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.

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

March 24, 2022 | by

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

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

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

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

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

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

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

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

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

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.

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

March 11, 2022 | by

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

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

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

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

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

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

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

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. 

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

March 10, 2022 | by

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

The telehealth rule extension includes:

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

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

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

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

The Theranos Trials, ch. 2: bail tightened for Holmes, previewing the Balwani trial, and ‘The Dropout’

March 2, 2022 | by | 2 Comments

Ms. Holmes will have to pony up cash or property for her bail. Back in January, Judge Edward Davila of the US District Court ruled that Elizabeth Holmes would be free on a $500,000 bond secured by personal property. As is typical in federal cases of this type, this was based on her signature. The prosecution, perhaps being extra cautious on the possibility of flight during the time leading up to Holmes’ sentencing to 26 September, motioned Judge Davila to have it converted to cash or the equivalent in personal property. The defense agreed, perhaps mindful of the appeal deadline of 4 March with hearings in June.

Ms. Holmes does own property, though it is unknown what her remaining assets are since she never sold her Theranos holdings. Her partner and family can help her with the requirement. Mercury News (paywalled, but refresh)  The Trial, ch. 1

Meanwhile, Sunny Balwani’s trial in the same Federal District court and with Judge Davila starts next Wednesday 9 March with jury selection. Balwani was indicted in 2018 on the same charges as Holmes’ but his trial was severed from Holmes’ when her defense raised charges of abuse. Judge Davila is making moves to ensure the trial moves along and does not suffer from the juror problems experienced with the Holmes trial. Six alternate jurors will be seated versus five in the Holmes trial, where three jurors were lost at the start, raising the possibility of mistrial. Hours will be longer, 9am to 3pm Tuesdays, Wednesdays, and Fridays — including some Mondays and Thursdays. Concessions were made to Holmes with a young baby to attend to, which is not Balwani’s situation. Yahoo!News, KPIX5 San Francisco

And to those craving a true crime fiction take on l’affaire Theranos, Hulu is airing an eight-part series, entitled ‘The Dropout’, and starring Amanda Seyfried and a ‘wondrously vile’ Naveen Andrews. According to the WSJ review (free registration required) Seyfried gets the weird baritone and facial tics correctly (and correctly timed). But the reviewer notes that it’s hard to tell even from Seyfried’s excellent performance of a troubled girl/woman how she got so many older ‘sage’ men to believe in her Fraud Tech. Perhaps it was the fevered time in health tech, or as this Editor has said previously, fear of missing out or wanting to believe. We now have a generation of con artist millennials in the zeitgeist. The reviewer sums it well: “What the fraudsters also share is a counterfeit benevolence: Everyone is doing what they’re doing–and stealing what they’re stealing—for the benefit of mankind.” Yet there comes a time when the fever breaks, and the fraudsters get their comeuppance. For a lighter take, the NY Times article on clothing as reflective of character development on the show, Silicon Valley values, and Holmes’ ‘costuming’, is recommended.

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

Wednesday roundup: athenahealth acquisition closes, Tyto Care receives lung sound CE Mark, NHS’ elective care recovery plan for 6 million, NSW health secretary to Telstra Health

February 16, 2022 | by

Bain Capital and Hellman & Friedman completed their $17 billion acquisition of athenahealth on Tuesday. The purchase was from Veritas Capital and Evergreen Coast Capital, which remain minority shareholders along with an affiliate of GIC and a wholly-owned subsidiary of the Abu Dhabi Investment Authority. athenahealth claims over 140,000 ambulatory care providers in the US, which is not much growth considering they had 88,000 in 2017 and reportedly grew to 160,000. Release 

Telehealth diagnostic monitor Tyto Care received CE Mark approval for the Tyto Lung Sounds Analyzer. It is a standalone Software as a Medical Device (SaMD) that alerts to the potential presence of an abnormal breath sound in respiratory recordings that may be wheezing in adults and children. The analysis is based on their database of clinical exam recordings. Release

Whither the 6 million waiting? The NHS intends to reduce the backlog of elective care caused by the pandemic through the Delivery plan for tackling the COVID-19 backlog of elective care. Highlights are the rollout of a new online platform called My Planned Care, as well as plans for 100 community diagnostic centres, new surgical hubs, and increased capacity to offer tests, checks, and treatments–over three years. Healthcare IT News

And in Australia, the revolving door spins. Elizabeth Koff, secretary of NSW Health, will be moving to Telstra Health as managing director effective 1 July. She succeeds Mary Foley, who will continue to be a special adviser and a non-executive director of the board. Ms. Koff has spent three decades in the state health department which manages 228 hospitals and around 127,000 staff. New South Wales was subject to severe lockdowns in 2020 and 2021, which continue to a lesser degree.  Healthcare IT News ANZ

The devil is in the (migrated) data: GAO watchdog barks at the VA’s transition from VistA to Cerner

February 9, 2022 | by

The US Government Accountability Office (GAO) released their “watchdog” report on the Department of Veterans Affairs’ first, failed implementation at Spokane’s Mann-Grandstaff VA Medical Center in October 2020. Their 52-page whopper of a report came to a simple conclusion: the VA didn’t ensure the quality of the data migrating from the EHR warhorse VistA and their Corporate Data Warehouse to Cerner Millenium. Thus clinicians couldn’t use Cerner two ways–one was training in how to use it (as noted in VA’s own analysis) so they could not find the patient information they needed–and the fact that even if they knew how to use it, the data migration apparently was incomplete. The GAO found that the VA did not establish performance measures and goals for migrated data quality based on Federal guidance. The result was inevitable. According to the report, “clinicians experienced challenges with the quality of migrated data, including their accessibility, accuracy, and appropriateness.” 

There is also a method called a stakeholder register which helps to identify and engage all key stakeholders. VA did not use this, so some areas were overlooked in the continuity of reporting and preservation of records. This affects not only patient records, but also scheduling.

The main takeaway is that GAO recommends to VA that they establish performance measures and goals that ensure the quality of migrated data and use a stakeholder register managed by the VA’s deputy secretary to engage all the relevant stakeholders in the migration in reporting needs. VA published its own analysis of its implementation and rollout failures in December. Healthcare IT News

Predictions, predictions for telehealth, digital health, and all those cybersecurity risks

February 3, 2022 | by

crystal-ballJanuary is the month for predicting what’s ahead, and while this Editor has no pretensions to be Sibyl the Soothsayer despite the picture, let’s look at what others see in their cloudy crystal balls.

Frank McGillin, CEO of The Clinic by Cleveland Clinic, works intensively with telehealth in this joint venture between Cleveland Clinic and Amwell. His prediction: telehealth will evolve towards concierge care, as providers reduce “platform sprawl”, coordinate the virtual care experience, and provide multidisciplinary virtual care.

  • Telehealth is now “a permanent mode of access”, though the pandemic created “platform sprawl” as providers reached for any and all modes and providers which could be implemented quickly
  • Healthcare providers and plans now have to scale back and reconcile all this to “design a digital trajectory with intention”
  • This means developing a personalized approach to telehealth delivery and to provide a seamless, highly coordinated care experience
  • Their approach is to focus on multidisciplinary virtual visits and case analysis for patients with complex conditions, such as their Virtual Second Opinions program for conditions such as brain tumors and prostate cancer.
  • Virtual multidisciplinary support reduces the risk of suboptimal treatment plans and can eliminate long travel times and exposure to COVID-19 for vulnerable patients. For payers and employers, this can add up to better outcomes and reduced cost of care.
  • “Intelligent” remote monitoring also removes another layer of risk in providing the right care at the right time
  • Continuation of relaxed interstate licensure requirements are needed to provide fast access to medical experts, particularly for primary care providers.

Interview with Healthcare IT News 

Healthcare Dive has been running a series on industry trends, and this installment focuses on digital health.

  • Healthcare will become more predictive and proactive, with insights fed by connected devices and analytics (commonly lumped under AI) that enable organizations to collect, analyze, and act on massive amounts of data.
  • But algorithms don’t have judgment and data can have bias, leading to poor decisions, such as the distribution of vaccines. Expect more oversight from the Federal level down on AI research and policymaking, 
  • Virtual care will continue to grow in virtual diagnostics, patient-reported outcomes applications, and digital homecare platforms
  • Telehealth and digital health is integrating into the traditional delivery and payment model–partnerships with health systems, payers, and employers.
  • Virtual care access is booming in niche areas such as women’s health, hospital at home, and mental health, with investment dollars flowing in. Telemental health is moving into consolidation.
  • Cybersecurity will become more of a focal point for healthcare companies in 2021, with hackers finding their way into all these contact tracing apps designed in a hurry, plus digital health systems, many of which are poorly protected. Targeted attacks have skyrocketed.

And speaking of cybersecurity, over at HealthITSecurity, they rounded up the experts to opine on All Those Security Risks that fast implementation of telehealth and moving devices out of the hospital walled garden have created. Remote patient management is now an asset, no longer a ‘nice to have’, for providers, setting up a situation where patients are increasingly both the beneficiaries of more convenient health delivery and victims of security breaches and ransomware.

  • ‘Out of hospital’ care means that data is being transmitted between multiple points. Network security isn’t guaranteed. So attacks can originate at the weak points–either the home or hospital environment.
  • The fast implementation of telehealth during the pandemic meant not only did systems not work together well, it also meant multiple points of vulnerability
  • Over 80% of surveyed healthcare providers globally harbor concerns about data security and privacy (Kaspersky/Arlington Research). And a shocking 70% admitted that their practice used outdated legacy operating systems, exposing them to security vulnerabilities.
  • “A culture of security” means maintaining endpoint security and BYOD policies across the organization’s network, identity management and zero trust tactics, and yes, security consciousness on patients’ parts.
  • Patients should not be responsible for security, providers partly, which leaves the responsibility with the vendor. But healthcare organizations are responsible for evaluating their vendors, and how they are interacting with and storing their data.