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

Babylon Health leads a $30 million Series B for Higi health kiosks, continuing US push

Here’s an interesting investment by Babylon Health. Earlier this week, diagnostic/symptom checking app Babylon Health was reported to lead a $30 million Series B investment in Higi. Higi has about 10,000 health monitoring kiosks (Smart Health Stations) placed in various US retail locations like supermarkets (Stop & Shop, Shop Rite), pharmacies (Walgreens), workplace and community locations. A user can check their blood pressure, pulse, weight, and BMI for free, along with uploading data from one of 80 connected devices and apps. What then happens is that Higi stores that data on their platform for the user, who can log in and access it from the Higi app on their computer or smartphone.

Higi claims 62 million people have used a Higi device for a total of 372 million tests. This Editor has seen them in some local stores, usually in a corner, sitting forlornly or with an out-of-service sign. (Sanitization, of course, is a real concern.) 

So what is Babylon’s interest in Higi? The US health data, of course, which Babylon can put into their database and improve their modeling. Babylon also is gaining a foothold in the US with high-profile partners such as Mount Sinai in NYC and with health plans in Missouri, New York, and California. For Higi, the tie with Babylon increases their clinical data information base and adds access to a symptom checking app. 

In the Series B, Babylon Health was joined by Higi’s Series A investors, 7Wire Ventures, Flare Capital Partners, Jumpstart Capital, Rush University System for Health, and William Wrigley Jr. Confusingly, on Crunchbase, these investors are listed as a Series C,  not a Series A. They list a B funding round with lead partner Blue Cross Blue Shield Venture Partners, without a funding amount, with the previous round as venture, so possibly the Series B failed. Higi’s funding to date is over $61 million not including the new round. TechCrunch, Higi blog

Mount Sinai Health Partners (NY) launches Babylon Health telehealth app

Mount Sinai Health Partners, through New York Telemedicine Associates, has premiered Babylon Health’s telehealth app as part of its services with five large New York health plans: Empire Blue Cross Blue Shield Commercial and Medicare Advantage; Humana Medicare Advantage; Oscar Commercial, and Cigna Commercial. The coverage of these five plans is claimed to be in the millions. Mount Sinai’s network covers Manhattan, Brooklyn, Queens, and most of Long Island.

The app includes the Babylon chatbot and the opportunity to set video consults with a doctor. The app also has COVID-19 information and a chatbot app which leads you through a self-diagnosis menu, interactive advice, and will set up an appointment to speak to a healthcare professional. Release, Babylon Health US’ page on the Mount Sinai program   This Editor will add that Mount Sinai is rather late to the party, as rival NYU Langone has been promoting their telehealth Virtual Urgent Care program for months.

The Forbes article starts off like a glossy Babylon press release, but continues on to some of Babylon’s recent and controversial press, such as Saudi Arabia’s Public Investment Fund (PIF) participating in the last $550 million investment round and the tart feedback of many UK doctors on how much ‘care’ can be pushed off onto apps like ‘GP At Hand’. Not mentioned is the controversy around the accuracy of the chatbots when it comes to giving advice, which was the subject of Newsnight and @DrMurphy11 (Dr. David Watkins), who has been raising performance issues for some time. [TTA 27 Feb]

Babylon Health fires back at critic @DrMurphy11; Dr. Watkins–and Newsnight–return fire (UK)

Last month, this Editor took note of the Twitterstorm around Babylon Health on the issues raised surrounding diagnosis of women’s cardiac symptoms. @DrMurphy11, who has been raising performance issues with the Babylon chatbot for the past three years, ran a test on the app. First using a male patient, then a woman, with identical cardiac symptoms, the app returned two different diagnoses: the man was advised to go to an ED on an emergency basis and given information on a heart attack, the woman to her GP in six hours and given information on a panic attack.

@DrMurphy11 came out earlier this week to BBC Two’s Newsnight’s Emma Barnett on a profile of ‘healthcare juggernaut’ Babylon as Dr. David Watkins, a consultant oncologist. You can see him on YouTube here (at the 1 minute and 3 min. 30 mark). He demonstrates the response of the chatbot, using as the patient an older male smoker with chest pains. The chatbot advises him that he might have either gastritis or ‘sickle cell crisis in chest’–and to go to his GP in 6 hours. What is far more likely than sickle cell with this history is, of course, a heart attack, as a consultant cardiologist, Dr. Amitava Banerjee confirmed on the program. Dr. Banerjee has also been critical of Babylon’s chatbot on cardiac diagnosis and Health Secretary Matt Hancock in his visible advocacy of Babylon in the NHS alone (at 6 min.) According to Dr. Watkins, he has been documenting chatbot problems to the MHRA and the CQC since 2017, and the problems haven’t been fixed.

Timed with the Newsnight piece, Babylon fired back with a press release labeling Dr. Watkins a “troll” and stating that only 100 of his 2,400 tests demonstrated any concerns with the chatbot. According to the release, Babylon’s staff “have attempted to start a positive conversation with this anonymous person. We have invited him in to start a dialogue, to test our AI, and to meet with the senior doctors who build our products” without response. Babylon has also cited that all of Dr. Watkins’ trials were theoretical tests and cites millions of real uses without a single report of harm, that it meets regulatory standards in five countries including use in the NHS, and that its real life users are highly satisfied (85 percent at 5 stars).

At 6:48 to 12:40 in the video, Newsnight’s Emily Maitlis grills both Babylon’s Dr. Keith Grimes and Dr. Watkins. She brings up that Babylon’s former head of regulatory affairs, Hugh Harvey, had stated that no one has assessed how well the app works. Dr. Watkins also counters Babylon’s non-contact claim that he contacted one of the Babylon leadership members back in 2018 on chatbot problems. Dr. Grimes responded to Ms. Maitlis’ remark that founder Ali Parsa is not a doctor that over 600 doctors work for Babylon. This Editor will leave it to Readers to decide what side won, or if it was a draw. Also Mobihealthnews global edition. (For US Readers, Newsnight and Ms. Maitlis conducted the exclusive, disastrous–for Prince Andrew–interview on his relationship with the late Jeffrey Epstein.)

Babylon Health criticized by Manchester CCG, cardiac activists in UK, Canada

News you may have missed. Over the holidays, Babylon Health took some hard knocks on two fronts, right after the announcement of their expansion into North America. 

The Manchester Clinical Commissioning Group (CCG) rapped the developer of GP at Hand fairly hard on their expansion plans to this Northern city. “We are not convinced that Babylon GP at Hand’s model of care is sufficiently integrated with other local and national services to ensure safe and effective care for local people. Areas of concern include screening programmes and safeguarding. We therefore asked Hammersmith and Fulham CCG, the formal commissioner of BGPaH, to object to the Babylon proposal to begin operating in Manchester from early 2020.” There is a 1,001-person cap on registrations which may be lifted this month if Babylon can address and mitigate these patient concerns.

It should be said that Birmingham had similar concerns to Manchester, but a similar cap was lifted last month. Babylon’s stated strategy is to work with the CCGs on their concerns to successfully roll out the service to offer in-person appointments and 24-hour digital appointments by early 2020. Digital Health

There’s also been charges of gender bias in diagnosis of cardiac symptoms by Babylon’s chatbot. When presented with

identical cardiac symptoms, the chatbot reportedly will tell a man to seek immediate care, but a woman is advised that it may be a panic attack or even depression. Here’s the Twitter discussion between @DrMurphy11 and past TTA contributor Carolyn Thomas, the “Heart Sister”, on this bias. When asked, Dr. Keith Grimes, Babylon’s Clinical Innovation Director, replied: 

Ms. Thomas is a long-time Canadian writer and activist on women living with cardiac conditions, how they are often misdiagnosed (The Grinch’s Guide to Women’s Heart Attacks), and how women’s symptoms of cardiac disease differ.  Her blog is personal, interesting, and informative. (Do read her 22 December post on the Christmas truce of December 1914)

Babylon Health to enter US market with two large strategic partners: report

An apparently exclusive report in Mobihealthnews confirms the recent speculation that Babylon Health is entering the US market starting next month with its smartphone-based chat and triage service. Kurt Blasena, Babylon’s senior managing director of commercial strategy and revenue growth, said at the October Digital Health Innovation Summit in Boston that there are two current partners and a projected additional one to three more in 2020. The hints were that they were two “very large” strategic partners and one implementation will be for the state Medicaid market. The partners were not named, which leads this Editor to guess that the Medicaid implementation hasn’t been cleared with its state yet.

Babylon is experienced at international rollouts but not the US market. According to Mr. Blasena, they been busy localizing the service for the US by adapting the chatbot’s natural language processing system and hiring US-based staff. Part of the US difference is negotiating through how local healthcare is delivered, plus the thicket (this Editor is being kind) of Federal, state, and local regulations.

Right now their US operations are in a Prospect Heights, Brooklyn NYC apartment and in a WeWork in Austin, Texas. Mr. Blasena, according to his LinkedIn profile, is resident in San Diego.

Babylon Health has abundant cash on hand from a $550 million August Series C led by the Saudi Arabia Investment fund along with previous investors Kinnevik AB and Vostok plus new investor Munich Re. The stated intent was to expand into the US and other international markets in addition to presently being in Rwanda and Canada. Release  Stay tuned….

News, moves and M&A roundup: Appello acquires RedAssure, Shaw departs NHS Digital, NHS App goes biometric, GP at Hand in Manchester, Verita Singapore’s three startup buys, Novant Health and Tyto Care partner

Appello telecare acquires RedAssure Independent Living from Worthing Homes. A 20-year provider of telecare services to about 700 homes in the Worthing area in West Sussex, the acquisition by Appello closed on 1 October. Previously, Appello provided monitoring services for RedAssure since 2010. Terms were not disclosed. Release.

Another NHS Digital departure is Rob Shaw, deputy CEO. He will be leaving to pursue a consulting career advising foreign governments on national health and care infrastructure. He is credited with moving the NHS Spine in-house and establishing NHS Digital’s cybersecurity function. The Digital Health article times it for around Christmas. Mr. Shaw’s departure follows other high-profile executives this year such as former chief digital officer Juliet Bauer who controversially moved to Kry/LIVI after penning a glowing article about them [TTA 24 Jan], Will Smart, Matthew Swindells, and Richard Corbridge.

One initiative that NHS Digital has lately implemented is passwordless, biometric facial or fingerprint-based log in for the NHS App, based on the FIDO (Fast-Identity Online) UAF (Universal Authentication Framework) protocol (whew!). NHS Digital’s most recent related announcement is the release of two pieces of code under open-source that will allow developers to include biometric verification for log in into their products.

Babylon Health’s GP at Hand plans Manchester expansion. The formal notification will likely be this month to commissioners of plans to open a Manchester clinic as a center for GP at Hand’s primarily virtual consults. This follows on their recent expansion into Birmingham via Hammersmith and Fulham CCG which will be notified. How it will work is that patients registering in Manchester would be added initially to a single patient list for GP at Hand located at Hammersmith and Fulham CCG. Babylon is now totalling 60,000 patients through GP at Hand.  GP Online

Singapore’s Verita Healthcare Group has acquired three digital health startups. The two from Singapore are nBuddy and CelliHealth, in addition to Germany’s Hanako. Verita has operations in Singapore, the US, Asia-Pacific and Europe, with 35 alliance partnerships with medical clinics and hospitals across Australia, Southeast Asia and Europe. Mobihealthnews APAC

Novant Health, a 640-location health system in North Carolina, is introducing Tyto Care’s TytoHome integrated telehealth diagnostic and consult device as part of its network service. Webpage, release

LIVI telemedicine app expands availability to 1.85 million patients with GPs in Birmingham, Shropshire, Northamptonshire, Southeast

The LIVI telemedicine app, which made news last year with UK partnerships in Surrey and Northwest England last year, has expanded to GP practices in Birmingham, Shropshire, Northamptonshire, and locations in the Southeast, as well as additional practices in Surrey. The Northampton General Practice Alliance and the Alliance for Better Care are among the federations partnering with LIVI.

LIVI offers NHS and private services for video consults with a GP. Patients can also access medical advice, referrals, and prescriptions. Unlike Babylon Health, the patient can use LIVI without having to register with a new, Babylon Health-linked practice and deregistering from the former GP practice. It is now available to 1.85 million UK patients. Known as Kry in the Nordic countries, LIVI also has a presence in France. 

In January, LIVI also acquired some notoriety when their current VP of product, Juliet Bauer, departed her chief digital officer spot with NHS England after an all-too-glowing article about LIVI’s Surrey pilot in The Times–without disclosing that she was joining the company in April [TTA 24 Jan] leading to charges of the ‘brazenly revolving door’ et al.

Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)

It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding.

The doors were blown off funding last quarter, so whither the year? Our first take 10 January on Rock Health’s 2018 report was that digital health was a cheery, seltzery fizzy, not bubbly as in economic bubbles.  Total funding came in at $8.1 billion–a full $2.3 bn or 42 percent–over 2017’s $5.7 bn, as projected in Q3 [TTA 11 Oct]–which indicates confidence and movement in the right direction.

What’s of concern? A continued concentration in funding–and lack of exiting.

  • From Q3, the full year total added $1.3 bn ($6.8 bn YTD Q3, full year $8.1 bn) 
  • The deals continue to be bigger and fewer–368 versus 359 for 2017, barely a rounding error
  • Seed funding declined; A, B, C rounds grew healthily–and D+ ballooned to $59M from $28M in 2017, nearly twice as much as C rounds
  • Length of time between funding rounds is declining at all levels

Exits continue to be anemic, with no IPOs (none since 2016!) and only 110 acquisitions by Rock Health’s count. (Rock only counts US only deals over $2 million, so this does not reflect a global picture.)

It’s not a bubble. Really! Or is it a developing one? Most of the article delivers on conclusions why Rock Health and its advisors do not believe there is a bubble in funding by examining six key attributes of bubbles. Yet even on their Bubble Meter, three out of the six are rated ‘Moderately Bubbly’–#2, #3, and #5–my brief comments follow. 

  1. Hype supersedes business fundamentals (well, we passed this fun cocktail party chatter point about 2013)
  2. High cash burn rates (not out of line for early stage companies)
  3. Unclear exit pathways (no IPOs since ’16 which bring market scrutiny into play. Oddly, Best Buy‘s August acquisition of GreatCall, and the latter’s earlier acquisitions of Lively and Healthsense didn’t rate a mention)
  4. Surge of cash from new investors (rising valuations per #5–and a more prosperous environment for investments of all types)
  5. High valuations decoupled from fundamentals (Rock Health didn’t consider Verily’s billion, which was after all in January)
  6. Fraud or misuse of funds (Theranos, Outcome dismissed by Rock as ‘outliers’, but no mention of Zenefits or HealthTap)

Having observed bubbles since 1980 in three industries– post-deregulation airlines in the 1980s, internet (dot.com) in the 1990s, and healthcare today (Theranos/Outcome), ‘moderately’ doesn’t diminish–it builds to a peak, then bursts. Dot.com’s bursting bubble led to a recession, hand in hand with an event called 9/11.

This Editor is most concerned with the #5 rating as it represents the largest divergence from reality and is the least fixable. While Verily has basically functioned as a ‘skunk works’ (or shell game–see here) for other areas of Google like Google Health, it hardly justifies a billion-dollar investment on that basis alone. $2 bn unicorn Zocdoc reportedly lives on boiler-room style sales to doctors with high churn, still has not fulfilled its long-promised international expansion, and has ceased its endless promises of transforming healthcare. Peleton is a health tech company that plumps out Rock Health’s expansive view of Health Tech Reality–it’s a tricked out internet connected fitness device. (One may as well include every fitness watch made.)

What is the largest divergence from reality? The longer term faltering of health tech/telecare/telehealth companies with real books of business. Two failures readily come to mind: Viterion (founded in 2003–disclosure, a former employer of this Editor) and 3rings (2015). Healthsense (2001) and Lively were bought by GreatCall for their IP, though Healthsense had a LTC business. Withings was bought back by the founder after Nokia failed to make a go of it. Canary Care was sold out of administration and reorganized. Even with larger companies, the well-publicized financial and management problems of publicly traded, highly valued, and dominant US telemed company Teladoc (since 2015 losing $239 million) and worldwide, Tunstall Healthcare’s doldrums (and lack of sale by Charterhouse) feed into this. 

All too many companies apparently cannot get funding or the fresh business guidance to develop. It is rare to see an RPM survivor of the early ’00s like GrandCare (2005). There are other long-term companies reportedly on the verge–names which this Editor cannot mention.

The reasons why are many. Some have lurched back and forth from the abyss or have made strategic errors a/k/a bad bets. Others like 3rings fall into the ‘running out of road and time’ category in a constrained NHS healthcare system. Beyond the Rock Health list and the eternal optimism of new companies, business duration correlates negatively with success. Perhaps it is that healthcare technology acceptance and profitability largely rests on stony, arid ground, no matter what side of the Atlantic. All that money moves on to the next shiny object.(Babylon Health?) There are of course some exceptions like Legrand which has bought several strong UK companies such as Tynetec (a long-time TTA supporter) and Jontek.

Debate welcomed in Comments.

Related: Becker’s Hospital Review has a list of seven highly valued early stage companies that failed in 2018–including the Theranos fraud. Bubble photo by Marc Sendra martorell on Unsplash

Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox)

There, it’s said. A recent investigative article by a Forbes staff writer, European-based Parmy Olson (as opposed to their innumerable guest writers), that dropped a week before Christmas Eve raised some uncomfortable questions about Babylon Health, certainly the star health tech company on the UK scene. These uncomfortable bits are not unknown to our Readers from these pages and for those in the UK independently following the company in their engagement with the NHS.

Most of the skepticism is around their chatbot symptom checker, which has been improved over time and tested, but even the testing has been doubted. The Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets in the MRCGP, with Babylon achieving a much-publicized 80 test score. A letter published in the Lancet (correspondence) questioned the study’s methodology and the results: the data was entered by doctors, not by the typical user of Babylon Health; there was no statistical significance testing and the letter claims that the poor performance of one doctor in the sample skewed results in Babylon’s favor.  [TTA 8 Nov]. 

The real questions raised by the Lancet correspondence and the article are around establishing standards, testing the app around existing standards, and accurate follow up–in other words, if Babylon were a drug or a medical device, close to a clinical trial:

  • Real-world evaluation is not being done, following a gradual escalation of steps testing usability, effectiveness, and safety.
  • How does the checker balance the probability of a disease with the risk of missing a critical diagnosis?
  • How do users interact with these symptom checkers? What do they do afterwards? What are the outcomes?

Former Babylon staffers, according to the Forbes article, claim there is no follow up. The article also states that “Babylon says its GP at Hand app sends a message to its users 24 hours after they engage with its chatbot. The notification asks about further symptoms, according to one user.” Where is the research on that followup?

Rectifying this is where Babylon gets sketchy and less than transparent. None of their testing or results have been published in peer-reviewed journals. Moreover, they are not helped by, in this Editor’s view, their chief medical officer stating that they will publish in journals when “when Babylon produces medical research.” This is a sad statement, given the crying need for triaging symptoms within the UK medical system to lessen wait times at GPs and hospitals. But even then, Babylon is referring patients to the ED 30 percent of the time, compared to NHS’ 111 line at 20 percent. Is no one there or at the NHS curious about the difference?

And the chatbot is evidently still missing things. (more…)

Is Babylon Health’s AI on par with a human diagnostician? Claim questioned in ‘The Lancet’.

In July, Babylon Health released the results of their testing against the MRCGP (Member of the Royal College of General Practitioners) exam based on publicly available questions. As we reported at the time, its AI system passed the exam with a score of 81 percent. A separate test where Babylon worked with the Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets. Babylon passed with an 80 score.

Now these results are being questioned in a letter to The Lancet. The authors–a medical doctor and two medical informatics academics–argue that the methodology used was questionable. ‘Safety of patient-facing digital symptom checkers’  shows there ‘is a possibility that it [Babylon’s service] might perform significantly worse’. The symptom checking methodology was questioned for not being real world–that the data in the latter test was entered by doctors only, not by patients or other clinicians. While the authors commended Babylon for being open about their research, they felt there was an “urgent need” for improvements in evaluation methods. “Such guidelines should form the basis of a regulatory framework, as there is currently minimal regulatory oversight of these technologies.” Babylon promises a response and additional improvements, presumably from its $100 million investment in AI announced in SeptemberDigitalHealth (UK), Mobihealthnews

AI promises, promises! Babylon Health to spend $100m, hire 1,000 to develop leading AI platform

Babylon Health’s CEO Ali Parsa announced at their headquarters last week that the company would be spending $100 million to develop the ‘world’s leading AI healthcare platform’. In the company of Health Secretary Matt Hancock, an admitted GP at hand fan (nothing goes better after poring over your red boxes), Mr. Parsa confirmed that the 1,000 data scientists, programmers, and clinicians would be based in London after a global search of suitable cities. They will be helping to design the next generation of health AI for diagnosis and to support patients with long-term conditions. 

The report in Digital Health noted that the audience included key figures such as Malcolm Grant, chairman of NHS England; Dr Simon Eccles, NHS England CCIO; and Juliette Bauer, head of digital experience. This is despite Babylon challenging the Care Quality Commission (CQC) over an unfavorable report [TTA 11 Dec] and being put on hold by Birmingham as well as Hammersmith and Fulham CCGs [TTA 23 Aug].

Babylon is well able to afford this as Prudential Asia (Prudential plc) has licensed Babylon’s software for its own apps across 12 countries in Asia for an estimated $100 million over several years. Forbes  It also inked a deal in June to provide insurer Bupa’s Instant GP to corporate clients [TTA 21 June]. Will this include a foray into the US? No clues so far!