TTA’s summer #10: Google shuts NHS’ Streams app, Headspace and Ginger merge for their mental health, healthcare too much for Big Tech, Cerner’s CEO pay packet, more!

 

 

Weekly Update

Google continues shedding Health initiatives with shutdown of NHS’ Streams clinical support app. But is health care too much for Big Tech accustomed to monetizing clicks and ads? Headspace and Ginger decide to merge rather than be bought, as digimental health stays hot. Beth Israel Deaconess shows how hospital IT can get its skates on with telehealth. And Cerner’s pay package for its new CEO shows you that crime does not pay, but healthcare certainly does!

Editor’s Note: We’ll be on hiatus from 31 Aug to 14 Sept for an extended end of summer holiday. Articles will resume around the 14th-15th and Alerts on 18 Sept. Enjoy the rest of summer and your holiday!

Mental health apps Headspace, Ginger to merge into $3B Headspace Health (Better to merge than to be bought? The sprint of digital mental health continues.)
Another Google termination: Google Streams clinical support app used by NHS (Another broken healthcare toy)
Amazon’s Chime telehealth solution rang Beth Israel Deaconess Medical Center’s bells–case study (How hospital IT can innovate under pressure)
Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package. (Too much, too soon?)

Our weekend lead news is Google Health’s shutdown, with its head graduating to the Big Job at Cerner. Rockley Photonics may be revolutionizing the smartwatch with its photonic vitals sensors. Sharecare expands health ed and enters the once-sleepy home care biz. Humana also bets big on home care with Kindred, SDOH heats up, Maven’s a unicorn, and Carrots are on the healthcare plate with the trimmings.

Breaking: Google Health shutting down, most employees scattered to other divisions (And its head is now Cerner CEO)
Deal and news roundup: Humana closes $5.7B Kindred at Home buy, Unite Us SDOH buys Carrot Health for data, Carrot Fertility raises $75M, Maven Clinic at $1B value, Privia partners with Babyscripts for moms, Tyto Care and Prisma Health
Sharecare expands health education capabilities, acquires CareLinx home care for $65M (updated) (A healthcare conglomerate in the making?)
Comprehensive “clinic-on-the-wrist” digital health sensor system debuts. Apple Watch of future? (UK/US) (Rockley Photonics’ big leap)

The news isn’t taking a Summer Holiday, neither are deals. Honor just rocked the sleepy home care world with its buy of Home Instead. UnitedHealth will have to wait till end of year for Change. Morgan Health debuts with $50M in Vera Health. The Telehealth Teeter-Totter continues with Amwell’s gloomy forecast, Teladoc’s Aetna deal. And Voices Carry with stress testing and a neuroprothesis that may give communication back to those who cannot speak. 

Home care rocked: Honor Technology acquires home care provider Home Instead (It’s all about the caregivers and hospital-at-home)
News roundup: update on UnitedHealth/Change Healthcare DOJ check, Tunstall adds new CTO, Amwell’s gloomy second half, Teladoc’s Aetna deal, Fitbit and LifeScan diabetes
Hearing voices: Cigna-Ellipsis AI-powered voice stress test; UCSF/Weill neuroprosthesis decodes attempted speech (Giving speech to the speechless in the future)
News and funding roundup: patient outreachers Relatient, Radix merge; health apps top 350,000; Morgan’s $50M in Vera Health; Communicare247, Doro, TeleAlarm join Scottish Digital Telecare’s list

A short one this week in the rollup to HIMSS. Funding and deals aren’t taking the summer off despite it being August, and this year’s first half just beat full year 2020.

News and funding roundup: BioIntelliSense ‘stickers’ $45M, Exo ultrasound scans $220M, Enovation gets Scotland OK, WellSky snaps up Healthify, Cerner’s good quarter despite VA (And summer is supposed to be quiet?)
2021’s bubbly $14.7 billion in digital health funding–six months that beat all of 2020 (Rock Health’s rock’n’rolling 1st half)

Telehealth Wars teeter-totter with now Amwell and national expansion on the upside. NHS England’s changing of the guard–Roy Lilley’s insightful interview with Sir Simon. Telemental health prospers. Alcuris gets the cyber-OK from Scotland. And Cerner needs to get it right with the VA, right quick.

The Roy Lilley-Sir Simon Stevens ‘Health Chat’ interview (As the order changes at NHS England)
News and deal roundup: another big mental health app funding, Happify Health’s prescription therapy app debuts, Alcuris approved by Scottish Digital Telecare for cybersecurity (Mental health continues to be the It of Digital Health)
Telehealth Wars: Amwell’s raises game with buys of SilverCloud and Conversa Health; Teladoc’s slow member, hospital growth lead to $133M Q2 loss (The seesaw goes up for one, down for the other)
Cerner execs to VA Congressional committee: “We are committed to getting this right” (After $16 billion, One. Would. Hope. So.)
Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care (Obsolete law change long overdue)

The big news for UK GPs this week was that the GPDPR’s extraction scheduled for 1 Sept is stopped for a Big Rework. Big Blue’s Watson Health dying in pieces, reportedly up for sale. But SPACs and investments have slowed only a bit for the summer with Owlet’s $1bn SPAC and digital health’s torrid $15bn first half. 

Softly, softly: GPDPR comes to screeching halt, indefinitely, to be reworked (Don’t hold yer breath!)
News and deals roundup: Owlet’s $1B SPAC, Carbon Health’s $350M Series D, Series Bs by Woebot Health and b.Well, digital health rakes in $15bn (Owlet ‘socks it’ to the market, behavioral health and digital health match the hot weather)
Oh, MAMA! The Medical Alert Monitoring Association meeting, 28-29 September, Chicago (They’ll need the alerts in Chi-Town)
IBM Watson Health’s stumble and possible fall (The World Was Not Theirs, leading to Death By A Million Cuts)

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: https://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Legrand/Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine, and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

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Another Google termination: Google Streams clinical support app used by NHS

Now that Google Health has been scattered within the Google Puzzle Palace like so many marbles, it should come as no surprise that its Deep Mind-created clinician support app, Streams, is being ‘decommissioned’. The terminology, used for military ships and basis, is quite odd. Termination, or terming, would be more accurate.

The users were concentrated in the UK: University College London NHS Trust, Imperial College Healthcare NHS Trust, Taunton & Somerset, and London’s Royal Free. But all contracts had expired with the exception of the Royal Free. It’s still active there and no definite date has been published for the service’s end.

Deep Mind, Google’s AI skunk works until it was also smushed into Google, started up the Streams app with the Royal Free in 2016 or 2017 and announced plans to integrate AI into it which never came to fruition. The predictive modeling came from the NHS. In the midst of five-year contracts with various Trusts, Streams was handed off in 2018 to Google Health, requiring 1) new contracts because Google was now handling patient data, and 2) dealing with the security and NHS restrictions. Still, the Trusts sustained the app till earlier this year, except for Royal Free’s continuance.

What they will do now that Streams is heading off to Google’s Box of Forgotten Toys? Well, they could adopt Care Studio, currently piloted with Ascension and Beth Israel Deaconess Medical Center (BIDMC). Care Studio also came in for some bad publicity in 2019 when Care Studio’s predecessor, Project Nightingale, piloted at Ascension, accessed 10 million identified patient records without patient or physician consent or knowledge, including patient name, lab results, diagnoses, hospital records, patient names, and dates of birth [TTA 9 April].

Google has become a perfect example of how Big Tech stumbles and misunderstands healthcare, whether in the UK or in the US [TTA 24 Aug]. Dropping it like another Google experiment, Google+, just doesn’t cut it. TechCrunch

Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package.

With Google scattering Google Health to the four winds of the organization--the heck with what employees recruited for Health think of being reorg’d to, say, Maps or YouTube and falling through the corporate rabbit hole–more detail has leaked of Apple’s struggles. This time, on the scaleback list (a/k/a chopping block) is Health Habit. It’s an app in the Apple Store that connects users with AC Wellness, a doctor’s group in Cupertino, California. The ‘eligible participants’ are restricted to Apple employees. From the app site, they can check weight, nutrition, blood pressure, and schedule wellness checks. It seems to be the typical ‘skunk works’ project that’s not ready for prime time, but its public fate seems to be poorly timed and simultaneously, overblown because they are–well–Apple

Bottom line, is healthcare once again proving rather resistant to being leveraged by technological solutions? Those of us who go back to the Stone Age of health tech, or those of us who joined in the Iron and Bronze Ages, remember when you couldn’t get into a conference cocktail party without a “wellness” app. (You say you’re in behavioral and remote patient monitoring for older adults? Oh, look! A squirrel!)

Microsoft was going to dominate consumer health with their HealthVault for personal health records (PHRs). We know how that turned out–dead apps, Fitbit an also-ran bought, Pebble and Misfit going to the drawer of failed toys, Jawbone t-boning plus Intel and Basis written off in 2017, and HealthVault unlamentedly put out with the trash at the end of 2019. Oh yes, there was an earlier Google Health for PHRs, which died with a whimper back in 2012 or so.

The press releases crow about Big Tech’s mastery of complexity, yet going off on their own without partners–or even with partners–never seems to work. In the industry, it makes for a few good articles and the usual rocket launching at places like Forbes, but the pros tend to treat it with a shrug and pull out a competitive plan. Glen Tullman, founder of Livongo who will never have to worry about paying for chateaubriand for two for the next billion years or so, stated the obvious when he said that patients cared about the overall experience, not the tech.

Speaking of experience, Amazon Care promises the best for its employees and enterprise accounts–a one-minute telehealth connection, a mobile clinician if needed within the hour, and drugs at the door in two hours. All with direct pay. This has met with skepticism from telehealth giants like Teladoc and Amwell with established corporate bases. There’s also CVS Health and Walgreens. The Editor has opined that care isn’t Amazon’s game at all–it’s accumulating and owning national healthcare data on Amazon Care and Pharmacy users that is far more valuable than whatever is spent on providing care and services [TTA 16 June]. Will Amazon really be able to pull it off?

Paddy Padmanabhan, the author of Healthcare Digital Transformation, lists a few more reasons It’s Too Hard For Big Tech In Healthcare in his HealthcareITNews article here….

  • Healthcare is a part-time job for Big Tech
  • Big tech firms want to solve the healthcare problem by themselves
  • Selling technology is not the same as selling healthcare services

…but holds out some hope that the initial success of “digital-first and virtual-first providers of healthcare emerging as challengers” will point the way for them.

And speaking of Google Health and former employees, Cerner’s necessary SEC disclosure today of new CEO and president David Feinberg, MD’s compensation package was sure to create some talk in Googleville among his now-scattered team. $34.5 million over the next 15 months is structured as follows:

  • $900,000 base salary
  • a target cash bonus of $1.35 million
  • a one-time cash bonus of $375,000 stock
  • $13.5 million in Cerner’s restricted shares for 2022
  • $3.375 million in stock shares for the fourth quarter of 2021
  • a new hire award of $15 million in restricted stock shares to offset his equity loss with Google. 

Whew! Becker’s HealthIT

TTA’s summer #9: Google Health shuts, vital signs photonics to Apple? Homecare hot with Humana and Sharecare. And more deals including Maven and dressed up Carrots!

 

 

Weekly Alert

Our weekend lead news is Google Health’s shutdown, with its head graduating to the Big Job at Cerner. Rockley Photonics may be revolutionizing the smartwatch with its photonic vitals sensors. Sharecare expands health ed and enters the once-sleepy home care biz. Humana also bets big on home care with Kindred, SDOH heats up, Maven’s a unicorn, and Carrots are on the healthcare plate with the trimmings.

Breaking: Google Health shutting down, most employees scattered to other divisions (And its head is now Cerner CEO)
Deal and news roundup: Humana closes $5.7B Kindred at Home buy, Unite Us SDOH buys Carrot Health for data, Carrot Fertility raises $75M, Maven Clinic at $1B value, Privia partners with Babyscripts for moms, Tyto Care and Prisma Health
Sharecare expands health education capabilities, acquires CareLinx home care for $65M (updated) (A healthcare conglomerate in the making?)
Comprehensive “clinic-on-the-wrist” digital health sensor system debuts. Apple Watch of future? (UK/US) (Rockley Photonics’ big leap)

The news isn’t taking a Summer Holiday, neither are deals. Honor just rocked the sleepy home care world with its buy of Home Instead. UnitedHealth will have to wait till end of year for Change. Morgan Health debuts with $50M in Vera Health. The Telehealth Teeter-Totter continues with Amwell’s gloomy forecast, Teladoc’s Aetna deal. And Voices Carry with stress testing and a neuroprothesis that may give communication back to those who cannot speak. 

Home care rocked: Honor Technology acquires home care provider Home Instead (It’s all about the caregivers and hospital-at-home)
News roundup: update on UnitedHealth/Change Healthcare DOJ check, Tunstall adds new CTO, Amwell’s gloomy second half, Teladoc’s Aetna deal, Fitbit and LifeScan diabetes
Hearing voices: Cigna-Ellipsis AI-powered voice stress test; UCSF/Weill neuroprosthesis decodes attempted speech (Giving speech to the speechless in the future)
News and funding roundup: patient outreachers Relatient, Radix merge; health apps top 350,000; Morgan’s $50M in Vera Health; Communicare247, Doro, TeleAlarm join Scottish Digital Telecare’s list

A short one this week in the rollup to HIMSS. Funding and deals aren’t taking the summer off despite it being August, and this year’s first half just beat full year 2020.

News and funding roundup: BioIntelliSense ‘stickers’ $45M, Exo ultrasound scans $220M, Enovation gets Scotland OK, WellSky snaps up Healthify, Cerner’s good quarter despite VA (And summer is supposed to be quiet?)
2021’s bubbly $14.7 billion in digital health funding–six months that beat all of 2020 (Rock Health’s rock’n’rolling 1st half)

Telehealth Wars teeter-totter with now Amwell and national expansion on the upside. NHS England’s changing of the guard–Roy Lilley’s insightful interview with Sir Simon. Telemental health prospers. Alcuris gets the cyber-OK from Scotland. And Cerner needs to get it right with the VA, right quick.

The Roy Lilley-Sir Simon Stevens ‘Health Chat’ interview (As the order changes at NHS England)
News and deal roundup: another big mental health app funding, Happify Health’s prescription therapy app debuts, Alcuris approved by Scottish Digital Telecare for cybersecurity (Mental health continues to be the It of Digital Health)
Telehealth Wars: Amwell’s raises game with buys of SilverCloud and Conversa Health; Teladoc’s slow member, hospital growth lead to $133M Q2 loss (The seesaw goes up for one, down for the other)
Cerner execs to VA Congressional committee: “We are committed to getting this right” (After $16 billion, One. Would. Hope. So.)
Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care (Obsolete law change long overdue)

The big news for UK GPs this week was that the GPDPR’s extraction scheduled for 1 Sept is stopped for a Big Rework. Big Blue’s Watson Health dying in pieces, reportedly up for sale. But SPACs and investments have slowed only a bit for the summer with Owlet’s $1bn SPAC and digital health’s torrid $15bn first half. In-person meetings are starting to come back as well (apparently HIMSS21 is still on too).

Softly, softly: GPDPR comes to screeching halt, indefinitely, to be reworked (Don’t hold yer breath!)
News and deals roundup: Owlet’s $1B SPAC, Carbon Health’s $350M Series D, Series Bs by Woebot Health and b.Well, digital health rakes in $15bn (Owlet ‘socks it’ to the market, behavioral health and digital health match the hot weather)
Oh, MAMA! The Medical Alert Monitoring Association meeting, 28-29 September, Chicago (They’ll need the alerts in Chi-Town)
Three healthcare startup events: MedStartr NYC Thursday 21 July, Dallas Startup Week starts 1 August–and apply now for UCSF Health Awards (Look to Texas and California)
IBM Watson Health’s stumble and possible fall (The World Was Not Theirs, leading to Death By A Million Cuts)

Teladoc’s new alliance with Microsoft Teams stakes out real estate with health systems–and more. There’s life in VistA yet as VA throws hands up, puts Cerner EHR on hold. UnitedHealthcare beefs up predictive analytics for SDOH as the Feds make moves, while the parent looks to transform. The King’s Fund’s annual conference is back in November. And just for fun–get your Dead Startup Toys!

Saturday summer morning fun: treat yourself (or your boss) to a Dead Startup Toy (Playtime! If not now, when?)
Volte-face: VA now puts their Cerner EHR implementation on hold (Is this a job for Samson or Superman?)
The King’s Fund annual conference returns in November, virtually (Given all, a good call)
The implications of Teladoc’s integration into Microsoft Teams (Now we know why InTouch Health in health systems was worth the mega-money)
UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’ (Plenty of room for tech in this vision)

PERS makes news with an insider view of what happened at Philips Lifeline as Connect America finalizes its buy, and VRI’s up for a new owner. AliveCor continues to play David to Apple’s Goliath, hospital-at-home gets a $250M boost, UK’s Physitrack IPO raises $20M. 

News roundup: AliveCor’s latest FDA clearance plus antitrust vs. Apple, VRI on the market, Walgreens’ ‘tech-enabled future’ indefinite plus VillageMD status, monthly telehealth usage drops 12.5%
An ‘insider’ point of view on the Connect America acquisition of Philips Lifeline (Good background from industry sources)
News/deals roundup: Connect America finalizes Philips aging/caregiving buy; Amedisys-Contessa $250M hospital-at-home; UK’s Physitrack $20M IPO, Dutch motion tracker Xsens

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: https://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Legrand/Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


Telehealth & Telecare Aware: covering the news on latest developments in telecare, telehealth, telemedicine, and health tech, worldwide–thoughtfully and from the view of fellow professionals

Thanks for asking for update emails. Please tell your colleagues about this news service and, if you have relevant information to share with the rest of the world, please let me know.

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

Breaking: Google Health shutting down, most employees scattered to other divisions (updated)

Breaking  Google Health is disbanding, according to an ‘insider’ report in the (paywalled) Business Insider, reported secondarily in Becker’s Health IT and in specialized websites such as Apple Insider. This comes on the heels of the departure of Google Health head and Google VP David Feinberg MD after two years on 1 Sept. He will become CEO and president of Cerner starting 1 October. Healthcare IT News, Healthcare Dive

Reports about the internal memo sent to Google employees from what Apple Insider calls “Google research whiff” (?) Jeff Dean indicates that the teams working on various health projects will be split up to other areas. For instance, Google Health’s clinical group including the EHR tool team will now report to Dean. Based on 2020 numbers, 500 employees will be affected. 

Google Health’s track record since its founding in 2018 hasn’t been superlative, despite the prestigious name and bankroll. They bought a failing Fitbit for $2.1 billion closing only in January, after a bouncy romance starting in 2019  with more than the usual share of controversy, with scrutiny from DOJ to EU regulators. Becker’s reports that Google’s CMO, Karen DeSalvo, MD, leader of clinical initiatives, will now report to the chief legal officer. The AI team on medical imaging will report to Google’s search and AI team. The memo also noted relocation of staff to Search, Maps, and YouTube. 

(updated) In June, Google Health reorganized to shed its consumer focus and focus more on clinical applications such as its controversial Care Studio and health AI, including projects moved from sister company Verily. Even losing 130 or so employees to other areas of the company from a unit high of 700, this apparently was not enough to justify its separate existence. TTA 18 June, FierceHealthcare 

Healthcare ain’t beanbag, as they say in New York, and even Apple with its Watch and innumerable apps has found it rough going. Reports this week stated that Apple is scaling back a specific health team that was focused on an internal health app.

For Dr. Feinberg, former CEO of integrated health regional Geisinger and CEO at UCLA Health, the Cerner position is ‘top of the world’. He is being hired as Cerner’s third CEO in 42 years and will be combining both the CEO and president positions which previously were separately held. He reportedly has been hired to be a strategic CEO, which is a change for the company reflecting its directional change to be a software-as-a-service (SaaS) business rivaling Amazon Web Services, marking a transition away from legacy EHRs. Cerner has had some significant challenges, with the VA implementation sidelined until sometime in 2022, and quite a few executive changes, with the current CEO and chairman departing immediately after three years without an expected transitional period, and a new chairman coming from the board of directors.

As for Google, Dr. Feinberg might agree with “amar99”, one of the commenters on Apple Insider, who said in part: “Great, now can Google please leave Google?”

News and deal roundup: Zus Health’s $34M ‘back-end in a box’, Bright Health’s IPO, Lyra Health’s $200M done, Valo Health’s $2.8B SPAC; UK’s Alcuris, Clarity Informatics, GTX test; Google’s health blues, Facebook’s smartwatch

Athenahealth founder’s latest health tech venture lays track. Jonathan Bush’s new venture, Zus Health, is being pitched to tech founders as providing a ‘Lego’ like back-end for startup digital health companies. Variously compared to ‘Build-A-Bear’ or track laying, it’s an ‘in a box’ setup that provides a data record back end, a software development kit (SDK) with tools and services, and a patient interface. Presumably, this will also assist interoperability. Mr. Bush has enlisted an all-star team and is basing outside of Boston in the familiar area of Watertown, Massachusetts. Andreessen Horowitz (a16z) led the $34 million Series A, joined by F-Prime Capital, Maverick Ventures, Rock Health, Martin Ventures, and Oxeon Investments. The financing will be used for engineering the tech stack. Current clients developed in stealth include Cityblock Health, Dorsata, Firefly Health, and Oak Street Health. Not a breath about the revenue model other than ‘partnership’. Make sure you pronounce Zus as ‘Zeus’ (Athena’s father for those who aren’t up on their Greek myths). Zus release, FierceHealthcare

This week’s IPO filing by insurtech/clinic operator Bright Health with the Securities and Exchange Commission (SEC) confirmed earlier reports that the offering will crest over $1 billion [TTA 28 May]: 60 million shares with an initial valuation of $20 to $23 is at a minimum of $1.2 billion. Company valuation is estimated at $14 billion which is about midpoint of earlier estimates. It will trade on the NYSE under BHG. The cherry on the cake is a 7.2 million 30-day share purchase option to their underwriters at the initial IPO price. Timing is not addressed in the release but expect it soon. BHG release, Mobihealthnews

Lyra Health banks an additional $200 million. This week the corporate mental health therapy provider completed their Series F $200M financing backed by Coatue, new investor Sands Capital, plus existing investors, for a total of $675 million to date (Crunchbase). Valuation is now estimated at $4.6 billion. Mental and behavioral health tech remains warm, with the thundercloud on the horizon Teladoc’s myStrength app [TTA 14 May]. Lyra’s strong corporate footprint puts them, along with Ginger, in a desirable place for acquisition by a telehealth provider or payer. Lyra release, FierceHealthcare

Drug discovery and development company Valo Health is going the SPAC route with Khosla Ventures. The special purpose acquisition company (SPAC) Khosla Ventures Acquisition Co. will form with Valo Health a new company (KVAC) with a pro for­ma mar­ket val­ue of approx­i­mate­ly $2.8 bil­lion with an initial cash balance of $750 million including a $168 million PIPE led by Khosla Ventures. Valo’s flagship is the Opal Computational Platform that creates an AI-based platform for drug discovery. The current pipeline has two clin­i­cal-stage assets and 15 pri­or­i­tized pre-clin­i­cal assets across car­dio­vas­cu­lar meta­bol­ic renal, neu­rode­gen­er­a­tion, and oncol­o­gy fields. Khosla has been largely absent from digital health investments. The SPAC route to IPOs has also cooled. Valo release, Mobihealthnews  

And short takes on other news… (more…)

Weekend ‘Must Read’: Are Big Tech/Big Pharma’s health tech promises nothing but a dangerous fraud?

If it sounds too good to be true, it isn’t. And watch your wallet. In 14 words, this summarizes Leeza Osipenko’s theme for this article. It may seem to our Readers that Editor Donna is out there for clicks in the headline, but not really. Dr. Osipenko’s term is ‘snake oil’. It’s a quaint, vintage term for deceptive marketing of completely ineffective remedies, redolent of 19th Century hucksters and ‘The Music Man’. Its real meaning is fraud.

The promise is that Big Data, using Big Analytics, Big Machine Learning, and Big AI, will be a panacea for All That Ails Healthcare. It will save the entire system and the patient money, revolutionize medical decision making, save doctors time, increase accuracy, and in general save us from ourselves. Oh yes, and we do need saving, because our Big Tech and Big Health betters tell us so!

Major points in Dr. Osipenko’s Project Syndicate article, which is not long but provocative. Bonus content is available with a link to a London School of Economics panel discussion podcast (39 min.):

  • Source data is flawed. It’s subject to error, subjective clinical decision-making, lack of structure, standardization, and general GIGO.
  • However, Big Data is sold to health care systems and the general public like none of these potentially dangerous limitations even exist
  • Where are the long-range studies which can objectively compare and test the quality and outcomes of using this data? Nowhere to be found yet. It’s like we are in 1900 with no Pure Food Act, no FDA, or FTC to oversee.
  • It is sold into health systems as beneficial and completely harmless. Have we already forgotten the scandal of Ascension Health, the largest non-profit health system in the US, and Google Health simply proceeding off their BAA as if they had consent to identified data from practices and patients, and HIPAA didn’t exist? 10 million healthcare records were breached and HHS brought it to a screeching halt.
    • Our TTA article of 14 Nov 19 goes into why Google was so overeager to move this project forward, fast, and break a few things like rules.
  • We as individuals have no transparency into these systems. We don’t know what they know about us, or if it is correct. And if it isn’t, how can we correct it?
  • “Algorithmic diagnostic and decision models sometimes return results that doctors themselves do not understand”–great if you are being diagnosed.
  • Big Data demands a high level of math literacy.  Most decision makers are not data geeks. And those of us who work with numbers are often baffled by results and later find the calcs are el wrongo–this Editor speaks from personal experience on simple CMS data sets.
  • In order to be valuable, AI and machine learning demand access to potentially sensitive data. What’s the tradeoff? Where’s the consent?

Implicit in the article is cui bono?

  • Google and its social media rivals want data on us to monetize–in other words, sell stuff to us. Better health and outcomes are just a nice side benefit for them.
  • China. Our Readers may also recall from our April 2019 article that China is building the world’s largest medical database, free of those pesky Western democracy privacy restrictions, and using AI/machine learning to create a massive set of diagnostic tools. They aren’t going to stop at China, and in recent developments around intellectual property theft and programming back doors, will go to great lengths to secure Western data. Tencent and Fosun are playing by Chinese rules.

In conclusion:

At the end of the day, improving health care through big data and AI will likely take much more trial and error than techno-optimists realize. If conducted transparently and publicly, big-data projects can teach us how to create high-quality data sets prospectively, thereby increasing algorithmic solutions’ chances of success. By the same token, the algorithms themselves should be made available at least to regulators and the organizations subscribing to the service, if not to the public.

and

Having been massively overhyped, big-data health-care solutions are being rushed to market in without meaningful regulation, transparency, standardization, accountability, or robust validation practices. Patients deserve health systems and providers that will protect them, rather than using them as mere sources of data for profit-driven experiments.

Hat tip to Steve Hards.

News roundup: Proteus may be no-teous, DOJ leads on Google-Fitbit, HHS’ mud fight, Leeds leading in health tech, malware miseries, comings and goings

Proteus stumbles hard, cuts back. The original ‘tattle-tale pill’ company, Proteus Digital Health, plans to lay off 292 people in the San Francisco Bay Area and to permanently close its three Redwood City and Hayward locations, starting 18 January, according to notices sent to California state and local offices, including the state employment development department. It is unclear where Proteus will be located after the closures.

This followed after Proteus failed to launch a twelfth funding round of $100 million. According to reports, they furloughed most of their employees for two weeks in November and are reorganizing. This is after a substantial number of investors have put in about $487M in funding through a Series H (Crunchbase), including a game-changing investment by Novartis dating back to 2010.  Proteus achieved unicorn status about three years ago, but its high-priced pill tracking technology with a pill sensor tracked by a skin-worn monitor reporting into a smartphone has a built-in limited market to expensive medication. Otsuka Pharmaceutical in 2017 partnered with Proteus for an FDA-cleared digital medicine system called Abilify MyCite that basically put an off-patent behavioral drug back into a more expensive tracking methodology. But Proteus remains a great idea on tracking compliance in search of a real market, and may not have much of a future. San Jose Mercury News, CNBC

But ingestible detectable pills are still being tested. On Monday, as Proteus’ bad news broke, eTectRx announced its FDA clearance of the ID-Cap System and its testing at Brigham and Women’s Hospital and Fenway Health, focusing on HIV medication when used for treatment and prevention. Release, HISTalk

Department of Justice taking the lead on scrutinizing Google’s Fitbit acquisition. The Federal Trade Commission also sought jurisdiction over the transaction. According to the New York Post, “both agencies are concerned that a Google-owned Fitbit would give the search giant an even bigger window into people’s private data, including sensitive health information, sources said. Under the Hart-Scott-Rodino Act, all large mergers must file proposals with both the DOJ and the FTC, but only one antitrust agency reviews the merger.”

Coal from stockings being thrown about at HHS. According to POLITICO and the New York Times, the disagreements between Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), and the Cabinet-level Secretary of Health and Human Services (HHS), Alex Azar, have boiled over, enough to have to be settled by the President’s acting chief of staff, Mick Mulvaney. According to the Times, both President Trump and VP Mike Pence have told them to find a way to work together. Both are administration appointees, but President Trump has not been reluctant to cut a mis-performing or overly contrary appointee loose. The latest salvo from those obviously not on Ms. Verma’s side was the revelation that she requested compensation for jewelry stolen on a business trip, contrary to government policy of course. She was compensated for other items which is standard. (Isn’t that what homeowners’ insurance is for? And what sensible person actually travels with valuable jewelry?) Under Ms. Verma, CMS has been quite progressive in developing new business models in Medicare fee-for-service, moving providers to two-sided risk, and innovating in both Medicare and Medicaid. It will either be settled, or one or both will be gone. Pass the popcorn.

Leeds picks up another health tech company. Mindwave Ventures is opening an office there, as well as appointing Dr Victoria Betton and Dr Janak Gunatilleke to the roles of chief innovation officer and chief operating officer. Mindwave develops technologies around digital products and services in healthcare and health research. Leeds reportedly is home to over 250 health tech companies and holds an annual Leeds Digital Festival in the spring [TTA 11 April].

Ransomware attack hits Hackensack Meridian. Systems were down for about a week. While this large New Jersey health system hasn’t admitted it, sources told the Asbury Park Press that it was ransomware. And if it’s not ransomware, its Emotet and Trickbot. Read ZDNet and be very apprehensive for 2020, indeed, as apparently healthcare is just one big target.

Comings and Goings: There may be some end of year bombshells, but after last week’s big news about John Halamka, it’s been fairly quiet. Paul Walker, whom this Editor knew at New York eHealth Collaborative, has joined CommonWell Health Alliance as executive director. Mr. Walker was most recently Philips Interoperability Solutions’ vice president of strategy and business development. CommonWell’s goal is improving healthcare interoperability and its services are used by more than 15,000 care provider sites nationwide. Blog release, Healthcare Innovation ….Dr. Jacqueline Shreibati, the chief medical officer for AliveCor, is joining Google Health in the health research area. Mum’s the word when it comes to Fitbit (see above). CNBC ….Peter Knight has pleaded guilty to falsifying educational credentials to gain his position as chief information and digital office at Oxford University Hospitals NHS Foundation Trust. He held that position from August 2016 until September 2018. BBC News

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