TTA’s summer #6: telehealth wars turn, mental health apps get $$, NHS England’s Sir Simon interviewed, Alcuris’ cyber-OK, Cerner promises to right the VA ship

 

 

Weekly Update

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

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

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

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

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

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

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

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

Summer is speeding up before our eyes as we in the US celebrate our Independence Day (sorry, George III!). Tunstall appeals Swedish procurement exclusion. Bright Health and Olive both had beaucoup funding. StartUp Health spotlights brain health. Cerner and VA, imperfect together. Telehealth usage settling down. And, in product tie-ins–buy a Black+Decker PERS, get a power drill?

Lightning news roundup: AI for health systems Olive scores $400M, VA’s sticking with Cerner EHR, Black+Decker gets into the PERS game (An unseen connection between power drills and PERS units?)
Tunstall under fire in Swedish court on appeal of Adda procurement exclusion (Their Nordic troubles continue)
Four ‘moonshot’ health tech startups aiding cognition and brain health (podcast) (A worthwhile half-hour)
‘Insurtech’ Bright Health’s IPO second largest to date, but falls slightly short of estimates (updated) (Bad market day for an interesting model)
Telehealth usage going flat, off by 1/3 and declining: Trilliant Health study (Not taking over the world)

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

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

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

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Telehealth Wars: Amwell’s raises game with buys of SilverCloud and Conversa Health (updated); Teladoc’s slow member, hospital growth lead to $133M Q2 loss

Updated. Amwell’s announcement today (28 July) of the twin acquisitions of SilverCloud Health and Conversa Health for the tidy total sum of $320 million in cash and stock was, if not quite a ‘see ya and raise ya’ move, a confirmation that Amwell was going to raise its game, at long last, versus Teladoc. SilverCloud provides digital telehealth programs for common behavioral health conditions. A spinoff of Trinity College Dublin, it counts as US clients Kaiser Permanente, Optum, and Providence Health, plus over 80 percent of NHS’ mental health service. Conversa is a StartUp Health portfolio company that developed a scalable care management triage system for at-risk patients that provides automated patient outreach and engagement tools that can move them to higher levels of care where needed. Clients include Northwell Health, UCSF Health, UNC Health, Merck, MedStar Health, and Prisma Health. 

For Amwell, this expands their capabilities in the hot behavioral health area and, with Conversa, into a care management platform targeted to providers, pharma, and payers. They see digital workflows, patient engagement, a longer-term relationship with their consumer base through the continuum of care, through these two companies’ hospital, health system, health plan, and employer clients.

The wrinkle? Neither company is all that far along–SilverCloud has total funding of only $26 million but is more established with 750,000 clients and 300 organizations. Conversa’s Series B was a tiny $8 million for total funding of $34 million. Amwell also paid a premium price. According to Healthy Skeptic, a blog written by long-time UnitedHealth Group senior healthcare executive Kevin Roche, their combined revenue was $15 million–more than a 20x multiple of the purchase price. The other challenge for Amwell? Making all the systems work together in a meaningful way–and to market what can be a confusing picture properly. Amwell press release, Mobihealthnews

Update 2 August. The Irish Times, undoubtedly working a local contact at Silver Cloud, ascertained that Silver Cloud was purchased by Amwell for a price in excess of $250 million. That means a tidy payday of €23 million ($27.3 million) for the company’s founders – Ken Cahill, James Bligh, Karen Tierney, Dr John Sharry, and Gavin Doherty. If that is so, Conversa was bought for $70 million or less. One wonders why a shell game tactic was used, as Conversa is known to be an early-stage company. Hat tip to HISTalk today.

For Teladoc, growing beyond urgent care, plus integrating the former Livongo and InTouch Health, presents difficulties. Telehealth usage continues to shrink as in-person visits rebound save for behavioral health, which is also bad news for the payers as utilization goes up. Teladoc now struggles to add new members after last year’s pace. Their hospital business that came with last year’s acquisition of InTouch Health is growing more slowly than expected [TTA 16 July]. The expected cross-sales traction with the former Livongo hasn’t caught fire yet, but that may change with myStrength Complete and the myStrength app going live with health plans or employers starting this month. The first enterprise customers are a major Blues plan (likely HCSC) and a Fortune 100 employer. [TTA 14 May]. Teladoc is also growing into other areas with more continuous user engagement, such as chronic care, weight management, and primary care. That program, Primary360, is in “very very late-stage” discussions with multiple payers. Teladoc, which has never been profitable, lost $133.8 million for Q2.   Healthcare Dive

The implications of Teladoc’s integration into Microsoft Teams

The Big News this week was the terse announcement by Microsoft and Teladoc that Teladoc’s Solo application for hospitals and health systems will be integrated into Microsoft Teams applications. The integration includes workflows and through Solo, integration into EHRs while remaining in Teams.

During the pandemic, many health systems resorted to Microsoft Teams to communicate internally and one-on-one with patients. Integration means that while on the Teams consult, a clinician can securely access clinical data included within the EHR and workflows via Teladoc Health Solo without leaving it. It can also connect care teams on the consult. The release also mentions the magic words artificial intelligence and machine learning, without giving examples. 

As of now, with telehealth receding to perhaps 5% of visits based on claims [TTA 9 July], it’s a strategic win for Teladoc to integrate with a part of the Microsoft suite widely used by providers. It also builds on an existing relationship between the companies, as Teladoc already uses Azure as one of its cloud providers. Health systems still have to license Teladoc Solo if they do not already, and engineering work is yet to be done. Teladoc has a substantial foothold in this market due to its July 2020 acquisition of InTouch Health. InTouch’s hospital-to-home telehealth is now Teladoc Solo, with a separate line of business into the specialty telehealth consult market through its portable wheeled telehealth carts for in-hospital use. It’s notable that the InTouch brand remains, albeit visibly transitioning to Teladoc.

According to Credit Suisse’s analysis (page 3), 46% of C-Level executives from hospitals and health systems (combined representing 563 hospitals) said that they currently work with Microsoft Teams as a telemedicine vendor. 11% said they already work with Teladoc/InTouch Health.

As for telehealth already used by providers, such as Zipnosis’ ‘white label’ triage/telehealth system (now owned by insurtech Bright Health) and Bluestream Health, can they compete? Also FierceHealthcare

Telehealth usage going flat, off by 1/3 and declining: Trilliant Health study

Trilliant Health, a healthcare data analytics and advisory shop based in Tennessee, has run some projections on the US healthcare market and telehealth, and they’re not as bright as many of us–and a lot of investors plus Mr. Market–have believed. It opens up on page 4 of the electronic document (also available in PDF) with this ‘downer’–that the largest sector of the largest global economy is overbuilt and unsustainable. Hospitals and health systems have operated for decades that basic economic factors–demand, supply, and yield–don’t apply, and there are more companies competing with them for the consumer healthcare dollar than they realize–with more proliferating every day. 

Sledding through their 160-page report, we turn to our sweet spot, telehealth, and Trilliant is not delivering cheerful news (pages 32-43). 

  • Unsurprisingly, demand for telehealth is tapering off. Based on claims data for face-to-face video visits, excluding Medicare fee-for-service (Original Medicare) and self-pay visits, they peaked above 12 million in April 2020 and, save for a bump up in December 2020-January 2021, steadily declined to about 9 million by March 2021.
  • Teladoc, the leading provider, is projecting that 2021 volume will only represent 4 percent of the US population–a lot more than before, but not growing as it did in 2020.
  • Telehealth’s growth was astronomical on both coasts–California, Massachusetts, Vermont, Oregon–and Hawaii–but relatively lower in middle and Southern America in places like Wyoming, North Dakota, Mississippi, and Iowa. Telehealth usage is declining sharply in that region as well but across the board in all states including California. In fact, Phoenix and Dallas had higher telehealth utilization pre-pandemic than during it.
  • Mental health drove telehealth growth during the pandemic, representing 35 percent of claims, almost four times the next group of categories at 8 percent. The largest group of diagnoses were for anxiety and depression among women 20-49. With the reopening of the US economy and children heading back to school, will this sustain or decline?
  • Women 30-39 are the largest users of telehealth–pre, during, and post-pandemic

Telehealth is not only proliferating, it is going up against now-open urgent care, retail clinics from Walgreens, Walmart, and CVS, plus tech-enabled providers that blend virtual care with home care, such as Amazon with a full rollout of Amazon Care and other employers. The cost of care is also a negative driver. FierceHealthcare analyzes other parts of the report impacting practices, health systems, and hospitals.

 

Disruption or giveaway: Amazon Care signs on employers, but who? Amazon Pharmacy’s 6 months of meds for $6. (updated)

Is this disruption, a giveaway, or blue smoke requiring IFR? An Amazon Care VP, Babak Parviz, said at the Wall Street Journal’s Tech Health virtual event that all is well with their rollout of virtual primary care (VPC). Washington state is first, with VPC now available nationally to all Amazon employees as well as companies. However, Mr. Parviz did not disclose the signed-up companies, nor a timetable for when in-person Amazon Care practices will be expanding to Washington, DC, Baltimore, and other cities in the coming months.

Mr. Parviz also provided some details of what Amazon Care would ultimately look like:

  • Clinician chat/video connected within 60 seconds
  • If an in-person visit is required, a mobile clinician arrives within 60 minutes, who can perform some diagnostic tests, such as for strep throat, provide vaccinations and draw blood for lab work. For other diagnoses, that clinician is equipped with a kit with devices to monitor vital signs which are live-streamed to remote clinicians.
  • Medication delivery within 120 minutes

FierceHealthcare

The timing of the Amazon Care rollout has not changed since our coverage of their announcement in March. This Editor noted in that article that Credit Suisse in their overview was underwhelmed by Amazon Care as well as other efforts in the complex and crowded healthcare space. Amazon Care also doesn’t integrate with payers. It’s payment upfront, then the patient files a claim with their insurer.

Existing players are already established in large chunks of what Amazon wants to own.

  • Both Amwell’s Ido Schoenberg [TTA 2 April] and Teladoc’s Jason Gorevic (FierceHealthcare 12 May) have opined that they are way ahead of Amazon both in corporate affiliations and comprehensive solutions. Examples: Amwell’s recently announced upgrade of their clinician platform and adding platforms for in-home hospital-grade care [TTA 29 Apr], Teladoc’s moves into mental health with myStrength [TTA 14 May].
  • Even Walmart is getting into telehealth with their purchase of a small player, MeMD [TTA 8 May].
  • CVS has their MinuteClinics affiliated with leading local health systems, and Walgreens is building out 500 free-standing VillageMD locations [TTA 4 Dec 20]. CVS and Walgreens are also fully integrated with payers and pharmacy benefit management plans (PBM).

Another loss leader is pharmacy. Amazon is also offering to Prime members a pharmacy prescription savings benefit: six-month supplies of select medications for $6. The conditions are that members must pay out-of-pocket (no insurance), they must have the six-month prescription from their provider, and the medication must be both available and eligible on Amazon Pharmacy. Medications included are for high blood pressure, diabetes, and more. The timing is interesting as Walmart also announced a few days earlier a similar program for Walmart+ members. Mobihealthnews.

crystal-ballThis Editor’s opinion is that Amazon’s business plans for both entities and in healthcare are really about accumulating data, not user revenue, and are certainly not altruistic no matter what they say. Amazon will accumulate and own national healthcare data on Amazon Care and Pharmacy users far more valuable than whatever is spent on providing care and services. Amazon will not only use it internally for cross-selling, but can monetize the data to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Shouldn’t privacy advocates be concerned, as this isn’t being disclosed? 

Teladoc integrates the myStrength cognitive mental health app with their telehealth network

Teladoc gets into the mental health app business, end to end. The myStrength cognitive health app, which was picked up as part of the Livongo acquisition, reappears as a Teladoc product called myStrength Complete. The front door is the myStrength app, which offers coaching, positive psychology, and cognitive behavioral therapy, which then connects with Teladoc’s therapists and psychiatrists to offer a comprehensive experience.  

Teladoc will offer this to consumers through their health plans or employers starting in July. The first enterprise customers, according to Teladoc, are a major Blues plan and a Fortune 100 employer. 

The company also provided the results of their proprietary third-party research, which indicated unsurprisingly that a majority who sought support (69 percent) indicated it would be difficult and/or overwhelming to use multiple websites, mobile apps, or virtual care platforms to address mental health needs. Nearly all of those surveyed who said they sought virtual mental health support – 92 percent – reported at least some improvement during the pandemic, with over one-third reporting significant improvement or a “breakthrough” during treatment.

An unintended consequence of Teladoc’s move? A cooling off of the mental health boomlet, now that the elephant has chosen where to sit. The stand-alone cognitive health apps such as AbleTo, Lyra Health, and Ginger, now need to seek partners, such as health plans (Vida Health) or telehealth providers. Unfortunately, the telehealth providers remaining have either some behavioral health capabilities–and that may be enough for their business–or find the price too high. Teladoc release, Mobihealthnews

News roundup: Buddi’s £500M LSE float, Accolade to buy PlushCare for $450M, Teladoc adds chief innovation officer, Tyto Care’s Italy expansion

Buddi going public later this year. Something we missed and found (quite by accident) was that the Buddi personal alert wearable will be floated on the London Stock Exchange later this year. According to the report in SkyNews, CEO and founder Sara Murray has appointed Zeus Capital to manage it. The value is rumored to be up to £500 million and will be a great reward for Ms. Murray and her other early investors. The bands, which connect to smartphones or a wireless-connected clip, then to pre-set connections or their 24/7 support, retail for up to £248. Buddi is reported to be used by more than 80 percent of local authorities in the UK, UK police forces for domestic violence cases and witness protection, lone worker situations, plus government customers internationally. Buddi also designs and assembles their Buddi units in the UK. Also City A.M. 

Accolade, a health benefits navigation provider, announced a definitive agreement to purchase one of the smaller telehealth players, PlushCare, for a plush price of $450 million, composed of $40 million in cash, $340 million in Accolade common stock, and up to (the usual) additional $70 million of value payable upon the achievement of defined revenue milestones following the closing, expected in June. Accolade, which itself went public on NASDAQ in July, raising $220 million, then in October floated additional shares to raise $221 million, has been on a telehealth acquisition tear of late. In March, they closed their acquisition of virtual second medical opinion provider 2nd.MD for $460 million. PlushCare will enable Accolade to directly offer primary and mental health care telehealth to its members. According to Steve Barnes, chief financial officer at Accolade, their addressable market will increase nearly five-fold to more than $200 billion. One wonders whether their existing relationships with Teladoc and Livongo will continue.  Release.  Also HealthcareDive and FierceHealthcare.

Teladoc adds a chief innovation officer. Claus Jensen, PhD comes from Memorial Sloan Kettering Cancer Center, where he served as chief digital officer and head of technology. His purview will include product innovation, information systems, health informatics, and data products. Previously, he was with Danske Bank, IBM, and chief technology officer of CVS Health-Aetna. Release, Becker’s Hospital Review

TytoCare advances further into Italy in a partnership with Multimed srl, a local medical device company. The partnership will develop the market there with local providers, hospitals, elder care facilities, independent physicians, and pharmacies, as well as at-home monitoring. Multimed is a multi-line distributor of surgical devices for robotic surgery, endoscopy, laparoscopy, orthopedics, sanitization/sterilization, and similar. Tyto earlier explored the Italian market in a partnership with the ASL of Vercelli hospital group, where physicians monitored and treated elderly and pediatric COVID-19 patients, performing pulmonary, cardiological, and dermatological telehealth visits. Release

Weekend reading: the strange reasons why Amwell doesn’t consider Amazon a competitor; ground rules for the uneasy marriage of healthcare and technology

Yahoo Finance interviewed co-CEO/founder of Amwell Ido Schoenburg, MD on the company’s 2020 results and forecast for 2021. It makes for interesting but convoluted reading on their growth last year in what is a consolidating field where Amwell was once one of the undisputed two leaders. They now compete against payers acquiring telehealth companies (MDLive going to Optum) and mergers like Doctor on Demand-Grand Rounds that are taking increasing market shares. Then there are specialty providers like SOC Telemed and white-labels like Bluestream Health. However, there are a couple of whoppers in the happy talk of growth for all. Dr. S pegs the current run rate of telehealth visits at 15-20 percent. The best research from Commonwealth Fund (October) and FAIR Health (August) tracked telehealth at 6 percent of in-office visits. Epic Health Research Network measured 21 percent at end of August. [TTA summary here

Then there’s the tap dance around Amazon Care. His view is that telehealth companies all need a connective platform but that each competitor brings ‘modular components’ of what they do best. What Amazon excels at is the consumer experience; in his view, that is their contribution to this ‘coalition’ because healthcare doesn’t do that well. There’s a statement at the end which this Editor will leave Readers to puzzle through:  

“And Amazon and others could bring a lot of value to those coalitions, they should not be seen as necessarily competing unless you’re trying to do exactly what they do. And there are some companies, including some telehealth companies, that that’s what they do. They focus on services. They try to sell you a very affordable visit with a short wait time and a good experience. They should be incredibly concerned when someone so sophisticated as Amazon is trying to compete in that turf.”

The last time this Editor looked, none of these companies were non-profit, though nearly all are not profitable.

Gimlet EyeLooking through her Gimlet Eye, Amazon Care is a win-win, even if the whole enterprise loses money. In this view, Amazon accumulates and owns national healthcare data far more valuable than the consumer service, then can do what they want with it, such as cross-analysis against PillPack and OTC medical shopping habits, even books, toys, home supplies, and clothing. Ka-ching!

A ‘bucket of cold water’ article, published in Becker’s Health IT last month, takes a Gimlety view of the shotgun marriage of healthcare and technology. Those of us laboring in those vineyards for the better part of two decades might disagree with the author in part, but we all remember how every new company was going to ‘revolutionize healthcare’. (The over-the-top blatherings of ZocDoc‘s former leadership provide a perfect example.) The post-Theranos/Outcome Health/uBiome world has demonstrated that the Silicon Valley modus operandi of ‘fake it till you make it’ and ‘failing fast and breaking things’, barely ethical in consumer businesses, are totally unethical in healthcare which deals in people’s lives. Then again, healthcare focused on ‘people as patients’ cannot stand either. Stephen K. Klasko, MD, President and CEO, Thomas Jefferson University and Jefferson Health in Pennsylvania, advocates for a change–far more concisely than Dr. Schoenburg. You may want to pass this along.

Two major moves and what they mean: Doctor on Demand, Grand Rounds to merge; Amazon Care will go national by summer (updated)

This week’s Digital Health Big Deal (as of Wednesday!) is the merger agreement between telehealth/virtual visit provider Doctor on Demand and employer health navigator Grand Rounds. Terms were not disclosed. It’s important because it extends Grand Rounds’ care coordination capabilities beyond provider network navigation and employee clinical/financial tools for six million employees into an extensive telehealth network with 98 million patients in commercial, Federal, and state health plans.

Both companies had big recent raises–$175 million for Grand Rounds in a September 2020 Series E (Crunchbase) and Doctor on Demand with a $75 million Series D last July (Crunchbase). The transaction is a stock swap with no cash involved (FierceHealthcare, CNBC), and the announcement states that the two companies will operate under their own brands for the time being. Owen Tripp, co-founder and CEO of Grand Rounds, will run the combined company, while Doctor on Demand CEO Hill Ferguson runs DOD and joins the board. The combined company is well into Double Unicorn status with over $2 bn in valuation. Also Mobihealthnews.

What it means. Smaller (than Teladoc and Amwell) telehealth companies have been running towards M&A, with the most recent MDLive joining Optum’s Evernorth [TTA 27 Feb] creating interstate juggernauts with major leverage. Doctor on Demand was looking at their options for expansion or acquisition and decided 1) the time and the $ were right and 2) with Grand Rounds, they could keep a modicum of independence as a separate line while enjoying integration with a larger company. The trend is profound enough to raise alarms in the august pages of Kaiser Health News, which decries interstate telehealth providers competing with small and often specialized in-state providers, and in general the loosening of telehealth requirements, including some providers still only taking virtual visits. Contra this, but not in the KHN article, this Editor has previously noted that white-labeled telehealth providers such as Zipnosis and Bluestream Health have found a niche in supplying large health systems and provider groups with customized telehealth and triage systems.

UPDATED. In the Shoe Dropping department, Amazon Care goes national with virtual primary care (VPC). To no one’s surprise after Haven’s demise, Amazon’s pilot among their employees providing telehealth plus in-person for those in the Seattle area [TTA 17 Dec 20] is rolling out nationally in stages. First, the website is now live and positions the company as a total care management service for both urgent and primary care. Starting Wednesday, Amazon opened the full service (Video and Mobile Care) to other Washington state companies. The in-person service will expand to Washington, DC, Baltimore, and other cities in the next few months. Video Care will be available nationally to companies and all Amazon employees by the summer.

Notably, and buried way down in the glowing articles, Amazon is not engaging with payers on filing reimbursements for patient care. Video Care and Care Medical services will be billed directly to the individual who must then send for reimbursement to their insurance provider. The convenience is compromised by additional work on the patient’s part, something that those of us on the rare PPO plans were accustomed to doing back in the Paper Age but not common now. It also tends to shut out over 65’s on Medicare and those on low-income plans through Medicaid. It is doubtful that Amazon really wants this group anyway. Not exactly inclusive healthcare.

TechCrunch, FierceHealthcare. Jailendra Singh’s Credit Suisse team has a POV here which opines that Amazon continues to have a weak case for disruption in VPC, along with their other healthcare efforts, and an uphill battle against the current telehealth players who have already allied themselves with employers and integrating with payers.

News and deal roundup: Signify Health’s $564M IPO, RapidSOS’ $85M Series C, Poland’s Telemedico raise, Livongo’s Zane Burke to Bardavon

The Big Deal of the Week is Signify Health‘s IPO which on 11 February raised $564 million on a sale of 23.5 million shares on the NYSE. Signify provides comprehensive care and management services such as complex care management, SDOH, episodes of care/bundled care programs, and specialized medical services in the home, utilizing technology and data analytics. Signify now has a market capitalization of $7.12 bn. FierceHealthcare, MarketWatch, Signify release.

RapidSOS, an emergency response data platform that provides Next Generation 911 and Emergency Services Network services to Emergency Communication Centers, had a Series C raise of $85 million led by Insight Partners and Global Venture Capital. The RapidSOS technology in global use links 350 million connected devices to first responders and 4,800 data centers. They have raised $205.7 million over 14 rounds since 2016. Crunchbase, release

On the other side of the deal continuum, Poland’s Telemedico, a telemedicine provider in multiple European and Middle Eastern countries, raised a modest €5.5 million (~$6.6 million) in a Series A round. The round is led by Flashpoint Venture Capital, Uniqa Ventures, PKO VC, Black Pearls VC, and Adamed. Mobihealthnews, TechCrunch

And in a coda to the Telavongo story (Teladoc and Livongo), former CEO Zane Burke joined as a director of workers compensation digital health company Bardavon Health Innovations. Mr. Burke led the $18.5 billion merger with Teladoc in his two years as CEO, after 20 years at Cerner. Becker’s Health IT, release (DigitalJournal)

Digital Health as Boom Town: 2020’s dizzying funding rounded up by Mercom Capital, StartUp Health

BOOM! Mercom Capital Group published their Q4 and 2020 roundup of global digital health investment and, no surprise, the investment picture for just about anything digital health was in sharp contrast to most of the COVID-afflicted world economy.

The topline:

  • Global VC funding (private equity and corporate venture capital) was $14.8 bn across 637 deals. It was a 66 percent increase in funding compared to 2019’s $8.9 bn in 615 deals. The modest increase in deal number and huge increase in funding points to the acquisition of more established companies requiring Big Deals.
  • Total corporate funding, including VC, debt, and public market financing, totaled $21.6 billion

 

In a stunning change, telemedicine was Top Of The Pops, with $4.3 bn in investment, 139 percent over 2019’s $1.8 bn. It was over double the former star categories of data analytics and mHealth apps.

The top five disclosed M&A transactions in 2020 they tracked were:

  • Teladoc’s acquisition of Livongo Health for $18.5 bn
  • Blackstone’s acquisition of a majority stake in Ancestry.com for $4.7 bn (despite the ‘bloom off the rose’ of consumer genetic testing)
  • Philips’ acquisition of BioTelemetry in cardiac monitoring for $2.8 bn
  • Invitae’s acquisition of ArcherDX for $1.4 bn
  • WellSky’s acquisition of Allscripts’s CarePort Health (CarePort) for $1.35 bn

The Executive Summary is available for free download at the link in the release. The full report will set you back $599 – $999, depending on the version.

StartUp Health has slightly different numbers but in total investment tracks almost to Mercom Capital’s estimate at $21.5 bn. For telemedicine, it still triples year-over-year but StartUp’s totals are lower: 2019’s $1.1 bn to 2020’s $3.1 bn. Part of the difference may be remote monitoring, which StartUp considers separately. It doubled from $417 million to $941 million. Their deal counts were also higher: 764 in 2020 compared to 716 in 2019. Another fun fact in their tracking are their city leaders in health innovation funding: Beijing, Tel Aviv, and London, confirming that New York and the San Francisco metro no longer have money, interest, or their former attraction. A fuller list would have been interesting. More is in their Part 1 study. Part 2, to be released next week, will cover their dozen ‘health moonshots’.

Amazon’s feint into large employer telehealth; HealthLake dives into structured health data analytics

Much ado about…..? Amazon is reportedly making an effort to lure large employers into its Amazon Care telehealth and in-person care platform. Amazon Care is a health benefit presently offered to Amazon employees, with telehealth nationally and in-person for Seattle area residents.  

About 300 Amazon employees use it, which is low given their employee size and after 15 months. Since internal takeup has to date been limited, this Editor observes that Amazon may be testing the scaleup waters by inviting other companies in. These reports indicate that online real estate marketplace Zillow was approached but has moved no further with it. Companies would be charged a per member per month fee plus a ‘technology fee’. 

For those interested in telehealth’s positioning among US employers, the Credit Suisse report by Jailendra Singh’s team makes important points on where both Teladoc and Amwell stand with employers and health plans–and it’s not promising for Amazon:

  • Telehealth has been adopted by 90 percent of employers, but it’s a fraction of benefit spending for them
  • What’s important to employers is not the cost of the program, but employee engagement, the potential volume of medical cost savings, and management of chronic conditions
  • Telehealth vendors are increasingly ‘carved into’ contracted health plans
  • Between direct employer contracts and health plans, Teladoc is settled into this segment, and diversified into medical systems with new acquisitions InTouch Health and chronic care management with Livongo. Amwell is situated in the white-label provider market with health systems and health plans, with few employer contracts. 

 AMZN Making a Push in Telehealth For Large Employers: Appears to Be More Noise than Substance

A better-positioned initiative for healthcare providers that Amazon just announced is HealthLake, which is a HIPAA-eligible AWS cloud service for storing and analyzing structured and unstructured data at petabyte scale. The ‘lake’ is the data lake in the cloud. It copies health data in the Fast Healthcare Interoperability Resources (FHIR) format, and analyzes unstructured data uses specialized machine learning models, like natural language processing, to automatically extract meaningful medical information. Current users, according to their website, are Cerner, Konica Minolta, and Orion Health. Hat tip to HISTalk.

Breaking: Teladoc and Livongo close merger in $18.5 billion deal, staff/board changeovers

Breaking: Today (30 October) Teladoc announced the closing of its merger with Livongo. The release itself is pro forma. The acquisition is interesting in how rapidly it was completed: from ‘git to gone’ in under three months. By contrast, Teladoc’s close on much smaller InTouch Health took eight months. It is, of course, still positioned as a merger, but it is clearly a purchase based on the terms and their branding. (More of Editor Donna’s thoughts on this here and here.) 

Livongo shareholders will receive 0.5920 Teladoc shares plus cash of $11.33 for each Livongo share (including the special dividend declared by Livongo). The Motley Fool did the math and valued it at $18.5 million after the shareholder approval. Current Teladoc shareholders will own 58 percent, with Livongo investors holding 42 percent. Mr. Market continues to be cross, as the day started with TDOC above $215 with the current price (1pm Eastern time) at just above $197, though Teladoc’s 3rd Q earnings were excellent. TDOC’s share price just before the acquisition hovered in the $230s.

This Editor has already noted the reported exodus of many of Livongo’s top management, presumably to the bank: CEO Zane Burke, President Jennifer Schneider, MD, CFO Lee Shapiro (widely conceded as the merger engineer), and SVP of business development Steve Schwartz. David Sides, Livongo’s COO, and Arnnon Geshuri, Cheif (sic) Human Resources Officer, retain their same position as at Teladoc. According to their latest (29 Oct) 8-K, new members of the board effective 19 November will include Glen Tullman (formerly Livongo Executive Chair), Chris Bischoff (Kinnevic AB), Karen L. Daniel, Sandra Fenwick, and Hemant Taneja (General Catalyst, of which more follows).

MedCityNews detailed the above plus that R&D will be headed on an interim basis by Yulun Wang, PhD, who came over from InTouch. Also, a number of Livongo execs (Glen Tullman, Schneider, and three other managers) are putting their new wealth to work for their futures with General Catalyst’s Hemant Taneja, a Livongo backer. An S-1 was filed on 19 October to create a new special-purpose acquisition company with the goal of raising $500 million. Commonly dubbed a ‘blank-check’ company, a SPAC is a public company designed to quickly take a private company public versus the slower process of an IPO. Recent healthcare examples have been Hims Inc. and SOC Telemed

Livongo’s website as to management is already updated and cut over. The Teladoc site does not have a Livongo page other than on press releases and a landing page here. Much remains to be seen in this consolidation of telemedicine and monitoring/coaching, including whether the combined company can deliver on much-needed profits.

News roundup: Kaiser/Best Buy Lively partners; Teladoc’s mental telehealth, Livongo execs depart; approved apps make comeback in US, DE; United Airlines tests COVID CommonPass for international flying

Kaiser Permanente is adding to its existing partnership with Best Buy Health. The joint program will develop remote patient-monitoring tools for older adults centered on Lively Mobile Plus. By pressing a button on the phone, users can connect with individuals trained to triage emergency and nonemergency situations, from car trouble, home lockouts, or medical emergency. Kaiser Permanente has rolled it out to their Medicare members as part of its Medicare Affinity Program for independent living at home. In 2019, the Kaiser system piloted Lively Mobile Plus after Best Buy’s acquisition of GreatCall. Becker’s Hospital Review 6 October and 22 October. Photo from Best Buy via Kaiser on Twitter, @aboutKP.

Teladoc launches mental telehealth to Canadian employers. Four Livongo C-levels will depart after closing. The Teladoc Mental Health Care program is available to employees of Canadian companies and provides access to psychiatrists, psychologists, and therapists via phone, web or mobile app. It is in addition to Teladoc’s Mental Health Navigator and disability products in Canada. Press release, Becker’s Hospital Review  Becker’s has also been keeping a close eye on Teladoc’s SEC filings. The letter, filed 15 October, stated that Livongo CEO Zane Burke, President Jennifer Schneider, MD, CFO Lee Shapiro (widely conceded as the merger engineer), and SVP of business development Steve Schwartz will leave the company after the closing. Livongo’s Executive Chair Glen Tullman will keep his seat on the combined company’s board of directors. Look for more changes that won’t make Livongo employees happy. Our previous Skeptical Takes on the merger here.

Approved Apps Revive! The American Telemedicine Association (ATA) announced a new partnership with the UK’s ORCHA–the Organisation for the Review of Care and Health Apps–to develop an approval procedure for health apps. Announced at the virtual HLTH conference, the objective is to create a review process to vet safe and effective health apps out of various app stores. ORCHA’s automated, intelligent review engine can assess thousands of apps against more than 300 measures in order for a healthcare organization to build and manage a health app program. Both are trying to solve the same problem faced by Happtique and IMS Health (now IQVIA) in those long-ago days of 2014. ATA release, Healthcare IT News 

For Readers with long memories, iMedical Apps is still with us and their team is still reviewing health apps both personal and professional. They’ve extended their reach to reviewing apps to prescribe with iPrescribeApps.

Meanwhile, in Germany, the Digital Healthcare Act (DVG) now finally permits doctors to officially prescribe apps to patients. The Federal Institute for Drugs and Medical Devices (BfArM) certified Kalmeda for tinnitus and Velibra, a therapy program for anxiety disorders as Germany’s first two insured health apps. Germany also is kick-starting prescribed health apps through fast-tracking medical apps that are CE-marked as Class 1 and 2a low-risk medical devices. Healthcare IT News

United Airlines is testing an app-based ‘health pass’ to speed safer global travel. CommonPass, created by the Commons Project Foundation and the World Economic Forum to enable travelers to securely share their COVID-19 test status, taken 72 hours before flight, across borders. The app will also facilitate a health declaration that may be required by the destination country and generates a quick response (QR) code scannable by airline staff and border officials. UAL’s London-Newark test follows on a test with Cathay Pacific between Hong Kong and Singapore. FierceHealthcare, MarketWatch

Teladoc sues Amwell on patent infringement–again

This week’s Big News in the Telehealth Wars was Teladoc suing their chief rival Amwell (the former American Well) for patent infringement. These relate largely to telemedicine carts and robotic technology patents acquired by Teladoc via InTouch Health, which was finalized in July. InTouch Health’s value in the neighborhood of $1bn, when all was factored in, was reinforced by its over 130 patents and pending applications.

Notices were sent by Teladoc in mid-September for compliance by 18 September. It was mentioned by Amwell as meritless in filings with the Securities & Exchange Commission but apparently did not make a dent in their through-the-roof IPO raise of $742 million on 16 September. Their share price remains steady at over a $10 per share increase from the IPO price.

Amwell’s infringing products, according to reports on the lawsuit filed in the US District Court for the District of Delaware, encompass their Carepoints line of digital scope, stethoscope, and four different types of telemedicine carts, including the Horus HD Digital Scope System and the Thinklabs One Digital Stethoscope. There are nine contested patents. Teladoc is asking for treble damages plus court fees. Amwell has already stated that this type of business for them is in single digits–5 percent of revenue in 2019.

Both Amwell and Teladoc have been down this road before in 2015 and 2016. Teladoc also started it then, with Amwell countersuing–and losing in June 2016, with additional patent challenges filed by Teladoc with the USPTO. This record doesn’t bode well for Amwell, but even though IP fights tend to generate nasty headlines and drain resources, what is contested is a fraction of their business. Curiously, to this Editor’s knowledge, there is no record of InTouch Health, prior to their acquisition, challenging Amwell on these systems. Healthcare Dive, Healthcare IT News, Fierce Healthcare, WSJ (paywalled)

Digital health investment smashes the ceiling: $9.4 bn invested through 3rd Q

$9.4 bn is a whole lot of bubbly! To no one’s surprise in the industry, kick-started by telehealth, Rock Health’s tracking of US digital health company investment through 3rd Q smashed through 2018’s full-year high point ($8.2 bn) with a cannonball of a total. Adding $4.0 bn to first half’s $5.4 bn, it represents 311 deals and is 27 percent above last year’s oddly fading-in-the-stretch $7.4 bn [TTA 7 Feb]. Rock Health projects the year total to be about $12 million and 400 deals. 

  • Average deal size topped $30.2 million, 150 percent greater than the $19.7 million average in 2019.
  • Driving this total were “mega deals” of $100 million or more, accounting for 41 percent of all deals (compared with 30 percent for year 2019). Even with the inclusion of fitness companies that this Editor does not consider true health tech, such as Zwift (interactive fitness entertainment), ClassPass (online fitness), and Tonal (more online fitness), the 20+ remaining companies indicate a concentration of Big Capital into Big Deals. The Big Deals concentrate in three sectors: on-demand virtual care delivery, R&D process enablement, and fitness/wellness.
  • Not surprisingly, telehealth and telemedicine are soaring: $1.6 bn in funding compared to $662 million same period 2019
  • Also pointing to concentration: 64 percent of this year’s investors have previously made investments in digital health, which exceeds any prior year. Institutional venture firms have the largest share of transactions (62 percent), with corporate venture capital accounting for 15 percent of transactions.
  • Given COVID and election year craziness, IPO action has moved right along and matched 2019’s six. Accolade and GoHealth in July; Amwell, Outset Medical, and GoodRx in September. Hims Inc. is merging with a blank-check company as SOC Telemed did in August. MDLive may be going public in early 2021.
  • What is down so far this year is merger and acquisition activity. Through September, there are only 63 acquisitions, which will likely trail by year’s end 2019’s 113. Teladoc is the 9,000 Elephant in M&A, with InTouch Health closing in August ($1 bn final due to the stock value soaring) and Livongo at $18.5 bn dwarfs the remainder. Optum-AbleTo has been reported in ‘advanced talks’ but there’s no confirmation of closing; it was reported to be at $470 million. 

Note: Rock Health only counts US deals in excess of $2 million, so international activity by companies like Doro are not included.

Also Mobihealthews.