TTA’s May Flowers: Walmart Health and Optum telehealth exits, UHG CEO’s Congressional roast, Teladoc’s red ink, Oracle’s Music City HQ move, MobileHelp PERS for sale, fundings, more!

 

 

Surprises and shockers abound this week. If Walmart can’t make it in providing basic health services, what hope does a retail model really have? Optum and Walmart exit telehealth, while Teladoc grows–firmly in the red. Change Healthcare’s troubles led to UHG’s CEO grilling on both sides of Congress and humiliation on MFA. MobileHelp PERS up for sale, Owlet’s new partner, fundings, partnerships. And a shrinking Oracle goes to Music City!

News roundup: UHG CEO’s Bad Day at Capitol Hill; Kaiser’s 13.4M data breach; Walgreens’ stock beatup; Cigna writes off VillageMD; Oracle Cerner shrinks 50%; Owlet BabySat gets Wheel; fundings for Midi, Trovo, Alaffia, Klineo (A rough week for some)
Teladoc’s Q1: increased revenue, increased net loss, dealing with slowing growth–as is CVS Health (Teladoc in existential crisis?)
Midweek news roundup: Optum exiting telehealth, laying off; Advocate Health selling MobileHelp; VA notifying 15M veterans re Change PHI breach, Oracle moving to Nashville–maybe? (updated) (A lot of jettisoning)
Walmart Health shutters health centers, Walmart Virtual Care, in sudden move (updated–why?) (If Walmart can’t make it…)

Returning to the Cyberattack That Changed Everything, wondering how much and to whom UnitedHealth paid ransom–now that they’ve finally admitted it. Also returning to those Merger Guidelines and how they may change the face of healthcare M&A. VA and DOD hard at work on their EHRs and systems, Lumeris gains a luminous funding, but Optum staff are seeing pink slips.

Two studies: Telehealth underutilized, underbilled, even during pandemic–and accounted for only modest increases in costs, and quality (Perhaps undercaptured?)
Short takes: VA seeks vendor to support EHR testing; Defense Health seeks ‘digital front door’ vendor; GAO recommendations to Oracle; Nonin partners with Finland’s Medixine; Lumeris gains $100M equity funding 
What the DOJ and FTC Merger Guidelines mean for healthcare M&A–a Epstein Becker Green podcast (Legal department torture)
Breaking: UnitedHealth admits to paying ransomwareistes on Change stolen patient data (updated) (For what and how much?)
Who really has the 4TB of Change Healthcare data 4 sale? And in great timing, Optum lays off a rumored 20K–say wot? (UHG has some ‘splainin’)

Another packed week, with a few baffling events. Leading in bafflement is NeueHealth’s additional $30M from NEA, which now owns 60%. UHG battling on multiple fronts between the Change hacking and the House, Walgreens lays off more to cut costs, VillageMD sued on ad trackers, and Cerebral’s comeuppance costs $7.1M. VA may restart Oracle Cerner implementation, Epic and Particle Health feud. But restoring faith in health tech benefiting a neglected group is TandemStride. 

TandemStride launches platform to assist survivors of traumatic injury; a personal look (A real care gap)
News roundup: Congress hammers absent UHG on Change cyberattack–and more; 10% unhinged at Hinge Health; Steward Health nears insolvency; Two Chairs $72M Series C (UHG’s troubles cover the waterfront)
ISfTeH student contest and award 2024–deadline 26 April! (Move fast!)
Mid-week short takes: UnitedHealth’s $1.2B Q1 loss from Change attack, another Walgreens layoff, Dexcom-MD Revolution partner, Kontakt.io $47.5 raise, GeBBS Healthcare may sell for $1B (Walgreens still downsizing–what’s next)
News roundup: VillageMD sued on Meta Pixel trackers; Cerebral pays $7.1M FTC fine on data sharing, cancellation policy; VA may resume Oracle Cerner implementation during FY2025; Epic-Particle Health dispute on PHI sharing (Cerebral still in trouble)
The New Reality, Bizarro World version: NeueHealth gets $30M loan increase from NEA, now majority owner (Baffling)

This packed week was about righting listing ships. Teladoc’s CEO suddenly departs, Amwell at risk of a NYSE delisting–we look at What Happened and what needs to be done. VillageMD gets new COO to manage the shrinkage. And Change Healthcare data on sale from disgruntled ALPHV affiliate. Digital health funding continues to limp along. Clover looks at another delisting, Walmart Health applies the brakes. And we highlight innovations from Novosound, Biolinq, Eko, Universal Brain. 

Digital health’s Q1 according to Rock Health: the New Reality is a flat spin back to 2019 (Limping, but alive)
VillageMD names new president and COO as it shrinks to 620 locations (Ex Centene, Humana exec comes out of short retirement to clean up)
News roundup: Now Clover Health faces delisting; BlackCat/ALPHV affiliate with 4TB of data puts it up for sale; $58M for Biolinq’s ‘smallest blood glucose biosensor’ (Will UHG pay more ransom?)
Opinion: Further thoughts on Teladoc, Amwell, and the future of telehealth–what happens next? (A hard look at the follies, mistakes, and saving ships)
News roundup: Amwell faces NYSE delisting; Walmart Health slows Health Centers, except Texas; Novosound’s ultrasound patent; Eko’s Low EF AI; Universal Brain; Elizabeth Holmes in ‘Dropout’ + update
Teladoc CEO Jason Gorevic steps down immediately in shock announcement (Now what?)

A damp start to April leads with puzzling news. NeueHealth loses plans and big money in ’23–but gives a big bonus to its CEO. Cano Health reorganizing or selling by June. ATA kicks DOJ about expediting controlled substance telehealth regs. Apple keeps kicking around the ‘Davids’, but Davids won’t stop slinging either. And if you work with a PR or marketing agency, our Perspectives has some advice for you.

More New Reality: NeueHealth (Bright Health) CEO’s $1.9M bonus, 2023 financials–and does Cano Health have a future? (Two stories gone way sideways)
ATA requests expediting of revised proposed rule on controlled substance telehealth prescribing; announces Nexus 2024 meeting 5-7 May (DEA needs to get moving now, not later)
Davids (AliveCor, Masimo) v. Goliath (Apple): the patent infringement game *not* over; Masimo’s messy proxy fight with Politan (updated) (Seeing value in Masimo?)
Perspectives: Working with a PR Agency–How to Make the Most of the Partnership (Expert advice if you manage communications)

It was a pre-Easter week that started as quiet and got VERY LOUD at the end. Walgreens took the hard road, writing down VillageMD even before the closures were final and lowering forecasts. An important metastudy+ casts doubt on the efficacy of present digital health diabetes solutions but provides solid direction forward. And it’s definitely an early sunny spring for funding, but there’s continued bad weather forecast for UnitedHealth Group and Oracle Cerner’s VA implementation.

Facing Future 2: Walgreens writes down $5.8B for VillageMD in Q2, lowers 2024 earnings on ‘challenging’ retail outlook (Biting bullet early and hard)
Short takes: PocketHealth, Brightside fundings; VA OIG reports hit Oracle Cerner; Change cyberattack/legal updates; UHG-Amedisys reviewed in Oregon; Optum to buy Steward Health practices (UHG carries on as does company funding)
Can digital health RPM achieve meaningful change with type 2 diabetics? New metastudy expresses doubt. (Major digital health findings from PHTI)

This week’s Big Quake was DOJ’s antitrust suit against Apple for smartphone monopoly and control over apps. Another quake: 2023 data breaches were up 187%–when a medical record is worth $60, it’s logical. Early-stage funding and partnerships are back with a roar when AI’s in your portfolio. And Walgreens shrinks both VillageMD and distribution.

2023 US data breaches topped 171M records, up 187% versus 2022: Protenus Breach Barometer (And that was LAST year!)
Why is the US DOJ filing an antitrust lawsuit against Apple–on monopolizing the smartphone market? (One wonders)
Mid-week roundup: UK startup Anima gains $12M, Hippocratic AI $53M, Assort Health $3.5M; Abridge partners with NVIDIA; VillageMD sells 11 Rhode Island clinics; $60 for that medical record on the dark web (Funding’s back and AI’s got it)
Walgreens’ latest cuts affect 646 at Florida, Connecticut distribution centers (More in next week’s financial call)


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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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Midweek news roundup: Optum exiting telehealth, laying off; Advocate Health selling MobileHelp; VA notifying 15M veterans re Change PHI breach, Oracle moving to Nashville–maybe? (updated)

Optum Virtual Care closing, staff layoffs in progress. Optum Everycare CEO Jennifer Phalen on an 18 April internal conference call announced that the unit would close. According to sources, some employees would have layoff dates in July. No further details were available on other layoffs or plans for integrating Virtual Care’s capabilities into other Optum units, except for generalities. “We are com­mit­ted to pro­vid­ing pa­tients with a ro­bust net­work of providers for vir­tu­al ur­gent, pri­ma­ry and spe­cial­ty care op­tions,” and “We con­tin­u­al­ly re­view the ca­pa­bil­i­ties and ser­vices we of­fer to meet the grow­ing and evolv­ing needs of our busi­ness­es and the peo­ple we serve.” a spokesper­son for Unit­ed­Health said to End­points, a biopharma publication from the University of Kansas which broke the story.

For Optum, this is the second shoe drop about layoffs and closures in less than two weeks. Reports from social media and layoff-specific boards indicated that thousands were being laid off, from their plans to urgent care and providers [TTA 23 Apr]. These were not confirmed by Optum nor by UnitedHealth Group. It’s not known if this unit’s closure was included in the total. 

The larger picture is that it is symptomatic of the sudden growth, then equally sudden consolidation, of general telehealth. Optum opened the unit in April 2021 as the pandemic entered year 2. Utilizing existing capabilities, UHG claimed it facilitated more than 33 million telehealth visits in 2020, up from 1.2 million in 2019. The number looks sky high but in that time of practices closing it was a free-for-all in telehealth–and ‘facilitating’ is a nebulous catchword that could mean a practice using Facetime, telephones, or an EHR/population health platform module. Commercial claims for telehealth have remained at 4 to 5% since (FAIR Health, Jan 2024). Even during the pandemic’s first year, telehealth claims hit a peak of 13 percent in April 2020 that dropped fast to 6% by August 2020. Well over 60% are for behavioral telehealth claims.

A leading indicator: Last June, Optum Everycare’s CEO from their 2021 start, Kristi Henderson, a former Optum SVP for digital transformation, departed to become CEO of Confluent Health, a national network of occupational and physical therapy clinics. It was about as far away as one could get from telehealth, digital transformation, and Amazon Care, her former employer that expired in 2022.

Apparently, UHG and Optum see no further need for a virtual care specialty unit, instead integrating it into plans and other Optum services. According to MedCityNews, industry analysts aren’t surprised. Both Amwell and Teladoc have had well-known struggles. The latest: Walmart, after investing millions into their unit that included full clinics and a virtual care service, also made news on 30 April that it is closing both. Also greatly on UHG’s mind: cleanup after the Change debacle, making Mr. Market happy, and the looming antitrust action by DOJBecker’s, Healthcare IT News, 

In another sign that healthcare investors are selling off ancillary businesses, Advocate Health is selling PERS provider MobileHelp. It “no longer fit the strategic priorities of Advocate Health” according to their 22 April audit report (see document pages 10 and 13) and was authorized last December.

Advocate, through its investment arm Advocate Aurora Enterprises, acquired both MobileHelp, one of the earliest mobile PERS, and sister company Clear Arch Health, a remote patient monitoring provider, in April 2022. Cost was not disclosed at that time but later was reported to be $290.7 million. The plan at the time was to combine both MobileHelp and Clear Arch with a senior care/home health provider earlier acquired by Advocate for $187 million, Senior Helpers. That company was sold in March to Chicago-based private equity firm Waud Capital Partners for an undisclosed amount. The MobileHelp sale is expected to close later this year. Buyer and price are not disclosed. The expected loss on the MobileHelp sale was figured into FY 2023 as part of an asset impairment write-down of $150 million, which Advocate said was “related to the expected loss on the sale of MobileHelp.” The PERS and RPM business is a largely consolidated ‘cash cow’ type of business that (Editor’s prediction) will be snapped up by another player like Connect America, Alert One, or a smaller player like ModivCare. Milwaukee Business Journal, Becker’s, Crain’s Chicago Business (requires subscription)

VA admits that some veterans may be affected by Change Healthcare data breach, PII/PHI disclosure. While Department of Veterans Affairs Secretary Denis McDonough at this time believes that “there’s no confirmation yet” that veteran data was exposed, the scope of the Change Healthcare breach has led VA to formally alert via email 15 million veterans and their families of the possibility. The email also included information “about the two years of free credit monitoring and identity theft protection” that Change Healthcare is offering to those affected by the attack. The VA maintains that the attack resulted in only a temporary delay in filling 40,000 prescriptions but did not cause “any adverse impact on patient care or outcomes,” according to a department spokesman. NextGov/FCW 26 April, 23 April 

In related news, HHS as of 19 April had not received any notification from Change Healthcare nor UHG. They are required to file a breach report as providers and also as covered entities. They have 60 days from the breach occurrence on 21 February to report, which is coming right up. Becker’s

If Larry said it, it must be true…assemble the moving boxes. At an Oracle conference in Nashville last week, Oracle chairman Larry Ellison said to Bill Frist of investment firm Frist Cressey Ventures that he planned to move the company to that city as “It’s the center of the industry we’re most concerned about, which is the healthcare industry.” It’s their second public Larry and Billy meetup in the last few months, the last in November at the Frist Cressey Ventures Forum where Ellison had previously touted Nashville. Ellison is investing in and building a 70-acre, $1.35 billion campus on Nashville’s riverfront. Oracle is currently HQ’d in Austin, Texas having moved in 2020 from Redwood City, California but with extensive facilities remaining in the state. Texas and Tennessee have one thing in common–a superior business climate. Both are long on lifestyle, though Austin is not as temperate (read, hot) as Nashville. What Nashville has that Austin doesn’t is being a healthcare hub. At least in Ellison’s view, healthcare is where it’s at and so is Nashville. So as long as he’s running Oracle from his manse on Lanai, Oracle does what Larry says. Healthcare Dive, Healthcare IT News, The Tennessean

More fun facts about Larry Ellison and Nashville: David Ellison, his son, is founder of Skydance Media, a major Hollywood production company (Mission: Impossible and others) and negotiating a zillion-dollar merger with Paramount Pictures. David’s wife is a singer trying to make it in Music City and they have a home there. Kind of like the age-old trend of moving the HQ near where the CEO’s living. On moving the HQ to Nashville from Austin, this would affect perhaps 2,500 workers based there currently. Most of Oracle’s workers are dispersed and work remotely. 6,400 of former Cerner-ites are still in Missouri and 7,000 remain in California. Big hat tip to HIStalk—scroll down and see more about Larry and Billy’s talk, which also covered cybersecurity, the NHS (which uses Cerner), and automating hospitals and the hospital-payer interface.

Two studies: Telehealth underutilized, underbilled, even during pandemic–and accounted for only modest increases in costs, quality

A newly published study in April’s Health Affairs Scholar points to telehealth’s surprisingly low reimbursable takeup among tradtional Medicare beneficiaries–even during the pandemic. This study evaluates E&M (evaluation and management) Current Procedural Terminology (CPT) billing against codes that were established during the pandemic to pay providers for telehealth (e-visits in the study), 99421-99423. It also broke down e-visits by different clinician types: primary care, medical specialties, surgical specialties, behavioral health, nurse practitioners, and physician assistants, and counted the most frequent diagnoses. E-visits constituted less than 0.1% of E&M services in the monitored period, 2020-22.

Key findings:

  • E-visit billing hit an absolute peak in April 2020 of 728 monthly encounters per 100,000 beneficiaries. It dropped off dramatically by summer 2020 and later stabilized to approximately 90 monthly encounters per 100,000 beneficiaries.
  • Only 0.8% of Medicare beneficiaries who received an E&M service were billed for at least one e-visit.
  • E-visits constituted 0.09%, 0.05%, and 0.05% of all E&M services in 2020, 2021, and 2022.
  • Primary care providers accounted for over 50% of the billing.
  • Approximately 30% were billed at the highest level of clinician time, requiring at least 21 minutes.
  • Hypertension was the most common diagnosis addressed in e-visits (21%), followed by diabetes (2.3%) and COVID-19 (2%).
  • Surprisingly, fewer beneficiaries receiving e-visits lived in rural areas.

HealthExec

Note to Readers: for those puzzled by the absence of mental health diagnoses, FAIR Health’s monthly telehealth tracker which during the pandemic showed Covid/respiratory diagnoses first, then mental health–and mental health as #1 in about 5% of claims since then –FAIR uses a different methodology. It tracks medical claims for private health plans only, not traditional Medicare, Medicare Advantage, or Medicaid. It also does a comparison on CPT 99213, comparing a specific procedure provided via telehealth to the same procedure provided in an office. 15 April methodology release

Editor’s Note, strictly anecdotal: As someone who worked as the sole marketer for a management services company with primary care ACOs during the period in early 2020 when HHS was turning out new codes nearly hourly to create telehealth flexibilities in Medicare, there was considerable confusion around codes and what they covered. Our teams, sourcing from HHS and the AMA, had our hands full to correctly specify and document the CPT codes established at that time. I know because I worked on said documentation that we condensed into a two-page fast guide and then into presentations. Many of the codes were telephonic. My conclusion about this study is that it was very narrow and tracked too few codes. Other factors: practices had difficulty using audio/video telehealth with their patient populations–if the practices had it, patients weren’t ready (tech barriers) or willing to use. Some of the practices reported that they didn’t bill for telehealth encounters during this confused time, trading off reimbursement for overall patient care and marking up quality metrics such as Annual Wellness Visits.

A second telehealth study, published this month in Health Affairs, looked at health systems to assess whether telehealth increased or decreased healthcare spending and usage by Medicare beneficiaries. The study defined by quartile health systems that had high telemedicine usage versus those with higher in-person usage, based on 2020 visits. Their conclusions tracked the changes between the 2019 baseline, 2020, and 2021-22. This study found only a modest increase after 2020 in visits and spend in the highest quartile of telemedicine usage for patient care.

  • In 2020, patients in the highest quartile of telemedicine use had 2.5 telemedicine visits per person (26.8 percent of visits) compared with 0.7 telemedicine visits per person (9.5 percent of visits) in the lowest quartile of telemedicine use.
  • Patients in the highest quartile had modest increases in office visits, care continuity, and medication adherence, as well as decreases in ED visits, relative to patients of health systems in the lowest quartile.
  • During 2021–22, relative to the lowest quartile, patients in the highest quartile had an increase of 0.21 total outpatient visits (telemedicine and in-person) per patient per year (2.2 percent relative increase)
  • That group also had a decrease of 14.4 annual non-COVID-19 emergency department visits per 1,000 patients per year (2.7 percent relative decrease)
  • Per patient per year spending increased by $248 (1.6 percent relative increase)
  • They also had increased adherence for metformin and statins.
  • There were no clear differential changes in hospitalizations or receipt of preventive care.

The researchers contend their findings confirm that the flexibilities around telehealth instituted during the pandemic for Medicare beneficiaries should continue past their scheduled expiration at the end of 2024. The moderate spending increase is also confirmed by another study through 2021 by the Medicare Payment Advisory Commission found that geographic areas with higher telemedicine uptake had a spending increase of $165 per patient and a 3 percent relative increase in total clinical encounters. Healthcare Dive

ATA requests expediting of revised proposed rule on controlled substance telehealth prescribing; announces Nexus 2024 meeting 5-7 May

ATA and 200 organizations request from DEA a revised proposed rule on controlled substance teleprescribing–stat. The American Telemedicine Association (ATA), in a 2 April letter (PDF link) with over 200 signatories, requests that the DEA quickly issue a revised proposed rule for industry comment.

Last October, the Drug Enforcement Administration (DEA) and Health and Human Services (HHS) extended for the second time pandemic flexibilities for prescribing controlled substances through 2024. The proposed rule issued in May had 38,000 comments, which overwhelmed DEA and HHS. The two agencies were unable to come up with a revised proposed rule by end of year and punted to 2024. The final rule is scheduled to be issued by this fall.

The 2 April letter advocates continuing many of the pandemic flexibilities due to care shortages and disruptions to patient care. If DEA were to create a special registration process for telehealth prescribers as many have proposed, transitioning and training would be needed to minimize disruptions in care to providers and patients in time for the new rule to take effect in 2025.

The controversy is around permitting and regulating the prescribing of controlled substances through telehealth. The pandemic rules suspended the Ryan-Haight Act restrictions that required in-person evaluations/visits prior to prescribing. Legally, that cannot continue. The extension of pandemic flexibilities permitted clinicians to prescribe Schedule II–V controlled medications via audio-video telemedicine encounters, including Schedule III–V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder. ATA release   HealthcareDive 4 April

ATA is also resuming an in-person spring conference, Nexus 2024, 5-7 May, at the Phoenix Convention Center in Arizona. It will have 300 speakers on 30+ topics. The meeting is being pitched to primarily care delivery and provider organizations. An overview of the conference is in the ATA release. More content information here (PDF link). Online registration (attendee and exhibitor) or email AmericanTelemedicine@​xpressreg.net

News roundup #2: Bright.md sells remaining customers to 98point6; Netsmart EHR up for $5B possible sale; Caregility intros two new telehealth systems

More from JP Morgan’s Healthcare Conference (JPM), CES, and after:

Bright.md’s remaining assets sold to 98point6. Now stay with your Editor as we sort through this. Bright.md was sold, we thought, to Cigna’s Evernorth MDLIVE telehealth unit last October, announcing at HLTH that MDLIVE would add Bright.md’s asynchronous telehealth technology to their platform. Evidently, Bright.md had other assets not included in that sale, namely the right to service 17 asynchronous telehealth provider customers such as Baptist Health and UAB Medicine. Those customers have been purchased by 98point6, a company that last year transitioned out of direct care into being a licensor of real-time and asynchronous telehealth, plus other software for clinical decision support and EMR integration.

98point6 pivoted last March by selling their physician group, self-insured employer business, and an irrevocable software license to Transcarent, in a deal worth potentially $100 million. What they bought from Bright.md can only be interpreted as those 17 customers were not obliged to go with MDLIVE in that earlier transaction. Those 17 customers now will license 98point6’s asynchronous telehealth. 98point6’s purchase price is 45% in cash and 55% in equity. 98point6 is also taking on six former Bright.md staff in commercial and sales. Another small puzzle is that the Bright.md website remains unchanged with last entries in July 2023 and no mention of MDLIVE. The company’s most recent LinkedIn posts also end in July 2023, yet a sample of the executive staff indicates that they remain employed at Bright.md. Axios, 98point6 release

Netsmart Technologies exploring $5 billion sale. The company is reportedly exploring a sale of its EHR and related software business via Goldman Sachs and William Blair in the coming weeks which could fetch up to $5 billion. The EHR has an estimated 754,000 users at community health centers, behavioral health centers, hospice care, and non-profits. This year’s EBITDA is estimated to be about $250 million. 

The current owners, GI Partners and TA Associates, bought it between 2016 and 2018, but its roots go back to 1992 (with an acquired company back to 1968). It went public in 1996, moved private in 2006, then went through various private equity owners including Allscripts, moving from NYC to Great River, Long Island and presently to Overland Park, Kansas. If the sale, likely to another group of PE investors, is successful, it would demonstrate signs of life in the dead healthcare M&A market.  Reuters   Axios’ sources estimate closer to a $4 billion sale

Another during CES announcement came from Caregility, which announced two new point of care telehealth edge devices. The APS200 Duo is the company’s first dual-camera, all-in-one system with onboard edge computing and a dedicated graphics engine. The new APS100 Pro is a second generation model of their all-in-one system with a wide-angle camera for remote patient observation. This can be upgraded with the APS FlexCam, an external high-definition 40x power zoom video camera for virtual nursing programs and remote patient examinations. The devices connect to the Caregility Cloud virtual care platform with multiple audio and video streams for clinical and care applications supporting workflows in acute and ambulatory settings. Release. Caregility also contributed a Perspectives on virtual nursing and telehealth in November.

News roundup: Apple Watch flagships cease sale due to Masimo ITC ruling (updated); Noom, WW enter GLP-1 telehealth business; Oracle sees health side up despite Cerner drag; Cigna has multiple bidders for MA business

Apple Watch Series 9 and Ultra 2 going off sale in the US this week, upholding the ITC patent ruling favoring medical device developer Masimo. On 26 October, the International Trade Commission (ITC) ruled that Apple in the Series 6 and later violated Masimo’s patents on pulse oximetry (SpO2) sensors and software. [TTA 27 Oct] While this is awaiting presidential approval in the 60-day review period which ends on Christmas Day, Apple proactively restricted US sales of its flagship Series 9 and Ultra 2 watches which contain the blood oxygen sensors. (The SE model does not and continues to be available for direct sale.) According to 9to5Mac, online sales end on 3 pm Eastern Time on Thursday 21 December, while in-Apple Store sales stop after Christmas Eve. Of course, this won’t stop resales of existing stock through outlets like Amazon, Best Buy, and eBay. Under the ITC order, Apple cannot import either model after 25 December as the ITC issued a Limited Exclusion Order (LEO) plus a Cease and Desist Order (CDO). 

The ITC is rarely vetoed by the White House in patent actions. After that point, Apple is free to appeal in Federal District Court, which is highly likely and where the deepest pockets usually win. Also HIStalk 20 Dec and Strata-gee 21 Dec

There are other wrinkles with Masimo, though. Strata-gee.com earlier this month (13 Dec) timelines Masimo’s patent difficulties with the US Patent and Trademark Office’s Patent Trial and Appeal Board (PTAB) ruling against the very same patents, decisions upheld by the Federal Circuit Court. The PTAB also ruled against Masimo in the requested review of two Apple patents. Apple’s retaliation is to threaten lawsuits on Masimo’s new smartwatches. The icing on this messy cake is the November Delaware Chancery Court decision against Masimo, awarding $17.8 million in legal fees to activist investors/shareholders Politan Capital Management and Politan Capital NY LLC in a board fight that culminated in two seats to Politan directors.  One can sense that Apple is biding its time, though they could end all of this by negotiating a royalty to Masimo. Updated: see report on the stay effective 27 December here.

Noom and WW enter the weight loss drug-by-telehealth race. Ozempic and Wegovy, GLP-1 agonists, are increasingly popular in off-label use for obesity to produce weight loss, prescribed and managed by telehealth teams.

  • Noom, previously stressing behavioral change via app coaching direct-to-consumer, in October announced at HLTH Noom Med, a drug-focused program prescribing medications such as Saxenda (liraglutide), Wegovy (semaglutide), and the new Zepbound (tirzepatide), a dual GLP-1/G1P, all of which are injectable medications along with other GLP-1 medications such as Ozempic.
  • WW or WeightWatchers last week announced the WeightWatchers Clinic program. Via their recently acquired telehealth weight loss platform Sequence, it will offer weight loss meds and team management.  

They join Teladoc in developing weight loss programs, though Teladoc supports a physician-based care product for employers [TTA 21 April]. Both Noom and WW emphasize that member patients must qualify for the programs based on weight, BMI, and medical condition. Participants are educated through materials, coaching on behavioral management, managing appetite, and nutrition, especially in maintaining adequate protein as these medications not only induce weight loss, but also muscle loss (sarcopenia). One hopes that their teams are also knowledgeable on how these medications that slow down digestion to induce a feeling of fullness don’t mix well with surgical sedation, and that they issue cautions to patients before elective surgery. MedCityNews, FierceHealthcare, Forbes   

Noom has also replaced most of its top management since its new CEO joined in July. There’s a new CFO, chief technology officer (CTO), general counsel, two senior VPs (corporate development and partnerships, healthcare sales and services) a senior director of brand and communications, chief growth officer, chief product officer, and head of people. FierceHealthcare

Oracle Q2 results miss forecasts in rebuilding Cerner. Oracle Health, including the former Cerner, and slowing cloud growth were the culprits in their fiscal Q2 2024. Total revenue was $12.9 billion, up 5% in US dollars (4% in constant currency). Analysts expected $13.05 billion. Excluding Cerner, growth would have been 6% though Oracle did not separately break out revenue for the Cerner EHR business. Investors have noted two consecutive quarters of off-track growth and a weaker forecast for the remainder of the year. According to CEO Safra Catz and chairman Larry Ellison on the earning call, many upgrades and “modernizations” are being made to Cerner Millenium that will wrap up this FY. Half of Millenium customers will be moving over to Oracle Cloud Infrastructure (OCI) by February. They are also “rewriting” Cerner’s health and data intelligence platform, Cerner HealtheIntent, to get into population-scaled health management. ‘Transforming healthcare’ is an expensive proposition indeed. No word on the VA.  FierceHealthcare, Oracle release

And a quick follow up on Cigna’s sale of their Medicare Advantage business. Two payers so far–Health Care Service Corp. (HCSC) and Elevance–are reported to be bidding for Cigna’s MA business. The value of the business is estimated to be about $3 billion and with just under 600,000 members as of September. Both HCSC and Elevance are much larger players in MA. HCSC has over 1 million MA members in Blue Cross Blue Shield affiliates in Illinois, Texas, New Mexico, Oklahoma, and Montana. Elevance, the former Anthem, has over 2 million MA members. Bidding is expected to close this week. While MA is losing money for Cigna, they could refuse to sell if bids are unsatisfactory. FierceHealthcare, Becker’s

Walgreens’ transformation continues: new CEO enters, CIO exits, launches Virtual Healthcare in 9 states

This week of HLTH has not been short of Big News from WBA, perhaps cleverly to ace out CVS, Amazon (facing retail monopoly charges from the FTC and 17 states), and Walmart. Regaining the lost momentum at Walgreens Boots Alliance will be a heavy lift.

Enter Tim Wentworth as CEO from retirement. Mr. Wentworth formerly helmed Express Scripts, coming on after that company’s acquisition of pharmacy benefits manager Medco. When Express Scripts was acquired by Cigna in 2018, he headed their health services area, now Evernorth, retiring from there at the end of 2021. He is exactly what executive chair Stefano Pessina (and the board) ordered–a younger executive (63) with CEO experience, energy, through-the-ranks background, and deep, deep experience in pharmacy management, payers, and healthcare. To CNBC on Tuesday, Mr. Wentworth said, “What made me decide to come back was a chance to lead this iconic brand and company at a time when it’s not in a steady state. It’s a massive platform…they touch almost 10 million people a day.” Plus undoubtedly an offer hard to refuse! He starts on 23 October. Walgreens replaced Roz Brewer, who departed 31 August [TTA 19 Sep], in record time. Her interim replacement, former pharma exec Ginger Graham, returns to her lead independent director spot on the WBA board. WBA release

Walgreens recently missed earnings estimates for its Q3 ending in May [TTA 28 June] with underperformance problems in retail consumer sales and urgent care CityMD. They have been selling peripheral businesses and investments, with plans to lay off 10% (500) of its workforce. It doesn’t help the bottom line that Walgreens last month settled a class action lawsuit about its long-ago Theranos clinics in Arizona for a tidy $44 million.

There’s trouble from the streets to the suites right now. Pharmacy workers walked out on 300 Walgreens locations this past Monday through Wednesday. Their big issues are short-staffing and overwork. Demands are, according to an organizer talking to the AP: to improve transparency about shifting hours and schedules; to set aside training hours for new team members; and to adjust tasks and expectations at each location based on staffing levels. They are also organizing for union representation. Walgreens isn’t alone in this–CVS has also faced pharmacy worker walkouts. Fortune  At the executive level, chief information officer Hsiao Wang left suddenly on 2 October after one year after a recent leave of absence. His departure was confirmed by Walgreens to industry publication PYMNTS. Neal Sample, a consultant and former CIO at Northwestern Mutual with experience at Express Scripts, will be stepping in on an interim basis. Retail Dive. This follows on Walgreens’ chief financial officer James Kehoe July departure after five years to join financial services firm FIS in August. Mr. Wentworth’s HR experience will come in handy on these issues.

On a positive note, WBA announced Monday at HLTH that its Walgreens Virtual Healthcare will start up in nine states later this month. Via their website, Virtual Healthcare will provide on-demand consults with providers on common medical conditions and for prescriptions. It will be available in California, Florida, Georgia, Illinois, Michigan, Nevada, North Carolina, Ohio, and Texas, which represent almost half of the US population as well as Walgreens’ pharmacy customer base. It will be primarily clinician chat-based, with synchronous video visits for select conditions. Conditions treated include seasonal allergies, COVID-19 or flu, erectile dysfunction, hair loss, birth control, and other common health needs. Cash only–$33 for chat with video visits $36 to $75, which puts it in line with Amazon Clinic’s cash charge of $35 and $75 respectively. Insurance may come in the future. WBA has had telehealth through VillageMD locations and has actually had tele-dermatology service since 2016. Walgreens’ move, though, is a little tardy given Amazon Clinic’s national rollout after privacy issues delayed it on 1 August [TTA 1 Aug] and CVS’ Virtual Primary Care nationally with Amwell a year ago [TTA 12 Aug 22]. Healthcare Dive

Two studies: telehealth’s ‘generation gap’ and $22B target for healthcare generative AI–by 2032

J.D. Power notices that older users aren’t all that comfortable with telehealth. On a 1,000 point scale, pre-boomers (!) and Boomers, score a 671 while Gen Y and Gen Z score 714 for an average of 698. Those surveyed liked telehealth for convenience (28%) and receiving care quickly (17%). 

Issues for the older group are trust, digital channels, and appointment scheduling. The latter two are, in this Editor’s view, interface related, with many telehealth providers neglecting mobile and tablet-friendly platforms, making typefaces large enough, and backgrounds contrasty enough.

CVS leads in satisfaction, surprisingly, in direct to consumer telehealth providers (744), with MDLIVE (Evernorth/Cigna) coming in at 741 and Amwell 739. CVS’ telehealth is provided by Amwell. Where telehealth is provided by a health plan, the numbers were extremely close. UnitedHealthcare scored the best (702), with Kaiser Foundation Health Plan immediately behind at 701 and Humana at 695. UnitedHealthcare uses Included Health’s Doctor on Demand, Teladoc for Kaiser. The June-July survey included over 5,400 telehealth users within the last 12 months. Healthcare Finance, J.D. Power study page (subscription required for report).

Generative AI for healthcare projected to be a $22 billion business by 2032 from $1 billion today. Generative AI is defined as AI that produces text, images, and other media, based on text, audio, and image data supplied to it. The PYMNTS and AI-ID “Generative AI Tracker” points to current uses in complex drug discovery acceleration and medical researcher capabilities. To realize its potential in other healthcare areas, tech companies must team up with payers, providers, and others to train large language models on healthcare-specific data and establish robust benchmarks. The PYMNTS study is available for download here. Healthcare IT News

News roundup: MHS Genesis EHR completes US rollout, telehealth selective savings by disease, CarePredict’s $29M funding, Amazon Alexa *Spying on You*

At least one part of Oracle Cerner’s work is done. The Military Health System (MHS), which covers 9.6 million active duty beneficiaries and 205,000 medical providers, announced yesterday that the rollout of the Genesis EHR is complete in the continental US. The final go-live was at Wright-Patterson Air Force Base, which covers 6,800 clinicians and providers in military hospitals and clinics across Ohio, Virginia, Maryland, Indiana, Texas, and Kentucky. It was also deployed at the National Oceanic and Atmospheric Administration, NOAA Corps, which is under the Department of Commerce. The final 14% of the MHS system is overseas. That rollout will start in September 2023, including Landstuhl Regional Medical Center in Germany and Royal Air Force Lakenheath in the UK. Bases in Guam, South Korea, and Japan will follow in October. DOD’s one joint facility with the VA, the James A. Lovell Federal Health Care Center in Chicago, will deploy in March 2024. All other VA healthcare centers are on hold indefinitely. With the wrapup of MHS Genesis and the pause on VA’s Millenium rollout, Oracle has reportedly laid off over 500 staff on these Federal projects [TTA 16 June]. DVIDS release

 Telehealth’s selective savings. A new study out of the University of Texas-Austin McCombs School of Business found, like other studies such as Epic Research’s, that telehealth visits reduced future outpatient visits, in their study within 30 days, by 14%. This saved $239 per patient in outpatient costs. But telehealth was more effective for some specialties than others. It had the most impact on cost reduction for behavioral health, metabolic disorders, dermatology, and musculoskeletal (MSK) disorders, with a significant reduction of 0.21 outpatient visits per quarter (an equivalent cost reduction of $179). This suggested to the researchers a substitution of telehealth versus traditional clinic visits. But telehealth’s impact was nearly nil when it came to circulatory, respiratory, and infectious diseases, not significantly reducing the number of future visits or costs. The study sampled hospital-based outpatient clinics in Maryland from 2012 (not a typo) to 2021. Becker’s, UT News, Informs Pubonline (abstract only)  

Senior living monitoring system CarePredict adds $29 million from four main investors. This is a Series A-3, which one assumes adds on to an existing Series A, which was $9.5 million in 2019. The round was co-led by SV Health Investors’ Medtech Convergence Fund and Aspire Healthtech Partners with existing institutional investors Secocha Ventures and Las Olas Venture Capital plus private family offices and individual investors. CarePredict pioneered a wearable bracelet, the Tempo, that wirelessly tracks residents’ activities of daily living (ADLs) in assisted living (AL), independent living (IL), and continuing care (CCRC) settings. Interpretation of ADLs in a platform can predict changes in health and wellbeing leading to better health and extended residence. CarePredict has expanded its platform reporting with other tracking such as context beacons, visitor and wander management, PinPoint digital contact tracing, and family communication apps. CarePredict release, Mobihealthnews

How much does Amazon have on you? If you are a user of Amazon’s Echo system, you already know that Alexa is always listening to you. What you may not know is that Amazon stores that information in a database, including parts of overheard conversations that have nothing to do with Alexa, since Alexa is always on. Even if you (like your Editor) don’t have an Echo but have a Kindle (unlike your Editor) or use the app residing on most smartphones, Amazon knows what you read, what you flip through, and your start and stop times. The Amazon Sidewalk mesh network, used with Alexa and Ring cameras, extends the reach of your router and shares your network with your neighbors. This is in addition to your shopping and even what you look at. In the context of the rollout of Amazon Clinic pending, delayed to 19 July [TTA 27 June], where Amazon is 1) only an intermediary to providers but 2) demand access to all your PHI and PII before allowing access to them, can we as professionals admit this is a glaring privacy violation and that the FTC is actually right?

Kim Komando, well known for her radio and online shows advising non-techies on tech, has an excellent article on how Amazon is piling up information on us all. This is based on a 2021 Reuters investigation and also contains a link to her interview with the two Reuters reporters. The article also describes how to find out what Amazon has on you. Warning–they don’t make it easy. She also addresses the Amazon clinic issue in a FoxNews article.

Mid-week roundup: telehealth success in opioid use disorder treatment, Epic sees fewer followup visits from telehealth vs in-office, telehealth usage slightly lower, HCA data theft may affect 11 million

Success reported in opioid use disorder (OUD) treatment using telehealth in conjunction with medication-assisted treatment (MAT). A recent study presented at the annual ASAM Conference indicates that in a study published by a telehealth MAT provider, Ophelia, that telehealth+MAT can achieve retention rates significantly higher than traditional in-person care. Published in The American Journal of Drug and Alcohol Abuse, their findings were that 56.4% of Ophelia’s OUD patients remained in treatment for six months, with 48.3% remaining for one year. Their MAT is based on the Massachusetts Collaborative Care Model adapted to telemedicine and providing a framework for licensed MAT providers. Ophelia is licensed to provide care in 36 states plus has national and regional insurance contracts covering 85 million lives, including bundled rates across Medicaid, Medicare and commercial populations. A second study presented at ASAM indicated that home-based buprenorphine inductions guided by telehealth are both feasible and well tolerated, with 90% of patients returning for one or more follow-up sessions and more than 80% met HEDIS engagement criteria. While OUD is statistically down among adults according to the National Survey on Drug Use and Health, overdose fatalities have increased due to the deliberate contamination of opioids with fentanyl.  HealthcareITNews

Telehealth users aren’t doing in-person follow up for most specialties–is this good or bad? Epic Research’s original study noted that most telehealth appointments didn’t require an in-person follow-up appointment in the next 90 days. Their new study compares in-office visits to telehealth and finds pretty much the same. Follow-up rates for telehealth and office visits in primary care were within two percentage points of each other. The largest difference was in mental health care, the majority of telehealth currently, with 10% of telehealth visits and 40% of in-person visits having in-person follow-up within 90 days. Epic Research, Healthcare Dive

Telehealth utilization is down slightly but remains above 5%. FAIR Health’s monthly national survey of claims from private insurance and Medicare Advantage has telehealth declining from 5.6% to 5.3% (-5.36%). Mental health is again in the far lead with 68.4% of all diagnoses. A new breakout is asynchronous telehealth (store and forward) where acute respiratory diseases and infections lead with 21.6% of diagnoses with 12.6% related to hypertension in second place. Another new breakout is audio-only telehealth comparing urban and rural usage, both near or over 5%. FAIR also breaks out data by four regions. Becker’s

Some post-July 4th fireworks came with the announcement of a data breach at HCA Healthcare, one of the largest provider networks in the US. The hacking took place through an external storage location exclusively used to automate the formatting of email messages. The information up for sale by the unidentified hacker on a ‘deep web forum’ had some personally identifiable information (PII) including patient name, address information, emails, telephone numbers, date of birth, and gender. Some of the data posted included medical appointment dates and locations. The unidentified hacker (unusual) notified HCA on 4 July with a list of unidentified demands to be responded to by 10 July. It was flagged on Twitter by Brett Callow, an analyst at New Zealand-based Emsisoft. What wasn’t included was typical personal health information (PHI)–sensitive clinical information, payment information, or other PII such as driver’s license and Social Security numbers that can be cross-referenced with other hacked data. The sheer scope of the breach–reportedly 11 million records for patients across 24 states and 171 healthcare facilities, perhaps one of the largest breaches ever–while limited in harm to patients, is still going to create a big headache for HCA. CNBC, Becker’s, HealthcareITNews, DataBreaches.net

Another Bright Health selloff: Zipnosis sold to Florence Labs

Bright’s money-raising continues. Bright Health’s Zipnosis was sold to Florence Labs for an undisclosed amount. Zipnosis, acquired stealthily by their Minneapolis neighbor Bright in the latter’s Happy Time of April 2021, is a telemedicine/telehealth company that provides white-labeled ‘digital front door’ asynchronous telehealth and diagnosis triage for large health systems fully integrated into hospital EHRs. Today’s release does not mention acquisition cost or management/employee transitioning, though Zipnosis is confirmed in their boilerplate to have about 60 employees. One suspects the sale amount was not large.

Notably, the Zipnosis website has been cleansed of any Bright Health identification or releases. A quick look at Zipnosis staff on LinkedIn indicates the cutover (and presumably the sale) took place in March but for various reasons such as financial closings was not announced until today.

Zipnosis is one of telehealth’s Ur-companies, founded in 2009 and gaining 50-60 health systems before their sale. Zipnosis was a good buy, lightly funded, and with a unique technology that fit well and conveniently into EHRs. It was a smart addition for Bright’s practices under NeueHealth along with entree to health systems. Their later and larger competition at least in synchronous telehealth for health systems was Bluestream Health, bought last month by eVisit as more evidence of healthcare consolidation. 

Florence Labs is a just-out-of-stealth startup based in NYC that automates clinical workflows and patient-facing access to address the problem of acute care clinical capacity. It was founded in 2021 by Aniq Rahman (president of Moat, acquired by Oracle in 2017 for $850 million). It was recently and modestly funded (March release) with $20 million in seed capital from Thrive Capital, GV (Google Ventures), and Salesforce Ventures with participation from Vast Ventures, BoxGroup, and Atento Capital. It’s currently working with about 40 healthcare systems, the most recently announced Luminis Health in Maryland.  It’s not to be confused with the significantly larger Florence Healthcare (clinical trial site enablement).  FierceHealthcare

Perspectives: Implementing technology in rural communities to support access to mental and behavioral healthcare

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Brian Kenah, Azalea Health’s chief technology officer responsible for engineering, software development initiatives, M&A integrations, and related areas. Azalea Health is a leading US-based provider of cloud-based healthcare solutions and services, including a complete solution of electronic health records (EHR), practice management (PM), revenue cycle management (RCM) billing services, as well as a patient health records portal, and a mobile mHealth application. This article discusses how technology can bridge care gaps that continue to be present in rural areas and enable greater access for individuals.

The COVID-19 pandemic illustrated the health needs facing many communities and nowhere was that more apparent than in rural communities.

Rural areas in the U.S. often have higher rates of mortality and morbidity from the leading causes of death compared to urban areas. A report by the CDC in 2017 found that people living in rural areas had a higher risk of death from heart disease, cancer, stroke, and respiratory disease combined than those living in urban areas. One factor contributing to these disparities is limited access to healthcare services – including behavioral and mental health.

Based on data from the American Psychological Association (APA), there is a shortage of mental health professionals in rural areas of the U.S. According to the APA, about 20% of Americans live in rural areas, but only about 10% of psychologists practice in these areas. Additionally, the APA reports that up to 80% of rural communities do not have a psychologist.

Rural communities may not have the same access to psychologists and other resources such as technology as urban areas, which can limit their ability to support mental and behavioral health. And, while many providers in rural communities cannot hire psychologists and other experts who specialize in mental and behavioral health, residents in these communities still need — and deserve — this type of care. There are efforts underway to address this issue and expand access, specifically with technology tools that can be used in rural communities to support mental and behavioral health issues. Some of these technology tools include the following:

  1. Access to Broadband: One challenge in rural areas is limited broadband internet access, which can make it difficult to access online mental health resources, telemedicine services, and other technology tools. According to the Federal Communications Commission (FCC), nearly one in four rural Americans lack access to broadband internet. Despite these challenges, there are initiatives to expand access to technology tools for mental and behavioral health in rural communities. For example, the FCC has established the Rural Health Care Program, which provides funding to help rural healthcare providers expand their telemedicine services and broadband access.
  2. Telehealth: Telehealth is a service that saw widespread adoption during the pandemic. Telemedicine allows patients in rural areas to access mental health services remotely via videoconferencing. This is especially important where there is a shortage of mental health providers. Investing in telehealth services provides healthcare organizations with an opportunity to revolutionize healthcare delivery. Investing in and expanding the use of telehealth provides an immediate way for providers in smaller communities to tap into larger health systems and their experts. It also strengthens the provider/patient relations by removing proximity as a potential barrier to connecting. Longer term, telehealth allows providers to offer new services and expand existing offerings they wouldn’t otherwise be able to. Telehealth can also help reduce patient wait times and allow providers to serve more patients without necessarily needing to hire additional personnel.
  3. Remote Patient Monitoring/Care: The challenges faced by rural communities in accessing behavioral health services are well documented – long travel times to clinics, limited availability of mental health professionals, and stigma associated with seeking help. Remote patient monitoring (RPM) tools can address many of these barriers and improve the overall quality of care. The use of technology to remotely collect and transmit health data from patients to healthcare providers, such as information on mood, anxiety, sleep patterns, and medication adherence, can help providers identify potential issues before they become acute and intervene accordingly. This can all be done remotely without travel, particularly important in rural communities where access to transportation can be limited. Additionally, remote patient care can increase the frequency of patient-provider interactions, leading to more timely interventions and better outcomes. Remote patient care also has the potential to address the shortage of mental health professionals in rural areas, helping those that are providing services to make better use of their time and resources, ultimately improving access to patient care .
  4. Predictive Analytics: Coupling solutions like telehealth with predictive analytics can enable providers to focus on those with the biggest needs, moving from triage mode to true holistic healthcare management. Rural areas already struggle with a shortage of psychologists, doctors, and nurses, and that shortage won’t stop the flow of patients needing support for mental health issues. Predictive analytics can often help provide support for those individuals with existing and ongoing conditions such as PTSD, phobias, and anxiety disorders.

Overall, technology can help bridge the gap in mental and behavioral health services in rural communities and provide access to virtual care that might not be otherwise available.

Healthcare outcomes shouldn’t be based on a patient’s zip code, but for too long, that’s been the case. Patients in smaller communities deserve the same level of care as their counterparts living in larger communities, and technology enables providers to deliver on that promise.

News from ATA 2023: debate over DEA in-person prescribing requirement, winners of Telehealth Innovators Challenge, 2024 board chair announced

The American Telemedicine Association’s annual conference, ATA2023, which wrapped two weekends ago, had some major debates, awards, and some board changes.

Special ‘listening’ session on DEA’s proposed changes on telemedicine prescribing of controlled substances. This would resume the in-person visit requirement for Schedule III-V non-narcotic controlled medications. A 30-day limit on a prescription would be permitted for a telehealth remote visit and prescription, but an in-person visit would be required during that period or thereafter before any renewal. The DEA proposed rule issued 24 February (draft here) includes allowing care to be delivered uninterrupted for 180 days after the end of the public health emergency (PHE) ending 11 May, but then requires an in-person physician visit. ATA opposes this new requirement for patients who were prescribed these medications solely during telehealth during the PHE (release 25 Feb). Public comment on the proposed rule is open for 30 days (27 March). A representative of the DEA was in the audience for the Monday 6 March discussion moderated by Kyle Zebley, ATA’s senior vice president of public policy. Other telehealth measures were extended for two years in last year’s passage of the 2023 Federal budget bill [TTA 4 Jan]. Healthcare Finance

Winners were announced for ATA’s Telehealth Innovators Challenge. The four categories and winners were:

Femtech and Women’s Health Winner: SimpliFed. SimpliFed is a virtual breastfeeding and baby feeding provider network that improves access to professional lactation support.

In-patient Care Solutions Winner: Great Speech. Great Speech provides speech therapy through a network of 200+ therapists and adds artificial intelligence (AI) technology and proprietary algorithms.

The Patient Experience: Clearstep Health. Clearstep guides healthcare consumers to the best next steps for care based on their symptoms, insurance, location and preferences via a virtual triage system set up for providers. 

Tools That Deliver Care: Strados Labs. The Strados Cardiopulmonary Platform, using the RESP Biosensor, captures wheezing, coughing, and other lung sounds plus respiratory dynamics, then to a clinician portal supported by machine learning algorithms.

SimpliFed also won the overall Judges’ Choice Award. Oshi Health, a virtual-first gastrointestinal care clinic integrating evidence-based medical care and behavioral health support into a convenient, high-touch, data-driven care model, received the overall People’s Choice Award. Release

Sree Chaguturu, MD, has been named Chair-elect of ATA’s Board of Directors for a two-year term starting May 2024. Dr. Chaguturu is executive vice president and chief medical officer, CVS Health. He has served on the ATA Board of Directors since December 2020. He will follow Kristi Henderson, DNP, CEO, MedExpress and senior vice president of the Center for Digital Health and Innovation for Optum Health, who is now Immediate Past Chair. Release

Telehealth extensions signed into US law with Federal FY 2023 omnibus bill

Jammed into the final moments of the now-ended 117th Congress before Christmas was the passage of the FY2023 ‘omnibus’ $1.7 trillion Federal budget bill. This bill did at least several good things for those of us concerned with US telehealth, as it extended provisions for Medicare reimbursement that become guidelines for commercial health plans and help to cement telehealth as a permanent part of health care delivery. There is also a tax provision that affects high-deductible health plans. 

Their passage is important as the Covid-19 Public Health Emergency (PHE) is set to expire on 11 January and no movement has been publicly discerned for its renewal. In the fall, the Department of Health and Human Services (HHS) notified US state governors that there would be at least a 60-day notice before the PHE ends. It is unknown whether this notice has been given.

To summarize the two-year extensions that go to the end of 2024:

  • Expanding originating and geographic site to include anywhere the patient is located, including the patient’s home
  • Expanding eligible practitioners qualified to furnish telehealth services, including occupational therapists, physical therapists, speech-language pathologists, and audiologists
  • Extending the ability for federally qualified health centers (FQHCs) and rural health clinics (RHCs) to furnish telehealth services
  • Delaying the in-person requirement for mental health services furnished through telehealth, including the in-person requirements for FQHCs and RHCs
  • Extending coverage and payment for audio-only telehealth services
  • Extending the Acute Hospital Care at Home (AHCAH) initiative, pioneered by Johns Hopkins two decades ago. It also requires the HHS Secretary to publish a report comparing AHCAH programs with traditional inpatient care delivery. 
  • Extending the ability to use telehealth services to meet the face-to-face recertification requirement for hospice care
  • Extending high deductible health plan (HDHP) safe harbor exceptions for telehealth services in high-deductible health plans.

The final bill did not extend the Ryan Haight in-person waiver for the remote prescription of controlled substances. As mentioned in our earlier article, this is a wise move in this Editor’s view given the abuse of this waiver by certain telehealth organizations. ATA/ATA ACTION release.

The HHS Secretary will be required to submit a report to Congress on the utilization of the above services. The interim report is due in October 2024 and the final report in April 2026, according to the American Hospital Association. Affecting hospitals and practices in the bill:

  • It delayed the statutory Pay-As-You-Go (PAYGO) Medicare 4% sequester for two years, preventing the $38 billion in Medicare cuts that otherwise would have taken effect in January.
  • Partial relief from a 4.5% reduction in physician reimbursement rates starting on 1 January. The legislation reduced the cut to 2% for 2023 and around 3% for 2024.

HealthcareFinance

Other features of this bill having an effect on healthcare and telehealth (from Infrastructure Report Card):

  • $455 million for the expansion of broadband service, including $348 million for the ReConnect program, a series of grants administered by the US Department of Agriculture for the construction, improvement, or acquisition of facilities and equipment needed to provide broadband service in eligible rural areas. This could help rural areas and hospitals in provider-patient and provider-to-provider consults.
  • $1.65 billion for the National Institute of Standards and Technology (NIST), an increase of $424 million, or 34%, above the FY 2022 enacted level. Specific funding is allocated for the measurement labs and research at $953 million, a $103 million or 12% increase above the FY 2022 enacted level. The goal is to spur research advances in cutting-edge fields like carbon dioxide removal, artificial intelligence, quantum information science, and cybersecurity.

The bill was signed into law by the president on vacation in St. Croix, USVI. Given the bumpy start of the 118th Congress today, these are at least not up for grabs.

Telehealth two-year extensions included in US Federal ‘omnibus’ budget bill

Expanded telehealth access extended for two years. The ‘omnibus’ fiscal 2023 spending bill before Congress Thursday contains extensions for four areas of improved national telehealth access developed during the COVID-19 Public Health Emergency (PHE) starting in January 2020. Because they apply to Medicare and high-deductible health plans (HDHP), they become guidelines for commercial health plans and help to cement telehealth as a permanent part of health care delivery.

The two-year extensions include:

  • Retained expanded reimbursable access to telehealth for Medicare beneficiaries put into place during the PHE
  • A two-year delay in implementing the Medicare telemental health in-person requirement
  • Extension of safe harbor provisions to offer telehealth as part of HDHPs with Health Savings Accounts (HSAs)
  • Extension of the Acute Hospital Care at Home Program. This waiver permits some emergency department and inpatient hospital patients to be treated from their homes. 

At this time, the PHE is set to expire on 11 January 2023. It has been extended every 90 days since January 2020 and may be extended again. The bill did not extend the Ryan Haight in-person waiver for the remote prescription of controlled substances, a wise move in this Editor’s view given the abuse of this waiver by certain telehealth organizations. It does request the Drug Enforcement Agency (DEA) to promulgate final regulations specifying the circumstances in which a Special Registration for telemedicine may be issued for controlled substances, and the procedure for obtaining the registration.

Another wise move on Congress’ part in this monster 4,000+ page, $1.7 trillion spending bill is to further prohibit the creation of a national patient ID for healthcare that supposedly would facilitate EHR interoperability. 

The bill is supposed to come before a lame-duck Congress at the eleventh hour before their Christmas leave on Thursday. Some opposition has coalesced due to wasteful earmarks covering pet projects that are included in the (unread by most representatives) bill and the fact that a new Congress with a change of party control in the House will be seated in January. However, for those of us in the US telehealth business, these inclusions are not controversial nor wasteful, and if the omnibus bill fails for some reason, will likely be included in any short-term extensions which are typical in keeping the government running. ATA release, POLITICO Future Pulse

Perspectives: Could the telehealth VIMPRO model save the NHS from drowning in demand?

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion area. Today’s Perspectives is from Adam Hunter, CCO at Phlo Connect, an API-driven pharmacy infrastructure platform to deliver enhanced patient and clinician experiences. Phlo Connect integrates with prescribing technologies and digital health platforms used by the NHS and by private healthcare providers, from the initial consult and prescribing, and processes the request through to patient delivery. This article discusses how Vertically Integrated Micro-Providers (VIMPRO) can work in partnership to streamline NHS services using technology and telehealth.

Interested in being a Perspectives contributor? Contact Editor Donna

The NHS is in crisis: with staff vacancies currently exceeding 130,000, elective care waiting lists are predicted to exceed 10 million by March 2024, and up to 22,000 appointments are cancelled every single day.

Speaking at a King’s Fund conference in London earlier this month, NHS Chief Executive Amanda Prichard told delegates that demand on national health and care providers is rising so quickly that patients are not always getting the level of care they deserve. Highlighting a projected £7bn NHS budget shortfall, she went on to emphasise that “We’ve got to shift the model of care from one that does late diagnosis and expensive treatment to one that does faster diagnosis, better treatment and better value for the taxpayer in the process.”

Such a model, where all patients can access timely, preventative care without exorbitant cost, is one that every developed national healthcare system aspires to adopt. Navigating the practicalities and finding the capacity for transformation has to date stalled the full realisation of this. However, gathering pace in the past decade has been the VIMPRO model of healthcare delivery, which is increasingly proving to be a successful way of meeting the needs of underserved patient groups and alleviating pressures. At this time of critical need, could this model save struggling public systems from drowning in demand?

The VIMPRO model explained

A Vertically Integrated Micro-Provider (VIMPRO) is a telehealth provider focused on delivering an end-to-end service to a specific patient group. VIMPROs are characterised by excellent user experience and personalised clinician-led care, and are increasingly entering into partnerships with national healthcare providers (including the NHS) to help bridge gaps in service delivery.

One example of a successful existing VIMPRO model operating in partnership with the NHS to meet a previously unmet patient need is Leva Clinic. They are UK leaders in chronic pain management and medical cannabis treatment. The majority of their users pay to use their digital platform, where they access psychology consultations, nurse appointments, physiotherapy advice, prescription and direct-to-door medication delivery.

This is a big step in the right direction towards meeting the needs of the UK’s underserved pain patients, many of whom have spent years with inappropriate support owing to a shortage of pain specialists and lack of personalised treatment options.

Patient and system benefits

From the perspective of NHS leaders, the benefits of the VIMPRO model are multiple. Firstly, they provide an alternative point of access to care for patients who’d otherwise need to be seen by GPs and referred on to NHS consultants. This frees up system capacity and cuts wait times and workloads. Secondly, VIMPROs provide the education and information that their specific patient group needs to manage their condition and improve their outcomes. This reduces the burden of ill health on the NHS further down the line. And thirdly, when VIMPROs are integrated properly with NHS systems, all the information about the patient’s care can be tracked in their electronic record without adding to practitioners’ admin burden. 

The VIMPRO model also offers multiple benefits to patients. Convenience and timeliness of access to healthcare are primary amongst these, as they remove the barriers of geography and waiting lists that obstruct care in the NHS. Patients can be quickly connected to leading specialists and prescribers anywhere in the county, and don’t even have to leave their homes to collect their medication. In addition, accessing remote care through a VIMPRO model means that patients who are reluctant to engage with local services for support – perhaps because of stigma around their condition – are offered an alternative source of care that’s entirely virtual and distinct from other NHS services. Finally, VIMPROs often take on the responsibility of creating education materials and championing the needs of their patient vertical. For example, men’s health VIMPRO Numan hosts a medically-reviewed blog delivering advice on weight management, erectile dysfunction, hair loss, mental health and other under-discussed men’s health issues.

The future of NHS care delivery?

There is no single solution that can fix the problems facing the NHS and other public health systems around the world. Replacing the core of NHS services with a network of VIMPROs is an unrealistic proposition that would be extremely difficult to achieve. However, carefully planned VIMPRO partnerships have already proven to be effective at redirecting patient demand to where it can be successfully dealt with.

If the right streamlined system integration and tailored digital infrastructure is put in place, patients and clinicians can enjoy seamless and convenient experiences. This means no clunky transition between platforms and service providers: from first consultation to the arrival of medication on the doorstep of the patient. 

Global health needs, and our expectations of healthcare, are constantly evolving. Only by constantly evolving the models of care delivery will we be able to keep up, and right now, that means embracing the opportunities of the VIMPRO model and making it work as well as we possibly can.