Breaking News–Teladoc: while accredited by NCQA, placed on ‘under corrective action’ status (updated)

May 16, 2019 | by

Breaking News. Teladoc–one of the two giants in telemedicine–has been placed on ‘under corrective action’ status in its latest (15 May) two-year accreditation with the National Committee for Quality Assurance, better known by its initials, NCQA. Their next review is slated for six months (18 Nov).

According to the earliest breaking report on Seeking Alpha, a business and stock market website, the move to ‘corrective action’ status has been brewing for some time. Teladoc was the first telemedicine company to win this coveted status in 2013. Now, of course, all major telemedicine players have this accreditation.

This is the latest mark against the company, which has gone through some recent ‘interesting times’ financially with accounting problems based on booking stock awards (2018), the CFO’s resignation, and lack of replacement. The report by a ‘bear’ on the stock indicates that its large contract with Aetna, among others, is up for renewal.

Exactly what this ‘corrective action’ is related to has not been made public by either NCQA or Teladoc. Comments under the article sourced from a Wells Fargo analyst that the action is arising from a workflow that Teladoc uses for credentialing providers.

A good portion of this article discusses revisions on the Teladoc website and marketing materials which ensues when something like this happens and it is the basis for a superiority or credentialing claim.

NCQA is a non-profit that advocates quality standards and measures for healthcare organizations, health plans, and organizations that provide services to the former. Their standards are widespread in the industry as a means of review and accreditation for providers and hospitals, as well as incorporated into quality metrics used by HHS and CMS. For those who may not be able to access the full article–requires free membership (but you’ll get emails) registration with the Seeking Alpha site–attached is a PDF of the article.

Update: While to the ‘bear’ Teladoc is a glass half empty and cracked, to another Seeking Alpha writer, the glass is more than half full even though the company continues to run substantial losses. Here’s an analysis that is mostly positive, though acknowledging the issues above.

International news roundup: ATA dispatches, compete for funding in Helsinki, Spry FDA-cleared for COPD, Merck acquires ConnectMed Kenya

April 18, 2019 | by

There’s not much news so far from the just-wrapped ATA 2019 conference in New Orleans, but POLITICO Morning eHealth highlighted a drop-by by Sen. Bill Cassidy from Louisiana, urging attendees to demonstrate to their local politicos that telemedicine is safe and effective–and be ready to answer questions about fraud or misuse. Louisiana’s Ochsner Health System is branching into retail with the O Bar, cleverly designed to look like an Apple Store to merchandise wearables and other health tech devices. For Ochsner patients, they can enroll into RPM programs and have their data directly input into their Epic EHR. American Well released a survey of 800 doctors, with the unsurprising finding that 22 percent have used telehealth to treat patients, but this is up 340 percent since 2015; also that the doctors finding telehealth most attractive to practice are also reporting high levels of burnout. Looking for more substantiative news from NOLA.

It’s Helsinki for pitching your digital health idea in June. The 11th edition of the interestingly named EC2VC Investors Forum and Pitch Competition is now part of HIMSS/ Health 2.0 Europe 2019. Healthcare startups and SMEs looking for funding can apply, with 12 companies to be selected to present before a jury panel of digital health investors. The format is a four-minute pitch, followed by six minutes of Q&A. More information and to apply by 6 May, with finalists selected by 13 May. The event is 11 June from 13:00 to 16:00 at Messukeskus Helsinki Expo & Convention Centre. 

Spry Health’s Loop wearable device gained FDA clearance. Spry is a RPM device company with a wrist-wearable device that measures pulse oximetry, respiration, heart rate, and blood pressure (research only) through optical sensors. While users can receive reports on the display and alerts, it is primarily meant for clinical monitoring by physicians in healthcare systems. The RPM is meant to detect signs of patient deterioration and exacerbations early so that actions can be taken. For the present time, the company is focusing on the device’s use in COPD patients. Certainly there is a large market in the US–there are 12 million diagnosed patients, with COPD the third leading cause of death with over 120,000 deaths per year. Mobihealthnews, BusinessWire, MDDIOnline

Merck acquires Kenyan digital health startup ConnectMed. The pharma company is purchasing ConnectMed’s telehealth applications in Kenya serving about 8,000 consumers, as well as related management systems. Merck will use the platform in conjunction with its Curafa point of care clinical and pharmaceutical services. Started in September of last year, these are run by local independent pharmaceutical technologists, clinical officers and nurses for underserved populations in Kenya. ConnectMed will cease operations. During its lifetime, it developed three DTC digital health services in Kenya and South Africa. WT/Startup Africa

Babylon Health’s expansion plans in Asia-Pacific, Africa spotlighted

April 18, 2019 | by

Mobihealthnews’ interview with Ali Parsa of Babylon Health illuminates what hasn’t been obvious about the company’s global plans, in our recent focus on their dealings with the NHS. For its basic smartphone app (video consults, appointments, medical records), Babylon last year announced a partnership with one of Asia’s largest health insurers, Prudential [TTA 18 Sept 18], licensing Babylon’s software for its own health apps across 12 countries in Asia for an estimated $100 million over several years. Babylon has also been active in Rwanda and now reaches, according to their information, nearly 30 percent of the population. There’s also a nod to developments with the NHS.

Parsing the highlights in Dr. Parsa’s rather wordy quest towards less ‘sick care’, more ‘prevention over cure’, and making healthcare affordable and accessible to everyone ’round the clock:

  • Asia-Pacific: Working with Tencent, Samsung and Prudential Asia through licensing software is a key component of their business. By adding more users, they refine and add more quality to their services. (Presumably they have more restrictions on the data they send to Tencent than what they obtain in China.)
  • Africa: How do you offer health apps in an economically poor country where only 5 percent of the population has a smartphone? Have an app that works for the 75 percent who have a feature phone. Babyl Rwanda has 2 million users–30 percent of Rwanda’s population–and completes 2,000 consultations a day. Babyl also works with over 450 health clinics and pharmacies. The service may also be expanded across East Africa, and may serve as a model for similar countries in other regions.
  • UK and NHSX: About the new NHS-formed joint organization for digital services, tech, and clinical care, Dr. Parsa believes it is ‘fantastic’ and that “it is trying to bring the benefits of modern technology to every patient and clinician, and aims to combine the best talent from government, the NHS and industry. Its aim, just like ours, is to create the most advanced health and care service in the world, to free up staff time and empower patients.” (Editor’s note:  NHSX will bring together the Department of Health and Social Care, NHS England and NHS Improvement, overseeing NHS Digital. More in Digital Health, Computer Weekly.)

News roundup from all over: prescribing apps is back! Plus telemental health Down Under, GreatCall’s health tech strategy, Wessex’s diabetic sim, telehealth growth outpaces urgent care

April 3, 2019 | by

Back to the future with prescribing apps! Early stage Xealth just gained a $11 million Series A from heavyweights such as Novartis, McKesson Ventures, UPMC, Philips, and ResMed. Clinicians can prescribe and monitor digital health care content, apps, devices, and services from within their EHR. Yet another thing to add to their 5+ hours a day in the system! Let’s hope that in staying away from certification, they are more successful than predecessors like the long-expired Happtique and the little-noticed but still in business Xcertia [TTA 6 Dec 15] Release 

Telemental health startup Lysn working to spread mental health access in Australia. In two years, it has grown to over 265 psychologists and partners with 53 GP clinics, mainly regional and rural. The creator of the service is a Canadian-born surgeon, Dr. Jonathan King, who is 35–and bootstrapped it with his own earnings and house. In The Black

A good coffee break read is an interview with GreatCall’s CEO David Inns outlining their health tech strategy for older adults, including a reboot of Lively Home (without the exclamation point) with Senior Whole Health in Massachusetts for ADL monitoring (set up by Best Buy’s Geek Squad), the predictive analytics part of HealthSense in using connectivity and monitoring to predict falls, depression, and diseases, and back to wearables with smartphones. What is interesting is the stunning claim that they can back up the “soak up 20 percent of the healthcare costs of the population that we’re working with” through these predictive analytics and monitoring by reducing long-term care expenses. (Reminds me of some of the claims we made at Living Independently!) However, if any company has the muscle to make it happen, they do. BTW, not a peep about the retail Assured Living in Best Buy stores we tried to find last year, in vain. Mobihealthnews.

Oxford Medical Simulation is partnering with NHS England to trial its virtual reality training for diabetic emergencies. The pilot is being directed by Health Education England Wessex at the Portsmouth and Southampton Hospitals. Fifty doctors will use Oculus Rift headsets to walk through Oxford’s 100 or so scenarios. Mobihealthnews.

The growth of telehealth is outpacing urgent care and retail clinics, according to FAIR Health. This healthcare nonprofit calculated a 53 percent growth rate for telehealth (defined as virtual visits) between 2016 and 2017. In contrast, urgent care use increased only 15 percent in urban areas but went flat in rural areas. Retail clinic use fell 28 percent in urban areas and with a small 3 percent increase in rural areas. The advantages of telehealth in rural areas (up 29 percent), of course, is not having to drive when you’re sick. For urban residents, the advantage is not having to leave the house. According to their analysis, the top three reasons for telehealth visits were acute respiratory infections, digestive issues and injuries, each representing 13 percent of telehealth diagnoses. Mental health, which led in 2016, dropped to fifth. Healthcare Dive

Suddenly hot: chronic condition management in telehealth initiatives at University of Virginia and Doctor on Demand

February 28, 2019 | by

Chronic condition monitoring is suddenly hot. UVA has been a telehealth pioneer going back to the early oughts, with smart homes, sensor based monitoring, and remote patient monitoring. Their latest initiatives through the UVA Health System focus on preventing or managing chronic conditions. It will include remote monitoring for patients with diabetes, screenings for patients with diabetic retinopathy, home-based cardiac rehabilitation programs for heart failure patients and streamlined access by primary care physicians to specialists through electronic based consults. The program will also include specialized trainings for health care providers.

The programs are being funded by a $750,000 grant from the federal Centers for Disease Control and Prevention (CDC) and the Virginia Department of Health. UVA press release, Mobihealthnews

Mobihealthnews earlier noted that Doctor on Demand, a smaller commercial telehealth company, is also expanding in the management of chronic conditions through a new service, Synapse, that creates a digital medical home for personal data. This data can include everything from what is generated by fitness trackers to blood pressure monitors. The data can be directly shared with a provider or across health information exchanges and EMRs. Doctor on Demand plans to use this longitudinal data to identify gaps in care and increase access to healthcare services–and also integrate it into existing payer and employer networks.

This Editor recalls that this was a starting point for telehealth and remote patient monitoring as far back as 2003, but somehow got lost in the whiz-bang gadget, Quantified Self, and tablets for everything fog. Back to where we started, but with many more tools and a larger framework.

The wind may be even stronger at the back of telehealth this year–but not without a bit of chill

February 13, 2019 | by

Late last year, this Editor noted that ‘the wind may finally be at the back of telehealth distribution and payment’. The expansion of telehealth access for privately issued Medicare Advantage (MA) plans, state-run Medicaid and CHIP (Children’s Health Insurance Plan) plan members, and this year’s Medicare Physician Fee Schedule, along with a limited expansion of telemedicine in the Value-Based Insurance Design (VBID) model for MA announced earlier this year by CMS, is a leading indicator that government is encouraging private insurers to pay doctors for these services, who in term will pay vendors for providing them.

The Veterans Health Administration (VA) has historically been the largest user in the US of telehealth services (home telehealth, clinical video telehealth, store-and-forward). They are also a closed and relatively inflexible system (disclosure–this Editor worked for Viterion, a former RPM supplier to the VA). In 2017, under then Secretary David Shulkin (who left under a cloud, and not an IT one), there were hopes raised through the Anywhere to Anywhere VA Health Care Initiative. So the news released at the start of HIMSS’ annual meeting that veterans will be able to access their health data through Apple’s Health Records app on the iPhone, perhaps as early as this summer, was certainly an encouraging development. According to mHealth Intelligence, the key in enabling this integration and with other apps in the future is the Veterans Health Application Programming Interface (API), unveiled last year.

Anywhere to Anywhere is also making headway in veteran telemedicine usage. Of their 2.3 million telehealth episodes in their FY 2018, over 1 million were video telehealth visits with veterans, up 19 percent from 2017. 105,000 of those video visits were through VA Video Connect to veterans’ personal devices. The remainder were real-time interactive video conferences at a VA clinic. The other half were assessment of data between VA facilities or data sent from home (the underused Home Telehealth).  Health Data Management

Virginia also moved to make remote patient monitoring part of covered telehealth services for commercial health plans and the state Medicaid program. The combined bills HB 1970 and SB 1221 will be sent for signature to Governor Ralph Northam, to whom the adjective ‘beleaguered’ certainly applies. National Law Review

But service providers face compliance hurdles when dealing with governmental entities, and they’re complex. There are Federal fraud, waste, and abuse statutes such as on referrals (Anti-Kickback, Stark Law on self-referral), state Corporate Practice of Medicine Doctrine statutes, and medical licensure requirements for telehealth practices. Telehealth: The Beginner’s Guide to Legal Pitfalls is a short essay on what can face a medical practice in telehealth.

The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta

February 6, 2019 | by

This curious and cautionary tale should be better known. A young entrepreneur named Keisha L. Williams from Ashburn, Virginia had an attractive proposition. She needed immediate funding to bring to the US an Austrian telehealth system described as “software that would allow doctors to remotely examine and talk with patients.” Ms. Williams had degrees in both law and electrical engineering, so credibility. She also had a story. The software was in ‘escrow’ in Austria. There were taxes and fees that had to be paid immediately. And she had family situations, financial and medical emergencies. In other words, she had a ‘great line of ‘stuff’ on the technology, urgency, and personally, a few tugs on the heartstrings.

Ms. Williams told this story enough times over four years, and to enough people who believed her–more than 50, who invested over $5.4 million.

What happened? 95% of the money was spent on over the top vacations to Bora Bora, Italy, the Bahamas, and Jamaica, plus the occasional yacht with ‘hand and foot services’ and shopping at top-end retail such as Bottega Veneta and Vuitton. $500,000 alone was spent on her girlfriend. About $300,000 was spent on the software.

The rest of the story involves 14 Federal fraud charges, four accomplices, and unwitting, likely vulnerable people who were talked into giving over their savings. Late in January, she was sentenced to 15.5 years in Federal prison.

Many of our Readers have started companies or worked with entrepreneurs who have a great story and need money. The stories touch our hearts–and sometimes our checkbooks. Apparently, Ms. Williams raised the money without exposing herself to anyone in the industry or private investors who would ask remotely leading questions. To us, this technology sounds hardly sexy–it’s telemedicine virtual visit software with maybe some remote patient monitoring thrown in. Yet to 50 people, who are now poorer or who were involved with the fraudulent scheme — it sounded really special. (The name is also common–there are quite a few people on LinkedIn with the same name, which may make life difficult for them.)

With the rising tide of telehealth, if your cousin or uncle has heard of a great way to visit your doctor over the phone and asks you if you’ve heard about it, you might want to ask Uncle to pass the pie as you switch the conversation to being on guard for fraudulent schemes. Washington Post (read the comments), Daily Mail, Seattle Post-Intelligencer, press releases 17 Oct and 18 Jan from the US Attorney’s office, Eastern District of Virginia

Telemedicine virtual visits preferred by majority in Massachusetts General Hospital survey

January 22, 2019 | by

The results are far better than parity with in-person visits for follow up. A group of 254 patients and 61 health care providers were the subject of a survey conducted by researchers at Massachusetts General Hospital, part of Partners HealthCare, and Johns Hopkins. It found that virtual video visits (VVVs) are perceived by the majority of patients as the same as or better than office visits in convenience and cost, at the same level of quality and personal connection. It measured responses from both patients and providers in the MGH TeleHealth (sic) program, in place since 2012, in follow up care from providers in psychiatry, neurology, cardiology, oncology and primary care (the last two added late in the survey).

The results were: 

  • The vast majority (94.5%) of patients preferred the travel time (minimal) and time convenience (79.5%) of the VVV
  • Most patients (62.6%) and clinicians (59.0%) reported “no difference” between VVV and office visits on “the overall quality of the visit.”
  • When rating “the personal connection felt during the visit”, over half–but more patients than clinicians–said that there was “no difference” with the VVV (patients, 59.1%; clinicians, 50.8%), although 32.7% of patients and 45.9% of clinicians reported that the “office visit is better”.
  • They were also willing to pay for it–and that increased with distance from the doctor. Among those who traveled more than 90 minutes to an office visit, 51.5% indicated they would pay a co-payment of more than $50 for a VVV compared with 30.4% of those who traveled less than 30 minutes.
  • Results graphs are here

The survey results were published in the American Journal of Managed Care. This month’s issue also examines gamification in healthcare, asynchronous communication between primary and specialty care practitioners at Geisinger, EHRs–and the relationship between data breaches and not surprisingly increased advertising expenditures after the fact to rebuild lost trust. According to this last article, breached hospitals were more likely to be large, teaching, and urban hospitals relative to the control group.

Also UPI and HealthDay.

Medicare Advantage model covering telehealth for certain in-person visits starting in 2020

January 22, 2019 | by

Another small step for remote monitoring and visits. Late last week, the Center for Medicare & Medicaid Services (CMS) announced a limited expansion of telehealth (remote patient visits) coverage as part of the Value-Based Insurance Design (VBID) model. In 2020, plans can apply to use telehealth as part of their coverage. According to the CMS release, Medicare Advantage (MA) is testing a new series of service delivery approaches, including “increasing access to telehealth services by allowing plans to use access to telehealth services instead of in-person visits, as long as an in-person option remains, to meet a range of network requirements, including certain requirements that could not previously be fulfilled through telehealth.” Other MA additions under the VBID mode include expanded rewards and incentives for beneficiaries for health improvement, and reduced cost sharing and additional benefits to enrollees, including those around chronic conditions or socio-economic status, such as aid around social determinants of health. 

The VBID model is administered under CMS’ Center for Medicare and Medicaid Innovation (Innovation Center, also CMMI), which tests innovative payment and service delivery models to lower costs and improve the quality of care. It began in 2017. The CMS VBID page lists 14 participating plans concentrated in a few states; however, it was open to 25 states this year. The 2020 model expands to 50 states under the Bipartisan Budget Act of 2018 plus will accept other MA plan types such as Special Needs Plans and Regional PPOs. Applications will start later this year. CMS press release, mHealth Intelligence 

It’s not a bubble, really! Or developing? Analysis of Rock Health’s verdict on 2018’s digital health funding.

January 21, 2019 | by

The doors were blown off funding last quarter, so whither the year? Our first take 10 January on Rock Health’s 2018 report was that digital health was a cheery, seltzery fizzy, not bubbly as in economic bubbles.  Total funding came in at $8.1 billion–a full $2.3 bn or 42 percent–over 2017’s $5.7 bn, as projected in Q3 [TTA 11 Oct]–which indicates confidence and movement in the right direction.

What’s of concern? A continued concentration in funding–and lack of exiting.

  • From Q3, the full year total added $1.3 bn ($6.8 bn YTD Q3, full year $8.1 bn) 
  • The deals continue to be bigger and fewer–368 versus 359 for 2017, barely a rounding error
  • Seed funding declined; A, B, C rounds grew healthily–and D+ ballooned to $59M from $28M in 2017, nearly twice as much as C rounds
  • Length of time between funding rounds is declining at all levels

Exits continue to be anemic, with no IPOs (none since 2016!) and only 110 acquisitions by Rock Health’s count. (Rock only counts US only deals over $2 million, so this does not reflect a global picture.)

It’s not a bubble. Really! Or is it a developing one? Most of the article delivers on conclusions why Rock Health and its advisors do not believe there is a bubble in funding by examining six key attributes of bubbles. Yet even on their Bubble Meter, three out of the six are rated ‘Moderately Bubbly’–#2, #3, and #5–my brief comments follow. 

  1. Hype supersedes business fundamentals (well, we passed this fun cocktail party chatter point about 2013)
  2. High cash burn rates (not out of line for early stage companies)
  3. Unclear exit pathways (no IPOs since ’16 which bring market scrutiny into play. Oddly, Best Buy‘s August acquisition of GreatCall, and the latter’s earlier acquisitions of Lively and Healthsense didn’t rate a mention)
  4. Surge of cash from new investors (rising valuations per #5–and a more prosperous environment for investments of all types)
  5. High valuations decoupled from fundamentals (Rock Health didn’t consider Verily’s billion, which was after all in January)
  6. Fraud or misuse of funds (Theranos, Outcome dismissed by Rock as ‘outliers’, but no mention of Zenefits or HealthTap)

Having observed bubbles since 1980 in three industries– post-deregulation airlines in the 1980s, internet (dot.com) in the 1990s, and healthcare today (Theranos/Outcome), ‘moderately’ doesn’t diminish–it builds to a peak, then bursts. Dot.com’s bursting bubble led to a recession, hand in hand with an event called 9/11.

This Editor is most concerned with the #5 rating as it represents the largest divergence from reality and is the least fixable. While Verily has basically functioned as a ‘skunk works’ (or shell game–see here) for other areas of Google like Google Health, it hardly justifies a billion-dollar investment on that basis alone. $2 bn unicorn Zocdoc reportedly lives on boiler-room style sales to doctors with high churn, still has not fulfilled its long-promised international expansion, and has ceased its endless promises of transforming healthcare. Peleton is a health tech company that plumps out Rock Health’s expansive view of Health Tech Reality–it’s a tricked out internet connected fitness device. (One may as well include every fitness watch made.)

What is the largest divergence from reality? The longer term faltering of health tech/telecare/telehealth companies with real books of business. Two failures readily come to mind: Viterion (founded in 2003–disclosure, a former employer of this Editor) and 3rings (2015). Healthsense (2001) and Lively were bought by GreatCall for their IP, though Healthsense had a LTC business. Withings was bought back by the founder after Nokia failed to make a go of it. Canary Care was sold out of administration and reorganized. Even with larger companies, the well-publicized financial and management problems of publicly traded, highly valued, and dominant US telemed company Teladoc (since 2015 losing $239 million) and worldwide, Tunstall Healthcare’s doldrums (and lack of sale by Charterhouse) feed into this. 

All too many companies apparently cannot get funding or the fresh business guidance to develop. It is rare to see an RPM survivor of the early ’00s like GrandCare (2005). There are other long-term companies reportedly on the verge–names which this Editor cannot mention.

The reasons why are many. Some have lurched back and forth from the abyss or have made strategic errors a/k/a bad bets. Others like 3rings fall into the ‘running out of road and time’ category in a constrained NHS healthcare system. Beyond the Rock Health list and the eternal optimism of new companies, business duration correlates negatively with success. Perhaps it is that healthcare technology acceptance and profitability largely rests on stony, arid ground, no matter what side of the Atlantic. All that money moves on to the next shiny object.(Babylon Health?) There are of course some exceptions like Legrand which has bought several strong UK companies such as Tynetec (a long-time TTA supporter) and Jontek.

Debate welcomed in Comments.

Related: Becker’s Hospital Review has a list of seven highly valued early stage companies that failed in 2018–including the Theranos fraud. Bubble photo by Marc Sendra martorell on Unsplash

VA expands telehealth services again with T-Mobile’s 70,000 lines

December 13, 2018 | by

The US Department of Veterans Affairs and T-Mobile announced on Monday that T-Mobile would be adding 70,000 lines of wireless service to increase telehealth services in the VA network and expand services to veterans, especially those in rural areas. The expanding network will connect veterans at home and at VA facilities, such as community-based outpatient clinics (CBOCs), with VA clinicians within the VA network.

This adds to VA’s push this year to extend telehealth to distant veterans in rural areas through initiatives such as with T-Mobile and the Spok Health – Standard Communications partnership to expand the Spok Care Connect messaging service to more VA healthcare systems. The VHA (Veterans Health Administration) has long been the largest user of telehealth services in the US. Until recently, their emphasis has been on store-and-forward and clinic-based patient consults, but finally Home Telehealth (HT) is being supported. Reportedly, only 1 percent veterans used Home Telehealth, while 12 percent used other forms of telehealth [TTA 24 May]. Yet the VA was among the earliest users of remote patient monitoring/home telehealth, dating back to 2003 and even earlier, with companies such as Viterion and Cardiocom.

While most of the news about VA has been about their leadership changes and their difficulties around EHRs, their ‘Anywhere to Anywhere’ program was finalized in May. This allows VA practitioners to provide virtual care across state lines to veterans, regardless of local telehealth regulations.

T-Mobile is already the lead wireless provider to the VA. The 70K line addition is part of the carrier’s $993.5 million five year contract with the US Navy.  Business Wire, Mobihealthnews

The wind may finally be at the back of telehealth distribution and payment (US)

November 15, 2018 | by

Medicare Advantage may lead, but Medicaid and regular Medicare are not far behind. The Centers for Medicare & Medicaid Services (CMS) has announced in two proposed rules changes expansion of telehealth access for both privately issued Medicare Advantage (MA) plans (26 Oct) and state-run Medicaid and CHIP (Children’s Health Insurance Plan) (14 Nov) plan members. This may mean greater acceptance by providers because they will be paid for these services.

For MA, the proposal would, starting in 2020 as part of government funded basic benefits, eliminate geographic restrictions (rural telehealth) and allow members in urban areas to access telehealth services. It would also broaden present location restrictions, allowing MA members to receive telehealth from home versus traveling to a health care facility. The most intriguing wording is here: “Plans would also have greater flexibility to offer clinically-appropriate telehealth benefits that are not otherwise available to Medicare beneficiaries.” which very well could mean remote patient monitoring in conjunction with visits. MA plans have always had more latitude to offer telehealth benefits to members, which are about 1/3 of Medicare-eligibles (over 65). Over 11 percent growth is forecast and it is highly competitive though dominated by United Healthcare and Aetna–over 600 new plans are entering the market next year. Enrollments close on 7 Dec for 2019. CMS.gov release, mHealth Intelligence, Healthcare Finance News.

For Medicaid and CHIP, which states use to extend insurance to low-income individuals and families via private plans, states would be able to, under an approved rule, to more flexibly determine what criteria determine telehealth access. Currently, states use proximity factors–distance from provider and time. The proposed criteria under 10. Network Adequacy (pages 15-16) recommends that time and distance be deleted and instead “adding a more flexible requirement that states set a quantitative minimum access standard (later listed) for specified health care providers and LTSS (long term services and supports) providers”. The reasons why are the limited supply of providers and the functional limitations of the LTSS population. Also notable was language in section 8 discussing access to provider directories via smartphone, as 64 percent of the population with incomes less than $30,000 own a smartphone and use it to access health information.  CMS proposed rule, POLITICO Morning eHealth

This adds to the momentum of the Medicare Physician Fee Schedule published on 1 Nov that added even more:

  • Virtual brief patient checkins and evaluation of patient-recorded photos and video to payments
  • CMS is also finalizing separate payments for three new codes covering chronic care remote physiologic monitoring that unbundle 99091 (CPT codes 99453, 99454, and 99457) and interprofessional internet consultation (CPT codes 99451, 99452, 99446, 99447, 99448, and 99449).
  • Two new codes covering telehealth for prolonged preventive services
  • Finalizing the addition of renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites
  • After 1 July, the home will be permitted as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. CMS.gov fact sheet 

The importance of this is that more digital health covered by Medicare and government payments in public/private programs such as Medicaid and MA lead private insurers to pay doctors for these services, who will then be willing to pay vendors for providing them. For the telehealth and telemedicine companies that have weathered the storms and lean times of the past decade, there may be light at the end of the tunnel that is not an oncoming train.

Canary Care re-emerges as Canary Care Global Ltd, confirms continued operations

November 8, 2018 | by

imageCanary Care, which entered administration in late August, has been reorganized and continues as Canary Care Global Ltd, remaining in Abingdon. The purchaser in the pre-packaged sale, as Readers learned here, is Lifecycle Software Ltd. Their marketing office sent a release last week confirming their operations. Stuart Butterfield, who answered our inquiries in September, is now managing and technical director. He is quoted in the release: “This is a really positive development for our company. We will continue to provide the Canary Care product and service that our existing customers know and love. Our new owner provides us with the stability and resources to further enhance the Canary Care offering and we’re very excited and optimistic about the future and the opportunity to bring Canary Care to a wider audience.”

The administrator’s latest filing with Companies House is clearly a wrapup of the sale as the best possible outcome for the company. Shareholders included major investor Mercia Fund Management. A quick read of the administrator’s proposal is an object lesson how quickly an insolvency can happen. In section 2, the company went from seeking fresh funding to expand markets in May, having been turned down by Mercia due to their funding criteria, to having an interested buyer who ultimately was not approved by the shareholders by a hairsbreadth, to insolvency by August.

We do wish Canary Care luck with their new ownership and success in this very difficult time for acceptance of –and payment for–telecare and TECS services. Release (PDF) Hat tip to Nicola Hughes of Lifecycle Software

Upcoming UK telecare and telehealth events; SEHTA calls for Healthcare Business Awards nominees.

November 1, 2018 | by

Winding up the year….

Managing digital change in health and care/The King’s Fund/Thursday 22 November/8.30am-4.30pm/The Met Hotel, King Street, Leeds, LS1 2HQ

This conference aims to support health and social care organisations that are looking to undertake large-scale digital change, no matter what their current level of technological advancement. Understand the factors that contribute to successful change by showcasing the experiences of different case study sites and Global Digital Exemplars that have already made significant progress. More information and registration here. 

UK Telehealthcare has several events coming up all over the country. For more information and registration, click here or the advert in the right sidebar and scroll down to ‘Members Events Coming Up’.

8th November 2018 – Suppliers’ Forum, Hammersmith Town Hall, King St. London W6 9JU
9th November 2018 – Providers’ Forum, Hammersmith Town Hall, King St. London W6 9JU
14th November 2018 – CECOPs Digital Health Masterclass, Carisbrooke Hall, Victory Services Club, 63-79 Seymour Street, London, W2 2HF
5th December 2018 – CECOPs Digital Health Masterclass, 2 Brewery Wharf, Kendell Street, Leeds, LS10 1JR.

UK HealthTech/4 December/Cardiff Park Plaza

At the UKHT conference, over 300 delegates will hear speakers discuss the major strategic issues and policy developments facing the life science and healthcare sectors. Showcases include the latest advances in R&D technologies and up and coming spinout companies. It closes with the 13th annual MediWales Innovation Awards, celebrating the achievements of the NHS, life science and health technology communities in Wales. More information and registration here.

SEHTA is calling for nominees for its 2018 Healthcare Business Awards through Friday 14 December. They are looking for the best achieving companies of 2018 in the following five categories: Export Achievement, Start-up, Innovation, Partnership with the NHS
MedTech, and the new category of Healthcare Investment of the Year (most significant/transformational public and/or private sector funding received in 2018). To download application forms, click here. Completed forms should be returned to Clare Ansett – clare.ansett@sehta.co.uk 

Accrediting telehealth and remote patient monitoring providers (US)

October 4, 2018 | by

Another organization has a go at it. ClearHealth Quality Institute (CHQI) of Annapolis, Maryland, an independent health care accrediting body, is developing two new telemedicine accreditation modules that cover Telemedicine Outcomes and Remote Patient Monitoring. The CHQI has formed a committee to develop standards in these areas to add them to current accreditation modules in telemedicine delivery: Consumer-to-Provider (C2P), Provider-to Consumer (P2C), and Provider-to-Provider (P2P). 

The need for clinical training and accreditation was recognized in August’s National Quality Forum report, Creating a Framework to Support Measure Development for Telehealth. Four domains of measurement were identified in the NQF report for telemedicine and telehealth organizations: 1) access to care, 2) cost effectiveness, 3) experience, and 4) effectiveness.

CHQI started in the insurance accreditation and compliance areas, expanding to telehealth recently. It is the only telemedicine accreditation program recognized by the American Telemedicine Association (ATA) and with major telemedicine providers such as American Well, Doctor On Demand, and MDLive.

Our Readers will remember that back in 2014, then Intel-GE Care Innovations in conjunction with the Jefferson College of Population Health had started the Validation Institute to accredit both individuals and companies. By last July, Care Innovations had sold it off to the Health Value Institute and had some time back concentrated on companies only. ClearHealth release, PatientEngagementHIT

Despite recruiting, Babylon Health’s GP at hand still on hold in Birmingham (UK); CEO steps down at rival Push Doctor

August 23, 2018 | by

GP at hand, Babylon Health’s NHS app and service for scheduling patients with local GPs, was expected to roll out in Birmingham, but the Hammersmith and Fulham CCG, from which Babylon operates, continues to halt its the expansion since the beginning of this month on patient safety concerns.

The app, which schedules patients with GPs and requires registration that effectively changes what we in the US call ‘attribution’, was set to add GP surgeries in Birmingham starting this month and was setting up an HQ at Badger House, an out-of-hours GP services provider based in Birmingham’s inner city. GP recruitment had started, according to Pulse, in late July. Patients would register in Babylon’s host practice Dr. Jefferies and Partner in southwest London through NHS’ out-of-area registration scheme.

The objections to Babylon’s expansion came initially from Paul Jennings, the chief executive of Birmingham and Solihull CCG. According to Digital Health, “he wrote to Hammersmith and Fulham to lodge a formal objection to the expansion. He argued the digital service was “not yet robust or tested for a national service to be delivered from a single practice outside of Birmingham”. Hammersmith and Fulham then stated that “further information is required to provide assurance on the safety of patients” before the Birmingham roll-out could be approved. 

This is despite the release of a equality impact assessment by Verve Communications on behalf of Hammersmith and Fulham finding mainly positive results, such as GP at hand “more likely to address most barriers than traditional GP services” in 10 out of 11 protected groups” and that “carers may benefit from [the] use of GP at Hand as this will allow them to consult a primary care practitioner whilst continuing with their care responsibilities.” The new Health Secretary Matt Hancock, a major advocate of technology in care, is himself registered with Babylon. Mobihealthnews

(If you are in the UK, you can hear it straight from Babylon’s CEO Ali Parsa, interviewed by Roy Lilley of nhsmanagers.net, on 10 September at the RSM.)

Rival telemedicine service Push Doctor is also undergoing changes with CEO and co-founder Eren Ozagir’s departure. It appears that he and the board had a difference around company direction, with the board recommending a cut of 40 jobs (Sunday Times). Their COO, Wais Shaifta, became acting CEO in July. In June 2017, a report by the Care Quality Commission (CQC) found the service to be delivering unsafe care via antidepressant and blood thinner prescriptions being given without requisite blood tests and monitoring. Digital Health