Babylon Health exits last NHS hospital contract as a ‘distraction’, looks to US market for growth

Babylon Health’s rollercoaster ride continues. Today’s news was that their last of three NHS Trust contracts, with Royal Wolverhampton NHS Trust (RWT), was ended by Babylon two years into a ten-year contract. This follows the end of two other contracts that drew a fair amount of controversy (see our index here)–the 2020 one-year Royal Berkshire NHS Foundation Trust with an accident and emergency triage app that was discontinued by Babylon, and with University Hospitals Birmingham NHS Foundation Trust (UHB) for a virtual A&E app that was ended in July.

In the UK, Babylon will continue its GP At Hand service that took over a GP office in Fulham, London in 2016. It now currently covers about 155,000 patients. It will also maintain the AI-based chatbot used for triaging patients. GP At Hand is not profitable. GP practices work on a flat fee per patient that averages £155 ($183) per patient per year.

Babylon and RWT contracted in 2021 for a digital-first primary care service that would cover 55,000 patients, with a patient portal that would enable them to view their health records and view appointments. The app would also monitor conditions and like the AI chatbot, help to diagnose illness and actions. Babylon is ending the ten-year contract after two, which would make it 2023.

From the bubbly Digital Enthusiasm of former Health Minister Matt Hancock (left) in 2018 to the storm around @DrMurphy11, a GP who raised performance issues with the Babylon chatbot that escalated to BBC Two’s Newsnight in February 2020, founder and CEO Ali Parsa is now in an unenviable position in two countries. He 1) has semi-exited the UK market, 2) ruthlessly cut costs to the bone because the stock is down 90%, and 3) shifted to the far larger but unforgiving market of the US. The bright spot here is that US patients covered have already topped 6 years of effort in the UK. Parsa has now moved to the US.

Parsa noted in a recent results call [Seeking Alpha-Ed.] with analysts. “Those two or three small NHS contracts that you refer to—and those are not our significant primary-care contracts— those are marginal contracts for us, more in that category of contracts where we could not see a significant contribution to our profit margin,” he said. “And they also had a rather small contribution to our revenue. And therefore we saw them as a distraction and terminated those contracts.”

This Editor has previously noted Babylon’s layoffs/redundancies of at least 100 staff to save $100 million by Q3, which we are now in. Expansion in the US has to take place with static staff to make goal. And as to the US being unforgiving: VCs are snapping their capacious purses shut, Mr. Market’s gone into rehab, and inflation is shrinking healthcare budgets from providers to payers to self-insured companies. The Big Kahunas with Big Bucks–CVS Health, Allscripts, UnitedHealth Group, Amazon, Walgreens, Walmart–and out-of-left-field players like Option Care Health bidding on Signify Health, are snapping up, as we’ve earlier put it, “healthy health tech companies at the right (discounted) price that fill in their tech gaps”. And making life difficult for single players like Babylon Health. Wired. And a snappy hat tip to HISTalk.

Babylon Health: fending off bubbly rumors of acquisition this week

On Monday, the New York Stock Exchange stopped trading of Babylon Holdings Limited (NYSE:BBLN), the corporate name of Babylon Health. The reason was a sudden spike in the share price along with a huge spike in trading volume. Price moved from $0.76 to $0.96 from 12.45 pm ET to 1.15pm, with volume spiking from ~3,000 to 1 million (see the bottom bar chart). The volume and price shift automatically trigger a stop trade. Based on the Yahoo Finance chart, it resumed Tuesday morning and cruised down to just above recent prices at $0.77 closing today at $0.79, along with a drop in trading volume nearer the recent averages.

Babylon issued two terse press releases: the first on Monday 3.59pm ET which stated “that it is not engaged in nor has it had contact or discussions with any potential acquirer”, then a second on Tuesday at 6am which briefly addressed the ‘M&A speculation’ and the sudden (but short-lived) 20% rise in share price. The response from CEO Ali Parsa was that they “delivered very strong financial results and operational performance that demonstrate its continued momentum. Babylon is taking active steps to maximize shareholder value and to improve its shareholder base and capital structure.” 

Babylon Health went public last October in likely the last of the major healthcare SPACs at a debut of over $10 and a valuation that exceeded $4 billion. Its current value represents a 90% loss, not much different than what happened to the share values of Amwell and Teladoc, as well as other health tech SPACs [TTA 15 July]. Before the SPAC, they raised $200 million and bought Meritage Medical Network and First Choice Medical Group, opening an office in Palo Alto. Babylon also bought the remainder of Higi health kiosks they did not own in December, closing out an investment option with Higi in May that this Editor thought was puzzling for starters.

Babylon’s Q2 financials were, as we noted, a mixed picture but encouraging [TTA 11 Aug] in their US growth and lack of drama. The company had previously stated that it intends to save $100 million in Q3 and discharge about 100 people as part of this. This is nothing that would prompt a sudden swoop by an investor or investors–not disclosed–reminiscent of the buccaneering days of T. Boone Pickens. But in recent weeks there’s been a change in the investment climate. Certain companies such as CVS and Allscripts plus health plans have signaled that they want to buy healthy health tech companies at the right (discounted) price that fill in their tech gaps. ‘Second generation’ remote patient monitoring (RPM) and telehealth are having a hot moment. For traders, it’s the boring dog days of August in a market that’s had more down than up days this year.

The market action was a blip, but one that benefited Babylon and certainly put it back in the news. Which can’t hurt.

Mr. Parsa announced back in January at JPM that Babylon’s goal was to close 2022 at $1 billion in revenue, triple that of 2021. With Q2 revenue of $265 million, they are on track (he quoted a run rate of $80 million per month). There is also the Transcarent/Glen Tullman (late of Livongo) investment connection that came over via the Higi acquisition. Transcarent is heavily invested in value-based care models for self-insured employers as a benefit for their employees, as is Babylon. Dots are here and ready to be connected.

 Also HISTalk.

Mid-week news roundup (updated 18 Aug): CVS eyeing Signify Health for in-home/VBC; Babylon Health mixed pic of revenue and losses up; Geisinger doubles telemed specialties; connected IoT devices expand cyber-insecurity (more); Owlet layoffs

CVS has dropped another sandal as to their quest to add primary care and home health to their portfolio [TTA 5 Aug]. Reports indicates that CVS Health is bidding to acquire Signify Health, which is up for sale. Signify is best known as a major provider of in-home health care in both evaluations and community-based services, with users such as health plans, health systems, community groups, non-profits, and government. In March, they added provider value-based care with Caravan Health, a mid-sized Accountable Care Organization (ACO) management service organization (MSO), for $250 million.  This would give CVS both leverage in in-home care and access to value-based care models in health systems and practices, adding a network of jumbo (100,000 lives+) ACOs to Aetna’s 500 ACOs.

Signify did take a bit of a bath with its acquisition/merger of Remedy Partners in 2019 which marked their entry into the Federal shared savings programs around Episodes of Care. While it created a $600 million company. Remedy’s Episodes of Care in the CMS Bundled Payments for Care Improvement (BPCI) program was always problematic for Signify on multiple levels (Editor’s experience). Signify announced its exit from the successor BPCI-A (Advanced) model last month to concentrate on home care and the Caravan business. The wind-down, which will take some time as these are Federal programs through CMS, will save Signify about $115-120 million in costs, compared to their annual direct and shared costs of $145 million. Restructuring costs such as severance may be only $35 million. After IPO-ing in February 2021 at $24 per share, it has only recently climbed to $23, having recently hit a 52-week low of $10.70. FierceHealthcare, HealthcareFinanceNews

Updated Perhaps in preparation for acquisition, Signify Health is shedding 489 people starting 1 October, including 45 in Connecticut, with the remainder in Texas, South Dakota, and New York. The information comes from required notices to the Connecticut Department of Labor. The majority of employees affected are remote workers. It appears to be related to Signify’s winding up of BPCI and Episodes of Care activity which are likely on calendar year contracts. The legacy company, Remedy Partners, had been headquartered in Connecticut with staff in New York. Moving forward with layoffs now makes the company more attractive for sale, as the separation expenses will not be an acquiring company liability. The 1 October start date is also a tell.  CT Insider, Becker’s

A mixed picture for Babylon Health. Its Q2 results were up substantially in revenue–4.6x year-over-year from $57.5 million to $265.4 million–along with key indicators such as US members up 220% and a 7.5% improvement in medical margins over three quarters. The US has been very very good to Babylon with value-based care membership growing 3.2x year-on-year to a total of approximately 269,000 US VBC members with 40% of its VBC revenue from Medicare contracts. However, losses are up along with growth–$157.1 million compared to $64.9 million loss PY. Babylon at end of July announced worldwide layoffs of at least 100 people of its current 2,500 in their bid to save $100 million in Q3. Babylon release, Mobihealthnews

Geisinger Health was one of the pioneers in telehealth and remote patient monitoring, from ur-days in the early 2010s to today. Much of its patient base in Pennsylvania is rural or semi-rural, living well away from care centers, with a clinician base equally scattered. They went with a single system–Teladoc–integrated into Epic. By the early days of the pandemic, Geisinger was able to expand their telehealth coverage from 20 to more than 70 specialties, 200 providers to more than 2,000 providers, and over two years (2020-2022) completing over 784,000 telehealth visits to homes, local clinics, or local hospitals. Case study in HealthcareITNews

If you’re a health system CIO managing lots of connected devices, you may need to go to a psychiatrist with your feelings of insecurity. That’s the gist of a new report, the Insecurity of Connected Devices in Healthcare 2022. A new-to-this-Editor cybersecurity firm, Cynerio, partnered with researchers at the Ponemon Institute to survey 517 executives at US health systems to find that their Internet of Medical Things (IoMT)/Internet of Things (IoT) vulnerabilities haven’t changed much since this Editor banged the gong about them well before the pandemic:

  • Cyberattacks–frequent: 56% of respondents experienced 1+ cyberattacks in the past 24 months involving IoMT/IoT devices; 58% averaged 9+ cyberattacks. Adverse impacts on patient care were reported by 45% and 53% of those resulted in increased mortality rates. 24% of hospitals noted an impact on their mortality rates.
  • Data breaches are routine: 43% of hospitals had one in the past two years
  • Risks may be high, but the reaction is sluggish: 71% rated security risks as high or very high, but only 21% report a mature stage of proactive security actions. 46% performed accepted procedures such as scanning for devices, but only 33% keep inventory.
  • Ka-ching! Goes the ransomware! When attacked, 47% paid the ransom, and 32% were in the $250-500,000 range.

The full report is available for download here. Those who prefer a webinar must wait till 17 August at 2pm (EDT)–registration hereCynerio release, HealthcareITNews

Updated. Having sat in on the webinar, some further information points from the Ponemon survey deepen the ‘gravity of the risk’:

  • IoT is different because a hack or cyberransoming prevents the device from working. It isn’t fixed by backup as data can be.
  • Health systems are still using IoT computer systems running Windows XT/95–and earlier (!)
  • The average total cost of the largest data breaches is $13 million–the most common cost is in the $1-5 million range. 
  • 88% of these data breaches involved at least one IoT/MT device
  • Risks are known, but action is lagging. 72% of health organizations report a high level of urgency in securing devices–yet 67% of organizations do not keep an inventory of IoT/IoMT devices that they scan
  • 79% don’t consider their activities to be ‘mature’
  • Security investment doesn’t reflect the gravity of the risk–only 3.4% of IT budgets focus on IoT/MT device security.

And in sad layoff news, Owlet Baby Care is shedding an unknown number of employees. Here is the notice on LinkedIn. We noted their FDA problems and a fast pivot last in February, but their going public via a SPAC has been rocky at best with shares lingering at $2 from the IPO at $8. Marketing a pricey baby monitor direct to consumer is expensive, even if it meets a need, and this is likely a cash crunch. At least the ‘leader of people & culture’ is giving them a proper sendoff of thanks–and more usefully, providing their contact information for potential job openings with other companies.

[This is in contrast to the gone-viral spectacle of the CEO of something called HyperSocial posting on LinkedIn his angst about laying off staff–along with a selfie of him weeping. Not exactly confidence-making and All About Him. This Editor’s comment is one of 6,000-odd posts which are largely doubtful to negative.]

Some thoughts on Teladoc and the Week That Was in telehealth

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

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

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

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

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

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

Friday roundup: LetsGetChecked buys Veritas Genetics, Everly Health adds CMO, Babylon sends chatbot to Higi, ConcertAI’s $150M Series C, AmplifyMD’s $23M, and two ‘Brights’ raise $155M

Home health testing company LetsGetChecked is buying Veritas Genetics and Madrid-based Veritas Intercontinental for an undisclosed sum. Veritas specializes in whole genome sequencing. For LetsGetChecked, they can now build out genomic testing as part of their broad range of at-home test kits and app reporting for a wide variety of wellness, sexual health, and men’s/women’s health. It also opens up targeted panels and tests such as Pharmacogenomics (PGx), cancer screening, carrier screening, and maternal-fetal testing.

LetsGetChecked, based in Dublin and NYC, has raised $263 million to date through a 2021 Series D from investors such as Casdin Capital, HLM Venture Partners, and Optum Ventures. Veritas Genetics and Veritas Intercontinental are very early stage companies HQ’d near Boston with $61 million in funding through several venture rounds. Veritas was founded by Harvard and MIT genomics experts to make genetic testing more available and affordable. The release implied that Veritas principals would be joining LetsGetChecked. The acquisition is expected to close shortly. Release, Mobihealthnews

New CMO at Everly Health.  Liz Kwo, MD will lead their clinical strategy as chief medical officer. A competitor of LetsGetChecked, Everly Health is the parent of direct-to-home testing Everlywell, enterprise-focused Everly Health Solutions, and recently acquired Natalist in the fertility and pregnancy testing area. Comparing the two, LetsGetChecked occupies a more clinical and condition-specific space (e.g. thyroid antibodies, hormones), while Everlywell is positioned in the general wellness testing area, e.g. allergies. Dr. Kwo previously was with Anthem as Deputy Chief Clinical Officer and is an interesting combination of clinician and digital solutions/advanced data analyst. Release, FierceHealthcare

Babylon Health’s recently acquired Higi mobile app now has Babylon’s well-known AI-enabled symptom checking chatbot. Higi’s main business are in-store health ‘stations’ that measure blood pressure, pulse and weight, plus diabetes and heart disease risk through symptom checkers. The integration with the Babylon app also demonstrates for other Babylon partners how their chatbot can be used. Mobihealthnews

ConcertAI, the former Concerto HealthAI, raised $150 million in Series C funding from Sixth Street for a total $300 million and boosting its valuation to $1.9 billion. ConcertAI specializes in life sciences and healthcare enterprise AI and RWD SaaS solutions for use in precision medicine. It has partnered with Pfizer, Bristol-Myers Squibb, and has begun a collaboration with lab-testing giant Labcorp to launch precision oncology studies. Its parent is SymphonyAI, a larger AI company in other areas such as retail. Release, Mobihealthnews

AmplifyMD, a telemedicine platform for medical facilities to connect to specialist doctors, raised a $23 million combination Series A/seed round from F-Prime Capital, with the seed co-led by Forerunner Ventures and Greylock. Their target market? Over 3,300 medical institutions with a lack of specialty access, which are often in rural or small regions of the US. Their specialties are cardiology, neurology, psychiatry, pulmonology/critical care, infectious disease, nephrology, and hematology/oncology. Release 

Two mental health ‘Brights’ raise a total of $155 million. Brightline Health, a pediatric mental health company for at-home therapy targeted to kids and teens, raised a $105 million Series C for a valuation of $705 million. The round was led by KKR with current investors GV, Optum Ventures, Oak HC/FT Partners, Threshold Ventures and Blue Cross Blue Shield of Massachusetts. It was co-founded by Livongo veteran Naomi Allen who left Livongo shortly before the Teladoc acquisition. The funding will be used for staffing and to broaden its offerings. Mobihealthnews, Bizjournals, Bloomberg

The other ‘Bright’ spot in mental health company funding is Brightside Health, which raised a $50 million Series B financing round led by ACME Capital and Mousse Partners, for a total of $81 million. Brightside is for adults combining an app-driven mental health assessment, therapist match and connectivity, and automated matching to medication if needed. They market membership to payers, providers, and employers as a benefit. Mobihealthnews, FinsMes

 

Connecting JPM and CES dots: Babylon Health tripling revenue in ’22 to $1 billion–how? And Bosch tiptoes back into healthcare.

Dig for dots with your Editor….Babylon Health used their JPM forum last week to announce that with some US agreements signed, they expect by the end of this month to top $80 million per month, closing in on $1 billion this year, based on signing US value-based care agreements. The US agreements add an estimated 88,000 organic new members, bringing global managed lives to over 440,000. The $1 billion in revenue is nearly triple their 2021 preliminary closing revenue of $321 million. Interestingly, the US agreements were not specified in the release.

Does this tie in with the Higi acquisition [TTA 7 Jan], or are there others? Looking back on the Higi buy, we see one of the investors coming over from Higi is Glen Tullman, CEO of Transcarent and Managing Partner of VC 7wireVentures. His comments about Babylon in that release glow:

“Babylon’s innovative value and risk sharing models fit well with market leaders and innovators, including Transcarent, because they believe that, with the appropriate use of technology, data science, and good old-fashioned clinical care, you can impact the member satisfaction and quality of care, while, at the same time, reducing costs. This is the formula everyone has been searching for and the combination of Higi and Babylon bring us all one step closer.”

Higi is not large enough (though they claim ‘millions’) to boost Babylon’s revenues into the stratosphere, but some of Transcarent’s business very well might.

  • Transcarent earlier acquired BridgeHealth, a surgical and value-based benefits provider claiming 1 million members.
  • In October, Transcarent inked an agreement with Walmart to provide services for self-insured employers linking them to Walmart’s, including drug prescriptions.
  • Transcarent is on a funding roll of its own, with its own announcement at JPM in landing a $200 million Series C.

We’ll see if this Editor’s dots connect correctly….

Remember Bosch and health tech? Bosch was one of the ur-companies in remote patient monitoring with Health Hero/Health Buddy plus other telehealth/telecare businesses. Once upon an early 2010s time, they were a major supplier to VA Home Telehealth along with Viterion, Cardiocom, and Medtronic. After multiple setbacks, rounded up by TTA here, they exited European telehealth/telecare in January 2015 and shuttered Health Buddy six months later. So it’s déjà vu all over again to see Bosch technology used in a three-way project with Highmark Health in Pennsylvania and their Pediatric Institute of Allegheny Health Network (AHN) in Pittsburgh. AHN will be using Bosch’s SoundSee sensor-based tech to capture patient breathing audio that is then analyzed via Bosch’s proprietary AI and machine learning to detect pediatric pulmonary conditions. Clinical studies at AHN will be starting this quarter. Bosch’s Intelligent IoT group responsible for SoundSee is located at Bosch Research in Pittsburgh. Bosch has patented SoundSee for multiple applications in industrial and healthcare monitoring. Release, FierceHealthcare

Buried in the release is Bosch’s other step back into health tech. Vivatmo me, a breath-gas analyzer device that allows patients to accurately determine levels of inflammation, documenting them via an app–a very interesting concept–has been commercially available from March 2020 in Germany and Austria. It may be introduced in the US.

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

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

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

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

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

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

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

Rating the States on Telehealth Best Practices

Short takes: 2022’s big kickoff with Babylon-Higi, Vera-Castlight buys; will funding slow down in ’22, eye-tracking telehealth for MS, vital signs tracking lightbulbs at CES 2022, and three catchups!

Babylon Health closed out 2021 by acquiring health kiosk Higi for an undisclosed amount. Babylon had earlier invested in Higi’s Series B [TTA 30 May 20] and was reported in October to be exercising its $30 million option to buy Higi after closing their SPAC. Release

Vera Whole Health, an advanced primary care provider and clinic group based in Seattle, is acquiring Castlight Health, a data and care navigation platform. Vera will acquire Castlight in a $370 million all-cash deal. Strategic partners and investors include Anthem, Morgan Health (the JP Morgan Chase & Co business for the transformation of employee healthcare), Central Ohio Primary Care, and Clayton, Dubilier & Rice funds. Former Aetna chairman and CEO Ron Williams will become chairman. Release.

Which leads to the usual question…will funding in 2022 continue the hot streak of 2021? It’s one opinion, but Lee Shapiro of 7wireVentures, formerly with Livongo, is sensing a slowdown, citing increased interest rates (money), the US midterm elections (which don’t affect the rest of the world), less new money, and investors wising up on the length of time any healthcare or health tech investment takes to pay off. 2021 with 79 digital health M&As plus an abundance of SPACs that tailed off by end of year will be hard to match. Mobihealthnews

XRHealth, a telehealth clinic that provides treatments in patients’ homes based on virtual reality treatment, has integrated Tobii‘s eye-tracking technology into the XR platform and the Pico Neo 3 Pro Eye VR headset. XR Health provides rehabilitative and pain management therapies via VR. The Tobii system will enable treatment using the headset for multiple sclerosis (MS), Parkinson’s, and other neurological conditions. According to the release published in Multiple Sclerosis News Today, “detecting subtle changes in eye movement can help diagnose these diseases at an early stage, as well as assess disease progression and response to treatment. Tobii‘s eye-tracking technology is able to detect those changes in real time, providing data and insights to clinicians during therapy sessions.” Hat tip to Editor Emeritus Steve Hards

CES 2022 is on this week, far less splashy than before as an in-person/virtual hybrid event. Debuting at CES is the Sengled Smart Health Monitoring Light. Looking like a standard LED lamp bulb, it contains sensors that network and can take passive vital signs measurements of sleep quality, breathing, heart rate, and motion of occupants in the home. The more bulbs the better, of course. Whether or not they can detect falls, as the article touts, is likely an inference on motion. They feed into either Alexa or Google Assistant, plus Sengled’s app, using Frequency-Modulated Continuous Wave (FMCW) radar operating in the 2.4 GHz range. Expect it to be coming out towards the end of the year and probably twice the price of conventional LED smart bulbs. TechRadar Hat tip to Adrian Scaife via LinkedIn

Catching up…

Walgreens and VillageMD continue on the ‘go big or go home’ highway with nine more Village Medicals at Walgreens in San Antonio, Texas. Plans are to build 600 Village Medicals at Walgreens in more than 30 markets by 2025, growing to 1,000 by 2027. HealthcareFinance

Centene, the health payer conglomerate, finalized its $2.2 billion acquisition of Magellan Health, a major behavioral health management company. It will likely be CEO Michael Neidorff’s swan song, as an activist investor forced his retirement (at age 78 after over 25 years at the helm) this year and significant board changes. Magellan’s former COO and president Jim Murray will become Centene’s chief transformation officer, a new position, lead what they term the Value Creation Office as well as the Centene Advanced Behavioral Health division. Forbes, Centene release

And suitors with a spare billion or so may be lining up to buy IBM Watson Health. The first offers came in on 4 January with the winner to be announced possibly by end of the month. IBM spent over $4 billion over time to build up Watson Health, but now wants out, badly. Axios

What’s next for telehealth? Is it time for a correction?

crystal-ballThe boom may be over, between shrinking visit volume and a pileup of providers. Is a correction in the cards? The flood of funding that started in 2020 and has not abated was kicked off by the pandemic and a massive shift to telehealth visits in March/April 2020 from a barely-above-plant-life number in January/February.

Post-pandemic, the shift corrected.

  • The peak of 69% of visits tracked by Epic in April had tailed off to 21% as early as May 2020 [TTA 2 Sept 20].
  • National commercial claims data via FAIR Health was lower. They tracked its peak also in April 2020 at 13%, falling continuously monthly: May to 8.69%, 6.85% in June, 6% in August, and 5.61% in October [TTA 9 Jan].
  • By mid-year 2021, the claims numbers continued to lose altitude: June 4.5%, July 4.2% (FAIR Health monthly report).

Despite the numbers, telehealth companies raised $4.2 billion of a total $15 billion in digital health funding in the first half of 2021, according to Mercom Capital Group, a global communications and research firm. So…what’s the problem with les bon temps rouler?

CB Insights notes the increased specialization of new entrants and, as this Editor has noted previously, the blending and crossing of business lines.

  • Companies like Heal, Dispatch Health, and Amazon Care will send a clinician to your house for a checkup–no running to your urgent care.
  • Kidney disease? Monogram Health. Musculoskeletal pain? Hinge Health. Child with an earache or fever? Tyto Care. Check symptoms first? Babylon Health.
  • Telemental health has gone from cocktail party repellent to the belle of the ball, concentrating on cognitive remote therapies. For the past year, it moved to more than half of all telehealth claims, with currently over 60% of procedure codes–and it’s consolidating. AbleTo was bought by Optum, Ginger bought by Headspace, SilverCloud by Amwell.

So for the Major League–Teladoc, Amwell, Doctor on Demand, Grand Rounds, and MDLive–what does this mean? If this interview with Teladoc’s CIO is an example, they plan to segue to a ‘hybrid’ model of virtual quick response plus integrating providers into a continuing care model with patients, creating a relationship with history and familiarity. A model that’s very much dependent on IT, analytics, and connecting with willing providers. But in this free-floating sea of verbiage, it didn’t come into misty focus till the very end, when he mentions Primary360 [TTA 7 Oct] and a virtual primary care team. (And let’s not forget Babylon360 along similar lines.) He finally sketches a view of all the connections to conditions coming together on a very far horizon. 

One can say it’s a cloudy crystal ball, indeed. FierceHealthcare, HealthcareITNews (Teladoc CIO interview)

News and deal roundup: Babylon’s $200M raise, Best Buy buys Current Health, Virgin Pulse-Welltok, Devoted Health’s $1bn raise, Withings watch gains FDA ECG clearance

Babylon Health adds $200 million to the accounts–in advance of its SPAC. Babylon’s raise of $200 million (€173M) in a ‘sustainability-linked investment’ came from the strategic capital investment firm, Albacore Capital Group. With the SPAC and PIPE, Babylon will now have access to over $800 million in capital [TTA 7 Oct]. Whew! Mobilhealthnews, Babylon release 

A score for Edinburgh. Current Health, a biosensor-based monitoring and home care management/remote patient monitoring system based in Edinburgh and Boston, sold itself to US retailer Best Buy. The company recently raised $43 million in an April Series B, which makes its quick sale somewhat unusual. Terms were not disclosed other than it was a cash deal and that Current’s CEO Christopher McCann will be remaining with the company. Best Buy extends its reach into digital home health, following on their 2019 buys of GreatCall, Critical Signal Technologies for RPM, and partnership with Tyto Care.

Current had achieved FDA Class II clearance in early 2019 [TTA 7 Feb 2019], had piloted with Mount Sinai Brooklyn and in the UK, Dartford and Gravesham NHS Trust for a post-discharge monitoring program, and recently had created a “Community” initiative to build diverse longitudinal datasets for decentralized clinical trials [TTA 18 Feb]. Current Health announcement, Best Buy release, Mobihealthnews, Healthcare Dive

The wellness app-employee/health plan engagement program area continues to consolidate with Virgin Pulse’s acquisition of Welltok. In recent years, Welltok has concentrated more on data analytics and predictive capabilities in its member experience and patient acquisition/retention platforms for health plans and systems, after a start in employee wellness programs. Virgin Pulse, which exited the Richard Branson universe (despite the logo) when sold to Morgan Equity Partners in 2018, is now backed by Marlin Equity Partners. Terms and leadership were not disclosed. Virgin Pulse release, HISTalk

‘Insurtech’ Devoted Health raised a hefty $1.15 billion Series D led by Uprising and Softbank Vision Fund 2, along with a long list of returning and new investors. Icing on the cake is that they are closing in on an additional $80 million in funding to accommodate an investor. Devoted is led by former athenahealth and government IT leaders Ed and Todd Park. It’s one of the smaller in footprint tech-based Medicare Advantage providers but combines their plans with health coverage via Devoted Medical, a telehealth and in-home care provider, and partner providers. FierceHealthcare

The ECG monitoring space is now a little more crowded. Withings finally received FDA clearance for their ScanWatch’s ECG and SpO2 monitoring, nearly two years after its introduction in January 2020. It received clearance in Europe a year ago. The cleared features are atrial fibrillation detection alerts, which advises users to take a 30-second ECG readings, and SpO2 blood oxygen monitoring for detection of respiratory issues. Withings joins the Apple Watch, Fitbit, Samsung, and the grandaddy of them all, AliveCor’s KardiaMobile, for ECG monitoring–but packs this monitoring into a good-looking watch. Mobihealthnews

Telehealth’s primary care wars heat up: Teladoc’s Primary360, Babylon 360

The new fronts in the Telehealth Wars continue to expand, with this week Teladoc announcing that their virtual primary care offering, Primary360, is now available for health plans, employers, and other payers. Babylon Health, in its push into the US market and their upcoming SPAC, also announced that their similar program, Babylon 360, is also being offered to health plans.

Both these services connect the patient users with an assigned doctor and primary care team for ongoing care. They emphasize building a relationship with a doctor and team, not just a random selection previously typical of telehealth. Both Teladoc and Babylon are fully virtual in exams and checkups, sending equipment where needed, ordering lab tests and prescriptions, and accepting your prior health records, plus have 24/7 coverage for urgent situations. Babylon’s service also offers a symptom checker and connection to social determinants of health (SDOH) community services.

It’s obvious that the payer-provider walls are coming down in all directions–telehealth is one more. Babylon, as we noted earlier, acquired two California-based practice groups. Payers like lower-cost, more convenient visits, and after a fractious start, have for some time. Many of the insurtechs either have close relationships with providers or have bought practices (Bright Health’s NeueHealth)–copying the Optums which have affiliations with or ownership of practices all over the US. It’s also another pressure on primary care practices around reimbursement. Often the answer is to either sell out or enter into value-based care arrangements.

For the patient/member, there’s the benefit of convenient care, and a relationship with a team, albeit not with an in-person option right now–if these services are consistent in their promise and steady in their physician/clinician groups. Mobihealthnews (Teladoc)

Babylon Health’s SPAC closing later this month at $4.2 billion value, buys California medical practices

Ali Parsa, CEO of Babylon Health, confirmed to FierceHealthcare yesterday that Babylon Health will be going public later this month via a SPAC. This is proceeding as closed in June with blank-check Alkuri Global Acquisition Corp., led by former Groupon CEO Rich Williams [TTA 1 June].

The pro-forma equity valuation is estimated as $4.2 billion, with Alkuri providing $575 million in gross proceeds to Babylon, including $230 million in a private placement from investors such as AMF Pensionsförsäkring and Palantir Technologies. The new Babylon Holdings Limited will be listed on the New York Stock Exchange under the ticker symbol BBLN.

After developing its GP in Hand triage service with the NHS starting in 2017, now claiming 102, 000 users, it has weathered controversies from clinical commissioning group (CCG) reservations to gender bias in its chatbot (‘Heart Sister’ Carolyn Thomas) to a litany from @DrMurphy11 to the BBC Two’s Newsnight treatment [TTA 9 Jan 20, 27 Feb 20]. However, Mr. Parsa believes that their value proposition (technically, a written document) is sound and that they are now poised for growth.

Newly developed products include Babylon 360, a digital-first value-based care service that includes the option for telehealth visits, and Babylon Cloud Services, a suite of digital self-care tools for patients and doctors, including an AI-enabled symptom checker. Expansion has been as far flung as Rwanda and the US, although in the crowded US telehealth market, Babylon has found it difficult to make a strong  impression versus Teladoc and Amwell, though they cover three million lives and has licensed providers in all 50 states.  They recently bought two California-based medical practices, Meritage Medical Network and First Choice Medical Group, opening an office in Palo Alto. Babylon also optioned to buy Higi health kiosks after a $30 million investment [TTA 30 May 20], which may close after the SPAC. Still, Mr. Parsa is staking the future on the US, where over 40% of global healthcare money is spent. 

Babylon has been growing 400% year to year for a few years with $79 million in 2020 unaudited revenue, a 394% year-over-year increase, and a projected $321 million in 2021, $710 million by 2022, and $1.4 billion by 2023. Hampering this sunny picture are Babylon’s continued losses: $76 million first half of 2021, less than their PY net loss of $91 million. 

News and deal roundup: OneMedical’s $2.1 bn for Iora, CareDx buys Transplant Hero, Mount Sinai’s Elementa Labs; UK news–NHSX/Babylon, Doro-Everon, Tunstall

West Coast-based concierge medical provider One Medical goes ‘mass’ with Iora. One Medical, best known for serving the affluent well through a membership fee, direct pay, commercial insurance, and sponsored contracts with large employers like Google for primary care, announced plans to acquire Boston-based Iora Health. Iora’s primary care providers serve a different market, with primarily Medicare patients moved into full-risk value-based models such as Medicare Advantage plans and practices in shared savings arrangements such as Direct Contracting. The investor presentation here discloses the all-stock purchase with 26 percent of ownership going to current Iora shareholders. Iora for now will be run separately, which makes sense given the disparity in patient base. The major element in common? Primary care practices and ‘white-glove’ services. Healthcare Dive, FierceHealthcare

Consolidation in digital transplant care assistance. CareDx, which provides a wide variety of management services for organ transplant providers and recipients, is acquiring New York-based Transplant Hero. Transplant Hero is an app that reminds recipients to take their vital medications, and was founded by a transplant physician. Financial terms and integration going forward were not disclosed. Release, Mobihealthnews.

Mount Sinai Innovation Partners (MSIP) creates a new health tech incubator. Elementa Labs launched this week, specifically seeking pre-seed or seed-stage healthcare and biotech startups. Companies must also have a clear objective for working with Mount Sinai to develop a comprehensive development plan.The first startup on board is avoMD, a mobile-friendly point of care clinical decision support platform. Applications for the 12-week program close 30 September. FierceHealthcare

UK activity heats up with the late spring…

NHSX and NHS England are assessing Babylon Health’s triage app. According to an exclusive in Pulse (may require registration), a senior delegation from both visited University Hospitals Birmingham NHS Foundation Trust (UHB) last month to look at its use of the Babylon technology. However, NHSX has disclaimed any work towards a national program with Babylon as practices reopen throughout the UK.

DoroCare UK and Everon announced a partnership on products and services for social care, such as Everon’s Lyra, a cloud-based emergency call system, and Doro’s Eliza, a smartcare hub. Release

Tunstall announced the release of the Tunstall Service Platform (TSP) in the UK. It’s described as a connected care software platform supporting the Tunstall Alarm Receiving Centres coordinated by local authorities and social housing providers. It has four unique functions: PNC (call handling), service manager, fieldforce manager, and proactive services. It also will transition these systems from analogue to digital and will be operable in both. Release

Babylon Health going the SPAC route with Alkuri Global for $4.2 billion value (updated for 3 June announcement)

Another big SPAC on the boards. Telemedicine/symptom checking app Babylon Health has closed a deal to go public via a SPAC (special purpose acquisition company) via Nashville-based Alkuri Global Acquisition Corp.  The deal with Alkuri, run by two former Groupon Inc. execs, was reported of 28 May and was imminent, according to the usual “people familiar with the matter” speaking with Bloomberg News (may be paywalled). 

If the Babylon-Alkuri SPAC comes to pass (it did–see below), the company valuation was reported to top $3.5 billion. Alkuri also is lining up investors for $270 million of private investment in public equity (PIPE) funding, the sources said. Alkuri is led by Groupon’s ex-CEO Rich Williams and former COO Steve Krenzer, The money connection is likely Sultan Almaadeed, a former executive at the Qatar Investment Authority, who is Alkuri’s chairman.

This isn’t the first time Babylon has talked SPAC. Back in April, Babylon almost went into a SPAC backed by financier Alec Gore. Other SPACs in prior talks with Babylon were Freedom Acquisition I Corp., backed by former Credit Suisse Group AG CEO Tidjane Thiam, as well as a vehicle from Klaus Kleinfeld, the former head of Arconic. Yahoo!Finance

Babylon’s last big raise was a $550 million Series C in 2019, led by Saudi Arabia’s Public Investment Fund with prior investors Kinnevik AB and Munich Re AB. Their total funding since 2015 is $631.1 million. Crunchbase.

Updated. And so it came to pass that on Thursday 3 June, two days after our article published (and while this Editor was on assignment), it was formally announced. Reuters reported that Babylon’s pro-forma equity valuation is up to $4.2 billion. Babylon will enjoy $575 million in gross proceeds. This includes a PIPE of $230 million, a little lower than earlier reports, from investors such as AMF Pensionsförsäkring and Palantir Technologies Inc. Existing Babylon shareholders will roll 100% of their equity into the combined company and will own approximately 84% of the pro forma company at closing sometime in the second half of the year. It will trade on NASDAQ under BBLN. Ali Parsa, Babylon’s founder, CEO, and face of the business, will remain chairman and CEO. Babylon’s release has the financial details, including the investor presentation. FierceHealthcare 

Comings and goings: Babylon Health, Seniorlink, Hinge Health

At Babylon Health, the US-based C-suite is now larger with the additions of Paul-Henri Ferrand, briefly of financial platform Brex and previously Google Cloud, as Chief Business Officer, Stacy Saal of Amazon as Chief Operating Officer, and Steve Davis from Expedia Group as Chief Technology Officer. Mr. Ferrand will lead business development, sales, marketing, and customer success efforts; Ms. Saal operational initiatives and goals; and Mr. Davis technology and data. They will concentrate on US growth plans plus refining and leveraging Babylon 360.  Babylon release

Seniorlink, a Boston-based provider of professional coaching, emotional and financial support services for caregivers through Medicare Advantage and Medicaid in nine states, and the developer of the Vela care coordination app, appointed Matt Marek as President and Chief Operating Officer. He comes from Further, a service company for healthcare spending accounts. He will be concentrating on strategy and increasing US growth and partnerships.  Release

Having raised $300 million in a January Series D [TTA 14 Jan] as a prelude to a rumored IPO, San Francisco-based Hinge Health has made some major management changes. Jim Pursley, longtime Chief Commercial Officer at Livongo Health who departed after the Teladoc Health acquisition, is now President. Lex Annison, formerly of Google, is now Chief Operating Officer. And their new CFO, Ron Will, comes from the financial world, most recently from Ripple, and apparently has experience with mergers. On their management roster, Hinge now has two presidents–Gabriel Mecklenberg, a co-founder, and Mr. Pursley. Hinge provides digital solutions that treat chronic musculoskeletal (MSK) conditions to the provider market. Hat tip to an industry insider.   

NHS digital triaging app eConsult closes £7 million funding round

Closing out last week was eConsult’s announcement of a new £7 million round of financing. The triage app is currently used by about 40 percent of NHS practices–3,200 NHS GP practices across the UK. The funding, on top of a £5 million Series A raise last October (Crunchbase, AngelNews) was via Gresham House Ventures (this raise and the Series A lead) and Calculus Capital, plus existing investors.

The fresh funding will boost eConsult capabilities for primary and secondary care, plus expansion into urgent care with an Urgent and Emergency Care tool, eTriage, and outpatient triage tool, eSpecialist. They are also developing a triaging service for Emergency Departments (EDs). 

eConsult was formed in 2013 by four NHS GPs. It uses a bank of over 10,000 questions from a number of clinical sources to direct patients to the most appropriate care, assign priority, and direct to a GP surgery. Their research indicates that 70 percent of GP enquiries can be closed without a F2F consult. 

Last August, eConsult, Q doctor, and Cognitant Group jointly created a toolbar that combined eConsult with Q doctor’s video consult technology and Cognitant Group’s ‘Healthinote’ verified patient information service. They later added HCI’s medical video library service. In June, eConsult added the Ministry of Defence; 183,500 service members and dependents in 124 international locations are able to access online consultations with Defence Primary Healthcare (release).

eConsult’s service volume exploded during the early pandemic and has held its leading share versus competitive services such as Babylon Health, Push Doctor, Infermedica, and Livi (Kry). Babylon has had its challenges in the UK market but is aggressively moving into enterprise accounts in the US and Canada, quietly raising just before Christmas $100 million (£74.5m) in a convertible loan led by VNV Global. Mobihealthnews. UKTechNews