TTA’s ‘winter dog days’ 5: Change Healthcare cyberattacked, Walgreens’ VillageMD exiting FL, Cigna $3.2B buyback, Cerner-VA problems, Teladoc’s weak ’24 forecast, telemental health revives, LockBit busted, more!

 

 

A few surprises at week’s end, with what appears to be a cyberattack taking down Change Healthcare’s systems and Walgreens’ VillageMD exiting Florida. There’s life in funding and stock buybacks but Oracle Cerner’s in the same-old with the VA. Teladoc on slow recovery road, telemental health coming back, LockBit busted, Musk’s Neuralink implant, and a few thoughts on AI. 

Weekend reading: AI cybersecurity tools no panacea, reality v. illusion in healthcare AI, RPM in transitioning to hospital-at-home, Korean study on older adult health tech usage (AI obsession?)
Breaking: Walgreens’ VillageMD shutting in Florida; Change Healthcare system websites cyberattacked (updated) (Two shockers)
Mid-week roundup: Cotiviti’s $10.5B stake to KKR; Cigna buys back $3.2B shares; VA Oracle Cerner faulty med records; LockBit ransomware websites cold-busted at every level, principals indicted; Trualta partners with PointClickCare
Teladoc closes 2023 with improved $220M loss, but weak forecast for 2024 leads to stock skid (Teladoc in recovery)
Telemental news roundup: Brightside Health expands Medicaid/Medicare partners; Blackbird Health gains $17M Series A; Nema Health’s PTSD partnership with Horizon BCBSNJ (A comeback badly needed)
Neuralink BCI human implant subject moving computer mouse by thought: Elon Musk (Controversy)

A week with a lot of Facing The Music, as the snow and chill continue as we’re ready for spring, already. Four payers scuttle mergers, Walgreens and Amazon are reorganizing big time, and the losses (Amwell especially) and layoffs continue. Apple wins a round in its patent fight with AliveCor. It’s the New Reality and let’s hope we get to a Newer, Better Reality soon. Maybe it’s time to focus on designing tech that is older adult (and not so older adult) friendly–and yes, there are some ‘green shoots’.

Weekend reading: why the tech experience for older adults needs a reboot (a boot in the….?), health tech takeaways from CES (Must reads)
Mid-week news roundup: Elevance-BCBSLA, SCAN-CareOregon mergers scuttled; Amwell’s $679M loss, layoffs; Invitae genetics files Ch. 11; innovations released from DeepScribe, Essence SmartCare (DE), fall detection at Atrium Health (SC)
Further confirmation of the New Reality for digital health–lower valuations, more exits, fewer startups, tech buyers not seeing ROI (The cleanout continues)
AliveCor v. Apple latest: Federal court tosses AliveCor suit on heart rate app data monopolization (This David v. Goliath round goes to Goliath)
Facing the Music of the New Reality: Amazon Pharmacy & One Medical restructure; Walgreens shakes up health exec suites again, cashes out $992M in Cencora; new takes on NeueHealth; Cue Health, Nomad Health layoffs

AI: how much of it is hype, how much harm can it do, and call in the lawyers. Rock Health sotto voce issued its downbeat 2023 roundup, with 2024 predictions familiar to our Readers. Ireland’s HealthBeacon sold to a new healthcare player–Hamilton Beach. Cano Health faces the Chapter 11 music, veterans at VA will Mynd, and mass outsourcing to Optum.

2023 was buying time, 2024 is face the music time: Rock Health (Blood out of a Rock?)
Another icy bucket: who is liable when a healthcare AI system fails? (More AI caveats)
First healthcare IPO: BrightSpring debuted at less than projected, but holding value (Nice to see)
Mid-week short takes: Ireland’s HealthBeacon bought by Hamilton Beach (!), Ambience AI raises $70M, VA to develop VR mental health app with Mynd Immersive (VA tries out digital therapeutics)
Two Must Reads: Is AI the next hype bubble replacing crypto–and capable of great harm? (Get set to be apprehensive)
News roundup: Cano Health files Ch. 11 bankruptcy, delisted (updated), Walgreens lays off more, Allina Health outsources 2,000 RCM jobs to Optum (The inevitable for Cano and Walgreens, along with speculation)

This week pinged between overstatement and underreporting. The press around the Blair and Hague recommendations around selling NHS medical data–exaggerated. Underreported? Who was targeted in 23andMe’s 6.9M record data breach–and their future. The upward trajectory of cyberattacks confirmed, Musk gets his brain implant going, Cigna sells MA but Amazon calls it off with iRobot, and a former CMS head to helm Oracle Health.

Sell NHS medical records to fund AI, biotech? Not quite what’s in the Blair-Hague report. (They didn’t read the National Purpose report)
23andMe data breach may have targeted those of Jewish and Chinese heritage; company valuation crashes (Is there a bottom?)
Short takes: Orion digital pain therapeutic to be commercialized by Newel Health; Verma to head Oracle Health; CVS to shut 25 LA-area MinuteClinics 
2023’s global cyberattack disaster: healthcare #3 in weekly attacks, 10% of organizations ransomwared–report (Beware)
News roundup: Musk’s Neuralink implants first human BCI; Cigna’s $3.7B MA sale to HCSC; no Amazon deal for iRobot; DispatchHealth-Instacart food Rx; 5 India health tech fundings 

A newsy week…a bit of catchup on JPM which has caught up to the New Reality explored in our ’24 forecast. Humana loses on MA, Walgreens now officially labeled ‘troubled’, but Bright Health survives and rebrands. Cybersecurity beat out AI this week with HHS performance goals (more work, fewer IT people) while breached patient records doubled last year. Fundings and more this ‘n’ that.

Short takes: Humana’s big MA loss; Medicare telemental care bill back in Senate; HHS releases cybersecurity performance goals; Texas Healthcare Challenge hackathon 23-24 February (HHS asking for cybersec upgrades while IT departments are laid off)
Midweek updates: Walgreens may sell Shields Health after 2 years; Ventric Health’s home cardiac RPM; Singapore military medical corps upgrades PACES 3 EMR (Walgreens now labeled as ‘troubled’)
Peering through the cloudy crystal ball into 2024 healthcare investment and company health (2024 a funhouse mirror image of 2023?)
News roundup: Bright Health now NeueHealth; breached patient records double, RCM as vector for hacking; Amazon’s CCM marketplace; JPM reflects the new reality; fundings for Vita Health, Turquoise, CardioSignal (Settling into the new normal)
Published: NHS guidance on integrating TEC providers into urgent community response (UCR) (UK) (Less stress on ambulance services and EDs)

In the ‘dog days’ of winter, Apple gets a comeuppance in its patent fights with Masimo and disables pulse oximetry in two Watch models. AliveCor moves forward against Apple in Federal court. We sort out a lot of new product introductions, a sale of a company we thought was sold, a possible Really Big EHR Sale, General Catalyst buys a provider…and 23andMe turns the tables on their massive data breach by Blaming the Victims. 

Got a data breach? Blame the victims like 23andMe did! (This is a first)
News roundup #2: Bright.md sells remaining customers to 98point6; Netsmart EHR up for $5B possible sale; Caregility intros two new telehealth systems (Maybe a big sale coming?)
Breaking: appeals court continues ITC ban on Apple Watches with working pulse oximetry (Masimo wins a round)
News roundup: Owlet’s Dream Sock, BabySat go to market; General Catalyst’s HATco agrees to buy Summa; Cigna’s contrasting provider strategy; new ElliQ robot assistant debuts at CES (HATCo’s first step into health transformation?)
Apple removes pulse oximetry from Watches to dodge ban; AliveCor advances patent review v. Apple (two big updates!)

Reality bites as we recap the 2023 hangover at several major companies with cutbacks from the suites to the streets and C-suite changes that you may have missed.

Wrapping up many changes at Walgreens, VillageMD, CVS Health, Oracle Health (A lot of musical chairs!)

Happy 2024! Breaking out of the January gate, Apple gets stay in the Masimo patent fight and Watch sales resume. The continuing soap operas of Cano Health and Veradigm resume. Bright Health’s cash from Molina gains some breathing room, and rival Devoted scores a tidy Series E. In the UK, telecare issues rise as the digital voice switchover nears–learn more next Friday.

A timely webinar Fri 12 Jan: Protecting a lifeline – preparing for the digital voice switchover (UK) (Trying to protect vulnerable elderly and disabled)
News roundup: Cano Health gets 2nd NYSE delisting warning; Veradigm acquires Koha Health RCM, faces class-action lawsuit; Bright Health-Molina sale closes; Devoted Health’s $175M Series E (updated) (Some funding ‘light’ and Bright sees some daylight)
Breaking: ban on sale of Apple Watches 9 and Ultra 2 stayed by federal appeals court Wed 27 December (Until mid-January for now)


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

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

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

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Weekend reading: AI cybersecurity tools no panacea, reality v. illusion in healthcare AI, RPM in transitioning to hospital-at-home, Korean study on older adult health tech usage

A potpourri of current articles. Hope you don’t feel like Pepper the Robot after you read them!

AI won’t boost cybersecurity, that’s cutting corners (Cybernews)

AI tools that make cybersecurity more effective and faster in response are increasingly available. They are estimated in a Techopedia article rounding up multiple studies to be a global market of over $133 billion by 2030. IBM claims that organizations with AI cybersecurity took 100 days less to identify and contain data breaches. Yet AI can also leave organizations more vulnerable to cyberattack. Hackers and ransomwareistes have been using AI for years in phishing and vishing (phone-based social engineering) attacks–now using OpenAI. What’s vulnerable? Large language models (LLMs) used in generative AI (AI with the ability to create content) can be corrupted and fed false information [TTA 7 Feb] or create deepfake images–Google Gemini is the latest example (not in article). FTA: “We need human critical thinking to use AI to solve and prevent problems. We’re adopting AI far faster than we have the ability to understand how to adopt it properly.” Another approach is to think like a cybercriminal and use AI to better understand how criminals can break into your systems.

What is real and what is illusion with healthcare AI? (03:16 video, Healthcare IT News)

This is a preview of a HIMSS24 talk on 11 March by Dr. Jonathan Chen, assistant professor at the Stanford Center for Biomedical Informatics Research. Patient care and outcomes are dependent on discerning what is real and what is not, especially in the use of chatbots in patient notes. Generative AI can be very convincing even if it’s not accurate, and that is not what is wanted in patient care. We are at the Gartner Peak of Inflated Expectations when it comes to AI–and we’ve been there before.

RPM strategies for moving from discharge to hospital-at-home care (Healthcare IT News) 

How can the home be better treated as a fundamental care setting? Understanding this is key to transitioning patients from in-hospital acute care to hospital-at-home, which is in reality not being discharged and requires managing a significant number of complex layers. Interview with Cindy Gaines, RN, chief clinical transformation officer at Lumeon, a clinical automation company.

Tailor fit digital health tech to the elderly’s needs: study (Mobihealthnews)

This summarizes a South Korean study that compared the usage of digital devices, such as smartphone apps, health apps, and wearables, among healthy and pre-frail/frail Koreans aged 65+. Smartphone use is nearly universal in South Korea, but wearables are only lightly used. Frailer respondents used social media more than healthy ones and used more healthcare apps on their phones. From the study: “There was a notable difference in the services used by pre-frail and frail respondents compared to healthy respondents. Therefore, when developing digital devices for pre-frail and frail older adults, it is crucial to incorporate customized services that meet their unique needs, particularly those services that they frequently use.”

505 participants completed the survey, with 153 (30.3%) identified as pre-frail or frail and 352 (69.7%) as healthy. Full study in the Journal of Korean Medical Science 27 November 2023

Figuring out the future for health tech after 2022’s realignments: new SVB study

As Readers who subscribe to our Saturday Alerts (repeated on Wednesday) have seen, this Editor has dubbed this season Realignment Autumn. From the fever pitch of funding, hiring, inflated valuations, SPAC funny money, and unrealistic expectations that started in 2020 and peaked in 2021, we in the industry are now fretting that we can’t get back to 2019 or 2020. Part of the new reality is that telehealth and health tech are far beyond that point in tech integration, ease of use, and takeup by enterprises, but has entered an uncertain business period more than a bit overextended and overexpecting. Unprofitable lines and side businesses, however promising, are being dropped or sold. Talented people who helped to start them are gone. The trend toward consolidation, which started last year, is accelerating.

For a more financial and data-oriented view, Silicon Valley Bank’s latest, “The Future of Healthtech 2022”, does not disappoint. This is a far deeper dive than served up by Rock Health, StartUp Health, and (unless you are a subscriber) CB Insights. This is a US and EU (including UK) view of how investment patterns have shifted, and a look at where investment may be going next year.

So far in 2022 they have seen:

  • Lower valuations and plummeting share value of public companies
  • A shift from ‘growth at all costs’ to a clear value proposition and creation: improving health outcomes, access or affordability.
  • Investments are more modest and at earlier stages–no more blockbuster Series Ds and Es (40% decline in mega-rounds of $100 million+)
  • No IPOs so far
  • Only 18 unicorns formed this year
  • M&A still rising at the right price
  • Companies have to deliver measurable value to continue driving innovation

Through 30 September, SVB tracked investment at $23 billion. Where it’s going:

  1. Provider operations: $7.0 billion–defined as technology that improves efficiency and accuracy of provider-provider, provider-patient interactions
  2. Clinical trial enablement: $6.8 billion
  3. Alternative Care (includes telehealth and mental health): $5.6 billion
  4. Wellness and education: $1.3 billion
  5. Healthcare navigation: $1.3 billion
  6. Medication management: $833 million
  7. Insurance: $117 million

Sections drill down on these sectors and subsectors such as mental health and women’s health, including an analysis of female-founded health tech companies, investors by sector, and a historical view of unicorns. Grab a cuppa and take your time with this one!

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.

US/EU 2021 healthcare VC funding soared 65%, but health tech performance slumped 28%–and 2022 surprises

This isn’t the usual Rock Health report of puppies and unicorns. Silicon Valley Bank is a source new to this Editor, but even in topline, the report is pretty bracing. Their coverage is broad and detailed–biopharma, health tech, dx (diagnostic)/tools, and device–on US and European venture capital (VC) funding from 2019 to 2021. There are some warning flags for the health tech sector through their report (summary page; report available for free download here).

What you’d expect: total health care soared in 2021 to over $86 billion–a 65% increase over 2020 (not 30%!). This was led by biopharma at $36.3 billion, then health tech at $28.2 billion. Dx/tools and devices had far more modest funding gains. 

For health tech: 

  • Funding was up 157% versus 2020–42 new ‘unicorns’, four times 2020
  • Provider operations companies comprised a record 35% of total seed/series A funding, up from 20% in 2020. The other hot areas were clinical trial enablement and alternative care. Surprisingly, healthcare navigation was next to last, perhaps indicating that these companies are further along in maturity.
  • Investors were numerous, but high frequency investors were Tiger Global, Andreesen Horowitz, General Catalyst, Casdin, and Gaingels.
  • SPACs slowed in 2021, trying to find the right match before their two-year window to complete a merger and reflecting greater SEC scrutiny of blank checks. Of those who ‘de-SPAC’ed in 2021, Talkspace and Owlet led in market losses, 80% and 73% respectively.
  • Post-IPO performance dropped 28%, led by insurtechs Oscar, Bright Health, and Alignment Health
  • There were 122 M&A deals. The $63 million median value was down 25% from 2020. marking a shift to vertical integrations in care continuums or horizontal to capture consumer bases.

2022 The Year of M&A and Acquire-to-Hire? The end of the report sounds a cautionary note to health tech ‘bulls’. Expect “massive” consolidation. Healthy investment will continue, but the opportunities will be for companies seeking expand product offerings, expand to other markets, or acquire to hire talent (!)–the latter something quite new.

Also FierceHealthcare

Alcuris acquired by the Access Group (UK)

The Access Group and social care digital connectivity/alarm developer Alcuris announced Thursday that Alcuris has been acquired by the Access Group to be part of their Health and Social Care business. The Access Group is a diversified business management software company with products in construction, education, not-for-profit, hospitality, legal, recruitment, and visitor attraction management. Alcuris founder and head Alex Nash said that “The Alcuris team is thrilled to be joining The Access Group, whose Health and Social Care division is the leading provider to the local government, health and social care sectors in the UK. Earlier this month we announced our partnership with Medequip Assistive Technology Ltd and Wirral Council; the first local authority to deploy next generation telecare services at scale. As part of the Access family, we look forward to setting the standard in a digital care system that connects people, data and services and enables intelligent care decisions at the speed of life.” 

The connection between Alcuris and the Access Group is an interesting one, through Loughborough University Science and Enterprise Park (LUSEP). Alcuris started up there in 2017 and Access one year earlier. Mr. Nash is a Loughborough graduate who studied Product Design Engineering and started Alcuris in 2015 during his studies there, following his grandfather’s diagnosis of dementia. Access is based at LUSEP and opened a £20 million headquarters there earlier this week, though it has operations outside the UK in Australia, New Zealand, Singapore, and Malaysia. Transaction cost and management transitions were not disclosed.

We wish them both bonne chance! Access (short) release, Loughborough University news site

European Patient Experience and Innovation Congress (EPIC 2020) invites world health tech to Croatia

European Patient Experience and Innovation Congress (EPIC 2020)
19-21 March
Valamar Lacroma Hotel
Dubrovnik, Croatia

One of our Readers from Croatia is the CEO of the Bagatin Clinic in Zagreb. In cooperation with the Cleveland Clinic, they are organizing this first-ever pan-European conference focusing on health tech and how it will impact the patient experience. This Editor has previously noted the growth of medical and healthcare tech in Central and Eastern Europe in places like Hungary and Estonia–and now, Croatia.

Ognjen Bagatin was kind enough to write me before the holidays and has since filled in some of the highlights.

  • Centered on the patient experience, it will explore the relationships among healthcare delivery, technology, private enterprise and the human beings who need and want these services.
  • Encompassing the scientific, clinical, behavioral and social perspectives, ranging from the futuristic, highly theoretical to current, best-in-class practice.
  • A high-energy, stimulating event for everyone, from c-suite executives, to clinical practitioners, clinic owners, scientists, and investors, EPIC will bring together some of the most influential physicians, med-tech startups and health professionals from Europe and beyond to the table to improve how your patients will experience healthcare in the near future.
  • As technology continues to help us achieve previously unattainable results in healthcare, the conference will bring an insiders’ look at which technologies, ideas, and innovations are improving the patient experience 
  • And, of course, there’s Dubrovnik
  • Speaker list here

Early registration closes on 19 January. More information here.

News roundup: The state of Finland’s health tech, American Well-Cisco team for TV consults, Tech for Quality Care in Manchester 9 July

Finland shows its sisu in health tech startups. It’s a country you wouldn’t think of readily as hospitable to startups, but they’ve leveraged their tech skills (think the pivots that Nokia has accomplished) to create patient outcome and remote patient monitoring companies that are making an impact in Europe. Some which are making an impact are Meru, Kaiku, and Navigil. Venture capital is ‘thinnish’ which leads to companies seeking seed and development funding from government sources and later on, foreign investors. Mobihealthnews is profiling these companies in conjunction with Business Finland, a government entity. HIMSS and Health 2.0 also had their European conference in Helsinki, and this article discusses how their national health service, Kanta Services, leverages digital health in e-prescribing, they have a national database called the Patient Data Repository that collect patient data records to make them accessible to providers and patients, and the My Kanta patient portal.

Back to the 1990s? Tech device maker Cisco is teaming up with American Well to convert TVs to a video portal via a set-top unit. This is targeted to older adults and those with multiple chronic conditions who may not be comfortable with laptops, tablets, or smartphones, but wouldn’t mind using their TV to connect to a doctor. How it work seems to require a ‘smart TV’–the patient would activate the device on the TV, connect it to Wi-Fi, and initiate the video consult with the doctor and caregiver. No information on timing, markets, or pricing at this time. CNBCWhy does this sound like a klutzy non-starter to this Editor, who went through the fad of interactive TV in the Mad ’90s? It seems to need more than just consults.  Mobihealthnews notes that Quil Health, a Comcast-Independence Blue Cross joint venture, is targeting pre- and post-care support through the TV. Comcast is also rumored to be working on an Alexa-like ambient sensor based device to monitor basic vital signs and fall detection.

Using Technology for Quality Care on 9 July is a free half-day conference/workshop at Kings House Conference Centre, Manchester. It is the first of a series of regional workshops in the North West region to learn from local areas where councils, care providers, and suppliers work together using technology to support care. More information is on this PDF and on the Local Government Association website. Hat tip to Reader Adrian Scaife who just recently joined Alcuris Ltd. as Business Development Manager.

Highlights of The King’s Fund Digital Health and Care Congress 2018

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/06/kf-digital-health-2018-300×145.jpg” thumb_width=”150″ /]As The King’s Fund itself pointed to these two Digital Health articles, this Editor (who did not attend) will summarize their findings on the two days. Surely more to come!

Day One: digital transformation was not just about patient and clinician tools, but also about culture and partnerships

  • The King’s Fund’s researchers presented findings from their recently released report, ‘Digital change in health and social care’ where local organizations can speed change faster than nationally (more detail here)
    • Tight collaboration is necessary to bring change, not only within organizations, but also with providers and suppliers
    • The culture gap is significant between technology and clinical and must be overcome
    • Technology may be the only way “by which the NHS would be able to face “long-term pressures” facing the healthcare system”
  • What are lessons learned from national and regional NHS digital transformation projects?
    • How do you bring data together on a large scale?
    • Primary care practice is the obvious place to engage people with technology
  • No ‘post code lottery’–All patients should have access to digital services (the standard criticism of Babylon Health)

Day Two: build the technology around the patient

  • Put the patient first–some technology does not
  • The paramount importance of safeguarding the patient
  • Patients should be involved continuously with technology–and patients inspire technology

TTA is a media partner of The King’s Fund digital health conferences and was pleased to be a supporter this year.

Soapbox: JPM’s Dimon takes the 50,000 foot view on the JP Morgan Chase-Berkshire Hathaway-Amazon health joint venture

Mr. Jamie Dimon, the chairman and CEO of JP Morgan Chase, had a few thoughts about the JPM-Berkshire Hathaway-Amazon healthcare JV for all three companies. You’ll have to fill up the tea or coffee mug (make it a small pot) for it’s an exceedingly prolix Annual Shareholder Letter you’ll have to sled through to find those comments. Your Editor has taken her punishment to find them, towards the end of the letter in ‘Public Policy’. 

They demonstrate what this Editor suspected–an headache-inducing mix of generalities and overreach, versus starting modestly and over-delivering.

  • Point #1 sets up what has gone wrong. Among several, “Our nation’s healthcare costs are twice the amount per person compared with most developed nations.” Under point 2 on how poor public policy happened, an admission that Obamacare fixed little:

Here’s another example: We all know that the U.S. healthcare system needs to be reformed. Many have advocated getting on the path to universal healthcare for all Americans. The creation of Obamacare, while a step in the right moral direction, was not well done. America has 290 million people who have insurance — 180 million through private enterprise and 110 million through Medicare and Medicaid. Obamacare slightly expanded both and created exchanges that insure 10 million people. But it did very little to fix our broken healthcare system and has, in fact, torn up the body politic over 10 years — and this tumult may go on for another 10 years.

  • Point #7 is about fixing the deficit and the ill effects if we don’t. In Mr. Dimon’s view, healthcare is a major part of this through the uncontrolled growth of entitlements, with Medicare, Medicaid and Social Security leading the pack–skipping over the fact that nearly all Americans pay into Medicare and SSI well in advance of any entitlement collection. Healthcare is also an offender through unnecessary costs such as administrative and fraud (25-40 percent),  and six mainly chronic conditions accounting for 75 percent of spending.
  • The experts–specifically, their experts–will fix it! “While we don’t know the exact fix to this problem, we do know the process that will help us fix it. We need to form a bipartisan group of experts whose direct charge is to fix our healthcare system. I am convinced that this can be done, and if done properly, it will actually improve the outcomes and satisfaction of all American citizens.”
  • The generalities continue with
    • The JV “will help improve the satisfaction of our healthcare services for our employees (that could be in terms of costs and outcomes) and possibly help inform public policy for the country.” 
    • Aligning incentives systemwide ‘because we’re getting what we incentivize’
    • “Studying the extraordinary amount of money spent on waste, administration and fraud costs.”
    • “Empowering employees to make better choices and have the best options available by owning their own healthcare data with access to excellent telemedicine options, where more consumer-driven health initiatives can help.”
    • “Developing better wellness programs, particularly around obesity and smoking — they account for approximately 25% of chronic diseases (e.g., cancer, stroke, heart disease and depression).”
    • “Determining why costly and specialized medicine and pharmaceuticals are frequently over- and under-utilized.”
    • “Examining the extraordinary amount of money spent on end-of-life care, often unwanted.”
    • “To attack these issues, we will be using top management, big data, virtual technology, better customer engagement and the improved creation of customer choice (high deductibles have barely worked”).

This Editor has observed from the vantage of the health tech, analytics, payer, and care model businesses that nearly every company has addressed or is addressing all these concerns. So what’s new here? Perhaps the scale, but will they tap into the knowledge base those businesses represent or reinvent the wheel? 

A bad sign is Mr. Dimon’s inclusion of ‘end of life care’. This last point is a prime example of overreach–how many of the JV’s employees are in this situation? The ‘attack’ tactics? We’ve seen, heard, and many of us have been part of similar efforts.

Prediction: This JV may be stuck at the 50,000 foot view. It will take a long time, if ever, to descend and produce the concrete, broadly applicable results that it eagerly promises to its million-plus employees, much less the polity. 

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Our Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]Love that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

Japan’s workarounds for adult care shortage: robots, exoskeletons, sensors

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/10/robear.jpg” thumb_width=”150″ /]The problem of Japan’s aging population–the oldest worldwide with 32 percent aged 60+ (2013, RFE)–and shortage of care workers has led to a variety of ‘digital health solutions’ in the past few years, some of them smart, many of them gimmicky, expensive, or non-translatable to other cultures. There have been the comfort robot semi-toys (the PARO seal, the Chapit mouse), the humanoid exercise-leading robots (Palro), and IoT gizmos. Smarter are the functional robots which can transfer a patient to/from bed and wheelchair disguised as cuddly bears (Robear, developed by Riken and Sumitomo Riko) and Panasonic’s exoskeletons for lifting assistance.

Japan’s problem: how to support more older adults in homes with increasingly less care staff, and how to pay for it. The Financial Times quotes Japan government statistics that by 2025 there will be 2.5m skilled care workers but 380,000 more are needed. The working age population is shrinking by 1 percent per year and immigration to Japan is near-nonexistent. Japan is looking to technology to do more with fewer people, for instance transferring social contact or hard, dirty work to robots. The very real challenge is to produce and support the devices at a reasonable price for both domestic use and–where the real money is–export. 

The Abe government in 2012 budgeted ¥2.39bn ($21m) for development of nursing care robots, with the Ministry for Economy, Trade and Industry tasked to find and subsidize 24 companies–not a lot of money and parceled out thinly. Five years later, the Ministry of Health, Labour and Welfare determined that “deeper work is needed on machinery and software that can either replace human care workers or increase staff efficiency.” Even Panasonic concurred that robots cannot offset the loss of human carers on quality of services. At this point. Japan leads in robots under development with SoftBank’s Pepper and NAO, with Toshiba’s ChihiraAiko ‘geisha robot’ (Guardian) debuting at CES 2015 and Toyota’s ongoing work with their Human Support Robot (HSR)–a moving article on its use with US Army CWO Romy Camargo is here. (attribution correction and addition–Ed.)

The next generation of care aids by now has moved away from comfort pets to sensors and software that anticipate care needs. Projects under development include self-driving toilets (sic) that move to the patient; mattress sensor-supplied AI which can sense toileting needs (DFree) and other bed activity; improved ‘communication robots’ which understand and deploy stored knowledge. Japan’s businesses also realize the huge potential of the $16 trillion China market–if China doesn’t get there first–and other Asian countries such as Thailand, a favored retirement spot for well-off Japanese. In Japanese discussions, ‘aging in place’ seems to be absent as an alternative, perhaps due to small families.

But Japan must move quickly, more so than the leisurely pace so far. Already Thailand is pioneering smart cities with Intel and Dell [TTA 16 Aug 16] and remote patient monitoring with Western companies such as Philips [TTA 30 Aug]. There’s the US and Western Europe, but incumbents are plentiful and the bumpy health tech ride tends not to suit Japanese companies’ deliberate style. Can they seize the day?  Financial Times (PDF here if paywalled) Hat tip to reader Susanne Woodman of BRE (Photo: Robear) 

Connected Health Conference 25-27 October, Boston–save $100! (updated)

Connected Health Conference, 25-27 October, Seaport World Trade Center, Boston Massachusetts

The eighth annual Connected Health Conference, is now presented by the Personal Connected Health Alliance (PCHAlliance) in partnership with Partners Connected Health, with a combined and rebooted annual meeting in Boston. The largest global conference in connected health has surfed many changes from the time it was started as the mHealth Summit (and Telecare Aware was one of the first media sponsors) in Washington, DC. This year’s theme, The Connected Life Journey: Shaping Health and Wellness for Every Generation, is centered around the future of technology-enabled health, wellness and what innovation means for over 2,000 providers, researchers, healthcare executives, and developers. CHC17’s location is now in Boston’s Innovation District versus a fairly remote part of Foggy Bottom–and early fall! (For more on CHC’s evolution, see here.)

Wednesday the 25th has a full day of pre-conference specialized sessions here, such as the Society for Participatory Medicine and Parks Associates‘ workshop, with the full conference and open exhibit hall on Thursday and Friday. Continua has a running Plugfest for those involved with Continua standards on Thursday and Friday. Also on those days is CHC’s own Health Tech StandOut! Competition featuring a group of ten finalists, free for conference registrants and the Connected Health Innovation Challenge (CHIC) (information here).

For the main website and for registration, click on the ad in the sidebar. TTA Readers save $100 on registration–use code CHC17TELE100. TTA is a media sponsor of CHC17. For updates, see on Twitter #Connect2Health and @PCHAlliance

Update: The PCHAlliance published today a research paper, Personal Connected Health: The State of the Evidence and a Call to Action. This is a meta-study of 53 studies and trials for setting an initial baseline for evidence in personal connected health. The key findings on the current state will come as no surprise–that better studies are needed that show evidence in clinical trials and real-world use. Release, study (download links)

September Health 2.0 NYC/MedStartr events–hurry!

If you are located in the NYC metro area, two Health 2.0 NYC/MedStartr meetings are coming up very soon!

Endless Summer Social–Friday 22 September, 6 pm, Spark Labs, 25 W. 39th Street, 14th Floor

Grab your surfboard and celebrate the end of summer next week at the MedStartr Labs Beta site embedded within Spark Labs’ new Bryant Park co-working space in midtown. Organizer Alex Fair promises good food, a great selection of beer and wine (courtesy of MedAux), a few presentations and awards, plenty of participation from members of the NYC health tech community, and tours of the new MedStartr beta site. Register at the Meetup site here.

Mental Health Innovations Summit–Thursday 28 September, 6-9pm, CohnReznick LLP, 1301 6th Avenue

One in every five adults in America experiences some form of a mental illness. Nearly one in 20, or 13.6 million, adults in America live with a serious mental illness. We aren’t replacing retiring psychiatrists. Mental health resources are maldistributed across the country. These problems call for new approaches. Panelists and presenters include leaders in the field and six early-stage companies presenting. Register at the Meetup site here.

TTA has been a MedStartr and Health 2.0 NYC supporter/media sponsor since 2010; Editor Donna is active as co-organizer/host and a MedStartr Mentor. 

Tender Alert: Scotland CAN DO Challenge, Bootle needs assistive tech

This Editor thought it would be quiet for the rest of the month, but our Eye on Tenders, Susanne Woodman, has alerted us to two freshly posted–and the first is major:

  • Scotland: The tender for the CAN DO Innovation Challenge Fund – Health & Social Care Challenges is so large it is in 10 lots which offer an initial market test, an evaluation by the fund, then a decision made on whether to pursue the potential project further with the public body. There are eight that directly involve healthcare technology:
    • Point of care lab testing
    • Adopting technology for care in the north of Scotland
    • Transforming nursing care processes for the 21st century
    • Creating and driving a clinically and cost effective pathway to improve recovery after critical illness enabled by data from hospital information systems
    • An IT system for care workers and patients for adherence to stroke management plans to enable real time monitoring
    • Transforming management of people with severe COPD to improve patient outcomes and quality of life and reduce healthcare costs
    • Glasgow TECS development to support care and digital cutover
    • Develop and integrate digital services that allow for consent-driven data sharing from patient records

There is no deadline listed. More information and required document links here on Public Contracts Scotland

  • Bootle (Merseyside) and Sovini Ltd are seeking assistive technology for about 1,000 residents of its local One Vision Housing with retirement and dispersed housing. Estimated value £180,000 over 24 months. Deadline is 18 Sept at noon. More information at Delta e-Sourcing and Tenders Electronic Daily.

First aging services tech investment fund debuts in Israel

Mediterranean Towers Ventures of Ganei Tikva, east of Tel Aviv, has launched an investment fund dedicated to supporting technologies that support quality of life–health, culture, and leisure–for older adults.  Co-CEO Dov Sugarman, via email to this Editor, confirmed that the venture fund is limiting itself for the time being to Israel-based companies in pre-seed and seed stages, although some later stage investments may be considered. They are “open to all opportunities in the aging tech space”. Interested companies should review their website and apply for funding here.

While Israel is statistically a young country, with only 11 percent or 900,000 aged 65 and over, this number is expected to increase to 1.3 million by 2025. At present, 25 percent of households have a member over 65, and because of this distribution, there is a substantial support network of supportive and adult housing. The venture fund grew out of Mediterranean Towers’ main business as a leading publicly traded provider of retirement housing. 

The venture capital group is headed by Dr. Yael Benvenisti, who is the chair of the SIG Technologies of Aging Well (Society of Electrical and Electronic Engineers in Israel), a member of the board of the Israel Association of Gerontology and an advisor to government bodies. Mr. Sugarman is the CEO of Aging2.0 Israel and founder of the third-generation technologies sector at JDC-Israel. (‘3rd generation’, ‘3rd tech’, and ‘third age’ are common expressions for aging and related tech in Israel.) ReleaseThe Marker (in Hebrew)