Funding roundup, 16 Feb: virtual mental health gains two (more) unicorns, Zocdoc’s fresh $150M, Owlet’s $325M SPAC

Virtual behavioral health continues its hot run with two companies’ funding launching them into Unicorn Stratosphere valuations. The latest is San Francisco-based Modern Health which closed a $74 million Series D investment round, led by Founders Fund with participation from Lachy Groom. Total funding now exceeds $167 million over the past two years. The company claims a valuation of $1.17 bn plus status as the fastest entirely women-founded company in the US to hit the magic unicorn mark. Modern Health provides for about 220 mid-sized companies an app platform combining therapy, coaching, and self-guided courses in 35 languages. On 1 February, Modern Health acquired Kip, another mental health platform that was also woman-founded, for an undisclosed amount.

In January, corporate mental health provider, Lyra Health, gained a Series E of $187 million, bringing its valuation to $2 bn. Lyra claims 2 million members in large companies like Pillsbury, Uber, and Morgan Stanley. Talkspace, a direct-to-consumer digital therapy provider, went public earlier in January via a $1.4 bn SPAC. [TTA 29 Jan] According to Crunchbase News, among mental health startups, 141 were venture-backed within five years to the tune of $1.3 bn in investment. The pandemic and ‘lockdown loneliness’, as we’ve noted, kicked digital health and mental health funding into overdrive. FierceHealthcare, Crunchbase 

Patient appointment setter Zocdoc also gathered $150 million in fresh funding–what’s termed growth financing from Francisco Partners, bringing their total financing to $376 million in 10 rounds. Zocdoc has changed its model in the past two years from a subscription basis–priced per provider–to a per-booking charge. They also added virtual visits. Zocdoc now claims to be profitable and has grown its network by 50 percent in some states. It was one of the early healthcare unicorns, controversial in its business practices as far back as 2016, with customer churn, low margins, and high customer acquisition costs leading to unprofitability [TTA 11 May 2016, 21 Jan 2019], plus a former CEO suing about his ouster after eight years. HISTalk, Zocdoc release

Owlet socks it to a Q2 SPAC. Baby monitoring system Owlet Baby Care becomes a unicorn of just over $1 bn through a SPAC (special purpose acquisition company) merger with Sandbridge Acquisition Corporation, backed by Sandbridge Capital and PIMCO private funds. It will trade on the NYSE (OWLT) and close in Q2. Anticipated value is as much as $325 million through cash ($230 million) and concurrent private placement (PIPE) of common stock ($130 million). Owlet started in 2013 with a ‘Smart Sock’ (left) using pulse oximetry to monitor baby heart rate, oxygen levels, and sleep patterns with readouts via their app, but has expanded to include an Owlet Cam. Owlet stated 50 percent revenue growth in 2020 after approximately $50 million in net revenue for 2019. Amazingly, Owlet in seven years raised a modest $48 million through 27 investors concluding with a two-year Series B. Awwww-worthy indeed. Release, Mobihealthnews

Telehealth claims rose 3,060 percent to October, settling in to over 5 percent of all claims–led by mental health (US)

Utilization statistics confirm telehealth’s staggering rise and stabilization. US private insurance telehealth claims data, collected by non-profit FAIR Health in the year October 2019 to October 2020, rose from 0.18 percent of medical claim lines in October 2019 to 5.61 percent in October 2020, a 3,060 percent increase. While the percentages may be low, this tracks with the rise and fall of telehealth visits from February tracked by the last Commonwealth Fund/Phreesia/Harvard University study in October to about 6 percent of medical visits [TTA 29 Oct 20] as well as Epic’s tracking into September [TTA 2 Sept].

According to FAIR’s claim data, telehealth utilization peaked in April at 13 percent, falling in May to 8.69 percent, 6.85 percent in June, and 6 percent in August. This followed the trends reported by both Commonwealth Fund and Epic.

Telehealth visits ticked up September to October, tracking with the rise of positive COVID diagnoses. Telehealth share of medical claim lines rose 10.6 percent nationally, from 5.07 percent in September 2020 to 5.61 percent in October 2020

In every month, mental health led the top five diagnoses in the 30-50 percent range, cresting above 51 percent in October. This points to a greater acceptance of telehealth treatment in this specialty, which is positive, but also the distressing rise in CoronaDepression which TTA has been tracking in both the US and UK [TTA 18 Dec 20]

‘Exposure to communicable diseases’ were, up to September, not consistently among the top five reasons for telehealth visits. They re-emerged on the list in October. In other months as well as October, ‘respiratory diseases and infections’ may have been where active COVID was categorized. Other telehealth conditions were ‘joint/soft tissue diseases’ and ‘developmental disorders’. CPT/HCPCS codes are also listed for reference.

To view FAIR Health’s monthly national and regional analyses, go to their Monthly Telehealth Regional Tracker. Release.

News roundup: Milken Institute’s telehealth brief with ATA push on Congress, GoodRx confirms 62% are CoronaDepressed, Johns Hopkins’ COVID mortality risk study and calculators

The hot US health tech issue is retaining, consolidating, and adding to the gains that telehealth and remote patient monitoring (RPM) made during the pandemic. The influential Milken Institute (formally the Milken Institute Center for the Future of Aging, Center for Public Health, and FasterCures) has published a short white paper on how best to increase access to telehealth services and support innovation as part of that aim. Their five core recommendations are: 

  1. Permanently lift Medicare location restrictions on telehealth to ensure that older adults can receive a variety of services in their homes and communities, regardless of where they live. (This was also recommended by the Taskforce on Telehealth Policy (TTP) [TTA 18 Sep] which was jointly formed by the ATA, NCQA, and the Alliance for Connected Care.)
  2. Meet the growing need for behavioral health care by addressing barriers to remote care and expanding the availability of telebehavioral  health services.
  3. Increase equitable access to telehealth services through digital technology, literacy programs, and broadband coverage.
  4. Support development and implementation of innovative telehealth and mobile health technology for prevention, well-being, clinical care, and research.
  5. Develop and document clear data sharing standards to support transitions of care across acute, post-acute, and long-term care settings, including care provided in the home and in residential care facilities. 

The consensus is that CMS’ 2021 Physician Fee Schedule post-pandemic (public health emergency=PHE) does not do nearly enough in that it returns–of legal necessity–to the status quo ante geographic restrictions, though it devised a temporary Category 3 to store over 50 telehealth billing codes [TTA 3 Dec]. The American Telemedicine Association (ATA) was joined by multiple organizations on Monday in pressing Congressional leaders to extend national telehealth ‘flexibilities’ as part of the $1.4 trillion omnibus spending deal that is needed to avoid a government shutdown on Friday (yes, this Friday) at midnight. The organizations joining the ATA on the letter to Congress are the Alliance for Connected Care, College of Healthcare Information Management Executives, Connected Health Initiative, eHealth Initiative, Health Innovation Alliance, HIMSS, and PCHAlliance. ATA release.

We are shocked, shocked that CoronaDepression worsens in those already suffering. Prescription discounter GoodRx analyzed prescription fill trends for anxiety and depression meds and found that they reached an all-time high in 2020–9.5 percent higher than the previous high in 2016. It peaked in April as the pandemic was underway, and possibly reflected some stockpiling.

Of their sample of 1,042 individuals diagnosed with anxiety and depression prior to the pandemic:

  • 22 percent responded that their symptoms were “much worse”
  • 40 percent said they were “worse”
  • 28 percent stated that symptoms were the “same”
  • a surprising 10 percent said symptoms were “better” or “much better” 

One of the main factors in that 62 percent reporting worse/much worse was the length of quarantine. “Those who reported quarantining due to COVID-19 were far more likely to report “worse” or “much worse” symptoms compared to those who did not quarantine. Over 70% of those who reported quarantining for more than one week said their depression and/or anxiety symptoms were “worse” or “much worse.” Loss of job and income, plus COVID-related events affecting friends and family, were also key in worsening symptoms. Many also had difficulty reaching their doctors/therapists and renewing medication. The study was conducted 1-10 November. GoodRx study

More depressing news (sic) of mental health challenges to older adults in the Isolation Age: The Future of Remote Care Technology, Lockdown Loneliness feared more than COVID, and the PLOS One study.

But cheer up and carry on, your COVID mortality risk may not be as bad as you think. A team of researchers at the Johns Hopkins Bloomberg School of Public Health created a COVID mortality risk calculator, based on algorithms calculating factors such as age, gender, sociodemographic factors, location, and a variety of different health conditions. Risk scores are grouped into five categories from lower than average/close to average to high.  While primarily for public health authorities to prioritize populations for vaccination, uninfected individuals can use it to determine their personal risk of future infection and complications after infection. It’s easy to use and your results may surprise you. There is also an interactive US map of the risk level of major cities, counties, and states. The study is published in a paper that appears in the journal Nature Medicine.  Johns Hopkins release, risk calculator

Lockdown Loneliness feared more than COVID-19 by nearly 1 in 6 over-65 Britons: study

Even with Margaret Keenan, 91, being the first person outside of the Pfizer clinical trial to receive a COVID-19 jab (that’s a vaccination to us Yanks) at Coventry Hospital on V-day 8 December, the Lockdown Blues will continue to play for the foreseeable future, right through the holidays and festive season. Last month this Editor noted a multi-country PLOS One study that pegged UK self-reported loneliness at 27 percent in the survey (March-April) period. 49 to 70 percent of respondents reported feeling isolated. Overall, “Being younger, female, having lower socioeconomic status, a pre-existing mental health condition, and living alone increased the odds of being lonely.” The survey was conducted via social media, so many of the findings detailed the effects among a younger group of adults.

28 percent of older Britons also believe that lockdown and enforced isolation have affected their mental health. A new study from SECOM CareTech that concentrated on older adults confirms even more depressing (sic) mental health findings in the older age group. Of their survey group of 500 people in the UK aged 65 and over (infographic at left):

  • Nearly 1 in 6 were more afraid of loneliness than COVID-19–and this is a group at high risk, with over 50 percent with one or multiple chronic conditions. A sample verbatim quoted: “I get depressed being in the house all the time, but I am too frightened to take the risk of going out even for a walk.”
  • Over half are worried about spending Christmas without their family. Another verbatim: “I seem to have nothing to look forward to now and the prospect of Christmas looks grim.”
  • 28 percent confirmed that COVID-19 had affected their mental health–of those, more than a quarter indicated that loneliness or not being able to see their family was a contributing factor.
  • 39 percent also reported that they had trouble sleeping. Verbatim: “I’ve had sleepless nights since the Covid-19 pandemic & lockdown… I’m constantly worried with the whole situation.”

What to do? Neil Fitzwalter, the care technology manager at SECOM CareTech, said, “More needs to be done to help those in long-term lockdown. That’s why we will be calling each of our CareTech customers on Christmas Day to wish them a Merry Christmas and make sure they’re okay.” Those on the monitoring teams will also be ‘signposting’ customers in the event they are experiencing a mental health crisis.

 

Drug discounter GoodRx plans US IPO; Ginger mental health coaching raises $50 million

The bubble bath got soapier with more IPOs and big raises on tap. 

GoodRx, the relentlessly advertised prescription discount scheme with spokespeople Martin Sheen and son Charlie, has filed initial paperwork with the US Securities and Exchange Commission (SEC) for a potential initial public offering (IPO). This has been in the rumor mill for a while. Timing would be about 4th Quarter or early in 2021, according to Reuters.

It may at least a partial exit for Sand Road PE giant Silver Lake Partners, which took a one-third interest in GoodRx in August 2018, creating an estimated value at $2.8bn. CNBC  Both their growth since then and key hires have indicated preparation for going public. According to MedCityNews, their revenue is up by 55 percent since 2018 and they now employ 350 people. As mentioned above, they advertise heavily on TV with celebrity endorsers. In June, two IPO-experienced executives joined the company (release): new president Bansi Nagji, McKesson’s former chief strategy officer who was on Change Healthcare’s board during its IPO; and CFO Karsten Voermann from acquisition company Mercer Advisors and who led Mercury Payment Systems through its 2014 IPO.

Ginger, formally known as Ginger.io, raised $50 million in Series D funding. Lead investors are Advance Venture Partners and Bessemer Venture Partners, with participation from Cigna Ventures, Kaiser Permanente Ventures, and LinkedIn Executive Chairman Jeff Weiner. Ginger provides on-demand mental health coaching as part of employee benefits within the US. Their release claims 200 companies, health plans Optum Behavioral Health, Anthem California, and Aetna Resources for Living, and tripled revenue in the past year. According to Crunchbase, this is their ninth funding round with a raise total of $120 million. Mobihealthnews

Digital Mental Health for Adults – a one day conference at the RSM on 23 September 2019 in London

The next event run by the Royal Society of Medicine’s Digital Health Council, on 23rd September, focuses on digital mental health for people over 18. There are two main sides in the high level discussion around this topic. There is an increasingly active (and commercially burgeoning) group of companies and individuals who believe that there are a digital tools that can help to screen, manage and in some cases treat people with mental health issues (or who suspect they may have one). Some of these are simply ways of digitally enabling remote conversations between mental health care providers and those that require advice or care. Some are AI driven tools that to some degree replace the human element of care and support. The event will discuss whether this not only addresses workforce issues but also delivers clinical efficacy.

On the other hand, many believe that the use of digital technologies can adversely affect the mental health of people who use them, often to excess. Do the potential benefits outweigh these negative factors, or is a digital detox something that your GP may soon be prescribing?

Come along and get involved! Booking is here – tickets start at £20 (RSM student rate) for the day including a delightful lunch.

VA’s REACH Vet uses algorithms and AI to predict critical mental health needs–including suicide risk

The Department of Veterans Affairs (VA) has been using artificial intelligence and patient data as part of a suicide prevention program for veterans–a top clinical priority for VA. The REACH Vet program, started in 2017, uses predictive algorithms to identify risk factors for suicide in millions of veteran patient records for medications, treatment, traumatic events, overall health, and other information. It then uses the information to determine the top 0.1 percent of veterans at any facility at the highest risk for suicide in the next year. Clinicians then call these veterans for about an hour’s conversation, offering to help them create a mental health care plan.

In its first year (2007-8), the program reached more than 30,000 veterans and identified about 6,700 active VA users a month. According to the short article on findings published by the Suicide Prevention Resource Center in 2018, “veterans who engaged with REACH Vet were less likely to be admitted to an inpatient mental health unit, and more likely to attend mental health and primary care appointments compared to those not in the program. REACH Vet infrastructure includes a coordinator at every VA facility and a national team of clinicians who provide overall program support.”

There are pros and cons to this proactive approach–the pros being a reduction in veteran suicides and evidence of higher suicide risk in the three-to-six months of starting–and ending–an opioid prescription; and the cons being that some of the algorithms may be inaccurate–a veteran could be inaccurately ‘dinged’ for risk or a traumatic involuntary hospitalization. VA is still refining its algorithms in areas such as changes in medication dosage (including opioids) and clinical notes for mention of negative personal issues. POLITICO Health Care

Proposed rule issued for ‘VA Anywhere to Anywhere’ telehealth cross-state care

The Department of Veterans Affairs ‘Anywhere to Anywhere’ program, which would enable VA doctors to treat VA patients across state lines via telehealth and telemedicine, yesterday (2 October) published in the Federal Register the required Federal proposed rule. There is a mandated 30-day comment period (to 1 Nov). In the Federal government, these rules move faster than any legislation. From the rule: “VA has developed a telehealth program as a modern, beneficiary- and family-centered health care delivery model that leverages information and telecommunication technologies to connect beneficiaries with health care providers, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located at the time the health care is provided.” PDF of rule.

VA Home Telehealth has both doctor-to-patient telemedicine and vital signs remote monitoring components. While VA is fully able to waive state licensing requirements if both the physician and the patient are in a VA clinic, because of state telemedicine laws they have not been able to provide the same care for veterans at home. VA also has a care distribution problem, with many veterans living in rural areas, at great distances from VA facilities, or with limited mobility. What this will enable is VA hiring in metro areas primary care and specialist doctors to cover veterans in rural or underserved areas and the expansion of mental health care. It also will facilitate the rollout of the VA Video Connect app for smartphones and video-equipped computers now in use by over 300 VA providers [TTA 9 Aug].

The VETS Act (Veterans E-Health and Telemedicine Support Act of 2017, S. 925) would permanently legislate this, but in the US system this type of Federal rule, in this circumstance, moves faster.  Fierce Healthcare, Healthcare Finance, mHealth Intelligence 

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. 

HRSA sets $16 million fund for 4 rural telehealth grant programs (US)

The Health Resources and Services Administration (HRSA), which is part of the Federal Health and Human Services (HHS) department, is making four grant programs available to support rural telehealth and quality improvement in 60 rural communities within 32 states, including a joint program with the Veterans Affairs Office of Rural Health. The four programs administered by the Federal Office of Rural Health Policy (FORHP) within HRSA are primarily three-year programs and include:

  • The largest amount, $6.3 million, will go to the Telehealth Network Grant Program: $300,000 each annually in a three-year program to 21 community health organizations for telehealth programs and networks in medically underserved areas, with a concentration on child health
  • The Flex Rural Veterans Health Access Program: $300,000 each annually in a three-year program to three organizations providing veteran mental health and other health services. This is a joint program with the VA totalling $900,000.
  • Small Health Care Provider Quality Improvement: $21 million will support 21 organizations over three years in improving care quality for populations with high rates of chronic conditions, and to support rural primary care.
  • Seven Rural Health Research Centers: $700,000 per year for four years, totalling $4.9 million, to support policy research on improving access to healthcare and population health in rural communities. (Funds that more usefully would have gone to veterans health?–Ed. Donna)

HHS releaseMobihealthnews, Healthcare IT News

Paper beats the EHR rock when it’s about accuracy: JAMIA study

A study published in the Journal of the American Medical Informatics Association (JAMIA) may be one swallow and not the spring, but points to something doctors have been reporting anecdotally for years. Researchers examined initial progress notes of patients admitted to Beaumont Hospital in Royal Oak, Michigan both before and after the Epic Systems EHR implementation (POLITICO Morning eHealth) in 2012. Their sample of 500 notes examined five specific diagnoses with invariable physical findings: permanent atrial fibrillation, aortic stenosis, intubation, lower limb amputation and cerebrovascular accident with hemiparesis. The error rate of EHRs compared to the paper charts was 24.4 percent versus 4.4 percent. Residents were better at EHR-ing than the more experienced attending physicians for inaccuracies (5.3 percent v. 17.3 percent) and omissions (16.8 percent v. 33.9 percent). As this is an older snapshot, it may have narrowed with familiarity and training, but this is in line with prior reporting in multiple countries (here) that customization by real clinicians needs to be part of the implementation (designed by IT people without clinical background), often design doesn’t meet clinical needs, many have glitches and that they take entirely too long to fill out, notoriously in mental health (see JAMIA study from April). And let’s not get into the plagues of hacking, ransomware and health data exchange. HealthcareITNews, JAMIA (abstract only)

Sonde Health using voice as a biomarker for diagnosis

Back in 2013, we profiled Max Little of the UK-based Parkinson’s Voice Initiative, who was in the fairly early stages of voice testing and analysis to aid early diagnosis of this disease. By 2015, he had over 17,000 voice samples, was partnering with the Michael J Fox Foundation, and was seeking to develop a non-invasive, quick, accurate test based on acoustic markers. Dr Little is an Oxford University PhD, currently a Wellcome Trust/MIT fellow at the MIT Media Lab. The Voice Initiative has additional support from PatientsLikeMe, Twilio and Aculabcloud.  But also developed at MIT, by Thomas Quatieri’s team at MIT’s Lincoln Laboratory, is a broader platform for voice diagnosis. This has been applied to mental health conditions such as depression, respiratory and cardiovascular conditions, and in pilots for TBI, cognitive impairment and…Parkinson’s. This has been licensed to Sonde Health, which hasn’t much on their website but is out of the Boston-based PureTech R&D/venture firm. The acoustic markers they cite are ‘dynamic changes in pitch and harmonics, articulation timing and hoarseness or breathiness that indicate and requires no analysis of words’. MedCityNews, MedTechBoston

Two events of interest, especially to digital health entrepreneurs

Prof Mike Short has drawn my attention to two events taking place in October:

‘The cupboard is bare: how technology can address key unmet needs in mental health’ – Cambridge Wireless Healthcare SIG event – this half day Cambridge event om 13th October, hosted by Philips Research Laboratories and jointly sponsored by TTP and Plextek, will explore the needs from the perspective of the healthcare professional and patient. More details here; book here.

6th Discovering Start-Ups Competition – a brilliant opportunity to win some really valuable prizes to get your start-up really started up, pitching to an elite panel of business leaders from Deloitte, Google, BT, IBM, Cambridge Angels, London Business Angels, Qualcomm Ventures, Samsung and more. Finals will be held at Deloittes in London on 21st October. Note entries have to be submitted by 14th September at the latest.

 

NHS Apps Library embraces mental health…and Mole Detective vanishes

Thanks to Mike Clark for pointing this editor to the breaking news that the NHS Mental Health Apps Library has now gone live. It features online tools, resources and apps that they claim have a proven track record of effectiveness in improving mental health outcomes.

It is accessible through the NHS Choices platform, a website that gathers over 40 million visits per month, 9.7 million of which are to pages on depression; 6 million per month to stress and 9.4 million to anxiety.

This is likely to be a major benefit to those who have difficulty obtaining access to face:face mental health services, especially as a number of presentations in the Royal Society of Medicine have suggested that online mental health services can often be more effective (more…)

Dr Topol’s prescription for The Future of Medicine, analyzed

The Future of Medicine Is in Your Smartphone sounds like a preface to his latest book, ‘The Patient Will See You Now’, but it is quite consistent with Dr Topol’s talks of late [TTA 5 Dec]. The article is at once optimistic–yes, we love the picture–yet somewhat unreal. When we walk around and kick the tires…

First, it flies in the face of the increasing control of healthcare providers by government as to outcomes and the shift for good or ill to ‘outcomes-based medicine’. Second, ‘doctorless patients’ may need fewer services, not more, and why should these individuals, who represent the high-info elite at least initially, be penalized by having to pay the extremely high premiums dictated by government-approved health insurance (in the US, ACA-compliant insurance a/k/a Obamacare)–or face the US tax penalties for not enrolling in same? Third, those liberating mass market smartwatches and fitness trackers aren’t clinical quality yet–fine directionally, but real clinical diagnosis (more…)

Addiction: Improving Outcomes using Computer-based Therapy

Computer-Based-Behavioral-Therapy-Shows-Promise-For-Addiction-Treatment

A recent randomised control trial gives support to the use of computer-based therapy for treatment of addictions. The results were reported this week at the annual convention of the Association for Psychological Science in San Francisco, following publication in the American Journal of Psychiatry. Although the trial focused specifically on cocaine-dependent individuals, it replicates findings of a RCT carried out in 2008, in which participants had a wider range of substance addictions.

Results of this latest study show that those who received computer-assisted therapy were significantly more likely to attain three or more consecutive weeks of abstinence from cocaine as compared to those not receiving any form of Cognitive Behavioural Therapy (CBT) – 36% compared with 17%. And the effects appear to last; the control group also had better outcomes six months after treatment had ended.

Individuals who receive CBT learn to identify and correct problematic behaviours by applying a range of techniques.  Central elements of the therapy include anticipating likely problems, correcting harmful thought patterns, and developing effective coping strategies. The techniques enable people to counteract addiction’s powerful effects on the brain, so they can regain control of their behaviour and lives. (more…)