Legal roundup: Dorsata sues athenahealth, provider group on trade secret theft, Nevada terms Friday Health Plans

Dorsata, a women’s health-focused EHR, filed a lawsuit on 19 July against athenahealth and provider group Unified Women’s Healthcare. The suit has nine counts that allege unfair and deceptive acts and practices, breach of oral contract, breach of fiduciary duty, common law fraud, unjust enrichment, theft of trade secrets, tortious interference with current customers, breach of nondisclosure agreement, and commercial disparagement. 

A joint venture that went very sideways. After Unified purchased Women’s Health USA in 2021, an existing customer of Dorsata, athenahealth approached Dorsata to create a joint solution to pitch to Unified. According to Dorsata, which signed a non-disclosure agreement, Dorsata provided trade secrets to athenahealth and the two made oral agreements to approach Unified as a joint venture. Dorsata developed a software product for this, vU, but to finance it had to borrow $6 million from athenahealth. Unbeknownst to Dorsata, athenahealth created its own version of vU using Dorsata’s information to sell into Unified, cutting out Dorsata. Provisions in the promissory note prevented Dorsata from competing with athenahealth. Unified is also named as a defendant as it aided athenahealth’s actions and failed to act while athenahealth cut Dorsata out of their business. 

The suit has been filed in the civil court of Suffolk County, Massachusetts and is searchable here. Dorsata is seeking damages incurred from a loss of expected profits, the value of injury to reputation, a loss of company valuation, the value of future lost business as well as damages for unlawfully gained commercial marketplace advantage. “We’ve been severely damaged, and we hope the court will rectify the situation,” David Fairbrothers, cofounder and CEO of Dorsata, told Mobihealthnews in an email. athenahealth has stated that the suit is ‘without merit’. Becker’s

Friday Health Plan’s last state, Nevada, shuts down their plans. The Nevada Division of Insurance is terminating all Friday plans effective 31 August. After the liquidation on 1 September, Nevada Life and Health Insurance Guaranty will pay provider claims through 31 August. Approximately 2,000 members of Friday’s plans will have to scramble to find coverage on Nevada’s Silver State Health Insurance Exchange (NevadaHealthLink.com) during the special enrollment period (SEP) ending 31 October. The Nevada exchange offers six different health plan carriers with 100 different options. Nevada, like Colorado, had hoped that the plan might survive until the end of the year. Earlier this month, Colorado terminated Friday Health Plans [TTA 20 July]. Friday leaves behind a lot of members in the lurch, providers who are wondering if their states will pay them, over 300 former employees, state insurance departments having to guarantee hundreds of millions in payments in seven states, and embarrassment by the state regulators and by CMS. FierceHealthcare, Nevada DOI release

Week-end roundup: more House actions on telehealth benefits, VA EHR; Oracle exec moves to FDA digital health; Angle Health raises $58M; layoffs at Akili, Innovaccer, Athenahealth, Mindstrong

Has the House in this 118th Congress acquired a propensity for taking fast action? It seems that under the new Speaker, the House on both sides, though divided, is energized and responding to changes that would benefit worker health–and perhaps find a way out of the VA Tower of Trouble that would ultimately benefit veteran care.

The first is a short (four page) bipartisan bill still in draft, the Telehealth Benefit Expansion for Workers Act, that would amend current law in the Public Health Service Act, the Employee Retirement Income and Security Act of 1974, and the Internal Revenue Code of 1986 to allow employers to provide telehealth to employees as excepted benefits. This allows employers to finance an additional benefit not covered under their primary health plan. Examples of excepted benefits are vision and dental plans. Sponsors of the bill are Rep. Suzan DelBene (D-WA) as lead and co-sponsors  Tim Walberg (D-MI), Angie Craig (D-MN), Ron Estes (R-KS), Mikie Sherrill (D-NJ), and Rick Allen (R-GA). This builds upon the Medicare and other plan reimbursement expansions contained in the omnibus budget plan passed in the 117th Congress that extended telehealth in high-deductible health plans with health savings accounts (HSAs). At this point, the bill is not numbered, submitted, or on Congress.gov. HealthcareITNews

Not addressed in this bill or any other is whether the extensions will cover hospital-at-home remote patient monitoring (RPM) that was permitted under waivers during the Public Health Emergency (PHE). With its scheduled 11 May end, the Connected Health Initiative (CHI) believes that CMS will not allow remote monitoring to continue in hospital-at-home programs, under current reimbursement and devices. CHI had sent Congress at the end of January a list of their priorities and they’ve received a hearing, but no action has been taken yet. Healthcare Finance

The second is a House bill that would support solving the issues around the VA implementation of the Oracle Cerner EHR without returning to VistA. This is being proposed by Democrats on the House Veterans’ Affairs Committee. According to FedScoop, which broke the story, this is being worked on as an alternative to Rep. Matt Rosendale’s H.R. 608 which would pull the plug on Oracle Cerner and revert back to VistA [TTA 1 Feb]. Exactly how this bill would solve Oracle Health’s issues with Cerner Millenium and support VA in continuing that EHR implementation after June is not specified. FedScoop’s source told them that “the proposal may have a wider scope than prior attempts at legislative oversight and could involve a complete rethink of how other IT projects are conducted within the agency. This proposal is focused at a higher level than just one program.” The lack of specificity in this broad brush is not precisely reassuring, but a bipartisan ‘game on’ by both parties on Veterans Affairs, perhaps a ‘good cop/bad cop’ treatment, could be an effective ‘nowhere to hide’ approach with Oracle. Becker’s

Oracle’s loss, FDA’s gain. Troy Tazbaz, formerly Oracle’s senior VP heading up their cloud transformation efforts, joined FDA as Director of their Center of Digital Health Excellence. In that capacity, he will be in charge of technology evaluation, policy development and strategic partnerships for safe healthcare use of digital technologies that advance public health. Certainly he is tanned, rested, and ready: Mr. Tazbaz  left Oracle last September and used part of that time to achieve a dream of bicycling from Chesapeake Bay in Maryland to San Francisco Bay over 58 days. FierceHealthcare

Employer insurer Angle Health raised a $58 million Series A. Lead was Portage Ventures, along with PruVen Capital, Wing Venture Capital, SixThirty Ventures, Mighty Capital, and several others. Angle’s angle is to act as a fully digital, full-stack insurance carrier that delivers comprehensive healthcare benefits tailored to startups and technology companies on one platform. Their baseline telehealth offering covers primary care, urgent care and behavioral health, outsourced to Included Health. They bundle this with administrative services and care navigation, and use the First Health and Cigna PPO networks according to their website. Angle recently expanded from Utah into Arizona, Georgia, Indiana, Ohio, Missouri, and South Carolina. Release, FierceHealthcare

Unfortunately, layoffs continue in and out of healthcare as funding and usage go south:

  • Akili Interactive in January cut 30% of staff, or 46 people. Akili has developed cognitive therapies for ADHD and other mental illness, including EndeavorRx, a prescription treatment delivered through a video game. Non-ADHD therapies have been put on hold. They announced going public via a SPAC in January 2022 via a merger with Social Capital Suvretta Holdings Corp. I which closed last August at over $14, and are currently trading at $1.92. Mobihealthnews
  • Innovaccer, a health data analytics company, later in January laid off 15%, or 245 people, in the US and India, to concentrate on their ‘core portfolio’. This is their second layoff round;  90 people or 8% went in September. This was quite a turnaround to their sunny-side up 2021, where they raised Series D and E rounds totaling $255 million backed by Tiger Global, Whale Rock, Mubadala Group, and Microsoft M12, achieving a unicorn valuation over $3 billion.  Mobihealthnews, Inc42.com
  • Athenahealth yesterday released 178, or 3% of its staff, two months after going private. They pointed to overhiring, a sluggish recovery in doctor visits, and inflation. They plan to release or move to less expensive office space in their current cities of Watertown, MA and Austin, TX. Boston Globe
  • In yet another sign that virtual mental health’s boom is deflating sharply, Silicon Valley-based Mindstrong is essentially shutting down. Almost all of its C-suite including the CEO and CFO are gone plus an additional 128 jobs including therapists. It is closing its headquarters and is ceasing patient services as of 10 March, yet is still recruiting on its website. Employees are departing between 24 March and 15 April, when presumably the last one out the door will turn out the lights.  Mindstrong raised over $160 million since 2014 including a $100 million Series C in 2020. Behavioral Health Business

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

athenahealth may go public a second time. This was teased by CEO Bob Segert in the Boston Globe (paywalled) earlier this week. He claimed in the article that since the company went private in 2019, they have added nearly 2,000 clients each year of the past three and that revenues are in the billions. Healthcare IT News recaps some of their moves from going from public to private and downsizing to today. Their other news is that they have instituted a clinical advisory board of 30 members (!) to provide feedback and guidance on clinical features and direction to athenahealth’s product team. One hopes that the sharper members advise a change in the first letter of their name from the oh-so-twee lowercase to an uppercase ‘A’. 

NextGen Healthcare, an EHR/EMR and revenue cycle management software provider for medical/dental practices, is acquiring reseller partner TSI Healthcare. The agreement is for $68 million in cash upfront, with a contingent consideration of up to $22 million in cash if TSI meets certain goals by March 2025. TSI has been a NextGen reseller for 16 years. The acquisition will enable NextGen to expand in key specialties including rheumatology, pulmonology, and cardiology. No mention is made of management or staff transition, nor of SEC review as NextGen is a publicly traded company on Nasdaq. Hat tip to HISTalk 2 Dec. Release, BusinessJournals Triangle

Massachusetts-based Cloudwave is acquiring Sensato Cybersecurity to increase cybersecurity capabilities. Cloudwave provides cloud services hosting with cybersecurity capabilities exclusively to healthcare organizations. Sensato adds cybersecurity-as-a-service (CaaS) to manage security needs, determine where security gaps are, and threat intelligence. Transaction price and details were not disclosed, but Sensato’s founder John Gomez will join CloudWave as chief security and engineering officer. Healthcare IT News  Cybersecurity continues to be top-of-mind for healthcare organizations. The latest Big Data Breach at CommonSpirit Health system hospitals got even worse, with the third-party breach of an undisclosed number of patient records at their Franciscan Health hospitals in September and October. This followed the ransomware attack on other CommonSpirit system hospitals’ EHRs in October. Healthcare IT News

As we near the end of the year, funding is wrapping up with a flurry in some surprising areas such as optimizing metabolism and care coordination for chronic conditions, reducing burden on primary care practices/GPs. One is for an early-stage company in the UK for the latter.

  • Lumen’s $62 million Series B was led by Pitango Venture Capital with Hanwha Group and Resolute Ventures.   Lumen measures metabolism via a handheld, breathalyzer-like device equipped with a CO2 sensor that analyzes whether the body is burning fats or carbs for fuel which can promote weight loss, energy for fitness, and sleep. With that data, the app delivers to users personalized meal plans and nutrition along with when to eat. The new funding will be used to expand these nutrition and lifestyle coaching services. The device is sold direct to consumers, with the app services sold on a SaaS basis: three yearly plans with a range of services from $249 to (on sale) $349.  Mobihealthnews, MedCityNews
  • Another Series B raise of $140 million went to UpStream, for total funding of $185 million. UpStream is in the decidedly unsexy area of care coordination, workflow, and financial platform technology for groups of advanced primary care practices enrolled in value-based full-risk care models, most of which are centered around Medicare and Medicare Advantage. They also deploy pharmacist-led care teams into primary care practices. Their platform and services are free to the practice, with a risk-sharing agreement that pays UpStream through savings (upside risk) but also holds them accountable if savings are below the benchmark (downside risk). Practices are paid on quality during the performance year versus having to wait for CMS to pay in Q3-4 of the following year. This is an MSO (management services organization) ‘in a box’ versus organizing ACOs that is mainly technology-based, a new wrinkle for this Editor who used to be in marketing this area. MedCityNews, Mobihealthnews
  • Aide Health is a clinician-to-patient platform for better management of chronic conditions now bolstered with £1 million in pre-seed funding. Founded by Ian Wharton, CEO, and Brian Snyder, COO, the platform measures physical, mental, and social wellbeing markers for more proactive care. Aide is piloting with the NHS for asthma or Type 2 diabetes with a cohort aged 18 to 75.  Funding was led by Hambro Perks through its EIS fund, with participation from Fuel Ventures, 1818 Ventures, and APX. BusinessCloud (UK)

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

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

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

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

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

News and deal roundup: Best Buy’s $400M for Current, VA’s Cerner restart 2022, CVS-Microsoft product deal, and Athenahealth (finally) sold for $17B

Whew! Best Buy revealed on its quarterly earnings call that they paid $400 million for Edinburgh/Boston-based RPM developer Current Health [TTA 13 Oct]. It’s near the end of the call transcript published on the Motley Fool. There will be no impact on their financial performance this year and will have a slightly negative impact on the Q4 non-GAAP operating income. Hat tip to HISTalk

Also today in HISTalk is a nifty summary of the Department of Veterans Affairs (VA) Cerner implementation timing and restaffing. There’s a graphic on the 2022-23 (FY 2022-24) rollout plus the new organization. VA has appointed a new Program Executive Director, Terry Adirim, MD, MPH, MBA, moving from Acting Assistant Secretary of Defense for Health Affairs, and established a new EHR Integration Council. VA release. VA also published a 10 page analysis on what went wrong with the initial tests and lessons learned, such as creating an EHR ‘sandbox’ for clinician training.

CVS Health and Microsoft continue with a new partnership, this time for digital health products. The five-year deal will include development in two areas: personalizing health recommendations that direct consumers to when and where they need a CVS, and operationally to leverage technology and machine learning for automation to reduce waste. Microsoft release, Healthcare Dive, HealthcareFinanceNews

And in the biggest non-surprise of the past few days, Athenahealth’s (or as they prefer, athenahealth) sale closed before the end of the year in a deal valued at $17 billion. The buyers were, as expected [TTA 19 Nov], Bain Capital and Hellman & Friedman, along with Singapore’s sovereign wealth fund GIC and a wholly-owned subsidiary of the Abu Dhabi Investment Authority. The 24 year-old Athenahealth, one of the EHR pioneers, was acquired by Elliot Investment Management’s PE arm Veritas and Evergreen Coast Capital in 2019 for about $5.7 billion. Its base is down to about 140,000 ambulatory care providers, having exited the small hospital market some time back. In the EHR market dominated by Epic and Cerner, surely Veritas and Evergreen are relieved to be at least getting some cash back. But there’s Misery Sharing, as they are both retaining a minority investment. (A small hint from a marketer–never lower-case the first letter in any part of your name. You make yourself unimportant and it hasn’t been ‘modern’ for a loooong time. It wasn’t lucky for British Airways, either. Perhaps the new majority owners will get this.)  Healthcare Dive, Business Wire

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.

Digital health: why is it a luxury good in a world crying for health as a commodity?

Why digital health still struggles to find its stride. Those of us in the healthcare field, especially Grizzled Pioneers, have been wondering for the past decade why Digital Health’s Year is always Next Year. Or Next Decade. 

Looking back only to 2000, we’ve had 9-11, a dot-com bust, a few years in between when the economy thrived and the seed money started to pollinate young companies, a prolonged recession that killed off many, and now finally a few good economic years where money has flooded into the sector, to good companies and those walking the fine line of mismanagement or fraud. We’ve seen the rise/fall/rise of sensors, wearables, and remote monitoring, giants like Google and Microsoft out and back in, the establishment of EHRs, acceptance by government and private payers, quite a bit of integration, and more. All one has to look is at the investment trends breaking all records, with funding rounds of over $10 million raising barely a notice–enough to raise fears of a bubble. Then there’s another rising tide–that of cyberattack, ransomware, insider and outsider hacking.

Is it this year? It may not be. Despite the sunshine, interoperability holds it all back. Those giant EHRs–Cerner, Epic, Athenahealth, Allscripts–are largely walled gardens and so customized by provider application that they barely are able to talk to their like systems. There are regional health exchanges such as New York’s SHIN-NY, Maryland’s CRISP, and others, but they are limited in scope to their states. The VA’s VistA, the granddaddy of the integrated system, died of old age in its garden. Paul Markovich, CEO of Blue Shield of California cites the lack of interoperability and being able to access their personal health data as a major barrier to both patients and to the large companies who want to advance AI and need the data for modeling. (China and its companies, as we’ve noted, neatly solve this problem by force. [TTA 17 Apr]) Apple is back in with Health Records, but Mr. Markovich estimates it may take 10 years to gather the volume of data it needs to establish AI modeling. Some wags demand that Apple buy Epic, as if Epic was up for sale. BSC, like others, is testing interoperability workarounds like Notable, Ooda Health, and Manifest MedEx. Mr. Markovich cites interoperability and scaling as reasons why healthcare is expensive. CNBC

And what about those thriving startups? Hold on. During the Google Cloud/Rock Health 3 June event, one of the panelists–from Partners HealthCare, which works both side of the street with Pivot Labs–noted that hospitals have figured out their own revenue models, and co-development with hospitals is key. Even if validated, not every tech is commercially ready or lowers cost. And employers are far worse than hospitals at buying in because they ultimately look at financial value, even if initially they adopt for other reasons. In addition, the bar moved higher. The new validation standard is now provider-centric–workload, provider satisfaction, and implementation metrics, because meeting clinical outcomes is a given. Mobihealthnews

And still another barrier–data breaches and cyberattack–is still with us, and growing. Quest Diagnostics’ data breach affects nearly 12 million patients. It was traced to an individual at a vendor, American Medical Collection Agency, and it involved Optum360, a Quest contractor and part of healthcare giant Optum. The unauthorized person had access to the network for eight months – between 1 August 2018, and 30 March 2019–and involved both financial and some health records. Quest now is in the #2 slot behind the massive 79 million person Anthem breach, which, based on a Federal grand jury indictment in Indianapolis in May, was executed by a Chinese group in 2015 using spearfishing and backdoors that gathered data and sent it to China. There were three other US businesses in the indictment which are not identified. Securing health data is expensive — and another limitation on the cost-lowering effects of interoperability. Healthcare IT News

Digital Health’s Year, for now, will remain Next Year–and digital health for now will remain fractional, unable to do much to commoditize healthcare or lower major costs.

Comings and goings: Cuts hit Athenahealth, IBM Watson’s Drug Discovery unit; Bain may sell Waystar RCM

Athenahealth has announced they are trimming 4 percent of their total workforce. With a large 900-person campus in Belfast, Maine that once belonged to MBNA credit cards, and a workforce of about 5,000 headquartered in Watertown, Massachusetts, there is considerable local concern in an area of Maine that offers few well-paying jobs. Reportedly dozens of jobs there will be lost. This caps a tumultuous period with the company. Athenahealth was acquired last November by Veritas Capital and Evergreen Coast Capital, then merged with a GE Healthcare spinoff they owned, Virence Health, in value-based care, under the Athenahealth name. Bangor Daily News

IBM Watson’s Drug Discovery product, which was targeted to pharmaceutical companies, is being cut back to work with only current partners and with clinical trials due to poor sales. According to The Register, a tart-tongued UK tech website which actually reached an IBM spokesperson, IBM’s Ed Barbini stated that “We are not discontinuing our Watson for Drug Discovery offering, and we remain committed to its continued success for our clients currently using the technology.” Also Seeking Alpha. IBM Watson and Watson Health, like Athenahealth, are moving through a rocky period of closing initiatives (Watson Workplace), layoffs, executive departures (head Deborah DeSanzo last November), bad publicity, and clients like MD Anderson who don’t part quietly. [TTA 8 Nov 18].

Another merged health infotech company may have a new owner soon. Waystar, which was formed by the acquisition of ZirMed and Navicure in 2017 and manages revenue cycles for 450,000 practices, is rumored to be up for sale by owner Bain Capital. Interested parties include Visa and OracleBloomberg

CVS-Aetna, Cigna-Express Scripts reportedly on road to merger approval; Athenahealth in hostile takeover–or not (updated)

CVS’ pickup of Aetna, and Cigna‘s acquisition of Express Scripts are reported to be clearing the Department of Justice anti-trust review within the next few weeks, just in time for pumpkin season. The DOJ may have concerns on some assets related to Medicare drug coverage and may require a sell-off to resolve them. One potential buyer is WellCare Health Plans, which this week completed its acquisition of Meridian Health Plans and entered the S&P 500 on Monday. The Cigna-Express Scripts combine may not require any asset selloff. Seeking Alpha (report is from the Wall Street Journal).

The once blazingly hot Athenahealth is up for sale but can’t seem to get arrested by another healthcare company. Both Cerner and UnitedHealthcare passed on an acquisition. One of the larger shareholders, Elliot Management, initiated moves toward a hostile takeover in May, and in the process managed to oust founder and CEO Jonathan Bush on still-murky charges of past domestic abuse and workplace sexual harassment. Mr. Elliot is partnering with Bain Capital which owns Waystar, a revenue cycle management (RCM) company from the merged ZirMed and Navicure. Waystar could benefit from Athenahealth’s systems and IP. Mr. Bush would receive a relatively small sum in a sale –$4.8 million– with new executive chair and former GE CEO Jeffrey Immelt earning $150,000 a month in salary and $150,000 in restricted stock perhaps looking for a new job. Elliot’s reputation is that of a corporate raider–taking over businesses to strip assets and sell off the remains. New York Post, POLITICO Morning eHealth.

UPDATED 19 Sept Reports from yesterday indicate that Mr. Elliot has ‘balked’ at the $160 per share price that Athenahealth is asking, and may be angling for a lower price, according to the NY Post report. Reportedly no one else–Cerner and UnitedHealthcare–is interested, though Athenahealth has extended the bid deadline to 27 September. There may be problems uncovered by the due diligence. It’s also a recognized hardball lowball strategy to get the share price way down. The industry is betting on the latter because the former is difficult to contemplate for customers and healthcare as a whole. Also HealthcareITNews.

Lyft and Uber’s big tech twists on a Social Determinant of Health–medical-related transportation

Social determinants of health (SDOH), that widely-discussed concept often dismissed as the turf of social workers and small do-good companies such as Healthify, are receiving a substantial boost from two profit-oriented, on-demand transportation companies: Uber and Lyft. Several years ago, smaller companies such as Circulation and Veyo [TTA 21 Feb, 26 Apr 17] entered the non-emergency medical transportation (NEMT) field with their on-demand services. These proved to be valuable links in the continuum of care–valuable in helping patients make their appointments, at generally a lower cost than Access-a-Ride or taxis, while collecting a wealth of data on usage.

Uber and Lyft’s recent announcements take the NEMT concept further with integration into discharge planning, chronic care management in practices, and EHRs while keeping it simple for patients and caregivers.

  • The launch of Uber Health, targeted to healthcare organizations (and just in time for HIMSS). The ride booking for both patients and caregivers uses a HIPAA-compliant dashboard for the health manager to book the ride, and text messaging to the patient for confirmations and pickup. Over 100 healthcare organizations are piloting the service. MedCityNews
  • Lyft Business inked a deal with Allscripts to integrate booking transportation into appointment setting. The Allscripts EHR is in 45,000 physician practices and 2,500 hospitals (which doesn’t include newly-acquired Practice Fusion’s 30,000 small ambulatory sites). Besides its own driver base, Lyft also has used its Concierge API to facilitate partnerships with NEMT brokers working with providers such as Circulation, National MedTrans (the NEMT provider for Anthem’s CareMore Health Plan HMO), and American Medical Response for drivers and more specialized vehicles. Hitch Health works with Lyft and independently integrates into Epic and Athenahealth. MedCityNews, POLITICO Morning eHealth (scroll down).

But does providing transport for appointments save money? The logic behind it is that missed appointments can exacerbate existing conditions; a direct example is dialysis, where missing an appointment could result in a hospital admission. Another area is patient avoidance of making appointments. The CareMore Health Plan study reduced waiting times and ride cost, increasing patient satisfaction–great for HEDIS and ACO quality scores, but the longer-term cost saving is still to be determined.

Another attraction for Lyft and Uber: steady revenue. In Medicare Advantage, 70 percent of members are covered and all state Medicaid programs reimburse their members for qualifying transportation.

EHR action: Allscripts acquires Practice Fusion, expands footprint in small/ambulatory practices

A significant EHR acquisition kicks off an action-packed week. Announced today by leading EHR Allscripts is their acquisition for $100 million of independent practice EHR Practice Fusion. Allscripts, which has been usually in the top five US EHRs (Kalorama April 2017 survey), vastly expanded its hospital market share with August’s acquisition of #2 McKesson‘s health IT business and with this would be ranked just behind EHR leader Cerner. In acute care settings, Epic and Cerner dominate with 25 percent of the market each with Allscripts/McKesson far behind #3 Meditech (KLAS April 2017). 

Practice Fusion, one of the pioneers in the small practice/ambulatory EHR starting with a basic free, ad-paid model in 2005, has 30,000 ambulatory sites serving about 5 million patients each month. In the Allscripts view, they will now be able to offer “last mile” reach to the under-served clinicians in small and individual practices” and close gaps in care. Allscripts President Rick Poulton noted in the statement that “We believe this transaction will directly benefit Practice Fusion clients, who will now have access to Allscripts solutions and services. We look forward to welcoming Practice Fusion team members to our family.” which leads one to believe that the Practice Fusion name will be sunsetted. Allscripts release and Healthcare IT News

From being the leader in small practice EHRs, Practice Fusion found the last few years difficult as competition expanded into their segment, from eClinical Works, drchrono, athenahealth, and NextGen to small practice packages from Epic and Cerner.

It should be noted that Practice Fusion in 12 years went through 13 funding rounds, raising almost $158 million from a long list of VC luminaries such as Kleiner Perkins, Artis Ventures, Founders Fund, and Qualcomm Ventures (Crunchbase). However, it disappointed its investors and Wall Street, which expected two years ago a $1.5 billion IPO. The $100 million from Allscripts is all cash and the price is “subject to adjustment for working capital and net debt”–an exit which was surely not the sugarplum in the eyes of its 2014 and prior  investors. CNBC

Friday’s cyberattack is a shot-over-bow for healthcare (updated)

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/03/26ED4A2300000578-3011302-_Computers_are_going_to_take_over_from_humans_no_question_he_add-a-28_1427302222202.jpg” thumb_width=”150″ /]Friday’s multiple distributed denial-of-service (DDoS) attacks on Dyn, the domain name system provider for hundreds of major websites, also hit close to home. Both Athenahealth and Allscripts went down briefly during the attack period. Athenahealth reported that only their patient-facing website was affected, not their EHRs, according to Modern Healthcare. However, a security expert from CynergisTek, CEO Mac McMillan, said that Athenahealth EHRs were affected, albeit only a few–all small hospitals.

A researcher/spokesman from Dyn had hours before the attack presented a talk on DDoS attacks at a meeting of the North American Network Operators Group (NANOG)

The culprit is a bit of malware called Mirai that targets IoT–Internet of Things–devices. It also took down the (Brian)KrebsOnSecurity.com blog which had been working with Dyn on information around DDoS attacks and some of those promoting ‘cures’. According to Krebs, the malware first looks through millions of poorly secured internet-connected devices (those innocent looking DVRs, smart home devices and even security devices that look out on your front door) and servers, then pounces via using botnets to convert a huge number of them to send tsunamis of traffic to the target to crash it. According to the Krebs website, it’s also entwined with extortion–read, ransomware demands. (Click ‘read more’ for additional analysis on the attack)

Here we have another warning for healthcare, if ransomware wasn’t enough. According to MH, “even for those hospitals with so-called “legacy” EHRs that run on the hospital’s own computers, an average of about 30 percent of their information technology infrastructure is hosted (more…)

Rounding up the funding rounds of 2015–and the deals some would like to see (?)

Mobihealthnews rounded up 2015’s hot funding in the mobile health/health tech-related space, with helpful links to their articles. They cite as we have previously [TTA 16 Dec] Rock Health‘s flattish year-to-year 2015 total of $4.3 bn, but also StartUp Health’s bloom-off-rose 2015 digital health total of $5.8 bn–larger than Rock Health’s tote, but 17 percent off their 2014 total of $7 bn. If you consider the proportions: the top 10 deals raised $738 million–$130 million alone to the endlessly funded but yet to take over the world ZocDoc –the roster below $20m remains the longest, which is completely in accord with the lower part of Rock Health’s pyramid of angel-A-B rounds.

Yet Aditi Pai’s detailed summary strikes this Editor as useful in an unanticipated way. There is a certain sameness in the products and services of these companies, as if funders are seeking validation in similarity. ZocDoc, DoctoLib and Vitals–doctor profiles and appointment booking. Sharecare, Welltok, Novu, Noom, AbilTo, SocialWellth, Health Recovery Solutions, Jiff–health and wellness engagement programs/apps, many for corporate programs. Whoop, Sano, Sproutling, TuringSensor, Valencell, Moff and four others–wearables. Hello, Sleepace, Sproutling (baby)–sleep tracking. Klara, SkinVision, Spruce–dermatology apps. Beyond the gloomy forecast for unicorns (Theranos being the Child on the Milk Carton), how many of these corporate wellness programs, sleep trackers and wearables will be around in 2017? Mobihealthnews’ 2015 funding roundup.

MedCityNews takes a lighter-hearted (I think) look at 2016 deals. IBM would buy athenahealth mainly for its EHR and practice management data, plus data aggregator Validic, to beef up Watson; 23andMe, past its two years of troubles after stepping on FDA Superman’s cape, would buy PatientsLikeMe (endangering its community shaped credibility? 23PatientsLikeMe?) and the best–Theranos bought by Boston Heart Diagnostics/Eurofin (EU lab testing giant), which would reduce this unicorn to a pony…but one that might make it. Theranos also made VentureBeat’s list of Likely Carcasses in the Valley of Unicorn Death (to quote the article’s author). Chris Seper’s Deals He’d Like To See.

Cerner acquires Siemens HIT business

The big news in HIT circles today was Cerner’s purchase of Siemens’ health IT business for $1.3 billion. Forbes has the most detailed analysis by far, which appears prepared in advance based on the 22 July rumor published by HISTalk at that time. HISTalk’s and their readers’ comments on the announcement conference call today are moderately scathing and worth reading if of interest to you. The takeaway for this Editor is that it was a defensive move for Cerner versus Epic Systems, Athenahealth and Allscripts; they bought out a competitor, bought market share with the acquisition (although how much of it would have fallen to them anyway is a question), gained more of an international foothold plus an inside track to customers eager to move to newer technology. For Siemens, it appears  (more…)

Epocrates ‘Bugs + Drugs’ infectious disease app inaccurate, should be pulled: reviewer

For clinicians who increasingly rely on major reference apps via smartphone and tablet, this sounds a loud cautionary note. This pharmacist’s detailed analysis of the errors and misinterpretation contained in the recently released and best-selling Epocrates reference app on the highly sensitive topic of infectious disease (including those that plague hospitals such as MRSA) culminates in a call to pull it from the Apple App Store. In several instances, the app pointed to the wrong antibiotic for an organism. The other faults are in using Athenahealth information to create what is called an antibiogram, “to identify what organisms are susceptible to what antibiotics in that locale”. The iMedicalApps analysis by Timothy Aungst, Pharm.D., professor at Massachusetts College of Pharmacy and Health Sciences has created quite a stir in the usual places. FierceMobileHealthcare covers this but decides to further blow up the balloon (or move off the point) in citing the IMS Institute for Healthcare Informatics and Journal of Cancer Education on the plain ineffectiveness and non-validation of the vast majority of healthcare apps–mainly consumer.