Philips is expanding their just-concluded three-year ACT program with ACT@Scale, a three-year research study which will track up to 75,000 chronic disease patients on health outcomes and economic impact data. They are working with specific EU regions (Northern Ireland, Spain’s Catalonia and Basque Country, southern Denmark and northern Netherlands) which are already innovating care/coordination services and use of technology in specific areas. A major university consortium is also joining with Philips to conduct the study: University Medical Center Groningen (The Netherlands), Aristotle University of Thessaloniki (Greece), City University London (UK), Universitätsklinikum Würzburg/Klinikum der Bayerischen Julius-Maximilians-Universität (Germany), University of Hull (UK), Kronikgune-Centre for Research Excellence in Chronicity (Basque Country, Spain) and Hospital Clinic of Barcelona (Spain). ACT@Scale is part of the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), an initiative from the European Commission under its Innovation Union strategy that aims to increase the average healthy lifespan by two years by 2020. More will be presented at eHealth Week, 8-10 June, Beurs van Berlage, Amsterdam, The Netherlands. Philips release.
Indian Health Service soliciting telemedicine providers to fix shortcomings (US)
In the US, as part of treaty obligations with Native American tribes, the Indian Health Service provides healthcare services for American Indians and Alaska Natives resident both on and off reservations. Shortcomings have been well-documented, but earlier this year in their Great Plains region, the Centers for Medicare and Medicaid Services (CMS) uncovered serious deficiencies in services, particularly in ERs, at the Pine Ridge and Rosebud Indian Reservations in South Dakota which led to CMS threatening to withhold payment for Medicare and Medicaid billings. While a remediation agreement was reached, IHS is now inviting telemedicine providers by June 6 to propose remote care at its seven hospitals and other facilities in Iowa, Nebraska, South Dakota and North Dakota, covering emergency services and specialty referrals services including an option for provider-to-provider consultations. Indian Tribes nationally, but especially in the Pacific Northwest and the Southwest, have long been active in telehealth as ‘rural’ is an understatement for many reservations and communities, specialty care is scarce even in hospitals and American Indians are overall underserved in healthcare services. IHS release, RFP information, Chron/Associated Press, mHealth Intelligence
Legrand adds Jontek to assisted living and healthcare businesses (UK)
Jontek Ltd, a Stockport-based developer and provider of monitoring software and response centers for telecare, telehealth, lone worker and mCare, is being acquired by Legrand, a specialist in digital building and electrical infrastructure. Jontek will be joining Tynetec in Legrand Electric Ltd’s Assisted Living & Healthcare Business unit. Like Tynetec, Jontek is one of our Grizzled Pioneers of telecare, having started their business over 20 years ago. Currently they provide services to over 60 organizations in the UK and are a Government Procurement Supplier.
Looking at the release, Legrand sees an opportunity to complement Tynetec’s current lines in at-home alarms and assisted living call systems with Jontek’s Answer-link monitoring software, which is a system integrating database queries/reporting, document management, emailing and incident logging. (This Editor also sees potential for these systems to enhance Tynetec’s telehealth RPM systems and Intelligent Care.) Managing Director Chris Dodd: “Historically, both Jontek and Tynetec have been committed advocates of an open protocol philosophy. This will continue to remain one of our primary considerations when developing integrated digital solutions and innovative IP care platforms of the future.” Legrand release.
Two important takeaways: We continue to see consolidation of health tech businesses with an eye to enhancing and widening capabilities. Companies with established businesses are moving to make their products more accessible and user-friendly with mobility and enhanced response–BYOD and call centers. In design, they are incorporating secure data integration and reporting capabilities to make the data useful to clinicians and to prove worth, reducing the number of time-consuming steps to obtain data–or fall inevitably behind other digital health competitors. The other is ‘open protocol’ which this Editor interprets in this context as the ability to integrate sensors, peripherals, software and other kit which are not proprietary–in other words, to play nicely in the sandbox. Another indicator that the ‘walled garden’ is coming to an end. Not that it is going to be easy for those firms which have invested in a certain way of doing business–a challenge that many heretofore successful companies are facing. Ed. disclosure: Tynetec is and has been a long time supporter of TTA.
Telehealth and COPD: meta-study shows little QoL improvement
A review of studies on the use of telehealth interventions (generally remote patient monitoring but also education and pulmonary rehabilitation) with COPD patients is equivocal to somewhat negative on the effectiveness of telehealth on quality of life (QoL) improvement and positive impact on disease progression. Only three of the 18 studies surveyed showed statistically significant improvements, with the others showing no significant improvement. However, the researchers noted the low number of studies and that large-scale controlled trials would be called for; also at the end, they note that what might be more valid is the “comparison to absence of deterioration, relative to control groups, as a perhaps more realistically acceptable success criterion.” Stasis might be a better thing to evaluate given that COPD patients can deteriorate quickly without the right care. Published by a Danish research team at the International Journal of Chronic Obstructive Pulmonary Disease. Dove Press open access. Also FierceHealthIT
State by State report on telehealth laws and policies (US)
A comprehensive scan of telehealth laws and Medicaid [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/05/State-telehealth-laws.jpg” thumb_width=”150″ /]program policies is available from the recently released report from the Center for Connected Health Policy, part of the Public Health Institute, a California based non-profit. This fourth annual review, State Telehealth Laws and Medicaid Program Policies, provides a current summary of telehealth policies and laws in all the states and the District of Columbia.
As we have covered in many previous articles, states are actively pursuing legislation to implement their own set of telehealth policies. This report is supposedly an up to date summary of these laws and regulations as of March 2016.
Some significant findings highlighted by the authors are
– 47 states and Washington DC provide reimbursements for some form of telemedicine video conferencing. This number is unchanged from last year.
– 9 states reimburse for store and forward services (e.g. medical images, documents and pre-recorded videos. Primarily sent between medical professionals)
– 16 states offer reimbursement for remote patient monitoring, unchanged from last year
The report is complemented by an interactive map located here.
Australia: Most of the benefit of NBN comes from Telehealth and Teleworking
A study has concluded that most of the benefit from the National Broadband Network in Australia comes from two sources, telehealth and teleworking. Economic Benefit of the National Broadband Network (NBN) is a report partially summarising a study by the Centre for Energy Efficient Telecommunications (CEET) at the University of Melbourne. The study analyses the potential economic impact of Australia’s NBN.
Assuming that eventual access speeds will reach 10-25 Mbps, the model used by CEET predicts long-term GDP increase of 1.8% and a 2% increase in real-term household consumption. Of six categories of services considered, cloud computing, e-commerce, online higher education, telehealth, teleworking and entertainment, it is telehealth and teleworking that have come up as the services that will generate the most benefit from the NBN.
The average annual household benefit is estimated to be around $3,800 by 2020. Recognising the significant investment being made in broadband in Australia, the paper attempts to describe how the NBN will influence the national economy through the adoption of new services and new ways of working.
The short summary report is in easily accessible language and well presented and is available here.
Charterhouse rejects buyout bid for Tunstall Healthcare, considers refinancing
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2014/07/Big-T-thumb-480×294-55535.gif” thumb_width=”150″ /]Breaking News. Some long-awaited updates on the ongoing rumors regarding Tunstall Healthcare and a potential sale surfaced on Bloomberg late yesterday. Citing ‘people familiar with the matter’, Charterhouse Capital Partners, the owner and main investor, rejected a £300 million (US$425 million) buyout offer from private equity investment firm Triton Partners and reportedly will seek refinancing as an option if a buyout offer cannot be accomplished. However, the same sources state that talks are ongoing including with Triton and other potential investors and that no decisions have been made.
Triton is an investment firm registered in St Helier, Jersey and with locations through Europe, China and New York. It represents around 100 institutional investors and concentrates in investments in medium-sized businesses in northern Europe, Italy and Spain. In looking at their sector mix on their website, health is a small slice of their interests under consumer. This Editor speculates that they were seeking to expand this area, and perhaps sensed a bargain, because Tunstall by no stretch could be considered ‘medium-sized’.
Another interesting tidbit is that the cited sources indicated that before a refinancing, the company might need to be deleveraged. There is about £230 million in debt excluding shareholder loans and bank debt, which if included would bring the total to an eye-blinking net debt of £1.2 billion. Charterhouse purchased Tunstall in 2008 for £530 million. Current sales are £212 million for the fiscal year ending in September 2015, down from £215.2 million in 2014 according to a filing with Companies House (see 4 Dec 15 PDF in the filing history tab).
Tunstall’s statement: “Tunstall’s turnaround plan is well advanced and we are seeing improved performance,” the company said in an e-mailed statement. “Our focus is on delivering for our customers and helping them exploit the possibilities that new digital technologies present.”
This Editor’s reflection is that Tunstall is in the situation that nearly every company in telehealth and in health tech is in–a confusing market with segments as fine as a garlic clove sliced with a razor, too many players, too many segments with too many names, all chasing not enough money whether private or government.
Certainly more to come. Hat tip re the article to a Reader with long-standing experience in the telehealth field.
Abstracts for Med-e-Tel now online
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/04/Med-e-tel-logo.jpg” thumb_width=”150″ /]Med-e-Tel Luxembourg, one of the longest continuously running health tech conferences in Europe (from 2004, certainly enough to qualify it as a Grizzled Pioneer), will be on this week from Wednesday to Friday, but if like this Editor you’ll be unfortunately far, far away, Prof. Maurice Mars, Richard E. Scott and Malina Jordanova of the organizing International Society for Telemedicine & eHealth (ISfTeH), have published the speaker abstracts online and free (requiring only registration.) See them here.
The abstract researchers span the globe–Nigeria, Greece, Sweden, Czech Republic, Brazil, New Jersey (!)…plus several from UK (including Malcolm Fisk), Portugal, France, Spain, Italy, South Africa and Bulgaria. Orange Labs will present the data of their diabetic bike riders from the 2015 mHealth Grand Tour (MHT)–this was a high point of last November’s mHealth Summit/HIMSS Connected Health [TTA 13 Nov 15]. There’s also research on topics you don’t hear about in most conferences: smart cities, mHealth’s environmental impact, telenursing, adapting eHealth to serve those of differing abilities, even substituting smart technologies for physical restraints. So many unusual views are represented here. Also in this issue, Vol 4 (2016), is a wealth of research from Brazil.
More in the Med-e-Tel update press release.
The mixed picture of health tech investment: a potpourri
One picture is generally positive–plenty of opportunity in the aging and ill population, particularly in data integration from various sources, and value-based care. Everyone loves the excitement that a startup with a novel technology or way it can make knowledge more useful brings to the field. Another picture is one of pitfalls aplenty, from overhyping technology (poster child, Theranos) to overestimating growth, overspending and especially picking the wrong (nervous, impatient) investors at the wrong time, which have left a general patina of mistrust around digital health. There’s also the fact that healthcare is a highly, confusingly regulated, long-cycle business that’s challenged money-wise, whether in the US, UK, Europe or Asia. Some advice to startups contained in these two articles, including from the principals of StartUp Health accelerator (who’ve seen it all), has to do with building trust, finding the right investors, the right advice/advisors, collaboration (though that is difficult with IP), finding proven (affordable) management and a sustainable (and resilient) culture. Underpromise, overdeliver. TechCrunch, Healthcare Dive
No wonder that investment was flat in 2015, and that much of the news is around acquisitions that rearrange companies and/or offerings. The latest today is Allscripts‘ and GI Partners’ acquisition of behavioral EHR/care coordination company Netsmart for $950 million; Allscripts is moving its homecare business into Netsmart’s CareFabric suite. Kansas City Business Journal, Healthcare Dive In addition we’ll cite our earlier Mo’ Money article on the $600 million in various digital health investments. UPMC, which had invested in Vivify Health’s telehealth/RPM platform, is spreading $3 million around partly in-house to six health tech projects developed under the Pittsburgh Health Data Alliance. And in an example of Wearables Confusion, investors put $16 million into LifeBeam to develop another DTC ‘holistic’ health wearable (LifeBeam’s origins are sensors for aerospace and defense) while early wrist fitness entrant Pebble has laid off 40 staff in an attempt to refocus on…fitness.
Early-stage companies are also alliancing and merging. Fresh out of Newark and the New Jersey Institute of Technology’s NJ Innovation Institute, the merger of Practice Unite (which knits together secure mobile clinician/patient communications into a customized platform) and Uniphy Health (physician engagement), is an example of complimentary enlargement. This expands care collaboration offerings and shades over into patient engagement if you look at the PHM quadrant here. According to Director/Chief Medical Officer Stuart Hochron, MD (who was a Practice Unite founder), “We’re really pleased with the outcome of this merger. It’s given us the capital and resources that we need to scale.” It’s also good to see that both the founders and the CTO are moving into the new Uniphy Health–and staying in Newark. Release
Population health management growing, segmenting; one investor’s helpful view
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/TPHM-Blog-PHM.jpg” thumb_width=”150″ /]An interesting post-HIMSS 16 view is a helpful attempt to sort out the miasma around ‘population health management’ (PHM). There were about 125 vendors categorized under PHM there, a good sized chunk, and PHM was the subject of much of the presentation content. Many vendors contend that they have or ARE the solution, but down here in the trenches where most of our Readers slog, we realize that each have only a piece of it.
The writer skillfully divides PHM companies into four main categories of main offerings and further into sub-functions (see left above):
- Data integration and management
- Clinical analytics
- Care coordination
- Patient engagement where telehealth/RPM generally fits also includes patient communications, treatment plans, educational content and closing gaps in care.
Only lightly touched on (more…)
Deloitte’s consumer view of technology acceptance in home health
The Deloitte Center for Health Solutions (DCHS), the research division of Deloitte LLP’s Life Sciences and Health Care practice, conducted six focus groups late last year to gauge the acceptance of technology in home health. They tested two main home health scenarios among 42 younger (<44) and older (45-64) adults, both drawn from healthy and chronic condition patients and with a mix of demographics.
In this qualitative study, the two scenarios tested were: technology that would help manage chronic conditions and tech to promote healthy living. The first scenario gives a very advanced vision of chronic care management that involves telehealth, telemedicine and residential monitoring in the management of chronic conditions (diabetes and CHF). The second involves lifestyle factors including eating, activity and exercise management and managing travel.
Some findings in the report summarized and linked for download here, including implications for companies:
- Overall they were open to and optimistic about using technology to enable better home care of older adults who require it–including embedded sensors.
- ‘Smart home’ has appeal, but there is a preference for the less intrusive (stove burner/cooking range sensors, fall detectors) and resistance to perceived invasions of privacy (sleep, bathroom and activity monitoring).
- They understood the balance of reward and risk in consideration of broad categories of nutrition, physical activity, prevention, and dealing with an acute episode (see quadrant below, click to enlarge)
Center Director Harry Greenspun, MD’s in his Health Care Current blog notes that TECS has the capability of providing services formerly provided only in a doctor’s office or hospital in the home, but “One question remains, “How quickly will consumers adapt and accept new technologies that bring care into their home?”–then answers his own question.
All of these innovations have given us a level of insight and capability we could not have imagined even a few years ago. At the same time, each raises privacy concerns.
So why do we do it? Because we get something out of it.
Telehealth reimbursement: a major growth obstacle overcome this year?
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/Hurdle.jpg” thumb_width=”150″ /]Will 2016 be the year where the hurdles are jumped? Telehealth systems and platforms are becoming more comprehensive and compatible with mobile technologies. While there are still discussions (arguments!) as to telehealth remote patient monitoring effectiveness in care models, with the occasional naysaying short-term or IVR study ‘proving’ RPM doesn’t work, the long-term positive VA Home Telehealth results since 2003, and the large body of research prove otherwise when integrated within a chronic or transitional care model. Yet at $14 million or .0025 percent, it was in 2014 a tiny part of Medicare payments because of CMS’ emphasis on rural telehealth at that point (and still). Medicaid (state programs for low-income children and adults under CMS oversight and administered through private payers) is more generous, with most states providing some payment and some having parity (with in-person visits) regulations.
A retrospective look at telehealth reimbursement is in a just-published paper by the Health Care Cost Institute (full PDF of report) which analyzed thousands of claims from four major insurers (Aetna, Humana, Kaiser Permanente and United Healthcare).to track trends in telehealth billings from 2009-2013. Key findings are summarized by senior counsel René Quashie of leading health tech law firm Epstein Becker Green in this article. It’s evident that the private payer sector didn’t exactly lead the way on commercial adoption of telehealth and telemedicine.
Here, the public sector is forcing change. Medicare rules on chronic care management changed for year 2015 to permit telehealth integration, and while complex (and not especially generous), CMS has further expanded them for ACOs in the Medicare Shared Savings Program (MSSP) and for new Next Generation ACOs. Yet only 20 percent of ACOs in the 2015 MSSP program actually used telehealth in care programs.
You can understand why from practices’ past experiences with payers. Becker’s Hospital Review cites from excerpts that while telehealth claims reimbursement on average rose 2009-2011 from $60 to $68/visit, in 2013 they dropped precipitously to $38. For all the hand-wringing over mental health, psychiatrists get the short end once again: a diagnostic interview exam (which is generally 1-2 hours if not more) cost $200 via telehealth (telemedicine) and $288 when the exam was conducted in person, but reimbursement was $77 and $105 respectively. After needing to invest in equipment and software, it’s understandable why physicians don’t look forward to getting paid less for their trouble.
But the argument is that things are changing for the better, and that is advocated by Nathaniel Lacktman, partner of tech law firm Foley & Lardner in his optimistic article in Advance Executive Insights, which maintains that 2016 is going to be the Year of Telehealth and remote patient monitoring. (more…)
Chubb Care System adds communities (UK)
Chubb Community Care launched the Chubb Care System at the end of last year [TTA 13 Dec 15], and following up, they have already become the approved technology adviser and provider for the Northern Housing Consortium and the Knowsley Housing Trust’s Bluebell Park Apartments. KHT provides housing for 27,000 residents in Knowsley. The Chubb Care System is a hybrid communication/monitoring system for residents in sheltered and extra care housing to communicate with staff and integrates with TECS, telehealth and fire/safety devices and systems. As Editor Charles put it, some have portrayed Chubb as the weakest of the ‘big three’ telecare providers, and it is heartening to see them move forward quickly.
Care Innovations’ ‘record growth in 2015’; replaces CEO; GE departs partnership
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]Care Innovations‘ recent (undated) press release (discovered as a LinkedIn update), if read without a Gimlet Eye, could be read as another one of those ‘good news’ releases that build company awareness and get it picked up on websites such as TTA. Certainly there’s a nice spin of positive news for remote monitoring technologies, particularly more complex ones in vital signs monitoring and broadening out their applicability. (More on those below.) But the observant eye will pick out a couple of ‘aha!’ moments at this company that got slipped in, but not slipped by, the Eye.
The first is that GE has departed the building. Always the junior partner except for the very beginning in 2009, GE apparently exited sometime after December based on the last press release with Intel-GE identification issued 1 Dec 2015. The boilerplate company description is no longer ‘Intel-GE Care Innovations’ but now ‘Care Innovations, a wholly-owned subsidiary of Intel Corporation’. Lift your eyes to the company logo at the top left of the web page, and there it is, ‘An Intel Company’. GE is not fully cleansed, still to be found on product pages such as Health Harmony and QuietCare, as well as the copyright line at the bottom of each web page. (More work to be done)
The second is the appearance of CI’s new CEO, Randy Swanson, in the executive quote and on the ‘team’ website page. His bio notes that he’s a 17-year Intel finance/business development veteran, at one point with responsibilities in the Digital Health Group. Tea leaf readers might well surmise that Intel will now emphasize profitability at CI after the major repositioning and partner expansion during the 2.5 years of Sean Slovenski’s tenure (a non-Intel’er departed in January to Healthways, TTA 13 Jan).
The release also has a few more interesting moments. (more…)
ATA 2016 announces keynoters
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/ATA2016Bannerv2-1.jpg” thumb_width=”200″ /]American Telemedicine Association 2016 Conference and Trade Show
Sat 14-Tues 17 May, Minneapolis Convention Center
ATA 2016 is the world’s largest and most comprehensive meeting focused on telemedicine, digital, connected and mobile health. Over 6,000 healthcare professionals and entrepreneurs in the telemedicine, telehealth and mHealth area are expected to attend the 75+ sessions and visit the over 300 exhibitors in the main hall. Keynote speakers announced are:
- Nicholas Negroponte, co-founder of the MIT Media Lab
- James Peake, former US Secretary of Veterans Affairs
- John Noseworthy, MD, President and CEO of the Mayo Clinic
- David Shulkin, MD, Under Secretary of Health for the VA
- Jack Resneck, Board of Trustees, American Medical Association
- Jonathan Perlin, MD, PhD, MSHA, MACP, FACMI, President, American Hospital Association
- Reed Tuckson, President, Board of Directors, American Telemedicine Association
Register today through 15 April to save $150. More information here on schedule, keynotes, housing and Minneapolis (which is lovely in the spring when the snow is all gone!). TTA is again a media partner of ATA’s annual meeting.
UK Telehealthcare’s London MarketPlace
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2016/03/UKtelehealthcare.jpg” thumb_width=”150″ /]6 April, 10am – 3pm at London Fire Brigade HQ, 169 Union Street, London SE1 0LL
UK Telehealthcare is organizing its first MarketPlace for 2016 at the LFB to commemorate its 150 years of service to the community. About 30 exhibitors will be presenting the latest in assistive technologies for the home including telecare, sensor-based and safety/alert. Best of all, it is free to professionals in social care, healthcare and security. See PDF attached or contact Gerry Allmark.
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