VA awards four remote patient monitoring companies to share in $1B Home Telehealth contract (updated)

June 9, 2023 | by

The Department of Veterans Affairs awarded on 1 May the latest contract for veteran Home Telehealth (HT) remote patient monitoring systems to four companies. They are perennial and incumbent vendor Medtronic Care Management Services, with HT newcomers Cognosante, Valor Healthcare, and DrKumo.

The duration of the Remote Patient Monitoring-HT contract is for a base period of two years and six (6) option periods. Each vendor can receive a minimum of $100,000 and maximum of $250,000,000 for a total value of all vendors in the contract of $1.032 billion, which is about the same as the previous award setup. It covers 72,000 patients with chronic care, acute care, health promotion/disease prevention, and non-institutional care (NIC) needs, and was awarded through the Office of Connected Care. This contract provisions for systems and hardware/software tools for the connected care of veterans at home. The solicitation originally came out in September 2021 and the award for multiple reasons was delayed for nearly two years.

Cognosante is perhaps the most interesting one here as an IT services company that offers telehealth and RPM as part of a main suite of diversified business process outsourcing. It already does business with the VA and the government, most recently with the VA in 2022 for support of a system used to manage referral and authorization processes for community care services (GovConWire). Former Senator Thomas Daschle is on their board of directors.

Valor Healthcare also is a current VA provider in operating more than 50 community-based outpatient clinics (CBOCs). Valor as prime contractor partnered with GlobalMed on the contract, with GlobalMed as the technology provider for software integration and security services. GlobalMed already provides telemedicine carts to the VA and is a contractor for virtual health services for the Defense Health Agency’s (DHA) Medical Community of Interest network.

DrKumo is the upstart, founded in 2021 by CEO Kelly Nguyen, Pharm.D and CTO Duc Pham. Their main feature is RPM for disease and chronic care management. 

All four companies prominently feature their connections with the VA and veterans, featuring the latter prominently in their management. Medtronic is the long-time (since the ’00s) incumbent and a leading vendor to the VA and the MHS in multiple areas.

The VA is a tough client, which other companies with HT contracts (and the personal experience of this Editor while marketing director of Viterion two contracts ago) can testify to. While VA may award contracts with four companies, many things can happen in the execution, such as failure to satisfy government US-origin requirements on the hardware origins, as specified in the Trade Agreements Act (TAA). Your hardware will need to be “substantially transformed” in the US or in a signatory country designated by the TAA. More than one vendor has effectively lost their contract over this; it happened to Vivify Health (now part of Optum) in 2018 and they with Iron Bow walked away [TTA 16 Jan 2018]. Another major hurdle is acceptance by VA care teams, and here all three companies are up against incumbent Medtronic.

Update 1 Nov: Another incumbent, AMC Health, which in 2022 partnered with GE HealthCare on post-hospital monitoring, switched partnerships and moved to partner with Cognosante. Partnerships are near-impossible to discern from the award notices. This is per their chief operating officer, James Considine, to the Editor. 

Becker’s, GovConWire, Valor release, GlobalMed release, SAM.gov award notice-Medtronic, SAM.gov award notice-Valor, SAM.gov award notice-DrKumo, SAM.gov award notice-Cognosante

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

Canary Care goes into administration, is acquired by Lifecycle Software (UK)

September 19, 2018 | by | 2 Comments
[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2018/09/Canary-Care.jpg” thumb_width=”150″ /]Abingdon-based Canary Care, a developer and marketer of wireless sensor-based home health monitoring systems, has gone both into administration (the closest US equivalent is Chapter 11 bankruptcy) and been acquired by Lifecycle Software Ltd., a developer of CRM and billing software for telecommunications, internet service providers, and utility companies. In US terms, this is basically a pre-packaged bankruptcy.

According to their listing on Companies House, the administration started on 31 August. At the end of August, Lifecycle acquired the company (5 September press release). The Lifecycle website now features that Canary Care will be ‘keeping your dearest nearest’.

Stuart Butterfield, a Canary Care director as well as interim managing and technical director, was kind enough to answer my inquiry about the company’s status with a message that expressed a great deal of hope:

So, we’re still very much alive, and will continue to provide the Canary Care product and service that our existing customers know and love. As you will be aware, adoption of TECS is painfully slow. However, our new owner provides us with the stability and resources to continue to develop 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.

Innovative assistive technology/TECS, despite the investments by major players, remains a difficult area for funding and adoption not only in the UK but also in the far larger market of the US and Canada. While we see a Best Buy acquiring GreatCall, we’re also reminded that GreatCall picked up the remnants of Lively for the IP and Healthsense for their assisted living customers and for the technology. The “name” health tech companies of the early ’00s are largely gone or no longer independent (Viterion, Living Independently, HealthSpot, Cardiocom, WellAware…)

In many ways, we have not progressed much from, say, 2007, in the field, except for tech advances and the number of players.

We wish Canary Care and Lifecycle success–and the patience they will need with this market. Hat tips first to a UK industry insider who alerted this Editor, as well as Gerry Allmark, managing director of UK Telehealthcare for help in sourcing Companies House.

Care Innovations sells off Validation Institute. But is there more to the story? And a side of Walmart Health action.

July 17, 2018 | by

The Health Value Institute, part of Woburn, Massachusetts-based conference organizer World Congress, announced late last week the acquisition of the Validation Institute from Care Innovations. Terms were not disclosed. The Health Value Institute and the Validation Institute recently partnered to validate the outcomes for the Health Value Award finalists and awards this past April at the 15th Annual World Health Care Congress. According to both parties, the acquisition will help to expand the membership of validated companies, and the present offerings for HR, broker, and benefit executives. Release.

The Validation Institute was launched with fanfare back in June 2014, when GE still had a chunk of the company and during the 2 1/2 year repositioning (revival? resuscitation?) led by Sean Slovenski from the doldrums of the prior Louis Burns regime. Mr. Slovenski departed in early 2016 to be president of population health at Healthways/Sharecare, which lasted a little over a year. However, this week Mr. Slovenski made headlines as the new SVP Health & Wellness of Walmart, reporting directly to the head of their US business.  The hiring of a senior executive with a few years at Humana and a short time at Sharecare, another Walmart partner, coupled with several years in healthcare tech and provider-side is certainly indicative of Walmart’s serious focus on healthcare provision. It’s a fascinating race with Amazon and CVS-Aetna–with the mystery of what Walgreens Boots Alliance will do. Also Healthcare Dive.

But back to Care Innovations. Signs of a new direction–and a loss. The case can be made that the Validation Institute, the Jefferson College of Population Health, and validating individuals and companies was no longer core to their business which is centered around their RPM platform Health Harmony (with QuietCare still hanging in there!) However, this Editor notes the prominent addition of  ‘platform-as-a-service’ advisory services for those who are developing health apps, which appears to be a spinoff of their engineering/IT services. Vivify Health, a competitor, already does this. There is a vote of confidence; in June, Roche signed on with a strategic investment (undisclosed) as well as integration of the mySugr integrated diabetes management/app solution (release).

Looking around their recently refreshed website, there is an absence–that of the two or three pages previously dedicated to the Veterans Health Administration (VA) and the press release of the VA award. This tends to lend credence to the rumors that there was a second company that did not pass the Trade Adjustment Act (TAA) requirements that knocked out Iron Bow/Vivify Health from the VA, or for another undisclosed reason CI bowed out of a potentially $258 million five-year contract. If so, that leaves for the VA Medtronic and 1Vision/AMC Health. It’s certainly a limited menu for the supposedly growing numbers of veterans requiring telehealth and a limited choice for their care coordinators–and not quite as presented to the public or the 2015 competitors in the solicitation. Who benefits? Who loses? (Disclosure: This Editor worked for one of the finalists and a VA supplier from 2003, Viterion.)  Hat tip to one of our ‘Industry Insiders’, but the opinions expressed here are her own.

A review of digital health patent slugfests and Unintended Consequences

September 7, 2016 | by

Mobihealthnews provides a recap of the past four years of patent actions pitting company against company in the hushed but deadly rings of the US Patent and Trademark Office (USPTO) and the US International Trade Commission. On the fight card: the never-ending American Well-Teladoc bout (Teladoc winning every decision so far by a knockout [TTA 18 June]–a second American Well patent being invalidated on 25 August); CardioNet vs MedTel, which the former won but has had to chase the latter out of the arena and down the street to collect; Fitbit-Jawbone which has gone both ways [TTA 27 July]; and the long trail of blood, sweat and Unintended Consequences around Bosch Healthcare’s heavyweight IP pursuit against mainly flyweight early-stage companies (not noting, as we did, their apparent ‘draws’ vs Philips and Viterion, then owned by Bayer).

The Reader will note our tracking Bosch’s activities go back to 2012 (here, here and here). Moreover, with Mr Tim Rowan of Home Care Technology, we broke the news of Bosch’s demise in June 2015, drawing the conclusion that their offense versus Cardiocom’s patents (now in Medtronic’s cardiac division) directly led to the invalidation of their key patents, IP–and the very basis of the company’s existence. See the 19 June 2015 article and our recap one year later in reviewing AW-Teladoc. (Any similar phrasing or conclusions within the Mobihealthnews article, we will leave to our Readers to decide!)

Can expanding telehealth help VA solve veteran access crisis?

May 18, 2016 | by | 1 Comment

The Department of Veterans Affairs (VA) has been both one of the largest US users of telehealth in various forms–and widely criticized for practices including veteran patient wait lists for care, a lack of accountability, a scheduling system full of problems, an ancient EHR (VistA), and an inability to meet interoperability and modernization goals set over years. Telehealth is, in fact, one of VA’s bright spots with store-and-forward imaging, clinical video telemedicine and home telehealth.

At the American Telemedicine Association ATA 2016 meeting Monday, Under Secretary for Health and VA Chief Executive Dr. David Shulkin noted that the crisis has pushed VA into other options for achieving the goals set for the end of year: every VA medical center provides same day primary care services and same day mental health services. One area of focus is telemental health. Dr Shulkin announced in his plenary speech the opening of five new Mental Health Telehealth Clinical Resource Centers this summer, located in Charleston, Salt Lake City, Pittsburgh, and a consortium of facilities in Boise, Seattle, and Portland, Oregon. West Haven, Connecticut is already open as a specialty hub focused on the most severe and complex mental health issues, such as chronic depression and bipolar disorder. Other VA telemedicine initiatives include kiosks and text messaging to help with medication adherence and chronic condition management. (We’ve reported on their partnering with nhssimple to develop ANNIE, a sister of NHS’ Flo in text messaging to encourage patients in their health monitoring, TTA 2 Dec 15.)

VA delivered 2.1 million episodes of telehealth care last year (FY 2015), in 45 specialty areas of care, including 400,000 telemental health visits. They also reduced bed days by 56 percent, reduced readmissions by 32 percent, and decreased total psychiatric admissions by 35 percent, maintaining high user satisfaction scores at 89 percent.

Dr Shulkin also noted that four generations of veterans are served by VA–WWII, Korea, Vietnam and Desert Shield through current Iraq/Afghanistan–and all four have different delivery requirements. He closed with what is, for VA which has been very proud of their ‘home grown’ solutions from the time of Dr Adam Darkins in the early 2000s on, something unusual: “We’re looking to learn, we’re looking to work with all of you who are innovating to help take better care of veterans.” (Next on tap: the award of the next five-year round of home telehealth providers, which is presently down to two Grizzled Pioneers, Medtronic (Cardiocom) and Viterion.) Mobihealthnews, VA press release

‘Déjà vu all over again’ or critical mass? NYTimes looks at older adult care tech

July 28, 2015 | by | 4 Comments

“It’s like déjà vu all over again” as Yogi Berra, the fast-with-a-quip Baseball Hall of Fame catcher-coach-manager once said. About 2006-7, telecare broke through as a real-world technology and the tone of the articles then was much like how this New York Times article starts. But the article, in the context of events in the past two years, indicate that finally, finally there is a turning point in care tech, and we are on the Road to Critical Mass, where the build, even with a few hitches, is unstoppable.

Have telehealth, telecare, digital health or TECS (whatever you’d like to call it) turned the corner of acceptability? More than that, has it arrived at what industrial designer Raymond Loewy dubbed MAYA (Most Advanced Yet Acceptable) in keeping older adults safer and healthier at home? The DIY-installed Lively! system keeps an eye on a hale 78 year old (more…)

Breaking news confirmed: Bosch exiting healthcare and telehealth in US–UPDATED

June 19, 2015 | by

Breaking News–UPDATED with Bosch response

Bosch has confirmed they are closing their telehealth business in the US. Please see their statement at the end of this article.

A home care industry newsletter, along with our own reliable industry sources, have confirmed the recent industry discussion that Bosch Healthcare, since January a solely US operation, is winding down its business without a definite turnover to a buyer. This Editor, in calling various departments in their Palo Alto, California offices for confirmation on Thursday, was (when she reached a human being) forwarded to HR where she could leave only voice mail. An email to marketing also received no response. All sources indicate that staff layoffs took place last Monday.

Editor’s Note: Bosch’s official press response follows this article. We have also made certain corrections to this article (see in red).

  1. The Home Care Technology Report, published by industry consultant Tim Rowan, on Wednesday posted two articles stating that Bosch laid off nearly all of its staff on Monday (15 June) save for customer service and some key operating areas. His information indicated that Health Buddy sales–new and existing orders–have been terminated. This includes orders placed through its McKesson partnership. Non-VA service will be terminated in 60 to 90 days.
  2. Home Care Technology also reported that Bosch’s business with the Veterans Health Administration (VA) will be maintained through April 2016, which is near to the contract end in May, but no new units will be delivered. The original contract was with Health Buddy hub developer Health Hero Network, sold to Bosch in 2008. With the later acquisition of ViTel Net, Bosch developed into one of the two leading VA Home Telehealth remote monitoring hub suppliers–the other being Cardiocom. VA Home Telehealth is the largest telehealth program in the US with over 156,000 patients (Federal Year 2014) (Ed. Note: VA has a third authorized and active VA supplier, Viterion).

As Mr Rowan did, this Editor will speculate on the reasons why there is this reported exit without a sale or spinoff, despite the substantial VA and other healthcare placements of Health Buddy. Our take is somewhat different than his: (more…)

Looking back over Telehealth & Telecare Aware’s predictions for 2014, part II

January 9, 2015 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/01/magic-8-ball.jpg” thumb_width=”150″ /]Editor Charles has treated you to a look back on his 2014 predictions, daring Editor Donna to look back on hers. Were they ‘Decidedly so’, ‘Yes’, ‘Reply hazy, try again’ or ‘My sources say no’? Read on…

On New Year’s Day 2014, it looked like “the year of reckoning for the ‘better mousetraps’”? But the reckoning wasn’t quite as dramatic as this Editor thought.

We are whipping past the 2012-13 Peak of Inflated Expectations in health tech, diving into the Trough of Disillusionment in 2014.

There surely were companies which turned up ‘Insolvent with a great idea’ in Joe Hage’s (LinkedIn’s huge Medical Devices Group) terms, but it was more a year of Big Ideas Going Sideways than Crash and Burns.

Some formerly Great Ideas may have a future, just not the one originally envisioned. (more…)

Conflicting telehealth signals – is the VA or E Riding of Yorkshire CCG on the money?

September 9, 2013 | by | 4 Comments

Can there be two greater contrasts than the recent decisions by the Dept of Veteran Affairs in the US (VA) to award a five year $28.8m telehealth contract to AMC Health and that of the E Riding of Yorkshire CCG to “axe” its telehealth service?

The sheer size of the VA deal makes every recent deal in Europe seem very small in comparison. AMC’s CEO said: “AMC Health’s outcomes-based approach to telehealth and ability to actively engage patients to proactively self-manage their chronic conditions perfectly aligns (more…)

Friday telehealth ‘snaps’

May 10, 2013 | by

It appears that Bayer HealthCare is exiting the telehealth business with the sale of Viterion TeleHealthCare to the newly formed Viterion Corporation. According to the press release, Japan’s NSD Co., Ltd. through its US subsidiary is providing the investment and strategic support, and taking on all products and personnel. Viterion’s offerings in recent years have remained fairly static, but the Viterion release promises a change to “advancing our technology offerings, and in particular the migration to wireless and mobile applications.” Viterion also had speakers and a booth at ATA 2013.

Mobile connectivity is now reaching everywhere. Canadian companies PatientOrderSets.com, a developer of web-based evidence-based clinical checklists to specify appropriate patient treatments, acquired fliiSolutions (pronounced Fly). Its fliiTherapy connects providers and patients through a rehabilitation/exercise prescribing/tracking app. Announcement on the PatientOrderSets.com website.

For mothers in the hospital temporarily separated by necessity from their babies in Los Angeles’ Cedars-Sinai Medical Center’s neonatal intensive care unit, the new Baby Time iPad app enables them to check on and interact with their newborns. This will aid the estimated 20 to 30 percent of mothers who undergo C-sections and cannot be ambulatory for 24 to 48 hours. Cedars-Sinai release. (Hat tip to TANN Ireland’s Toni Bunting)

Tunstall Americas announced at ATA the introduction of its Vi telehealth/two-way PERS unit, iVi fall detection pendant and the CEL450 home-based cellular PERS, although the blog placement is rather low-key. Release.