TTA’s Autumn Falls #4: Amazon Care’s slow growth, Google Care Studio’s app, Grand Rounds rebrands, Theranos’ silty bottomless deception well, more!

 

 

Weekly Update

Editor’s Note: We’re looking for contributors–if interested, email Editor Donna

The pace of financings and M&A slows down a bit, though the realignments are important–and the renaming starts. Google creates an app around their Care Studio EHR search tool. Another look at Amazon Care and their possible strategy as they spend beaucoup lobbying bucks. Theranos proves to be a bottomless well of deception, darkly tinted with silty water.

Short takes: Google’s Care Studio app debuts, Modern Age’s healthy (aging) $27M Series A, OnSky Health launches pad-based RPM
Amazon Care confirms five more cities, beefs up DC lobbying–but what’s the real game? (It may be your data, not your health, as competition ramps up)
Theranos, The Trial of Elizabeth Holmes, ch. 4: we deceive those who want to believe (A skillful shell game that worked very well until The End)
News roundup: Grand Rounds rebrands as Included Health, HealthEdge buys Wellframe, TytoCare rings Google Chime

The Trial reveals Walgreens’ and Safeway’s frustrations and deceptions with Theranos that ultimately cost them a collective $520 million. Walgreens learned its lesson, bringing home the primary and post-acute care of VillageMD and CareCentrix. Babylon raises even more $, Best Buy moves into home care management with Edinburgh’s Current Health. And stepping back, is telehealth now due for a correction?

Short takes: Walgreens now majority share of VillageMD, CareCentrix; Lark Health lifts $100M, UnitedHealth Group’s profitable Q3 and Change delay
What’s next for telehealth? Is it time for a correction? (Maybe not as much as we cracked it up to be)
News and deal roundup: Babylon’s $200M raise, Best Buy buys Current Health, Virgin Pulse-Welltok, Devoted Health’s $1bn raise, Withings watch gains FDA ECG clearance
Theranos, The Trial of Elizabeth Holmes, ch. 3: Safeway, Walgreens execs testify to deception, frustration with Holmes, failed pilots and labs (updated) (Expensive lessons!)

The trial of Theranos founder Elizabeth Holmes moves to the Hot Grill, with the former lab director turning slowly on the spit to ‘well-done’. Babylon Health is finally SPAC-ing–and buying US practices. And in TelehealthWorld, both Teladoc and Babylon are offering similar virtual full-service primary care to payers and employers for members.

Telehealth’s primary care wars heat up: Teladoc’s Primary360, Babylon 360 (Telehealth ain’t beanbag)

Babylon Health’s SPAC closing later this month at $4.2 billion value, buys California medical practices (Now to turn that red ink to black)
Theranos, The Trial of Elizabeth Holmes, ch. 2: the lab director’s contradictions, competence questioned (The best defense that money can buy)
 

The trial of Theranos founder Elizabeth Holmes slugfests on, with prosecution hammering away at knowing malpractice in patient care with the Edison labs, and the defense using every Perry Mason-like trick in the book to break witnesses. And back in the real world, Walgreens continues to explore outside of Drug Store World with a rumored pass at management services company Evolent Health.

Theranos, The Trial of Elizabeth Holmes: ch. 1 (The defense lawyers must have been paid in advance)
Walgreens may acquire Evolent Health: report (Possible reach into tech-based management services)

Google continues shedding Health initiatives with shutdown of NHS’ Streams clinical support app. But is health care too much for Big Tech accustomed to monetizing clicks and ads? Headspace and Ginger decide to merge rather than be bought, as digimental health stays hot. Beth Israel Deaconess shows how hospital IT can get its skates on with telehealth. And Cerner’s pay package for its new CEO shows you that crime does not pay, but healthcare certainly does!

Mental health apps Headspace, Ginger to merge into $3B Headspace Health (Better to merge than to be bought? The sprint of digital mental health continues.)
Another Google termination: Google Streams clinical support app used by NHS (Another broken healthcare toy)
Amazon’s Chime telehealth solution rang Beth Israel Deaconess Medical Center’s bells–case study (How hospital IT can innovate under pressure)
Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package. (Too much, too soon?)

Our weekend lead news is Google Health’s shutdown, with its head graduating to the Big Job at Cerner. Rockley Photonics may be revolutionizing the smartwatch with its photonic vitals sensors. Sharecare expands health ed and enters the once-sleepy home care biz. Humana also bets big on home care with Kindred, SDOH heats up, Maven’s a unicorn, and Carrots are on the healthcare plate with the trimmings.

Breaking: Google Health shutting down, most employees scattered to other divisions (And its head is now Cerner CEO)
Deal and news roundup: Humana closes $5.7B Kindred at Home buy, Unite Us SDOH buys Carrot Health for data, Carrot Fertility raises $75M, Maven Clinic at $1B value, Privia partners with Babyscripts for moms, Tyto Care and Prisma Health
Sharecare expands health education capabilities, acquires CareLinx home care for $65M (updated) (A healthcare conglomerate in the making?)
Comprehensive “clinic-on-the-wrist” digital health sensor system debuts. Apple Watch of future? (UK/US) (Rockley Photonics’ big leap)

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: https://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Legrand/Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

News roundup: Grand Rounds rebrands as Included Health, HealthEdge buys Wellframe, TytoCare rings Google Chime

Grand Rounds Health rebranding to Included Health. Virtual care and navigation telehealth company Grand Rounds, which merged with Doctor On Demand back in May, is adopting the new and inclusive name, Included Health. Aside from the full rebranding as a company that is “turning the existing model on its head” for those who “feel marginalized by today’s healthcare, and it’s all about subtraction, taking things away from us,” as Owen Tripp, CEO stated in the announcement at HLTH21, it’s also a convenient name. Around the time the merger was being finalized, this Editor noted that Grand Rounds had acquired a small care concierge/health navigation targeting the LGBTQ+ community called…Included Health [TTA 28 May]. Release, FierceHealthcare

HealthEdge acquires Wellframe. HealthEdge, which specializes in payer administrative and clinical systems connectivity and automation software, announced their intent to acquire digital health and care management company Wellframe. Terms were not disclosed. Wellframe currently serves more than 33 million members. HealthEdge stated that they would be integrating their GuidingCare and HealthRules Payor with Wellframe’s systems, along with Wellframe co-founder and CEO Jake Sattelmair, his leadership team, and approximately 150 employees. While there’s some overlap, the two companies greatly complement each other in integrating payer systems to work more efficiently end-to-end in member and care management.  Release

TytoCare Chimes In. Telehealth diagnostic TytoCare upgraded its two-way video capabilities using the Amazon Chime platform. Its new video features include enhanced video quality, multi-party calls, and the ability for clinicians to conduct remote visits on any tablet, including iPads. TytoCare enables users to perform remote physical exams of the heart, skin, ears, throat, abdomen, and lungs, plus measure blood oxygen levels, heart rate, and body temperature. Release

TTA’s Autumn Falls #2: Theranos trial–the lab director grilled, well done; Babylon Health’s SPAC coming up shortly; Babylon and Teladoc move into virtual full service primary care

 

 

Weekly Update

 

Editor’s Note: We’re looking for contributors–if interested, email Editor Donna

The trial of Theranos founder Elizabeth Holmes moves to the Hot Grill, with the former lab director turning slowly on the spit to ‘well-done’. Babylon Health is finally SPAC-ing–and buying US practices. And in TelehealthWorld, both Teladoc and Babylon are offering similar virtual full-service primary care to payers and employers for members.

Telehealth’s primary care wars heat up: Teladoc’s Primary360, Babylon 360 (Telehealth ain’t beanbag)

Babylon Health’s SPAC closing later this month at $4.2 billion value, buys California medical practices (Now to turn that red ink to black)
Theranos, The Trial of Elizabeth Holmes, ch. 2: the lab director’s contradictions, competence questioned (The best defense that money can buy)
 

The trial of Theranos founder Elizabeth Holmes slugfests on, with prosecution hammering away at knowing malpractice in patient care with the Edison labs, and the defense using every Perry Mason-like trick in the book to break witnesses. And back in the real world, Walgreens continues to explore outside of Drug Store World with a rumored pass at management services company Evolent Health.

Theranos, The Trial of Elizabeth Holmes: ch. 1 (The defense lawyers must have been paid in advance)
Walgreens may acquire Evolent Health: report (Possible reach into tech-based management services)

Google continues shedding Health initiatives with shutdown of NHS’ Streams clinical support app. But is health care too much for Big Tech accustomed to monetizing clicks and ads? Headspace and Ginger decide to merge rather than be bought, as digimental health stays hot. Beth Israel Deaconess shows how hospital IT can get its skates on with telehealth. And Cerner’s pay package for its new CEO shows you that crime does not pay, but healthcare certainly does!

Mental health apps Headspace, Ginger to merge into $3B Headspace Health (Better to merge than to be bought? The sprint of digital mental health continues.)
Another Google termination: Google Streams clinical support app used by NHS (Another broken healthcare toy)
Amazon’s Chime telehealth solution rang Beth Israel Deaconess Medical Center’s bells–case study (How hospital IT can innovate under pressure)
Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package. (Too much, too soon?)

Our weekend lead news is Google Health’s shutdown, with its head graduating to the Big Job at Cerner. Rockley Photonics may be revolutionizing the smartwatch with its photonic vitals sensors. Sharecare expands health ed and enters the once-sleepy home care biz. Humana also bets big on home care with Kindred, SDOH heats up, Maven’s a unicorn, and Carrots are on the healthcare plate with the trimmings.

Breaking: Google Health shutting down, most employees scattered to other divisions (And its head is now Cerner CEO)
Deal and news roundup: Humana closes $5.7B Kindred at Home buy, Unite Us SDOH buys Carrot Health for data, Carrot Fertility raises $75M, Maven Clinic at $1B value, Privia partners with Babyscripts for moms, Tyto Care and Prisma Health
Sharecare expands health education capabilities, acquires CareLinx home care for $65M (updated) (A healthcare conglomerate in the making?)
Comprehensive “clinic-on-the-wrist” digital health sensor system debuts. Apple Watch of future? (UK/US) (Rockley Photonics’ big leap)

The news isn’t taking a Summer Holiday, neither are deals. Honor just rocked the sleepy home care world with its buy of Home Instead. UnitedHealth will have to wait till end of year for Change. Morgan Health debuts with $50M in Vera Health. The Telehealth Teeter-Totter continues with Amwell’s gloomy forecast, Teladoc’s Aetna deal. And Voices Carry with stress testing and a neuroprothesis that may give communication back to those who cannot speak. 

Home care rocked: Honor Technology acquires home care provider Home Instead (It’s all about the caregivers and hospital-at-home)
News roundup: update on UnitedHealth/Change Healthcare DOJ check, Tunstall adds new CTO, Amwell’s gloomy second half, Teladoc’s Aetna deal, Fitbit and LifeScan diabetes
Hearing voices: Cigna-Ellipsis AI-powered voice stress test; UCSF/Weill neuroprosthesis decodes attempted speech (Giving speech to the speechless in the future)
News and funding roundup: patient outreachers Relatient, Radix merge; health apps top 350,000; Morgan’s $50M in Vera Health; Communicare247, Doro, TeleAlarm join Scottish Digital Telecare’s list

A short one this week in the rollup to HIMSS. Funding and deals aren’t taking the summer off despite it being August, and this year’s first half just beat full year 2020.

News and funding roundup: BioIntelliSense ‘stickers’ $45M, Exo ultrasound scans $220M, Enovation gets Scotland OK, WellSky snaps up Healthify, Cerner’s good quarter despite VA (And summer is supposed to be quiet?)
2021’s bubbly $14.7 billion in digital health funding–six months that beat all of 2020 (Rock Health’s rock’n’rolling 1st half)

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)

Have a job to fill? Seeking a position? Free listings available to match our Readers with the right opportunities. Email Editor Donna.


Read Telehealth and Telecare Aware: https://telecareaware.com/  @telecareaware

Follow our pages on LinkedIn and on Facebook

We thank our present and past advertisers and supporters: Legrand/Tynetec, Eldercare, UK Telehealthcare, NYeC, PCHAlliance, ATA, The King’s Fund, DHACA, HIMSS, Health 2.0 NYC, MedStartr, Parks Associates, and HealthIMPACT.

Reach international leaders in health tech by advertising your company or event/conference in TTA–contact Donna for more information on how we help and who we reach. See our advert information here. 


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

Telehealth’s primary care wars heat up: Teladoc’s Primary360, Babylon 360

The new fronts in the Telehealth Wars continue to expand, with this week Teladoc announcing that their virtual primary care offering, Primary360, is now available for health plans, employers, and other payers. Babylon Health, in its push into the US market and their upcoming SPAC, also announced that their similar program, Babylon 360, is also being offered to health plans.

Both these services connect the patient users with an assigned doctor and primary care team for ongoing care. They emphasize building a relationship with a doctor and team, not just a random selection previously typical of telehealth. Both Teladoc and Babylon are fully virtual in exams and checkups, sending equipment where needed, ordering lab tests and prescriptions, and accepting your prior health records, plus have 24/7 coverage for urgent situations. Babylon’s service also offers a symptom checker and connection to social determinants of health (SDOH) community services.

It’s obvious that the payer-provider walls are coming down in all directions–telehealth is one more. Babylon, as we noted earlier, acquired two California-based practice groups. Payers like lower-cost, more convenient visits, and after a fractious start, have for some time. Many of the insurtechs either have close relationships with providers or have bought practices (Bright Health’s NeueHealth)–copying the Optums which have affiliations with or ownership of practices all over the US. It’s also another pressure on primary care practices around reimbursement. Often the answer is to either sell out or enter into value-based care arrangements.

For the patient/member, there’s the benefit of convenient care, and a relationship with a team, albeit not with an in-person option right now–if these services are consistent in their promise and steady in their physician/clinician groups. Mobihealthnews (Teladoc)

Over 400 telehealth groups urge Congress to retain CARES Acts gains on remote care

430 telehealth and remote care companies, along with major health providers and associations, have organized to petition Congress to make permanent the changes instituted by the Coronavirus Aid, Relief, and Economic Security (CARES) Act for the duration of the COVID-19 public health emergency (PHE). These changes will expire this year unless the pandemic emergency extends into 2022.

Like the Senate Telemental Health Care Access Act of 2021 that would extend telemental health Medicare coverage to patients without a prior in-person visit [TTA 16 June], the extension of CARES Act coverage would require Congressional action to amend the Social Security Act: for telemental health, Title XVIII; for telehealth, Section 1834(m). While the Telemental bill is actually in the Senate, the permanent expansion of telehealth and remote care would require its own and far more complicated bill and corresponding regulations.

Based on the letter (PDF link), these changes would include:

  1. Remove Obsolete Restrictions on the Location of the Patient and Provider. This is the rural geographic restriction.
  2. Maintain and Enhance HHS Authority to Determine Appropriate Providers, Services, and
    Modalities for Telehealth. This would expand the list of practitioners, services, and also expand telehealth in some cases to audio-only consults.
  3. Ensure Federally Qualified Health Centers, Critical Access Hospitals, and Rural Health Clinics
    Can Furnish Telehealth Services After the PHE. These are the ‘safety net’ providers for underserved and rural areas.
  4. Remove Restrictions on Medicare Beneficiary Access to Mental and Behavioral Health Services
    Offered Through Telehealth. This covers much the same ground as the Telemental bill.

What is unclear, of course, it being Washington, is how quickly Congress will bestir itself to enact these changes to existing law before the end of 2021 and the expiration of the CARES Act window with, presumably, the end of the PHE. American Telemedicine Association (ATA) releaseHealthcareITNews, FierceHealthcare

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%

AliveCor disclosed its latest FDA 510(k) clearance for the KardiaMobile 6L, for calculation of patients’ QTc interval by the patient remotely or in the office with a physician or other clinician. QTc interval is, for those of us who aren’t cardiologists, is the total time from ventricular depolarization to complete repolarization. If too long (prolongation) or too short (congenital short) for the heart rate, it can indicate a dangerous ventricular arrhythmia or atrial or ventricular fibrillation. The manual measurement takes 30 seconds. AliveCor also has clearance on software (InstantQT) that measures QT intervals quickly and accurately to detect potentially dangerous QT prolongations in patients. Prolongations can be triggered by medications including anti-arrythmia drugs, anti-fungals, antibiotics, and some psychiatric drugs. AliveCor release. In other recent news, in June they acquired CardioLabs, a monitoring and cardiac diagnostic service provider based in Tennessee, to expand their clinical servies. Release.  

And in David Sues Goliath–Again–News, AliveCor also filed, in that quiet week right before Memorial Day, a Federal antitrust suit in the Northern District of California. This lawsuit is over Apple’s exclusion of other heartrate analysis providers from the Apple Watch, harming AliveCor and consumers, and seeks damages plus an injunction to cease the exclusion. Release  This is in addition to their US International Trade Commission (ITC) complaint on infringement of AliveCor patents held for heart monitoring on the Apple Watch 4, 5, and 6. That seeks to bar importation of Apple Watches [TTA 29 Apr]. No update on that so far. 

‘Insider’ report: VRI on the market. PERS Insider, our newly discovered source for news about the emergency response device market, reported on 22 June that VRI, a PERS and remote patient monitoring provider, is up for sale. It has been majority-owned by Pamlico Capital, a private equity company, since 2014. VRI does not sell direct to consumer but concentrates on health insurance, government programs, and other B2B through its dealer network. No reasons for sale given, but with all things telehealth and most things remote healthtech fetching hefty sums post-pandemic, perhaps Pamlico senses a fortuitous time to test the waters for an exit. Article. (Subscribe here to their weekly free letter)

Walgreens Boots Alliance’s new CEO promises a ‘tech-enabled’ future for the chain, sans details. The incoming CEO, Rosalind Brewer, fresh from her COO position at Starbucks, on WBA’s Q3 earnings call mentioned a buildout of a “previously communicated tech-enabled healthcare initiative” but no further information, as still reviewing the company. Stefano Pessina has retired from the long-held CEO position, but retains the executive chair title in addition to being WBA’s largest individual shareholder. Forbes’ breathless report. More to the profit point, the latest on Walgreens and VillageMD’s full-service Village Medical practices at Walgreens locations: 29 new locations in Houston, Austin and El Paso, Texas this year, staying on track for 600 primary care practices in more than 30 markets over next four years. Business Wire

National telehealth usage dips to 4.9% of US claims in April, a 12.5% drop from March. Analyzing regional and national insurance claims data, non-profit health analytics company FAIR Health in its monthly report tracks telehealth receding as patients return to in-person care. Telehealth is now dominated by mental health procedure codes, accounting for 58.65% of diagnoses, with all other conditions at 3% or lower. Regionally, the Northeast is even higher at 64.2% and the Midwest above 69%. Monthly National report, Monthly Regional Tracker page

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.

 

Telemental Health Care Access Act introduced in US Senate to repeal in-person requirements for mental telehealth care

Eliminating the Medicare requirement for an in-person visit prior to telehealth used for mental health services. Yesterday, the Telemental Health Care Access Act of 2021 (PDF link) was introduced in the US Senate. It is a bipartisan bill sponsored by four senators, Bill Cassidy, MD (R-LA), Tina Smith (D-MN), Ben Cardin (D-MD), and John Thune (R-SD). It specifically amends Title XVIII of the Social Security Act to ensure coverage of mental health services furnished through telehealth without a prior in-person visit.

The 2021 Consolidated Appropriations Act on one hand removed the geographic restrictions for Medicare, but on the other imposed a restriction that requires physicians to see their mental health patients in-person at least six months prior to a Medicare-reimbursed telehealth visit. It’s significant as Medicare and the Physician Fee Schedule (PFS) [TTA 3 Dec 20] set the standards for commercial payers on coverage and reimbursement. The bill, so new it does not have a number yet, is designed to eliminate that requirement.

In the US, there is an acute shortage (at least 6,000) of mental health providers, particularly psychiatrists. Back in 2013, 70 percent of psychiatrists were over the age of 50 and due to retire. As to the top of the funnel, few medical graduates choose psychiatry due to compensation issues (paying for expensive medical education). Those who do are trained in residencies and tend to stay near large cities, further exacerbating the existing geographic imbalance. It’s a situation that hits this Editor close to home as her own brother is one of those semi-retired psychiatrists. He apparently has not been replaced in the clinic practice in which he worked for over 20 years and his private practice is self-limited. Most of the psychiatrists in his suburban area are retiring as well. Psychiatric mental health advanced practice registered nurses (PMH-APRN) fill only part of this gap. (For a further discussion of APRNs and their role in mental health practice, see this issue of Psychiatric Times)

Telemental health can fill some of the gap in rural areas, for continued support in mental health counseling and medical management, and for those who would benefit from cognitive therapies, a burgeoning area for telehealth companies.

The bill is supported by the American Telemedicine Association (ATA), the American Psychiatric Association, the American Psychological Association, and at least 30 companies (including the leading telehealth providers such as Teladoc and Doctor on Demand) and non-profit organizations such as the American Foundation for Suicide Prevention. ATA release and overview of present in-person requirementsSenator Bill Cassidy release.

Survey: 80% of Americans believe telehealth can provide quality medical care–up 23 points from 2020

Directional data that confirms the acceptance of telehealth gained five years of progress in one–and that could justify continued massive investment in telehealth. One year after COVID-19 introduced Americans to telehealth as the sole alternative to the in-person medical visit, perceptions have changed positively among users and non-users. Customer engagement/business process services company Sykes Enterprises surveyed 2,000 US adults (18+) in March and found the majority of their respondents not only now believed that they could receive quality care via telehealth, but also that it provided needed care and is preferred for parts of their annual exam, in addition to other specific acceptance points.

Highlights of the survey: (more…)

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

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.

Deals and news roundup: Ginger’s $100M, myNEXUS to Anthem, Everlywell snaps up PWN, Amwell’s banner year for revenue–and loss, VA reviews Cerner rollout, voice visits for MA, GE’s vScan goes wireless, uBiome founders indicted

Deals–and news–are piling up like Easter eggs before the hunt. Mental health and cognitive digital therapy scored another raise with Ginger‘s $100 million Series E to fund expansion into health plan and government partnerships. Blackstone Growth led the round. Total funding to date is $220 million. It’s entered unicorn status with a valuation just north of $1 bn. Ginger to date has concentrated on corporate mental healthcare. From being an ugly duckling only a few years ago, digital mental therapies are this year’s ‘it’. But competition is fierce: the traditional telehealth companies such as Teladoc, Doctor on Demand, and Amwell are closing in on the early entrants such as AbleTo. Direct-to-consumer models like Talkspace; UK/Ireland’s SilverCloud Health; and Lyra, Spring Health, and Happify, which just closed a $73 million Series D, all step out with slightly different ‘differentiators’ but target the same companies, health plans, and health systems. FierceHealthcare, Ginger release

Home health is also another former ugly duckling transformed into a swan. Anthem is acquiring home health/nursing management company myNEXUS, which manages home-based nursing services for 1.7 million Medicare Advantage members across 20 states. Their digital authorization and visit management couples with a nationwide network of providers and nursing agencies for local care. Exiting myNEXUS are private equity investors led by New York’s WindRose Health Investors, after four rounds and a conservative $31 million in funding (Crunchbase). Neither terms nor management transitions were disclosed. myNEXUS will join Anthem’s Diversified Business Group. FierceHealthcare, release.

Home testing+telehealth company Everlywell (not connected with the Everly Brothers) has a different take on home health. They are now integrating their self-test kits with fully owned lab testing. New acquisitions PWNHealth and its subsidiary Home Access Health Corporation will join Everlywell in Everly Group. PWN was Everlywell’s main telehealth partner and diagnostic testing partner since 2016. It will become Everly Health Solutions with their testing data kept separate from Everlywell’s. Home Access was PWN’s self-collected lab test company. Everly Health now will support more than 20 million people annually in all 50 U.S. states, Canada, and Puerto Rico. Acquisition terms were not disclosed. PWN’s CEO will take a seat on the Everly Group board to assist integration. Valuation is now estimated at $2.9 bn.  Mobihealthnews, Everly release, Bloomberg News

And in other news…

Amwell reported a Very Good Year in their telehealth services, with visits growing to 5.9 million from 2019’s 1.1 million. Total revenue was up over 65 percent to $245.3 million. However, profitability continues to be elusive, with net loss almost equaling revenue. Release

The Department of Veterans Affairs (VA) finally announced a review of the Cerner-Leidos EHR integration. Back in February, VA was hanging tough on the rollout after the GAO report questioning its wisdom and recommending postponement until high severity issues were corrected. Secretary Denis McDonough, new VA head, has directed the undertaking of a 12 week strategic review without pausing the project. Taking bets on that 12 weeks! Healthcare Dive

Payers and their lobbyists are supporting a newly reintroduced House bill that would permit telephonic-only telehealth visits to be reimbursed for their Medicare Advantage plans after HHS closes the pandemic period. There is considerable information that video/audio virtual visits still have limitations with the 65+ group, clustered around high-speed internet or good data connections, smartphones, and computers with cameras, making video visits difficult or impossible. Which begs the question about continuing coverage for those on Original Medicare. Healthcare Dive

Those readers with long memories will recall GE Healthcare’s heralded introduction of the VScan handheld clinical-grade ultrasound device–back in 2010, complete with Eric Topol rave and demo. Not much has been heard from GEHC since till this month, and other competitors, such as the Butterfly IQ from 4Catalyzer, have made handheld ultrasound common and affordable. GEHC announced Vscan Air, a fully wireless version that connects to iOS or Android. It was FDA cleared in November 2020 and will be shipping its dual-headed probe and accessories starting 1 April for a US-listed target price of $4,495. GEHC page (with the cute domain vscan.rocks), Mobihealthnews

And in our Scandal Sheet section, a Federal grand jury in the Northern District of California has indicted the founders of now-bankrupt uBiome on 40-odd counts encompassing conspiracy to commit securities fraud, conspiracy to commit health care fraud, money laundering, and identity theft. Separately, the Securities and Exchange Commission (SEC) also filed charges. Between 2016 and 2018, uBiome had raised $100 million through a Series C, and was likened to Theranos, after its fall, in the Big Claim (‘inventing the microbiome industry’). Its business was analyzing the DNA of fecal and other biological matter to sequence the bacteria of the body’s microbiome. Starting with low-cost, limited data comparison for at-home tests, the founders progressed to claiming to doctors that their diagnostic tests were clinical-quality and would be reimbursed by payers. Payers did–for awhile–and the investors piled in. By 2019, the wheels fell off their scheme and the FBI came knocking at their Silicon Valley offices after the founders cashed in. Chapter 7 followed in late 2019. The Register reports that the two married founders are on the run, whereabouts unknown. US Attorney’s Office release, SEC filing (PDF)

 

News and deal roundup, 5 March: Oscar Health’s $1.4 billion IPO, telehealth expansion in Congress, what people *really* do during a telehealth visit

What a difference a month makes in a blazing healthcare market. ‘Neoinsurer’ Oscar Health went public on Tuesday, selling over 37 million shares at $39 each, reaping an eyeblinking $1.44 bn. While shares took a tumble on Wednesday and Thursday, closing at just above $32, the valuation of the company could be anywhere between $7.92 and $9.5 bn (calculating in options and the like). Quite a difference from the estimate in early February, which was a modest–and as now we know, totally sandbagged–$100 million [TTA 9 Feb]. A lovely payday for their backers and all at Oscar who had stock grants, indeed.

As we’ve seen from recent IPOs, they have all been underestimated (e.g. Signify Health’s $100 million filing transubstantiated into $561 million). The downward glide slope in share price is typical. Whether it will rise will depend very much on strong results for this quarter, half year, and full year as Oscar presses harder into the competitive Medicare Advantage, exchange, and small group markets. How they, and all the other payers do, will be dependent on health policy permutations and emanations from the DC Swamp. CNBC, TechCrunch, FierceHealthcare

Speaking of the DC Swamp, telehealth expansion is enjoying real traction in Congress and with Health and Human Services (HHS). The chair of the House Health Subcommittee, Rep. Anna Eshoo (D-Calif.) has called for many of the flexibilities on payments and locations granted temporarily during the pandemic’s liberalization of coverage to be made permanent. These affect Medicare and other types of Federal payments. [Review of the 2021 Medicare Physician Fee Schedule re telehealth here]  They expire after the public health emergency (PHE), extended in January to end of April, so a clock is ticking, quickly.

The basics are that Congress must pass legislation that removes restrictions on geography (currently rural only) and permits the patient home to be used as a ‘distant site’. Advocates also want to add to Medicare telehealth coverage hospice and home dialysis care, more types of eligible care providers such as physical therapists and other allied health professionals, and audio-only (telephonic) consults. Others are pushing for reinstating HIPAA compliance for telehealth platforms.

The Telehealth Modernization Bill that covers most of the above was introduced on 23 February in both the Senate and House, in a rare show of both bipartisanship and bicamerality. (Excluded: telephonic consults, HIPAA compliance) Rep. Eshoo’s remarks were made during last Tuesday’s Committee on Energy and Commerce Health Subcommittee hearing.

HHS is also backing this, based on HHS’ Office of the Inspector General’s recent statement praising the expansion of telehealth. Recognizing that concerns have been raised about ‘telefraud’, IG Christi Grimm noted that they have been vigorously prosecuting fraudulent claims [TTA 2 Oct 20] with telehealth being used in a broad sense for billing other goods and services such as medications and durable medical equipment. FierceHealthcare, Healthcare Dive, ATA News 26 Feb

Speaking of telehealth visits, what do the patients do during them? This Editor had filed away, waiting for an opportune moment to share it, a surprising study by DrFirst, a mobile telehealth and communications platform. It was conducted online during the Pits of the Pandemic (June 2020). It may not surprise you that most patients weren’t fully engaged in the process. Bored, isolated, mostly male patients–73 percent men, 39 percent women–multitasked and distracted themselves during the virtual visit by: 

Surfing web, checking email, texting – 24.5%
Watching the news, TV, or movie – 24%
Scrolling through social media – 21%
Eating a snack or a meal – 21%
Playing a video game – 19%
Exercising – 18%
Smoking a cigarette – 11%
Driving a car – 10% (!!!!)

And the best….Having a “quarantini” cocktail or other alcoholic beverage – 9.4%

Reasons for consults were unsurprising: annual checkup – 38%, mental health therapy – 25%, and specialist visits (e.g., dermatologist, hematologist, or oncologist) – 21%.  N=1,002 US consumers. 44% of Americans Have Used Telehealth Services During Coronavirus Pandemic but Some Admit Not Paying Attention. Also Advisory Board blog.

The shape of telemedicine during the first half-year of the pandemic: significant but wildly uneven usage

There has been a plethora of tracking studies starting last year on how telemedicine stepped in for in-person visits during the early months of the COVID-19 pandemic. Telehealth visits peaked, then tapered off as medical offices reopened. Reviewing our articles:

  • Commonwealth/Phreesia: tracking the latter’s practices, they dropped from a high of 13.9 percent on 18 April to 6.3 percent by early October. Where telemedicine use stayed high was behavioral health–psychiatry–which remained at 41 percent.
  • Epic Health Research Network’s data, which concentrated on hospitals and clinics, showed a similar drop from the mid-April high of 69 percent but ended August at 21 percent. Regionally, the South had the least takeup of telehealth even in the critical period. 
  • FAIR Health, using insurer claims data, tracked with Commonwealth/Phreesia from 13 percent in April to 6 percent by August.

The latest study has been just published in Health Affairs (abstract free, paid access full study). Using data from 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020, the steep rise from a negligible base was the same but the percentages were between the Commonwealth and Epic studies. 30.1 percent of all visits were provided via telemedicine (including telephonic) and the weekly number of visits increased twenty-three-fold compared with the prepandemic period. The database also permitted a deeper analysis of usage.

  • Telemedicine use was lower in communities with higher rates of poverty (31.9 percent versus 27.9 percent for the lowest and highest quartiles of poverty rate, respectively). Unfortunately for comparison, not included in the information was the actual rate in wealthy counties.
  • Overall visits (in-person and virtual) plummeted by 35 percent, a backlog in deferred care still being made up
  • Rural telemedicine use was lower than urban–24 percent versus 31 percent by county
  • How specialties incorporated telehealth varied widely. As previously reported, psychiatry had a high uptake of telemedicine and reported the least drop in overall visits. Surprisingly, endocrinology (68 percent) and neurology also had high utilization. Only 9 percent of ophthalmologists reported telehealth use, because the physical exam requires highly specialized equipment. 
  • Management of chronic conditions was in between those two extremes. Conditions like hypertension and diabetes had a big drop in care volume that was mitigated by a large increase in telemedicine use.

Healthcare Dive 

Bluestream Health telehealth partners with Impresiv Health management consultants

Bluestream Health, which we noted back in November as partnering with LanguageLine to add language interpretation to their telehealth platform, has a new partnership with the interestingly named Impresiv Health. Impresiv is a national healthcare management consulting firm concentrating in clinical, operations management, and software consulting for payers and accountable care organizations (ACOs). They also provide permanent and interim staffing in multiple healthcare areas. Adding virtual care now allows Impresiv to deliver telehealth services as part of their management services menu. Bluestream Health is a secure telehealth platform which provides whitelabeled telehealth services to approximately 50,000 providers. Release   Hat tip to Erin Farrell-Talbot

COVID-19 and telehealth–promise or peril? And the perils of digital health in conflict countries and India.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) has published its latest issue today (13 Jan). JISfTeH is one of the few journals which shine a bright spot on digital health in developing countries. This month concentrates on conflict countries and COVID in India: 

  • Scaling Up Digital Health In Conflict Countries discusses the lack of any form of digital health and coordination in Afghanistan, Somalia, Sudan, and, with some exception, Nigeria. It compounds the extreme lack of healthcare services–for instance, 23 percent of Afghanis have poor access to healthcare, resulting in a high mortality rate. It can change. Rwanda, once synonymous with war, has one of the best healthcare systems in Africa due to the use of digital health services. India is using digital health in combating the TB explosion of 300,000 cases in one year. The exception in Nigeria is the liftoff of 54Gene, a genomic studies company in the world’s most genetically-diverse continent, which has secured $4.5 million in seed funding.
  • Speaking of India, telehealth has been kickstarted there due to COVID-19. The Indian Government is prioritizing the use of telehealth in the population and both public and private institutions have rolled out initiatives. India’s challenges are how patients pay for it (70% of healthcare expenses out of pocket) and how it reaches the two-thirds of population in rural areas where there is inadequate telecom and broadband for services. The irony, of course, is that India is a huge exporter of software and telecom services to the world. COVID-19 As A Catalyst for Telehealth Growth In India: Some Insights.

The editorial by Richard E. Scott of Canada and Prof. Maurice Mars of South Africa, COVID-19 and eHealth: A Promise or Peril Paradox?, cautions on the floodgates opening for telehealth in COVID’s wake. Spontaneous telehealth, where “healthcare providers themselves saw the value of an eHealth solution and implemented it independently and without traditional steps or approval” is quite separate from evidence- and needs-based telehealth. There is a lot of pressure at the national level, by the WHO, and by vendors to ‘make hay while the sun shines’. “Enthusiasm must be tempered with thoughtful guidance” on multiple and quite variable factors.