TTA’s Swinging Summer 3: Amazon’s One Medical buy, Oracle fixing Cerner’s VA EHR problems, investment revival, companies shed real estate and people, more

 

 

 

Weekly Update

Much news this week, some good and some not-so. Oracle’s new sheriff moves to fix Cerner’s VA EHR problems, quickly. Investment is reviving, led by Amazon’s buying One Medical, Cleerly, and 3M’s 2023 healthcare spinoff. But Teladoc continues its losing streak. Health plans are shedding real estate and holdings. Also shedding are unicorns–Babylon Health, Included Health, and Noom.

Week-end roundup of not-good news: Teladoc’s Q2 $3B net loss, shares down 24%; Humana, Centene, Molina reorg and downscale; layoffs at Included Health, Capsule, Noom, Kry/Livi, Babylon Health, more (Hit by both telehealth and tech downturns)
Weekend investment/divestment roundup: 3M to spin off Health Care, Cleerly’s $223M Heartbeat, Elation’s $50M Series D, Health Note’s $17M Series A, Galen bought by RLDatix (A revival?)
Oracle’s ‘new sheriff’ moving to fix Cerner EHR implementation in the VA: the Senate hearing (High Noon at VA?)
Amazon moves to acquire One Medical provider network for $3.9B (revised) (Another worry for providers)

Having survived heat waves on both sides of the pond, the news is emerging from its lull. The most significant is around Oracle Health sunsetting the Cerner brand, which frankly has become a bit tarnished. Some of it is about staff cuts and hack attacks piling up, for different reasons in the US and UK. Other news is encouraging in that investment and business are moving forward, despite the parlous state of the markets.

Special congratulations to Herts Careline on its 40th birthday! 

Week-end news roundup: Fold Health launches OS ‘stack’; admin task automator Olive cuts 450 workers; 38% of UK data breaches from cyber, internal attacks; hacking 80% of US healthcare breaches; does AI threaten cybersecurity?
VA’s final, troubling OIG ‘unknown queue’ report on Cerner Millenium rollout; Oracle’s Sicilia to testify before Senate today (Oracle’s inherited mess)
Herts Careline marks 40th Anniversary (Congratulations!)
Midweek heat wave roundup: GE Healthcare’s new name, hospital-to-home health trending big, over 2 million patient records hacked (Hint: GEHC doesn’t have to change the brochures right away)
Cerner’s business now consolidated under Oracle Health (Excuse Cerner as it disappears–but save the swag for eBay!)

Summer is hot and the news is sideways. On the sunny side, bracing news for RPM is a Froedtert/GetWell Network study that reduced hospitalizations for Covid patients. More proof that UnitedHealth Group has mega-money for digital engagement is their Optum JV with Red Ventures’ health media properties. And UK keeps the funding going. But summer rain is depressing US digital health funding, SPACs, NHS England. 

Home-based remote monitoring for Covid reduced hospitalizations, hospital length of stay: JAMA study (Important proof of efficacy, Froedtert Health Network/GetWell RPM)
Weekend reading roundup: Amwell’s Schoenberg opines to Politico; Teladoc’s new CMO also opines, SPACs are done, done, done (Managing telehealth press, SPACs ending a short run)
Weekend UK news roundup: NHS England’s growing bed shortage as backlog hits 6.6M, Inoapps software for US health vans, Data Driven Healthcare Birmingham 1 Aug, Oto raises £2.8M, WeWALK £1.7m in funding
Thursday news roundup: RVO Health JV combines Optum-RV Health consumer health assets; Holmes sentencing for Theranos fraud delayed (RVO Health all about the patient engagement)
The clunk continues: Q2 2022 digital health funding fades to $4.1B in Q2, down 50% from 2021 (Back to 2019 if we’re lucky)

Summer’s in swing and resembling a normal season, but are there July-type storm clouds on the horizon (other than inflation and government upheaval, of course)? Certainly, the day he knew would arrive finally did for Theranos’ Sunny Balwani. The Feds may not stop at telemental health prescribing but look at reimbursed telehealth billing. The NoKos are sowing Maui ransomware all over health care. And yet another company–the retreaded Watson Health, now Merative–promises healthcare transformation. (Better news from Novartis with their Biome UK cardiac challenge.)  

Weekend news roundup: Teladoc adds to Primary360; Novartis, Medtronic support UK digital cardiac startups; Bluestream adds PrimaryOne Health; NoKo ransomware threatens healthcare; more Fed scrutiny on telehealth Rx, billed time may be coming (The last a grey cloud on telehealth horizon. Biome UK applications close 31 August)
Two telehealth case studies: St. Luke’s University Health, CommonSpirit Health (How does your program stack up?)
Verdict Balwani: guilty on all 12 Theranos fraud charges (Limp defense, no jury sympathy)
Thursday news roundup: IBM Watson Health sale closed, now Merative; OneMedical inviting buyers–maybe; worst healthcare data breaches rounded up (Merative another ‘transformative company’, ho-hum)

AliveCor got an impressive initial decision from the ITC which may be bad news for the Apple Watch in the US. Teladoc’s CEO’s interview may not have been the best idea at this time. Telemental health Cerebral’s business practices apparently went over the line and down the street, while the jury’s out for Theranos’ Sunny Balwani. Bionic clothing for MS, Tunstall supports a Doncaster trust, and a bit of funding made it through. Have a happy 4th!

Weekend news, deal roundup: Teladoc CEO’s tapdance interview, VA EHR cost reporting now law, Tunstall-Doncaster Deaf Alliance partner, Cleveland Clinic’s $33M medtech spinoff (A curious way for Teladoc to damage control)
‘Bionic clothing’ to aid mobility tested for foot drop in MS patients (Watch this one)
Wednesday news roundup: PicnicHealth $60M Series C, can a downturn be good for digital health, Cerebral ran wild, a tart take on HIMSS and where it’s going (Bursting the funding bubble is beneficial, maybe. And HIMSS needs some rethinking.)
Theranos Summer Rerun: Sunny Balwani trial verdict countdown analysis (updated) (Will be updated until the verdict’s in)
US International Trade Commission initial determination: Apple infringed AliveCor’s patents (updated) (David got Goliath. Boink!)

The Meta Pixel story continues with a major US children’s hospital system with over-the-top use and the first class action against Meta filed in Federal District Court. Cerner’s VA miseries increase with a damning OIG report. Optum bids high for EMIS, Talkspace holds out for its own high bid. And ISfTeH comes back on our screens with courses and a report.

Catching up with ISfTeH (International Society for Telehealth and eHealth): three courses and a report (It’s been two long years)
Let the lawsuits begin: Meta sued by health system patient for Meta Pixel info gathering (A John Doe that may not have standing?)
Wednesday news roundup: March telehealth claims down to 4.6%, state telehealth waivers expiring, UnitedHealth’s Optum bids for EMIS, Talkspace reportedly rejected Amwell, Mindpath bids
Facebook Meta Pixel update: Nemours Children’s Health using 25 ad trackers on appointment scheduling site (It gets worse)
More bad news for Cerner’s VA rollout–draft report cites 150 “cases of harm” due to the ‘unknown queue’ (Now Oracle’s headache with the OIG)

 


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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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Amazon moves to acquire One Medical provider network for $3.9B (updated)

Amazon joining the in-person provider network space for real. Amazon Health Services last week moved beyond experimenting with in-person care via provider agreements (Crossover Health, TTA 17 May) to being in the provider business with an agreement to acquire One Medical. Earlier this month, news leaked that One Medical as 1Life Healthcare was up for sale to the right buyer, having spurned CVS, and after watching their stock on Nasdaq plummet 75%.

  • The cash deal for $3.9 billion including assumption of debt is certainly a good one, representing $18 per share, a premium to their $14 share IPO in January 2020. (The stock closed last Wednesday before the announcement at just above $10 per share then plumped to ~$17 where it remains.)
  • The announcement is oddly not on One Medical’s website but is on Amazon’s here.
  • The buy is subject to shareholder and the usual regulatory approvals. The IPO was managed by JP Morgan Securities and Morgan Stanley. It is primarily backed by Alphabet (Google).
  • One Medical’s CEO Amir Dan Rubin will stay on, but there is no other executive transition mention.
  • Also not mentioned: the Iora Health operation that serves primarily Medicare patients in full-risk value-based care models such as Medicare Advantage (MA) and Medicare shared savings, quite opposite to One Medical’s membership-based concierge model. However, Iora’s website is largely cut over to One Medical’s identity and their coverage is limited to seven states.

There is a huge amount of opinion on the buy, but for this Editor it is clear that Amazon with One Medical is buying itself into in-person and virtual primary care for the employer market, where it had limited success with its present largely virtual offering, and entree with commercial plans and MA. One Medical has over 700,000 patients, 8,000 company clients and has 125 physical offices in 12 major US markets including NYC, Los Angeles, Boston, and Atlanta. It has never turned a profit. Looking at their website, they welcome primarily commercial plans and MA (but not Medicare supplement plans).

Amazon, with both a virtual plus provider network, now has a huge advantage over Teladoc and Amwell, both of which have previously brushed off Amazon as a threat to their business. There is the potential to run two models: the current Amazon Care pay-as-you-go model and the One Medical corporate/concierge model. This puts Amazon squarely in UHC’s Optum Health territory, which owns or has agreements with over 5% of US primary care practices, is fully in value-based care models such as Medicare shared savings through its ACOs, and is aggressively virtual plus integrating services such as data analytics, pharmacy, and financial. Becker’s

What doesn’t quite fit is Iora Health and the higher cost/higher care needs Medicare market that is less profitable and requires advanced risk management, a skill set that Amazon doesn’t have. This Editor will make a small prediction that Iora will be sold or spun off after the sale.

This Editor continues to believe that the real game for Amazon is monetizing patient data. That has gained traction since we opined that was the real Amazon Game in June and October last year, To restate it: Amazon Care’s structure, offerings, cheap pricing, feeds our opinion that Amazon’s real aim is to accumulate and own national healthcare data on the service’s users. Then they will monetize it by selling it to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Patients may want to think twice. This opinion is now shared by those with bigger voices, such as the American Economic Liberties Project. In their statement, they urged that the government block the buy due to Amazon’s cavalier attitudes towards customer data and far too much internal access, unsecured, to customer information (Revealnews.org from Wired). Adding PHI to this is like putting gasoline on a raging fire, and One Medical customers are apparently concerned. For what it’s worth, Senator Bernie Sanders has already tweeted against it.   MarketWatch

Whether this current administration and the DOJ will actually care about PHI and patient privacy is anyone’s guess, but TTA has noted that Amazon months ago beefed up its DC lobbying presence last year. According to Opensecrets.org, they spent $19.3 million last year. In fairness, Amazon is a leading Federal service provider, via Amazon Web Services. (Did you know that AWS stores the CIA’s information?)  One Medical is also relatively small–not a Village MD/Village Medical, now majority owned by Walgreens Boots. This is why this Editor believes that HHS, DOJ, and FTC will give it a pass, unlike UHG’s acquisition of Change Healthcare, especially if Amazon agrees to divest itself of the Iora Health business.

Treat yourself to the speculation, including that it will be added as an Amazon Prime benefit to the 44% of Americans who actually spend for an Amazon Prime membership. It may very well change part of the delivery model for primary care, and force other traditional providers to provide more integrated care, which is as old as Kaiser and Geisinger. It may demolish telehealth providers like Teladoc and Amwell. But as we’ve also noted, Amazon, like founder Jeff Bezos, deflects and veils its intents very well. FierceHealthcare 7/25, FierceHealthcare 7/21, Motley Fool, Healthcare Dive

Weekend reading roundup: Amwell’s Schoenberg opines to Politico; Teladoc’s new CMO also opines, SPACs are done, done, done

If Teladoc’s Jason Gorevic [TTA 1 July] and new CMO Vidya Raman-Tangella (below) are suddenly available to the health press, can a Schoenberg brother be far behind? This brief Q&A with Politico is with Roy Schoenberg of Amwell and covers the state of telehealth, obstacles, abortion, consolidation, and automation. He stays pretty much on message with no surprises as the questions are short and, as is the practice, pre-submitted:

  • Telehealth is a distribution arm of healthcare, not just videoconferencing
  • The biggest war in telehealth remains state licensure–as it was pre-pandemic, past the ‘jumping in’ stage
  • Telehealth will not be a ‘pill mill’ for abortion pills (abortifacients) or controlled substances–it will be based on clinician professional judgment. (In the Editor’s opinion, this ‘hot potato’ was pre-written by the legal department.)
  • Consolidation as a question is not answered. We will see telehealth delivered by large healthcare organizations and telehealth that works with multiple brands. (What is not addressed is what telehealth services large healthcare organizations will go forward in using–the ‘high-priced spread’ of all-inclusives or the white-labels)
  • His opinion around automation is that it will be split between the camps of replacing clinicians, or augmenting them plus giving patients the opportunity to manage their health reality. (One wonders for what reality Amwell is preparing)

Teladoc’s new chief medical officer Raman-Tangella is also on the healthcare charm offensive with a Healthcare Dive interview on strategy and new products. She discusses enterprise clinical strategy and whole-person care, which echoes the Gorevic interview. There’s a diversion to ‘health equity’ which is first defined as a continuum [Editor’s term] of gathering data, taking solutions to customers, and seeking outcomes that validate the first two. She then moves on to closing care gaps through this information, especially in musculoskeletal and physical therapy, and returning to health equity, disparities and then (what we used to define as) proactive care based on all this patient information.

Forget the fork. SPACs as an IPO method are burnt and heading to the trash bin. Again [TTA 9 June] we have PrivCo’s Daily Stack addressing their demise, this time quantifying the crack of the full SPAC market (in and outside healthcare):

  • From one in 2009 to 248 in 2020
  • 2021: an estimated 50% of the total US IPO market in Q1 with 299 listings valued at $98.3 billion
  • 2022: 18 registrations this entire 2022 year and still in the process of raising $2 billion. (This Editor noted that the only healthcare SPAC apparently in progress is VSee and iDoc Telehealth with Digital Health Acquisition Corporation to close in Q3.)

As we’ve previously noted, SPACs are under attack by the SEC and by perpetual hair-on-fire for the press Senators such as  Elizabeth Warren. According to Bloomberg (sign-in needed), 30 SPACs have been called off this year. And as we’ve noted, there are healthcare SPACs like SOC Telemed which went private at a fire sale discount. Others like Owlet, Headspace, and Talkspace are struggling. Watchful eyes are on late SPACs such as Pear Therapeutics and Babylon Health. It’s a less-than-grand finale to what was touted as a low-muss way to IPO.

Weekend news roundup: Teladoc adds to Primary360; Novartis, Medtronic support UK digital cardiac startups; Bluestream adds PrimaryOne Health; NoKo ransomware threatens healthcare; more Fed scrutiny on telehealth Rx, billed time may be coming

Teladoc had some positive news this week with additions to Primary360, its new primary care service for the provider/payer market. It added in-network referrals and care coordination capabilities, free, same-day prescription delivery from Capsule, and in-home, on-demand phlebotomy from Scarlet Health. The release notes that about half of patients fail to pick up their prescriptions. In addition, Priority Health, a nonprofit health benefits company serving Michigan, has added Primary360 to its fully insured virtual first plan design for employers. FierceHealthcare

Some good news from the UK in a time of government upheaval. Novartis is supporting cardiac digital health startups through the Novartis Biome UK Heart Health Catalyst 2022. This investor partnership is to identify and scale innovations for non-invasive lipid testing and at-home blood pressure testing using software as a medical device. Partners in support are Medtronic, RYSE Asset Management and Chelsea and Westminster Hospital NHS Foundation Trust and its official charity CW+. Successful applicants will receive support from partners during the competition process, the opportunity of investment up to £3 million provided by RYSE Asset Management, subject to due diligence at RYSE`s discretion, access to the Novartis Biome UK eco-system located in White City, and opportunities to work with our NHS partners to set up and deliver a pilot evaluation of the winning innovation. Applications must be in by 31 August–form is here. FierceBiotech

Bluestream Health adds PrimaryOne Health. Bluestream provides a white-labeled customized virtual care service that will be integrated into PrimaryOne’s services. This medical group of 11 community healthcare facilities across central Ohio serves 48,000 patients with primary care, OB-GYN, pediatric, vision, dental, behavioral health, nutrition, pharmacy, physical therapy, and specialty care.  Release

North Korea’s Maui Ransomware is no Hawaiian vacation. The threat has built enough since May 2021 for the Federal Bureau of Investigation (FBI), Cybersecurity and Infrastructure Security Agency (CISA), and the Department of the Treasury (Treasury) to release a joint Cybersecurity Advisory (CSA) on Thursday warning healthcare and public sector health organizations. It is state-sponsored North Korean malicious cyber activity. The CSA provides a sample of how it executes, what it targets, how it encrypts files, and how to respond. Hackermania, NoKo Style, is Running Wild with breaches piling up [TTA 7 July], and not only in healthcare. Healthcare Dive, Healthcare IT News

And in Dog Bites Man News, a former US assistant district attorney for Massachusetts predicts that Federal entities such as the Department of Justice (DOJ) may not stop with telemental prescribing. They will not only be ramping up their scrutiny of telemental health companies–but also telehealth billing. For Cerebral and Done Health that facilitate the prescribing of Schedule 2 drugs, this assumption of scrutiny has become a no-brainer. What it also is: a caution for mainstream telehealth providers such as Teladoc and Amwell charging into psychiatric telehealth.  But the former ADA, Miranda Hooker, now a health sciences area partner with Troutman Pepper in Boston, makes a broader prediction. Prosecuted telehealth fraud, as this Editor has noted, has grown in other areas, such as prescriptions for durable medical equipment (DME) billed to Medicare [TTA 6 May] and cardiologists moonlighting as Dr. Mabuse, Master Cybercriminal [TTA 19 May]. But the next frontier may be time-specified telehealth consults billed to Medicare under various CPT codes (e.g. 994XX). A 15-minute consult billed as a more lucrative 30-minute consult can be considered fraud. The Cerebral investigation, according to Hooker, marks a shift by the DOJ into investigating the actual provision of telehealth services and whether they are being billed properly. FierceHealthcare

Weekend news, deal roundup: Teladoc CEO’s tapdance interview, VA EHR cost reporting now law, Tunstall-Doncaster Deaf Alliance partner, Cleveland Clinic’s $33M medtech spinoff

Teladoc CEO Jason Gorevic’s curious tapdance of an interview. Teladoc has had a rough 2022 to date. Their 2022 Q1 financials [TTA 4 May] were disastrous, their share price has not recovered since it cracked in late April with a 62% year-to-date plunge, the Livongo acquisition is shaping up to be the healthcare equivalent of Eastern Airlines’ takeover by Texas Air Corporation circa 1986, and shareholders are filing class action lawsuits. Now this Editor doesn’t mean to pile on. As a professional in two fields, she does understand the value of the press and leadership being available. But FierceHealthcare’s Heather Landi cleverly got Mr. Gorevic to stake his ground for growth yet again on “holistic, integrated solutions” that combine multiple care services from primary to complex care as the ‘longitudinal’ way to go. Yet Ms. Landi does have the nerve to bring up recent history and their long-time competitors like Amwell and Doctor on Demand (now Included Health) in the same space. Then there are the slices taken by players in the direct-to-consumer and niche target players (she cites troubled Cerebral and Talkspace–I’d offer DTCs like Babylon Health and the ‘white-labels’ like Bluestream Health and Zipnosis, now owned by BrightHealth, which are directly and cost-effectively working with providers). Think of this: in an economic downturn, will providers buy the ‘premium spread’ that requires a big implementation lift, or get by a less comprehensive solution that’s easier to implement and costs less?  Surprisingly, given the ‘everyone wants everything’ strategy, he again blames the cost of paid search advertising and brushes off Microsoft and Amazon. I’m not so sure that so soon after their Q1 bad news in May, with lawsuits centering on statements to investors, and nothing new in good news, this interview was particularly good timing.

VA corralled by Congress on Cerner EHR. The Department of Veterans Affairs now, by Federal law enacted late last week, has to prepare quarterly reports on its transition to the Cerner Millenium EHR to both House and Senate Veterans committees on performance and cost, including a breakdown of program funding sources. The new bipartisan law’s title is the VA Electronic Health Record Transparency Act.  Healthcare Dive

Tunstall Healthcare is now working with a local trust, the Doncaster (UK) Deaf Trust, to provide support for deaf and hearing-impaired children and adults. With Whitley Parish Council, Tunstall is working with the specialist gardening team at Communication Specialist College, part of Doncaster Deaf Trust, to secure over 100 plants for the planters which have been grown at the Trust’s gardens. Tunstall volunteers planted them in the planters across the village. Doncaster Free Press

Cleveland Clinic’s successful spinoff, Centerline Biomedical, closed a $33 million Series B equity financing. Leading it was Cleveland Clinic with participation by GE Healthcare, RIK Enterprises, JobsOhio, Jumpstart Ventures, and G2 Group Ventures. Centerline’s technologies improve visualization and guidance of stents, catheters, and guidewires in endovascular procedures, reducing dependence on radiation and contrast agents with the goal of improving patient outcomes. These include sensors and electromagnetic tracking that create 3-D color visualization and navigation of the human vascular system. Release, Becker’s

Wednesday news roundup: March telehealth claims down to 4.6%, state telehealth waivers expiring, UnitedHealth’s Optum bids for EMIS, Talkspace reportedly rejected Amwell, Mindpath bids

Telehealth usage continuing its downward trend. At 4.6%, telehealth medical claims in March were off over 6% (0.3 points) versus February’s 4.9%. Again, 65% of claims were for mental health conditions, and social workers were the leading providers of telehealth at 32% for primarily one hour of psychotherapy at 26%. FAIR Health monthly US tracker.

One possible contributing factor is states pulling back on the broad telehealth provider location and other waivers (such as platforms) that were enacted during the Covid emergency. These waivers primarily permitted out-of-state providers. The expiration of waivers thus return telehealth delivery to in-state licensed providers unless covered by other regulations, for instance Medicaid. Last year, 26 states waived in-state licensure requirements; this year, only 12 states have these waivers. California and New Jersey are due to expire soon.  NBC News with a hat tip to HISTalk.

Optum bids to buy UK health software provider EMIS. The bid of £1.24 billion ($1.5 billion) was announced last Friday. A UK affiliate of Optum, Bordeaux UK Holdings II Limited, is the actual entity for the acquisition, recommended by the EMIS board. The offer is in cash and represents a 49% premium to the current share price. EMIS is a leading provider of software and systems to the NHS, serving primary care, community care and pharmacy, acute care, and the Patient.info website. When completed, EMIS would be UnitedHealth’s largest acquisition in the UK and Europe. FierceHealthcare 

Troubled telementalhealth provider Talkspace reportedly rejected a bid from Amwell pretty much out of hand, leading to speculation that it’s up for sale but being picky-picky-picky.  According to the report in Behavioral Health Business, from Seeking Alpha, their talks did not even reach number discussions. This is after Talkspace rejected another bid in May from another telementalhealth provider Mindpath, backed by Centerbridge Partners and Leonard Green & Partners. Sources were split on whether $500 million was offered or not (Axios).

Talkspace is one of the poster children for Cracking SPACs. It hit the market in January 2021 at a valuation of $1.4 billion, opening above $8, hitting a peak of about $11 per share. Share price declined to as low as $1.06 before rising on this acquisition talk to $1.58. Current valuation is $58 million, but it is sitting on a reported $184 million in cash. Reportedly their CEO search is going nowhere. Much like Teladoc, one year after their SPAC, investor lawsuits were filed against the company for misleading investors. Look for Talkspace to be sold over the summer.

Weekend review: FDA clears Apple Watch ‘AFib History’, OS9 adds health features; Amwell’s new CMO; 2M records breached at New England provider, largest this year

Apple Watch adding first-ever ‘AFib History’ in watchOS 9 software release. Announced 6 June, Apple received their FDA 510(k) clearance for this new feature which adds on to the existing ECG app and irregular rhythm notification. The History feature includes an estimate of how frequently a user’s heart rhythm shows signs of atrial fibrillation, including additional weekly notifications to understand and track this on a printable PDF. According to their release, users can view a detailed history in the Health app, including lifestyle factors that may influence AFib, like sleep, alcohol consumption, and exercise, which can be downloaded and printed.

Other health-related features on the watchOS9 release include:

  • Medications app for managing medications, vitamins, and supplements, including a medications list, schedules and reminders, and directly view medication information in the Health app
  • Sleep Insights, an add-on to the existing sleep tracking that informs users of sleep stages. Using signals from the accelerometer and heart rate sensor, it will detect and track when users are in REM, core, or deep sleep.

Apple release 6 June, FierceHealthcare

Amwell names new chief medical officer. Carrie Nelson will be working with payer and provider organizations in care delivery from Amwell’s new platform, Converge. In addition, she will be heading up the Amwell Medical Group, their clinical partner. Dr. Nelson was formerly Advocate Aurora Health’s senior vice president and CMO for Population Health and Health Outcomes, where she was also chief clinical officer for Advocate Physician Partners, their value-based care physician group. Amwell is transitioning practices from its prior platforms and needs to maintain their presence with both groups as many are finding alternative telehealth systems. Amwell release, Healthcare Dive

And what week wouldn’t be complete without a massive healthcare data breach? The leading event so far this year took place over two weeks in March at 60 healthcare facilities affiliated with Massachusetts-based Shields Health Care Group. While it was only 7 to 21 March and discovered 28 March, apparently the quaintly-titled ‘unknown actor’ was able to compromise data. The investigation by Shields and Federal and state regulators is ongoing as to what data was accessed and taken; to date, there is no evidence to indicate that any information from this incident was used to commit identity theft or fraud. The difference in breaches between now and the past is how rapidly it’s discovered.  Shields Health notice, Healthcare Dive

Wednesday AM roundup all about money: $28B Oracle-Cerner closes today, 9 June strategy talk; Teladoc class-action lawsuits begin; Cigna’s look at loneliness

As you read this, Oracle has closed on their acquisition of Cerner Corporation. According to the Oracle release, approximately 204,280,589 shares, or 69.2% for $28 billion, have been validly tendered and other conditions, such as passing antitrust approvals, have been satisfied. If there are other loose ends to tie off, they aren’t impediments to the closing.

Interested Readers can register to hear Larry Ellison, Oracle’s chairman, and other speakers outline Oracle’s strategy to “redefine the future of healthcare” (a song we’ve heard before) on 9 June at 3pm Central Time. If our UK Readers have been wondering what former PM Tony Blair’s been up to, he’ll be on this call. Other UK speakers are David Walliker, chief digital officer of Oxford University Hospitals, and Kevin Jarrold, joint CIO of Imperial College Healthcare. Another outside speaker is Meharry Medical College‘s CEO, James E.K. Hildreth, MD, PhD. Meharry, located in Nashville, is the second oldest medical school founded (1876) to educate black Americans in medicine and dentistry.  

Here we go with class-action lawsuits against Teladoc based on loss of share value and misleading statements. Teladoc, whose stock has taken a long jump off a very tall building (90% loss from the high), is being sued in US District Court for the Southern District of New York by a shareholder, Jeremy Schneider. This is a Federal securities class-action lawsuit (text here) with Mr. Schneider representing shareholders who purchased Teladoc shares between 28 October 2021 and 27 April 2022 (the date of announcing Q1 2022 results). The charges involve materially false statements that Teladoc made on its business, operations, and prospects including minimizing competition leading to increased advertising costs, unrealistic projections for revenue made in the period, and the impact of the Livongo writeoff announced Q1–a noncash goodwill impairment charge of $6.6 billion, or over $41 per share [TTA 4 May recaps Q1].

A lookup on Justia indicates that Mr. Schneider is being represented by Jeremy Alan Lieberman of Pomerantz LLP. The filing names Jason Gorevic, CEO, and Mala Murthy, CFO as individual defendants along with Teladoc. Mr. Schneider is not a large shareholder; his investment was a little over $250,000 from December 2021 to February 2022. Other shareholders may join the suit by contacting Pomerantz.

What usually happens after this is other firms file class-action suits in the same court representing other shareholders. An example of this trolling is this announcement/release from Bernstein Liebhard LLP

If you like risk and volatility, TDOC and AMWL shares remain relatively cheap (the latter below $5) and haven’t recovered. TTA reflected on Amwell’s equally shaky Q1 and growing losses in May 

If and when they’ll recover is anyone’s guess, with increased direct-to-consumer competition from retail (CVS, Walmart) and with providers maintaining their own telehealth systems, homegrown and whitelabeled (Bluestream Health, Zipnosis). Healthcare Dive, Mobihealthnews recap much of what led to this point.

If you feel a little lonelier after your Teladoc (or other telehealth) shares tanked, or you feel like life hasn’t gotten back to normal now that the pandemic is really over (despite the hoo-hah over monkeypox), Cigna’s latest research commissioned from Morning Consult will be on point. Isolation is a function of lower income, lower physical and mental health, and being a single parent or mother. Contrary to the usual assumption, young adults 18 to 24 feel lonelier and more left out (79%) compared to those aged 66 and over (41%). (Your Editor speculates that the office and workplace are more necessary for socialization by those starting their careers than those toward the end who’ve built their networks.) What’s also a little surprising is the increased indication of loneliness among racial lines with black/African American (68%) and Hispanics (72%) feeling significantly lonely. The impact at work is less productivity and more unhappiness with their jobs. The study recommends increases in work and community activities, work flexibility, improved benefits, and workplace inclusion. A bit more along with quotes from Cigna’s Evernorth subsidiary in FierceHealthcare

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

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

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

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

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

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

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

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

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

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

Some thoughts on Teladoc and the Week That Was in telehealth

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

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

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

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

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

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

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

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

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

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

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

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

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

The end of the bubble? SOC Telemed, SPAC’d at $10 per share, acquired for $3 and $300M by Patient Square Capital

SOC Telemed (NASDAQ: TLMD), one of the earliest health tech SPACs [TTA 4 Aug 2020], is going private in a deal with the Sand Hill Road healthcare investment firm Patient Square Capital. Patient Square is paying $3 per share in cash.

Based on the 100,840,000 shares outstanding (MarketWatch), this Editor’s best estimate of the transaction is about $303 million. Holders of 39% of the outstanding shares have already voted in favor of the transaction. The deal includes a 30-day “go shop” period in which SOC Telemed’s board of directors can solicit additional bids. Unless there is a superior bid, the deal with Patient Square is expected to close in the second quarter of 2022. 

According to the release, Dr. Chris Gallagher, CEO since September of 2021 will remain. He was previously co-founder/CEO of Access Physicians, a multi-specialty acute care telemedicine business acquired by SOC Telemed in March of 2021. SOC Telemed claims to be the largest telemedicine provider in the US acute care market, supplying virtual consults in specialty areas such as neurology, psychiatry, and ICU. 

Here is where it gets interesting–and worrisome for telehealth. SOC Telemed’s SPAC in August 2020 started at $10.00 per share and a valuation of $720 million. On 2 February, two days before the announcement, SOC Telemed was trading at $0.64 per share. That is a plunge of 94% from the SPAC, with a 72.6% drop in the prior three months that was only arrested by the buyout. The reality is that the Patient Square offer represents a 368% premium over SOC Telemed’s closing share price on 2 February. It is currently trading in about the $2.75 range. 

The worrisome trend is that since August, the publicly traded and established industry giants, Teladoc and Amwell, have also taken it in the shins on their share prices. Teladoc has tumbled by half and Amwell (American Well) by 60%. Even the private companies like MDLive and Included Health (Grand Rounds + Doctor on Demand) must take note that telehealth consults have plunged to about 4% of claims. SPACs, which had opened up an alternate, less complicated channel of public financing for health tech and had its own role in inflating company valuations, have faded due to a combination of circumstances. Will more cautious investments and fewer IPOs be the trend in telehealth for 2022?

What’s next for telehealth in the (almost) aftermath–and rating the US states on policies

crystal-ballWhat’s in that cloudy crystal ball?  Last year, especially the first half, saw telehealth acquisitions, stock prices and valuations hit the roof. The roof proved to be high but sturdy, as they bounced right back down, not unexpectedly. 

But gee whiz, Fast Company’s article seems to be shocked, shocked at all this, calling it a bubble. This Editor sincerely doubts that any investor that tracked telehealth over the last 10 years would have NOT expected this ride on the rollercoaster after the urgent care and practice offices reopened starting in mid-2020 and worked slowly through 2021. The rebound, as with health insurance payers, took a few months to work through into 2021. Telehealth usage in 2021 receded steadily to single digits, and at last report to just above 4% of claims as of October 2021 (FAIR Health US claims data).  What remains is the continued dominance of mental health–62% for mental health codes. It’s turned out that Babylon Health‘s SPAC was the last of the major action for 2021, getting in under the wire in October. 

It’s obvious that investors will be more realistic in assessing telehealth companies, looking at the areas that sustained telehealth usage, such as behavioral health. Another surprising niche is LGBTQ telehealth–Grand Rounds’ buy of Included Health in May, which then led to the entire company, including Doctor on Demand, adopting the name [TTA 20 Oct].

The other move that telehealth companies are making is to take more of the patient than a few virtual visits. They’ve moved into offering primary care teams to patients in employer plans (Babylon360 and Teladoc’s Primary360). Amazon Care moved into in-home health and clinics with Crossover Health. Amwell acquired SilverCloud for expanding behavioral health capabilities internationally, and stuck a toe into care management with their Converge platform and acquiring startup Conversa‘s health coaching app. The flip side is retail health migrating into in-person and virtual primary care–CVS Health and Walgreens, via VillageMD.

What also held telehealth back for over a decade of less than 1% was reimbursement by Medicare, Medicaid, and private insurers. The pandemic broke through that barrier. While it has narrowed considerably, CMS will still reimburse audio-only telehealth for behavioral health services, addiction treatment, and in-home health visits. State policies on telehealth practices can positively influence telehealth growth for patients and physicians. Free-market organizations Reason Foundation, Cicero Institute, and the Pioneer Institute have reported on all 50 on several policy metrics: 

  • In-person requirements
  • Modality neutral (asynchronous or synchronous, technology including audio, video, store and forward, and remote patient monitoring.)
  • No state barriers
  • All providers can use telehealth
  • Independent practice (including nurse-practitioners)
  • No coverage or payment mandates
  • Cross-state compacts

Rating the States on Telehealth Best Practices

Short takes: Athenahealth close to sold, Teladoc wants More of the Patient, CVS fewer store customers

Some thought starters for your weekend…

Reportedly, EHR and systems provider Athenahealth is thisclose to being sold. Via Becker’s Health IT, Seeking Alpha, a stock analysis site, connects the dots. In September, Bloomberg reported that private equity firms Veritas Capital and Elliot Investment Management (Evergreen Coast Capital) were considering selling Athenahealth for $20 billion or filing an initial public offering (IPO), two dramatic ways to exit. They entered in 2019 for $5.7 billion when it was already public, taking it private and combining it with a GE acquisition, Virence Health.

Timing is now Q1 2022. The most interested investors apparently are Hellman & Friedman, Bain Capital, KKR, Thoma Bravo, and Brookfield Asset Management. While no longer the powerhouse it once was in EHRs and related systems, it still can fetch a good return and provide a favorable exit for the two companies. Athenahealth had no comment for Becker’s. 

Teladoc and Big Telehealth wants More of the Patient, but will it be profitable? Our Readers are well aware of the War of the Roses (because it’s gone on so long) among the traditional telehealth players: Teladoc, Amwell, Included Health (Grand Rounds-Doctor on Demand), MD Live, with other smaller players jumping out of the juggernauts’ way and sticking to their knitting. With the addition of primary care (and, one can assume, the pandemic push), health systems and companies like Amazon Care and Babylon Health have jumped into the mix with ‘hit them where they ain’t’ offerings–Amazon offering house calls and services direct to employers, and Babylon 360 being offered to health plans and employers. Babylon and Teladoc’s Primary360 cover much the same ground, though, in connecting the patient users with an assigned doctor and primary care team for ongoing care.

As noted last month [TTA 7 Oct], the walls between payer and provider in primary care are collapsing in multiple ways in telehealth and payer models like insurtechs. Another model is Amwell’s reinforcing behavioral health capabilities (SilverCloud) and sliding into care management (Conversa and Amwell’s Converge platform).

Readers do not have to go far for confirmation that Teladoc aggressively wants most or all of the patient and isn’t going to settle for less. This is conveniently summarized by HISTalk from Teladoc’s Investor Day (with Editor’s emphasis)

image

Teladoc’s investor day presentation predicts that consumers will expect virtual-first encounters whose quality equals in-person ones and that offer them a variety of coordinated care services. The company says it has evolved from fee-for-service video visits and will become a partner with its customers in offering whole-person care at under value- and risk-based arrangements. It says it will be “the first place consumers turn to for all healthcare needs” for “whole-person care that is personalized, convenient, and connected.” TDOC shares dropped 8% on the day and have shed 25% in the past 12 months, with the company’s market value being $20 billion versus the $18.5 billion in cash it paid to acquire Livongo in late October 2020.

As we’ve previously noted, Teladoc has never made a profit. Many felt it overpaid for Livongo and cut loose too many in the leadership with truckloads of gold. Investors weren’t quite on board with the whole-person vision either, looking at the share price trends. 

CVS Aetna, on the other hand, wants fewer store customers, more patients. Their announcement this week is that they are closing 10% of their stores (900 of 9,900) to focus on urgent/chronic care HealthHUBs, expand those services, and cut down on the brick-and-mortar. This responds to Walgreens buying a majority interest in VillageMD/VillageHealth with adjacent full-service primary care practices and CareCentrix for home care [TTA 14 Oct]. Reuters

Say goodbye to the local, easily navigated ‘boulevard’ CVS, often furnishing food, writing tablets, wrapping paper, and paper towels along with prescriptions and shampoo, often patronized by an older age group, for a barn-like, coldly-lit superstore that you have to drive to. (And say goodbye to pharmacy head Neela Montgomery.) And why is every HealthHUB this Editor has seen unimpressive–strangely under-staffed or no-staffed, tatty waiting areas with a couple of plastic chairs, expanded with ugly outside trailers that cut down on parking spaces?

Cui bono? According to CNN Business, it’s Dollar General, which loves those local locations and has been planning to beef up its health-related OTC meds. They also now have a chief medical officer who is evaluating in-store eye exams, telemedicine, and partnerships with local pharmacies. Given inflation, more customers will be checking Dollar General out.

Short takes: Now J&J splits up, a Color(ful) $100M, Cue Health goes DTC, Amwell’s busy Q3, Teladoc’s Investor Day 19 Nov

Breaking up seems to be the thing this month. Now Johnson & Johnson is spinning off its consumer brands into a separately traded public company, retaining the pharmaceutical and medical device businesses. The consumer business includes such J&J global signature products such as Band-Aids, Neutrogena, Q-tips, Baby Powder and Shampoo, and the Listerine line of products. It’s expected to take 18 to 24 months. The pharma/med device business will retain the J&J brands, sub-brands like Janssen, and development in AI and robotics. The consumer products divisions will have to hunt around for a new one. Outgoing CEO Alex Gorsky must be heaving a sigh of relief and dreaming of a long vacation, as he won’t have to shepherd this one– incoming CEO Joaquin Duato starts in January. Pharma/med device is much larger, with $77 billion in revenue. Consumer accounts for $15 billion, with four products alone accounting for $1 billion each. The reason behind it, of course, are the talc lawsuits around Baby Powder and Shower to Shower which have been adroitly hived off, but continue. CNBC, Reuters

Population health and genomics is more Color(ful) than ever, with the company’s $100 million Series E topping off last year’s $167 million Series D for a total of $497 million since 2014 (Crunchbase). Valuation of the company is now at $4.6 billion. Color’s platform is targeted primarily to the public sector–health agencies, research institutions, employer organizations, health systems, and others for custom-built software that can integrate patient information and genomics with lab results and education.  It previously teamed up with the National Institutes of Health for the ‘All of Us’ project collecting research data from a broad scope of the US population. Mobihealthnews

San Diego-based Cue Health, which up to now was known for a molecular COVID-19 at-home test, is expanding its direct to consumer market with a virtual health platform featuring their COVID-19 test (on FDA EUA, CE marked) starting on 15 November. It’s expanding ‘on cue’ with a membership offering, Cue+, with 24/7 online medical consults, e-prescriptions, what they term CDC-compliant test results for travel through in-app video proctoring, and same-day delivery of their products. Membership starts at $49.99 per month for the lowest level plan, escalating to $89.99/month for supervised COVID-19 testing. To make this work requires a Cue Reader that costs $249 along with testing packs priced at $225 for three. Cue also has in development testing for other factors–where it started prior to the annus horriblis of 2020. Not for those on a tight budget, but if you need it…. Cue release, Mobihealthnews

Amwell’s busy Q3 in visits reflected the uptick in the ‘delta’ variant of COVID-19, but was disappointing on the earnings side as urgent care brings in less revenue than behavioral health or specialty care. Amwell’s year-to-year revenue was down less than 1% to $62.2 million, but the decrease is forcing a revision in 2021 full year forecasted revenue. The Converge platform [TTA 29 April] has reached 4,000 providers and 43 enterprise clients which was far more than forecasted. Newly acquired SilverCloud and Conversa Health [TTA 29 July] are integrated into Converge and already cross-selling. Amwell, however, remains in the red with a quarterly net loss of $50.9 million. Healthcare Dive  

The Telehealth Wars continue to see-saw, with Teladoc’s Investor Day on Thursday 19 Nov next week. According to Seeking Alpha, a stock analysis site, “Bank of America is cautious on TDOC ahead of the event, citing questions about the near-term margin trajectory and competition. Shares of Teladoc rose 22% in the three weeks following its last investor day.”

Amazon Care confirms five more cities, beefs up DC lobbying–but what’s the real game?

Amazon Care will be expanding in 2021, confirming five new locations–and maybe more. Kristen Helton, the director of Amazon Care, confirmed at HLTH21 that 2021 rollouts of the virtual + mobile care service would include Dallas, Chicago, Philadelphia, Boston, and Los Angeles, ‘to name a few’. Ms. Helton confirmed that Washington DC and Baltimore region are live. The website does not state active cities, only permitting a zip code search and confirmation. Pharmacy delivery is also available in select, but not stated, areas. Healthcare Dive

Amazon Care originated with Amazon employees as a telehealth service, with in-person available to employees in the Seattle area. By March, they opened the full service (Video and Mobile Care Medical) to other Washington state companies. At that time, they announced that Video Care will be available nationally to companies and all Amazon employees by the summer–and claimed that in-person services would be rolled out to multiple cities by the summer. That did not happen. 

In June, at a Wall Street Journal Tech Health event, while being coy about the rollout, Amazon Care VP Babak Parviz said that the service would look like:

  • Clinician chat/video connected within 60 seconds
  • If an in-person visit is required, a mobile clinician arrives within 60 minutes, who can perform some diagnostic tests, such as for strep throat, provide vaccinations and draw blood for lab work. For other diagnoses, that clinician is equipped with a kit with devices to monitor vital signs which are live-streamed to remote clinicians.
  • Medication delivery within 120 minutes

Basically, what is not being said is that Amazon has been slow walking Amazon Care, probably wisely. With telehealth visits, mobile care, and pharmacy, there are multiple and complex elements to mesh seamlessly, which is after all Amazon’s Promise. What’s not so seamless is paying for it. While for Amazon it is with immediate payment for service, it is not for the patient–obtaining reimbursement, if available, is left up to the patient–at least for now, as reports indicate they are negotiating with Aetna. Amazon Care is also its own closed network.

There’s also the blunt fact that Amazon is moving into territory well staked out by major players that integrate employers, insurance, primary care, and pharmacy: Teladoc, Amwell, Included Health (Grand Rounds + Doctor On Demand), MD Live. They are now joined by UnitedHealth Care’s announcement a few days ago of NavigateNOW, a new virtual-first commercial plan rolling out next month to employers in nine markets and 25 markets by end of 2022. It offers 24/7 primary care, urgent care, and behavioral health care services through Optum as well as UnitedHealthcare’s national provider network. Many services and medications will have $0 copayments. Healthcare Dive, FierceHealthcare

However, if the cost of Washington lobbying is any indicator, Amazon is blasting off in healthcare. According to a report in OpenSecrets.org, “Amazon, which is creating its own health care service, is the biggest corporate lobbying spender so far in 2021. The company has spent nearly $10.2 million on lobbying in the first six months of the year, and spent $18.7 million in 2020.” The (unfortunately paywalled) report in STAT confirms the hire of Claire Winiarek from PCMA to be their new director of health policy.

This Editor’s opinion remains as in June–that Amazon’s business plans for Care and Pharmacy, and generally in healthcare, are really about accumulating data, not user revenue, and are certainly not altruistic no matter what they say. Amazon will accumulate and own national healthcare data on Amazon Care and Pharmacy users far more valuable than whatever is spent on providing care and services. Amazon will not only use it internally for cross-selling, but can monetize the data to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. That’s a very different game than traditional insurers and the telehealth giants.