News briefs: ResMed-Verily’s Primasun sleep solution; Maven Clinic’s $90M Series E; Mount Sinai genomics spinoff Sema4 lays off additional 500, exits women’s health

November 16, 2022 | by

The large conference HLTH is underway in Las Vegas and like pre-Covid, conferences are a platform for announcements. Verily, which is Alphabet’s (Google’s) life sciences and health skunk works, and ResMed, a large company in respiratory medical devices for sleep apnea and sleep disruption treatment, have formed a joint venture, Primasun. Their target market is employers and providers to identify patients at risk for sleep disorders, particularly obstructive sleep apnea. About 75% of those in the US experience some form of sleep disruption at least a few times a week, leading to behavioral and physical problems. Mobihealthnews has the basic information on the launch but also some side information on Verily. Back in September, alongside a $1 billion raise to fund precision health, controversial founding CEO Andy Conrad announced he was stepping down effective in January 2023, replaced by current president Stephen Gillett. Dr. Conrad survived a brace of bad press back in 2016 [TTA 6 Apr 2016] and multiple ups and downs in the past six years.

Maven Clinic, a virtual care company targeting women and families, bucked the trends and locked up a $90 million Series E financing. Led by General Catalyst, there are nine other investors including La Famiglia, CVS Health Ventures, and Intermountain Ventures, bringing total funding to just under $300 million (Crunchbase) and unicorn valuation last year. Maven focuses on women’s health journey from fertility through menopause. The company claims to host 15 million members through primarily companies and health plans, and has contracts with half of the Fortune 15. Recently, they launched a menopause and ongoing care program with 1.2 million lives covered across 150 employer clients.  Release, Mobihealthnews  Notably, General Catalyst has been a bullish funder of both US and UK health systems such as Banner Health, Cincinnati Children’s Hospital Medical Center, Hackensack Meridian Health, HCA, and Intermountain Health, along with Guy’s and St Thomas’ NHS Foundation Trust in the UK. Mobihealthnews

Unfortunately, Mount Sinai spinoff Sema4 continues to cut back and restructure. Their latest round of layoffs affects 500, or 32.5% of its workforce. Sema4 will be exiting its reproductive and women’s health testing business and shuttering operations located in Stamford, Connecticut by end of Q1 2023. Going forward, they will concentrate operations in Maryland. In August, they discharged 250 staff, about 13% at that time, including its founder from both the president and director slots. With this latest restructuring, their workforce has been reduced to 1,100. Their release states that they will concentrate on their high growth, high margin pediatric and rare disease business using whole exome/genome diagnostic testing, achieve annual revenue growth in excess of 20%, and reach profitability by 2025. MarketWatch, Becker’s, Mobihealthnews

Yes, Virginia, there is an Amazon Clinic, after all; stripped down, non-face-to-face consults for common conditions

November 16, 2022 | by

On the move while Care is shutting down and OneMedical is not yet onboard as awaiting Federal approvals, Amazon Clinic’s premature leak generated press for the service’s formal debut on Tuesday. The leak was remarkably accurate [TTA 11 Nov] in describing it for the New York Minute it was up. According to their introductory blog, Amazon Clinic will operate in 32 US states (not specified, but a quick check indicates it’s not available in Alaska and New Hampshire). It provides message-based virtual care for more than 20 common health conditions, such as allergies, acne, eczema, UTIs, and hair loss. (The website lists conditions covered and prescription renewals for previously diagnosed conditions such as asthma, hypothyroidism, high cholesterol, and migraine.)

What it is: a stripped-down, questionnaire-driven provider referral platform, enabling a non-face-to-face telehealth consult or prescription renewal. It’s not clear from available information whether the messaging is synchronous, asynchronous (delayed), or a combination of both. This certainly sounds less ambitious than the home-based delivery/enterprise membership model of Amazon Care. How Clinic works:

  • Select your condition
  • Pick your preferred provider from a list of licensed and qualified telehealth providers. Costs and if available in your state are disclosed in the selection process.
  • Complete intake questionnaire
  • Connect with clinician through a secure message-based portal
  • After the message-based consultation, the clinician sends a personalized treatment plan via the portal, including any necessary prescriptions to the customer’s preferred pharmacy including Amazon Pharmacy. Here, costs may be covered by insurance.

As Care was, payment is upfront as Amazon doesn’t accept insurance. The cost of consultations will vary by provider and condition but tend to be in the $40 – 50 range. This includes ongoing follow-up messages with the clinician for up to two weeks after the initial consultation. Some conditions, such as rosacea, require a prior diagnosis.

In addition, the services provided are available only to those aged 18-64, which strikes this Editor as discriminatory for those 65 and over who can well pay cash and might prefer a ‘visit lite’.

No mention of whether those laid off at Amazon Care or through the rest of Amazon (10,000 announced) can apply for jobs with this new service; it sounds largely referral, highly automated, manageable, and not requiring heavy oversight. The last can be a problem all its own. TechCrunch, Mobihealthnews, CNBC

Short takes: Will there be an Amazon Clinic?, Transcarent and Teladoc, perfect together?, Get Well partners with Palomar Health, expands with Veterans Health Administration

November 11, 2022 | by | 1 Comment

Did Amazon prematurely leak an initiative? Or was it an error? The Verge reports that a video was uploaded to Amazon’s YouTube page on Tuesday–then taken down–describing a new service that would offer assessment, diagnosis, and treatment of common conditions such as allergies. The Amazon Clinic video depicts a user taking an online questionnaire about their symptoms, After paying a fee, a clinician reviews it, diagnoses, and prescribes as needed, sending to the patient’s pharmacy. The disclaimer: “Telehealth services are offered by third-party healthcare provider groups.” The video directs to amazon.com/clinic which is not live. Another Amazon Mystery. Amazon Care is shuttering and the company is jumping through Federal hoops to get approval to close their buy on OneMedical. Hat tip to HISTalk today.

HISTalk also pointed to a Forbes article on health navigator companies such as Castlight and Firefly Health, with a bit of a ‘sting’ at the end. Transcarent, a health navigator that takes on risk integrating its services into employee benefits, is the latest enterprise founded by Glen Tullman, a serial entrepreneur who founded Livongo, investor group 7Wire Ventures, and built up Allscripts as CEO. The writer speculates that Tullman should buy Teladoc to give Transcarent a distribution system–a built-in network of physicians and health system relationships. Yes, this is the same Teladoc that Tullman sold Livongo to for a tidy $18.5 billion, then earlier this year wrote off $6.6 billion as an impairment. This one drips with irony. With its stock down nearly 90% from its January 2021 high, it’s never been cheaper!

Get Well, an RPM, patient care management, and workflow automation company, announced new and expanding partnerships. The new one is with Palomar Health, a health system in Escondido, California. This will implement Get Well services in four phases in five areas to improve patient experience: digital care management (GetWellLoop), inpatient experience (Get Well Navigator and a workflow automation for hospital staff), emergency department experience, care gap closure, and health equity through additional features. Becker’s  The second is an expansion with the Veterans Health Administration (VHA) into 70 Veterans Affairs Medical Centers (VAMC) and a fifth Veterans Integrated Service Network (VISN) with nine facilities. They also now have a FedRAMP “In Process” designation for cloud services which is enabling expansion of GetWellLoop care plans with a VAMC. Release (Business Wire)

Figuring out the future for health tech after 2022’s realignments: new SVB study

November 10, 2022 | by

As Readers who subscribe to our Saturday Alerts (repeated on Wednesday) have seen, this Editor has dubbed this season Realignment Autumn. From the fever pitch of funding, hiring, inflated valuations, SPAC funny money, and unrealistic expectations that started in 2020 and peaked in 2021, we in the industry are now fretting that we can’t get back to 2019 or 2020. Part of the new reality is that telehealth and health tech are far beyond that point in tech integration, ease of use, and takeup by enterprises, but has entered an uncertain business period more than a bit overextended and overexpecting. Unprofitable lines and side businesses, however promising, are being dropped or sold. Talented people who helped to start them are gone. The trend toward consolidation, which started last year, is accelerating.

For a more financial and data-oriented view, Silicon Valley Bank’s latest, “The Future of Healthtech 2022”, does not disappoint. This is a far deeper dive than served up by Rock Health, StartUp Health, and (unless you are a subscriber) CB Insights. This is a US and EU (including UK) view of how investment patterns have shifted, and a look at where investment may be going next year.

So far in 2022 they have seen:

  • Lower valuations and plummeting share value of public companies
  • A shift from ‘growth at all costs’ to a clear value proposition and creation: improving health outcomes, access or affordability.
  • Investments are more modest and at earlier stages–no more blockbuster Series Ds and Es (40% decline in mega-rounds of $100 million+)
  • No IPOs so far
  • Only 18 unicorns formed this year
  • M&A still rising at the right price
  • Companies have to deliver measurable value to continue driving innovation

Through 30 September, SVB tracked investment at $23 billion. Where it’s going:

  1. Provider operations: $7.0 billion–defined as technology that improves efficiency and accuracy of provider-provider, provider-patient interactions
  2. Clinical trial enablement: $6.8 billion
  3. Alternative Care (includes telehealth and mental health): $5.6 billion
  4. Wellness and education: $1.3 billion
  5. Healthcare navigation: $1.3 billion
  6. Medication management: $833 million
  7. Insurance: $117 million

Sections drill down on these sectors and subsectors such as mental health and women’s health, including an analysis of female-founded health tech companies, investors by sector, and a historical view of unicorns. Grab a cuppa and take your time with this one!

Oracle proceeds with $7B bond sale to restructure debt funding Cerner buy

November 10, 2022 | by

As expected at end of October, Oracle is refinancing debt incurred to acquire Cerner. Bloomberg reported the bond sale is in as many as four parts. “The longest portion of the offering, a 30-year note, yields 2.55 percentage points above Treasuries after earlier discussions of about 3.1 percentage points, said the person, who asked not to be identified as the details are private.” The bridge loan (revised) of $11 billion was further reduced by $1.3 billion. Citigroup Inc., Bank of America Corp., Goldman Sachs Group Inc., HSBC Holdings Plc, and JPMorgan Chase & Co. are managing the bond sale.

Oracle has one of the highest debt loads in tech, exceeding $90 billion. Fitch Ratings has downloaded their bond rating from BBB+ to BBB overall, the next to lowest investment grade rating. The new notes were rated BBB by Fitch and S&P Global Ratings. An investment company queried by Bloomberg noted that as recently as 2020, Oracle’s debt was rated high A. Also Becker’s.

News roundup: cybersecurity benchmarking study, Tyto Care’s Home Smart Clinic, Long Island’s $2.6B life sciences hub, Singapore’s Speedoc raises $28M, NantHealth’s sinking feeling, Hims & Hers revenue up 95%

November 10, 2022 | by

Censinet, the American Hospital Association (AHA), and KLAS Research announced at industry confab CHIME22 Fall Forum a benchmarking study on health system cybersecurity. The study, currently enrolling hospital and health system participants, according to the release will enable a comparison of cybersecurity investments, resources, performance, and maturity to peer organizations across key operational cyber metrics. It will also cover NIST Cybersecurity Framework (NIST CSF) and Health Industry Cybersecurity Practices (HICP). Censinet provides healthcare risk management solutions, consolidating enterprise risk management and operations capabilities. Hat tip to HISTalk 9 Nov.

TytoCare’s latest is the rollout of the Home Smart Clinic, a platform that combines TytoCare’s FDA-cleared handheld for remote physical exams; Tyto Insights, their AI-powered diagnostic support that aids diagnosis in remote physical exams; Tyto Engagement Labs, a suite of user engagement services including behavioral science-backed blueprints, consulting services, and marketing tailored to each specific program and cohort; and support for multiple provider models and different patient populations. The new platform is targeted to health plans and providers. Release (Yahoo)

Long Island NY’s proposed Midway Crossing project, creating a life sciences hub in quaintly named Ronkonkoma, would cost about $2.55 billion, but create an estimated 4,300 science, technology, engineering, and healthcare positions. They’d also be lucrative, with salaries mostly well over $100,000 a year. The proposal was authored (sic) by Michael Dowling, president of Northwell Health, and James Hayward, PhD, president and CEO of Applied DNA Sciences, and appeared in Newsday (paywalled). Its 179 acres would include a STEM educational center, research labs, biotech manufacturing facilities, health care offices, a hotel and convention center plus connect to the LIRR and Long Island-MacArthur airport. While approved by local authorities, it now needs funding. Becker’s

Traveling to the far Pacific…Speedoc, a home health company based in Singapore, raised $28 million. Speedoc offers app-based video consults and home visits, non-emergency ambulance transport, and remote monitoring for several chronic conditions. It is available in nine cities in Singapore and Malaysia. According to Mobihealthnews, it is also one of the technology partners for the two-year pilot of the Mobile Inpatient Care@Home initiative by the Ministry of Health’s Office for Healthcare Transformation. The pre-Series B funding round was led by its new investors Bertelsmann Investments, Shinhan Venture investment, and Mars Growth. Vertex Ventures Southeast Asia & India, which led its $5 million Series A funding round in 2020, also participated. 

Our Readers with very long memories will remember that transformative health darling, NantHealth. This Patrick Soon-Shiong NantWorks company, originally in genetic sequencing for cancer research, was caught en flagrante in a ‘pay to play’ scheme with the University of Utah funding NantHealth and providing data that would prove useful to other Soon-Shiong companies [TTA 18 April 2017]. It’s long since pivoted to payer/provider data solutions (NaviNet). What’s not improved is their bottom line. It lost $13.7 million, or $0.12 cents per share, increasing loss by 26% from 3Q 2021. Shares on NasdaqGS are trading at $0.31. Yahoo!Finance/SimplyWallSt. Another tip of the cap to HISTalk 9 Nov.

And who said all of telehealth is suffering? Online direct-to-consumer marketer Hims & Hers posted a third consecutive $100 million+ quarter in revenue. Their Q3 revenue was up 95% versus Q3 last year, reaching $144.8 million. They also gained 70,000 new online subscribers for a total of 991,000, up 80% year over year. Q4 guidance is up to $159 million to $162 million, with a full-year revenue forecast of $519 million to $522 million. And yes–they’re profitable. Their embarrassing TV spots notwithstanding, they seem to have found The Magic Formula. FierceHealthcare

VillageMD opens the Walgreens purse, set to buy Summit Health for $8.9B

November 9, 2022 | by

Moving from rumor to deal in a New York Minute. Primary care provider VillageMD has moved to a definitive agreement to acquire specialty/urgent care provider Summit Medical in an $8.9 billion deal including debt. This was heavily rumored last week [TTA 1 Nov]

This will create a provider behemoth of 680 provider locations, 750 primary care providers, and 1,200 specialty care providers in 26 markets. The fun facts:

  • VillageMD has 342 total primary care clinics in 22 southern and northeastern markets covering 15 states, with 152 co-located with Walgreens; these will eventually increase to 200.
  • Summit Health has 370 locations in New York, New Jersey, Connecticut, Pennsylvania, and central Oregon. VillageMD and Summit do not overlap (except in NJ) on markets.  
  • VillageMD consists of primarily owned and affiliated primary care practices; Summit Health specialty practices (neurology, chiropractic, cardiology, orthopedics, dermatology) plus 150 CityMD urgent care locations.
  • VillageMD has successfully mastered value-based care models in Medicare and entered advanced Medicare ACO models early and vigorously (Editor’s information). Summit Health presently is primarily is fee-for-service with some participation in value-based programs.

The participation in this one is interesting: 

  • Walgreens Boots Alliance (WBA) will invest $3.5 billion through an even mix of debt and equity 
  • Cigna’s health services organization Evernorth will become a minority owner; the exact percentage is not disclosed at this point
  • It’s not disclosed at this time whether Summit Health’s current majority owner, Walburg Pincus, will retain an interest in the combined companies. 

WBA remains the largest and consolidating shareholder of VillageMD, but with this acquisition, reduces its ownership share from approximately 62-63% to 53%. WBA’s other US non-retail healthcare interests include specialty pharmacy company Shields Health Solutions and at-home care provider CareCentrix.

Based on their release, the acquisition is expected to close in January 2023, subject to the usual Hart-Scott-Rodino Act (HSR) premerger notification and report with the DOJ and the Federal Trade Commission (FTC) that initiates a 30-day waiting period.

Bet on VillageMD and Summit closing deeper into Q1–but closing. This Editor’s over/under is that this is overly optimistic given the current DOJ and FTC’s scrutiny and apparent dislike of healthcare acquisitions, even though the provider groups don’t overlap except in a minor way in NJ. But perhaps Amazon, with a healthcare footprint primarily in pharmacy and shuttering Amazon Care, thought OneMedical would move smartly. CVS thought the same with Signify Health, yet both are on information Second Requests that extend the waiting period. DOJ is after all smarting hard with a Federal District Court nixing their challenge of UHG’s Optum with Change Healthcare, but it’s hard to throw typical antitrust at this one.

Go big or go home, indeed.     Healthcare Dive, Becker’s

J.P. Morgan forms life sciences/healthcare VC group; virtual care Ovatient formed by MUSC Health, MetroHealth; Oracle’s putting lots of KC office space on market

November 2, 2022 | by

Some more good news in healthcare–maybe a bit of spring in autumn?

J.P. Morgan is setting up a new venture capital team to invest in life science healthcare companies. The new group, Life Sciences Private Capital, will sit within J.P. Morgan Private Capital. Investments will be in early and growth-stage companies developing novel therapeutics and technologies in several target areas including genetic medicine, oncology, neurodegenerative disease, rare diseases, autoimmunity, AI/ML platforms, metabolic diseases, and neuropsychology. Heading the group is Dr. Stephen Squinto as Chief Investment Officer and Managing Partner. He joins from OrbiMed Advisors, and previously co-founded and built numerous biotechnology companies including Alexion Pharmaceuticals plus being a scientific founder of Regeneron Pharmaceuticals. Also joining are Dr. Gaurav Gupta and  Anya Schiess with experience at OrbiMed and Healthy Ventures respectively, as well as a prestige group of advisors. JPM press release, Becker’s. 

The Medical University of South Carolina health system (MUSC Health) and The MetroHealth System (MetroHealth) are partnering in a joint venture for virtual and in-home care. From the press release, Ovatient is designed to improve the care experience by linking patients to the delivery of virtual and in-home care via a platform that connects to health systems and acute or procedural care, eliminating fragmented care experiences. The JV also intends to sell the platform to other providers. Other health systems are either joining forces with virtual care providers and AI platforms or forming their own, such as NYC’s Hospital for Special Surgery with their RightMove virtual MSK spinoff, and Northwell Health. MetroHealth release, Mobihealthnews

And if you’re a company looking for luxe office space, Oracle’s putting a lot of it on the market. Granted, it’s in Kansas City, but it’s two buildings: the former Cerner World Headquarters in North Kansas City and a separately located Realization Campus in KC. Current onsite employees will be consolidated at the fairly new Innovations Center in KC by 30 November, which has a substantial 2 million square feet of space. The health clinic part of WHQ will close as well, but not the data centers–at least for now. (A gargantuan task!) Both WHQ and Realization, according to the Oracle Cerner thread on Reddit, have been largely unused since 2020, the pandemic, and Cerner’s transition to a hybrid workforce. Cerner had from 2021 been reducing KC-area office space which had been funded locally by $170 million in sales tax and revenue bonds. The downside is once moved, how many will remain? Oracle reportedly has been considering $1 billion in cuts and is busily refinancing its debt incurred by the Cerner purchase [TTA 27 Oct]. Ridding itself of empty office space is actually a good start, versus cutting heads–a bad move as Oracle tries to save Cerner at the VA and MHS. HealthcareITNews, HISTalk, KSHB 41

VillageMD considering $5-$10B merger with Summit Health provider group: reports

November 1, 2022 | by

Two large provider groups, VillageMD and Summit Health, reportedly are considering a merger. VillageMD, which now is majority owned (62%) by Walgreens Boots Alliance, has 342 total primary care clinics in 22 southern and northeastern markets covering 15 states, with 152 co-located with Walgreens eventually increasing to 200. Summit Health has 370 locations in five states, including specialty practices and CityMD urgent care locations. Summit Health is majority owned by Walburg Pincus.

This reinforces a trend of cross-healthcare sector buys, consolidations, and control. VillageMD’s move from a co-location deal with Walgreens to majority ownership (but controlled by an independent board) was one step starting during the pandemic in July 2020 [TTA article series here].

  • Amazon agreed to acquire OneMedical (1Life) for $3.9 billion at the end of July, and abandon Amazon Care, though now running into FTC/DOJ review headwinds with a second request for information [TTA 15 Sep].
  • CVS Health has made no secret of its desire to acquire primary care, provider enablement, and home health companies (Signify Health, also under DOJ scrutiny), but apparently has abandoned or put on hold a deal with Cano Health [TTA 21 Oct].
  • Walmart continues to go direct by opening full-service clinics, announcing the expansion of 16 based in the Tampa, Jacksonville, and Orlando areas in 2023 (Healthcare Dive, Healthcare Finance News).

Valued at $12.9 billion and with Walgreens’ backing, VillageMD has the ‘go big or go home’ resources to execute Walgreens’ version of this strategy.

Why this very well may happen. The two do not overlap (except in NJ) on markets. VillageMD is primarily owned and affiliated primary care practices; Summit Health specialty practices (neurology, chiropractic, cardiology, orthopedics, dermatology) and CityMD urgent care. VillageMD has successfully mastered value-based care models in Medicare and entered advanced Medicare ACO models early and vigorously (Editor’s information); Summit Health primarily is fee-for-service with some participation in value-based programs. More to come. Bloomberg, Becker’s, and a very big hat tip to research from Jailendra Singh of Truist Securities  (paper here)

Telehealth-only follow up increased repeat ED visits by 2.8%, return admissions by 1.1%: JAMA Network study

October 28, 2022 | by

Not good news for telehealth using the ‘lower healthcare utilization’ talking point, if this study is confirmed by others and not an outlier. A study published this week in JAMA Network Open could be dismaying for those advocating a ‘straight line’ view of telehealth as a complete substitute for the in-person visit. The researchers from University of California, UCLA, and the Wharton School – University of Pennsylvania (Leonard Davis Institute for Health Economics) found that telehealth follow-up was “associated with 28.3 more repeated ED encounters and 10.6 more return hospital admissions per 1000 patients compared with in-person follow-up.” In percentage terms, they are 2.8% and 1.15 respectively.

The retrospective study was based on 2 in-system EDs of a single integrated urban academic integrated health system in Los Angeles from 1 April 2020, to 30 September 2021. They sampled over 12,000 patients with close to 17,000 ED encounters who were discharged home, then obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days).

Based on postdischarge follow-up visits:

  • In-person: 1865 (16%) were followed by an ED return visit and 438 (4%) with a hospital admission within 30 days
  • Telehealth:  937 (18%) were followed by an ED return visit and 238 (5%) with a hospital admission within 30 days

The percentage is small in this study, but there, for which there is no substitute for in-person follow-up visits. The study conclusion addressed this with the following points:

  • “Patients with telehealth follow-up who return to the ED might have greater illness severity when they arrive or possibly other medical or social circumstances that prevent ED physicians from being able to discharge them home.”
  • Patients in the study who used telehealth follow-up lived farther from the ED than in-person patients
  • “A potential mechanism to explain increased health care utilization after telehealth visits is the inherent limitation in the ability of clinicians to examine patients, which may compel clinicians to have a lower threshold for referring patients back to the ED for an in-person evaluation if they have any ongoing symptoms.” There is additional discussion of how the lack of a physical examination during telehealth may hamper clinicians in fully evaluating evolving illness or deterioration.
  • “Telehealth is not well suited to evaluate specific concerns, such as chest pain, abdominal pain, or shortness of breath, which represent a large proportion of post-ED follow-up visits” based on two other qualitative studies.
  • “The association of telehealth with increased health care utilization warrants further study to evaluate its appropriateness as modality for post-ED follow-up.”

Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department (JAMA Network Open–PDF, online link)

Pre-weekend short takes: Teladoc posts much smaller Q3 loss, 17% revenue boost; is telehealth threatening disability care quality; $2.8M for Australian wearables; more healthtech layoffs at Antidote, OrCam, Ada Health

October 28, 2022 | by

Teladoc today (27 Oct) beat Wall Street consensus in reporting revenue of $611.4 million, a 17% increase versus prior year. It also reduced its per-share losses to 45 cents per share ($73.5 million) versus last year’s Q3 loss of 53 cents ($84.3 million) and Q2’s stunning $3.1 billion loss due to goodwill impairments from the Livongo acquisition [TTA 30 July]. Powering today’s stock bump (6.5% to $28.47) was primarily loss reduction from the prior quarter zeroing out the goodwill impairments and lower net interest expense. Motley Fool, Mobihealthnews

Disability groups are expressing concern that incentives to promote telehealth may be discriminatory. The concerns are primarily around the need for in-person care.  Groups such as the American Association of People with Disabilities admit that telehealth can benefit the disabled, but are wary of a swing towards telehealth as a cost-saving measure versus in person. Federal data confirms that Medicare beneficiaries due to disabilities use telehealth at about twice the rate of age-eligible Medicare beneficiaries. There’s also concern about how the disabled can access and use telehealth platforms, as well as the quality of assessment during the virtual visit. POLITICO.

The Australian government is funding three five-year projects using wearable sensors for activity and diagnostics. The US$2.8 million will go to Curtin University for monitoring activity in children with cerebral palsy who are unable to walk (US$950,000), University of New South Wales for a cuffless blood pressure for hypertension monitoring (US$1.2 million), and Bond University for a project combining data from wearable devices and medical records for Type 2 diabetes patients (US$700,000). Mobihealthnews

More healthcare tech layoffs confirm that VC Elvis has left the building. The tech downturn has hit Israel-based startups particularly hard, but Europe is also affected. This is despite fundings for two of them earlier this year.

  • Pinkslipping over a third (23) of its employees is telehealth platform Antidote Health. Based in Tel Aviv and New York, the layoffs hit primarily R&D staff in Israel. Antidote in March closed a $22 million Series A, bringing total funding to $36 million (Crunchbase). Antidote offers telehealth primary care, mental health, and hypertension chronic care as well as featuring sinus, tick bite, and UTI treatment on its website. The platform connects users to a network of about 100 doctors with a smart chatbot and through video calls. Their target audience is uninsured and underinsured people. Calcalist CTECH, Mobihealthnews   
  • Larger OrCam in Jerusalem is laying off about 16% (62) of staff, again primarily in Israel, as part of a reorganization. OrCam develops devices to help blind or visually impaired people read and navigate daily life more easily via AI. OrCam has over $86 million in funding through a Series A and three venture rounds (Crunchbase), the last in 2018. A planned 2020 IPO valuing the company at $3 billion never happened. The company also has offices and staff in New York, London, and Cologne. Calcalist CTECH, Jewish Business News

Berlin, Germany-based Ada Health also pinkslipped 50 people. According to a spreadsheet linked on Layoffs.fyi, most of the layoffs are in Europe and the UK in tech and product development, with others in marketing and medical. Ada has a medical assessment app that claims 10 million users and 25 million assessments. Employees are based in the US, London, and within Germany. Most recent funding was in March from a $30 million Series B, adding to a 2021 Series B of €74 million funded by Bayer (Crunchbase).

News updates: Theranos’ Holmes goes ‘mental’ in last ditch defense; troubled Cerebral telemental health fires another 400

October 26, 2022 | by

Blood out of a rock? The Holmes’ defense goes ‘mental’ with Dr. Adam Rosendorff. Reduced to a limited hearing before Judge Edward Davila and the US District Court in San Jose, where Rosendorff not only reaffirmed his testimony but also explained the circumstances around his visit to the home, the Holmes defense filed a motion on Monday, citing an obscure interview published in September by the South African Jewish Report to cast doubt about the veracity and credibility of his testimony. Rosendorff, who was born in South Africa, recounted to the interviewer that the stress from blowing the whistle on Theranos led to a “breakdown, medication, hospitalization, and health problems.”

Rosendorff also stated in the interview that by the time the trials (Holmes and Balwani) were scheduled in early 2020, he was off medication. The trials finally took place in 2021 (Holmes) and this year. When questioned last week by defense lawyer Lance Wade about his mental state, his response was that “I’m finding this line of questioning to be invasive.” and that his “mental state was solid” when he drove to Holmes’ home wanting to speak with her. The prosecution objected to the questioning and Judge Davila upheld it.

The prosecution’s response to the defense filing is that the court record “contains no indication whatsoever that Dr. Rosendorff suffered from a mental health issue that affected his ability to serve as a reliable witness,” and that “newly raised and uncorroborated insinuations about Dr. Rosendorff’s mental health do not justify discounting his testimony or granting a new trial.”

The Mercury News’ money quote from New York defense lawyer Jennifer Kennedy Park: “I think the judge already made the decision that this is not relevant.” Another lawyer quoted, former Santa Clara County prosecutor Steven Clark, said that the stress can be difficult but that it apparently didn’t affect Rosendorff’s capacity to testify–and that he was consistent across two trials.

Unless Judge Davila decides to delay–not likely given the above and the pending sentencing for both Holmes and Balwani–or there are additional magic ‘rabbits out of hats’, Holmes’ sentencing remains scheduled for 18 November, Balwani’s later this year.

And speaking of mental health, beleaguered telemental health provider Cerebral let go of 400 more staff, or another 20% of their remaining workforce. This follows a layoff of ‘hundreds’ of contractors, including nurse practitioners who did counseling and support staff, at end of May. Cerebral is ‘restructuring’ under a new CEO, David Mou, who replaced CEO and co-founder Kyle Robertson  forced out by the Cerebral board after the first round of investigations by the Department of Justice (DOJ) on over-prescribing of controlled substances and the subsequent defection of CVS Health and Walmart, as well as Truepill on mail fulfillment. Their statement cites “operational efficiencies while prioritizing clinical quality and safety across the organization.” Cerebral had at its peak in the spring 4,500 employees.

In addition to the DOJ investigation, the FTC is investigating Cerebral for deceptive advertising [TTA 1 June] and a former VP of product and engineering, Matthew Truebe, is suing for wrongful dismissal, further exposing the inner workings of the company [TTA 16 June]. Employees have gone public with tales of pushing prescriptions to 95% of patients, disregarding state regulations, and generally Running Wild over any semblance of clinical probity [TTA 29 June]. Certainly Softbank cannot be delighted at the rolling crackup of their once-valued $4.8 billion baby for which they’ve led funding of over $426 million. TechCrunch, Healthcare Dive.

Meta Pixel ad tracker collects another 3 million data breaches at Advocate Aurora Health; Zuckerberg getting Senate scrutiny

October 21, 2022 | by

The Pixel ad tracker continues to be a Big Problem for Meta and Facebook. Advocate Aurora Health, a large health system in Illinois and Wisconsin, this week informed 3 million patients of a potential data breach connected to the use of Meta Pixel. The Meta Pixel snippets of JavaScript code were used within their Epic MyChart and LiveWell websites and applications, as well as on some of their schedulers.

As we have previously noted (below), ad trackers like the Meta Pixel are used to target website visitors and also to track ads placed on Facebook and Instagram. Developers routinely permit these snippets of code as trackers for better performance and website tracking, but the problem here is that sensitive patient information (PHI) is being sent back to Facebook where it violates patient privacy and can be misused.

Advocate Aurora cited that Meta Pixel may have collected “IP address; dates, times, and/or locations of scheduled appointments; your proximity to an Advocate Aurora Health location; information about your provider; type of appointment or procedure; communications between you and others through MyChart, which may have included your first and last name and your medical record number; information about whether you had insurance; and, if you had a proxy MyChart account, your first name and the first name of your proxy.” It did not collect social security number, financial accounts, credit cards, or debit card information. At this point, there is no reported misuse of information. Bleeping Computer, HealthcareITNews

That this is at all problematic is being vigorously denied by Facebook. But in an unusual move, Senator John Warner (D-VA) sent a letter yesterday to Meta CEO Mark Zuckerberg, containing seven fairly rigorous questions based on The Markup’s articles to be answered by 3 November. This follows on Sen. Jon Ossoff’s request via the Senate Homeland Security Committee (below)  (Editor’s opinion: to be written by Meta’s lawyers, and don’t hold your breath for any rending of garments or mea culpas.) HealthcareITNews, The Markup

Our previous articles on The Markup‘s research and Meta Pixel:

Breaking: Hospitals sending sensitive patient information to Facebook through website ‘Meta Pixel’ ad tracker–study

Facebook Meta Pixel update: Nemours Children’s Health using 25 ad trackers on appointment scheduling site

Let the lawsuits begin: Meta sued by health system patient for Meta Pixel info gathering

Novant Health notification 

Meta facing some Senate scrutiny on Meta Pixel’s health data collection–and how it’s used

Breaking: CVS’ Signify Health buy under DOJ scrutiny in ‘second request’

October 21, 2022 | by

Not unexpectedly, the US Department of Justice (DOJ) is taking a hard look at the Signify Health acquisition by CVS Health. The two companies were notified Wednesday on DOJ’s Second Request for information. This was disclosed on an SEC Form 8-K. The DOJ now has 30 additional days to investigate antitrust aspects of the merger, once that additional information is received. 

The timetable goes like this:

  • 19 Sept: CVS filed its premerger notification and report with the DOJ and the Federal Trade Commission (FTC) under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 (HSR). This initiates a 30-day waiting period.
  • 19 Oct: At deadline, the request for additional information initiated by the DOJ was received by both CVS and Signify (Second Request)
  • The Second Request extends the waiting period under the HSR Act by 30 days after both CVS and Signify have substantially complied with the Second Request. The DOJ can terminate the waiting period earlier, or move it to an agreed-upon later date. 

CVS continues to affirm closing the deal by first half 2023 as planned, which is a fairly wide window.

The current government’s DOJ and FTC have made no secret of their policy-driven yen for using antitrust in the name of lowering healthcare costs (even favored pharma). The crashing failure of DOJ’s antitrust motions against UnitedHealthGroup and Change Healthcare [TTA 20 Sept] must have smarted. What this usually initiates is the search for a quick and easy win to put said embarrassment behind them. CVS Health is certainly a high-profile target, though Signify even at $8 billion, like Change, is not except in the industry. 

Signify’s competitive overlap with CVS/Aetna isn’t as large or obvious as UHG’s Optum with Change, but there is some: home health management and (in this Editor’s view), ACO management services with Signify’s Caravan, which participates in multiple Federal shared savings models where Aetna also is. One wonders if some divestment will be demanded by DOJ. Even before the auction, Signify started the complicated and long exit from the failing Bundled Payments for Care Improvement (BPCI) programs inherited from the Remedy Partners buy.

Could the DOJ action have played a role in CVS’ sudden cold feet in acquiring Medicare/Medicaid primary care provider Cano Health? [TTA 20 Oct] The timing is certainly close. 

DOJ is not working alone. The FTC also has a yen for Amazon in their 2 September second request for information on their acquisition of OneMedical, which also added 30 days to the Hart-Scott-Rodino (HSR) clock after compliance. Amazon is already going through this with their iRobot acquisition [TTA 15 Sept]. Reuters, FierceHealthcare, Home Health Care News

News roundup: CVS abandons (?) Cano Health buy; Signify adds home RPM; BioIntelliSense RPM acquires AlertWatch; GE Healthcare, AMC Health partner; Viome raises $67M, other fundings

October 21, 2022 | by | 1 Comment

CVS Health apparently backs away from a strategic primary care buy. Earlier this week, both Barron’s and DealReporter (via FactSet) reported that CVS Health is no longer pursuing an acquisition of Cano Health, a primary care provider group in Florida, Texas, Nevada, California, Illinois, New Mexico, and Puerto Rico that concentrates on senior health, Medicare Advantage patients, and value-based care. Cano has 4,000 employees and 280,000 members. Reasons why were not disclosed by either CVS or Cano. Cano shares listed on the NYSE fell on the news from Monday’s open of $8.22 to $4.50 today (20 Oct). An alternative buyer may be Humana, which has a right of first refusal on a sale dating back to 2019, but Humana has been quiet on the acquisition front of late.

Walking away seems contrary to CVS’ stated strategy of pursuing deals in primary care, provider enablement, and home health, but CVS can afford to be choosy. There’s speculation that CVS has a different provider/VBC enablement target in mind.  Jailendra Singh of Truist Securities identified ACO management services organization Privia Health as a potential buy that would fit well with CVS’ pending buy of Signify Health, which includes competitor Caravan Health (more on this here). But who knows if this ‘walk away’ is final? Healthcare Finance, FierceHealthcare

CVS’ pending deal, Signify Health, announced the addition of spirometry testing to evaluate patients for COPD. This will be added to their existing suite of in-home diagnostic testing and tracking, In-Home Health Evaluation, targeted to Medicaid and Medicare Advantage members. Mobihealthnews

If there’s a Cinderella this inflationary, recessionary year, it’s remote patient monitoring (RPM). BioIntelliSense has been in RPM since 2020 with on-body/stick-on sensors such as the BioButton and the BioSense 30-day monitor. Their latest addition through acquisition is the AlertWatch clinical intelligence and triage system. AlertWatch will join BioIntelliSense’s product group within Medtronic’s HealthCast portfolio in US hospital patient monitoring as part of their existing partnership. In the past ten years, AlertWatch achieved four FDA 510(k) clearances for its specialized product offerings for the operating room, intensive care unit, and labor and delivery unit.  BioIntelliSense release

Veteran RPM company AMC Health will be partnering with GE Healthcare (GEHC) for post-discharge in-home care monitoring. This will extend GEHC’s hospital-based monitoring into post-acute patient needs and anticipate future care needs, potentially reducing unnecessary readmissions. It’s also planned that eventually both hospital and home data will be integrated into GE’s Edison Health database. GEHC also announced additional details about its spinoff, due to happen in early 2023. [Also TTA 12 Nov 21 and 20 July] Mobihealthnews

Healthcare/health tech raises haven’t entirely disappeared. Viome, which uses AI to test the oral and gut microbiome to prevent, diagnose, and treat chronic diseases and cancer, just raised a $67 million Series C led by Bold Capital Group with participation from Khosla Ventures, West River Group, Glico, Ocgrow Ventures, and Physician Partners, for a total raise since 2017 of over $169 million (Crunchbase). Viome recently launched the CancerDetect test for oral and throat cancers under the FDA Breakthrough Device Designation. Last year, they expanded their partnership with GlaxoSmithKline to research and potentially develop interventions for some cancers and autoimmune diseases. Viome release  

Mobihealthnews rounds up several other financings from genomic tester Variantyx’s $20 million in debt financing to mental health app Mindful Care’s modest $7 million Series B and dataset research collaboration platform Rhino Health‘s $6.7 million seed round extension for an $11 million total.

Rosendorff stands pat on Theranos’ Elizabeth Holmes: “She needs to pay her debt to society”

October 20, 2022 | by

Monday’s limited hearing in US District Court on Adam Rosendorff’s Mysterious Visit to Casa Holmes is likely to be a Defense Dud. Rosendorff walked Judge Edward Davila through the circumstances of his visit, what he said–which differed from Holmes’ partner Billy Evans’ recollection–and reaffirmed his testimony in the Holmes trial plus his sworn declaration given prior to the hearing.

  • He recounted his feelings of distress that Holmes’ and Evans’ son would “spend his formative years” without his mother in prison. The surprise contained here is his testimony that “It’s my understanding that Ms. Holmes may be pregnant again.” Follow-up by reporters outside of court was not answered by either Dr. Rosendorff or Evans.
  • Rosendorff reaffirmed that he testified “truthfully and honestly” on Theranos. “At all times the government has encouraged me to tell the truth and nothing but the truth.” 
  • Regarding telling Evans that the prosecution made the situation at Theranos sound worse than it was, Rosendorff did not recall that. He reconfirmed that he didn’t believe the prosecution did that. Rather, the prosecution “was trying to paint an accurate picture of Elizabeth Holmes.” 
  • As to another Evans statement that Rosendorff regretted that the prosecutors made people at Theranos look bad, he countered that “to the extent that other people looked bad, it was because of their association with Elizabeth.”
  • Overall, “I don’t want to help Ms. Holmes. At this point she needs to pay her debt to society.”

For anyone who has been through a legal process, Dr. Rosendorff’s all-too-human reactions after the extraordinary strain of two trials as well as the destruction of his career, his wanting to square things with, and confront, the cause of years of tsuris is understandable. That, of course, was ill-advised in the extreme. One only hopes that he has family and friends to comfort, counsel, and help him in moving toward a satisfying future, perhaps well away from California. He can also reflect that the four counts for Holmes and 12 for Balwani were on fraud, proved by the testimony of others who certainly aren’t running to Casa Holmes banging on her door.

Barring any other defense rabbits out of hats, Holmes is scheduled to be sentenced by Judge Davila on her four counts on 18 November to begin paying her debt to society. Mercury News