TTA’s Brrrrr Season 2: JPM drear, misunderstood Babylon, Teladoc layoffs, CVS’ open purse, KillNet threatens, UKTelehealthcare’s new help for TECS, more!

 

 

Weekly Update

It must be Mid-Winter Blues, but the news was fairly light this week–even from the JPMorgan health conference, a soggy SFO affair indeed. (At least the streets were cleaned.) Babylon feels ‘misunderstood’, Teladoc lays off 6%. CVS keeps funding and KillNet keeps threatening IT Havoc. Good news from UKTelehealthcare with TECS help for the digital switchover. Plus ISfTeH’s annual meeting now set for Winnipeg and news from ATA.

Industry org news: ISfTeH International Conference call for presentations, new leaders for ATA Policy Council (Good news!)
UKTelehealthcare launches TECS consultancy in partnership with TECS Advisory (Expert help on the digital switch)
Interesting pickups from JPM on CVS, Talkspace, Veradigm backs Holmusk, ‘misunderstood’ Babylon Health; six takeaways (News from a damp, dreary, insane JPM)
Teladoc laying off 6%, reducing real estate, in move to “balanced growth” and profitability (Nice move if they can do it)
‘KillNet’ Russian hacktivist group targeting US, UK health info in Ukraine revenge: HHS HC3 report (Healthcare becomes a side battle)

A mulligan stew of a week. CVS moving in on primary care with (possibly) Oak Street, funding Carbon Health in-store clinics while the latter downsizes. Walgreens’ VillageMD closed on Summit Health and Teladoc paints a brighter revenue picture with BetterHelp. Rock Health quantified a deflated 2022 year in funding, but M&A/VC investment still proceeds in its ‘boring’ way. Verily, Alphabet’s wandering ‘bet’, finally gets a needed trim. And Theranos is still in the news from appeals to post-prison requirements.

Weekend short takes: Theranos’ Holmes post-prison mental health + more on Shultz and Balwani; global M&A, funding roundup
Rock Health puts a kind-of-positive spin on digital health’s ‘annus horribilis’ 2022–a boring 2023
Mid-week roundup: Teladoc gets BetterHelp to boost Q4 ’22 revenue; fundings for Array, Paytient, Telesair, three others; layoffs hit at Alphabet’s Verily, Cue Health
CVS works their plan in Oak Street Health buy talks, Carbon Health $100M investment + clinic pilot; VillageMD-Summit finalizes (updated)
Theranos trial updates: Holmes’ freedom on appeal bid opposed; Balwani files appeal to conviction

Two surprises not under the Christmas tree or New Year’s hat. The ITC upheld AliveCor patents and damages versus Apple, pending their PTAB appeal, and Amazon got its first state approval for One Medical. As expected, telehealth’s national Medicare reimbursement was extended for two years, setting policy for health plans. And NHS advanced rapid stroke diagnosis with Brainomix trial in 22 hospital trust trial, tripling near-full recoveries to 48%.

Weekend news roundup: GE Healthcare spins off, adds CTO; Allscripts now Veradigm; NHS Brainomix AI stroke trial success; Withings home urine scanner; Careficient buys Net Health EMR; CommonSpirit’s class action suit on data breach
Amazon-One Medical gains conditional OK in Oregon–a preview of coming scrutiny?
(What happens at the big state and Fed level?)
Telehealth extensions signed into US law with Federal FY 2023 omnibus bill (Major breakthrough to widen nationally reimbursed telehealth)
Split decision! ITC rules that Apple violated AliveCor patents; enforcement held for PTAB appeal (David v Goliath continues!)

A potpourri of news wraps 2022, starting with confirming how telehealth can stand on its own even in specialty care visits and its continued strength in mental health. In the US, most telehealth expansion is confirmed for two years. But as predicted, DEA is going hard after ADHD misprescribing — a unicorn may lose its horn as a result. Oracle is erasing Cerner’s home town presence as Epic stomps a patent troll. And beware of DDoS–it may distract from more nefarious cybercrimes.

We wish our Readers all the happiness of the season, as we look forward to the start of the New Year. We’ll be back with new articles after 2 January. 

We wish our Readers a happy, healthy holiday season and New Year!
News roundup: DDoS attacks may be ‘smokescreen’, DEA slams Truepill with ‘show cause’, telehealth claims stabilize at 5.4%, Epic squashes patent troll, Cerner meeting exits KC, MedOrbis, Kahun partner on AI intake (From cybercrime to Cerner, c-c-c-changes roll)
Telehealth two-year extensions included in US Federal ‘omnibus’ budget bill (Tucked into a Moby Dick-sized whale of a bill)
Few specialty telehealth visits require in-person follow up within 90 days: Epic Research study 2020-2022 (Findings, though, may be pandemically skewed)

It’s a week of contrasts as the holiday season starts. There are ‘green shoots’ in startups and fundings, yet so many organizations have run into the red, with a high human cost. A literal bright spot–a lighting system that can detect and report falls. And the Holmes Defense Team files an appeal for a new trial that may delay her delivery to Club Fed for a long time. (Hoping the Feds will forget?)

Rounding up fundings and startups: Override(ing) pain; brainy Synchron and In-Med Prognostics; Click off migraine; Cardiosense and CHF detection (A touch of seasonal cheer)
Smart lighting that detects and reports falls in older adults–and more–debuts in UK and Ireland (Lighting up fall detection is a big step forward)
10 reasons for a new trial? Elizabeth Holmes’ legal team files appeal, delay in prison start (updated) (Foot dragging strategy continues as financial penalty to be decided)
Mid-week roundup: Wisconsin’s Marshfield Clinic zeros out telehealth staff; Komodo Health lays off 9%; epharmacy Medly’s Ch. 11, PharmEasy layoffs; OneStudyTeam releases 25% (Coal in too many stockings)

Windups as the holidays and year-end loom. AliveCor loses its David vs Goliath patent battle with Apple, with consequences to come. The Theranos drama nears its end with Balwani’s sentence. But in new developments, robotics for care support and care becomes part of…energy management? And can VIMPRO help NHS manage its patient population crush?

Theranos’ Balwani gets an unlucky 13 year sentence, restitution to come (No tears, no dramatic statements, little media scrum, and a lighter sentence than expected)
AliveCor loses Patent Office ruling with Apple; three patents invalidated (This one isn’t over–the stakes are high)
News (and robot) roundup: ElliQ companion robot upgrades, named to 2022 TIME list; Robin the Robot introduced for older adult care; Utilita acquires Canary Care (UK) (Robots advance, interesting integration of care with energy management)
Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand? (A smarter approach advocated in managing patient populations )
Optum Labs creates and funds digital health research hub at Cornell Tech NYC (Reviving NYC in digital health, or gathering ideas for Optum to develop elsewhere?)

Something a bit different this week with two maximum roundups. athenahealth may IPO–again. Amwell may bolster telemental health with Talkspace. Cerebral and former CEO dueling in court. Taking bets on where Theranos’ Elizabeth Holmes will spend her sentence–and when. Plus…year-end buys and fundings. 

Who’s buying, selling, funding wrapup: athenahealth IPO deux?, NextGen EHR buys reseller TSI for $68M, Cloudwave buys Sensato; fundings for Lumen, UpStream, Aide Health
“Big Story” update: where Elizabeth Holmes will spend 11 years, Cerebral sues former CEO Robertson, Amwell buying Talkspace? 

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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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Industry org news: ISfTeH International Conference call for presentations, new leaders for ATA Policy Council

The International Society for Telehealth and e-Health (ISfTeH) is holding its International Conference in Winnipeg, Manitoba, Canada this year, 31 May to 2 June. It is being organized in collaboration with the University of Manitoba’s College of Rehabilitation Sciences and with support from Tourism Winnipeg. If you are interested in submitting a presentation proposal, go online to https://easychair.org/cfp/ISFTEH2023, or contact the Conference Chair, Dr. Amine Choukou (amine.choukou@umanitoba.ca). Abstracts are due on 3 February and full presentations by 17 February. Go to their main website (link above) for a link to the conference website (to come). ISfTeH is one of the oldest organizations in telehealth–a 25-year-old global federation of 45 national professional organizations in the field of telemedicine and eHealth, plus institutional, corporate, and individual members in over 35 countries worldwide.  Hat tip to Frederic Lievens of ISfTeH.

The American Telemedicine Association (ATA) announced new leadership joining their ATA Policy Council. Mary Griskewicz, MS, FHIMSS, director of federal policy, Cigna, joins the Policy Council as chair, along with Alyssa Keefe, system senior vice president, public policy and advocacy, CommonSpirit Health; Leslie Krigstein, vice president, government affairs, Transcarent; and Sarah-Lloyd Stevenson, MPH, senior manager, Amazon. Current chair Mark Hayes, senior vice president, Federal policy and advocacy, Ascension, remains on the Policy Council as immediate past chair. Readers should note the new mix of organizations. The ATA Policy Council makes final determinations on policy positions taken by the ATA and ATA Action, the ATA’s affiliated trade organization. Reminder–ATA 2023 is 4-6 March. Release

ATA organizes Telehealth Awareness Week this week

The American Telemedicine Association has, without a lot of advance fanfare, put together Telehealth Awareness Week this week from Monday 18 through Saturday 24. The purpose of the week is to showcase the many ways virtual care improves access to quality healthcare services for all individuals, including members of rural and underserved communities.

Events both virtual and local are listed here including two later events:  ISfTeH’s Global Connections for Sustainable Telehealth, 6-7 November, in-person in San Jose [TTA 12 Aug], and Forefront 2022: Provider-to-Provider Telemedicine Summit, held virtually on 12 October. The Week’s 53 endorsing and founding partners are also supported by 71 Congressional Policy Champions. ATA release (PDF) 

Week-end news roundup: Fitbit revives with 3 new watches, Sena Health hospital-at-home, SteadyMD surveys telehealth clinicians, 9.4% fewer adult dental visits in England, save the date for ATA 2023

Fitbit’s three new wearables–will they revive the brand? Fitbit, now owned by Google, announced the debut of two new smartwatches and one fitness tracker, available now for preorder and shipping in September. Will buyers find them more attractive than their predecessors? From left to right:

Fitbit Inspire 3 upgrades from the predecessor with a color display and similar $99.95 price. Monitors for irregular heartbeat, reminders to move, wakey-wakey alarm, apps, and more.

Fitbit Versa 4 is a thin, light fitness smartwatch with sleep, SpO2 monitoring, GPS, irregular heartbeat, stress, pay hands free, Amazon Alexa, and connects to your smartphone. Four colors, will set you back $229.95.

Fitbit Sense 2 is chunkier with more information and tracking on health and stress than Versa 4 for a higher price at $299.95.

Readers can weigh in on whether these will be attractive, as the Fitbit brand has, over the past two years, almost vanished from the fitness smartwatch consciousness. GearPatrol, Mobihealthnews

New entrant in the developing hospital-to-home service provision area Sena Health is partnering with southern New Jersey’s Salem Medical Center to deliver Salem’s hospital-to-home program. Sena’s capabilities with Salem include up to 23 hospital-level services at home and 24/7 care coordinators. To qualify, patients must have been seen in the ER and evaluated on certain criteria. When cared for at home, they receive two in-person nursing visits daily and can connect with a dedicated clinical team if needed. Hospital-to-home is being trialed all over the country and is considered to be ‘hot’, but at this point is not all that widespread. HealthcareITNews

SteadyMD conducted a survey among a group of potential workers for their telehealth care team, among 1,700 clinicians: doctors (35%), nurse practitioners (52%), and therapists (12%). Some interesting findings such as:

  • Experienced (10 years +) doctors and therapists are most interested in telehealth practice, with nurse-practitioners (NPs) less so
  • Flexible schedules and working from home are the main attractions
  • Night shifts are attractive to 86% of therapists. Doctors and therapists average about 60%. But the latter two are far more interested in weekend work–not the therapists.
  • Telehealth as a full time delivery of care goes between 50 and 69% for each. Clinicians want more hours if the arrangement is part-time.

SteadyMD is a telehealth infrastructure provider that works with healthcare organizations, labs and diagnostics companies in 50 US states.

Something that can’t be delivered by telehealth except for diagnosis is your annual dental visit and treatments, and it’s down 9.5% in England, based on a report published by NHS Digital. The tracking of NHS adult dental visits covers the 24 months prior to June 2022 compared to the 24 months prior to June 2021. When compared to the 24 months up to June 2019, the reduction is 25.3%. Since dental practices closed except for emergency care due to Covid in March of 2020, there is an overlap in the numbers. They do indicate that dental treatments have not recovered in volume from before the pandemic. One good sign is that child dental treatment has strongly rebounded, up 42.1% in the 12 months prior to June 2022 versus up to June 2021, but still down over 20% compared to the 12 months prior to June 2019. Regional data is included in the NHS Digital report (link above).

The American Telemedicine Association announced its 2023 ATA annual conference will be in San Antonio, 5-7 March 2023. More information on “From Now What? to How To! The Vision and Realities of Telehealth Adoption” already is up on their website here.

Weekend short takes: ATA, APA call for permanent in-person evaluation waiver, mental healthtech raised $5.5B in 2021, Allscripts sells hospital/large physician EHRs to Harris Group for $700M, Cognizant-Microsoft extends telehealth-RPM

72 groups asking for permanent telehealth in-person evaluation waiver prior to prescribing controlled substances. The American Telemedicine Association (ATA), ATA Action, and the American Psychiatric Association (APA) plus 69 other healthcare groups have written the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) to make the temporary waiver of in-person patient evaluation prior to prescribing controlled substances permanent, and to remove restrictions on patient location. The rationale is to increase access to care, specifically for mental health and substance use disorder treatment. Currently, under the soon-to-be ending COVID-19 public health emergency (PHE), mental health providers can prescribe controlled substances remotely through a telemedicine consult. The letter points out that studies confirm efficacy, clinician and dispensing would remain under current restrictions, and that DEA and HHS can work together to prevent drug diversion. Other signatories include Babylon Health, Teladoc, Zipnosis, One Medical, and Northwell Health. ATA release, ATA/APA letter.

Mental healthtech’s banner 2021 totaled $5.5 billion across 324 international deals. Industry researcher CB Insights found that:

  • Investment was up 139% versus 2020
  • Exits were also up 87% (43 versus 23). Of the 43, there were 35 M&As, five SPACs and three IPOs.
  • US companies dominated in mental health, raising $4.5 billion; EU $651 million, and Asia $289 million
  • Mega-rounds ($100 million+) totaled 15, all US and in Q4, versus four in 2020.

State of Mental Health Tech 2021 Report free download available on the CB Insights page. Mobihealthnews

Allscripts is unloading its declining hospital and large physician practice EHRs to Ottawa-based Harris Group for $700 million in a cash plus contingent deal. The Allscripts EHRs in the transaction are Sunrise, Paragon, Allscripts TouchWorks, Allscripts Opal, and dbMotion. Although the unit generated gross revenue of $928 million in 2021, its revenue was expected to decline 3-4% and EBITDA to shrink 10-15% in 2022. Allscripts is retaining Veradigm, which is growing 6-7% annually, and stated that expected after-tax proceeds of $600 million will be used for share repurchase and potential M&A related to Veradigm. Harris Group acquires and manages computer systems companies in North America, Europe, Asia, and Australia covering four sectors: public, private, healthcare, and utilities. It is owned by Toronto-based Constellation Software. HISTalk reports on the Allscripts investor call, Constellation release

Cognizant announced a collaboration with Microsoft Cloud for Healthcare to extend telehealth and remote patient monitoring (RPM) capabilities for their offerings combining remote patient monitoring and virtual health, utilizing connected devices such as smartwatches, blood pressure monitors, and glucose meters to collect and communicate patient health data to providers. Cognizant release

Friday short takes: Uber Health taps geriatrician CMO (updated), Sensyne Health completes £11M financing as part of formal sale, ATA + ECHAlliance ally, add GHCP Summit, Reimagine Care home-centered cancer care lands $25M

Uber Health’s first-ever chief medical officer is an unusual choice–a geriatrician. Michael Cantor, MD, JD is a board-certified geriatrician. According to his LinkedIn profile, he had previously been a CMO at insurtech Bright Health and CareCentrix. From the release, his expertise is in designing clinical programs for older adults and vulnerable populations for the most pressing gaps in care–and how technology can address them. Uber’s focus is in mobility–patient transportation and deliveries as part of social determinants of health (SDOH). They report 71% gross bookings growth for the business unit from Q4 2020 to Q4 2021. Release, Healthcare Dive

An update on Dr. Cantor: his CMO position at Uber Health is part-time, according to his LinkedIn profile. He will be continuing at Intuition Robotics as their CMO, having started with them in May 2021 (release). Intuition developed the ElliQ robot companion and is extending it to healthcare for older adults. Hat tip to Laurie Orlov for the info.

Some dismaying news from Oxford is that Sensyne Health, a clinical AI company for life sciences companies that analyzes data from US and UK health system EHRs, is having financial difficulties that have caused them to enter a Formal Sale Process (FSP). The £11.35 million will keep them solvent and not force a stop to their trading on the London Stock Exchange, and the FSP process will organize their outstanding debt until a purchaser can be found. Sensyne was founded by former UK science minister Lord Paul Drayson, and only last May inked two deals with the Colorado Center for Personalized Medicine (CCPM) and St. Luke’s University Health Network (PA/NJ) to expand its dataset. Sensyne release, Healthcare IT News

The American Telemedicine Association (ATA) announced that they will collaborate with Belfast-based ECHAlliance (European Connected Health Alliance) in the Global Health Connector Partnership (GHCP). The GHCP includes HLTH, The Digital Health Society, Health Parliament, the Commonwealth Centre for Digital Health, and Africa Health Business. The Global Health Connector Partnership Summit will convene at ATA2022, 1-3 May, in Boston. Release

Nashville-based Reimagine Care completed a $25 million capital raise led by Santé Ventures, Martin Ventures, and LRVHealth. Reimagine is a provider of home-centered cancer care for oncology practices and providers. The funding will be leveraged to further develop and commercialize the company’s first-of-its kind technology-enabled services in the Access Care Platform, launch their virtual care center, and expand the patient care team. Home-centered treatment reduces costs and increases patient convenience.  Release

American Telemedicine Association sets up ATA Action for policy advocacy

The American Telemedicine Association (ATA), which has been known for its advocacy of telemedicine and telehealth since 1993 (!), is doubling down with setting up a separate “affiliated trade organization”, ATA Action, for policy advocacy. This is centered on making permanent pandemic-expanded telehealth access for Americans, state and federal telehealth coverage, and appropriate payment policies. ATA Action will be led by Kyle Zebley, ATA vice president, public policy, as executive director. There is a long list of ‘founding members’ and ‘Advocacy Council Members’ listed in the ATA release.

Key policy advocacy is centering on nine major points, including: 

  • Removing the in-person telemental health requirement
  • Increased broadband access
  • Coverage through federal programs such as Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), the Indian Health Service, TRICARE, and the Veterans Health Administration
  • Telehealth across state lines while maintaining state authority to regulate the clinical practice
  • Remove regulatory roadblocks to decentralized clinical trials
  • Align Medicare coverage of remote patient monitoring with how it is practiced

ATA is also confirming that their 2022 annual meeting will be in-person at the Boston Convention & Exhibition Center 1-3 May. Information and registration are here.

News & deal roundup: Oak Street adds telespecialty RubiconMD, ATA plumps for wider telehealth access, yet claims fall to 4%, West Suffolk NHS adds Zivver mail/file security, Northwell’s $100M for AI–and miss industry shows yet?

Primary care network Oak Street Health acquired virtual specialty telehealth provider RubiconMD for $130 million. Oak Street is a 19-state network of physicians in care centers who specialize in Medicare patients. RubiconMD has 230 specialists who provide doctor-to-doctor teleconsults (eConsults) in 120 specialties, with an emphasis on cardiology, nephrology, and pulmonology, which is a strong fit for Oak Street. RubiconMD also has separate offerings for specialty care panels and behavioral health. The $130 million includes up to $60 million in cash or cash/stock, subject to achievement of defined performance milestones. Management transitions were not disclosed. Release, FierceHealthcare

The American Telemedicine Association wants to preserve wider telehealth access into 2022–even if the public health emergency (PHE) for Covid has to be extended. Although the Medicare Physician Fee Schedule proposed by CMS for 2022 includes areas of wider telehealth access and reimbursement (temporary access under Schedule 3 added in 2021) into 2023 regardless of the PHE, Congressional action is required to permanently expand telehealth beyond the existing programs mostly for rural areas. If necessary, ATA is advocating that Health & Human Services (HHS) extend the PHE through 2022 so that telehealth access and reimbursement are preserved. ATA releaseFierceHealthcare

While this Editor can understand ATA’s frustration and the sincerity of its aims, it distorts the emergency meaning of a PHE that is just about nonexistent except for mandates. And telehealth claims, even with current access, have sunk down to a tick above 4%, 60% of which are mental health codes (FAIR Health July national data). Too many providers, too little demand? 

The West Suffolk NHS Foundation Trust (WSFT) has selected Zivver UK to secure its mail and file transfer systems, as it migrates from NHS Mail to Microsoft 365. It includes encrypted email to patients as a core requirement meeting NHS digital standards, and ease of use for both sender and recipient in MS Outlook. 4,800 staff at WSFT, which covers 280,000 people who live in West Suffolk. Release. Hat tip to HISTalk for this and the next two stories.

Northwell Health backs AI health startups via joint venture with Aegis Ventures with $100 million stake. The JV between the two New York-based companies “will ideate, launch, and scale AI-driven companies to address healthcare’s most challenging quality, equity, and cost problems” with stakeholders across Northwell’s extremely large system. According to the release, “Northwell has a track record of success in AI research, including the development of a landmark algorithm that predicts patients’ overnight stability to reduce the need to wake them for vital sign checks.” Nice to know that a health system appreciates patient sleep. 

And finally–miss the grip and grin of a F2F industry trade show and presentations? Your Editor, who was once a habitué of meetings from Boston to Florida, does. Really! Virtual conferences, once fun, are now tedious. So enjoy this walk through of HLTH21 by Ben Rooks, the Investor Man, at the Boston Seaport (a great venue, though not precisely central), right down to the barbers, puppy rescue, disco ball, and juice shots. Courtesy of HISTalk

Short takes, 4 Feb: HIMSS 21 Global/APAC go ‘hybrid’; ATA announcements including virtual ATA2021; Hillrom acquires EarlySense monitoring tech

It’s 4 Feb, and while All Is Not Right With the World, we should be reassured that a real, in-person HIMSS 21 Global conference is apparently still On Target for 9-13 August in Las Vegas. What’s new is that it will have a virtual component (the ‘hybrid’) in addition to the Three Ring Circus spread among the Venetian-Sands Expo Center, Caesars Forum Conference Center, and the Wynn. t Hotel reservations ARE open, but registration is not. (Those who wish to transfer the 2020 registrations to 2021 will have to wait for an email.) HISTalk, which always seems to have the Inside Line on the conference, confirmed that HIMSS is kicking the can down the road on an in-person conference. It’ll depend on vaccination rates, infection rates, and federal guidelines, all of which are indefinable bars to something six months down the road. The next HIMSS21 update will be published on 19 February. It may include an announcement of the registration opening date. As the HIMSS update page is singularly uninformative, this Editor is subscribing to their update emails as offered.

Reading further down on HISTalk, the long-standing co-located CHIME (College of Healthcare Information Management Executives) annual conference is no more. CHIME will be holding a hybrid Fall Forum in October and virtual events in April and June. Will this mean that a lot of CIOs and senior IT people–the deciders–will not be as eager to go to Las Vegas and HIMSS will turn even more into a ‘boat show’, in HISTalk’s words? 

Meanwhile, in Singapore on 18-19 May, HIMSS APAC is full hybrid with both in-person and virtual sessions. The theme is Future-Proof Healthcare: The Emergence of Asia. If you’d like to nab a speaking or panel spot, act fast–it closes on 28 February and is only open to government/healthcare providers. More info is on their website.

The American Telemedicine Association just wrapped its four-part ATA EDGE virtual conference. Like a lot of virtual events, it’s split into relatively short sessions (about 2.5 hours) and multiple days. EDGE was on Tuesdays starting 12 January and wrapped 2 February. Announcements and related news from EDGE and ATA include an announcement for ATA2021:

  • The Telehealth Equity Coalition (TEC) launched. TEC is a data-driven project to review public data on telehealth adoption in communities across the country. The objective is “to improve access to quality and affordable healthcare by increasing adoption of telehealth, especially among those who have been left out or left behind. Together with nonprofit, academic, and industry partners, TEC will offer a unique voice to optimize equitable telehealth delivery and utilization.” Founding members are Hims & Hers, the ATA, and the National Health IT Collaborative for the Underserved. Release
  • ATA2021 will be full virtual in June and take place on Tuesdays and Thursdays. This year’s theme is Telehealth: Enabling Flexible, Inclusive and Contemporary Care Delivery. More information on the content and program, including links to proposal submission forms, is here. Deadline for General Program speaker nominations and Research Presentations/Posters is 26 February. The registration page is not yet active.
  • On the policy front, ATA commended Texas Governor Greg Abbott on his advocacy of telehealth expansion as key to quality care for Texans. In his State of the State annual address, he outlined goals for the executive and the legislature in expanding both telehealth and broadband access. Release  ATA also sent a letter to the Arizona State Legislature in support of House Bill 2454 which makes some comprehensive changes to telehealth policy that will increase telehealth options in that state. Letter

And in the Continuing Story of Big Company Buys Little Company’s Tech, Hillrom, which just acquired cardiac monitoring company BardyDx, has now acquired contact-free continuous monitoring technology from EarlySense. Hillrom already has equity in the Massachusetts and Israel-based company. A portion will go in payment for the monitoring technology, plus a cash consideration of $30 million with potential payments based on the achievement of certain commercial milestones. EarlySense will also have a license to the technology, useful as EarlySense continues to develop next-generation AI-based sensing technologies specifically for the remote patient care market. Hillrom is incorporating it in its Centrella Smart+ med-surg bed and ecosystem of connected devices for the monitoring of heart and respiratory rates over 100 times per minute. Release 

News roundup: Milken Institute’s telehealth brief with ATA push on Congress, GoodRx confirms 62% are CoronaDepressed, Johns Hopkins’ COVID mortality risk study and calculators

The hot US health tech issue is retaining, consolidating, and adding to the gains that telehealth and remote patient monitoring (RPM) made during the pandemic. The influential Milken Institute (formally the Milken Institute Center for the Future of Aging, Center for Public Health, and FasterCures) has published a short white paper on how best to increase access to telehealth services and support innovation as part of that aim. Their five core recommendations are: 

  1. Permanently lift Medicare location restrictions on telehealth to ensure that older adults can receive a variety of services in their homes and communities, regardless of where they live. (This was also recommended by the Taskforce on Telehealth Policy (TTP) [TTA 18 Sep] which was jointly formed by the ATA, NCQA, and the Alliance for Connected Care.)
  2. Meet the growing need for behavioral health care by addressing barriers to remote care and expanding the availability of telebehavioral  health services.
  3. Increase equitable access to telehealth services through digital technology, literacy programs, and broadband coverage.
  4. Support development and implementation of innovative telehealth and mobile health technology for prevention, well-being, clinical care, and research.
  5. Develop and document clear data sharing standards to support transitions of care across acute, post-acute, and long-term care settings, including care provided in the home and in residential care facilities. 

The consensus is that CMS’ 2021 Physician Fee Schedule post-pandemic (public health emergency=PHE) does not do nearly enough in that it returns–of legal necessity–to the status quo ante geographic restrictions, though it devised a temporary Category 3 to store over 50 telehealth billing codes [TTA 3 Dec]. The American Telemedicine Association (ATA) was joined by multiple organizations on Monday in pressing Congressional leaders to extend national telehealth ‘flexibilities’ as part of the $1.4 trillion omnibus spending deal that is needed to avoid a government shutdown on Friday (yes, this Friday) at midnight. The organizations joining the ATA on the letter to Congress are the Alliance for Connected Care, College of Healthcare Information Management Executives, Connected Health Initiative, eHealth Initiative, Health Innovation Alliance, HIMSS, and PCHAlliance. ATA release.

We are shocked, shocked that CoronaDepression worsens in those already suffering. Prescription discounter GoodRx analyzed prescription fill trends for anxiety and depression meds and found that they reached an all-time high in 2020–9.5 percent higher than the previous high in 2016. It peaked in April as the pandemic was underway, and possibly reflected some stockpiling.

Of their sample of 1,042 individuals diagnosed with anxiety and depression prior to the pandemic:

  • 22 percent responded that their symptoms were “much worse”
  • 40 percent said they were “worse”
  • 28 percent stated that symptoms were the “same”
  • a surprising 10 percent said symptoms were “better” or “much better” 

One of the main factors in that 62 percent reporting worse/much worse was the length of quarantine. “Those who reported quarantining due to COVID-19 were far more likely to report “worse” or “much worse” symptoms compared to those who did not quarantine. Over 70% of those who reported quarantining for more than one week said their depression and/or anxiety symptoms were “worse” or “much worse.” Loss of job and income, plus COVID-related events affecting friends and family, were also key in worsening symptoms. Many also had difficulty reaching their doctors/therapists and renewing medication. The study was conducted 1-10 November. GoodRx study

More depressing news (sic) of mental health challenges to older adults in the Isolation Age: The Future of Remote Care Technology, Lockdown Loneliness feared more than COVID, and the PLOS One study.

But cheer up and carry on, your COVID mortality risk may not be as bad as you think. A team of researchers at the Johns Hopkins Bloomberg School of Public Health created a COVID mortality risk calculator, based on algorithms calculating factors such as age, gender, sociodemographic factors, location, and a variety of different health conditions. Risk scores are grouped into five categories from lower than average/close to average to high.  While primarily for public health authorities to prioritize populations for vaccination, uninfected individuals can use it to determine their personal risk of future infection and complications after infection. It’s easy to use and your results may surprise you. There is also an interactive US map of the risk level of major cities, counties, and states. The study is published in a paper that appears in the journal Nature Medicine.  Johns Hopkins release, risk calculator

News roundup: Kaiser/Best Buy Lively partners; Teladoc’s mental telehealth, Livongo execs depart; approved apps make comeback in US, DE; United Airlines tests COVID CommonPass for international flying

Kaiser Permanente is adding to its existing partnership with Best Buy Health. The joint program will develop remote patient-monitoring tools for older adults centered on Lively Mobile Plus. By pressing a button on the phone, users can connect with individuals trained to triage emergency and nonemergency situations, from car trouble, home lockouts, or medical emergency. Kaiser Permanente has rolled it out to their Medicare members as part of its Medicare Affinity Program for independent living at home. In 2019, the Kaiser system piloted Lively Mobile Plus after Best Buy’s acquisition of GreatCall. Becker’s Hospital Review 6 October and 22 October. Photo from Best Buy via Kaiser on Twitter, @aboutKP.

Teladoc launches mental telehealth to Canadian employers. Four Livongo C-levels will depart after closing. The Teladoc Mental Health Care program is available to employees of Canadian companies and provides access to psychiatrists, psychologists, and therapists via phone, web or mobile app. It is in addition to Teladoc’s Mental Health Navigator and disability products in Canada. Press release, Becker’s Hospital Review  Becker’s has also been keeping a close eye on Teladoc’s SEC filings. The letter, filed 15 October, stated that Livongo CEO Zane Burke, President Jennifer Schneider, MD, CFO Lee Shapiro (widely conceded as the merger engineer), and SVP of business development Steve Schwartz will leave the company after the closing. Livongo’s Executive Chair Glen Tullman will keep his seat on the combined company’s board of directors. Look for more changes that won’t make Livongo employees happy. Our previous Skeptical Takes on the merger here.

Approved Apps Revive! The American Telemedicine Association (ATA) announced a new partnership with the UK’s ORCHA–the Organisation for the Review of Care and Health Apps–to develop an approval procedure for health apps. Announced at the virtual HLTH conference, the objective is to create a review process to vet safe and effective health apps out of various app stores. ORCHA’s automated, intelligent review engine can assess thousands of apps against more than 300 measures in order for a healthcare organization to build and manage a health app program. Both are trying to solve the same problem faced by Happtique and IMS Health (now IQVIA) in those long-ago days of 2014. ATA release, Healthcare IT News 

For Readers with long memories, iMedical Apps is still with us and their team is still reviewing health apps both personal and professional. They’ve extended their reach to reviewing apps to prescribe with iPrescribeApps.

Meanwhile, in Germany, the Digital Healthcare Act (DVG) now finally permits doctors to officially prescribe apps to patients. The Federal Institute for Drugs and Medical Devices (BfArM) certified Kalmeda for tinnitus and Velibra, a therapy program for anxiety disorders as Germany’s first two insured health apps. Germany also is kick-starting prescribed health apps through fast-tracking medical apps that are CE-marked as Class 1 and 2a low-risk medical devices. Healthcare IT News

United Airlines is testing an app-based ‘health pass’ to speed safer global travel. CommonPass, created by the Commons Project Foundation and the World Economic Forum to enable travelers to securely share their COVID-19 test status, taken 72 hours before flight, across borders. The app will also facilitate a health declaration that may be required by the destination country and generates a quick response (QR) code scannable by airline staff and border officials. UAL’s London-Newark test follows on a test with Cathay Pacific between Hong Kong and Singapore. FierceHealthcare, MarketWatch

News roundup: Amwell’s socko IPO raises $742M, Walmart and the Clinic Wars, Taskforce on Telehealth Policy report released, Israel’s Essence releases fall detection sensor system

Telehealth bullishness shows no sign of diminishing. On Wednesday, Amwell‘s (the former American Well) IPO stunned markets by not only debuting at $18 per share (a price only large investors received) but also opening at $25.51 on the NYSE (AMWL) and floating more than 41 million shares for a raise of $742 million. If underwriters exercise all their options, the raise could exceed $850 million. Only last week, the SEC filing projected a sale of 35 million shares at $14 to $16 a share. Back in August, the raise was estimated to be only about $100 million. (One could consider this a prime example of ‘sandbagging’.) Friday closed at $23.02 in a week where Mr. Market had a lot of IPOs and hammered traditional tech stocks. As reported earlier, Amwell is backed by Google via a private placement and also Teva Pharmaceutical.

Smaller and lower profile than Teladoc, Amwell provides services for 55 health plans, 36,000 employers, and in 150 of the nation’s largest health systems, with an estimated 80 million covered lives. Like Teladoc, Amwell has yet to be profitable, with 2019 losses of $88 million and $52 million in 2018. FierceHealthcare, Marketwatch. Meanwhile, the Teladoc acquisition of Livongo has gone quiet, as is usual.

The Clinic Wars continue. Another front in the consumer health wars (and repurposing retail) is more, bigger, better clinics onsite. CVS drew first blood early this year with the expansion of MinuteClinics into fuller-service HealthHUBs, with a goal of 1,500 by end of 2021. Walgreens flanked them with 500 to 700 Village Medical full-service offices [TTA 9 July]. In this context, the expansion of Walmart Health locations looks limp, with their goal of 22 locations in Georgia, Florida, Arkansas, and Chicago metro by end of 2021. Another concern is with scale and modularizing the Walmart Health locations’ construction via constructor BLOX,  One wonders with recently reported layoffs of 1,000 at corporate and the replacement of industry innovation veteran Sean Slovenski with Lori Flees, whether there’s some radical rethinking of their clinic business investment as not mass but targeted to underserved areas that avoid CVS and Walgreens. FierceHealthcare, Walmart blog  CVS also announced the doubling of their drive-thru COVID-19 testing sites to 4,000 by mid-October. FierceHealthcare

More Weekend Reading. Here in the US, the Taskforce on Telehealth Policy, a joint effort between the National Committee for Quality Assurance (NCQA), the Alliance for Connected Careand the American Telemedicine Association, has issued a report that focuses on maintaining quality care, fitting telehealth into value-based care models, enforcing HIPAA for patient privacy, and ensuring widespread and equitable access to broadband and technology. The involvement of the NCQA is a major step forward in advancing policy in this area. Press release/summary, Report page, Powerpoint slides, and webinar recording  Hat tip to Gina Cella for the ATA.

New entrant in passive fall detection. Israel’s Essence SmartCare is launching MDsense, a multi-dimensional fall detection solution for the residential market. It is sensor-based, using wall mounted intelligent sensors rather than wearable devices that statistically are not worn about half of the time and have their own well-documented performance concerns. The release also mentions it can differentiate between multiple persons and pets, which this veteran of QuietCare would like to see. MDSense is part of Essence’s Care@Home system which uses AI and machine learning to continuously collect actionable data to respond to fall events and manage care better towards improved outcomes.

COVID effect on US practices: in-person visits down 37%, telehealth peaks at 14%; ATA asks Congress to make expansion permanent

A Commonwealth Fund/Harvard University/Phreesia tracking study of outpatient visits in 50,000 US healthcare practices, specialty as well as primary care, has tracked the effect of the COVID pandemic on practice visits during the period 8 March through 20 June. Using as their baseline the week of 1-7 March, which was the last ‘normal’ week in line with February, the results are not unexpected:

  • From 15 March to 20 June (three months), practice visits, including telehealth, plummeted 37 percent
  • Disproportionately affected were pediatricians, pulmonologists, and surgical specialties such as orthopedics
  • Against the baseline, week of 14 June visits are still down 11 percent
  • The nadir was 29 March, off 59 percent
  • The rebound tracks the same by US region, with the least dip in South Central and Mountain regions. (The most affected, of course, are New England-Mid-Atlantic and Pacific, with the highest COVID rates and the least rebound.)
  • Looking at the ‘rebound week’ of 14 June, the effects linger on in pediatrics, pulmonology, and (interestingly) behavioral health. (Anecdotally, behavioral health patients are continuing with telehealth for convenience versus the physical visit.)
  • Telehealth visits took off starting 8 March and at their peak were 13.9 percent of visits (19 April)
  • Since 26 April, telehealth visits have declined as in-person visits resume, and are at 7.4 percent as of 14 June (46.7 percent less). However, compared to the baseline of nearly zero (0.1 percent), it’s nearly a 140 percent increase.

Phreesia is a scheduling and patient check-in platform. The practices surveyed are Phreesia clients, covering 1,600 provider organizations, with 50,000 providers in 50 states.

Physicians were also interviewed as part of the study. The office operation has had to change, and the patient experience in returning to practices is very different. Making up deferred care is complicated, and precautions to mitigate risk of viral transmission inevitably slow care down. 

Much of the press around this study is that telehealth is receding quickly. As a trend in an extraordinary time when there was no alternative, as practices reopen a shift back to the office is to be expected, and often there is no substitute for in-person exams and procedures. Still, there are elements of long-term uncertainty on the future of practice telehealth. Both CMS and payers announced that payments for telehealth (audio/visual and telephone only) would remain in place only for the duration of the pandemic. What are their long term plans? Providers are having difficulty getting paid or paid enough even in parity states. State Medicaid presents even more of an unwanted ‘discount’.  Telehealth also demands a commitment to (ultimately) a HIPAA-compliant platform, workflow/staff support, and input in the practice’s EMR/population health platform. STAT, HealthcareITNews

The American Telehealth Association (ATA), coming off their virtual annual meeting last week, sent a letter to Congress with 340 signatories supporting a permanent expansion of telehealth after the public health emergency (PHE) ends in four priority areas:

  • Remove location restrictions 
  • Maintain HHS authority to determine eligible practitioners who may furnish clinically appropriate telehealth services
  • Authorize Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) to furnish telehealth services 
  • Make permanent the HHS Temporary Waiver Authority to respond to emergencies

Release and letter

ATA’s annual conference now 22-26 June–and fully virtual; announces three awards and Fellows

The American Telemedicine Association has reimagined their annual conference and gone fully virtual–including an exhibit hall and poster displays. This year’s theme is “Moving at the Speed of Innovation…. Accelerating Telehealth Adoption”–if it hasn’t accelerated enough during the COVID pandemic, there’s always consolidating the gains.

Perhaps due to the complete cancellation of HIMSS and the addition of Joe Kvedar, MD, incoming ATA President, this year’s ATA has a five-day menu of healthcare leaders and over 300 speakers in 100+ sessions. Here’s a sample from the keynotes:

  • Ken Abrams, MD, Chief Medical Officer, Deloitte Consulting
  • Rachel Dunscombe, CEO, NHS Digital Academy; Tektology
  • Jesse Ehrenfeld, MD, Chair, AMA Board of Trustees
  • Thomas Goetz, Chief of Research, GoodRx
  • Jennifer Goldsack, Executive Director, Digital Medicine Society
  • Victoria Guyatt, Head of Ethnography, IPSOS
  • Joe Kvedar, MD, Professor, Harvard Medical School; Senior Advisor, Mass General Brigham (Partners HealthCare); Incoming President, the ATA
  • Ali Parsa, Founder and CEO, Babylon Health
  • Suchi Saria, Assoc. Professor, Machine Learning & Data Intensive Computing Group, Johns Hopkins University and Bayesian Health
  • Jennifer Schneider, MD, President, Livongo
  • Michelle Segar, Director, Univ. of Michigan Sport, Health and Activity Research & Policy Center
  • Jeroen Tas, Chief Innovation & Strategy Officer, Philips Healthcare

Registration is priced gently at $450. Full information, schedule, and registration here.

ATA 2020 Awards

The ATA Champion award this year is to the Veterans Health Administration, US Department of Veterans Affairs. The VA has been a leader in telehealth and store-forward technologies since, well, 2002 or so. VA Video Connect last year had 1.3 million appointments. (Sadly, your Editor’s former company, Viterion, which pioneered with VA in a RPM platform, is not currently a telehealth/RPM vendor–VA’s sole vendor is Medtronic.)

The President’s Award for the Transformation of Healthcare Delivery went to The Children’s Health Virtual Care Program at Children’s Health in Dallas. They have pioneered telemedicine programs for children.

The ATA’s Woman of the Year is  Tania S. Malik, J.D., an entrepreneur and a lawyer focused on healthcare, and specifically, telehealth solutions that facilitate online patient-provider interactions for primary care, mental health treatment, and naturopathic and integrated medicine.

Six Fellows were also named to ATA’s College of Fellows. Release.

 

$8bn COVID-19 supplemental funding House bill waives telehealth restrictions for Medicare beneficiaries (US)

The House of Representatives, which controls appropriations, has passed H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act. The bill provides $8.3 billion in new funding that includes a significant telehealth waiver for Medicare. From the bill summary on Congress.gov:

Within the Department of Health and Human Services (HHS), the bill provides FY2020 supplemental appropriations for

the Food and Drug Administration,
the Centers for Diseases Control and Prevention,
the National Institutes of Health, and
the Public Health and Social Services Emergency Fund.

In addition, the bill provides supplemental appropriations for

the Small Business Administration,
the Department of State, and
the U.S. Agency for International Development

The supplemental appropriations are designated as emergency spending, which is exempt from discretionary spending limits.

The programs funded by the bill address issues such as

developing, manufacturing, and procuring vaccines and other medical supplies;
grants for state, local, and tribal public health agencies and organizations;
loans for affected small businesses;
evacuations and emergency preparedness activities at U.S. embassies and other State Department facilities; and
humanitarian assistance and support for health systems in the affected countries.

The bill also allows HHS to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.

Sponsored by retiring Rep. Nita Lowey (D-NY), it was introduced and passed in the House 415-2.

In the text of the bill, the telehealth-pertinent portion permitting CMS to waive restrictions on telehealth for Medicare beneficiaries during this emergency is Division B, Sections 101-102. This cost is estimated at $500 million by The Hill.

The bill went to the Senate yesterday (4 Mar) for final approval. There is already an amendment proposed by Senator Rand Paul (R-KY) to offset the $8 bn of the bill with unobligated, non-health related foreign aid funds (FreedomWorks). Whether this is the ‘offset’ for telehealth that is mentioned in The Hill as under negotiation is not revealed.

The American Telemedicine Association (ATA) approved of the waiver. Ann Mond Johnson, the ATA’s CEO, urged “CMS to implement its waiver authority as soon as possible to ensure health care providers understand any requirements and help speed the deployment of virtual services” and pledged “The ATA and its members will continue to work with federal and state authorities, including HHS and the CDC, to address the COVID-19 outbreak and ensure resources are appropriately deployed for those individuals in need of care and help keep health care workers safe.” ATA press release, Hat tip to Gina Cella for the ATA heads-up

News roundup: docs dim on AI without purpose, ‘medtail’ a mall trend, CVS goes SDH, Kvedar to ATA, Biden ‘moonshot’ shorts out, and Short Takes

Docs not crazy about AI. And Dog Bites Man. In Medscape‘s survey of 1,500 doctors in the US, Europe, and Latin America, they are skeptical (49 percent-US) and uncomfortable (35 percent-Europe, 30 percent-Latin America). Only 20 percent fess up to actually using an AI application, and aren’t crazy about voice tech even at home. Two-thirds are willing to take a look at AI-powered tech if it proves to be better than humans at diagnosis, but only 44 percent actually believe that will happen. FierceHealthcare

This dim view, in the estimation of a chief analytics and information officer in healthcare, Vikas Chowdhry, is not the fault of AI nor of the doctors. There’s a disconnect between the tech and the larger purpose. “Without a national urgency to focus on health instead of medical care, and without scalable patient person-centered reforms, no technology will make a meaningful impact, especially in a hybrid public goods area like health.” The analogy is to power of computing–that somehow when we focused behind a goal, we were able to have multiple moon missions with computing equivalent to a really old smartphone, but now we send out funny cat videos instead of being on Mars. (And this Editor growing up in NJ thought the space program was there to market Tang orange drink.) HIStalk.

Those vacant stores at malls? Fill ’em with healthcare clinics! And go out for Jamba Juice after! CNN finally caught up with the trend, apparent on suburbia’s Boulevards and Main Streets, that clinics can fill those mall spots which have been vacated by retail. No longer confined to ‘medical buildings’, outpatient care is popping up everywhere. In your Editor’s metro area, you see CityMDs next to Walmarts, Northwell Health next to a burger spot, a Kessler Health rehab clinic replacing a dance studio, and so on. The clever name for it is ‘medtail’, and landlords love them because they sign long leases and pay for premium spots, brighten up dim concourses, and perhaps stimulate food court and other shopping traffic. Of course, CVS and Aetna spotted this about years ago in their merger but are working expansion in the other direction with expanding CVS locations and on the healthcare side, testing the addition of social determinants of health (SDH) services via a pilot partnership, Destination: Health with non-profit Unite Us to connect better with community services. This is in addition to previous affordable housing investments and a five-year community health initiative. Forbes, Mobihealthnews

ATA announces Joseph Kvedar, MD, as President-Elect. Dr. Kvedar was previously president in 2004-5 and replaces John Glaser, PhD, Executive Senior Advisor, Cerner. He will remain as Vice President of Connected Health at Partners HealthCare and Professor of Dermatology at Harvard Medical School. A question mark for those of us in the industry is his extensive engagement with October’s Connected Health Conference in Boston, one of the earliest and now a HIMSS event. ATA’s next event is ATA2020 3-5 May 2020 in Phoenix–apparently no Fall Forum this year.

The Biden Cancer Initiative has shut down after two years in operation. This spinoff of the White House-sponsored ‘moonshot’ initiative was founded after the death of Beau Biden, son of Democrat presidential candidate Joe Biden. Both Mr. Biden and wife Jill Biden withdrew due to ethics concerns in April. According to Fortune, the nonprofit had trouble maintaining momentum without their presence. However, the setup invited conflict of interest concerns. The Initiative engaged and was funded by pharmas and other health tech companies, directly for Initiative support but mainly for indirect pledges to fund research. Most of these organizations do business with Federal, state and local governments. Shortly after the formal announcement, Mr. Biden the Candidate announced a rural health plan to expand a federal grant program to include rural telehealth for mental health and specialized services. Politico   But isn’t that already underway with the FCC’s Connected Care Pilot Program, coming to a vote soon? [TTA 20 June]

And…Short Takes

  • Philips Healthcare bought Boston-based patient engagement/management start-up Medumo. Terms not disclosed. CNBC
  • London’s Medopad launched with Royal Wolverhampton NHS Trust (RWT) in a three-year RPM deal. DigitalHealthNews
  • Parks Associates’ Connected Health Summit will be again in San Diego 27-29 August with an outstanding lineup of speakers. More information and registration here.

And in other news, Matt Hancock holds tight to his portfolio as UK Secretary of State for Health and Social Care in the newly formed Government under new PM Boris Johnson. Luckier than the other 50 percent!