Deals of the day: American Well partners with Philips for global telehealth apps, gains $59 million partnership with Allianz

January 9, 2018 | by

The large partners with the large, adding a global dimension. Telemedicine provider American Well and Philips announced today a global alliance to integrate American Well’s patient-doctor video consults with a range of Philips’ healthcare monitoring program. First up will be adding American Well consults to the Philips Avent uGrow parenting app. This is an Apple/Android app that presently tracks baby feeding, weight, and sleeping patterns, tying into Philips baby monitoring products such as an ear thermometer and babycam. The second stage with American Well involves their mobile telehealth software development kit (SDK) to integrate video consults into other Philips’ digital health solutions and the Philips HealthSuite Digital Platform. Philips also announced that uGrow will include voice activation with the ever-trendy Amazon Echo and the Philips Avent smart feeding kit to automatically monitor the time, volume and duration of a baby’s feeds. Philips release

American Well’s second global deal of the day is with insurer Allianz’s digital investment fund, Allianz X.  The latter, funded with a $59 million investment, creates another partnership dedicated to developing a digital product that combines wearable sensors, remote monitoring, and virtual visits. The goal is to widen patient access, lower cost and improve healthcare quality. As part of the deal, Allianz X will be joining American Well’s Board of Directors. Allianz is not well known as a health insurer in the US, but is active in the international health insurance area for individual expats and employers with international employees.  Release, Mobihealthnews

Rounding up the roundups in health tech and digital health for 2017; looking forward to 2018’s Nitty-Gritty

December 29, 2017 | by | 2 Comments

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/Lasso.jpg” thumb_width=”100″ /]Our Editors will be lassoing our thoughts for what happened in 2017 and looking forward to 2018 in several articles. So let’s get started! Happy Trails!

2017’s digital health M&A is well-covered by Jonah Comstock’s Mobihealthnews overview. In this aggregation, the M&A trends to be seen are 1) merging of services that are rather alike (e.g. two diabetes app/education or telehealth/telemedicine providers) to buy market share, 2) services that complement each other by being similar but with strengths in different markets or broaden capabilities (Teladoc and Best Doctors, GlobalMed and TreatMD), 3) fill a gap in a portfolio (Philips‘ various acquisitions), or 4) payers trying yet again to cement themselves into digital health, which has had a checkered record indeed. This consolidation is to be expected in a fluid and relatively early stage environment.

In this roundup, we miss the telecom moves of prior years, most of which have misfired. WebMD, once an acquirer, once on the ropes, is being acquired into a fully corporate info provider structure with its pending acquisition by KKR’s Internet Brands, an information SaaS/web hoster in multiple verticals. This points to the commodification of healthcare information. 

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/canary-in-the-coal-mine.jpgw595.jpeg” thumb_width=”150″ /]Love that canary! We have a paradigm breaker in the pending CVS-Aetna merger into the very structure of how healthcare can be made more convenient, delivered, billed, and paid for–if it is approved and not challenged, which is a very real possibility. Over the next two years, if this works, look for supermarkets to get into the healthcare business. Payers, drug stores, and retailers have few places to go. The worldwide wild card: Walgreens Boots. Start with our article here and move to our previous articles linked at the end.

US telehealth and telemedicine’s march towards reimbursement and parity payment continues. See our article on the CCHP roundup and policy paper (for the most stalwart of wonks only). Another major change in the US is payment for more services under Medicare, issued in early November by the Centers for Medicare and Medicaid Services (CMS) in its Final Rule for the 2018 Medicare Physician Fee Schedule. This also increases payment to nearly $60 per month for remote patient monitoring, which will help struggling RPM providers. Not quite a stride, but less of a stumble for the Grizzled Survivors. MedCityNews

In the UK, our friends at The King’s Fund have rounded up their most popular content of 2017 here. Newer models of telehealth and telemedicine such as Babylon Health and PushDoctor continue to struggle to find a place in the national structure. (Babylon’s challenge to the CQC was dropped before Christmas at their cost of £11,000 in High Court costs.) Judging from our Tender Alerts, compared to the US, telecare integration into housing is far ahead for those most in need especially in support at home. Yet there are glaring disparities due to funding–witness the national scandal of NHS Kernow withdrawing telehealth from local residents earlier this year [TTA coverage here]. This Editor is pleased to report that as of 5 December, NHS Kernow’s Governing Body has approved plans to retain and reconfigure Telehealth services, working in partnership with the provider Cornwall Partnership NHS Foundation Trust (CFT). Their notice is here.

More UK roundups are available on Digital Health News: 2017 review, most read stories, and cybersecurity predictions for 2018. David Doherty’s compiled a group of the major international health tech events for 2018 over at 3G Doctor. Which reminds this Editor to tell him to list #MedMo18 November 29-30 in NYC and that he might want to consider updating the name to 5G Doctor to mark the transition over to 5G wireless service advancing in 2018.

Data breaches continue to be a worry. The Protenus/DataBreaches.net roundup for November continues the breach a day trend. The largest breach they detected was of over 16,000 patient records at the Hackensack Sleep and Pulmonary Center in New Jersey. The monthly total was almost 84,000 records, a low compared to the prior few months, but there may be some reporting shifting into December. Protenus blog, MedCityNews

And perhaps there’s a future for wearables, in the watch form. The Apple Watch’s disconnecting from the phone (and the slowness of older models) has led to companies like AliveCor’s KardiaBand EKG (ECG) providing add-ons to the watch. Apple is trying to develop its own non-invasive blood glucose monitor, with Alphabet’s (Google) Verily Study Watch in test having sensors that can collect data on heart rate, gait and skin temperature. More here from CNBC on Big Tech and healthcare, Apple’s wearables.

Telehealth saves lives, as an Australian nurse at an isolated Coral Bay clinic found out. He hooked himself up to the ECG machine and dialed into the Emergency Telehealth Service (ETS). With assistance from volunteers, he was able to medicate himself with clotbusters until the Royal Flying Doctor Service transferred him to a Perth hospital. Now if he had a KardiaBand….WAToday.com.au  Hat tip to Mike Clark

This Editor’s parting words for 2017 will be right down to the Real Nitty-Gritty, so read on!: (more…)

2017 wrapup: state telehealth reimbursement policies and progress made

December 28, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/12/CCHA-infograph.jpg” thumb_width=”200″ /]Our first 2017 wrapup is from the Center for Connected Health Policy at the National Telehealth Policy Resource Center which has helpfully organized the state of telehealth reimbursement policies in the 50 US states into an interactive map. 2017 state legislative actions are available in a summary sheet cross-referenced with linked bill numbers. 63 pieces of legislation focusing on telehealth or telemedicine were approved by 34 state legislatures this year.

True policy wonks will want to peruse on their holiday time the 262-page full report of policies as of October.

Based on the report, one of the major changes is in private payer reimbursement: “36 states and DC have laws that govern private payer reimbursement of telehealth. This number has increased by two since April 2017, although additional states have made modifications to their private payer law. Some laws require reimbursement be equal to inperson coverage, however not all laws mandate reimbursement.” The rest of the findings are highlighted in the infographic (left above) and the CCHP release.

Becker’s Hospital Review also surveyed the changes this year, as did mHealth Intelligence.

Far from a tipping point: only 18 percent of consumers using telemedicine. An expectation gap? (US)

December 19, 2017 | by | 3 Comments

When will we get there? And what needs to happen? Telemedicine provider Avizia surveyed both consumers and healthcare professionals earlier this year, and the results are not encouraging. For the huge investments made by telemedicine and telehealth companies, along with providers and payers, the key finding here is that only 18 percent of the 403 consumers surveyed in March had even used telehealth.

Of that 18 percent (N=72), it’s been a positive experience:

  • On a 1 to 10 scale, with 10 signifying a “great experience,” 62 percent of consumers who used telehealth ranked their experience a 10, 9, or 8.
  • Consumers who used telehealth appreciated time savings and convenience (59 percent), faster service and shorter wait times to see the doctor (55 percent), and cost savings due to less travel (43 percent)

Modern Healthcare also sponsored the outreach to healthcare professionals who are subscribers, locating 444 respondents whose organizations currently use telehealth or telemedicine.

  • They are most interested in telehealth’s ability to expand access or reach to patients (72 percent). Barriers are reimbursement (41 percent), program cost (40 percent), and clinician resistance (22 percent)
  • Their #1 use cases are for stroke and neurology (72 percent), followed by behavioral health (41 percent) and intensive care (20 percent).

What’s unsaid in this write-up? Consumers and clinicians clearly have differing expectations on how they want to use telemedicine. Consumers are largely using it as an alternative to an in-person visit for less serious medical needs. Clinicians use it for very serious situations–stroke, neurology, mental illness, ICU. Perhaps this is why the takeup of telehealth among consumers is low.

Mike Baird, CEO of Avizia, is quoted in the release as saying “Health systems are investing in telehealth, even as uptick is slow among consumers, because they understand the potential of the technology to impact patient care in a profound way.” But as a Grizzled Pioneer in this field said to this Editor in confidence, how many of these companies have the revenues and patient investors to enable them to stay alive till they get to the Promised Land–and how far is it? Closing the Telehealth Gap (white paper requires free registration and download), Becker’s Hospital Review

OnePerspective: VA shows how technology can improve mental health care

December 2, 2017 | by

Editor’s note: This inaugurates our new series of ‘OnePerspective’ articles. These are written by industry contributors on issues of importance to our Readers and are archived under ‘Perspectives’. For more information on contributing an article to our OnePerspective program, email Editor Donna.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Gigi-Sorenson-GlobalMed.jpg” thumb_width=”150″ /]By: Gigi Sorenson

The shortage of mental health professionals in the U.S. is becoming more acute for two reasons: 1) more health professionals are encouraging their patients to seek treatment, and 2) more people now have health insurance due to the Affordable Care Act.  A December 2016 assessment showed that over 106 million Americans live in areas where there are not enough mental health providers to meet the need. Because of this provider shortage, as well as the stigma attached to behavioral health treatment, roughly half of mental illness cases go undiagnosed or unaddressed.

However, telehealth could fill much of this gap, and the beginnings of this trend are already evident. A growing number of psychiatrists and psychologists are using video and audio teleconferencing to treat patients remotely. Patients have access to this “telemental health” either in clinics and medical centers or, in some cases, through their Internet-connected personal devices. Studies of telemental health have found that it is effective for diagnosis and assessment in many care settings, that it improves access and outcomes, that it represents a portable, low-cost option, and that it is well-accepted by patients.

VA Program Sets the Pace

The Department of Veterans Affairs (VA) began to deploy telemental health in the early 2000s, and the VA now has the largest and most sophisticated such program in the U.S. In 2016, about 700,000 of American’s 22 million veterans used VA telehealth services. In 2013, 80,000 veterans used telemental health services, and over 650,000 veterans took advantage of those services in the previous decade.

The VA system has trained more than 4,000 mental health providers in evidence-based psychotherapies for post-traumatic stress disorder (PTSD) and other mental health conditions.  It has expanded the use of telemedicine at its 150 medical centers and its 800 outpatient clinics.  It is relying increasingly on telemental health to serve its beneficiaries, partly because nearly half of the veterans of Iraq and Afghanistan live in rural areas. Mental health professionals are often unavailable in these regions, and it can be difficult for these veterans to travel to metropolitan areas where VA clinics and medical centers are located.

Telemental health can address these issues.

(more…)

VA’s Secretary Shulkin wants more private care options for veterans as part of reforms

November 27, 2017 | by

Released days before our Thanksgiving turkey (or steak, or lasagne), the Department of Veterans Affairs Secretary David Shulkin, in an interview with The Wall Street Journal (paywalled), stated his aims to increase veteran access to private care without having to rely on the VA to approve or coordinate it. This is in the direction of the recently signed bill with $2.1 bn in funding for the Veterans Choice program that targets veterans living in areas without ready access to VA facilities, or who are told they cannot get an appointment within VA within 30 days.

“The direction I’m taking this is to give veterans more choice in their care and be the decision maker for their care, which I fundamentally believe is a concept that has to be implemented,” Shulkin said. He admitted that opening the VA to private care programs will be gradual. Mentioned in the article were commodity, non-urgent services like podiatry and audiology.

For instance, the Veterans Choice program started in 2014 after wait times exploded in multiple regions, delaying care past 30 days for over half a million veterans for years well into 2015. Veterans died after waiting for care or follow up for months, notably at the Phoenix VA, creating a massive and rightfully political problem. 

Dr. Shulkin’s drive for reform and speed of care is also increasing the pace telehealth expansion with programs such as Anywhere to Anywhere which would allow cross-state consults and care that published their Federal proposed rule last month, and the rollout of VA Video Connect [TTA 9 Aug]. Earlier this year, four companies were awarded a total of over $1 bn to provide Home Telehealth over five years, reviving a fading program and updating it to not only smaller in-home tablets, but also to mobile and laptop devices. As noted in our OnePerspective article on telemental health deployment, the VA has the largest program in the US, dating back to the early 2000s.

While some veterans organizations, such as the Veterans of Foreign Wars, have been critical of moves towards integrating private care, this Editor cannot see where the problem truly is. Healthcare Dive, The Hill 

Tunstall partners with voice AI in EU, home health in Canada, update on Ripple alerter in US

November 17, 2017 | by

Tunstall Healthcare seems to be a recent convert to the virtues of partnership and not trying to do it all in-house. Here’s a roundup of their recent activity in three countries with advanced technology developers. 

Perhaps the most advanced is conversational computing, which with Siri and Alexa is the 2017-2018 ‘IT Girl’, albeit prone to a few gaffes.  The European Commission is incentivizing the development of the next generation of interactive conversational artificial intelligence to assist older adults to live independently within their home. The largest award of €4m is going to Intelligent Voice, a speech recognition company based in London. The EMPATHIC project will develop a conversational ‘Personalized Virtual Coach’ with partners including Tunstall and the University of Bilbao, as well as several other companies and academic organizations in seven European nations. Digital Journal

On the other side of the Atlantic, Tunstall is partnering with TELUS Health in Toronto. TELUS will use Tunstall’s ICP Integrated Care Platform with remote patient monitoring and videoconference telehealth capabilities to monitor patients in their network. Apparently, this is the first use of the ICP in the Americas, as previous deployments have been in Europe, Australasia, and China. It is also additive to TELUS’ own capabilities. TELUS itself is a conglomerate of healthcare tech, with EHRs, analytics, consumer health, claims/benefits management, and pharmacy management. TELUS release.

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/02/ripplenetwork_5890862790fc7.jpg” thumb_width=”150″ /]This Editor also followed up with the CEO of Ripple, the smart-looking compact alerter targeted to a younger demographic that would dial 911 in emergency situations through a smartphone app or for a subscription fee, connect to Tunstall’s call center network. It was Americas’ CEO Casey Pittock’s last move of note back in February. In June, with his departure, a check of Kickstarter and social media indicated that Ripple also disappeared. Last month, after reaching out to their founder/CEO Tim O’Neil, it was good to hear that this was quite wrong. Ripple was featured on HSN on 23 September (release) and joined that month with Michigan Governor Rick Snyder and first lady Susan Snyder at the End Campus Sexual Assault Summit. On the new website, it’s priced as an affordable safety device: $19 for one unit connecting to an app to push notifications, plus $10 monthly for 24/7 live monitoring through Tunstall. A discreet alert device that has a jewelry-type look, pares safety down to the essentials, and extends safety coverage to the young does have something on the ball.

 

Telemedicine comes to Saint Lucia–and the Caribbean

November 16, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/11/Coat_of_arms_of_Saint_Lucia.jpg” thumb_width=”100″ /]The wide world of telemedicine! It’s hard to get away from the internet (see The Telegraph’s digital detox list of countries and areas with little to none, like North Korea), but your Editors have found that telemedicine is reaching far away places like the small, volcanic Windward Island of Saint Lucia. For those who are considering a winter holiday or are resident in this eastern Caribbean Commonwealth-member island with a dual French and British history, you can take advantage of Bois d’Orange’s Easycare Clinic‘s telemedicine services. These include real-time video consults, answers to healthcare questions, creation and maintenance of PHRs, vital signs tracking, and full access to a health network. Registration is free at www.easycare-stlucia.com along with the app. St. Lucia Times

Elsewhere in the Caribbean, a report from the Bahamas tells us that that the Princess Elizabeth Hospital A&E department is now covering Fresh Creek Community Clinic in Andros and Marsh Harbour in Abaco (the ‘family islands’). According to Edward Stephenson, a healthcare consultant in the Caribbean, telemedicine has been established privately in Turks & Caicos, Haiti, Dominican Republic and St. Vincent. The VA’s Home Telehealth program was established in Puerto Rico and the USVI, although in what present condition after two hurricanes is unknown. The University of the West Indies has had a telehealth program for Trinidad and Tobago since 2004 and works with The Hospital for Sick Children (SickKids) in Toronto in a program that includes that country as well as the Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent and the Grenadines.

ATA has had a long-standing Latin America and Caribbean Chapter (ATALACC) which also is affiliated with the University of Arizona’s well-known Arizona Telemedicine Program–which in turn is affiliated with Panama’s Proyecto Nacional de Telemedicina y Telesalud. Readers’ updates welcome on this subject!

Telehealth roundups: Cuyahoga County (OH), BMJ systematic review, AAFP Forum

November 14, 2017 | by
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/stick_figure_push_up_arrow_400_clr.png” thumb_width=”100″ /]Telehealth/telemedicine case studies are many, but those of us in the field are always on the hunt for fresh results. And the results seem to be fairly successful.

Cuyahoga County in Ohio instituted a telehealth program for its 569-person Educational Service Center this past July. In the first 90 days, 45 telemedicine consultations were completed with an average savings of $342 for each visit. Median wait time to the doctor consult was 2 minutes, 23 seconds. This amounted to a 130 percent return on investment, or $48,000. This is over the summer, when many employees were on leave, and does not calculate productivity gains, e.g. less sick time. The ESC goal is 80 percent utilization. This last would boggle the Big Minds over at the RAND Corporation which criticized the 88 percent rise in utilization when CalPERS members used Teladoc. TTA 8 Mar, 25 Mar  The provider of telehealth services is First Stop Health. Healthcare IT News.

BMJ reviewed 44 studies (of over 2,100 studies surveyed in the last five years) to identify factors around telehealth effectiveness and efficiency. “The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences.” Patient satisfaction was achieved when providers delivered healthcare via videoconference or any other telehealth method. Telehealth and patient satisfaction: a systematic review and narrative analysis (PDF)

The American Academy of Family Physicians (AAFP) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care hosted a Capitol Hill meeting on telehealth in primary care 9 November. The conundrum that PCPs face: telehealth is well-suited to primary care, the CPT codes are there, physician time can be easily recorded, and patients now are comfortable with it–but connectivity, health plans, and expansion of the referral network beyond the local are still not there. Regina Holliday, a well-known patient advocate who will be speaking at MedMo17, spoke about telehealth’s great advantages in mental health, especially to younger patients who want anonymous counseling and those in rural areas where it’s hundreds of miles to a mental health clinic or a psychiatrist. AAFP Forum Report

Tender/Prior Information Alerts: North Yorkshire, North Ayrshire

November 14, 2017 | by

Susanne Woodman, our Eye on Tenders, has located more complete information on a North Yorkshire tender we listed on 7 Nov and a prior information notice by North Ayrshire for a contract to be published next month.

  • North Yorkshire: The North Yorkshire County Council has listed full information on the tender for Assistive Technology services for North Yorkshire. It is for technology, monitoring and support to extend healthier independent living in the home and reduce demand on social care services. It is a three-year contract (extension up to 24 additional months) valued at £4.85 m. Bids close on 17 January 2018. TED–Tenders Electronic Daily 
  • North Ayrshire (Scotland): This Prior Information Request by North Ayrshire Council is for a 24/7/365 call handling system which is fully compatible with alarm equipment and telecare peripherals installed or provided by the Council in the full North Ayrshire Council area which includes the islands of Arran and Cumbrae. There are about 4,200 services users of primarily Tunstall equipment with a volume of 21,000 to 28,500 calls per month. The contract will be from 01 September 2018 to 31 August 2019. The contract will be published on 4 Dec. Public Contracts Scotland and TED

Distance concierge medicine: telemedicine connects US doctors to Chinese patients

October 25, 2017 | by

Another ‘burden shift’ in medical care. As we in the US wrestle with the issues of telemedicine, cross-state consults, and payment parity, companies are finding a niche in cross-border international virtual consults. A startup in NYC, Docflight, now connects Chinese patients to a claimed several hundred US doctors from prestigious medical centers: Dana-Farber Cancer Center, NYU Langone, Brigham and Women’s Hospital, Massachusetts General, New York-Presbyterian, and others. Founded by Sally Wang, an attorney with a MPH, she developed the idea after negotiating the US healthcare system for her mother with breast cancer and considering how difficult it would be in China to do the same.

The patients pay an upfront fee of about $2,000 in what is essentially long-distance concierge medicine. Docflight first screens the patient, then recommends an appropriate specialist. Once matched, Docflight collects the patient’s medical records (machine translated then human reviewed) and schedules the consult time. The US doctor then advises their Chinese patient on health issues and performs a virtual visit, often with an attending Chinese doctor, and offers recommendations for treatment in an average 45 minute session. The doctors cannot prescribe, perform treatments or procedures. 

China has a burgeoning middle class and an aging population, which in combination with the hospital-based system of care in China means that individual patients receive little time with a physician, don’t have a personal relationship with one or more doctors, and don’t expect much of a personal relationship with their doctor. Their government is trying to swing the balance to a primary care model, but with 1.4 bn people that will take awhile. Telehealth and remote patient monitoring is one avenue being explored [TTA 12 Oct 16] but for acute care, a different model is needed. For the Chinese middle class, Docflight is an alternative to medical tourism, a time-tested safety valve for the affluent commonplace for patients from Canada, Latin America, the Middle East, and Asia to international medical centers, though Docflight will arrange such trips to the US.

It’s reasonable that healthcare crosses borders to increase access and overcome language barriers. We’ve previously profiled Mexico’s Salud Interactiva, which provides telephonic consults within the country plus select services through partners ConsejoSano (US) and Konsulta MD (Philippines) [TTA 16 Aug]. Dictum Health, an early-stage health tech company dual-headquartered in Dubai and Oakland, Calif., provides telehealth/telemedicine services long-distance to clinics in Costa Rica, refugee camps in Jordan, and oil rigs [TTA 19 Sep]. Crossing borders to burden-shift care and using technology to facilitate it is a trend to watch for in 2018. NBC News (video), Bold Global Media (video), Crunchbase  Hat tip to reader Jeanmarie Tenuto of Healthcare Technical Solutions.

Impact of IP telephony on UK telecare systems

October 24, 2017 | by | 8 Comments

The Telecare Services Association (TSA) in the UK has recently released a white paper addressing the impact of a fundamental change to the [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/10/connecting-people-saving-lives.jpg” thumb_width=”150″ /]UK Public Switched Telephone Network (PSTN) that is now being contemplated. This change will eventually see the replacement of the current PSTN and Integrated Services Digital Network landline networks with IP telephony (the type of phone connectivity that has been commonly used in most modern office environments for some years).

Two years ago BT, who essentially owns practically the whole of the UK PSTN, proposed that the change of their network would be completed in 2025.

This has an impact on the telecare services to the extent that many telecare alarm devices in use connect to the call centres via the PSTN and hence such devices and/or the infrastructure used by suppliers of such services will need to be upgraded when the underlying network is changed. There are, according to the TSA paper, 1.7 million users of such devices in the UK.

The TSA is essentially the UK industry body for telecare and telehealth and as such it is understandably trying to raise awareness of the need for both the commissioners and suppliers of these services to prepare for the change. This paper is said to be a result of gathering views from “key stakeholders” related to this change.

The potential impact, however, seems to be somewhat exaggerated. It should be remembered that the UK very successfully underwent another major switch-over not that long ago in 2012 – from analogue to digital TV. It required every analogue TV in the country to be either fitted with a set top box or replaced with a digital TV.

TSA also suggest that this changeover be used as an opportunity to roll out more internet based digital health functionality to end users. Of course, such functionality is already widely appearing in the form of health monitors, exercise and medication reminders etc. and are not dependent on the switch over. So it is unfortunate that the paper flips between the two topics and asserts a dependence of internet based digital services on the PSTN switch-over.

The document feels more like marketing material than a white paper with about 1/3 of it taken up by irrelevant photographs of random happy smiling or laughing (mostly older) people. It reminded me of some of the material that came out the the 3 Million Lives project. If only our elderly people living alone or in our care homes were as happy as this!

The paper is available to download here.

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

October 21, 2017 | by

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

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

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

American Well/Medtronic release, Healthcare Informatics, MassDevice

Improvements in telehealth reimbursement, interstate coverage urged in Florida

October 18, 2017 | by

Florida is one of the 34 states (plus the District of Columbia) to have legislated telehealth commercial insurance coverage, usually termed ‘parity’, for telehealth (telemedicine) virtual visits. It’s also the headquarters of many telehealth related companies, which makes it surprising that it took till 2016 for legislation to pass. In the law was the formation of a Telehealth Advisory Council within Florida’s Agency for Health Care Administration (AHCA) to report on the actual performance of insurers in paying for telehealth services. This Advisory Council recently met to review a draft copy of a 32-page report that will be sent to Florida’s Governor and Legislature later this month. That report contained some aggressive recommendations based on their provider survey, such as:

  • Establishing a practitioner/patient relationship through telehealth alone, without a prior in-person visit
  • Real parity in insurance company payment with in-person visits–in other words, payment at the same rate, which is explicitly stated in regulations in only three of the 34 states with telehealth ‘parity’ legislation
  • Amend Medicaid rules to give provider reimbursement for more telehealth services–currently, Medicaid provides for reimbursement of live video conferencing only
  • Authorize participation in interstate “compacts” that enable cross-state licensure for telehealth services. This was in the Florida House version of the bill in 2016 but dropped from the final version approved by both chambers.

The Advisory Council’s survey prior to the draft report showed lower than the national usage of telehealth: 6 percent of practitioners versus nationally 16 percent. 45 percent of Florida hospitals used telehealth, below the 52 percent of hospitals (with another 10 percent in the process) found in a 2013 national poll. For practitioners, the key barrier was financial in three areas: required investment, adequate reimbursement for services, and a financial return.

By law, the Advisory Council must complete its report by December 1, 2018, but it appears they are well ahead of schedule. Health News Florida (WUSF). Background from law firm Foley on the original legislation 14 March 2016

Proposed rule issued for ‘VA Anywhere to Anywhere’ telehealth cross-state care

October 3, 2017 | by

The Department of Veterans Affairs ‘Anywhere to Anywhere’ program, which would enable VA doctors to treat VA patients across state lines via telehealth and telemedicine, yesterday (2 October) published in the Federal Register the required Federal proposed rule. There is a mandated 30-day comment period (to 1 Nov). In the Federal government, these rules move faster than any legislation. From the rule: “VA has developed a telehealth program as a modern, beneficiary- and family-centered health care delivery model that leverages information and telecommunication technologies to connect beneficiaries with health care providers, irrespective of the State or location within a State where the health care provider or the beneficiary is physically located at the time the health care is provided.” PDF of rule.

VA Home Telehealth has both doctor-to-patient telemedicine and vital signs remote monitoring components. While VA is fully able to waive state licensing requirements if both the physician and the patient are in a VA clinic, because of state telemedicine laws they have not been able to provide the same care for veterans at home. VA also has a care distribution problem, with many veterans living in rural areas, at great distances from VA facilities, or with limited mobility. What this will enable is VA hiring in metro areas primary care and specialist doctors to cover veterans in rural or underserved areas and the expansion of mental health care. It also will facilitate the rollout of the VA Video Connect app for smartphones and video-equipped computers now in use by over 300 VA providers [TTA 9 Aug].

The VETS Act (Veterans E-Health and Telemedicine Support Act of 2017, S. 925) would permanently legislate this, but in the US system this type of Federal rule, in this circumstance, moves faster.  Fierce Healthcare, Healthcare Finance, mHealth Intelligence 

NHS Kernow forced to postpone telehealth end by patient legal action (updated)

October 3, 2017 | by | 1 Comment

Your opinion counts. Use it! (Also see below for another cut to be made) NHS Kernow, which back in July snap announced an end to telehealth monitoring for budgetary and ‘outcome proof’ reasons, has been forced to back down on ending the program by a patient’s legal action. Ian Wyness, a 55-year-old patient with a severe heart condition, took up the fight with NHS Kernow CCG, first with letters, then in the local court. NHS Kernow is now maintaining the service to over 900 patients and on 19 Sept opened up for a six-week public consultation.

According to Cornwall Live, local people will be able to share their views about the service to 7am on Wednesday 1 November through a survey distributed online at www.surveymonkey.co.uk/r/KCCG-TelehealthSC or returning a printed copy. Cornwall Live also lists times and locations for four public hearings, inviting users and caregivers, on 24 and 26 October. The service will be continued until a final decision is reached by the CCG–according to them, in December.

International headlines were made in July when the plight of Bodmin resident Jill Diggett, who has five serious medical conditions that have hospitalized her multiple times, but has stayed out of hospital with telehealth, went viral via Cornwall Live, many publications like TTA, and an ITV interview where she begged the CCG to ‘Let me die at home’ [TTA 7 July]. Ending her service would not only affect her and her husband’s quality of life, but also made no sense financially with the daily cost of her long hospital stays. The promise of transitioning her care to a distant Cornwall location also hadn’t been kept.

Mr. Wyness is a former RAF service member from Davidstow who had his own dramatic medical experience leading to telehealth monitoring. In one day in 2012, he had been resuscitated 14 times in three locations due to his heart condition. Telehealth now monitors his blood pressure. When monitoring staff noted a drop, he was taken to hospital ‘just in time’. When the closing was announced, Mr. Wyness went to court with the assistance of the Leigh Day firm. They made and won a legal argument that closing telehealth services without consulting with members of the public was illegal. “I decided to fight for everyone because many patients who use the service who may have dementia or may be old are unable to take on that fight.” Bravo! Hat tip and thanks to Suzanne Woodman for the follow up.