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

Weekend Must Read: The Future of Remote Care Technology and Older Adults 2020

Laurie Orlov, founder of Aging and Health Technology Watch and well-known industry analyst/advocate in health and aging-related technologies, has released her latest report, The Future of Remote Care Technology and Older Adults 2020 (PDF, free download). Recently, Laurie and I had an opportunity to catch up and review her findings.

This Editor immediately went to the ‘bleed lead’ which was:

COVID-19 HARMED THE WELLBEING OF OLDER ADULTS
Gap in technology access widened into connection chasm

The University of Michigan study from June (cited above and elsewhere in the report) illustrates the change in social isolation for those aged 50 to 80, with numbers that were slightly high to begin with in 2018. Isolation rocketed to 56 percent, putting a Klieg light on mental health that we’ve seen continued in the recent ‘lockdown loneliness’ PLOS One and SECOM studies. The reasons why will be no surprise, as they’re true for nearly all: a screeching halt to in-person experiences, severing in-person connections with family and friends, closing the doors of senior living and nursing homes to visitors (still closed in many states!), breaking healthcare contacts with providers, and losing timely diagnosis of health conditions, new and ongoing.

Most of the report documents the consequences: how telehealth rose, then fell (Epic and Commonwealth Fund last reports), how the experience wasn’t entirely satisfactory and held multiple structural limitations (e.g. tech, vision, hearing, dexterity) for the 50-80 age group (nor providers in obtaining a physical sense of the patient)–a POV you won’t see in mainstream healthcare/tech media nor the funding markets–and how technologies scrambled to fill the gaps (with plenty of examples).

But moving on to the future, which is the aim of this report, there are many gaps which need to be closed that are bigger than Teladongo:

  • synchronous and asynchronous telehealth–the latter primarily remote patient monitoring (RPM)
  • adoption of voice tech
  • broadband and device access, including training and management
  • governmental policy at all levels from Federal to local, including payer reimbursement

The last section of the report (page 18 to end) takes a look at where innovations could take remote care, where expectations are now, and where the opportunities are in connecting older adults. On page 22, there is a checklist for care providers and what they must consider in managing remote care. The summary of the future on page 23 wraps it all nicely.

The Future of Remote Care Technology and Older Adults 2020 (PDF, free download)

 

UK highlights: Doro acquires Connexus Careline, Tunstall warns on winter isolation and disconnected care, Buddi seeks Sales Account Manager

Doro continues its acquisition streak in the UK, acquiring the assets of Connexus Careline from Connexus Housing Group. Connexus currently provides services to local authorities, housing associations, the private sector, and charities, with about 25,000 telecare connections in the UK. Terms and timing were not disclosed. Based on the August count, this brings Doro in at over 250,000 UK connections. Doro’s acquisitions have been ElderCare UK [TTA 11 Aug], Invicta Telecare, parent of Centra Pulse and Connect [TTA 19 Sept 19], and Welbeing [7 June 18], Press release (PDF).

So many open questions… What are their future plans for integrating all these individual systems and different technologies? What will Doro UK represent in the market, now that they are second in the UK?

Tunstall Healthcare UK is also reminding local governments, health and social care leaders that winter is approaching, and now is the time to set up remote patient monitoring to connect to care the most vulnerable in cold weather, a factor magnified by their isolation during the continuing pandemic. Tunstall features several solutions in RPM which are mentioned in the release.

Editor’s note: this type of seasonal release was a staple for QuietCare when I was in marketing for our activity/temperature monitoring of those living at home alone. We also included a proprietary study made during winter (and later summer) among our client base. 1) It’s surprising that more RPM and telecare companies don’t take this approach, especially now, but 2) Tunstall could have made an even greater case for itself with some quantitative research stats.

Buddi is seeking a Sales Account Manager position to join their Health Sales Team based in the southern half of England. The particulars are here (PDF) including application and contact information. Thank you Fiona Carmichael of Buddi for reaching out to us! (If you have a position to fill, our listings are complementary.)

Reflections in a Gimlet Eye: further skeptical thoughts on the Teladoc acquisition of Livongo (updated)

Gimlet EyePerhaps it’s Reflections in a Gimlet Eye, but this Editor remains bemused and slightly dyspeptic about the acquisition of ‘health signals’ remote patient monitoring management platform Livongo by telehealth giant Teladoc.

Here’s the latest, courtesy of Credit Suisse equity research analyst Jailendra Singh on deal rationale and the potential synergies, based on his Q&A with Teladoc and Livongo management (link here):

  • Livongo: “The company was not for sale, and LVGO did not view the transaction with TDOC as a sale. Instead, management views the deal as a merger of the two leaders in virtual care.” 
  • It had nothing to do with pressure from CVS and UnitedHealth Group (UNH). 
  • There are major cross-selling opportunities, starting with an overlap of 25 percent of their clients. There are also opportunities with the InTouch Health client base in acute care, Aetna plus UNH on the health plan side, and employer administrative services only (ASO) plans. This is part of the calculation of synergies totaling $500 million in 2025 which they believe are conservative given the math.
  • They are also seeking to approach their client base before the closing through a reseller agreement, as Teladoc was able to do with InTouch.

Mr. Singh’s analysis is conservative and sober from a strictly financial viewpoint. His two-page analysis is, as usual, worth the read. 

But then we stumble across one particularly helium-charged claim. It’s projected that Teladoc and Livongo would have a combined company market cap of $38 bn, whereas the pre-pandemic value of the companies was $8 bn. (Steve Kraus, Partner at Bessemer Venture Partners, now on the board of Ginger, as quoted in Forbes). That is optimistic, considering that patient primary care virtual visits have flattened down to about 7.4 percent of visits as of June (Commonwealth Fund/Harvard/Phreesia study). It’s assuming a great deal that people will continue to shy away from in-person care going forward. Perhaps to a degree this will, as in-person fear is only starting to flatten, but not everything can be done virtually, even RPM. Telehealth and RPM also present challenges for practices in value-based care models, in workflows, and even with the liberalization of Medicare reimbursements, financially.

Livongo’s great asset, which was understandably compelling for Teladoc, is chronic condition management, RPM, and all that patient data, which can be broadened past their diabetes base (with a small one in behavioral health courtesy of their myStrength acquisition) into other chronic conditions which was Livongo’s strategy anyway. To be determined is how compelling this will be for Teladoc’s customer base and for new customers, particularly if the economic environment is constrained and health plans don’t get on board. 

So why is Mr. Market not mad about this ‘merger’? TDOC has taken a spill since its (adjusted) close on 4 August at $249, and is trading below $200 at $193. LVGO took a lesser hit, from $144 to $121. Another Bessemer Venture Partners investor, Morgan Cheatham, in the Forbes article linked above, was quoted that Livongo had clear market leadership in the employer and health plan market, then expressed surprise at why Livongo agreed to be acquired: “The company had a real shot at becoming a $100 billion business by running the ‘digital hospital’ playbook. In some ways, the acquisition feels premature.” Teladoc’s COO David Sides promised that the combined company will aid practices in the transition from hospital to home care, touting the consumer focus of both companies. (Have they consulted already burdened and strained providers how this can be made easier for them and fit into value-based care models as well as their financials?) But they may have to make more acquisitions to facilitate this. So $18.5 billion plus $1 bn for InTouch isn’t enough to get the job done?

Is it synergy, the wave of the future, or an overloaded Christmas Tree of features, not benefits?

Reminder: to date, neither company has been profitable.

So, what does this mean for other digital health companies? Initially, it’s quite positive that Teladoc could round up nearly $20bn in six months. John Halamka MD, a well-known digital health visionary now at Mayo Clinic, sees it as a bridge to the digital health ecosystem including other companies. A contrarian view was expressed by Mr. Cheatham.  Teladoc-Livongo is a challenge for other digital health companies in that they won’t, and cannot, be Teladocs and Livongos–in other words, an unrealistically high bar for them. “Why can’t Telavongo build this?”

Finally, a personal and slightly jaundiced view from this Editor. Let’s take a good hard look at the Human Factors that make companies go. This is an acquisition by Teladoc of smaller Livongo, despite the merger statements. Employees in both companies are wondering who will go, who will stay, who they will report to if they stay, and where they will be. They have about four to six months to mull what their future might look like at a tough economic time. This will — not may, will–have an effect on operations and attitudes, especially at Livongo.

There are some doubleplus ungood signs that make the assertion that this is a “merger” of companies questionable:

  • Jennifer Schneider, MD, president of Livongo, has stated that both companies are currently hiring and don’t plan layoffs as a result of the merger (Becker’s Health IT). Blanket statements like this are usually made at the start to assure employees. Anyone who has been through a merger knows there are overlapping areas such as HR, marketing, and financial. There are only so many chairs at the organizational table especially at the director and above level. The happy talk doesn’t change the reality that not everyone will be given the option to stay.
  • Statements on similar cultures notwithstanding, the fact is that both companies have different cultures and experiences because they have radically different histories and personalities running them. This Editor would suspect that Livongo employees, having come up in a young and smaller company, in an intense entrepreneurial environment, with employees who were among the first 50 or 100, have a great identification with Livongo and pride in their success.
  • Not one Livongo senior executive was named publicly as taking a new operational role in the merged entity. (Board seats don’t count. But then again, they will be walking away with a major payday, reputed to be in the hundreds of millions for the top executives. What they will do with their future is a major unknown.)
  • The HQ will be in Purchase. Most Livongo employees are in California.
  • The company will be named Teladoc and will not be renamed. That says a lot, even though industry wags are calling it Telavongo and other names.

One would hope that both companies make every effort to reorganize the company staffs in a way where layoffs are minimal, those who are packaged out are treated generously, but better, valued employees from both companies are retained and incentivized to stay–sooner rather than in 4th quarter–in a fair and unbiased evaluative process in how they support their businesses presently and going forward as part of the combined companies future. But this is not typically the case.

One would also hope that the clients and individuals who pay the bills were told, timed with the public announcement, that this was happening and what it means for them. Leaving them to read the announcement online is usually what happens. It’s not automatic, and I’ve seen this treated as an afterthought in both large companies and small, with line of business folks scrambling to put together customer messages, and delayed in getting them approved as after all they have to go through both corporate and investor communications. This is typically the case, as communications cease to be a priority at the market/LOB level when the SEC or DOJ are involved.

Reminder: the Human Factors will fly this aircraft–or auger it in. 

Agree? Disagree? Comments welcomed.  TTA’s earlier ‘skeptical take’ commentary here.

More consolidation: BioTelemetry acquires population health platform from Envolve/Centene, inks agreement with Boston Scientific

BioTelemetry , a RPM company in the cardiac monitoring, population health management, and clinical trials research, quietly announced last week two agreements that once again confirm the consolidation of now the remote patient monitoring market:

  • The acquisition of the On.Demand remote patient monitoring (RPM) and coaching platform, formerly owned and operated by Envolve People Care, Inc., a Centene Corporation subsidiary. The population health management platform contains real-time monitoring of biometric data with cellular- and web-based technology (including Alexa), proactive and reactive health coaching, population health reporting, and customizable interventions. While acquisition cost was not disclosed, BioTelemetry retains through a strategic partnership agreement Envolve and its base with Centene health plan members for diabetes RPM for the remainder of 2020. BioTelemetry is also free to pursue business with other health plans. Release.
  • BioTelemetry will also be a sales agent in the United States for the Boston Scientific LUX-Dx Insertable Cardiac Monitor (ICM) System. Release.

If you go back to 1994, up to 2013, BioTelemetry was CardioNet and one of the Ur-Companies in the RPM space. They went public in 2015 on Nasdaq, and have quietly made many acquisitions both before and after the IPO. Their 2nd Quarter results were $99 million in revenue; operations were profitable, despite a downturn in revenues from the pandemic and beat their estimates (Zacks). Unlike Teladoc and Livongo, their shares have been solidly up since end of July and they’re rated a ‘hold’. Nothing flashy, but solid work.

FCC approves 70 more COVID-19 telehealth funding applications for an additional $32 million

The US Federal Communications Commission (FCC) today (1 July) approved 70 additional applications for funding telehealth during the COVID-19 pandemic. This funding covers both urban and rural providers, from large health systems to local community health centers. The funds for this thirteenth group totals $31.63 million of the $189.27 million in total funds awarded. To date, the FCC’s COVID-19 Telehealth Program, authorized by the CARES Act, has approved 514 funding applications in 46 states plus Washington, D.C. Equipment covered includes telehealth, computers, smartphones, tablets, remote patient monitoring equipment, and software.

A small sample of this group of healthcare organizations:

  •  Avera Health, South Dakota
  • Barnabas Health in NJ for remote patient monitoring equipment
  • Boston Children’s Hospital
  • Greater Philadelphia Health Action
  • Lehigh Valley Health Network in Allentown PA
  • Montefiore Medical Center in the Bronx, NY
  • Ryan Health in Manhattan
  • University of Alabama at Birmingham Hospital
  • UPMC in Harrisburg PA

FCC release. Full list of Telehealth Program recipients here.

Tyto Care telehealth diagnostics raises $50 million in venture round

Tyto Care today (7 April) announced a venture round investment of $50 million by Insight Partners, Olive Tree Ventures, and Qualcomm Ventures LLC plus previous investors. The new investment will pay for commercialization throughout the US, Europe, and Asia as well as to introduce new advanced product capabilities including AI and machine learning-based home diagnostics solutions and other patented technologies. 

Tyto’s timing could not be better for the raise. In the US, led by CMS with private payers following in near lockstep, the past month has seen the rapid unrestricting of payment for telehealth services like virtual visits of the audio-visual type and short asynchronous and synchronous image and audio/telephonic short visits. Tyto’s remote medical exams of the lungs, heart, throat, ears, abdomen, and body temperature fits into the current and likely future need. Both live exams and asynchronous forwarding of data are part of a platform that integrates with EHRs and third party exam tools.

Tyto Care works with hundreds of hospitals and over 100 health organizations including health systems, payers and strategic partners, primarily in North America, Europe, and Israel. In 2019, they had over 200,000 examinations.

If, like your Editor, you believe that the tidal wave of telehealth has changed the office visit model for keeps, adding remote diagnostics can be a winner–if Tyto can navigate the tricky shoals of a largely consumer-based marketing strategy (Best Buy) and gain adoption by health systems and payers, as they have in Israel with Sheba Medical Center [TTA 28 Feb]. Release, FierceHealthcare

Digital health on the front lines of coronavirus checking, treatment and prevention (updated 2 Mar)

Coronavirus (COVID-19), which originated in Wuhan, China and has spread to at least 40 countries and 80,000 victims, with 2,700 fatalities, has been roiling both financial and healthcare markets. The stock price of payers in the US have been hit hard due to an anticipated uptick in illness, but interestingly, Teladoc has been up quite smartly in the past few days. Teladoc reported that one of eight virtual visits in January was due to flu, which isn’t atypical–but half had not used Teladoc before. Analysts do expect that there’s an opportunity for telehealth and telemedicine providers to attract new users due to what this Editor has dubbed ‘conscious contact’–that if you even feel remotely sick, you’re going to turn to a virtual visit.

COVID-19 is not remotely near a pandemic outside of China. The three hallmarks of a pandemic are cross-seasonal outbreaks (so far only in China), cross-geography (done), and most importantly, attacking the well. The fatalities have been among those with compromised immune systems, not among the young and healthy who do get it. It’s alarming, like SARS, because of the origination in animals, and the ease of person-to-person transmission via travel, as the outbreaks in Iran, South Korea, Italy, and on cruise ships visiting Asia have confirmed. In the US, the CDC is reporting that it is not currently spreading in the community, but is preparing for that scenario including containment, and has been since January.

But beyond the virtual visit, there are other areas where digital health is part of dealing with COVID-19:

  • Preventing the spread to the patient’s family members. Avaya has been working in China since January to provide enterprise customers with home agents to prevent the spread of the virus. For hospitals, they have donated equipment to enable remote consultation services and remote visiting video at the hospitals, including observation of isolation wards. They have provided a case study of their work with the Tongxiang Hospital at the Tongxiang Branch of Zhejiang Province People’s Hospital. (Photo at left courtesy of Avaya.) 
  • Another is remote patient monitoring. Sheba Medical Center in Tel Hashomer, Israel, is using Tyto Care to monitor the 12 Israeli returnees from the Diamond Princess cruise ship, who continue to be in isolation. The patients will perform the tests on themselves, especially respiratory tests. Jerusalem Post 
    • Update 2 Mar: A representative from Sheba, the largest hospital system in the Middle East, was kind enough to contact me with additional information on their RPM program for COVID-19. For patients requiring isolation in that stage of treatment, Sheba has implemented a modular ‘field hospital’ setup, similar to what the Israeli (and US) military use, which can be set up in any open area. This isolation is to protect immunosuppressed patients from disease spread in the main hospitals. Telehealth being used in addition to Tyto are the Vici telemedicine robot and the Datos Health app for home treated patients. This Editor believes that both European and US public health systems are looking at the Sheba and Israeli approach.
  • Robots–actually a telehealth cart–are being tested for patient self-testing, much like Tyto Care’s use at Sheba. Robots could also deliver food (although they could also carry germs) and sweep streets.
  • Other monitoring can be done via symptom checkers (Babylon, K, and others). 98point6 released a coronavirus screening chatbot app as early as January, but what they’ve turned up so far is more cases of the flu. STAT
  • Data analytics can pinpoint outbreaks. The Epic, Athenahealth, and Meditech EHRs have released new guidance, testing orders and screening questions (e.g. around travel and contacts) that will help to identify outbreaks.

Update 28 Feb: This Editor would like to know more about UV disinfection being used versus coronavirus for large spaces such as in hospitals and aircraft. If you have information on technologies such as PurpleSun which have been tested against hospital pathogens also being used against coronavirus, please contact Editor Donna.

Healthcare technologies which weren’t around during the SARS and swine flu epidemics may make a big difference in the spread, treatment and mortality rate of COVID-19. Healthcare Dive, HealthTechMagazine

UPDATE 28 FEB

As a service to our Readers, we are providing the following health service update links:

The UK Department of Health and Social Care and Public Health England has provided the following links to coronavirus guidance (hat tip to DOHSC via LinkedIn):

👩‍⚕️ Health: http://bit.ly/37qkWaV
🚂 Transport: http://bit.ly/2HDOFBW
👩‍🎓 Education: http://bit.ly/38KT41O
👨‍💼 Employers: http://bit.ly/2TfwpUT
🏡 Social care: http://bit.ly/2VhBIG9

US Centers for Disease Control (CDC)

World Health Organization (WHO) main website on coronavirus:https://www.who.int/health-topics/coronavirus

Health Canada’s main page: http://ow.ly/bLtF50yfJb7

Tyto Care partners with Avera eCARE for telehealth delivered to medically underserved populations

Following on last week’s announcement of Tyto Care‘s partnership with Novant Health, Sioux Falls SD-based telemedicine provider Avera eCARE will be introducing Tyto Care’s professional version, TytoPro, into its telemedicine service using high-definition video for virtual consults. What TytoPro will add is remote diagnostic capability and collection via the TytoVisit platform, using the TytoApp and Clinician dashboard. Avera will use TytoPro’s hand-held device with exam camera, thermometer, otoscope, stethoscope (with volume, bell, and diaphragm filters), and tongue depressor adaptors.

In a test of Avera eCARE plus Tyto Care in an assisted living community, the pairing of the two systems reduced emergency department transfers by 20 percent, with 93% of residents treated in place.

Avera eCARE, a part of Avera Health, provides telemedicine services to medically underserved populations via local healthcare systems, rural hospitals, outpatient clinics, skilled nursing facilities, assisted living communities, schools, and correctional facilities. It has over 400 providers in its comprehensive virtual health network across the US. A ‘white paper’ on the Avera/Tyto Care partnership is here. Release 

News roundup: Virginia includes RPM in telehealth, Chichester Careline changes, Sensyne AI allies with Oxford, Tunstall partners in Scotland, teledermatology in São Paolo

Virginia closes in on including remote patient monitoring in telehealth law. Two bills in the Virginia legislature, House Bill 1970 and Senate Bill 1221, include remote patient monitoring (RPM) within their present telehealth and telemedicine guidelines and payment in state commercial insurance and the commonwealth’s Medicaid program. It is currently moving forward in House and Senate committees with amendments and. RPM is defined as “the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including monitoring of clinical patient data….” Both were filed on 9 January. Virginia was an early adopter of parity payment of telemedicine with in-person visits. The University of Virginia has been a pioneer in telehealth research and is the home for the Mid-Atlantic Telehealth Resource Center. mHealth Intelligence

Chichester Careline switches to PPP Taking Care. Chichester Careline is currently a 24/7 care line services provided by Chichester District Council. Starting 1 March, PPP Taking Care, part of AXA PPP Healthcare, will manage the service. According to the Chichester release, costs will remain the same, technology will be upgraded, and telecare services will be added. Over the past 35 years, Chichester Careline has assisted over 1 million people across Britain. 

Sensyne collaborates with University of Oxford’s Big Data Institute (BDI) on chronic disease. The three-year program will use Sensyne’s artificial intelligence for research on chronic kidney disease and cardiovascular disease. Sensyne analyzes large databases of anonymized patient data in collaboration with NHS Trusts. BDI’s expertise is in population health, clinical informatics and machine learning. Their joint research will concentrate on two major elements within long-term chronic disease to derive new datasets: automating physician notes into a structure which can be analyzed by AI and integrating it into remote patient monitoring.  Release.

Tunstall partners with Digital Health & Care Institute Scotland. The partnership is in the Next Generation Solutions for Healthy Ageing cluster. Digital Health & Care supports the Scottish Government’s TEC Programme and the Digital Telecare Workstream. The program’s goals are to help Scots live longer, healthier lives and also create jobs.  Building Better Healthcare UK

Teledermatology powered by machine learning helps to solve a specialist shortage in São Paolo. Brazil has nationalized healthcare which has nowhere near enough specialists. São is a city with 20 million inhabitants, so large and spread out that when the aircraft crew announces that they are on approach to the airport, it takes two hours to touch the runway. The dermatology waitlist was up to 60,000 patients, each waiting 18 months to see a doctor. The solution: call every patient and instruct them to go to a doctor or nurse to take a picture of the skin condition. The photo is then analyzed and prioritized by an algorithm, with a check by dermatologists, to determine level of treatment. Thirty percent needed to see a dermatologist, only 3 percent needed a biopsy. Accuracy level is about 80 percent, and plans are in progress to scale it to the rest of Brazil. Mobihealthnews.

Why they matter: the $225 million acquisition of Propeller Health; Hill-Rom’s integration of EarlySense’s bed monitor

It’s all about the integration of newer technology and partnerships into established, older tech–or furniture. In late 2014, a seven-year-old early-stage company from Wisconsin had a booth at the NYeC Digital Health Conference. Their digital, connected monitors attached to prescription inhalers and tracking app interested this Editor enough for her to discuss it with a telehealth company she consulted for at the time as a natural fit for their digital remote monitoring of COPD and asthmatic patients. The startup had a few major clients, mainly drug companies, and would have been boosted by Viterion’s VA business. (Editor note: it didn’t go anywhere)

Flash forward to November 2018, and after $70 million in funding and marketing in 16 countries, integration with nearly 90 percent of commercial inhalers, Propeller Health is being acquired by the much larger ResMed for $225 million, closing in March 2019. This is surprising as Propeller never exceeded $10 million in revenue (Research2Guidance).

Why it matters: Propeller brings to ResMed’s older respiratory technology not only new yet proven technology, but also established partnerships with pharma, healthcare, and payer organizations. They inhabit a huge and growing worldwide market. According to WHO, asthma affects 334 million people worldwide; COPD 250 million people. Digital solutions could be targeting as many as 270 million patients by 2023. Propeller also brings eight US FDA 510(k) clearances and CE markings. All of this makes this small digital medical company worth a serious multiple of revenue with the prestige of being a standalone unit within ResMed led by the co-founder. Read more about it from Research 2 Guidance’s “ten major reasons” why Propeller was worth it, Mobihealthnews, and MedCityNews.

An even smaller monitoring company, Early Sense, has made a significant lift (sic) in a partnership with leading hospital bed manufacturer Hill-Rom. Early Sense has been featured at many CES Unveileds (New York) as one of many Israeli companies with a growing US presence. While starting in the hospital area years ago with bed and chair sensors, within the past two years this Editor noted their move into consumer with an under-mattress sleep sensor unit that could track (via an app) your sleep, stress, heart rate, breathing–and fertility. Their clinical version tracks heart and respiratory rates, alerted for patient falls out of bed, and patient movement (or lack thereof) as an indicator of risk for pressure ulcers. Hill-Rom, which claims to be the world leader in hospital beds, is adding the Early Sense technology to its Centrella model to create a smart hospital bed–one that will monitor heart and respiratory rates over 100 times a minute. A 2015 study quoted in the release stated that mortality related to “code blue” events was reduced by 83 percent, cardiac arrests by 86 percent, and reported overall hospital length-of-stay was reduced by 9 percent ICU days by 45 percent.

Why it matters: Even hospital equipment has to differentiate versus competition, and one way is going digital RPM integrated into the bed itself. The least expensive way of doing so is to buy new technology and incorporate in your ‘traditional’ offering. For the smaller company, it is worth its weight in gold in publicity and the potential business through the giant company. ReleaseMedCityNews, Mobihealthnews

The wind may finally be at the back of telehealth distribution and payment (US)

Medicare Advantage may lead, but Medicaid and regular Medicare are not far behind. The Centers for Medicare & Medicaid Services (CMS) has announced in two proposed rules changes expansion of telehealth access for both privately issued Medicare Advantage (MA) plans (26 Oct) and state-run Medicaid and CHIP (Children’s Health Insurance Plan) (14 Nov) plan members. This may mean greater acceptance by providers because they will be paid for these services.

For MA, the proposal would, starting in 2020 as part of government funded basic benefits, eliminate geographic restrictions (rural telehealth) and allow members in urban areas to access telehealth services. It would also broaden present location restrictions, allowing MA members to receive telehealth from home versus traveling to a health care facility. The most intriguing wording is here: “Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.” which very well could mean remote patient monitoring in conjunction with visits. MA plans have always had more latitude to offer telehealth benefits to members, which are about 1/3 of Medicare-eligibles (over 65). Over 11 percent growth is forecast and it is highly competitive though dominated by United Healthcare and Aetna–over 600 new plans are entering the market next year. Enrollments close on 7 Dec for 2019. CMS.gov release, mHealth Intelligence, Healthcare Finance News.

For Medicaid and CHIP, which states use to extend insurance to low-income individuals and families via private plans, states would be able to, under an approved rule, to more flexibly determine what criteria determine telehealth access. Currently, states use proximity factors–distance from provider and time. The proposed criteria under 10. Network Adequacy (pages 15-16) recommends that time and distance be deleted and instead “adding a more flexible requirement that states set a quantitative minimum access standard (later listed) for specified health care providers and LTSS (long term services and supports) providers”. The reasons why are the limited supply of providers and the functional limitations of the LTSS population. Also notable was language in section 8 discussing access to provider directories via smartphone, as 64 percent of the population with incomes less than $30,000 own a smartphone and use it to access health information.  CMS proposed rule, POLITICO Morning eHealth

This adds to the momentum of the Medicare Physician Fee Schedule published on 1 Nov that added even more:

  • Virtual brief patient checkins and evaluation of patient-recorded photos and video to payments
  • CMS is also finalizing separate payments for three new codes covering chronic care remote physiologic monitoring that unbundle 99091 (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).
  • Two new codes covering telehealth for prolonged preventive services
  • Finalizing the addition of renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites
  • After 1 July, the home will be permitted as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. CMS.gov fact sheet 

The importance of this is that more digital health covered by Medicare and government payments in public/private programs such as Medicaid and MA lead private insurers to pay doctors for these services, who will then be willing to pay vendors for providing them. For the telehealth and telemedicine companies that have weathered the storms and lean times of the past decade, there may be light at the end of the tunnel that is not an oncoming train.

More good news for telehealth, RPM in FCC approval of $100M Connected Care Pilot Program

The Federal Communications Commission (FCC) moved relatively quickly to approve the Connected Care Pilot Program, approving broadband-enabled telehealth and remote patient monitoring services in underserved rural and remote areas. Funding for the program has been pegged at $100 million. The approval was unanimous on the program proposed by FCC commissioner Brendan Carr and Mississippi Sen. Roger Wicker.

CCPP will provide $100 million for subsidies to hospitals or wireless providers running post-discharge remote monitoring programs for low-income and rural Americans. An example is those run by the University of Mississippi Medical Center. The goal is to lower same-cause readmissions and improve patient outcomes. [TTA 13 July] Hearings late last month also were structured to support the program and start to fill out the details for a 2019 start [TTA 1 Aug].

Public comments are now open for a 2019 start to the program (see FCC website–look under Connect2Health which is the umbrella site for this and similar programs). Commissioner Carr had to look no further than the VA to see how Home Telehealth and other remote monitoring programs worked to drive down cost and improve patient outcomes. VA Health’s remote monitoring program cost $1,600 per patient compared to $13,000 for traditional care in one study. The trick is now translating this into an open system.

This is a nice boost to both real-time video and asynchronous remote patient monitoring in market development (and getting paid) in areas of great need. It’s also another Federal signal (so to speak) for 2019, following the proposed Medicare Physician Fee Schedule’s increased payments and broader applicability for both.  mHealthIntelligence, Mobihealthnews, FCC Release Hat tip to reader Paul Costello of Medopad.

News roundup: FCC RPM/telehealth push, NHS EHR coding breach, unstructured data in geriatric diagnosis, Cerner-Lumeris, NHS funds social care, hospital RFID uses

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”125″ /]FCC backs post-discharge RPM plan. The “Connected Care Pilot Program” proposed by FCC commissioner Brendan Carr would provide $100 million for subsidies to hospitals or wireless providers running post-discharge remote monitoring programs for low-income and rural Americans such as those run by the University of Mississippi Medical Center. The goal is to lower readmissions and improve patient outcomes. The proposal still needs to be formalized so it would be 2019 at earliest. POLITICO Morning eHealth, Clarion-Ledger, Mobihealthnews

NHS Digital’s 150,000 patient data breach originated in a coding error in the SystmOne EHR used by GPs. Through the error by TPP, SystmOne did not recognize the “type 2 opt-out” for use of individual data in clinical research and planning purposes. This affected records after 31 March 2015. This breach also affects vendors which received the data, albeit unknowingly, but the duration of the breach makes it hard to put the genie back in the bottle, which NHS Digital would like to do. Inforisktoday, NHS Digital release

Unstructured data in EHRs more valuable than structured data in older adult patient health. A new study in the Journal of the American Geriatrics Society compared the number of geriatric syndrome cases identified using structured claims and structured and unstructured EHR data, finding that the unstructured data was needed to properly identify geriatric syndrome. Over 18,000 patients’ unstructured EHR notes were analyzed using a natural language processing (NLP) algorithm.

Cerner buying a share in population health/value-based care management company Lumeris through purchasing $266 million in stock in Lumeris parent Essence Group Holdings. The angle is data crunching to improve outcomes for patients in Medicare Advantage and other value-based plans. Lumeris also operates Essence Healthcare, a Medicare Advantage plan with 65,000 beneficiaries in Missouri. Fierce Healthcare

NHS Digital awarding £240,000 for investigating social care transformation through technology. The Social Care Digital Innovation Programme in 12 councils will be managed by both NHS and the Local Government Association (LGA). Projects to be funded span from assistive technologies to predictive analytics. Six winners from the original group of 12 after three months will be awarded up to a further £80,000 each to design and implement their solutions. New Statesman

Curious about RFID in use in healthcare, other than in asset management, access, and log in? Contactless payments is one area. As this is the first of four articles, you’ll have to follow up in Healthcare IT News

CMS urged to further reimburse telehealth remote patient monitoring with three new CPT codes

The Centers for Medicare & Medicaid Services (CMS), which controls payments to doctors for the Medicare and state Medicaid programs, has been urged by 49 healthcare organizations and technology vendors to further unbundle the controlling CPT code for remote patient monitoring (RPM), 99091. The 2018 Physician Fee Schedule (PFS) Final Rule finally separated RPM from telemedicine remote visits by permitting separate payment for remote physiological data monitoring by unbundling CPT 99091 to reimburse for patient-generated health data (PGHD)–a new term. The letter to Administrator Seema Verma proposes 2019 adoption of three additional American Medical Association CPT Editorial Panel-developed codes which further break down various aspects of RPM, while maintaining 99091. 

CPT codes for Medicare and Medicaid are important because they also influence private insurers’ reimbursement policies. Practices which get paid for RPM are more likely to adopt enabling technologies if they are affordable within how they are paid. 

CMS started to include telehealth RPM in 2015 in a chronic care management code, 99490, but specifically prohibited the use of CPT 99091 in conjunction with CCM. This created a lot of confusion after some brief moments of hope by tying technology to a complex CCM model.

It’s possibly a ‘light at end of the tunnel’ development for hungry tech companies, but one which won’t be determined till end of year when PFS rules are released. Also Healthcare Dive.

Can chronic disease apps get adopted? Is it as simple as four steps? HBR states the obvious.

“Why Apps for Managing Chronic Disease Haven’t Been Widely Used, and How to Fix It” is an enticing title, and in the Harvard Business Review no less.

Here’s the advice that two Harvard Business School professors have for app developers. First, find an organization–an employer, an integrated health system that includes a payer–that’s willing to pay for your app. Then work the “adopt-diffuse-use-improve” cycle. Get them to adopt it, diffuse it through potential users (as in getting them to try the app), get them to continue using it, and improve the product.

You have to sled through about 500 words of exposition to get to this conclusion, obvious to anyone who’s worked in the field more than a couple of months. And oh, as if these steps were so easy to achieve! There’s the given example of Fitbit buying the Twine Health tracking/coaching app in a bid for a more integrated chronic disease management (CDM) approach–for those who’ve tracked Fitbit, and even the professors, its success remains to be seen. 

There are some nuggets of confirmation useful for presentations, such as you can’t generally sell monitoring apps direct to consumer because managing chronic disease is largely something to be avoided, except for the few with a different attitude, and most believe that insurers should pay for them at least in part. For clinicians, reimbursement and the differential between remote patient monitoring and in-person visits is a big factor.

What’s not mentioned: sustainable pricing that’s low enough for a health system, high enough to support a business; clinicians fitting All That Data into a clinical workflow, much less a patient record in an EHR.