Search

Event: The introduction of augmented reality (AR) and virtual reality (VR) into healthcare has tremendous potential to improve access, lower costs, and give patients a better understanding of their health. Over time it should help to improve overall long-term health outcomes. Previously, AR, VR, and spatial computing have been used in healthcare on a limited basis, but the broad rollout of 5G communications bandwidth and technologies will allow providers to integrate these technologies more broadly into the delivery network. As the pandemic continues, many providers are looking to virtual and augmented reality tools to enhance/expand the scope of procedures offered, facilitate medical training for difficult procedures, build better connections with patients both on and off-site, and support more personalized care. This is especially true in scenarios where the geographical distance or lack of specialized clinicians may limit available services. The inclusion of these technologies can introduce a different perspective of healthcare that will benefit the populations for generations to come. Description: Augmented reality (AR) is a technology that combines real-world and virtual elements. The implementation of this tool in a healthcare setting is useful when trying to get patients to become more engaged with prototypes and for helping them understand a key component to their care. Virtual reality (VR) is a computer-generated simulation where people can interact within an artificial three-dimensional environment using electronic devices. It stimulates vision and hearing, causing the user to feel like they are actually sensing and feeling the simulated reality firsthand. This includes the use of a specialized headset with a built-in screen as well as gloves fitted with sensors. Although both use the same types of technology to create an enhanced experience, AR is more accessible through mobile devices, laptops, smartphones, and tablet computing devices and VR is usually delivered through a head-mounted or handheld controller. During COVID-19, many countries faced challenges due to a shortage of doctors, excessive workload, and less access to in-person doctor’s visits. Although other telemedicine options were given, the use of AR significantly improved patient’s experience. According to a study entitled “Combating COVID-19—How Can AR Telemedicine Help Doctors More Effectively Implement Clinical Work” AR telemedicine could be put on smartphones and tablets that were easy to navigate for consultations, instructions, and demonstrations from their providers, and for self-monitoring purposes as well. For example, the shortage of primary care physicians during this era has resulted in many newer physicians with little respiratory care experience coming into practice. Using AR video fusion and labeling function, respiratory experts were able to conduct real-time remote guidance and training in respiratory medicine. This is especially important in rural areas, where physician shortages, accessibility, and travel costs have always been barriers to care, particularly for the disadvantaged and those in underserved areas. In addition, through AR/VR technology, experts were able to conduct remote ultrasound guidance, emergency remote rescue, remote surgical guidance, as well as guide clinicians remotely in many other procedures. They were also able to blend computer-generated images and data from MRI and CT scans with real world views to allow doctors to visualize the patient’s bones, muscles, and internal organs without having to perform surgery. The images and findings could then be shared with other healthcare professionals to be further analyzed, decreasing the likelihood of misdiagnosis. According to an article from the Borgen Project, “5 Technologies Improving Healthcare in Rural Areas”. Purdue University created an AR technology that allowed more experienced medical professionals to assist inexperienced doctors and surgeons with fewer tools and materials yet complete certain procedures, ultimately maximizing the patient’s outcome. Additionally, the introduction of 5G, the fifth generation of cellular wireless data has helped to further enhance healthcare professional’s ability to deliver innovative, less invasive procedures. According to an article from Health Europa,”Why 5G Enabled Healthcare Is Important for Patients and Spatial Computing”, this technology offers better connectivity and broadband speeds that are required for streaming during remote surgical procedures. With the broader development of the technology, AR/VR development is also getting easier and cheaper as 5G is now becoming more accessible on cellular devices, enabling faster downloads and streaming on devices that many people already own or can more easily afford. Moreover, more powerful and affordable headsets are increasingly coming onto the market empowering more widespread consumer access and use, particularly in healthcare applications. Implications: The introduction of AR and VR into healthcare settings has significantly impacted health disparities and access to health issues as it gives alternative options for patients to access resources they need using this technology. With the shift to greater use of telehealth, as well as improvements in technology and communications there’s been an increase in more affordable equipment for patients as well as healthcare providers. While there was improved access to telemedicine visits and increased insurance coverage during COVID due to a relaxation of regulations and waivers, it will be incumbent on healthcare organizations and regulators to find a way to adopt the use of these technologies as a standard of care. Incorporating AR and VR technologies into certain visits and treatment will ensure a better patient experience and optimal outcomes. Moreover, these technologies facilitate improvements in training, guidance, and collaboration among physicians, especially those in rural areas with fewer resources, allowing providers to better assess ailments, perform difficult surgeries, and disintegrate existing barriers to care amongst vulnerable populations. As AR and VR continue to become more broadly used and accepted in healthcare they can continue to make care more efficient, increase access, improve patient outcomes and solidity provider/patient relationships. Combating COVID-19—How Can AR Telemedicine Help Doctors More Effectively Implement Clinical Work; 5 Technologies Improving Healthcare in Rural Areas; Why 5G Enabled Healthcare is Important for Patients and Spatial Computing Dr. Google Actually Improves Diagnostic Accuracy Event: A recent article in MobiHealthNews discussed a new study published in JAMA, which examined the association between an internet search for health information (often referred to as checking with Dr. Google) by nonphysicians and improved accuracy in diagnosis and triage. The study concluded that an association exists and online investigations for self-diagnosis lead to slightly more accurate diagnoses. Description: This study comprised survey results of 5,000 adults asked to assess validated case vignettes of common illnesses like viral infections to severe conditions like heart attacks. Participants spent an average of 12 minutes researching the symptoms before concluding their diagnosis. They were asked to relay their diagnosis, triage, and anxiety regarding one of these cases before searching the internet for health information. The study found that 49.8% of participants correctly guessed the health condition being described prior to the internet search, and that result improved to 54% following the search. Improvements in diagnostic accuracy occurred across all forms of triage categories provided: emergent (3.1%), same day (3.5%), same week (6.4%), and self-care (3.7%). Finding useful information was difficult for participants, but they said the most helpful online resources were search engines (48.2%) and health specialty sites (42,9%). Researchers explained that performing an internet search was associated with an improved diagnosis. Implications: Checking symptoms online is common among adults even though most patients are generally advised not to self-diagnose themselves. This is generally because clinicians fear that self-diagnosis using the internet can lead to inaccurate diagnosis, incorrect treatment, or increased anxiety about the seriousness of the illness. Between 2012 and 2013, 72% of people used the internet to look up health information, and 35% were classified as “online diagnosers.” Websites such as WebMD have taken steps to make their symptom-checkers more accurate, and there are numerous other apps on the market that can help people diagnose and triage symptoms. These sources provide a convenient way to pinpoint what condition a person’s symptoms may indicate. A 2018 review of direct-to-consumer self-diagnostic apps found that apps vary widely in functionality, accuracy, safety, effectiveness. While the generally accepted advice has been to instruct patients not to diagnose themselves the results of this study may indicate that a better approach may be to help guide patients to improve their diagnosis. This would include assisting them in what questions to ask, simple signs that may help them distinguish the severity of conditions, and when self-diagnosis may simply be impossible given the range of symptoms. Internet Searching Found to Improve Layperson Diagnostic Accuracy Population Health Platform, IBH To Acquire Digital Mental Health Company, Uprise Event: A recent article in MobiHealthNews reported that IBH, a tech-enabled population health platform, recently completed its acquisition of digital mental health company Uprise. The acquisition will give IBH access to the Uprise platform which provides self-guided mental health tools delivered via self-guided modules, live coaching, and in-person therapy. The acquisition will also allow the two companies to merge large data sets, which can be used to gain insights into members' needs. Description: Both companies, IBH and Uprise, work in the employer health space and focus on behavioral health. According to the press release, IBH, “offers digitally-enabled employee assistance programs bolstered with personalized coaching, chronic condition management, managed behavioral health, data analytics, and opioid assessment and treatment solutions.” IBH focuses on behavioral health, substance abuse monitoring, maternity management, and both population and occupational health. Uprise’s platform also allows employees to complete a well-being checklist and those who are “designated at risk get a call within 24 hours of their assessment and are then triaged to appropriate services.” The company offers telehealth services as part of its employee assistance and managed behavioral health programs. Implications: Behavioral health issues are common in the U.S., and employers focus on employee mental health has become a significant objective of employers around the world. IBH's acquisition of Uprise should help them gain scale in the Employee Assistance Program (EAP) space and leverage the advantages of larger data sets to population health in the field of behavioral health. This is especially important during COVID as, according to the CDC, 11.2% of adults report feeling worried, anxious, or nervous, while another 4.7% report regularly feeling depressed. In addition, the American Psychiatric Association reported that depression is the leading cause of disability worldwide and costs the U.S. economy roughly $210 billion a year due to absenteeism, reduced productivity, and medical costs. Many digital health companies like IBH and Uprise have begun focusing on the employer mental health space. Other companies like Modern Health, a mental health and wellness platform, have also been looking to grow with Modern Health recently raising $74 million in February and Unmind in the U.K securing $10 million in funding for its workplace mental health platform in February of 2020. Population Health Company IBH Snaps up Mental Health Focused Uprise Surgical Specialty Pre-Op and Post-Op Telehealth Visits Slow After June 2020 Event: Healthcare IT News reported on a study conducted by JAMA on the use of telehealth by surgical specialties during the COVID pandemic. The Michigan-based surgical specialties found 58.8% of the 4,405 active surgeons used telehealth during the peak of the pandemic. The conversion rates- defined as the rate of weekly new patient telehealth visits divided by the mean weekly number of total new patient visits in 2019 showed 109,610 surgical new outpatient visits from March through September 2020. Of those, 6.1% (6,634) were telehealth visits compared with 8 telehealth visits (<0.1%) during the same time in 2019 Description: The field of surgery readily adopted telehealth during the pandemic and was a major modality of health care delivery. Prior to the pandemic, the Surgical field was using telehealth for the preoperative and postoperative follow-up visits though the numbers were significantly less. Among surgery, the highest utilization of telehealth was seen among neurosurgery and urology and the lowest was seen in the orthopedics and ear, nose, and throat (ENT) departments. In addition, the Kane and Gillis cross-sectional study also reported that surgical specialties’ use of telehealth was 11.4%, the lowest among service lines. For example, telehealth utilization ranged from 12.7% in primary care to 39.5% in radiology. Surgical telehealth adoption prior to the pandemic was difficult to adopt which resulted in a decline in the surgery telehealth services when in-person clinics started to reopen. This was due to patient reservations who had initially postponed appointments as they preferred in-person visits as well as hesitancy among surgeons. With the policy-level barriers, surgeons found it concerning investing time and resources to update clinical workflows to learn new patient engagement through telehealth which they perceived would likely be an added burden. In addition, there were also patient barriers that prevented the use of telehealth which included: lack of private space, poor connectivity, no device on which to contact clinicians, and digital literacy. Implications: During the pandemic, telehealth was one of the best modalities to reach patients given the lack of in-person visits and the need to protect patients from exposure to COVID infection. Nevertheless, the adoption of telehealth by surgical specialties remained particularly difficult when compared with other specialties. Not only were there reservations from patients, but there were also reservations from clinicians. For physicians, the main concern was about the inability to perform physical examinations properly or not being trained on proper methods to conduct physical examinations via this platform. As physical examinations are used to diagnose and determine treatment plans, enrolling surgeons in training initiatives on how to properly engage and evaluate patients via telehealth platforms would encourage both surgeons and patients to utilize this platform. In addition, adding training via residency and fellowship curriculums would also boost the use of telehealth in specialties that are still hesitant to use this platform. In addition, clinicians should also be mindful of technological barriers to access such as availability of technology and broadband communication services which may prevent patients from utilizing telehealth. Bearing these in mind, these factors should be discussed and addressed by patients and clinicians, for the broadest group of those seeking care to realize the benefits of telehealth. Telehealth for Surgical Specialties Saw a Slow Decline After June 2020

Event: Ginger, a San Francisco based mental health startup, recently raised $100M in a series E round. Ginger partners with companies to provide its users a personalized plan through a platform equipped with evidence-based therapy sessions and psychiatry services; a self-care library offering over 120 stress management activities; and behavioral coaches available 24/7. As reported by Fierce Healthcare, since 2020 many investors have backed digital mental health startups, with the number of employees utilizing these mental health services increasing by 66% during the COVID pandemic. Founded in 2011 and spun-out from MIT Media Lab, Ginger has raised over $236M backed by investors from Kaiser Permanente Ventures, Cigna Ventures, Bessemer Venture Partners, Advance Venture Partners, Khosla Ventures, Health Velocity Capital, City Light Capital and WP Global Partners. This is the second time in that last 8 months that Ginger has raised capital raising $50M in August of 2020. Description: Ginger provides an on-demand system that brings together behavioral health coaches, therapists, and psychiatrists, to deliver personalized care platform for the delivery of mental healthcare. Ginger’s approach combines high-quality human care with science and augmented intelligence offering conversational interfaces and behavioral pattern recognition for the treatment of stress, depression, and issues with work or relationships. Ginger offers its mental health and wellness platform to over 200 companies, across 40 countries, connecting over millions of employers, employees and payers with their services. Additionally, BusinessWire notes that Ginger offers their services to 30 integrated health systems and health plans. According to the company, “70% of members see an improvement in depression symptoms within 10–14 weeks of care” and using peer-reviewed assessments, Ginger promises a return on investment of 4.2 times. The company also stated that since last year, Ginger has tripled in revenue, “tripled its employee base and expanded its team of behavioral health coaches, clinicians, engineers, and operational leaders.” Ginger CEO Russ Glass noted that the company intends to use the funds to “continue expanding access to value-based mental healthcare through additional partnerships with multinational employers and health plans” and “to extend its reach to support underserved populations through new government payer relationships and collaborations with non-profit organizations”, among other things. Implication: Ginger offers its services to over 10 million people, yet demand remains as “high as 3x pre-pandemic levels”. As more people are working from home, isolated and stressed, the need for on-demand telebehavioral health services is on the rise. For example, a 2020 survey by Vyond suggested 45% of employees who are isolated at home want education in mental health strategies from their employers…” Specifically, the need for integrated and virtual mental health care is evident, as many clinics are shifting to virtual care or an omnichannel model that combines many care delivery models (in-person, virtual, etc.). Nevertheless, according to the World Innovation Summit for Health (WISH) despite the fact that about one in five people are affected by mental health issues and an estimated one in twenty disabled by mental health issues, getting people into care remains a barrier. As a result, Gingers evidence-based platform and others like it, which are reasonably priced (typically under $500 per year) provide an opportunity to address mental health issues in a convenient, stigma free way from the privacy of their homes. Moreover, by allowing people to track their progress and personalize when and how they receive care can empower Ginger users to take command of an issue that many may have felt were beyond their control.. Ginger Banks Another $100M to Ramp up Partnerships with Health Plans, Government Payers; Ginger Announces $100 Million Series E Financing from Blackstone to Bring Value-Based Mental Healthcare to Millions of Employees and Health Plan Members

Our Take: The rise in substance use disorder (SUD) fueled by the opioid epidemic has increased demand for behavioral health services and exacerbated the behavioral health workforce shortage. There is a marked discrepancy between the number of people who need addiction treatment in the United States compared to those who receive it. According to the American Addiction Centers, approximately 21 million people (12 and older) need substance abuse treatment, and only an estimated 3.8 million people have gotten treatment, signaling that only 18% of those who needed treatment were able to access it. Innovations such as telehealth can provide lower-cost and widely available approaches to serve as an alternative treatment option for people suffering from SUD. Telehealth can connect geographically dispersed patients and providers and is a promising approach to expanding access to those suffering from opioid use disorder and other SUDs and seeking treatment. Utilizing digital tools through companies like Eleanor Health, Genoa, Pear, and Marigold can provide supplemental, individualized treatment plans that address challenges faced with SUB exacerbated by the numbers involved with the opioid crisis. Description: As noted above, less than 20% of those who need treatment for SUD actually receive it. Reasons for access limitations include a limited supply of rehab facilities, lack of specialty SUD treatment providers, lack of primary care physicians with experience in behavioral health treatment, and privacy and stigma concerns among those suffering from opioid and other addictions. Untreated drug and alcohol use contribute to tens of thousands of deaths every year and impact the lives of many more. While treatment providers possess a number of effective tools, including medications for opioid and alcohol use disorder, that could likely prevent many deaths, they are still not utilized widely enough. In addition, many people who could benefit from available treatments do not seek them out because of the stigma that surrounds addiction and addiction treatment. While less common, healthcare providers may consciously or subconsciously view a patient’s drug or alcohol problem as a sign of moral weakness which may lead to substandard care. For example, patients with indications of acute intoxication or substance withdrawal symptoms are sometimes expelled from emergency rooms because staff fear their behavior, which may appear erratic, or assume that they are only seeking drugs. As a result, people with addiction may internalize this stigma, become humiliated, and refuse to seek treatment which can lead to an inability to get control of their addiction and play a part in the vicious cycle driving these addictive behaviors. Given the ability to receive care without having to appear in-person or at any type of addiction clinic, telehealth for SUD can help reduce or eliminate this stigma. In addition studies indicate that telehealth can fill the care void as evidenced by the rapid increase in telehealth services during the pandemic which demonstrated that telehealth services are an effective adjunct and substitute for in-person care of SUD. For example, a study entitled, “How is telemedicine being used in opioid and other substance use disorder treatment” analyzed claims data from a large commercial insurer from 2010-2017. The authors found that the while the number of telemedicine visits for SUD from 97 to 1,989 (~1900%) during the same period general telebehavioral health visits increased from 2,039 to 54,175 (~ 2500%) implying telemedicine visits for SUD could be more broadly used. Increased use of telemedicine can allow patients with opioid use disorder to stay in treatment and receive counseling to further their recovery. In addition, broader use can offer patients, physicians, and the health care system as a whole enhanced convenience, reduced travel time, and cost savings and thus can be used as a useful substitute or additive treatment for patients suffering from substance use. Another study, entitled, “Telemedicine-delivered treatment interventions for SUDs: A systematic review” examined the delivery of substance use treatment via video conference. It assessed the clinical impacts on substance use, treatment retention, acceptability, and feasibility. The study found that telemedicine can be associated with improved treatment retention compared to participants traveling for in-person treatment. Another systematic review of behavioral health articles conducted in three regions (United States, European Union, and Australia) indicated that telemedicine was associated with reduced depression, decreased cost, and increases in patient satisfaction, accessibility, and quality of life. Interventions included mobile health, electronic health, telephone, and two-way video. While telemedicine can be a useful substitute or adjunct to in-person therapy, there are still two pressing issues that remain to be addressed: the delivery of Buprenorphine and training. Buprenorphine is a common medication used to treat opioid use disorder, acute pain, and chronic pain. According to the American Addiction Centers, 90% of the physicians who are approved to prescribe Buprenorphine practice in urban areas. About 53% of rural counties do not have any physician who can prescribe it, and rural providers who can prescribe buprenorphine report high demand, a lack of resources, and long wait times for patients. This issue is not likely to be addressed in the short-term via telemedicine, however, longer-term thought should be given to allow other clinicians to administer Buprenorphine under the guidance or remote management of more senior providers. Similarly training of additional clinicians to treat SUD will take time. For example, according to the American Society of Addiction Medicine, treating 20.7 million Americans with a SUD will require training that is too often lacking in our nation’s current addiction workforce. The society noted there are too few clinicians with the requisite knowledge and training needed to prevent, diagnose, and treat addiction. Recognizing this need, in 2016 Congress authorized a training demonstration program within the 21st Century CURES Act. The Act authorized $10 million per year and awarded grants to medical schools and federally qualified health centers to support training for medical residents, fellows, nurse practitioners, physician assistants, and others to practice in psychiatry and addiction medicine. Here too, innovative approaches using telemedicine may help leverage the capabilities of the system to address the shortage of providers. Implications: Telemedicine is under-utilized, despite having great potential for assisting recovery and treating patients with SUDs. Telemedicine allows patients with opioid use disorder to stay in treatment and receive counseling to further their recovery. A study conducted by Yang et al. showed that telemedicine offers additional benefits for patients, physicians, and the greater health care system through enhanced convenience, reduced travel time, and cost savings.[v] Due to the lack of treatment centers in rural areas, patients may have difficulty with transportation, particularly when in outpatient treatment that may require multiple trips to a treatment center each week. Public transportation is generally not as convenient or readily available in non-urban areas and patients may live a long way away from a program. Even where patients may have access to convenient and reliable transportation, cost may be prohibitive, making telehealth a much more cost-effective means of accessing care. Companies such as Eleanor Health and Genoa are developing innovative ways integrating value-based care and evidence-based medicine to deliver more traditional therapies for those affected by addiction and SUD to help them live healthy, productive lives. Companies like Pear Therapeutics, Marigold, and WorkIt Health are incorporating new digital therapeutic (DTx) approaches to improve patient outcomes through digital applications that can be made broadly available. These companies provide evidence-based therapeutic interventions driven by high-quality software programs to increase abstinence from a patient’s substances of abuse during treatment. Despite the limitations of current studies, the researchers conclude that telemedicine-delivered treatments are a promising alternative, especially when evidence-based treatments are not readily available. For specific treatment and substance use categories, mainly when treatment adherence is a key goal, telemedicine can result in improved patient retention and treatment adherence due to increased accessibility. There is limited evidence that digital recovery support services (telehealth) effectively deal with all substance abuse situations. More and more research has been done on the brain, and the impact of chemical imbalances and susceptibility to addiction is becoming more evident. For example, brain changes are substantially influenced by factors outside of an individual's control, such as genetics or the environment in which one is born and raised. Unfortunately, along with the breadth of the opioid crisis has come better understanding and treatment, yet still more needs to be done. More studies and additional research are needed to understand the opportunities and barriers for telehealth treating behavioral health. Further evaluation should be conducted to measure the impacts of existing telehealth services and programs targeted to behavioral health solutions. Researchers have concluded that much work needs to be done to get more people to use telehealth for addiction treatment. Alleviating stigma is not easy, in part because the rejection of people with addiction or mental illness arises from violations of social norms. Treating patients with dignity and respect is crucial for people across healthcare, from staff in emergency departments to physicians, nurses, and physician assistants. Everyone should be trained to care for people with SUDs compassionately. How Is Telemedicine Being Used In Opioid And Other Substance Use Disorder Treatment?; Telemedicine-Delivered Treatment Interventions for Substance Use Disorders: A Systematic Review; Telemedicine’s Role in Addressing the Opioid Epidemic(subscription may be required) Talkspace’s Controversial Reno Contract and How Users Could be Left Behind Event: Recently STAT+ reported on Talkspace’s controversial contract with the city of Reno, Nevada. Under the deal, the City of Reno decided to spend $1.3M of expiring CARES Act funding to provide Talkspace therapy services to virtually every resident, excluding children, free of charge, for approximately one year. According to the article the contract was the idea of Mayor Hillary Scheive, who was looking to help residents following a surge in deadly COVID cases and her own personal difficulties finding a therapist in Reno after she herself was “devastated after her brother and sister both died within weeks of each other.” Local therapists opposed the plan since they were not consulted, felt that Talkspace’s services were “therapy-lite” and that patients could be left stranded when the contract expires in December 2021. Description: As noted, the Talkspace initiative was headed by Mayor Schieve when the Mayor herself was in dire need of therapy but was unable to get an appointment for weeks and ultimately found help through the Talkspace app. Following her experience, Mayor Schieve consulted with Reno resident Kathryn Goetzke, who has been working on global mental health strategy as director of Mood Factory which sells wellness products and the International Federation for Research and Education on Depression (iFred) a non-profit. Following discussions with the company, a deal was worked out to provide therapy to virtually all residents of the city via Talkspace at the monthly rate of 55 cents per person for chat and monthly video sessions (which ordinarily the service would have cost $316/month). While Talkspace’s vision of catering to a wider range of people than typically reached by standard therapy was well received by some, there were still local therapists that were distrustful of Talkspace. The therapist's main concern was that the majority of Talkspace’s interactions would be via text-based therapy, and the quality of care delivered by the app as compared to what could be delivered in person. In addition, therapists were concerned that Talkspace could realize disproportionate profits from the deal if fewer than anticipated residents took advantage of the offer from the City. The local therapist’s were also concerned that by using Talkspace local residents could open a Pandora's box of deep psychological wounds that couldn’t be treated appropriately by Talkspace and that could potentially leave residents in the lurch without mental health services when the contract ended in late 2021. Talkspace and the City responded by noting “the company has 10 independent studies to back it’s approach” and was already looking at ways to transition patients once the contract ends. As of late March, Reno’s grand experiment with Talkspace had roughly 1,350 active users — people who had signed up for the service and communicated with a therapist. Implications: Apps like Talkspace have effectively managed to fill the gaps in the nation’s tattered mental health system. While the therapist community in Reno opposed the move, recognition has to be given to the fact that the state of Nevada ranked dead last in a composite score by Mental Health America for prevalence of mental health issues and access to care. Although the service may not have been ideal it did cater to people who otherwise may have opted out of seeking mental health care due to stigma, cost, or lack of availability. Moreover the conflict in Reno is indicative of the tension between making limited services broadly available and perhaps making more intensive services less widely available. For example, the Talkspace program provided services to 200,000 people while an alternative proposal by local therapists would have only provided services to 12,000 people. To us the solution appears to be somewhere in the middle. Apps like Talkspace make it simple to connect with therapists with the added convenience of services like text, audio, and video messaging and they are extremely cost-efficient. However, platforms like Talkspace are not going to replace therapy for those who need intensive therapy or treatment for complex conditions although they may help bring people into treatment or provide a bridge to care until in-person care is available. Moreover, the ability of app based platforms to serve patients in multiple languages makes care more appealing and available. However, even with the attractions, these platforms do have drawbacks. The requirement of a smartphone is a necessity which is a potential barrier. Also, patients requiring long-term therapy for serious conditions should not depend solely on these apps and the apps themselves must be able to provide transitions to more appropriate care when necessary. These app-based therapy provisions are not replacements for conventional therapy but the easy accessibility and convenience in regard to cost and easily available slots for appointments with 24/7accesibility with a licensed therapist can serve to fill the gaps for an overburdened mental health system. Inside the Battle Over Talkspace and a Grand Experiment in Mental Heal (subscription required) Google Cloud Healthcare Projects to Keep An Eye On Event: On March 30th, STAT+ reported on five Google projects to watch as it builds up the healthcare segment of its Google Cloud platform. The company is focusing on projects that more broadly deploy AI to “improve how doctors and hospitals manage and exchange health data” as well as how they “use it to predict medical problems and direct health systems resources”. The five projects include AI factory, Care Studio, tools to improve detection of cancer, augmenting telehealth, and improving the interoperability of health records. Description: One of the main goals of Google’s deeper push into healthcare is to simplify the complexities associated with creating an AI empowered digital transformation. The first project is to “build an assembly line for novel artificial intelligence tools in a partnership with the Mayo Clinic.” According to the article, Google and the Mayo Clinic are hoping to build new AI products that will improve patient outcomes and make care more efficient. These products include a tool to target radiation therapy, using AI to analyze radiology images to detect chronic disease, and creating a clinical assembly line for AI solutions. More important than the specific project, Google and Mayo hope to build a process for assessing and improving AI solutions against real world situations. Another project was Care Studio, which is meant to act like a Google search engine for electronic health records. According to the article, the idea is to allow clinicians to type a query into a search bar so they may retrieve everything in a patient's history by using the company’s method of routing complicated streams of data through one portal. Google notes that the software is designed to work in tandem with existing EHR software not to replace it. The company is also working with the U.S. Department of Defense to apply AI to improve cancer detection on lung and breast images. The goal is to improve the accuracy of diagnosis through early detection and reduce the incidence of false positives via more precise analysis or tumors and tumor biopsies. In more direct consumer facing care, Google is also working with Amwell to provide cloud services and AI tools to improve the customer experience. According to the article, Amwell will use Google technology to “automate the waiting room and check out processes, responding to inquiries, and help triage patients”. The goal of the project is to improve the quality of care while helping streamline the experience for patients. The final project reviewed in the article is interoperability of health records. As the article notes, currently there is no “seamless flow of patient information within the healthcare system, that [makes] it easier to trade [or] use to inform decision making”. The goal of the project is two-fold, to help hospitals and payers adhere with new federal rules that prevent information blocking making it easier for patients to get electronic access to their data, while at the same time advancing Google’s goal of moving data to the Cloud where it will be easier for organizations to exchange and access data via APIs, Implications: With the creation of these projects, Google is working to deepen its role in healthcare through its core competence of search. Each of these aim to improve patient/provider experience, navigation through medical records, and introduce new AI tools into healthcare. However, some have exposed Google and its partners to criticism around the steps taken to ensure data privacy and security, which will remain a core concern going forward. This is especially important during this era where more patients are having to use digital health platforms and looking for simple alternatives. Google and other new entrants are likely to be held to a higher standard as they prove they are worthy of patients' trust and as such have got to emphasize transparency and communication with both providers and patents as they work to improve the use of new technologies in the system. Google’s efforts will put them squarely in the cross-hairs of other tech and retail players such as Amazon, Walmart and Microsoft all of whom are working to gain share in healthcare. All of the players would do well to remember the recent words of one large hospital system CEO who noted that there is tons of data in healthcare but none of it is easy to get to! 5 Health Care Projects to Watch at Google Cloud (subscription required)

Event: Thrive Global was founded by Arianna Huffington and launched in 2016 with a focus on reducing burnout with a strong focus on the proper role of sleep in self-care. While just one of many companies focusing on improving sleep habits, Thrive is at the forefront of this new technology. As noted by Thrive’s chief platform officer, “sleep is the underpinning of every aspect of our physical well-being, our mental well-being and our performance, including our creativity, decision-making, problem-solving and ability to focus.” Description: According to Crunchbase over $1.9B in venture capital has been raised to improve the quality of sleep. According to the same article, the global sleep market is expected to expand to over $150 billion by 2024 as lack of sleep and poor sleep hygiene remain a public health issues. Statista estimates that $430 billion is spent annually on sleep aids and that the global sleep economy will grow to almost $600B by 2024. Proper sleep is a key element of proper overall health and wellbeing; however, the majority of adults and children do not get the recommended amount of sleep. In fact, studies indicate that most people tend to overestimate the amount of sleep they get. For example, according to a study entitled, Sleep and Mental Health Amidst the 2020 Coronavirus Pandemic, “teens and young adults had the worst quality sleep, and reported the highest rates of depression; women were twice as likely to report taking longer to fall asleep than men; and 45 percent of respondents reported heightened anxiety while 24 percent reported heightened feelings of depression”. With COVID resulting in more employees putting in more hours while working from home, this made them more prone to burnouts, depression, and anxiety. The epidemic of poor sleep, when combined with a rigorous work culture and poor health literacy led many to look for immediate and accessible innovations. Arianna Huffington, the founder of the Huffington Post, collapsed from stress and burnout in 2007, which resulted in a broken cheekbone and the founding of Thrive Global. Thrive promotes mental health wellbeing through different mediums, including sharing her own experience of burnout. Thrive Global is a behavior-changing platform that seeks to promote health literacy through workshops, podcasts, and intelligently tailored “microsteps” allowing the individual to take charge of their health in achievable milestones, along with their peers for accountability and sustainability measures. With various “global hubs” including in Mumbai, Athens, and New York, Thrive Global is encouraging corporates to rethink their work culture, urging for a sustainable way of living, prioritizing wellbeing and health over success and work productivity. Thrive Global partners with larger corporations providing their employees with wellness tools and workshops resulting in better health outcomes. On their website, Thrive Global highlights its ability to boost work productivity and performance, reduce employee turnover rates and improve employee engagement. Along the same lines, the global sleep industry is seeing a number of other innovative startups to combat the state of sleeplessness. For example, Bryte, “a restorative sleep technology company that is developing an artificially intelligence-connected and robotics powered bed” raised $25M in Series A funding in January led by ARCHina Capital. The Bryte mattress intelligently monitors temperature and pressure points to provide an optimal sleep environment on a daily basis. This Los Altos sleep startup aims to accelerate the sleep tech industry by partnering with companies that will utilize their intelligent sleep platform. Sleep Cycle, a Swedish-based company, offers an app alternative to sleep aid which monitors sleep cycles and intelligently schedules an alarm to wake the person up during their lightest sleep phase. Implications: As sleep research improves from sleep logs to tracking sleep duration via mobile devices, sleep study is still insufficient. The novel pandemic is exposing the harrowing results of poor investment in mental and emotional health leaving many Americans, both adults and children, with an increase in reported new health conditions such as depression, anxiety, and stress. Poor sleep and its effects can lead to chronic health conditions but preventative care is available and readily accessible, due to strides in technological advancements and telemedicine. There is an opportunity for telehealth and healthtech to alleviate the burden placed on existing disease management services and equip patients with preventative care plans more efficiently. By allowing patients to measure their sleep patterns more accurately, conveniently, and safely, the new sleep startups have the potential to improve sleep tracking and research. More importantly, there is a way to aggregate these data points and connect patients with more holistic treatment plans as technology allows for accuracy and accessibility. The technology to collect and analyze data regarding sleep management and monitoring is a useful tool for telemedicine to incorporate for their patients. With proper utilization, the existing activity tracking technology has provided a working foundation for both providers and patients; additionally, it can also allow for an emphasis on preventative care from both parties. These Startups Want To Give Us The Best Night’s Sleep And Investors Are Tucking In & 10 Years Ago I Collapsed From Burnout and Exhaustion, And It’s The Best Thing That Could Have Happened To Me Bryte Raises $24M and Begins Licensing its Tech in Addition to Selling $8K AI-Powered Mattresses

Our Take: Increased adoption of telehealth will improve patient satisfaction and outcomes. Telehealth has become a core part of the healthcare system in the U.S. following a dramatic increase in use during the pandemic. Providers and payers have implemented new platforms into their care delivery systems to more directly cater to patients’ needs. The combination of a number of these tools all of which encourage flexibility and patient engagement, including 1) Home-based diagnostic tools, 2) Digital self-service tools, and 3) Wearable healthcare devices leading to better health outcomes, reductions in no-show rates, and improved patient satisfaction. While the pandemic may have been the catalyst, the trend towards incorporating telehealth into care delivery plans will continue forcing providers to work towards better delivery of services through a digital medium to create a more user-friendly and customer satisfying experience. Description: As a result of the pandemic, digital health has proven to be a convenient means to receive proper care in a timely manner. Prior to the pandemic, only a small minority of patients routinely utilized digital health tools to track their health conditions or visit doctors. While the adoption of digital health was slowly advancing and was recognized as having great potential for the delivery of care, it hadn’t caught up to speed. COVID fast-tracked the whole dimension in the use of technology in healthcare. Consequently, more than ever with the incorporation of digital tools and patient/provider acceptance, technology has become a crucial part of the healthcare delivery system. Along with increasing use and increased choice in offerings has come improved patient satisfaction. For example, according to the J.D. Power 2020 U.S. Telehealth Satisfaction Study, overall patient satisfaction score across all telehealth providers came in at 860 on a 1000-point scale. This was the highest patient satisfaction score for a healthcare service study ever done. According to Symphony Performance Health Analytics (SPH), 70% of patients preferred virtual visits over in-person visits to save time. Similarly, according to a study entitled “Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic”, the convenience of telehealth services reduced caregiver burden for a certain patient demographic and saved travel time and cost as well. They reported, “telehealth is not only advantageous for patient satisfaction but also for increasing the efficiency of healthcare resources by significantly reducing patient no-show rates.” The study demonstrated a 7.5% no-show rate for telehealth visits as compared to the in-person no-show rate of 29.8%. The Cleveland Clinic is also conducting a study to compare no-shows among in-person visits and virtual visit appointments. While the study is ongoing, based on Cleveland Clinic’s historical experience, the hypothesis estimated a 76% in-person no-show rate and 51% for virtual visits. The assumption is that no-shows are due to poor engagement, inconvenience, and difficulty of getting to appointments. Health systems and clinician practices consistently report lower no-show rates with telehealth, especially in behavioral care where telehealth removes the stigma of visiting a behavioral clinic. For example, the baseline no-show rate for psychiatry services is between 19 and 22 percent of appointments – while MDLive reports no-show rates of only 4.4-7.26 percent for its behavioral health telehealth visits. Implications: Telehealth uses technology to provide convenient, high-quality care and patient access, which ultimately leads to improved patient satisfaction and outcomes. As many of the healthcare systems rolled out broader telehealth services they acknowledged their patients easily adopted telehealth as they didn’t have to deal with transportation issues, take time off work or find childcare in order to make it to their appointments. While this required additional investment in technology and services to cater to patients’ needs, it also led to a decrease in no-show rates, long a challenge for the industry. Nevertheless, while improvements have been made, patients also reported varying degrees of satisfaction with their healthcare payers, many of which provided telehealth services through their health plan benefits. For example, Cigna was the top-ranked payer-provided telehealth service, receiving a patient satisfaction score of 874, with the Kaiser Foundation Health Plan getting a score of 867, ranking second, while UnitedHealthcare ranked third, with a score of 865 out of 1,000. However, though telehealth convenience has been acknowledged there are barriers that need to be addressed. There are still limited services, technology requirements are confusing as some patients are not as technologically-savvy, and issues remain with broadband availability. Enhancement and expansion of telehealth will further improve health outcomes as well as satisfaction but that will depend on policymakers, governments, and perhaps public-private partnerships to make broadband access more equitable and available. In-person care has been leading to an increasing number of missed appointments which ultimately decrease care plan compliance and lead to more expensive care needs. However, telehealth has shown offsetting effects on no-show rates along with better care plan adherence which has contributed to downstream cost savings likely mitigating some of the incremental costs. In addition, digital tools such as telehealth, remote patient monitoring, and virtual care could likely aid in reducing costs for patients requiring costly long-term chronic care, which can be done in the comfort of the home, For example, in diabetes care management, routine visits can help prevent long-term costly effects, yet patients often end up missing their monthly/3monthly check-ups due to inconvenience- this ultimately hampers their health leading to a rise in the cost of care and additional potential complications.. As policymakers evaluate the proper guidelines for telehealth, and with oversight bodies such as MedPAC saying they want to take 1-2 years’ time evaluating telehealth’s impact on outcomes before changing regulations, it is imperative that indirect costs such as these be considered in the equation. In addition, NCQA also reported the need to consider telehealth’s impact on no-show rates. If we truly want to move to a value-based paradigm, telehealth must not be viewed just as a replacement for episodic in-person visits, a key element in a model of continuous care given its ability to make delivery more convenient and easily accessible with more frequent but shorter encounters. This model provides many more opportunities for early testing, diagnosis and intervention for the health of the patient. Telehealth should further aim to improve the quality of healthcare, with special attention to overcoming existing barriers in access to care, including the burden of time and financial costs that patients and families bear in non-medical costs such as lost work, wages and the need for family caregivers associated with traditional in-person visits. Patient Satisfaction with Telehealth High Following COVID-19; Findings and Recommendations: Telehealth Effect on Total Cost of Care; Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic How Can Hospitals Prepare for the Hospital at Home? Event: Healthcare IT News recently interviewed Tom Kiesau, Director and leader at Chartis Group, a healthcare advisory and analytics firm. Kiesau discussed the importance of identifying the right patient populations that stand the most benefit from acute care remote patient monitoring as organizations move toward expanded use of the hospital at home in the near future. The article emphasized that more hospitals and health systems are pushing to expand remote patient monitoring programs – up to and including the provision of acute care at home. Description: The hospital at home is a clear pathway for parity reimbursement during public health emergencies, and it is here to stay. On the contrary, many questions remain as regulations and reimbursement mechanisms are unpredictable as momentum builds behind the concept of hospital at home. Amazon has teamed up with blue-chip health systems such as Ascension and Intermountain for the new Moving Health Home collaborative, whose goal is to "change the way policymakers think about the home as a site of clinical service." The group plans to lobby policymakers to broaden coverage for care services in the home, which include expansion of the Centers for Medicare and Medicaid Services' Hospital Without Walls provisions – advocate for bundled-payment models, home-based care, and more. Based on this goal, Kiesau implied that health systems should be prioritizing their investments in patient-facing tools and technologies, command centers, delivery services, administrative support, IT infrastructure, and more. He also explained that the hospital of the home bears many benefits such as lower costs, reduced readmissions, and may be a better replacement for acute care. Yet, a paradox exists because clinical populations must be identified that are deemed appropriate for remote services. Once this is resolved, thought must be given to what unique tools are needed to service these populations, the financial implications, and economic viability. Understanding the population that one intends to serve involves looking at the data you will target and how the hospital at home would impact them. Many organizations figure that a hospital at home model will provide a better experience with increased positive outcomes and reduced readmission rates. The interview also addressed considerations that should be given if unforeseen problems occur, such as unreliable internet connection or how someone would get into a patient's home if there is a medical emergency. Implications: According to the study, Telehealth: A Technology-Based Weapon in the War Against the Coronavirus (2020), researchers predicted that the pandemic would continue to reshape care delivery and provide major opportunities for virtual care. Researchers were right because the COVID pandemic prompted an enormous uptick in virtual care use from patients and providers. Telehealth, remote patient monitoring, digital therapeutics, provider home visits, and shareable medical records have "shown that care in the home can be at least equivalent to, if not better than the care offered in facilities." The “hospital at home” will provide flexibility to patients and providers alike by offering remote support through a digital infrastructure that will take the place of major health institutions. As discussed in the interview, the hospital at home will lead to better patient experiences and clinical outcomes by providing convenient and cost-effective access to patients seeking care. The CMS estimates that home health care in Medicare will save at least $378 million a year in just the nine states that are part of the Home Health Value-Based Purchasing. Additionally, research shows that home-based care is likely to reduce hospital readmissions by about 25% within 30 days of discharge. This new transformation of healthcare at home makes it possible for clinicians to observe, report, and analyze patients' acute or chronic conditions, no matter their location and in real-time. How Health Systems Should be Preparing Now for the Future of Hospital at Home & Health Systems, Care Delivery Groups, Amazon Launch Hospital-At-Home Initiative Leveraging Real-World Data in Cross-Sector Partnerships Event: A recent article in MobiHealthNews highlighted presentations from the HIMSS’ Accelerate Health event. During the event, Christopher Boone, VP and Global Head of Health Economics and Research Outcomes of Abbvie shared his game plan for how stakeholders can use big data. According to Boone, big data can be used to further the quality, safety, and effectiveness of drug therapies in a post-pandemic environment. He suggested leveraging as many lessons as possible from his pandemic experience to institutionalize them in the health system. Description: During the event, Boone explained that big data can be used to reimagine clinical discovery, clinical development, and commercialize drug therapies. Using real-world data gathered outside of the clinical trial setting and used across the life cycle of drug development must be expanded in order to achieve this. This kind of data will be used to determine the feasibility of clinical trials, recruit participants, inform regulatory safety decisions, lead commercialization and customer support programs. It is essential to have this data to understand the benefits and risks of all drug therapies and think about what precision health looks like from a cross-sector partnership perspective. Boone added three strategic steps that can be taken to achieve quality, safety, and effectiveness of therapies include: 1) Establish a shared vision and agenda for clinical practice and development focused on the issues of all communities, specially those facing health disparities; 2) Develop a joint plan of action that addresses systemic racism, inequalities, social determinants and diversity; and, 3) Invest in foundational data analytic capabilities such as curation, tagging, linking and searching to allow for public health surveillance. Implications: As the world begins to move towards the end of the pandemic, stakeholders are strategizing on how to use the lessons learned and apply them to a post-pandemic environment. As noted in the article, it is essential to understand the needs of individuals based on trust and transparency. In addition, siloed sectors of the industry need to form new models of collaboration. New cross-sector relationships among pharmaceutical companies and provider organizations will provide many opportunities for both sides and patients. As part of the transition to value-based care, pharmaceutical companies can demonstrate their therapies' effectiveness while giving providers the benefit of optimizing treatment for better outcomes and allowing them to achieve their value-based goals. The three strategies outlined above will facilitate faster, better, and cheaper clinical discovery and development efforts of drug therapies. These strategies suggest how partnerships can continue to be created and sustained, overcome hurdles, and build trust between two entities, which is key to success. Leveraging Real-World Data in Cross-Sector Partnerships is Key to Advancing Clinical Development Drones That Can Make Telehealth House Calls Event: On March 19th, mHealthIntelligence reported that researchers at the University of Cincinnati are creating a drone with the ability to make telehealth house calls. With the emergence of the COVID pandemic causing the increased need for telehealth care delivery, the creation of this tool is vital to improve patient’s accessibility to healthcare resources and to ensure that those with life threatening or chronic illnesses are still receiving care while still social distancing and avoiding potential exposure to the Coronavirus. Description: The drone has several features and capabilities that will greatly aid users with telehealth needs. According to the article, it includes an audio-visual telemedicine platform along with a waterproof compartment for carrying medical supplies and sample tests. With its small design, it can effectively maneuver into and around a patient’s home to bring patients their essentials. Researchers are also not limiting the drone’s capabilities to inside homes and medical facilities but are also exploring its ability to deliver medications, supplies, and labs to the country’s most secluded regions. This will enable clinicians to conduct many different functions including chronic disease management, post-operative care monitoring, health coaching, and consultations. Additionally, the drone may have applications where living conditions need to be assessed and even deliver interventions in special cases when a patient may be unable to contact anyone. This is pivotal in the case of the elderly or disabled patients, who live alone, especially during the pandemic. Implications: While the drone is still exploratory, adoption of it and other devices like it can help fill a void for patients with a lack of access to healthcare resources. For example, such devices could be used in rural areas to provide services to those who routinely cannot access care due to limited access in transportation. Devices like the drone are very timely in that many people continue to test positive for COVID and still need medications and everyday resources while remaining in quarantine. This is especially true in rural areas, where people already face issues of limited access to physicians and healthcare facilities, grocery stores, and other essentials. This drone could easily be coupled with telehealth systems, to help fight health inequality and help reduce other negative factors associated with the social determinants of health. Researchers Work on a Drone That Can Make Telehealth House Calls UnitedHealthcare Launches Virtual Hearing Aid Program Event: On March 18th, UnitedHealthcare unveiled a new virtual care option called Right2You. The program expands access to custom-programmed hearing aids that will potentially reduce the need for in person appointments for fittings or adjustments. The introduction of this product will provide greater convenience and affordability for eligible hearing impaired UnitedHealthcare members, addressing any disparities patients may face with traditional models which typically require an in-person visit to an audiologists office. Description: The introduction of the Right2You hearing device is based on UnitedHealthcare’s already established home delivered hearing healthcare model. The device adds a virtual care component that is designed to reduce the need for in-person appointments for hearing aid adjustments and support. According to the article, eligible patients can take an online hearing test to determine what their current hearing status is and if the tests indicated potential hearing loss, the patient could obtain the results of the audiogram from an in-person appointment with an UnitedHealthcare Hearing audiologist or another credentialed hearing healthcare provider. Custom-programmed hearing aids are then shipped directly to the person’s home. According to UnitedHealthcare, the program allows further customization remotely with a smartphone or tablet paired to the hearing aids instead of through an in-person appointment. They can then have the custom hearing aids sent to their homes. For those who don’t wish to take advantage of the online model, the program also allows the option for patients to see an audiologist from United’s large network or credentialed audiologist and hearing professionals. Implications: As a result of the pandemic, hearing aid sales have declined significantly as patients who are at risk seek to avoid exposure to COVID. This is a major issue since there are more than 48 million Americans with hearing loss and a number of viable solutions exist to improve the quality of their lives. This virtual care option removes the barriers to care that have developed because of the pandemic, enabling people to conveniently receive treatment while minimizing exposure to COVID through this virtual platform. Hearing significantly impacts overall well-being, therefore, improving the cost and access to hearing health treatment and hearing aids will help to improve overall health outcomes. UnitedHealthcare Hearing Launches Virtual Option to Help Plan Participants Remotely Access Hearing Health Care and Treatment & UnitedHealthcare Launches Virtual Hearing Care Program

Event: On March 23rd, DexCare, an AI-powered platform that manages and schedules patient care, raised $20M in oversubscribed funding led by Define Ventures joined by Kaiser Permanente Providence among others. DexCare is a spin-out from Providence St. Joseph’s Digital Innovation Group which attempts to incubate innovative healthcare solutions for health systems by spinning out digital start ups. Puget Sound Business Journal reported that DexCare partnered with 6 major health systems, providing them multiple point solutions through a unified system. including “Providence, Community Health Network, Houston Methodist, and Froedtert and the Medical College of Wisconsin health network”. Description: Founded in Seattle 2016, DexCare, a platform-as-a-service (PaaS), promises to support the increased patients’ consumption for healthcare to match the novel demand for ambulatory and telehealth services simultaneously. According to DexCare, “the innovative technology allows [patients] to access healthcare, make appointments and receive follow-up care based on [their] health needs, preferences, location and schedule. In terms of ambulatory care the service connects patients to clinics or providers that are the most appropriate site of care and where care can be provided within the same day. While DexCare was initially used as the platform to access same-day care at Providence, when COVID hit, Providence scaled up the DexCare platform to increase its use in other areas. As the innovative technology evolved it helped Providence coordinate resources and shift from in-person care to telehealth visits to ensure providers could meet the unprecedented demand. During COVID health systems saw unprecedented increases in telehealth volume causing a need to coordinate numerous variables in healthcare delivery. DexCare aims to intelligently provide on-demand healthcare services by leveraging the health systems’ available resources and capacity. For patients, the DexCare platform provides a self-directed, easy-to-use digital experience that removes barriers to care and improves access by allowing them to use whatever modality is most convenient for them (online, in-clinic, chat-based or in-home). In addition, DexCare allows patients to understand and select the best care option given your symptoms and appointment availability, determine insurance eligibility and matches them with a provider that has the highest net promoter score (NPS) a form of customer satisfaction score. On the hospital side, the benefits of sustaining ambulatory care are cost-effectiveness, prompt care delivery, and increased patient retention and satisfaction. According to DexCare it “has enabled service lines to attract 30% more new patients, capture 5x downstream revenue, generate $22 per patient encounter in cost savings, and deliver a net promoter satisfaction score greater than 80”. Implications: While the use of telehealth increased dramatically during COVID the delivery of care, the customer’s journey through the healthcare maze and the quality of the patient experience really did not change dramatically, Getting patients into the system, handling all the administrative tasks and directing them to the most appropriate sites of care to deliver a consumer focused experience is still not delivered in an integrated manner. For telemedicine and healthtech to finally achieve it’s promise not only must care be delivered more efficiently it must be delivered where consumers want it (home, online, facility), when they want it, and easily like all of their other digital experiences. DexCare and other services like it, are helping to make the patient journey more consumer-centric and retail-like, which will be necessary to both meet demand and lower cost as well. Latest Providence Spinout Raises $20M to Fuel Expansion Plans & Providence’s Newest Digital Health Spinout Snags $20M

Our Take: While non-traditional tech and retail disrupters in healthcare, like IBM, Walmart, Amazon, J.P. Morgan and Berkshire Hathaway (through the Haven joint venture), and Google, all had different goals in changing the face of healthcare, they have all had difficulty gaining significant traction the marketplace for similar reasons. These reasons include: reasons include starting too ambitiously with a poorly defined strategy; lacking distinct goals; failing to align their interests with patients and providers and, under or over-marketing their healthcare product. Description: Non-traditional, tech, and retail giants like IBM, Walmart, the Haven J.V. partners, and Google either recently or historically have all entered the consumer-facing portions of healthcare for different reasons. IBM built up and eventually branded its AI healthcare unit as Watson Health to use AI to improve health outcomes in Cancer and other diseases; Walmart planned to leverage its existing brand and retail store base to build 4,000 primary-care clinics initially focusing on underserved communities; Amazon, J.P. Morgan, and Berkshire Hathaway through the Haven joint venture attempted to reimagine the delivery of employer-based healthcare; while Google created Google Health back in early 2011 as a repository of health records and data (known as a personal health record) to allow patients to have access to all of their health records in one place. While all of these were worthwhile goals, many of them were too ambitious and poorly defined. For example, IBM focused Watson on curing cancer, as noted by Ariell Trzcinski, an analyst at Forrester, “these {were} really ambitious goals. One of the things we see with organizations that have been more successful in applying AI in healthcare is that they start small”. Similarly, one observer commenting on the collapse of Haven noted, “a boulder-sized problem as big as healthcare cannot be solved with an equally sized sledgehammer solution. It is best done in moderation with a chisel, and over time”. In addition, often these goals are very broad and lack a specific achievable goal. Walmart’s goal was to be “America’s neighborhood health destination” with a strategy that included a timeline of opening 125 clinics by the end of 2021, 1,000 clinics by 2024, and 4,000 by 2029, according to Business Insider. Along the same lines, IBM referred to Watson as a Cancer moonshot while Haven’s goal was “reimaging employer-sponsored care”. While we are not privy to internal projections which likely contain more explicit financial goals, the goals in these statements, though laudable, are not very specific in terms of treatment of distinct medical conditions or costs. In addition to overly ambitious and broadly defined goals, these initiatives often fail to align their interests and incentives with those of patients and payers. For example, according to Adam Bosworth the original leader of Google Health, Google never really pushed to see what people would want, they basically offered a place to store data. [People] want to be healthy but they need more than that. Connecting these efforts to the interests of payers is equally important, as noted by current co-founder and CEO of Health Rosetta and former Microsoft executive Dave Chase, “as much as we’d like to think it isn’t the case, the fundamental driver of most (not all) behavior in healthcare is the reimbursement scheme”. Likewise with Haven as one observer noted, despite the presence of many large organizations in healthcare, “healthcare is always a local delivery and local financed industry...the challenge is always aligning interests and goals.” Finally, not surprisingly given the importance of healthcare as a vertical for these disruptors, these efforts often fall prey to over-hyped marketing strategy. According to STAT+, IBM “announced a flurry of partnerships before it had the resources, the scientific evidence, and in some cases the technology to support them.” Similarly while Haven’s marketing team touted their goal of providing “simplified, transparent healthcare at a reasonable cost”, Haven’s partners never clearly outlined what their contributions to the partnership would be or what their commercial expectations were.” In the same vein, Google Health was poorly marketed and lacked support at the highest levels of the company to succeed. Implications: For non-traditional entrants like retail and tech entering healthcare and gaining market share in the consumer-facing aspects of the industry is difficult, time-consuming, and fraught with risk. The varied nature of healthcare data, the intricate nature of data privacy and security rules such as HIPAA and CCPA, and the often complicated relationships between patients, providers, and payers can make navigating the space difficult at best. While the technology is often steeped in a culture of “move fast and break things”, healthcare is infamously associated with Hippocrates and his oath to “do no harm”. As a result, achieving change in healthcare can be methodical, require broad consensus, and involve cross-collaboration support from broad swaths of an organization or parts of the industry. In the words of the former worldwide head of healthcare at Microsoft, “health is hard, it takes a lot of time, money and partners to transform an industry”. As a result, we recommend disruptors approach the market tactically with very specific, defined, and realistic goals to cure one problem. Innovators need to realize that success will breed success and drive internal demand from customers which can dramatically shorten the sales cycle. Moreover, while groundbreaking technology is wonderful, realize the limitations of the technology itself. For if the technology does not align with the customer’s problems or allow them to impact something under their control it likely will not succeed. In the words of Amit Kaushal, professor of bioengineering at Stanford, “having technology that works is necessary, but it’s not sufficient to ensure you’re going to alter clinical outcomes”. Lastly, disruptors must also identify their market strategy and be careful not to oversell their health products without inflating the capabilities recognizing that healthcare may be a very different market from where they are coming from. As noted by STAT+ “IBM failed to fully comprehend the differences between its traditional tech business lines and the complex world of health care." Goodbye, Haven: The Benefits Industry Reacts; 10 Reasons why Google Health Failed; Inside the Fall of Watson Health: How IBM’s Audacious Plan to ‘Change the Face of Health Care’ with AI Fell Apart; Walmart is Slowing its Ambitious Push Into Healthcare, Employees and Leaked Documents Reveal (subscription required for last two articles) MedPAC Recommends More Telehealth Study, Concerned About Fraud and Waste Event: An article from mHealthIntelligence describes the stance taken by the Medicare Payment Advisory Committee (MedPAC) relating to the future of telehealth coverage after the COVID pandemic. In the report, MedPAC did not endorse any final decisions concerning telehealth rules that were suspended during the public health emergency (PHE), instead suggesting that many temporary measures be extended so that they could be studied further. Description: On March 15th, MedPAC submitted its March 2021 Report to the Congress: Medicare Payment Policy to Congress that contains the Commission's recommendations on the future of telehealth coverage by Medicare. The report recommends that the telehealth coverage expansions that were put in place during the COVID PHE be extended for 1-2 years so that additional data can be collected to evaluate the impact of telehealth on healthcare costs and quality. During the pandemic limits on a number of telehealth rules including those limiting originating site requirements, cross-state licensure, and others were suspended or not enforced so that services that could not be safely delivered in person could be delivered. Importantly, the report recommended “Medicare should return to paying the fee schedule’s facility rate for telehealth services and collect data on the cost of providing these services” after the PHE ends, essentially returning to covering telehealth services at a lower rate than in person visits. In addition the commission suggested extending coverage for telehealth services regardless of originating site, (telehealth is often used to overcome distance for patients who cannot reach their provider easily), and recommended allowing clinicians to be allowed to bill for audio-only services (which were not covered prior to the PHE). In defending it’s recommendations MedPAC stated it prefers the continuation of this evidence-gathering period, over a permanent extension of all of the over 140 added telehealth services by the Centers for Medicare and Medicaid Services (CMS). It also recommended that providers no longer be allowed to waive cost-sharing for telehealth services. Implications: As noted by mHealth Intelligence, many will be disappointed that MedPAC did not embrace the alternative for permanent extension for the majority of the approximately 140 coding changes that it mentions. Many industry participants had hoped, and anticipated that the massive uptake in telehealth usage during the pandemic would lead to a shift in policy. While it is important to note that MedPAC's recommendations are not binding and it has no official role over CMS, the Commission's recommendations often carry much weight. In addition, if Congress and CMS do not act, once the PHE ends, certain limitations on telehealth services like those limiting originating site of services will go back into effect. Moreover, although the Commission is right to focus on the potential for fraud and abuse in telehealth, as demonstrated by success of telehealth during the pandemic, those concerns may be outweighed by the benefits that can be brought to patients, particularly the underserved. Though some have pointed to the recommendation for further evidence gathering and study noting disappointment, we believe the Commission’s recommendations indicate that some, but not all, of the regulation changes to telehealth services covered during the public health emergency will eventually be made permanent, but there are no guarantees. As we pointed out earlier, the Commission appears to be focusing only on direct costs and does not appear to be taking into account other indirect cost and the opportunity costs of lost improvements in care. While many of these are difficult to measure, they should be taken into consideration as we seek to broaden access with new, more innovative tools. MedPAC Recommends Limiting Post-COVID-19 Telehealth Coverage, More Study & MedPAC March 2021 Report to the Congress: Medicare Payment Policy Using Telehealth to Keep People with Developmental Disabilities at Home Event: Recently, Healthcare IT News reported on a plan that Partners Health Plan of New York has implemented to use telemedicine to decrease ED visits for its members. According to the report, Partners is a managed care organization that is dedicated to helping people with intellectual and developmental disabilities (IDD). It noted that those with IDD may experience trauma associated with hospitals, often can have difficulty dealing with change and may face discrimination or difficulties communicating. As a result, all of these issues can lead to people with IDD having negative experiences in medical settings. Description: Patients with IDD can “go downhill with hospital admission.” While IDD has not been among the fields to provide advanced technical support to patients, Partners had begun rolling out telehealth programs aimed at helping this demographic even before COVID. Partners was working with StationMD prior to other healthcare providers opening the telehealth platform for IDD patients. The telehealth program Partners implemented showed both hospital admissions and emergency room visits decline since 2018. Following the pandemic, their telehealth program reported 91.6% of calls were treated via telehealth itself and only 8.4% transferred to the emergency department. The pilot program for Partners and StationMD included providing residential staff members with stethoscopes, pulse oximeters, blood pressure monitors as well as equipping doctors with a detailed history of patients historical claims data. As a result, by the time the pandemic hit, the system was already in place. Given the success that Partners has had rolling out telehealth to its IDD population it looks forward to implementing urinary tract infection management as a continuum of at-home service. Implications: As noted in the article, 1 in 4 adult patients have IDD and approximately 50% of adults with IDD are frequent visitors to the emergency department. Their reported satisfaction to the ED is very low as they often face some sort of discrimination or challenges in an ED. While telehealth skyrocketed in popularity during the pandemic, concerns arose that telehealth could worsen the digital divide especially for people with disabilities since providing telehealth visits to patients with IDD was very new to providers. This new initiative by Partners Health Plan which sought to broaden the use of telehealth to people with IDD, while taking into account their unique needs and working closely with local providers, appears to have been a success. Not only has it allowed patients with IDD to have a positive experience it has also allowed them to experience it from the comfort of their own homes. Telehealth care for IDD patients indicates the use of such applications can support their particular communication needs which enables simple behavioral interventions and provides support in treatment. By creating multi-modal telehealth applications that are adapted to the health needs and capabilities of these patients, innovative care delivery teams like Partners are broadening the scope of care that can be delivered to people with IDD at home thereby improving outcomes and reducing costs. This approach, along with the development of AI based tools has the potential to revolutionize the care for patients with intellectual/developmental disabilities. Telehealth as a Tool to Keep People with Disabilities out of the Hospital Trialing an Edible Camera to Improve Detection of Colon Cancer Event: (3/11) A recent article in MobiHealthNews highlighted Medtronic's new Pillcam Colon 2 technology. The NHS in England will perform a trial to check for colon cancer signs among participants given the edible miniature camera. Description: A recent study by Oxford University noted that thousands of patients might have untreated bowel cancer as a result of diagnostic testing that was deferred during the COVID pandemic. Between April 2020 and October 2020, over 3,500 fewer patients than expected were diagnosed with bowel cancer in England. The Pillcam Colon 2 technology seeks to provide a quick, safe, and convenient approach to patients who have to monitor or test for colon cancer signs. The pill is a vitamin-sized capsule that is taken orally, does not require sedation, anesthesia, or radiation. Once swallowed, the camera-enabled capsule will take images as it passes through the bowel. The images will then be transmitted to a recording device that the patient wears. After the camera has passed through the body, it can be flushed away. The NHS plans to trial the pill by giving it to 11,000 participants in more than 40 areas in England to look for signs of colon cancer. The endoscopy team at University College London Hospitals NHS Foundation Trust, NHS in Scotland, and other international health clinics are already using Pillcam technology. Implications: The new and innovative Pillcam technology has the potential to replace the traditional endoscopy where patients are required to undergo in-person procedures to have a tube inserted. The Pillcam technology will provide a diagnosis within hours, speed up checks, and detect cancers at an earlier stage where they are easier to treat. Clinicians can remotely monitor their patients and provide the help and support they need in real-time. Since bowel cancer is more likely to be curable if detected at its early stages, this technology can make a clear impact on identifying and treating patients with bowel cancer. Innovations like the Pillcam Colon 2 technology can help the tens of thousands living with underlying symptoms and undiagnosed cancer due to routine screenings that have been delayed or skipped during COVID. This technology, and others like it, can provide a quick and efficient diagnosis to patients from the comfort of their own homes. NHS Trials Edible Capsule Cameras to Detect Colon Cancer

Event: On March 5th, MobiHealthNews reported that TytoCare raised an additional $50 million in Series D funding this year .TytoCare innovated a handheld comprehensive exam kit; making telehealth more accessible and reliable. Ten days later, West Michigan’s Spectrum Health, announced its partnership with TytoCare. TytoCare aims to use the funding to update their AI functionality and expand its platform to more markets in Europe, Asia, and the U.S. Lessons Learned Along the Way: Telehealth has still not fulfilled its promise, there's more to be done in remote and virtual care Convenience and access are key, patients will transform healthcare just as they've changed ever other industry Increases in technology have realistically reached the point where they can increase the nature of procedures done outside of hospitals/physician offices. AI and ML will allow providers to leverage clinicians in areas where doctors/specialists are in short supply Description: Founded in Israel in 2012, TytoCare markets telehealth-enabled/connecting medical devices through a kit that includes a stethoscope, a high-definition camera, an infrared thermometer, an otoscope-device to examine the ears, and a tongue depressor adapter for examining the throat. By using the kit, patients can enhance a traditional telemedicine visit enabling doctors to remotely measure blood pressure and examine a patient’s ears, heart, lungs, and skin (among other things). As TytoCare describes it on their website, their innovation delivers care “just like visiting the doctor in person”. We spoke with David Bardan, VP and Head of U.S. Commercial at TytoCare who noted that the COVID pandemic had increased the demand for telehealth services generally resulting in a 2.5x increase in demand for the company recently. Bardan also noted that approximately 90% of the company’s business is in the U.S, where they have partnerships with over 120 health systems and are in over 300 Best Buy retail stores. TytoCare said they will use the funds to expand its platform into additional markets in the U.S., Europe, and Asia. In addition to expanding their platform, TytoCare will introduce more machine learning capabilities to their examination kit making these telehealth visits even more personalized and accessible. For example, Venture Beat noted that 9 out of 10 seniors prefer receiving at-home health care; increasing a demand for remote health monitoring innovations, long before the pandemic. Barden also pointed out the TytoCare devices enable the ability to perform more health management and monitoring at home which should help greatly with improving diagnosis and outcomes and even allow the company to extend the reach of care in rural communities where the number of doctors and specialists may be limited (ex: by having patients visit a clinic staffed by a PA or LPN who could then transmit the data to a doctor at another location). The company also plans to use the AI and Machine Learning capabilities incorporated into its products to broaden and deepen its clinical services. Barden noted that the company’s products can already detect a wheeze in a patient’s lungs. Implications: TytoCare has created a product that has the potential to dramatically change the way telehealth is being practiced; allowing for patients to perform clinical tests at home. In addition to reducing the burden on healthcare providers and systems, TytoCare will allow patients to be more hands-on with their health, allowing for wellness and preventive checks even when they aren’t sick. TytoCare is already updating its practices and closing the information gap by allowing TytoCare providers to “transfer data into the EHR” via Epic’s App Orchard. Additionally, TytoCare is working on improving its AI functionality; allowing for patients to detect heart murmurs simply, without the use of ECG. The ability to gain series of vital measurements cheaply, cost-effectively, and with better quality can alleviate much of the burden currently placed on strained healthcare resources while simultaneously lowering costs. Bardan noted that as telehealth and TytoCare’s digital health devices improve, the company envisions a model where clinics equipped with the company’s devices can function as a hub for patients who may not have access to care or broadband services that allow them to take advantage of its products. This hub and spoke model has great potential to bring affordable healthcare to many who are geographically isolated or technologically deficient. TytoCare is hoping to change the way people perceive healthcare to one focused on wellness and preventive care all the while taking advantage of the shift in the way people acquire healthcare as a result of COVID. Let us help you: Design/refine your go-to-market strategy Develop a targeted pilot project strategically designed to match your domain expertise with pre-identified prospects Establish a continuous feedback loop from early wins to build a growth flywheel and scale your solution

Our Take: As one of the steps towards improving coverage and access to health care coverage in the United States, Medicaid should shift to an auto-enrollment mechanism, whereby beneficiaries are automatically-enrolled in coverage by some sort of mechanism (separately determined), without requiring them to actively seek out coverage or submit an initial application. Medicaid, is designed to cover people near or below the Federal Poverty Level (FPL), but unlike Medicare, its federal counterpart for those over 65 or with a disability, Medicaid and the Children's Health Insurance Program (CHIP) do not have any auto-enrollment mechanism in place. As a result, low income individuals, many of whom live in underresourced areas and lack transportation, must currently take affirmative action to seek out and sign up for their government-funded health insurance benefit. Intended or not, this effectively leaves millions of eligible Americans without healthcare coverage leading to a debate as to whether costs and quality would be improved if they were automatically enrolled in the system. Description: The current U.S health insurance system is dominated by employer sponsored coverage (ESI) which covers approximately 155M employees and their beneficiaries. Many others get access through the health insurance marketplaces set up under the Affordable Care Act (ACA) and may or may not receive subsidies to help them pay for premiums under the ACA as a function of income. Medicare currently covers nearly all citizens and permanent residents over age 65 or with a disability automatically. This is also true of the CHIP which covers children whose parents or guardians have income too high to qualify for Medicaid but low enough that affording insurance for an entire family is difficult. This patchwork system still leaves a large portion of the population lacking access to health insurance coverage through these means, but generally eligible for Medicaid. Medicaid is a state-run but majority federally-funded program with the federal government setting baseline benefit and eligibility standards but different states have different eligibility and coverage thresholds. However, as noted above, while many may be eligible for coverage they still must enroll to receive benefits, which leaves many uninsured. According to Kaiser Family Foundation, 27% or 8.8 million of the 32.3 million total non-elderly uninsured in the US were eligible for Medicaid or CHIP in 2016. While the age composition of this eligible unenrolled group varied by state, Kaiser found that 18% were adults eligible for Medicaid and 10% were children eligible for CHIP. Moreover, another study found that if those who were eligible had been enrolled by a parent or guardian, the number of uninsured children in the US would have been cut from 3.7 million to 1.6 million. We believe auto-enrollment would help solve the problem of many being eligible for Medicaid but not enrolling, and there is evidence it works. By way of illustration, studies indicate that auto-enrollment is helpful in retaining beneficiaries who may have let their coverage lapse. For example, a September 2019 article in the Journal of the American Medical Association (JAMA) found that people who had insurance from the ACA marketplaces that allowed for automatic re-enrollment were 30% more likely to retain coverage the following year than people whose offerings did not include auto re-enrollment. JAMA found while there were several factors that lead to people not re-enrolling in a plan, they included reasons other than a lack of knowledge or willingness to re-enroll. Auto-enrollment is not without its issues for the states, which would face their own set of challenges to implement it. A report from the Brookings Institute found four policy problems for auto-enrollment in health insurance, two of which would pertain to exactly this issue with Medicaid; obtaining eligibility information and managing false positives and false negatives. These eligibility and verification issues both hinge on the availability of comprehensive and quality data. While Medicaid must already obtain eligibility information, this process expands in both scope and difficulty when states are required to find every person who qualifies and enrol them. By contrast, managing false positives is already something done as part of the Medicaid program’s current operations given that they have to deal with fraud cases, however, managing false negatives would be a new task. In determining what method to connect auto-enrollment to a number of solutions have been proposed including enrollment at tax filing (many who qualify for Medicaid are working poor), when people file for unemployment insurance and even when renewing drivers licenses. While none of these methods are perfect, increasing access to coverage would help more people get into the system, improve the quality of their care and ensure that they are receiving care at the right sight of care. Implications: Closing the gap for insurance coverage is essential to promoting the health of Americans. The people who are uninsured are often referred to as the “donut hole,” those whose income falls in between eligibility for Medicaid and the amount necessary to afford private insurance. Policies like CHIP and the ACA were designed to meet that need, and the potential for expansion of subsidies under the Biden administration is promising. Yet, if people who are eligible for Medicaid are not enrolled, the donut has a bite taken out of it, and there is more space to fill. According to Kaiser, a majority of eligible unenrolled people are people of color. In non-expansion states, close to a third are Black, and in total nearly a third are Hispanic. The health metrics for these populations are lower across the board than those of White people. The barriers to enrollment are often unique to underserved communities such as an experience with government and healthcare that has been less than forthright. As a result, there is a history of distrust that is not unreasonable. In addition, given the political divisions around immigration, the federal government has enacted and enforced anti-immigration policies that have an impact on healthcare access. For example, according to the Urban Institute these policies have led to 1 in 5 adults in immigrant families with children to be less likely to claim public benefits such as Medicaid in 2019. Interestingly, as a result, while many of the positions opposing immigration are rooted in the financial burden on state and Federal governments, this may lead to even more accessing of care when a condition is acute and often via the most expensive means (typically the ER). Improving coverage via Medicaid has always been a matter of health equity, but auto-enrollment for Medicaid would help improve coverage for a portion of uninsured Americans who are arguably most vulnerable. A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP; Association Between Having an Automatic Re-enrollment Option and Re-enrollment in Health Insurance Marketplaces; Three Ways to Make Health Insurance Auto-Enrollment Work NQF Reassess Telehealth Parity and Health Outcomes Event: On March 8th, mHealthIntelligence reported the National Quality Forum (NQF), a not for profit, nonpartisan membership-based organization working to catalyze improvements in healthcare, is planning to update their 2017 framework for measuring the success of telehealth. NQF is going to review it’s 2017 guidance and examine where improvements need to be implemented. In partnering with the Centers for Medicare and Medicaid Services, the organization hopes to improve telehealth platforms to achieve better health outcomes. The organizations are looking to improve health system readiness, especially in areas severely impacted by the COVID pandemic. Description: The NQF is a membership-based organization that brings together diverse organizations such as patients, caregivers, hospitals, healthcare systems, clinicians, insurers and employers. It is made up of over 400 organizations and institutions across the healthcare sector that learn, influence, connect, and become informed on healthcare issues. In partnership with the Centers for Medicare and Medicaid Services, the organization plans to measure how connected health tools and platforms have impacted clinical outcomes, access to care, patient engagement, and the cost of care. According to the article, telehealth resources were scarce and only existed in large health systems in urban areas, disregarding the need for these resources in rural areas that lack access to healthcare due to distance, cost, and lack of physicians. The new studies conducted can help to examine if rural healthcare delivery has been affected by telehealth, particularly looking at usage during COVID. As noted by Sheri Winsper, SVP of Quality Measurement for NQF “telehealth existed in pockets, primarily in large health systems in urban areas. When COVID hit, however, everyone sought to push as much care as possible from in-person to virtual channels, in essence pushing the telehealth development curve ahead by 10 years.” As a result, Winsper added, “the NQF’s mission now is to take the data gathered by the surge in telehealth use and figure out whether it’s solving barriers to care or improving outcomes.” The organizations stress the need to update these measures, especially during a period where all different populations are heavily relying on these platforms to maintain their health and have direct access to healthcare providers at an affordable cost. Implications: With the continued surge of the COVID pandemic, patients continue to rely on telehealth platforms since in some cases, they are still unable to see their physicians unless the situation is critical. It is important to reassess these platforms to ensure that they are meeting the current needs of patients, especially in the case of patients with chronic or life-threatening diseases, where lack of access, or missed follow-up appointments could have been exacerbated due to concern of COVID exposure. Some of the key takeaways NQF can learn from the data include: 1) how telehealth should be compared to in-person care, especially in areas where access to in-person care is limited, 2) how to measure different modalities, should they be measured differently or evaluated against similar standards of care, 3) what information patients should receive when selecting different platforms to access care. This report not only hopes to link the quality of telehealth care with outcomes but also to compare telehealth to in-person care. Clinical evidence of both of these outcomes would be positive to influence post-COVID reimbursement of telehealth which is critical to maintaining usage and expanding into underserved communities. National Quality Forum Looks to Update Telehealth Quality Benchmarks Automated Reminders Help Warren Clinic Reduce Vaccine Waste Event: On March 9th, Healthcare IT News ran an article about the Warren Clinic in Tulsa, Oklahoma which is the hub seeking to provide three million people with the COVID vaccine. Warren is the hub for Tulsa, OK as well as seven surrounding counties. As a result, Warren Clinic's priorities were to develop an effective way to communicate with its patients and at the same time make sure that vaccine doses don’t get wasted, especially given the vaccine's short shelf life. Description: As noted in the article, Warren Clinic is a 450-provider employed medical group that is part of the Saint Francis Health System which would be responsible for distributing the vaccine to 3 million people in Tulsa and the surrounding counties. Given the strong expected demand for the vaccine Warren Clinic wanted to minimize “no-shows'' via automated appointment reminders to ensure none of the vaccine that had been thawed to room temperature would go unused and have to be thrown out. Warren Clinic worked with their long time health IT vendor Relatient which provides their bi-directional appointment-reminder solution that had been seamlessly integrated into their Epic EHR. The Relatient solution helps with direct-to-patient reminders that allows staff to automate text, email, and phone reminders. We spoke with Relatient CEO Michele Perry who added that “you have to engage patients in a way that is going to be super easy...you need a vaccine, here are your options but you still need the basics, how do you get updated medical histories and other information to the doctors.” For example, once Warren Clinic’s patients make an appointment, they receive reminders and their responses, including cancellations, which are then noted in the department appointments report. This way the team can see any new vacancies opened up from appointment cancellations. In addition, as part of Warren Clinic's new Epic EHR build, the first vaccine appointment automatically triggered a second appointment 21 days later at the same time as the first. This strategy was used in an aim for zero waste in vaccine doses as well as minimizing no-shows. Warren Clinic, which had been working with Relatient for five years, had piloted the Relatient automated reminder system earlier at six of its provider locations with the highest no-show rates (unrelated to COVID), and saw an immediate drop in no-shows by 52%. Implications: As noted in the article, among the lessons learned by the Warren Clinic were: 1) patient’s receiving information directly on their phones where the information was easily accessible seemed to contribute directly to the decline in “no-shows”, 2) have vendors who are integrated, such as Relatient and Epic and don’t be afraid to ask them to move fast to help get your strategy in place, and, 3) ensure that when asking vendors for solutions IT integration has already occurred and put until later asking for things that are not integrated, As noted by Collin Henry, Vice President of Operations and Physician Recruitment for Saint Francis Health System, “[have] a myriad of vendors who offer great service, are responsive and act more like partners than vendors. Then leverage those relationships so you can respond quickly and get a plan in place.” Relatient’s Perry added that to achieve this type of partnership with customers from the vendor side “you have to have a healthy balance between anticipating customer needs so you are there for them, and hearing what they say. Customers want to know they have a voice and that they will be heard”. From the Warren Clinic side Henry added that having vendors who “most importantly, ... understand the values and expectations of one's organization – makes the rollout of any new project or technology easier.” As a result, Warren Clinic has been able to use some of the best practices to reduce no-shows including: 1) Setting automated client appointment reminders via multiple mediums (text and email), 2) Allowing patients to confirm via text/email, 3) Automating bi-directional reminders where a patient’s response to the text reminder either confirms their appointment or provides alternative appointment times for them to select, and, 4) Automated patient instructions that include, clinic addresses traffic routes and COVID safety protocols. Warren Clinic Wastes No Vaccine with Help from Automated Reminders How Femtech is Breaking the Taboo Around Women’s Health Event: A recent article in MobiHealthNews reviewed femtech's roles in tackling subjects such as pregnancy, miscarriages, physical shame, menopause, periods, and fertility. Lina Chan, founder, and CEO of women’s fertility platform Parla, noted that these areas have always been understudied because women find it uncomfortable to discuss their health issues. The new femtech movement is working to support these issues and close the health gap to ensure women live happier, healthier, shame-free lives. Description: Women's health care has been shrouded in taboo because women have traditionally been taught from a young age to be ashamed of their bodies. Their health has always been understudied because there have long been various cultural norms that women are always supposed to look pretty, have no flaws, and stay small. Often, women are discouraged from sharing their experiences involving miscarriages and fertility struggles because they are ashamed. However, when women do share these experiences they find out that they aren't the "only ones" who have experienced these situations. As noted in the article, the unnecessary stigma associated with this misguided belief system can lead to isolation and affect a woman's mental wellbeing and physical health. In addition, this can cause women to withdraw from support networks and feel uncomfortable sharing things with providers. According to the article, the only way to end this cycle is to open up the conversation and break the taboo. If women do not reach out for professional help and medical advice, it can lead to delayed diagnosis and possibly a more severe condition. A recent study showed that 70% of women who experience a miscarriage would have some symptoms of PTSD because it isn't something many medical professionals are prepared to deal with. The rise of femtech brands should help break the cycle and end taboo thereby resulting in women's health no longer being on the sidelines, and ending the shame around women's health. Brands like Elvie (who caters to pelvic floor dysfunction and breastfeeding), Clue (menstrual cycle tracker), and Bayer (who specializes in menopause) all can break the taboo. Women who have been affected by underlying issues are included in the design process to ensure companies and products are catering to women's needs and are sensitive to their feelings. Implications: Because a taboo exists, sometimes even the most well-meaning medical professionals can find themselves under-informed and ill-prepared to offer practical solutions and support for sensitive women’s health issues. To break the taboo, women need to have the confidence to talk about their feelings and experiences to transform their overall health and wellbeing. Indeed, many businesses at the forefront of the femtech movement have been founded by women who have felt under-served by the traditional approach to healthcare which in and of itself should help the problem. They are providing support by creating more products and services they weren't able to access themselves and putting the needs of women at the forefront of design and user-experience. Investors have begun to recognize the importance of this sector and are slowly giving companies financial backing to help more women. These companies help close the care gap caused by shame and technology, making it easier for women to connect with healthcare professionals remotely and at their leisure. Technology can make it easier for women to connect with healthcare professionals from the comfort and emotional security of their own home. Consequently as noted by Ms. Chan, “this means it can be done anonymously, encouraging women to deal with conditions they may have previously avoided”. Moreover, femtech founded companies don’t just develop a product that solves a clinical problem, they also create brands that start a conversation which should elevate the discussions around women’s health issues and help reduce the stigma. How Femtech is Breaking the Taboo Around Women’s Health and Closing the Gender Health Gap

Event: Redox recently announced that they raised $45M in a Series D round, bringing its total raised to $95M. The round was led by Adams Street Partners, joined by Avenir and prior investors Battery Ventures and .406 Ventures and RRE Ventures. Redox’s cloud-based platform simplifies integration and scaling for software developers looking to build applications for healthcare providers. Lessons Learned Along the Way: Analyze where the value is being created and move in that direction Create a defined and integrated way of attacking the problem Tackle the problem in phases and keep working incrementally to maintain and improve functionality. Description: Redox is a Wisconsin domiciled cloud-based integration software provider that helps accelerate the adoption of healthcare technology. We spoke with Redox President Niko Skievaski, the company’s data platform allows developers and providers to connect its network once and then exchange data across the company’s platform with any other connected company once they join the platform. More than 1,400 healthcare delivery organizations, including most top hospitals, and 350 independent software vendors use Redox’s service to exchange and integrate more than 12 million patient records. According to the company, almost 70% of the traffic on its network is bi-directional. Redox’s system is able to exchange data across over 50 EHR systems and currently has over 1,400 live connection points (as of the time of our interview). Visually one can think of Redox as powering a “two-sided network” with software developers on one end and healthcare providers on the other, with the Redox cloud powering the connection between the two. According to Skievaski, the power of Redox’s model is that once an app developer or provider is connected to the network, each successive integration becomes “magnitudes easier”. While the average implementation time is approximately 4-6 weeks (currently running 35 days), the company pointed to one example where the company tested and implemented an application for an existing customer during a 30-minute phone call. Interestingly, from a business model perspective, while Redox could have chosen to focus on selling to providers, they felt that would require them to customize each integration and probably would have effectively ended up leaving them with 20 large customers. By contrast, Skievaski noted that while selling to developers was initially a risk, by “seeing where the value is and moving in that direction” they were able to create a whole network of data and share it more effectively. As a result, their software developer customers actually end up recruiting providers to the Redox network thereby enhancing its power. Similarly, following a sharp slowdown in project activity at the beginning of the pandemic (when almost 70% of projects were put on hold or canceled) ensuing layoffs precipitated Redox to form specialized verticals focused on growth areas such as remote patient monitoring, telehealth, labs and diagnostics all of which are projected to do quite well coming out of the pandemic. Implications: The ability to exchange information and turn it into timely, usable, and actionable data will probably be the single most important issue in controlling healthcare costs and improving the delivery of healthcare over the next decade and beyond. As demonstrated by the COVID pandemic, in a hyper-connected world, disease and pathogens can spread across the globe in the course of a few plane trips. As a result, the need to track, trace and type people and goods that may harbor pathogens will be dependent upon our ability to gather and share quality data. On a more local level, data will power earlier/improved diagnostics and risk-stratification needed for improved population health, comparative effectiveness, and attribution for value-based care as well as the user analytics and recommendation engines that will power consumer health apps. Healthcare has tremendous amounts of data but it is difficult to get to, often siloed off, and even harder to share. Solutions from standards bodies like FHIR and HL7 as well as private market solutions like Redox and others are necessary to break the logjam to free up data intelligence and make healthcare more responsive and adaptive to the demands of the market. Let us help you: Analyze how your core competencies match up with unmet needs in the market Develop a targeted pilot project strategically designed to match your domain expertise with pre-identified prospects Establish a continuous feedback loop from early wins to build a growth flywheel and scale your solution This Startup Raised $45 Million To Connect Healthcare Data In The Cloud & Healthcare Strategy Bullpen Interview Niko Skievaski, President Redox, 3/10/21

Enhancing Telemedicine Can Close The Infant and Maternal Mortality Gap Our Take: Increasing implementation of telemedicine in women’s pregnancy care has not only helped women during the COVID-19 pandemic but will also improve overall lagging maternal and infant morbidity and mortality rates in the U.S. According to the Commonwealth Fund, the U.S. maternal mortality rate is 17.4 per 100,000 pregnancies, ranking the U.S. last overall amongst industrialized countries. According to the CDC in 2018, the infant mortality rate was 5.7 deaths per 1,000 live births. This is especially important for minority women, who according to the CDC, are two to three times more likely to die from pregnancy related causes than White women and are also at a higher risk for hospitalization due to the Coronavirus. Increased adoption of telemedicine technology for prenatal and maternal care will help women and children of lower socioeconomic status who often lack access to healthcare services due to location, healthcare coverage, and other barriers. Some of the services offered via telemedicine include; video-conference routine visits, at home monitoring for at risk conditions like diabetes and hypertension, and phone/video consultation with specialists (high-risk obstetricians, lactation consultations, mental healthcare providers, etc.). The addition of this resource is a significant asset to maternal health and should contribute to the improvement in maternal and infant morbidity, specifically in the United States. Description: For many years, the United States has lagged other high-income countries in infant mortality statistics due to poor access to prenatal care, chronic disease, and cost barriers to healthcare access, particularly in underresourced communities. Increased use of virtual care in women’s health during COVID has exposed new avenues to deploy healthtech to increase women’s access to care. According to the Kaiser Family Foundation (KFF), routine pregnancies typically require 14 in person clinician visits when factoring in ultrasounds, lab tests, and vaccinations. For other periodic follow ups, patients in eligible states are given instructions and supplies to monitor the fetuses blood pressure, weight, fetal heart rate, and fundal height at home. These devices help maintain continuity of care with patient’s OB providers, while allowing patients to remain in their homes. According to a recent article by A. Bartley Britt, Chief Medical Officer of Fierce Healthcare, the maternal mortality crisis reflects an American healthcare system where comprehensive care is fragmented, face to face time with providers is short, and long-term care relationships are nonexistent. This prevents OBGYNs from developing the collaborative relationships with their patient’s primary care providers in a way that would help to understand their maternal health in a more comprehensive manner. By contrast, healthtech can overcome some of these problems by facilitating direct communication with providers. By giving patients the ability to message nurses and peers through available online platforms and downloading apps that provide pregnancy education, appointment reminders, and assist with insurance benefits and coverage information. All of these services help better educate patients and strengthen trust between them and their clinical teams. For example, according to the article, a study was conducted on the Due Date Plus app, a platform created by Wyoming Medicaid patients for direct nursing support. The study of 85 app users compared to 5000 nonusers found using phone applications was associated with lower risk of delivering a low-birth-weight infant and higher likelihood of completing prenatal care appointments. Telemedicine also fills a vital void for patients who need to travel long distances to receive care. In many rural communities, there is a shortage in healthcare specialists, particularly maternal-fetal medicine doctors, putting women experiencing high risk pregnancies at a severe disadvantage. With telemedicine, these patients have the ability to video conference with specialists, be evaluated remotely, and receive customized care management plans if necessary. These technologies also permit specialists to review ultrasound imaging performed by technicians conducting an exam on a patient in a remote location. Postpartum care is another key service offered. Typically, patients wait 6 weeks before their in-person postpartum doctor’s visits and up to 40% of women do not attend these visits at all. Fortunately, through the introduction of telehealth platforms, patients have access to app-based support, virtual communication with their providers, at home blood pressure monitoring, and can see a nurse practitioner at 1-week post-partum if enrolled in a program called MultiCare. The Medical University of South Carolina even offers behavioral health telemedicine visits for pregnant/postpartum patients in the area and the service accepts most insurance plans. Lastly, tele lactation services are offered for mother’s experiencing breastfeeding difficulties as well. Implications: The integration of women’s pregnancy resources onto telehealth platforms will greatly improve maternal and infant mortality outcomes. Although these resources are not as broadly deployed as they could be at this time, the lower costs and improved outcomes demonstrated by the technology should drive adoption going forward. In general these technologies help reduce the time and expense of travel and enable families to continue to tend to their other responsibilities without the inconvenience and cost associated with frequent visits. This should positively impact compliance as these are among patients major complaints when having to attend frequent doctor’s visits during pregnancy. In addition, as demonstrated during this pandemic, telemedicine also allows patients to have access to their physicians without having to put themselves at risk in healthcare facilities which can be pivotal for this high-risk population which must lower exposure risks. Instead of missing appointments or risking exposure, expecting mothers have access to their OBGYN’s from the comfort of their homes. As noted this is especially important for minority women, who are significantly more likely to die from pregnancy related causes than White women and who are at a higher risk for hospitalization due to the Coronavirus. Nevertheless, as noted in an article from the Kaiser Family Foundation entitled, Telemedicine and Pregnancy Care, while telemedicine access for maternal care is valuable many who need it still face limitations including: 1) Not having access to devices to connect their home to clinicians for monitoring due to high out of pocket cost, 2) Lack of reimbursement for telemedicine during pregnancy despite the ACA and Medicaid expansion programs that cover maternity costs, 3) Lack of coverage for pregnancy telemedicine services under private insurance plans without showing medical necessity, 4) Lack of internet access in certain low income and rural areas, 5) Lack of adoption in many struggling states. Clearly these issues need to be addressed if healthtech is to achieve its potential in improving maternal and infant mortality in the U.S. The technologies are not only useful in addressing rural-urban health disparities, but also improve access to specialists and mental health providers, enable home monitoring and improve the flow of communication between patients and their providers Telemedicine and Pregnancy Care; Maternal Mortality in the United States: A Primer ; Maternal & Infant Health, CDC Incorporating Digital Health Literacy as a Social Determinant of Health Event: Healthcare IT News recently reported on the importance of empowering patients with digital health literacy in order to allow them to take control of their own health data and close the digital health equity gap. During the event, Dr. Jorge Rodriguez, a health technology researcher and hospitalist at Brigham and Women’s Hospital, classified digital health literacy as a social determinant of health. Dr. Rodriguez along with other panelists, outlined five main facets that should be addressed when considering digital health equity: tech access, tech literacy, implementation, payment, and standard of care. A few recommendations were also given that can bring equity to patient-facing digital health tools. Description: The report reviewed the WEDI Quest for Health event, presented by the Workgroup for Electronic Data Interchange (WEDI) which investigated and showcased the significance data interoperability has to help eliminate healthcare disparities in the U.S. During the event a number of the speakers highlighted that the U.S. Department of Health and Human Services' recent finalizing of rules around the 21st Century Cures Act has highlighted questions about patients' ability to take control of their own health data. According to speakers at the event, not everyone has the same knowledge and level of self-determination to access digital healthcare. The article highlighted that approximately 21 million people in the U.S. lack broadband access or a physical device to seek digital health services. Rodriguez and his co-panelist, Dr. David Bates, General Internal Medicine Division Chief at Brigham & Women’s, stated that the five main facets that should be addressed when considering digital health equity are: tech access, tech literacy, implementation, payment, and standard of care. Dr. Rodriguez also made additional recommendations around ways to bring equity to patient-facing digital health tools. Those recommendations include: Classifying digital health literacy as a social determinant of health. Dr. Rodriguez advised providers and vendors to develop linguistically and culturally tailored digital health tools to engage diverse populations. Invest in patient portals and apps that address the needs of underserved populations. Track digital health access and usage across sociodemographics. Focus on patient training in the deployment of new technologies to account for varied digital literacy levels. Develop workflows that allow clinical teams to engage with diverse patients across digital health platforms. Clinical teams should offer all patients access to digital tools and encourage them to use those tools as part of standard care. Implications: According to speakers at the WEDI Quest for Health event, “digital health equity is essential for our success and the sustainability of digital health overall.” The novel Coronavirus crisis has highlighted the disparities and digital divide that continues to exist in accessing digital health. In addition, studies have shown that minority patients routinely receive inferior care because they may be bouncing between hospitals and clinics and also have higher rates of chronic illnesses like diabetes and hypertension, which research indicates can be better addressed by digital technologies. Having access to digital technology can empower consumers to make better-informed decisions about their health, provide new options for facilitating prevention, and manage chronic conditions outside of traditional health care settings. Addressing digital health literacy as a social determinant of health can bridge the gap in digital health within both rural and urban settings. Moreover, providing digital literacy to consumers will offer new ways to engage and serve medically complex and low-income populations that are often not well tracked by the healthcare system. This can significantly impact patient care and improve outcomes. Digital Health Literacy as a Social Determinant of Health Equity and Artificial Intelligence in Surgical Care Event: On February 24th the Journal of the American Medical Association (JAMA) published an opinion article about equity in the use of artificial intelligence (AI) for surgical care. The article reviews the disparities in surgical procedures and how AI holds the potential to both reduce and exacerbate disparities depending upon how it is used. Description: The use of AI in surgical care can exacerbate existing disparities if they are incorporated into models without discretion. For example, AI algorithms are trained and modeled on data sets, so if a data set which is used to train and perfect the model is biased then the resulting AI will be biased. AI models can legitimately incorporate racial composition of a sample population for an AI model, however, since racial composition may vary drastically from between geographic areas, the resulting AI could result in decisions that aren’t universally applicable. Similarly, if physician notes and their underlying experiences are input to the AI, any implicit bias from the physician's background and experience could be inadvertently incorporated into the AI. The authors note several studies referenced demonstrate bias in physician judgment across multiple demographic factors including, race, gender, and insurance type. This could introduce bias by including while potentially introducing inaccuracies into the models by intentionally excluding them. The authors conclude that for racial and ethnic data to be included in training and recommendation engines underlying AI they must be able to demonstrate causality. Interestingly the report also illustrates that while AI can exacerbate disparities, AI also holds the potential to counteract disparities in care if applied correctly. For example, in surgical settings, clinicians are often required to make high-stakes decisions virtually instantaneously. As a result, when faced with making a decision without sufficient time to assess a situation and thoroughly examine the factors before them, research in behavioral psychology has shown that humans will rely on prior knowledge and heuristics -psychological shortcuts formed from similar prior experiences. Unfortunately, this research has also established that such heuristics are also affected by bias. Consequently, AI models ability to rapidly incorporate large amounts of data could counter the bias in heuristic-based human inference and lead to more equitable decisions. Along these same lines, models that can incorporate representative data on patient-centered outcomes, such as those which integrate data around racial disparities in surgical procedure survival rates, can empower physicians with the ability to make more informed decisions with less bias. Implications: AI will likely be implemented in surgical care settings in the future at an increasing pace. It is essential that people applying any new procedures, technologies, and policies in health care keep the impact on equity in mind. As the article illustrates, there is evidence that disparities in surgical care exist and there is the opportunity to reduce their prevalence and magnitude using AI tools. However, if AI models are not examined, both pre and post development and their conclusions do not align with clinical intuition, the application of AI could result in unwanted results. In particular, poor application of AI could result in the worsening of already disparate allocation and outcomes of surgical care among differing ethnic and racial populations. As a result, data scientists and clinicians must undertake a coordinated effort to ensure the equity concerns are addressed when designing, training and testing such models. Equity and Artificial Intelligence in Surgical Care Going Digital with Healthcare Payments Will Improve Customer Experience Event: A recent article in MobiHealthNews presented three strategies for how organizations could keep up with the pace of digital transformation from Stuart Hanson who leads the Corporate Treasury Consulting and Healthcare Solutioning groups for J.P. Morgan (and a former chair of several HIMSS task forces). Mr. Hanson also provided innovative ideas to illustrate the strategies he recommends. Description: The COVID-19 pandemic reinforced the shift to more modern digital payment systems in the healthcare sector. Organizations have sought ways to deepen EHR integration to share patient healthcare data seamlessly across different platforms. The sudden shift to digital systems during COVID has accelerated the pace of change and forced organizations to consider longer-term strategies as patients are now expecting greater innovation. As consumers embrace greater use of clinical digital health technologies, these same organizations must adopt more innovative business strategies to keep up with consumer needs. According to Hanson, three strategies to keep in mind include: 1. Embracing digital patient engagement by prioritizing consumer-centric solutions that improve the patient experience. Hanson recommended creating a digital front door across all patient engagement points, providing easier access points like online self-scheduling, mobile pre-registration and check-in and electronic payments to name a few. 2. Expanding touchless and reduced-touch efforts by frequently disinfecting high-touch surfaces and limiting direct contact with shared surfaces for patients and employees. According to Hanson, touchless strategies can also extend outside of physical surroundings. For example, providers should take inventory on how many solutions and vendors are tied to financial transactions, and where possible reduce this number. 3. Focusing more on cybersecurity by having more robust controls and security measures that reduce the risk from ransomware attacks against payers, providers, and patients and protect PHI. Hanson recommended ensuring correct implementation of cybersecurity platforms that employ artificial intelligence, machine learning, and predictive analytics to help healthcare providers add additional security controls to protect critical data and secure payments. All three of the above strategies are a reflection of the increased use of digital technologies in healthcare and illustrate the need for innovative ideas that organizations can and should implement to keep up with the trend. Implications: Healthcare has long been viewed as ripe for digital innovation as demonstrated by rapid adoption and progression of telehealth with the onset of the pandemic. COVID-19 presented many challenges to the healthcare sector, such as adapting to new digital solutions, applying technology in innovative ways to keep people out of harm’s way and remain in positions to support additional growth. However, organizations may find it challenging to continue to embrace digitization due to concerns around continued sustainability of adoption and the need to invest in competing priorities for capital resulting from the financial toll of COVID on procedure volumes and margins. In addition, organizations have also been reticent to invest in new technology as consumers or partners have long been slow to adopt it in healthcare. Nevertheless, Hanson recommends that organizations must evolve with patient experience to meet the changing needs in an increasingly digital world by developing a consumer-centric healthcare landscape. While typically slow to adapt to technological change, the recent barrage of change in healthcare will not only create new opportunities to solve long-standing problems but it will also offer the opportunity to deliver new experiences that meet the expectations of today’s digitally native consumers. What Payers, Providers, and Patients can Gain from Going Digital with Healthcare Payments Video Telemedicine Usage Spikes Disproportionately for Higher Income and Higher-Educated Event: On March 4th Rock Health’s published it’s Digital Health Consumer Adoption Survey which revealed an increase in telehealth utilization and wearable usage. While the report revealed the increase in utilization was higher among the high earners (85% of responders earned a salary of over $150,000) and higher educated (86% with a graduate degree or higher) population there was a large drop in usage based on income or education. For example, only 65% of those with incomes between $35K-$75K and only 63% of those with incomes below $35K used telemedicine, while only about 60% or less with some college or no college used telemedicine. Description: Early on during the pandemic, telemedicine usage among patients fell with 60% fewer visits compared to the same period (March) of the previous year. However, as the pandemic took a peak, the uptick in live video telemedicine use rose from 32% in 2019 to 43% in 2020. The demographics using telehealth services were seen among those who were high earners and those with chronic conditions (78%) as opposed to those without a chronic condition (58%). The report also looked at telemedicine use by a number of demographic factors including age, sex, income, education, geography, as well as racial and ethnic groups. In terms of age, the report found that those 35-54 were most likely to use telemedicine while those 55 and older were least likely to use telemedicine, reporting a drop in utilization down to 59% (vs. 71% in 2020). In terms of sex, the report found that 74% of men were likely to use telemedicine, compared to only 66% of women, a drop of almost 11% points in utilization for women. Among income levels, as noted above, those earning $150K or more reported a utilization rate of 86% compared to 65% or less for all other groups. By education, those with a postgraduate degree or more reported utilization rates of almost 90% while utilization levels dropped to just under 70% for those with a bachelors or associates degree and approximately 60% or less for those who with no college degree or less. In terms of geographic differences in adoption, utilization was highest for those in urban areas, reaching almost 80% while dropping to just 60% for those in rural areas. Interestingly, Rock Health did not note a dramatic difference in adoption across different racial and ethnic groups but noted that a number of studies have noted different conclusions. We continue to believe there are significant differences by racial and ethnic groups (please see our blog post “Access to Telemedicine Is Hardest for Those Who Need It Most” link here) and "Health Inequalities in the Use of Telehealth in the United States in the Lens of COVID-19" (link below). Implications: The Rock Health Consumer Adoption survey found that telehealth users were heavily concentrated among the higher income brackets and among the educated, continuing a trend witnessed before the pandemic. However, given the increase in access that telehealth promotes (by eliminating commute time and the need to take leave from work) as well as the opportunity it provides for consumers to be active participants in managing their own health via wearable devices, remote monitoring, digital health broadening this access should be promoted. Increasing availability and ease of use of telemedicine would ensure that patients of all demographic groups are made aware of the benefits of this growing trend. The disparities in usage should be identified, and digital health innovators need to keep iterating and leaning in to uncover areas where adoption doesn’t match the potential for growth. Health care organizations need to reinforce and encourage making telehealth affordable, accessible to all and build confidence for consumers to want to utilize it. The regulatory reforms implemented during the pandemic last year, brought positive responses to the use of technology. Assuming many of these reforms can be made permanent or at least less challenging to implement, telehealth utilization would be more accessible to the general population and less disparities would be seen. In addition, with the cross-state licensure still in place, this platform also has the potential to give patients in underserved areas the ability to gain access to the best care across the nation at greater convenience and lower cost. Rock Health Digital Health Consumer Adoption Report 2020 & Health Inequalities in the Use of Telehealth in the United States in the Lens of COVID-19

Event: Venture Beat reported that Medisafe, “a personalized medication management platform to help patients stay on top of their prescriptions”, announced it had raised $30 million.” According to Medisafe it uses “digital drug companions” to improve medication adherence and compliance for patients. VentureBeat noted 20%-30% of prescriptions are never even filled costing the U.S. healthcare system approximately $100 billion to $300 billion per year. Description: Medisafe was founded in 2012, and has raised approximately $52 million, including this round. The company has operations in Boston, Israel and London, with 50 employees and revenue of several million dollars. As noted by VentureBeat, once a patient enters their medication into Medisafe’s smartphone app, it guides them through a process to collect patient release forms and help them with drug titration schedules. Once entered into the app, Medisafe’s “Just-in-Time-Interventions” (JITI) applies its artificial intelligence algorithm to: 1) help patients administer medication, 2) evaluate whether they qualify for financial support programs, 3) assist with refill ordering, and, 4) collect information for providers via surveys. Medisafe claims that its analytics and real-time behavioral assessments can boost adherence by up to 20% and that the technology drives average adherence rates of almost 90%, compared to an industry average of approximately 50%. Medisafe competes with the MyTherapy app by Apotheke of the Netherlands, Walmart’s Care Zone, Healthprize and ZappRx among others. Implications: Medication adherence and compliance have long been a significant problem for patients, often leading to ineffective treatment and poor outcomes. Services like Medisafe’s in-app Care Connector feature, create a convenient way to facilitate communication between patients and doctors around concerns or issues with their medications that may ultimately lead them to discontinue use. Not only does this help patients maintain their medication schedules, it also allows physicians to be alerted to issues, some of which are easily addressed, that without intervention may lead to non-compliance (ex: patients inability to tolerate medication or side effects). In addition, when platforms contain additional features like Medisafe’s Maestro which provides information on patient census, program reporting and integrations with pharmaceutical company data, additional insights are gained and improve the effective prescribing and post-approval surveillance of medications. However, they must always be implemented with strict safeguards to ensure this isn’t abused for marketing purposes. Mobile medical apps like Medisafe as well as medtech tools such as smart pill bottles, smart packaging systems, smart pill dispensers and even smart pills have the potential to greatly improve compliance at low cost all while supplying practitioners and researchers with real-time data on usage patterns. Medisafe Raises $30 Million for Predictive AI That Reminds People to Take Their Pills & Medisafe Raises $30 Million in Series C Led by Pharma Giant Sanofi Editors Note: Beginning this week, each Friday we are going to profile a healthtech prospect, an interesting, up-and-coming healthtech company. This is not an endorsement, nor are we getting compensated for the profiles. Instead, we want to highlight an intriguing company that may have caught our eye due to the friction it eliminates, the space it's in, or the ingenuity of its solution, etc.