesting part and affect many of us in the US.

Perspectives: Where next for technology-enabled care after 2025?

May 17, 2022 | by | 1 Comment

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today, we have a contribution from Adrian Scaife, Global Product Manager at Tunstall Healthcare Group. Can telecare save the UK more than £14bn over the next 10 years, as FarrPoint projected–or is that an underestimate based on the past? Can we do better than this?

Interested contributors should contact Editor Donna. (We like pictures and graphs too)

FarrPoint recently published a report showing how extending telecare services to more people could save the UK more than £14bn over the next decade. While £14bn is no small sum, it is based on the evidence of hindsight and importantly through current models of reactive service provision.

In a LinkedIn post I boldly suggested that this should be an underestimate of the benefits that Technology-Enabled Care, associated with a wider transformation of care, could deliver over the next decade.

With increasing demand for care and support combined with finite resources for provision, the statutory care system is facing a perfect storm. The cracks have been appearing for some time but have become apparent to a much wider audience during the Covid pandemic. To be blunt, the current model of care provision is unsustainable in the medium term. (And many would argue today!)

By moving to more preventative, personalised, joined up and proactive service models, supported by communities as well as statutory services, the benefits are potentially much bigger across the whole care ecosystem. (The care ecosystem includes health care, social care, housing, the third sector and, the largest group of all, informal family carers.)

Source: Social Care Future  

This new vision is being discussed by many people and organisations across the care ecosystem and has been referenced, in whole or part, in a host of reports over the last couple of years. What is most encouraging is the consensus around the direction of travel.

The real challenge is the transformation of services from purely reactive, one size fits all, to a preventative and person-centred approach across housing, social care, health care, and the third sector, supported by families, friends, and communities, while still retaining a reactive safety net.

There are important questions around the how? Enabling and underpinning these new service models will be technology using data, information, and actionable insight. New technology has already created dramatic changes in many other sectors across the UK. There is a huge demand for a new set of tools that can, for example, flag everything is OK today or when an early intervention may be required. These tools will work on an individual personalised basis and all the way up to the population level. Joining up data and using insight provided by analytics will enable new high value timely personalised interventions and provide improved outcomes for all stakeholders. 

The good news is that there are a huge variety of companies already working on these challenges from start-ups to SME’s, larger companies, and even global players. The real challenge will be around people (e.g., new working practices) and processes (e.g., new models of commissioning), and of course, culture. Part of the new story will be about enabling working across all stakeholder groups and indeed recognising families as equal partners.

Finally, this is not a transformation that will take place overnight or even within a year but a journey that will take five or more years before it reaches any type of maturity. The green shoots already exist if you look for them, they may be a little tender and frost sensitive, but they are growing! It reminds me of the early telecare journey in the late 90s and early 00s when many could not see how it would scale to where we are today!

While £14bn from traditional reactive services would be welcome, the real opportunity for improved outcomes for all stakeholders across the care system is much greater and not just in an economic context. Personally, I am enormously excited to be playing a part in enabling those tender shoots to grow, thrive, and become the norm over the next few years.

Further reading:

News roundup: telehealth claims drop 9% in February; Amwell’s good news, bad news Q1; tech-enabled practice Crossover Health growing; NowRx and Hyundai test semi-self-driving delivery

May 17, 2022 | by

FAIR Health’s February monthly tracker is pointing downward again. After a brief post-holiday rise to 5.4% of claims in January, it dropped to 4.9% in February, a 9% drop. Mental health claims seized the lead again by a country mile at 64.2% of claims. COVID-19 fell off the list of top 5 claim areas, though only 3.4% in January compared to 58.9% for mental health. This month lists categories of specialists delivering telehealth, and social workers topped the list at over 31%, which fits the telemental health picture. 

Amwell’s shaky opening to 2022. It should not come as any surprise to our Readers that Amwell, the Avis to Teladoc’s Hertz, didn’t have a good Q1. Most of their key indicators around total revenue, providers, and visits grew smartly. Unfortunately, their losses did too. Comparisons are to Q1 2021 unless noted:

Revenue grew to $64.2 million [$57.6 million], up 11.5%
Gross margin: 42.8% [38.0%], up 12.6%
Total active providers grew 12% from Q4 to approximately 102,000 [91,000] Total visits also grew 20% from Q4 to 1.8 million [1.5 million]

But there’s no turning the corner on losses this quarter, despite Converge, their unified platform, shifting over telehealth visits as planned, and adding SilverCloud, Conversa, and specialty telehealth with musculoskeletal (MSK) and dermatology programs to the totals.

Net loss was ($70.3) million, compared to ($39.8) million, an increase of 77%
Adjusted EBITDA was ($47.1) million, compared to ($26.4) million, an increase of 78%

Amwell’s projected 2022 is the same–growth mixed with financial losses: revenue between $275 and $285 million, adjusted EBITDA between ($200) million and ($190) million.

Inquiring investors may very well ask when Teladoc and Amwell, now smaller by a factor of just over 9, will ever be profitable. Mr. Market had its say over the past year, from a high of $14.26 in early June 2021, to today’s close of $3.09, an enterprise valuation loss of $11.17 or 78%, just a little better than Teladoc’s 81% in the same period. It will likely be no time soon. But the shares may be an excellent opportunity at a low cost. Yahoo Finance, FierceHealthcare, Becker’s 

Crossover Health, a hybrid virtual/in-person primary care practice group, announced that they would be opening new centers in Seattle, Austin, and another one in New York this year. Their virtual care operates in all states, while their in-person footprint consists of 41 health centers in 11 states which are generally about 5,000 square feet. They have 33 on-site clinics for employers, which are a combination of exclusive to one company and shared, and in total cover 400,000 eligible employees and dependents including for 115,000 Amazon employees and dependents. In addition to corporate clinics, Crossover offers individual membership plans in a concierge, under one roof type model. FierceHealthcare

In another tech area, med delivery company NowRx is partnering with Hyundai for a limited test of their self-driving cars in the LA area. Hyundai will be using slightly modified Hyundai Ioniq 5 electric vehicles with some autonomous capability, but using a driver. The purpose of the test is to simulate and gather data on autonomous vehicle delivery, such as delivery statistics, dispatch and customer interactions, and feedback. NowRx offers free same-day prescription delivery in the San Francisco Bay area, Orange County, and Los Angeles areas. FierceHealthcare

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

May 6, 2022 | by

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: AON)  Release
  • 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. Release, Mobihealthnews

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

May 4, 2022 | by

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”. 

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

April 6, 2022 | by

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

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

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

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

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

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

April 2, 2022 | by

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

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

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

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

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

March 23, 2022 | by

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

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

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

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

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

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

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

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

March 18, 2022 | by

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

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

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

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

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

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

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

March 17, 2022 | by

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

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

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

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

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

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

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

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

March 10, 2022 | by

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. 

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

March 3, 2022 | by

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

Predictions, predictions, for weekend reading: is telehealth usage shrinking or growing? It depends on your perspective.

February 26, 2022 | by

crystal-ballTwo very divergent views on the future of telehealth were published this week. Bloomberg Intelligence on the economics side is seeing nothing but blue skies for telehealth for the next five years, while predictive analytics shop Trilliant Health crunches their numbers and sees the opposite picture. Trilliant predicts the downward trend, which they first observed in their mid-2021 [TTA 30 June 2021] healthcare report, will continue except in the select area of mental health. Here are their predictions:

In Bloomberg Intelligence’s Digital Reshaping the Health-Care Ecosystem report, their projection is that telehealth by 2027 will be at minimum $17 billion of healthcare revenue. Their target numbers are $20 billion and 15% of outpatient visits with a three-year compound annual growth of 25%. This is based on claims trends they see (we don’t–see our reports on FAIR Health’s claims data) as well as revenue consensus by public telehealth companies such as Teladoc. However, as the report puts it, it cannot completely account for telehealth acquisitions by larger managed-care companies or the extension of telehealth across existing consumer and patient platforms which if anything would increase the picture. 

  • The ‘flywheel’ effect of the pandemic raised awareness of telehealth by both patients and providers
  • Payers have moved aggressively to incorporate telehealth as their members demand it: CVS Aetna with Teladoc, UnitedHealth with NavigatorNOW, Cigna with Oscar (which has $0 co-pay virtual health plans in many states), Cigna-MDLIVE, and others.
  • The ubiquity of mobile phones, smartphones and apps

From the report: “Virtual care will [increasingly] become the norm, we believe, after the pandemic pushed patients away from in-person visits. A reversion to old practices and business models appears impossible to us after the pandemic forced meaningful change across all the key constituents.”  The rest of the report covers international growth in remote patient monitoring, such as continuous glucose monitors (CGM) ($12 billion) and implantable and wearable cardiac monitors, based on similar corporate projections.

Trilliant Health’s Trends Shaping the Health Economy: Telehealth (e-doc and downloadable PDF) takes the opposite view–that telehealth usage continues to shrink inversely to in-person visits being restored.  It questions whether the “forced adoption” of telehealth over the past two years (March 2020 to November 2021) has actually changed patient and provider behaviors. Patients used it then, will they continue to use it in the future? It’s nowhere near a norm with the exception of growth in behavioral health. Demographically, utilization is uneven. Highlight findings:

  • Even during the pandemic, only 25.6% of Americans used telehealth over the tracking period
  • 46% of telehealth patients used it only once
  • The total addressable market for telehealth is <1% of the health economy and declining, because most prefer in-person care
  • Monthly usage continues to decline even with Covid variants
  • Primary care visits continue to decline as well, but telehealth does not fill that gap
  • The type of telehealth usage hasn’t shifted much, with audio-video leading the way with over 60% share
  • 57.9% of telehealth visits were attributed to behavioral health diagnoses and is growing in share–and this has not changed pre/post-pandemic
  • Between 2020 and 2021, 79% of telehealth patients had between one and four visits. But less than 3% of telehealth patients
    were “Super Utilizers” with 25 or more telehealth visits. And they’re younger–aged 21-36, female (58%), and live in high income areas.
  • The psychographics of telehealth users is interesting. They are not the ‘Priority Jugglers’ of busy moms and hipsters you’d expect, accounting for 15% of users. 30% are “Willful Endurers” who live in the “here and now” and presumably turned to telehealth when they just couldn’t ignore an illness anymore, followed at 25% by their opposites–“Self Achievers” who are very proactive about their health and wellness.
  • Most niche telehealth entrants are targeting the same discrete markets, like women, who will continue to use telehealth
  • Most providers are not equipped to continue to provide telehealth, versus retail suppliers like CVS, Walmart, and Walgreens
  • Public policy calling for permanent expansion of access is inconsistent with actual low telehealth utilization in the past two years, where in-person visits were limited, Medicare and insurance restrictions were put aside, and providers expanded availability

The report looks at all forms of synchronous and asynchronous telehealth modalities–the latter often lost in the shuffle–concentrating on synchronous audio-video and audio-only, plus asynchronous interactions such as email. This is a 69-page report worth your ponder; there are charts and graphs that lighten the load of their conclusions, which directionally seem to fit what this Editor has been seeing in since last autumn. Hat tip to Sanjula Jain, chief research officer of Trilliant. Also Healthcare IT News

The shoe dropped: DOJ sues to block UnitedHealth Group-Change Healthcare merger. What’s next?

February 25, 2022 | by

To nearly no one’s surprise, the US Department of Justice did what was reported back on 17 Jan: block UnitedHealth Group’s (UHG) bid to acquire Change Healthcare on anticompetitive grounds. Earlier today, the DOJ issued their statement in a release on the joint civil lawsuit with the attorneys general of New York and Minnesota. (This Editor finds the New York AG participation interesting, as Change is HQ’d in Nashville, Tennessee with UnitedHealth in Minnesota. The usual grounds are state interest and commerce.)

The reasons cited will also not come as any surprise to our Readers, as these objections were raised from the start in that the acquisition would give UHG an unfair advantage against their payer competition and squelch innovation. These are from the DOJ release and the complaint filed today (24 February) in the US District Court for the District of Columbia.

  • UHG is the US’ largest insurer and also a major controller of health data. Change is a major competitor to UHG/OptumInsight in health care claims technology systems, which was the basis of the American Hospital Association’s (AHA) objections.
  • The acquisition would eliminate a major competitor to UHG in claims processing. Moreover, 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.
  • UHG would be able to view competitors’ claims data and other competitively sensitive information through Change. “United would be able to use its rivals’ information to gain an unfair advantage and harm competition in health insurance markets.”

The plaintiffs–DOJ, New York, and Minnesota–conclude with a request of the court to 1) enjoin (stop) the acquisition and 2) award restitution by UHG and Change for costs incurred in bringing this action.

Consider this acquisition one for the books–the one embossed ‘Nice Try, But No Dice’. 

So what’s next? Here’s your Editor’s speculation.

Change is one of the ‘shaggiest’ independent companies in healthcare, in so many businesses (many acquired) that it’s hard to understand exactly what they stand for. It has extensive businesses not only in the areas above that will nix the UHG buy, but also in imaging, data analytics, clinical decision making, revenue cycle management, provider network optimization and related solutions, pharmacy benefits, patient experience in billing and call centers, funding healthcare….and that’s just the surface of a giant list. From the outside, it’s hard to see how all these parts coalesce.

In the industry, Change was long rumored to be for sale. Recently, it’s become unprofitable. It closed its FY 2021 (ending 31 Mar 2021) with a $13.1 million loss and through Q3 FY 2022 with a $24.5 million loss.

At the end of this, Change may be better advised to sell off some of its businesses, retrench, and refocus on its most cohesive and profitable areas. 

Thursday news roundup: Teladoc’s cheery 2021, uncertain 2022; DOJ deadline UnitedHealth-Change Sunday, Cerner’s earnings swan song, Humana feels the activist lash; funding/M&A for WellSky, Health Catalyst, Minded, Automata, MediBuddy

February 24, 2022 | by

Teladoc closed 2021 on Tuesday with record revenue of $2,032.7 billion, 86% over 2020. Visits were up 38% to 15.4 million with 53.4 million paid members. Q4 revenue was $554.2 million, 45% over Q4 2020, all of which exceeded investors’ expectations. Despite moving to a positive cash flow of $194 million, Teladoc is still not profitable, with full-year losses of almost $429 million and net loss per share of $2.73, somewhat lower than 2020.

The outlook for 2022 is less certain. For the full year, they anticipate a nice rise in revenues to $2.55 to $2.65 billion but a net loss of $1.40-1.60 per share, a little more than half 2021. Paid membership they project will grow to 54 to 56 million. The stock did take a bit of a bath due to market uncertainty with Ukraine-Russia and also a lowered forecast for first quarter. Teladoc earnings release, Healthcare Dive

DOJ has till Sunday 27 February to sue to stop the UnitedHealth acquisition of Change Healthcare. The acquirer and acquiree popped their 10-day notice on 17 February through their 8-K filing with the SEC. They had previously agreed to hold their closing until after 22 February. So if the DOJ is going to block the deal, as has been reported [TTA 17 Feb], they have from today to Sunday to do it–and courts aren’t open Saturday and Sunday. Healthcare Dive, Becker’s Health IT

Cerner’s 2021 swan song kind of… honked. Their net loss for the year was $8.8 million in 2021, compared with a net income of $76.9 million in 2020. Total net earnings topped $555 million in net earnings in 2021, down 29% from $780.1 million in 2020. Cerner release, Becker’s. Meanwhile, Oracle’s acquisition high hurdles continue [TTA 11 Feb] with the Feds, passing the first mark of the Hart-Scott-Rodino Act waiting period as of 11.59pm on 22 February. Still to go is the SEC review of Oracle’s tender offer for Cerner shares.  Becker’s Health IT

Humana joins Centene in insurers forced to change by activist shareholders. Starboard Value, a hedge fund, reached an agreement with Humana that Humana would add two independent board directors backed by Starboard. The first will be named on 21 April with the second to follow. They replace incumbents who will not stand for re-election. Starboard owns 1 million Humana or 0.79% of shares, but is well known for wielding them effectively to leverage change when the business hits a pothole–Humana’s $14 million Q4 loss and Medicare Advantage losses to both traditional rivals and insurtechs.

Humana is standing by its 2022 projection of 11-15%  growth but slowing performance in large areas such as Medicare Advantage. The company has stated that they will funnel funds back into Medicare Advantage through its “value creation plan”, which sounds very much like Centene’s “value creation office”. You’d think they’d come up with cleverer names and less anodyne ‘strategies’ for extracting savings from these lemons wherever possible, including selling off assets and “optimizing its workforce”. Reuters, Healthcare Dive

And quick takes from the US, UK, and India…

WellSky is acquiring TapCloud for an undisclosed amount. WellSky is a data analytics and care coordination automation company in the acute care and home care markets, with TapCloud a patient-facing engagement and communication platform. Release

Another data analytics company, Health Catalyst, is bolstering capabilities with its agreement to buy KPI Ninja, a provider of interoperability solutions and population health analytics. Purchase price and management transitions undisclosed, though from the release it appears that all KPI Ninjas will be onboarded.

Minded, a NYC-based mental health med management company, scored $25 million in seed funding from Streamlined Ventures, Link Ventures, The Tiger Fund, Unicorn Ventures, and private individuals. They provide direct-to-patient behavioral health medications through virtual evaluations with treatment plans without in-person visits, which are still unusual in psychiatry. At the present time, it is available only in New York, New Jersey, Pennsylvania, Florida, Texas, Illinois, and California.

The founders are an interesting mix: David Ronick, who previously co-founded fintech unicorn Stash, Gaspard de Dreuzy, the co-founder of telehealth company Pager, and Dr. Chris Dennis, a multi-state licensed psychiatrist. Their rationale for founding the company does resonate with this Editor, whose brother is a board-certified MD psychiatrist, and who knows well 1) the challenges of remote therapy and 2) the scarcity of psychiatrists in most of the US beyond urban and academic areas. Release, TechCrunch, Mobihealthnews

In the UK, London-based Automata, which automates lab technology to shorten turnaround time and scale up lab capacity, along with deploying automation with contract research organizations, research labs, and blue-chip healthcare institutions, announced a $50 million (£36.8M) Series B raise. The round was led by Octopus Ventures with participation from returning investors Hummingbird, Latitude Ventures, ABB Technology Ventures, Isomer Capital as well as strategic investors including In-Q-Tel. Mobihealthnews

From Bangalore, India, virtual health company MediBuddy $125 million Series C funding was led by Quadria Capital and Lightrock India, bringing their total funding to over $191.1 million, a hallmark of a largely bootstrapped company. MediBuddy uses a smartphone app for 24/7 real-time video doctor consults and at-home lab testing covering the family and in more than eight languages, important in India which has hundreds of languages and local dialects. Great smiles on the founders too! Mobihealthnews

Will ’22 digital health investment be historic? Or a question mark? The jury is out.

January 29, 2022 | by

Some say historic, or will it be a historic question mark? It’s only January…Earlier this month, a Silicon Valley healthcare VC funding analysis [TTA 14 Jan] looked at 2021 funding — up over 150%–that was skewed to biopharma and health tech. It noted the SPAC slowdown, anemic post-IPO performance, and a decline in M&A value, while consolidation and buying for expansion will be the trend.

Healthcare Dive spoke to some industry mavens, and came up with a split picture. Some see turbulence ahead due to rising interest rates, a fluctuating market, and political instability leading to tighter purse strings, others see blue skies and lots of money flooding in from new investors in love with health, following the Amazons and Microsofts, fearing that they’ll miss out. Certainly, 2021 was more than warm. Both Silicon Valley Bank in the previous analysis and Rock Health came up with just under $30 billion in 2021 investment.

The feather in the wind: Rock Health’s numbers indicated skyrocketing exits–with SPACs nearly double that of IPOs. Funding hit record mega rounds of $100 million+ that spread to early rounds–10 Series B and one Series A. Mega money means mega pressure to perform in young companies. The SPAC highway increasingly narrowed to a two-lane road by end of year based on regulatory scrutiny and even some timing out (SPACs have to consummate a deal in two years). Exits for investors are to take back money or write off losses, if they get shaky about a company or category, even if they find a more attractive squirrel. Yet the fact is that $13 billion raised by VCs this month has to go somewhere–but will it be in health tech? Time will reveal all.  Also Healthcare Dive on the Rock Health year-end report.