News roundup: CVS abandons (?) Cano Health buy; Signify adds home RPM; BioIntelliSense RPM acquires AlertWatch; GE Healthcare, AMC Health partner; Viome raises $67M, other fundings

October 21, 2022 | by | 1 Comment

CVS Health apparently backs away from a strategic primary care buy. Earlier this week, both Barron’s and DealReporter (via FactSet) reported that CVS Health is no longer pursuing an acquisition of Cano Health, a primary care provider group in Florida, Texas, Nevada, California, Illinois, New Mexico, and Puerto Rico that concentrates on senior health, Medicare Advantage patients, and value-based care. Cano has 4,000 employees and 280,000 members. Reasons why were not disclosed by either CVS or Cano. Cano shares listed on the NYSE fell on the news from Monday’s open of $8.22 to $4.50 today (20 Oct). An alternative buyer may be Humana, which has a right of first refusal on a sale dating back to 2019, but Humana has been quiet on the acquisition front of late.

Walking away seems contrary to CVS’ stated strategy of pursuing deals in primary care, provider enablement, and home health, but CVS can afford to be choosy. There’s speculation that CVS has a different provider/VBC enablement target in mind.  Jailendra Singh of Truist Securities identified ACO management services organization Privia Health as a potential buy that would fit well with CVS’ pending buy of Signify Health, which includes competitor Caravan Health (more on this here). But who knows if this ‘walk away’ is final? Healthcare Finance, FierceHealthcare

CVS’ pending deal, Signify Health, announced the addition of spirometry testing to evaluate patients for COPD. This will be added to their existing suite of in-home diagnostic testing and tracking, In-Home Health Evaluation, targeted to Medicaid and Medicare Advantage members. Mobihealthnews

If there’s a Cinderella this inflationary, recessionary year, it’s remote patient monitoring (RPM). BioIntelliSense has been in RPM since 2020 with on-body/stick-on sensors such as the BioButton and the BioSense 30-day monitor. Their latest addition through acquisition is the AlertWatch clinical intelligence and triage system. AlertWatch will join BioIntelliSense’s product group within Medtronic’s HealthCast portfolio in US hospital patient monitoring as part of their existing partnership. In the past ten years, AlertWatch achieved four FDA 510(k) clearances for its specialized product offerings for the operating room, intensive care unit, and labor and delivery unit.  BioIntelliSense release

Veteran RPM company AMC Health will be partnering with GE Healthcare (GEHC) for post-discharge in-home care monitoring. This will extend GEHC’s hospital-based monitoring into post-acute patient needs and anticipate future care needs, potentially reducing unnecessary readmissions. It’s also planned that eventually both hospital and home data will be integrated into GE’s Edison Health database. GEHC also announced additional details about its spinoff, due to happen in early 2023. [Also TTA 12 Nov 21 and 20 July] Mobihealthnews

Healthcare/health tech raises haven’t entirely disappeared. Viome, which uses AI to test the oral and gut microbiome to prevent, diagnose, and treat chronic diseases and cancer, just raised a $67 million Series C led by Bold Capital Group with participation from Khosla Ventures, West River Group, Glico, Ocgrow Ventures, and Physician Partners, for a total raise since 2017 of over $169 million (Crunchbase). Viome recently launched the CancerDetect test for oral and throat cancers under the FDA Breakthrough Device Designation. Last year, they expanded their partnership with GlaxoSmithKline to research and potentially develop interventions for some cancers and autoimmune diseases. Viome release  

Mobihealthnews rounds up several other financings from genomic tester Variantyx’s $20 million in debt financing to mental health app Mindful Care’s modest $7 million Series B and dataset research collaboration platform Rhino Health‘s $6.7 million seed round extension for an $11 million total.

Home-based remote monitoring for Covid reduced hospitalizations, hospital length of stay: JAMA study

July 15, 2022 | by

Activation of remote patient monitoring (RPM) in this study is associated with lower hospitalization, intensive care use, and if hospitalized, length of stay. Conducted by Froedtert & Medical College of Wisconsin Health Network with Covid-19 positive ambulatory patients who accepted RPM in the home (N=9,378), the study’s purpose was to evaluate the implementation of a large-scale daily RPM program for patients who were managing symptoms from home. They compared those who activated their RPM (N=5,364, 57%) versus those who did not (N=4,014, 43%). The mean age was 46 and 58% were women.

  • 878 patients  (16.4%) had at least one RPM alert
  • 2.4% (128) of the activated patients were hospitalized, compared to 3.9% (158) of inactivated patients

A weighted regression analysis, adjusted for demographics, comorbidities, and time period, compared RPM-activated to the tracked but inactivated patients:

  • Lower odds of hospitalization (odds ratio, 0.68; 95% CI, 0.54-0.86; P = .001)
  • Greater time between test and hospitalization for RPM-activated patients 6.67 [3.21] days vs 5.24 [3.03] days)
  • Shorter length of stay (4.44 [4.43] days vs 7.14 [8.63] days)
  • Less intensive care use (15 patients [0.3%] vs 44 patients [1.1%])

The study excluded patients younger than 18 years, those with asymptomatic tests (because these were often scheduled before procedures or other planned admissions), patients who were admitted within 24 hours of a positive test, and those who already had internal PCPs to reduce the chance of missing hospitalizations. The RPM provider was GetWellNetwork using the GetWellLoop monitored by a centralized team of Froedtert & Medical College of Wisconsin nurses. Patients used the web or a mobile app to record their symptoms, temperatures, and pulse oximetry readings. Hospitalization Outcomes Among Patients With COVID-19 Undergoing Remote Monitoring (abstract and downloadable PDF)

The clunk continues: Q2 2022 digital health funding fades to $4.1B in Q2, down 50% from 2021

July 13, 2022 | by

Digital health funding continues to take a plunge. Knocked about by the hangover from the pandemic, a grinding war between Russia and Ukraine, gasoline prices jacked up worldwide, and knock-on inflation and looming stagflation, funding continues to slide. The decline in Q2 digital health deals and funding to $4.1 billion more truly reflects the downturn than Q1’s relatively buoyant $6.1 billion, which benefited from the carryover of deals negotiated during 2021’s boom and closing then [TTA 6 April]. Year over year, it was half of 2021’s high of $8.3 billion.

  • 2022’s first half (H1) total of $10.3 billion was down 31% from 2021’s $15 billion. Despite this, it is 63% above the pandemic-stricken 2020’s H1 $6.3 billion. 
  • Average deal size has dropped to $31.2 million from 2021’s full-year $39.5 million and even 2020’s $30.6 million, accounting for inflation in the past two years. Looking at funding size by series year over year, Series A funding is flat but funding for Series B, C, and D+ have dropped substantially.
  • No startups went public but four digital health companies announced plans to go public or were reported to be planning public exits. One SPAC was announced in June to close in Q3, that of VSee and iDoc Telehealth with Digital Health Acquisition Corporation. SPACs, as this Editor has noted, have gone from Funding Hero to Zero under 2022’s economics, causing many SPACs to crack (Owlet, Talkspace) and increased scrutiny by the Feds [TTA 9 June]. SOC Telehealth, an early SPAC, went private after a 90% share price drop [TTA 8 Feb].
  • Average monthly M&A has dropped substantially. 2021’s monthly average of 23 has dropped to 20 in Q1 and 13 in Q2, for a H1 average of 16.
  • Most popular funding areas are mental health (a far ahead #1 at $1.3 billion), oncology, and cardiovascular. Diabetes dropped from #2 to #4, skewed last year by Teladoc’s acquisition of Livongo. Oncology rose to #2 from #6 in 2021. For mental health, given increased Federal scrutiny and legal problems of companies like Cerebral plus the expansion of Teladoc and Amwell into the area, this Editor does not expect telemental health companies to continue to attract this level of funding but may be attractive for M&A.
  • Disease monitoring (a/k/a RPM) as a value proposition moved from #8 to #3 in investment at $1.4 billion. R&D and on-demand healthcare remained in their #1 and #2 positions.

As TTA has noted previously, this was all to be expected. Will 2022 funding perk up like 2020’s did through Q3 and Q4, or fall off like in 2019 as money sits on the sidelines? Rock Health does try to put a rosier shine on the retrenchment in its roundup, as has venture capital–reality can be good for you. Another depressive factor is regulatory uncertainty in multiple areas and Federal involvement, which some companies can work to their advantage. The Rock Health summary discusses this at length. Also Mobihealthnews. 

Thursday news roundup: bet on Oracle-Cerner closing next week, VA EHR progress reports mandated, Homeward-RiteAid rural care, Medtronic-DaVita kidney JV, Withings reenters RPM, Lightbeam buys Jvion AI

June 1, 2022 | by

The Oracle acquisition of Cerner will close as early as Monday next week, no later than mid-June. Mid-June is the prediction of Seeking Alpha. They based it on Oracle-Cerner already passing Australia’s Foreign Investment Review Board, no questions posed by the UK antitrust authority, and the US waiting period expiring in February. As rumored [TTA 25 May], European Commission regulators approved it today (Barrons, paywalled) which predicts the close will be next Monday. Hat tip to HISTalk for their alert yesterday.

Scrutiny of Cerner’s $16 billion EHR implementation with the Department of Veterans Affairs by Congress ramps up. New legislation due to be signed by the president shortly will require the VA Secretary to submit regular reports 30 days after the last day of each fiscal quarter on the VA’s Electronic Health Record Modernization (EHRM) program. Content will include spending, performance metrics, outcomes, safety, transitioning from VistA to Cerner Millenium, interoperability, and progress or issues with all. Text of Senate bill, FierceHealthcare  TTA’s previous article on Cerner EHR interoperability problems with DOD and VA

Bringing healthcare to rural America is Homeward with a freshly inked deal with RiteAid. Founded by former Livongo president Jennifer Schneider, MD, Homeward will set up distinctive purple mobile van clinics at up to 700 Rite Aid location parking lots in rural communities starting Q3 this year. Michigan will be the first market. Homeward will accept regional Medicare Advantage plans and Medicare.

The company is targeting the 60 million Americans who live in rural areas and have been losing access to basic medical care as local practices and clinics close. Their technology enablement will be for appointments, checkins, telehealth, remote patient monitoring, and scheduling home visits. Homeward announced its launch at the recent ViVE2022 in March including $20 million in funding from General Catalyst. Other Livongo alumni with the new company are Brian Vandenberg, former general counsel, Amar Kendale, former chief product officer, and Bimal Shah, MD, former chief medical officer at Livongo. Nice to know that they have moved to another healthcare chapter of real need, versus cruising the Caribbean in very large yachts. FierceHealthcare, Homeward release

Medical device giant Medtronic and DaVita are establishing a joint venture by next year to advance kidney care therapies and technologies, including new products to be used in clinics and in the home. The intent of the JV is to increase the availability of kidney care including dialysis. 10% of adults worldwide–700 million people–have chronic kidney disease. 2.6 million have kidney failure. The JV is expected to be formed in early 2023 with each company owning an equal share. Initial investment is not disclosed. According to the release:

  • Medtronic will contribute its Renal Care Solutions (RCS) business including the current product portfolio (renal access, acute therapies, and chronic therapies), product pipeline, and global manufacturing R&D teams and facilities.
  • Both companies will provide an initial investment to fund the new company (NewCo) and future certain operating capital.

FierceBiotech, Medtronic release

Withings reenters remote patient monitoring with Withings RPM. Their initial entry was with MedProCare back in 2019 but apparently in the repositioning of the company since the buyback from Nokia in 2018, it was back-burnered. The new RPM will be based on an app that will:

  • track time for CMS-compliant billing reports and uploadable to the provider EHR
  • support billing for CMS codes 99453, 99454, 99457, 99458
  • a digital patient-facing assistant
  • full connectivity to Withings devices such as scales, blood pressure monitors, and sleep monitors
  • implementation support by their Health Solutions teams

Withings RPM page, Outsourcing-Pharma

Looking hard for an M&A that relates to us in this very quiet market, Lightbeam Health Solutions, a population health software company, is acquiring Jvion Inc. Jvion has AI-enabled prescriptive analytics and social determinants of health (SDoH) solutions which will be combined with Lightbeam’s health analytics and outcomes for payers and providers. Terms of the acquisition and leadership transitions were not disclosed. Lightbeam release

What can be the long-term drivers of remote patient monitoring growth?

March 10, 2022 | by

Is it as simple as getting simpler to use devices to collect long-term data that picks up trends and provides feedback that motivates to users? That is the surprise at the very end of this pre-HIMSS Healthcare IT News interview with Dr. Waqaas Al-Siddiq, chairman, CEO, and founder of Biotricity, a biometric monitoring and telemedicine company incorporating devices into monitoring systems for cardiac and pain management. Those of us who have worked for RPM companies know the variety of devices typically used by those monitored for chronic conditions can be stunning–and most of them aren’t easy to use for those with sight difficulties or mobility problems. Pain monitoring is especially tricky and subjective. Gaps in use are to be expected, even as these systems have become more mobile and smartphone connected. The popularity of continuous glucose monitoring (CGM) monitors such as the Dexcom G6 and Abbott’s Freestyle Libre system is a predictor–make it simple, eliminate something unpleasant, provide easy feedback, and you have a winner.

Dr. Al-Siddiq points out that we are at the early stages of monitoring for chronic disease. People with COPD, sleep apnea, and atrial fibrillation right now don’t have CGM level monitoring. There are also patients who are sent home from the hospital with no monitoring devices at all and won’t (or can’t) visit a doctor’s office. RPM organized at discharge, set up with a nurse, and connected to a doctor’s office would be ideal if the offices adopt a cohesive monitoring approach. But Dr. Siddiq adds the feedback to the user to trigger motivation, which to this Editor has been a missing element. 

So much of this is dependent on device and system design–clinical quality monitoring that’s easy to use and almost forgettable in everyday life, that provides feedback (reward experience), and that provides quality data that doesn’t overwhelm the clinician. A familiar trio to those of us who’ve been in the RPM Wars. 

PERS/RPM catchup: VRI bought by ModivCare for $315M; Connect America buys AI-powered RPM 100Plus, opens new SC center

October 27, 2021 | by

ModivCare buys VRI. While your Editor was on holiday leave enjoying the beautiful beaches of late-late summer, the long-rumored sale of PERS and remote patient monitoring provider VRI [TTA 9 July] closed on 22 September. The buyer is a non-emergency medical transportation (NEMT), home care (Simplura), and meal delivery company once known as Circulation and now ModivCare. Purchase price is $315 million, subject to customary purchase price adjustments. VRI generated $56 million of revenue and $21 million of adjusted EBITDA for the twelve-month period ended June 30, 2021. The majority owner of VRI since 2014 was Pamlico Capital. VRI will remain HQ’d in Franklin, Ohio and Sullivan, Illinois. Jason Anderson remains as its CEO under ModivCare. Business Wire release, ModivCare news site. And PERS Insider has an insightful article with a link to the investor presentation

VRI gives ModivCare immediate revenue, as well as impressive capabilities in medical alert systems, established monitoring centers, connecting care in the home plus other residential settings, and cross-selling in ModivCare’s relationships with Medicare Advantage and Medicaid (state) plans. Your Editor became familiar with VRI as far back as 2006 in her QuietCare days, then when Andy Schoonover and Chris Hendricksen ran VRI (and your Editor wished they’d buy the company). Andy Schoonover is now the CEO of CrowdHealth, a community-based provider of health services.

ModivCare has managed 48.2 million trips through the industry’s largest network of contracted transportation companies. They recently signed another agreement with Uber Health to provide on-demand transportation in underserved communities. They claim to be the largest NEMT company in the US with a 40% market share and trades publicly on NASDAQ with a market capitalization of $2.3 billion. NEMT is one of the linchpins of social determinants of health (SDOH). 

And Connect America treated itself to a snack after the big meal of Lifeline. PERS Insider broke the news on their purchase of 100Plus, supposedly the first AI-powered RPM company. Terms, purchase price, and management changes were not disclosed. Their pitch is to providers with an essentially turnkey system: identify eligible patients, perform patient consent and training, ships devices directly to your patients ready to use, and a ‘virtual medical assistant’ to monitor patients. The AI part of this is Ava, an AI-enabled, text message-based chatbot. This strengthens Connect America’s small RPM division, ConnectVitals. Release  

Connect America also announced in August that they will be opening a new facility to consolidate the scattered Lifeline operations into a single purpose-built location. The new $1 million, 25,000 square-foot facility will bring 71 jobs to the area and will open by end of year. PERS Insider, Upstate Business Journal 

Philips awarded by VA 10-year, $100 million remote ICU, telehealth contract; partners with BioIntelliSense for RPM

July 17, 2020 | by

The US Department of Veterans Affairs (VA) awarded Philips a ten-year contract to build out their remote intensive care (ICU) service infrastructure to make it accessible to veterans from any location in the US. The VA currently manages 1,800 ICU beds nationwide in its approximately 1,700 sites. Based on the release, the Philips engagement in VA Tele-Critical Care will expand the VA’s current capabilities to encompass telehealth, tele-critical care (eICU), diagnostic imaging, sleep solutions, and patient monitoring. The agreement may total $100 million over the 10-year contract duration.

Philips has about 20 percent of the adult eICU market. They claim that 1 in 8 adult ICU patients are monitored 24/7 by their eICU Program, which combines audio/visual technology, predictive analytics, data visualization, and advanced reporting capabilities. Their proprietary research points to shorter ICU visits by eICU patients plus better outcomes. Healthcare IT News, Philips release (Photo: Philips)

By this Editor’s calculation, VA remains the single largest user of telehealth in the US. In their FY 2019, the first year of the ‘Anywhere to Anywhere’ initiative [TTA 24 May 2018], VA delivered more than 2.6 million telehealth episodes to 900,000 veterans. During the early part of the pandemic, they grew virtual home visits from an average of 10,000 to 120,000 per week. By the end of FY 2020, their goal is to deliver all primary care and mental health provider services, both in-person and via a mobile or web-based device. The VA release from November 2019 does not break out the different types of VA telehealth and usage.

Philips and BioIntelliSense have also inked a partnership deal to integrate BioIntelliSense’s BioSticker sensors into their post-acute remote patient monitoring (RPM) systems. The BioSticker is a wearable FDA-cleared 510(k) Class II sensor that transmits passive monitoring of key vital signs, physiological biometrics, and symptomatic events up to 30 days. The first announced user of the RPM+BioSticker systems will be Healthcare Highways of Frisco, Texas, a provider of health plans, employer self-funded health plans,  pharmacy benefit management, population health management, and benefit plan administration. Healthcare Highways is participating in seven patient monitoring programs to assess patient health status with providers: COVID-19, CHF, hypertension, diabetes, total joint replacement, cancer, and asthma. Release (Photo: Philips)

Best Buy buys Critical Signal Technologies, increasing telehealth footprint

June 13, 2019 | by | 3 Comments

Late last month, Best Buy with little fanfare bought Critical Signal Technologies (CST) of Novi, Michigan. CST is a device-agnostic telehealth monitoring and social work services platform through its Care Center, covering services such as PERS monitoring, medication management, and remote patient monitoring. Terms were not disclosed for this private company founded in 2006, but CST cares for 100,000 patients and has partnerships with 1,500 payers, including many Medicare Advantage plans. 

For those seeking the sunnier uplands of digital health, it’s surprising but gratifying to see Best Buy place another sizable bet in the home health area. The recent acquisition of GreatCall for $800 million is larger, but GreatCall is a turnkey, profitable company. The partnership with Tyto Care [TTA 17 April] to retail their system is relatively low risk, limited in scope, and follows their Midwest intro pattern (followed over 12 years ago with, believe it or not, QuietCare when owned by Living Independently).

Best Buy has gained kudos for moving into specialty areas in healthcare when its fellow retailers have been falling by the wayside. It covers both their bricks-and-mortar–where older adults still like to shop–and online, delivering a large slice of health tech directly to consumers. One asset, the tech-oriented Geek Squad, is a ready made unit for installing and walking older adults through using home tech. MedCityNews, MarketWatch

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

January 29, 2019 | by

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.

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

August 9, 2018 | by

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.

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

June 14, 2018 | by

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.

Medtronic, American Well mega-partner for telehealth + telemedicine for chronic care

October 21, 2017 | by

Boston-based American Well and Dublin-based Medtronic announced this week a partnership to integrate telemedicine and telehealth for chronic care management, targeting complex, chronic and co-morbid patients. Under the agreement, American Well’s telemedicine services will integrate into Medtronic Care Management Services (MCMS) video-enabled telehealth platforms for remote patient monitoring and video consults. The goal is to provide more information so that clinicians gain a more complete view of a patient’s health status when making care decisions, thus reducing the cost of care and improving patient outcomes. Care for patients with multiple chronic conditions accounts for over 70 percent of healthcare spending, according to an AHRQ study.

American Well is currently partnered with 250 healthcare partners in the US and more than 750 health systems and 975 hospitals, along with most major health plans. MCMS has two video telehealth platforms including the mobile NetResponse and the LinkView Wi-Fi tabletop. Their most recent activity is with the Midwest’s Mercy healthcare system for data sharing and analysis to gather clinical evidence for medical device innovation and patient access. MCMS platforms are also being integrated into the VA’s Home Telehealth program [TTA 6 Feb and 15 Feb]. It indicates that Medtronic is seeking to grow its telehealth device business, which has largely (except for VA) been a backwater in the immense Medtronic empire.

This is a very logical and in this Editor’s estimation, overdue type of partnership between a telehealth provider to enhance telehealth and RPM. (An easy bet: expect Teladoc to follow with another telehealth provider)

American Well/Medtronic release, Healthcare Informatics, MassDevice

Want to know effectiveness of telehealth, interoperability? NQF reports take their measure.

September 15, 2017 | by

There’s been an increase in doubt about the efficacy of telemedicine (virtual visits) and telehealth (vital signs monitoring) as a result of the publication of two recent long-term studies, one conducted by the University of Wisconsin and the other by CCHSC for Telemonitoring NI [TTA 13 Sep]. These follow studies that were directionally positive, and in a few cases like the VA studies conducted by Adam Darkins, very much so, but mostly flawed or incomplete (low N, short term, differing metrics). What’s missing is a framework for assessing the results of both. In an exceptionally well-timed announcement, the National Quality Forum (NQF) announced their development of a framework for assessing the quality and impact of telehealth services. 

In a wonder of clarity, the NQF defines telehealth’s scope as telemedicine (live patient-provider video), store-and-forward (e.g. radiology), remote patient monitoring (telehealth), and mobile health (smartphone apps). Measurement covers four categories: patients’ access to care, financial impact to patients and their care team, patient and clinician experience, and effectiveness of clinical and operational systems. Within these categories, NQF identified six areas as having the highest priority for measurement: travel, timeliness of care, actionable information, added value of telehealth to provide evidence-based practices, patient empowerment, and care coordination. Finally, the developing committee identified 16 measures that can be used to measure telehealth quality.

The NQF also issued a similar framework for interoperability, a bête noire that has led many a clinician and developer to the consumption of adult beverages. Again there are four categories: the exchange of electronic health information, its usability, its application, and its impact—on patient safety, costs, productivity, care coordination, processes and outcomes, and patients’ and caregivers’ experience and engagement. And it kept the committee very busy indeed with, from the release, “53 ideas for measures that would be useful in the short term (0-3 years), in the mid-term (3-5 years) and in the long-term (5+ years). It also identified 36 existing measures that serve as representative examples of these measure ideas (sic) and how they could be affected by interoperability.”

Both reports were commissioned and funded a year ago by the US Health & Human Services Department (HHS). We will see if these frameworks are extensively used by researchers.

NQF release, Creating a Framework-Telehealth (download link), Creating a Framework-Interoperability (download link), Mobihealthnews 

Telehealth in China: the largest market of them all?

October 12, 2016 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/10/HC_Bulletin_F14_bigdata_china_feature.jpg” thumb_width=”250″ /]Is China ready for telehealth, and the needed investment? It turns out that according to this article, the market does strongly resemble Western, Latin America and APAC countries in its needs and aging, dispersed population. The numbers (left) say yes. The market divides into three for the writer:

  1. A supplement to the public community care system, which has motivated most of the interest the Chinese government has in telehealth to care for millions (defined in the article as patient-doctor video consults, but doesn’t appear to exclude remote patient vital signs monitoring) as well as EHRs, scheduling, online access to diagnostic test results, and e-prescribing.
  2. Rural health care, not as unique as the writer seems to believe. Virtual consults and telehealth are used, and paid for, by CMS in US rural areas and on Native American reservations by the Indian Health Service. We also wrote about it in Brazil [TTA 27 Feb].
  3. Second opinions by Western physicians desired by high net worth individuals and upper middle class families. Again, not that unusual as this resembles the health tourism practiced by the affluent in Latin America and the adoption of video consults. This is denoted as the narrowest and chanciest of the three markets.

Chinese patients in (1) and (2), for the most part, would see any of these as an improvement. Their experience is that they get little time with a physician, don’t have a personal relationship with one or more doctors, and don’t expect much of a personal relationship with their doctor. So telehealth and RPM would be huge upgrades for China.  From Healthintelasia. Illustration from Analysis Group

The mixed picture of health tech investment: a potpourri

March 25, 2016 | by

One picture is generally positive–plenty of opportunity in the aging and ill population, particularly in data integration from various sources, and value-based care. Everyone loves the excitement that a startup with a novel technology or way it can make knowledge more useful brings to the field.  Another picture is one of pitfalls aplenty, from overhyping technology (poster child, Theranos) to overestimating growth, overspending and especially picking the wrong (nervous, impatient) investors at the wrong time, which have left a general patina of mistrust around digital health. There’s also the fact that healthcare is a highly, confusingly regulated, long-cycle business that’s challenged money-wise, whether in the US, UK, Europe or Asia. Some advice to startups contained in these two articles, including from the principals of StartUp Health accelerator (who’ve seen it all), has to do with building trust, finding the right investors, the right advice/advisors, collaboration (though that is difficult with IP), finding proven (affordable) management and a sustainable (and resilient) culture. Underpromise, overdeliver.  TechCrunch, Healthcare Dive

No wonder that investment was flat in 2015, and that much of the news is around acquisitions that rearrange companies and/or offerings. The latest today is Allscripts‘ and GI Partners’ acquisition of behavioral EHR/care coordination company Netsmart for $950 million; Allscripts is moving its homecare business into Netsmart’s CareFabric suite. Kansas City Business Journal, Healthcare Dive  In addition we’ll cite our earlier Mo’ Money article on the $600 million in various digital health investments. UPMC, which had invested in Vivify Health’s telehealth/RPM platform, is spreading $3 million around partly in-house to six health tech projects developed under the Pittsburgh Health Data Alliance. And in an example of Wearables Confusion, investors put $16 million into LifeBeam to develop another DTC ‘holistic’ health wearable (LifeBeam’s origins are sensors for aerospace and defense) while early wrist fitness entrant Pebble has laid off 40 staff in an attempt to refocus on…fitness.

Early-stage companies are also alliancing and merging. Fresh out of Newark and the New Jersey Institute of Technology’s NJ Innovation Institute, the merger of Practice Unite (which knits together secure mobile clinician/patient communications into a customized platform) and Uniphy Health (physician engagement), is an example of complimentary enlargement. This expands care collaboration offerings and shades over into patient engagement if you look at the PHM quadrant here. According to Director/Chief Medical Officer Stuart Hochron, MD (who was a Practice Unite founder), “We’re really pleased with the outcome of this merger. It’s given us the capital and resources that we need to scale.” It’s also good to see that both the founders and the CTO are moving into the new Uniphy Health–and staying in Newark.  Release