TTA’s April Showers: digital health funding’s slow start, UHG/Optum sticking with Change, buys Kelsey-Seybold, Walmart’s health superstores, Walgreens/Blue Shield CA’s Health Corners, Tivity & MobileHelp sold, more!

 

 

Weekly Update

April is proving to be an active month for something other than rain and blooming cherry trees, including company sales of Tivity and MobileHelp. UnitedHealth and Optum won’t give up on Change, including a hefty break fee, nor big buys. On the retail front, Walmart finally opens up Florida superstores powered by Epic, and Walgreens ‘corners’ with Blue Shield in California. Some local telehealth grants and the surprising vitality of audio telehealth for the underserved. And, to no one’s surprise, digital health got off to a slow start in Q1.

Weekend roundup: telehealth claims ticked up again in January, Walmart opens Florida health ‘superstores’, Blue Shield California partners with Walgreens’ Health Corners 
Thursday roundup: UHG/Optum, Change extend merger deadline to 31 Dec, buys Kelsey-Seybold; $2B Tivity Health sale; General Dynamics enters derm AI diagnostics; MobileHelp PERS sold to Advocate Aurora (A recovery in the works?)
Digital health funding’s Q1 hangover from 2021’s bender–and Q2 is a question mark, even for Rock Health (Some companies have aching heads still)
Wisconsin’s $5M for child psychiatry, community telehealth; FQHC patients prefer audio-only telehealth–Rand (Back to the roots of telehealth for less health served populations)


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The first full week of Spring turned out to be a busy one, from big buys by UHG/Optum in home and mental health, a significant one by LetsGetChecked, and more health tech fundings. Babylon’s Higi integrates their chatbot. Optum’s physician telehealth study shows there’s a way to go, along with Laurie Orlov’s aging tech studies and articles. The former Practice Fusion’s miseries with DOJ continue. And Amazon Health’s looking for talent.

Weekend wrapup & reading: Amazon Health on talent hunt, Practice Fusion fined $200K for violating $145M prosecution agreement, and must-read studies and articles on older adults tech (Read in between spring cleaning)
What do physicians really think about telehealth, now that they’ve used it? Lower use, substantial frustrations remain. (Another needle puncturing the bubble)
Friday roundup: LetsGetChecked buys Veritas Genetics, Everly Health adds CMO, Babylon sends chatbot to Higi, ConcertAI’s $150M Series C, AmplifyMD’s $23M, and two ‘Brights’ raise $155M (Reviving market?)
UnitedHealth Group makes two jumbo buys for Optum: LHC Group home health for $5B, Refresh Mental Health (Optum not letting grass grow with the Change DOJ lawsuit)

Winter turned into Spring, it’s raining, and it’s time for pleasant thoughts of a cheerful movie about the Umbrellas of Cherbourg. Speaking of France, Glooko’s European tour picked up DIABNEXT. Action in Asia-Pac with Vietnam’s Jio Health and Pear for sleepless Japanese. Certainly Sunny Balwani isn’t getting much sleep lately with the kickoff of Theranos Trial #2. And after 25 years of one man at the top, it’s a young tech-savvy woman in charge at Centene–and their cubies are hanging on.

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 (More consolidation, funding, and a changing of the guard after 25 years)
The Theranos Trials, ch. 3: Sunny and Elizabeth were in it together, all the way (Balwani’s rerun of Holmes’ trial)
DOJ lawsuit to block UnitedHealth-Change Healthcare’s acquisition now set for 1 August trial (UHG and Change not giving up)

We edge closer to Spring and our Headline News is a little here and there. ElliQ launches its desktop companion robot for seniors, GE Healthcare and AliveCor partner for cardiac monitoring, and Komodo Health and Included Health may IPO. NHS Digital is also playing catchup. All’s well in Walmart’s World. But given the real Headline News, insurer Anthem made a Myopic Move in announcing a name change now.   

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 (A Friday potpourri)
NHS Digital roundup: £200M allocated for research, COVID-19/cancer cross-research using the new Trusted Research Environment (TRE) (TRE is high value for research)
Thursday news roundup: Walmart hiring 50K workers including health, Anthem name-changing, GE Healthcare-AliveCor partner, IPO for Komodo Health amid slowdown? 

It was nearing the Ides, but absent health tech reckonings in the run up to HIMSS next week and many digital health types partying at ViVE in Miami. (The hot war in Ukraine more than qualifies.) Congress was busy spending US taxpayer money in a 2,000-page+ spend bill that happily included some long-debated telehealth expansions. Tunstall expands in Germany with BeWo acquisition. Amwell maneuvers with LG into the hospital market, CVS stakes a claim in the metaverse, budget smartwatch Orbic debuts, and have a think around how you partner.

Weekend short takes, UK edition: Tunstall acquires Germany’s BeWo, AWS UK healthtech accelerator launches, Fidgetbum bed sleep aid gains US patent 
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 (Is there life in the metaverse?)
What can be the long-term drivers of remote patient monitoring growth? (Simplify, simplify)
Congress may extend emergency telehealth flexibilities for Medicare, high-deductible plans for five months in spending bill (House passed Wednesday, but what’s telehealth’s fate later this year, in the runup to the midterms?)


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Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine, and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

News roundup: UnitedHealth Group pushes off Change closing again, Amazon’s new healthcare head, Centene’s shakeup of CEO, board, holdings

Change won’t come easy, as this Editor predicted. Now the closing of the Change Healthcare acquisition by UnitedHealth Group has been pushed off to April 2022. Announced in January, it was delayed in August and October/November with the Department of Justice review of the merger under the Hart-Scott-Rodino Antitrust Act (HSR). This SEC filing by UnitedHealth is the first time a definite date target has been set. Change’s diversified health IT/data analytics/imaging/payments systems would be combined with OptumInsight. HealthcareFinanceNews

Amazon finally named a head of healthcare to oversee Amazon Care, Amazon Pharmacy, Halo and Alexa’s healthcare uses. Neil Lindsay, former head of Amazon Prime, was named senior vice president of health and brand within Amazon’s global consumer business, reporting to CEO Andy Jassy. Mr. Lindsay sits on the so-called ‘S-team’, Amazon’s most influential executive group. Take this as an indicator of the importance of healthcare to their business. The terseness of the information has been typical of Amazon. Becker’s Hospital Review, CNBC

Centene, one of the top 10 health plan companies in the US, had a major shakeup this week. Long-time CEO Michael Neidorff will retire and exit sometime in 2022. The board, now set at 14 members, retired three directors via a new age limit of 75. Five new directors will come on board, including Ken Burdick, former CEO of WellCare Health Plans, acquired by Centene in 2020, and Wayne DeVeydt, former Anthem CFO.

The shake-n-bake has been shaking since November, when activist investor Politan Capital Management started to press for changes. Other changes include a projected sale of non-core assets, including private hospitals Circle Health in the UK and Ribera in Spain, with combined revenue of $2 billion. The rather ‘shaggy’ list of Medicaid managed care, Medicare Advantage, and exchange plans–none of which carry the Centene brand–and a potpourri of other units and management services are being examined bottom up by a three-person “value creation office”, as are Centene’s extensive real estate holdings and leases, to extract savings wherever possible. One area mentioned was hybrid and at-home work, a major change to the Centene “cubie” culture.

Neidorff joined a tiny Centene as CEO in 1996 and is now 78. There is no update on the delayed Magellan behavioral health management acquisition. Healthcare Dive 14 Dec, 13 Dec. Centene releases on Neidorff’s retirement as “leadership succession plan” and governance/board changes.

Amazon’s Chime telehealth solution rang Beth Israel Deaconess Medical Center’s bells–case study

A short case study that shows what Big Tech–and attuned clinical IT people–can do under pressure. Beth Israel Deaconess Medical Center (BIDMC), a Harvard Medical School affiliate, had at the start of the Covid pandemic limited and multiple telehealth systems for 1,400 physicians. They quickly adopted systems such as SnapMD, Google Meet, Zoom, Doximity, and Doxy.me. They were not interoperable nor did they interface well with their EHR. While this was going on and in parallel, BIDMC’s tech team developed and deployed a new integrated telehealth system using Amazon Chime on the existing AWS platform. This integrated video conferencing into workflows with telehealth tools such as multiple participants, security, EHR integration, live translation, and chat equipped with Google Translate. Despite this, BIDMC physicians at the virtual peak of 66% in March-April 2020 were still conducting 73% of visits telephonically. By June 2021, video visits as a percentage of total telehealth were 50% in June, with 65% of the video visits done on the new platform. HealthcareITNews.

Two major moves and what they mean: Doctor on Demand, Grand Rounds to merge; Amazon Care will go national by summer (updated)

This week’s Digital Health Big Deal (as of Wednesday!) is the merger agreement between telehealth/virtual visit provider Doctor on Demand and employer health navigator Grand Rounds. Terms were not disclosed. It’s important because it extends Grand Rounds’ care coordination capabilities beyond provider network navigation and employee clinical/financial tools for six million employees into an extensive telehealth network with 98 million patients in commercial, Federal, and state health plans.

Both companies had big recent raises–$175 million for Grand Rounds in a September 2020 Series E (Crunchbase) and Doctor on Demand with a $75 million Series D last July (Crunchbase). The transaction is a stock swap with no cash involved (FierceHealthcare, CNBC), and the announcement states that the two companies will operate under their own brands for the time being. Owen Tripp, co-founder and CEO of Grand Rounds, will run the combined company, while Doctor on Demand CEO Hill Ferguson runs DOD and joins the board. The combined company is well into Double Unicorn status with over $2 bn in valuation. Also Mobihealthnews.

What it means. Smaller (than Teladoc and Amwell) telehealth companies have been running towards M&A, with the most recent MDLive joining Optum’s Evernorth [TTA 27 Feb] creating interstate juggernauts with major leverage. Doctor on Demand was looking at their options for expansion or acquisition and decided 1) the time and the $ were right and 2) with Grand Rounds, they could keep a modicum of independence as a separate line while enjoying integration with a larger company. The trend is profound enough to raise alarms in the august pages of Kaiser Health News, which decries interstate telehealth providers competing with small and often specialized in-state providers, and in general the loosening of telehealth requirements, including some providers still only taking virtual visits. Contra this, but not in the KHN article, this Editor has previously noted that white-labeled telehealth providers such as Zipnosis and Bluestream Health have found a niche in supplying large health systems and provider groups with customized telehealth and triage systems.

UPDATED. In the Shoe Dropping department, Amazon Care goes national with virtual primary care (VPC). To no one’s surprise after Haven’s demise, Amazon’s pilot among their employees providing telehealth plus in-person for those in the Seattle area [TTA 17 Dec 20] is rolling out nationally in stages. First, the website is now live and positions the company as a total care management service for both urgent and primary care. Starting Wednesday, Amazon opened the full service (Video and Mobile Care) to other Washington state companies. The in-person service will expand to Washington, DC, Baltimore, and other cities in the next few months. Video Care will be available nationally to companies and all Amazon employees by the summer.

Notably, and buried way down in the glowing articles, Amazon is not engaging with payers on filing reimbursements for patient care. Video Care and Care Medical services will be billed directly to the individual who must then send for reimbursement to their insurance provider. The convenience is compromised by additional work on the patient’s part, something that those of us on the rare PPO plans were accustomed to doing back in the Paper Age but not common now. It also tends to shut out over 65’s on Medicare and those on low-income plans through Medicaid. It is doubtful that Amazon really wants this group anyway. Not exactly inclusive healthcare.

TechCrunch, FierceHealthcare. Jailendra Singh’s Credit Suisse team has a POV here which opines that Amazon continues to have a weak case for disruption in VPC, along with their other healthcare efforts, and an uphill battle against the current telehealth players who have already allied themselves with employers and integrating with payers.

Haven finds no haven in healthcare, will close in February

Man Plans, God Laughs. Haven, the joint venture cobbled together by JP Morgan, Berkshire Hathaway, and Amazon to transform corporate healthcare three years ago, will be shuttering next month. The website has but a single page of signoff. All it is missing is a bit of sad synth music like the air crash simulations and analyses so popular on YouTube.

Haven’s founding in January 2018 made for expansive, far-seeing (sic) 50,000-foot quotes by JPM’s Jamie Dimon and B-H’s Warren Buffett about the ‘hungry tapeworm’ of healthcare costs and the need to simplify it for their million-odd employees. Surely it made for great speeches at annual meetings and glossy Annual Report pages. But in its three years of existence, Haven never found a home. It had the ambitious mission of “partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs” and setting up an independent company “free from profit-making incentives and constraints” [TTA 31 Jan 2018]. Yet it spent its first six months without a CEO, over a year without a name, and never created a clear direction. 

Atul Gawande, MD, one of the big thinkers on the broken US healthcare system, joined as CEO six months in, but oddly did not give up his teaching, clinical, and writing commitments. It left the sense that for the doctor, Haven was a part-time gig [TTA 21 June 2018]. One can imagine how Dr. Gawande, without a strong business management background, dealt with the egos of the Bezos-Dimon-Buffett trio without a strong backup team to deal with them, get a plan together, and execute.

The signs of failure were increasingly apparent by the Year of the Pandemic. Health systems and insurers–the ones with the data and the leverage–were never bought (though WellCare, a leading Medicare Advantage payer, was up for sale in 2019 and snapped up by Centene) or even engaged in partnerships. Management fled starting in 2019, accelerating in 2020: COO Jack Stoddard for personal reasons in May 2019, then in 2020 financial head Liam Brenner and people head Bryan Jones in April, Dr. Gawande in May, Head of Measurement Dana Safran in July, and CTO Serkan Kutan in September. Becker’s Hospital Review The one partner with retail consumer healthcare experience–Amazon–increasingly and publicly pulled off in its own beneficial directions, acquiring PillPack in mid-2019 as the first move towards a PBM, then in the past few months pushing Amazon Care for large employers and creating Amazon Pharmacy. The other two companies also, according to reports, executed their own projects with their own teams.

The small employee group (under 60) may find spots at one of the three companies. The official announcement states they will ‘collaborate informally’. Not with a bang, but with a whimper. Fierce Healthcare, CNBC, HISTalk.

Amazon’s feint into large employer telehealth; HealthLake dives into structured health data analytics

Much ado about…..? Amazon is reportedly making an effort to lure large employers into its Amazon Care telehealth and in-person care platform. Amazon Care is a health benefit presently offered to Amazon employees, with telehealth nationally and in-person for Seattle area residents.  

About 300 Amazon employees use it, which is low given their employee size and after 15 months. Since internal takeup has to date been limited, this Editor observes that Amazon may be testing the scaleup waters by inviting other companies in. These reports indicate that online real estate marketplace Zillow was approached but has moved no further with it. Companies would be charged a per member per month fee plus a ‘technology fee’. 

For those interested in telehealth’s positioning among US employers, the Credit Suisse report by Jailendra Singh’s team makes important points on where both Teladoc and Amwell stand with employers and health plans–and it’s not promising for Amazon:

  • Telehealth has been adopted by 90 percent of employers, but it’s a fraction of benefit spending for them
  • What’s important to employers is not the cost of the program, but employee engagement, the potential volume of medical cost savings, and management of chronic conditions
  • Telehealth vendors are increasingly ‘carved into’ contracted health plans
  • Between direct employer contracts and health plans, Teladoc is settled into this segment, and diversified into medical systems with new acquisitions InTouch Health and chronic care management with Livongo. Amwell is situated in the white-label provider market with health systems and health plans, with few employer contracts. 

 AMZN Making a Push in Telehealth For Large Employers: Appears to Be More Noise than Substance

A better-positioned initiative for healthcare providers that Amazon just announced is HealthLake, which is a HIPAA-eligible AWS cloud service for storing and analyzing structured and unstructured data at petabyte scale. The ‘lake’ is the data lake in the cloud. It copies health data in the Fast Healthcare Interoperability Resources (FHIR) format, and analyzes unstructured data uses specialized machine learning models, like natural language processing, to automatically extract meaningful medical information. Current users, according to their website, are Cerner, Konica Minolta, and Orion Health. Hat tip to HISTalk.

Walgreens Boots goes big with billion-dollar medical office deal with VillageMD

Go big or go home. That seems to be Walgreens Boots Alliance’s’ theme in its 8 July announced deal with and investment in primary care provider VillageMD. They will set up 500 to 700 co-located full-service Village Medical offices in more than 30 markets over the next three to five years. The “Village Medical at Walgreens” offices will be staffed by a projected 3,600 primary care providers and fully integrated with Walgreens pharmacists for one-stop shopping. According to the release:

  • Most of the Village Medical medical offices will be approximately 3,330 square feet each, up to 9,000 square feet, and utilize existing store space. “80% will be used by VillageMD to fund the opening of the clinics and build the partnership.”
  • 24/7 care will be available via telehealth and at-home visits
  • Fees will be covered by insurance or for those without, on a sliding scale
  • Over 50 percent will be located in Health Professional Shortage Areas and Medically Underserved Areas/Populations, as designated by HHS. These would reach underserved “older, sicker, and poorer patients” without regular access to care, said VillageMD CEO Tim Barry in an interview with CNBC
  • Capacity would be 100 to 120 patients per day 

This follows on a pilot of five Village Medical clinics at Walgreens locations in Houston, and Village Medical’s eight-state expansion in the Find Care telehealth program announced in April.

Walgreens Boots Alliance will invest $1 billion in equity and convertible debt in VillageMD over the next three years, including a $250 million equity investment to be completed today which will culminate in about 30 percent ownership.

To this Editor, Walgreens is sitting at a giant poker table, stacking the $1,000 chips, and saying to its rivals, ‘see ya and raise ya’. These are full-service offices, not urgent care clinics, and they are investing in their provider. It could be transformative–or flop on executional niceties such as location, medical competition, or even COVID keeping down physical visits. The competition is also daunting on the retail side. Recently Walgreens has pared back hundreds of locations and faces the deep pockets of CVS-Aetna, which plans to open 1,500 HealthHUBs which integrate stores, MinuteClinics with nurse-practitioners, pharmacies, and health data, Amazon with PillPack aimed at its pharmacy business, and Walmart with its toe in the water with clinics. 

Village Medical, formerly Village Family Health, is a multi-state primary care provider which is part of Chicago-based VillageMD. Both include more than 2,800 physicians across nine markets, so the Walgreens deal will more than double their size. Also Forbes (Photo: Walgreens)

News roundup: Teladoc closes InTouch, Samsung bets on tele-genomics, SURE Recovery app, Optimize.health’s seed round, Walgreens’ Microsoft boost

Teladoc completed the acquisition of InTouch Health on 1 July. The purchase, announced at the JP Morgan soireé in January (and an eternity ago) took place just before the ’10 years in 2 months’ leap forward in telehealth services. InTouch’s telehealth offerings are primarily for hospitals and health systems, heavily based on multi-feature carts and camera setups. The purchase price of $150 million in cash and 4.6 million shares of Teladoc Health common stock, valued then at $600 million, may be a great bargain for Teladoc considering the rich prices that other telehealth-related companies commanded during the peak of the pandemic, and that Teladoc’s revenue boosted to almost $181 million in revenue in Q1 2020, up 41 percent versus Q1 2019. Release

Samsung makes a telemedicine bet with Genome Medical. Through its Catalyst Fund, Samsung is the lead among 15 investors in a $14 million Series B extension financing that includes LRVHealth, Revelation Partners, and Kaiser Permanente Fund. Genome Medical’s connection to telemedicine is on-demand, standard-of-care genetics and genomics through virtual health services, including counseling, patient drug response, and provider-to-provider consults through its platform. Release. CNet. Crunchbase.

Mindwave Ventures, which this Editor noted last December was opening up an office in the Leeds health tech hub, has continued its development and research with multiple platforms and apps in partnership with NHS and academic/research clients. One that came on our ever-whirling radar screen is the release of the SURE Recovery app, for those in recovery from alcohol and drug problems. It enables users to work with the SURE (Substance Use Recovery Evaluator) and SUSS (Substance Use Sleep Scale) measures, plus a personal diary, to track their recovery over time. Mindwave developed the app in conjunction with The King’s College London and theInstitute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. The app is now available to download; search ‘SURE Recovery’ on the App Store or Google Play. The page on the Mindwave site is on their Clinical Research page–click the tab for SURE. Hat tip to Ellis Noble of KC Communications.

Connected to telehealth and RPM is provider reimbursement. Optimize.health is an early-stage company which provides a turnkey setup for practices for its remote patient monitoring platform, with the usual features such as patient engagement, integrated devices with the platform, and call center support. The apparent difference is the emphasis on sharing data and simplifying reimbursement, the hard part of any RPM or telehealth platform. Announced this week: a $3.5 million seed round led by Bonfire Ventures. A small boost to this part of the telehealth field which has not had the great success of virtual consults. Release.

Back in January 2019, Walgreens Boots announced a partnership with Microsoft to migrate their IT over to the Azure platform. It took a while for results to manifest to the public. When COVID happened, they rolled out a COVID-19 risk assessment tool on its website and mobile app based on Azure. Their Find Care platform doubled the number of virtual care providers and services available. Walgreens also provided a link to COVID-19 clinical trials through the Find My Clinical Trial program on its mobile app. This article in FierceHealthcare touts how they are maneuvering to stay even with CVS Aetna and Amazon, which is hardly waiting for its partners in the gone-pearshaped Haven.

News roundup: LabCorp CRO boosts Medable, Propeller Health gains 510(k), EU’s 34 medtech startups, Amazon’s healthcare moves, Google’s Arizona privacy lawsuit

It does seem ages since our last one! One major winning category for digital health is clinical trials. LabCorp has one of the largest CROs (contract research organization), Covance. LabCorp has partnered with startup Medable, a Palo Alto-based company that decentralizes the gathering and analysis of clinical trial data from recruited participants through apps and telemedicine. Mobihealthnews  Confirming this trend: earlier this month, Medable cleared a $25 million venture round from GSR Ventures. Crunchbase  This does make rival CRO PRA Health Science’s pickup of Care Innovations from Intel late last year, for an undisclosed amount, look like a prescient (and likely a bargain) purchase.

Propeller Health, which specializes in digital respiratory health with sensors connected to inhalers and apps, gained 510(k) FDA clearance for a sensor/app for use with AstraZeneca’s Symbicort inhaler. This medication is used for asthma and COPD. It does not seem that long ago (2014) that the startup was at trade shows like NYeC and mHealth Summit with an exceedingly modest display of popups and brochures. Their 2019 acquisition by ResMed for the stunningly premium price of $225 million made news in late 2018. Mobihealthnews

In Europe, COVID-19 has boosted at least 34 medtech startups, including 11 in UK alone, followed by Switzerland and Sweden. This is based on a study by Oxford University data visualization spin-out Zegami. One of them happens to be Zegami on a project in using a limited dataset to distinguish between x-rays of COVID-19 infections and infections caused by viral or bacterial pneumonia, as well as images of healthy lungs. On the list are (naturally) Babylon Health and the slightly mysterious Medopad. Sweden’s Kry (LIVI in the UK) is also on the list. Kry/LIVI last made some news when Juliet Bauer of NHS Digital ankled to Kry in early 2019, Med-techInnovationNews, Mobihealthnews

Amazon’s latest stretches into healthcare are noted in a brief Becker’s Health IT article which notes AWS’ deals with Cerner and addition of healthcare-specific features with hospitals using AWS. Mayo Clinic has partnered with Alexa for voice responsive ‘Mayo Answers’. Some Amazon employees now have access to telehealth benefits (this Editor wonders why not all, beyond those Seattle warehouse workers). Industry research company CB Insights is projecting that Amazon’s next move will be a benefits marketplace for employers and payers. Meanwhile, their partnership with JP Morgan Chase and Berkshire Hathaway, Haven, has stumbled with its CEO Atul Gawande, MD, leaving the post to return to practice after less than two years. Executive turnover has been high, and the company has yet to announce a major initiative. FierceHealthcare 

Meanwhile, Arizona’s attorney general has sued Google for violating state privacy laws. Seems like Android users are trackable, even if they turn off location on their phones, through Google apps like Maps and Weather. The lawsuit also charges that Google changed its default tracking settings without informing users, using data for targeted ads. Becker’s Health IT 

Google’s ‘Project Nightingale’–a de facto breach of 10 million health records, off a bridge too far?

Breaking News. Has this finally blown the lid off Google’s quest for data on everyone? This week’s uncovering, whistleblowing, and general backlash on Google’s agreement with Ascension Health, the largest non-profit health system in the US and the largest Catholic health system on the Planet Earth, revealed by the Wall Street Journal (paywalled) has put a bright light exactly where Google (and Apple, Facebook, and Amazon), do not want it.

Why do these giants want your health data? It’s all about where it can be used and sold. For instance, it can be used in research studies. It can be sold for use in EHR integration. But their services and predictive data is ‘where it’s at’. With enough accumulated data on both your health records and personal life (e.g. not enough exercise, food consumption), their AI and machine learning modeling can predict your health progression (or deterioration), along with probable diagnosis, outcomes, treatment options, and your cost curve. Advertising clicks and merchandising products (baby monitors, PERS, exercise equipment) are only the beginning–health systems and insurers are the main chance. In a worst-case and misuse scenario, the data modeling can make you look like a liability to an employer or an insurer, making you both unemployable and expensively/uninsurable in a private insurance system.

In Google’s latest, their Project Nightingale business associate agreement (BAA) with Ascension Health, permissible under HIPAA, allowed them apparently to access in the initial phase at least 10 million identified health records which were transmitted to Google without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names and dates of birth. This transfer and the Google agreement were announced by Ascension on 11 November. Ultimately, 50 million records are planned to be transferred from Ascension in 21 states. According to a whistleblower on the project quoted in The Guardian, there are real concerns about individuals handling identified data, the depth of the records, how it’s being handled, and how Google will be using the data. Ascension doesn’t seem to share that concern, stating that their goal is to “optimize the health and wellness of individuals and communities, and deliver a comprehensive portfolio of digital capabilities that enhance the experience of Ascension consumers, patients and clinical providers across the continuum of care” which is a bit of word salad that leads right to Google’s Cloud and G Suite capabilities.

This was enough to kick off an inquiry by Health and Human Services (HHS). A spokesperson confirmed to Healthcare Dive that “HHS’ Office of Civil Rights is opening an investigation into “Project Nightingale.” The agency “would like to learn more information about this mass collection of individuals’ medical records with respect to the implications for patient privacy under HIPAA,” OCR Director Roger Severino said in an emailed statement.”

Project Nightingale cannot help but aggravate existing antitrust concerns by Congress and state attorneys general on these companies and their safeguards on privacy. An example is the pushback around Google’s $2.1 bn acquisition of Fitbit, which one observer dubbed ‘extraordinary’ given Fitbit’s recent business challenges, and data analytics company Looker. DOJ’s antitrust division has been looking into how Google’s personalized advertising transactions work and increasingly there are calls from both ends of the US political spectrum to ‘break them up.’ Yahoo News

Google and Ascension Health may very well be the ‘bridge too far’ that curbs the relentless and largely hidden appetite for personal information by Google, Amazon, Apple, and Facebook that is making their very consumers very, very nervous. Transparency, which seems to be a theme in many of these articles, isn’t a solution. Scrutiny, oversight with teeth, and restrictions are.

Also STAT News , The Verge on Google’s real ambitions in healthcare, and a tart take on Google’s recent lack of success with acquisitions in ZDNet, ‘Why everything Google touches turns to garbage’. Healthcare IT News tries to be reassuring, but the devil may be in Google’s tools not being compliant with HIPAA standards.  Further down in the article, Readers will see that HIPAA states that the agreement covers access to the PHI of the covered entity (Ascension) only to have it carry out its healthcare functions, not for the business associate’s (Google’s) independent use or purposes. 

Short Takes: Amazon buys symptom checker Health Navigator; Ettain Group acquires EHR consultant Leidos Health (updated)

Amazon’s acquisition of startup Health Navigator, a developer of online symptom checking and triage tools sold to other digital companies to integrate into their digital health solutions, is another foray into healthcare. In this case, Health Navigator is a straightforward fit into their Amazon Care unit which provides enterprise virtual care benefits. No transaction amount, leadership, nor timing are mentioned. This is unlike their purchase earlier this year of online pharmacy PillPack for a stunning $700+ million. After roadblocks on getting the patient data they need [TTA 12 Sept], and other stumbles, PillPack has been folded into their consumables group and right now is not challenging CVS or Walgreens in any meaningful way. CNBC

Charlotte NC-based ettain group has purchased EHR consultancy Leidos Health. The divesting parent, Leidos Inc. is best known to our Readers for its contract with the US Department of Defense in the replacement of the ancient AHLTA EHR with a Cerner system. The acquisition will reinforce Ettain’s healthcare IT sector. Leidos Inc. remains in business in the government and private healthcare sectors for consulting and retains the MHS Genesis contract. Unfortunately, the announcement is dimmed by a poorly written and elliptical release.

Update: A spokesperson for ettain group (lower case correction) has clarified via email that they have “acquired Leidos Health LLC which is a commercial EHR staff augmentation services business. This is not to be confused with Leidos Inc, the original parent company that still maintains a health business that manages the DOD MHS Genesis program. Basically, the ettain group transaction doesn’t include MHS Genesis.”

News and event roundup: Amazon PillPack, Humana joins CTA, NH’s telemedicine go, Fitbit Lives Healthy in Singapore, supporting Helsinki’s older adults, events

Now that we are past the unofficial end of summer, it’s time to spin that lasso and rope us some news.

Amazon’s PillPack loses a critical data partner. Electronic prescriptions clearinghouse Surescripts terminated their data contract with ReMy Health, which supplied PillPack with information on patients’ prescriptions. Surescripts found fraud in several areas of their relationship with ReMy Health including medication history, drug pricing, and insurance billing. Now PillPack has to obtain it the old-fashioned way–by asking the patient. This can lead to errors and inaccuracies in things like dosages and whether a drug is brand-name or generic. Now PillPack, in the lurch, is seeking a direct relationship with Surescripts. Seeking Alpha, CNBC

Health plan Humana is the first payer to join the Consumer Technology Association (CTA). Humana has been building up his data analytics and digital health capabilities with new ‘studios’ in Boston and hiring USAA’s CTO.  It’s piloting an app for Medicare Advantage patients to connect them with pharmacists and medication management via Aspen RxHealth plus working on a virtual digital primary model with telemedicine provider Doctor on Demand. Fierce Healthcare

New Hampshire is joining the telemedicine reimbursement bandwagon, with its legislature and Gov. Sununu approving primary care providers and pediatricians to bill Medicaid and private insurance for telemedicine visits starting in January 2020. This also ties into rural telehealth. AP, Mobihealthnews

Internationally….Fitbit is partnering with Singapore’s Health Promotion Board (HPB) for the Live Healthy SG behavioral change program, based on the Fitbit Premium program, starting in late October. Mobihealthnews A-P   In Finland, Digital Service Center Helsinki is creating digital tools and virtual care systems to enable older adults to safely and independently live at home, including socialization to prevent loneliness. It’s a significant challenge as over 22 percent of Finland’s population is over 65. Mobihealthnews Europe-UK

Events:

The 9th International Digital Public Health Conference series (#DPH2019), 20-23 November, Marseille, France. This conference is billed as the digital health partner of the 12th European Public Health Conference and brings together the areas of public health, computer and data science, medtech, and NGOs. Conference information here.

Aging 2.0 New York Global Innovation Showcase 4 December, NYC. One of a series of global Aging 2.o events, startups will present aging-focused innovations. Want to pitch? It’s still open–apply here. Register to attend here. Additional information on this and on CREATE’s Design for Older Adults Workshop on 21-22 October at Weill Cornell is here.

 

CVS-Aetna merger closes, but hardly ‘rubber stamped’ in Federal court

The deal is done, but expect unhappy holidays. As expected, the $69 million CVS-Aetna merger closed the week after Thanksgiving, on Wednesday 26 November, and are proceeding with their integration. Later that week, a Federal judge in the Washington, DC District Court complained at a hearing that both companies had treated him as a “rubber stamp” for the agreement. He was “less convinced” than the Department of Justice that the merger was legal under US anti-trust law. Yesterday (Tuesday 3 Dec), Judge Richard Leon ordered both companies and the DOJ to file briefs by 14 December “to show why their integration should not be halted while he considers whether or not to approve the consent decree reached in October,” according to Reuters.

This is despite various pounds of flesh:

  • The Department of Justice imposing the condition that Aetna sell its Medicare Part D drug plan business to far smaller WellCare Health Plans
  • New York State’s Department of Financial Services extracting concessions around their concerns: acquisition costs will not be passed onto consumers through increased premium rates or to affiliated insurers; maintaining current products for three years; privacy controls; cybersecurity compliance. Oh yes, a small $40 million commitment to support health insurance education and enrollment. (Healthcare Finance 26 Nov)
  •  But New York is a piker in its demands compared to California. The Department of Managed Health Care Director approved the merger based upon:
    • Minimal increases in premiums–and no increase due to acquisition costs
    • Investing $240 million in the state healthcare delivery system, including $166 million for state healthcare infrastructure and employment; $22.8 million to increase the number of healthcare providers in underrepresented areas like Fresno and Walnut Creek by funding scholarships and loan repayment programs; and $22.5 million to support joint ventures and accountable care organizations (ACOs) in value-based care (Healthcare Finance 15 Nov)

A CVS spokesman said in an email after the hearing: “CVS Health and Aetna are one company, and our focus is on transforming the consumer health experience.” (CNBC)  That transformation according to CVS president Larry Merlo involves expanding healthcare services beyond their present clinics to managing high-risk, chronic conditions, and transitions in care. Aetna’s expertise will be invaluable here as well as in an rumored expansion to urgent care (Seeking Alpha). All to out-maneuver Amazon, of course, which is promoting (on TV) PillPack and has applied for additional pharmacy licenses to ship drugs to customers in Washington, New Mexico and Indiana from their Phoenix facility (Healthcare Finance).

It appears that Judge Leon has his own serious reading of the 1974 Tunney Act, which requires a Federal court to ensure the agreement is in the public interest, despite the states and the DOJ.

Comings and goings: CVS-Aetna finalizing, Anthem sued over merger, top changes at IBM Watson Health

imageWhat better way to introduce this new feature than with a picture of a Raymond Loewy-designed 1947 Studebaker Starlight Coupe, where wags of the time joked that you couldn’t tell whether it was coming or going?

Is it the turkey or the stuffing? In any case, it will be the place you’ll be going for the Pepto. The CVS-Aetna merger, CVS says, will close by Thanksgiving. This is despite various objections floated by California’s insurance commissioner, New York’s financial services superintendent, and the advocacy group Consumers Union. CEO Larry Merlo is confident that all three can be dealt with rapidly, with thumbs up from 23 of the 28 states needed and is close to getting the remaining five including resolving California and NY. The Q3 earnings call was buoyant, with CVS exceeding their projected overall revenue with $47.3 billion. up 2.4% or $1.1 billion from the same quarter in 2017. The divestiture of Aetna’s Medicare Part D prescription drug plans to WellCare, helpful in speeding the approvals, will not take effect until 2020. Healthcare Dive speculates, as we did, that a merged CVS-Aetna will be expanding MinuteClinics to create urgent care facilities where it makes sense–it is not a big lift. And they will get into this far sooner than Amazon. which will split its ‘second headquarters’ among the warehouses and apartment buildings of Long Island City and the office towers of Crystal City VA.

Whatever happened to the Delaware Chancery Court battle between Anthem and Cigna? Surprisingly, no news from Wilmington, but that didn’t stop Anthem shareholder Henry Bittmann from suing both companies this week in Marion (Indiana) Superior Court. The basis of the suit is Anthem’s willfully going ahead with the attempted merger despite having member plans under the Blue Cross Blue Shield Association meant the merger was doomed to fail, and they intended all along for “Anthem to swallow, and then sideline, Cigna to eliminate a competitor, in violation of the antitrust laws.” On top of this, both companies hated each other. A match made in hell. Cigna has moved on with its money and bought Express Scripts.

IBM Watson Health division head Deborah DiSanzo departs, to no one’s surprise. Healthcare IT News received a confirmation from IBM that Ms. DiSanzo will be joining IBM Cognitive Solutions’ strategy team, though no capacity or title was stated. She was hired from Philips to lead the division through some high profile years, starting her tenure along with the splashy new Cambridge HQ in 2015, but setbacks mounted later as their massive data crunching and compilation was outflanked by machine learning, other AI methodologies, and blockchain. According to an article in STAT+ (subscription needed), they didn’t get the glitches in their patient record language processing software fixed in ‘Project Josephine’, and that was it for her. High profile partner departures in the past year such as MD Anderson Cancer Centers, troubles and lack of growth at acquired companies, topped by the damning IEEE Spectrum and Der Spiegel articles, made it not if, but when. No announcement yet of a successor.