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  • Drinking During Virtual Visits?, Hospital Cyber Threats, Fitbit's Digital Plans-The HSB Blog 11/3/20

    Patients Report Scrolling on Social Media, Exercising and Drinking During Virtual Doctor Appointments Event: On October 28th, an article in Mobihealthnews reported that patients admit to often being distracted during virtual doctor appointments, with as many as 24% reporting multitasking during the visit. The article noted that new research from DrFirst showed the most common distractions were surfing the web, checking emails, or texting. Description: Virtual doctors’ appointments have given patients the ability to consult with healthcare providers at their convenience. DrFirst surveyed 1,000 consumers nationally ages 18 and up in June of 2020. Of those surveyed, 73% of men and 39% of women said they had been distracted during a telehealth visit, and more than 24% of respondents admitted they had been distracted by things such as watching TV (24%), checking social media (21%), eating (21%), playing video games (10%), working out (18%) and even drinking (9%), The survey asked patients how telehealth can be improved, and responses indicated there could be higher-quality video, texting doctors before the appointment with any questions, the option to see their personal physician for telehealth visits and more user-friendly technology. Implications: While research from Massachusetts General Hospital suggests that “virtual visits are just as effective as in-person visits.” Empirical survey research like the above challenge that assumption, especially when it indicates that patients are distracted and not fully engaged with their healthcare providers. In addition, although telehealth usage has increased dramatically with 22% of consumers indicating they have had a virtual visit in 2020 (up from 8% in 2019) and 80% of physicians reporting they have had a virtual visit in 2020 (up from 22% in 2019) quantity and quality are not the same. Although telehealth has made dramatice strides in 2020, when patients are multitasking and inattentive, they are less proactive about their health, potentially leading to lower quality care and poorer health outcomes. Patients Report Scrolling on Social Media, Exercising and Drinking During Virtual Doctor Appointments FBI, HHS Warn of "Increased and Imminent' Cyber Threat to Hospitals Event: On October 29th, Healthcare IT News reported that the FBI and HHS had issued a joint alert warning of ‘increased and imminent’ cyber threat aimed at healthcare providers and public health agencies via ransomware. The warning suggested hospitals, practices and public health organizations take "timely and reasonable precautions to protect their networks from these threats" – which they said include targeting with Trickbot malware, "often leading to ransomware attacks, data theft, and the disruption of healthcare services. Description: The alert sent by the Cybersecurity and Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI), and the U.S.Department of Health and Human Services (HHS) state that malicious cyber actors indicated their desire to infect systems with Ryuk ransomware (responsible for 75% of attacks) at more than 400 healthcare facilities for financial gain thus, suggesting timely and reasonable precautions to be taken against these threats. The illegal cyber activities include credential harvesting, mail exfiltration, crypto mining, point-of-sale data exfiltration, and the deployment of Ryuk ransomware. The agencies advise patching operating software, changing passwords regularly, multifactorial authentication, disabling remote desktop assistance, and configuration check to prevent issues. These attacks have recently affected hospitals in upstate New York causing system failures. UNC1878 has disrupted hospitals throughout the U.S. with ransomware, forcing them to divert patients to other healthcare providers as the hospital networks go offline. Implications: With Ransomware attacks on the healthcare system not only threaten the security of the institution in terms of medical data, but it will prolong patients' wait time to receive critical care as a result of hospital networks being taken offline. This could be especially troublesome with COVID cases on the rise. While these threats are still ongoing, hospitals and healthcare organizations need to take up precautionary recommendations suggested by CISA, FBI, and HHS in a timely manner and secure their systems. The warning also noted that the perpetrators were often demanding ransom payments both to preserve the data that had been compromised and a second ransom to decrypt it. Attacks such as these demonstrate the continued increase in risk of health data as a cyber target as well as the need for vigilance against multiple types of threats going forward. FBI, HHS warn of 'Increased and Imminent' Cyber Threat to Hospitals Fitbit CEO Hints at Company's Telemedicine Plans Event: A recent article in TechSpot reviewed an interview Fitbit CEO James Park gave to the Wall Street Journal where he discussed Fitbit’s strategy in wearables and telemedicine as it pursues its merger with Google, noting that Fitbit’s premium health and fitness service already has over 500K users worldwide. The article noted that although the company has experienced some hardship it has managed to remain among the top five wearable makers worldwide and hopes to have a more significant impact on healthcare with the addition of new software and services. Description: One of the first developers of wearable technology, Fitbit has generally been focused around health and fitness, agreeing in 2019 to be bought by Google (the purchase still needs regulatory approvals). While Fitbit had expected demand for its devices to decline during COVID lockdowns, the company has noticed that business is doing better than expected and users remain connected to their devices and software services. In addition, earlier in 2020 Fitbit released results of a study with the Stanford Medicine Healthcare Innovations Lab and Scripps Research Translational Institute that validated an algorithm Fitibit had developed for the successful detection of COVID prior to the onset of symptoms. The company is doing additional research and is expected to seek regulatory approval for the device. Implications: Upon completion of its merger with Google, Fitbit will have a solid and loyal user base combined with a generous balance sheet to continue to pursue innovations within health and fitness. In addition, aligned under the Google umbrella along with its other consumer brands such as Nest, and YouTube, Fitbit has the potential to leverage its consumer reputation along with its future parents to tap into the growth of telemedicine. However, given several data privacy miscues by Google, Fitbit will have to provide solid reassurances about data privacy in order to convince consumers to invest in tools like a connected thermometer and an otoscope with confidence. Fitbit CEO Hints at Company's Telemedicine Plans & Fitbit CEO Reveals the Company's Plan to Conquer Fitness Wearables and Telemedicine Nutrium App, which links Dietitians and Patients, Raises $4.9M Led by Indico Capital Event: In a recent article, Tech Crunch noted that Nutrium, a digital health startup which links dieticians and patients via an app had raised $4.9m. According to the article Nutrium now offers professional nutrition software to 80,000 nutrition professionals and 800,000 patients in more than 40 countries. Description: Nutrium gives patients integrated nutrition counseling which combines professional advice, continuous monitoring, nutritional analysis, meal planning and access to commercial products all in one place. This app brings together nutritionists, patients, products and wellness data to enable healthier and happier lives. With this investment round, Nutrium plans to double the team size in the next 24 months in order to focus on platform development and expand global sales in markets like Spain, France, Italy, the U.S. and the U.K., where the company already has a strong customer base. Implications: A healthy diet throughout life supports normal growth, development and aging, helps to maintain a healthy body weight, promotes healthy pregnancy outcomes and reduces the risk of chronic disease leading to overall health and well-being. This app, and others like it, which give the user critical tools for a healthy diet could be an essential part of maintaining a healthy lifestyle. In addition, poor diet and nutrition levels, particularly earlier in life have been linked to slower educational and emotional development in children which can often plague them later in life. Apps such as Nutrium, which expand access to easy and convenient nutritional counseling can help increase healthy lifestyles, particularly in underserved communities. Nutrium App, which links Dietitians and Patients, Raises $4.9M Led by Indico Capital Fitness Wearable Whoop Joins the Unicorn Club with $1.2B Valuation Event: MobiHealth News reports that the fitness wearable Whoop announced a $1.2 billion valuation following its $100 million in Series E Funding. Unlike many other fitness wearables, Whoop is available via a subscription service and measures sleep performance and heart rate variability, which is part of the information used to calculate a proprietary active recovery score called the Whoop recovery score. Description: The WHOOP Strap 3.0 collects 24/7 physiological data including sleep, fitness and recovery to provide the most accurate and granular understanding of your body. That data is then sent to a corresponding app, which can give users insights about their training and recovery. WHOOP Strap 3.0 also comes along with personalized coaching. The app will provide users with sleep recommendations and can measure the stress someone has over a 24-hour period. It's lightweight, waterproof, and features the new and improved 5-day battery life and bluetooth low energy connect. Implications: Wearable device tech companies are growing, from Apple Watch, to Fitbit, to Amazon to now Whoop. Whoop uses its data to provide personalized coaching on sleep and stress as well as the amount of sleep and recovery a body needs from certain activities. Exercise technology which incorporates body feedback can be used not only to improve athletic performance but also to monitor and react to certain disease states. As a result, this will likely accelerate the pace of change in the traditional patient-doctor relationship due to the influence medical wearables have given their ability to automate processes, expedite diagnosis and treatment and allow people to monitor their own health. Fitness Wearable Whoop Joins the Unicorn Club with $1.2B Valuation Cross-border Collaborations Lead to Data Sharing Efforts During COVID-19 Event: A recent article in Mobihealthnews highlighted lessons learned from panelists who attended the World Health Summit, centered around the importance of global collaboration and data sharing during a pandemic. Among the conclusions noted was that in taking on a pandemic, “global collaboration and data sharing are key”. The panel also highlighted the importance of digital technology as the world tries to understand, manage, and overcome the impacts of the disease. Description: The World Health Summit was held virtually October 25th-27th, with this year’s topic naturally being current knowledge about Coronavirus,new strategies in the worldwide fight against pandemics and the role of Europe and the WHO in global health. During the presentations, panelists noted, “in a pandemic there is no sense in having solutions which apply only within our national borders. You have to have solutions that work around the world because people are moving all the time." The panel also pointed out how digital solutions have become seamlessly crucial as the world continues to overcome COVID-19. Including the new European Union (EU) interoperability gateway system, which connects contact tracing and warning apps amongst participating EU countries. The system would notify a person of the possible risk of infection if they were around someone who was infected, regardless of their location [if participating]. While COVID is the Summit’s current focus, the article noted that participants were also joining forces to look ahead at pandemics of the future, including the UK’s Trinity Challenge. Implications: The Summit clearly highlighted that “digital collaboration underpins the coordinated systematic approach we need to strengthen health systems and our healthcare.” However, panelists remained mindful of the need for data security, with the article pointing out that while the applications for digital are increasing, protecting patient privacy should still be front and center. Participants also concluded that although collaborating globally and accelerating interoperability, has the potential to improve response to future disasters, “the use of data and analytics in global public health, particularly the use of non-health data is not as good as it needs to be and varies across countries”. This clearly indicates the potential for strides to be made in all countries on the issue of social determinants of health data and solutions. Cross-border Collaborations Lead to Data Sharing Efforts During COVID-19

  • FDA & Adaptive AI, Systems Plan for New Digital Pay Rates, VNAs for Imaging-The HSB Blog 10/27/20

    FDA Patient Engagement Advisory Committee (PEAC) Meeting on Adaptive AI and ML Event: (10/22) On October 22nd, the FDA Patient Engagement Advisory Committee (PEAC) held a meeting to discuss complex issues surrounding Artificial Intelligence (AI) and Machine Learning in Medical Devices. Attendees included several patients, companies, clinicians, and other high-level leaders. The meeting was centered on issues around the medical devices, its regulation, and usage by patients, in addition to their concerns on data privacy and transparency. The committee made recommendations on improving AI and machine learning in medical devices by giving careful consideration to datasets and how it can be used to train and improve algorithms. Adaptive AI presents new challenges for patients, companies, and regulators regarding informed consent, considering where the device would learn algorithms, use algorithms to improve decision-making, and make advanced improvements moving forward. Description: AI technology will be used to improve diagnosis and make recommendations for a course of treatment. Using adaptive AI will allow machines to learn more freely and improve what it learns from each sequence it is running. For future AI models to be successful, there must be a diverse representation in the intended patient population's data. Diverse and unbiased patient cohorts will allow for less biased data and remove clinical variables that lead to AI devices' mistakes. When data is not present for certain groups in a population, AI researchers cannot study them and find ways to combat societal issues. Incorporating and collaborating with patients in the creation of AI technologies will provide transparency and confidence in the products; however, many barriers exist even after a product makes it to market because criteria can change over the device's life. Adaptive AI makes decisions dependent on the life it sees out there – an apparent reason why it must be regulated because devices should differentiate between good and bad decisions to ensure safe outcomes. The committee struggled with a decision on how to explain the challenges of how explainability and transparency in AI models can be presented to patients. Implications: Large clinical datasets can be used to train and improve AI algorithms, leading to immense improvements in AI-based systems that diagnose as well as those that determine treatment protocols and actually treat patients. AI technologies will change clinician workflow and ensure continuous safety and efficacy in delivering ongoing quality care to patients.However, because ML algorithms can “learn” and “change” over time, medical diagnoses and treatment can change as adaptive AI models change as well, raising ethical concerns around transparency and informed consent. In addition, adaptive AI models also suffer from the shortcoming of biased training sets and under representation of underserved communities. As a result, patients and regulators need the ability to understand and examine models too so that the risks and consequences of any changes to treatment protocols due to improvements in the models can be assessed. In addition, the committee appeared to strongly imply that new informed consent releases would be required when changes to AI algorithms make meaningful changes in treatment or diagnosis protocols. FDA Patient Engagement Advisory Committee (PEAC) Meeting [YouTube Video] After COVID-19 Spurred a Boom in Telehealth, Systems Mull How to Sustain Momentum Event: (10/20) Healthcare Dive recently published an article highlighting the Center for Connected Medicine/Klas Research’s 4th Annual “Top of Mind for Top Health Systems Report”. Among other things the report looked at trends in telehealth reimbursement post-COVID and health system’s potential responses. Description: When the pandemic began both commercial and government insurers waived numerous rules and regulations to increase access to telehealth including waiving co-pays for telehealth visits and equalizing reimbursement for in-office and telehealth visits. While the Federal and State regulators continue to explore which rules to make permanent (for Medicare and Medicaid beneficiaries), some private insurers have recently changed some rules (including the waiver of patient co-pays) for telehealth visits. This survey of 117 executives at 112 provider organizations gave some insight into how provider organizations were planning to respond depending on how these changes settle out. Implications: As noted by Healthcare Dive “a lot of how much [providers] are going to invest in technology is going to have to have to do with what regulations end up looking like.” Since the regulations will to a large extent dictate reimbursement (which were approximately 30% lower for telehealth prior to COVID), despite the recent uptick in volumes, profitability will drive continued usage. For example, over 30% of respondents to the study noted that they were unsure of what they would do if reimbursement returned to prior levels, while 20% said they would continue providing telehealth services and 16% said they would analyze the continued viability of continued use. Moreover, it looks like payment and regulation will be top of mind for the foreseeable future with 25% or respondents noting that payment models and regulation were the top areas for future telehealth improvement. How [Vendor Neutral Archives] VNAs can Address the Challenge of Data Accessibility and Analysis How [Vendor Neutral Archives] VNAs Can Address the Challenge of Data Accessibility and Analysis Event: (10/19) A recent article in Mobihealthnews noted that if healthcare providers had more accessibility to aggregated data, it would be easier to combat difficulties such as reducing clinician burnout, improving efficiency, and increasing patient satisfaction. Vendor Neutral Archives (VNAs) can drive better outcomes by enabling data to be provided as a source of AI, business intelligence, or to deliver clinical information and insights. Description: A recent survey conducted by McKinsey & Company found that data integration and analytics is one of the major trends reshaping imaging services and influencing the future of healthcare. VNAs which allow access to data from any vendor system in multiple formats, improving workflow and reducing the time taken to complete different stages of an imaging exam will enable data to use artificial intelligence to provide decision-making support. This is an essential component in connecting existing systems to open platforms and specialists with patients. VNAs will eliminate the need to switch between systems or wait for data to arrive from other sites because prompt access will be given to correct data from any location in the network. Implications: The world and healthcare in particular is in the middle of a data explosion. The amount of healthcare data collected is currently projected to double every 73 days compared to 2010 when it was said to be doubling every three and a half years. As a result, healthcare costs have been growing faster than expected, and payers are looking to more sophisticated technology to improve the management of costs. Data integration and analytics to realize the value of data have become more crucial for healthcare delivery. Using VNAs will improve clinician workflow, financial, and operational performance of departments and organizations, reduce clinician demand, lower costs, and provide better patient outcomes. How [Vendor Neutral Archives] VNAs can Address the Challenge of Data Accessibility and Analysis CDC's 'Virtual Human' Relays Prostate Cancer Info Through Candid Conversations Event: (10/19) Mobihealth News recently published an article that the CDC launched a prostate cancer information program with a uniquely digital face: a "virtual human" named Nathan who speaks with men about screening and treatment. The CDC noted that the tool can help increase screening since “the decision to be screened and treated for prostate cancer can be overwhelming and complicated” … “some of this is driven by discomfort and long-identified stigma” with a prior examination protocol. Description: "Talk to Someone About Prostate Cancer" takes the form of an in-browser interactive video developed by health simulation company Kognito. In the video, Nathan introduces himself and prompts the viewer by asking how confident they are talking to their provider about prostate cancer screening. Users indicate their response by clicking one of several text responses, prompting a relevant reply, and kicking off a series of question and answer conversation trees. Implications: Prostate cancer is among the most common cancers in American men. Thirteen in 100 men will develop prostate cancer during their lifetime, and two or three will die due to it, according to the CDC. As symptoms vary, there is a high need for men to speak to doctors about whether or not they should undergo screening. Virtual health engagement tools that employ digital avatars can help some patients open up about difficult-to-discuss topics, providing a new way for individuals to become more engaged in their care. The CDC's virtual conversation effort comes after this summer's "Access Initiative for Quitting Tobacco," which combines free nicotine replacement therapies and conversations with a similar digital human named Florence that used a microphone and artificial intelligence to interpret spoken questions. CDC's 'Virtual Human' Relays Prostate Cancer Info Through Candid Conversations COVID-19 Impacts on Cancer Care Event: (10/21) On October 21st, the Journal of Clinical Oncology Clinical Cancer Informatics published an article highlighting the significant drop in cancer screening, diagnosis, and treatment for Medicare beneficiaries. The changes in the utilization of cancer care services is attributed to the decrease in routine healthcare visits brought on by the COVID pandemic.The research was conducted by Avalere, a leading healthcare consulting firm, in collaboration with the Community Oncology Alliance, a non-profit advocating for community oncology practices. Description: The study found that for the period March-July 2010 compared to 2019, there was a significant decrease in cancer screening, biopsies, surgery, office visits, and therapy with variation by cancer type and site service. At the peak of the pandemic in April, screening for breast (-85%), colon (-75%), prostate (-74%) and lung cancer (-56%) were all all significantly lower as indicated. The decrease in diagnosis and delay in care is attributed to the stay at home order to reduce COVID-19 transmission, especially amongst the elderly and immunocompromised. As a result, many healthcare providers accommodated short term adjustments to cancer care delivery, such as temporarily discontinuing non-emergent care screenings, shifting delivery of care to telehealth, and delaying surgeries and other in-office cancer services to reduce transmission risk. Although the stay at home orders were lifted in May and June, utilization of certain oncology services continue to lag, fewer patients are undergoing screening, with many providers and patients choosing to reschedule or completely forego screening, leading to fewer cancer diagnoses. Implications: With the decrease in screenings, diagnosis, and cancer care delivery, researchers found that cancer is likely to present itself at a later stage and require more complex care thus lowering the likelihood that patients will respond and ultimately be cured. To combat this, stakeholders are encouraged to increase awareness of the dangers of medical distancing and regain seniors’ confidence in their ability to safely receive care. Policies and technology to promote access to cancer care have the potential to reduce the projected morbidity and mortality amongst the population. However, further studies need to be conducted to understand the overall impact on different patient populations and potentially take corrective action. COVID-19 Impacts on Cancer Care Researchers Combine AI with EHRs to Improve [COVID] Hospitalization Prediction Event: (10/21) A recent study by researchers at the NYU Grossman School of Medicine has applied AI to EHR (electronic health records) data to predict more accurately good outcomes from COVID-19 treatment. In particular researchers wanted to provide clinicians with actionable information that could be easily integrated into their exister workflows Description: Researchers undertook the study to apply AI to EHR data to help hospitals and doctors more accurately manage patients who had tested positive for COVID. The model analyzed 3000 retrospective cases and developed a model that could identify hospitalized patients likely to have good outcomes with 90% accuracy. In addition, researchers deliberately sought to reduce the number of features and variables used in the model, opting to go with the minimum data requirement needed to make a prediction. Implications: The study predicts outcomes in hospitalized COVID patients with a high degree of accuracy while integrating to current data infrastructure. However, researchers noted the need to remain vigilant when designing AI related tools as there are instances where the physician’s knowledge exceeds that of the machine and must be integrated with the AI output. The researchers also found that to be effective AI learning solutions require two distinct components; 1) addressing a clearly defined use case that clinical leaders will champion and 2) [developing a model that] motivates changes in clinical management, based on model predictions. Researchers Combine AI with EMRs to Improve [COVID] Hosptialization Prediction

  • Deploying Conversational AI, Mental Health Gyms?, Healthcare Leader Disparites-The HSB Blog 10/20/20

    What Did We Learn Implementing...Conversational AI in Healthcare? Event: (10/7) On October 7th, an article was published in Medium regarding Inception Health’s efforts and insight into implementing conversational AI in healthcare. Although the healthcare field may seem ideal for the implementation of AI tools and resources, they encountered several barriers that would present some difficulty in the process. Description: Inception Health (created by the Froedtert & the Medical College of Wisconsin) partners with innovative companies to solve key health care problems, develop new ideas, and scale solutions across their network and beyond. As a result, the organization sought out conversational AI because it seemed to have everything needed to have a positive impact on healthcare practice. Conversational AI is designed to teach computers to answer questions and help guide a person based on prompts. In healthcare, it can enable an enhanced and personalized patient experience and scale data access, transparency, and health literacy. While there are several tools available, the article mentions the challenges that would come with the implementation of this AI tool. This includes the biases associated with using data generated by current healthcare systems and legal restrictions that impact the ability to create these tools. As a result, the authors opted to use open source solutions to help build conversational AI agents (including Parl AI and BERT). Implications: The use of conversational AI has many components and designs that can be used by researchers to improve healthcare disparities, but the legal restrictions and biases have limited the development of medical AI to a few research projects and a few AI startups. While there continues to be a large amount of data generated by healthcare providers, most of it cannot be used for training algorithms and are severely restricted by data privacy and security regulations. While several solutions have been proposed such as developing an open-source healthcare chatbot dataset or using desensitized data to create “fake” patients with realistic health conditions for training algorithms, the data is still difficult to retrieve and additional processes are in place that create barriers. As a result of these issues, deployment of conversational AI in healthcare is not as effective as it could be and it remains behind other industries with similar amounts of data at its disposal. What Did We Learn Implementing GPT-2 and BERT for Conversational AI in Healthcare? Therapy Startup Coa Raises $3M to Launch World's First Gym for Mental Health Event: (10/14) On October 14th, Coa, a platform that offers therapy-led classes and one-on-one therapy, announced it had closed a $3 million seed round of funding. Since March 2020, demand for its workplace curriculum has grown 900% according to the company’s press release. To date, more than 3,500 people have joined Coa's waitlist for the studio launch. Coa aims to build a home for therapy, emotional fitness classes, and a sense of community. Background: Coa offers several services, giving communities a "gym" for mental health. These include emotional fitness classes to teach patients how to treat their mind like a muscle and increase resilience to deal with stress and anxiety. Users can also fill out a short questionnaire to be matched with therapists for one-on-one sessions. Coa also has the ability to partner with employers to provide employees with deep-dive sessions to develop mental health and emotional fitness skills, Q&A sessions about managing anxiety in the workplace, and workshops that follow a "learn, exercise, breakout, discuss" framework built on Coa founder Dr. Emilty Anhalt's research into the 7 Traits of Emotional Fitness. Implications: Coa's educational and emotional fitness services can help users in group or one-on-one environments in the comfort of their own home (and can even influence users to pursue careers in therapy). By partnering with employers, Coa is building an emotional safety net for employees with their companies and giving them additional resources during this difficult time. Once the pandemic is over, Coa can continue to maximize company’s and individuals' emotional well-being through regular classes, workshops, and one-on-one sessions. Therapy Startup Coa Raises $3M to Launch World's First Gym for Mental Health Oliver Wyman Executive says “Men and Women View Leadership Differently, Propelling the Gender Gap in Healthcare” Event: (10/15) A recent article in Mobihealthnews examined the continuous underrepresentation of women in leadership positions within the healthcare sector, despite years of initiatives. The article was a summary of the women in the workplace event at the HLTH VRTL conference. Description: Healthcare has a gender parity issue in terms of leadership positions with women making up only about 24% of executives of Fortune 500 healthcare companies, approximately 37% of hospital executives, and only 14% of digital health deals (defined as closed by female-led startups). Experts have noted that when companies attempt to address gender inequality without meaningful improvement there is usually something unexamined going on beneath the surface. According to many of these experts, the challenge for some women is the inconsistency at a leadership level of what a leader looks and acts like. Research indicates that the definition of leadership skills were often a function of which gender someone was speaking about. For example when leaders were asked about the top 3 leadership traits for both men and women they agreed that the most important leadership trait was confidence. Answers differed sharply on the 2nd and 3rd traits with “direct” and “decisive” cited for males, while “empowering teams” and “being collaborative” were cited for females. This inconsistency in leadership expectations sends a mixed message and makes it difficult for women to understand and demonstrate the appropriate skill sets to advance. Implications: As a result of this dichotomy, while there have been a wave of programs and initiatives at boosting women in leadership roles the results have been mixed at best. This signals that commonly implemented initiatives are not aligned with what experts think are most effective ways to close the gap. Among steps organizations can take are to directly and clearly address and eliminate the differing expectations for men and women in leadership roles. In addition, aspiring women leaders should be paired with sponsors (as opposed to mentors), who use their own political capital and credibility to advocate on these aspiring leader’s behalf. Oliver Wyman Executive says “Men and Women View Leadership Differently, Propelling the Gender Gap in Healthcare” Twentyeight Health Raises $5.1M to Scale Affordable Telemedicine Solution for Women’s Sexual and Reproductive Care Event: (10/15) TechCrunch recently profiled Twentyeight Health, a health tech company expanding access to women's sexual and reproductive healthcare for those on Medicaid or uninsured, which closed $5.1 million in seed funding last week. Background: Twentyeight Health was formed to bring contraceptive care to a population that historically hasn’t had as good access to “quality, dignified and convenient care”. To ensure it is catering to underserved communities the company works with Bottomless Closet, a workforce entry program for women as well as 8 colleges in the City University of New York (CUNY) system where 70% of the students come from families making less than $30K in annual income. The Company’s services are available in FL, MD, NY, NJ, NC and PA and it is the only telemedicine company focused on contraception services to accept Medicaid. Implications: Women who are on Medicaid, who are underinsured or without health insurance often struggle to find access to reproductive health services, and these struggles have only increased with COVID-19 pandemic limiting access to in-person appointments. Where seeking the right sexual health treatment may be overwhelming for women, Twentyeight Health makes this easier. As the company notes, low income women are 3x more likely than average to have an unintended pregnancy and nearly ⅓ of physicians nationwide aren’t accepting Medicaid. Services like Twentyeight health and others are demonstrating the efficacy of using digital tools to bring broader, more convenient and more inclusive access to care to under-resourced populations. Twentyeight Health Raises $5.1M to Scale Affordable Telemedicine Solution for Women’s Sexual and Reproductive Care Spain’s Savana Medica Raises $15 Million to Bring to the US its AI Toolkit Turning Clinical Notes Into Care Insights Event: (10/15) On October 15th, Spain’s Savana Medica announced that it had raised $15 million to bring its AI based technology from Europe to the U.S. Telehealth market. Savana has a machine learning-based service that turns clinical notes into structured patient information for pharmacists and physicians. Description: According to the company, Savana is already working with the world’s largest pharmaceutical companies and more than 100 healthcare facilities. The company states it has already processed some 400 million electronic medical records (EMRs) in English, Spanish, German and French. According to Savana Chief Executive Jorge Tello, one of the company’s main value propositions is its focus on security, where “information remains controlled by the hospital, with privacy guaranteed by the de-identification of patient data before [they] process it”. Implications: As the COVID pandemic has demonstrated, having up-to-date actionable information is crucial to treating patients as effectively as possible. Given The company’s mission is to “predict...disease at the patient level” and “discovering new ways of providing medical knowledge in almost real time could provide crucial minutes in the treatment of certain diseases and could be especially valuable during public health crises like the current pandemic. The integration of technology like Savana’s into US hospitals could ease the burden on healthcare providers, and speed response times. Spain’s Savana Medica raises $15 million to bring to the US its AI toolkit turning clinical notes into care insights Lifelight and Karantis360 Partner to Deliver Social Care Remote Patient Monitoring Event: (10/16) A recent article in MobiHealth News noted that UK companies Lifelight and Karantis360 had formed a partnership to enable safer independent living for older and vulnerable individuals by delivering a remote picture of their wellbeing. The Karantis360 solution will run on the IBM Cloud and use IBM AI and analytics coupled with a network of smart sensors to identify and learn an individual’s typical behavior. Description: According to the companies, their solution allows regular behavior and vital sign readings to be taken in homes and other outpatient care settings safely, and has optimized clinician’s workflow.The combined solution allows for timely interventions and clinical actions based on real-time physiological data. Lifelight allows the contactless measurement of vital signs by using a standard smartphone or tablet and will detect tiny changes in facial skin color which may indicate a deviation in heart rate, blood pressure, respiration, or oxygen levels. If changes appear in relation to an individual’s daily routine or vital sign readings, automated alerts will be sent to the care provider and family members. Implications: The continuing need to physically distance has increased the demand for virtual care tools like the one described by the partnership. While telehealth visits are increasingly replacing many in-person visits some conditions still require physical observations. A digital tool with sensors and remote monitoring capabilities reduces the need for certain in-person visits, while improving patient care and supporting clinical decision-making. As such the combined solution can help support earlier patient discharges and prevent readmissions in real-time without the need or cost of additional hardware. These types of apps reinforce the role of IoT devices in healthcare in the move to value-based care via lower cost, higher quality, and patient friendly solutions. Lifelight and Karantis360 Partner to Deliver Social Care Remote Patient Monitoring

  • Telehealth Satisfaction Up Snags Remain, Home Care Cuts Medicare Costs & more -The HSB Blog 10/13/20

    Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds Event: (10/1) On October 1st, J.D. Power released its 2020 U.S. Telehealth Satisfaction Study noting that while “public awareness with Telehealth is higher due to ...COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme” in their research. Description: The survey of approximately 4,200 healthcare consumers who have used telehealth services within the last 12 months, was conducted from June-July 2020. The survey measures consumer satisfaction based on 4 factors (in order of importance): customer service, consultation, enrollment and billing/payment. Among the key finding of the study were: 1) overall customer satisfaction scores for telehealth were among the highest of all healthcare, 2) barriers to access still exist with 52% of telehealth users stating they had encountered at least one barrier that made it difficult to use telehealth: with the most common complaints being services were too limited (24%), technology requirements were confusing (17%), or there was lack of awareness around cost (15%). Researchers found that many of those who were less satisfied with telehealth had lower self-reported health, lower wellness levels, and an overall lower health status Implications: While overall telehealth patient satisfaction scores have risen, both technical and access barriers remain (with technical audio issues being the most frequently reported problem). Driven to telehealth largely by the COVID pandemic with 46% of respondents indicating safety as the main driver for utilization, providers and payers now need to address how to make the technology even easier and more accessible. It is especially important for those in under resourced communities which may have technological limitations as well as for seniors who may struggle with the technology due to physiological issues (hearing or vision loss, etc). Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds Avalere Analysis Shows Home Care Services Reduce Medicare Spending Event: (10/2) Healthcare consulting firm Avalere recently released an analysis that showed Medicare Fee-for-Service (FFS) patients getting home-based care services experienced a reduction in Medicare spending compared to patients who did not receive home based care and actually saw an increase in spending. Specifically Avalere determined the average Medicare FFS change in per-beneficiary-per-month (PBPM) was a decrease of about 5% for those with home care versus an increase of approximately 16% for those without home care.The study also found the spending difference was higher among Medicare beneficiaries with functional limitations and multiple chronic conditions. Description: Avalere conducted a retrospective study to analyze the comprehensive effect of home care interventions on Medicare spending. The Avalere retrospective study conducted from 2009 through 2018, compared 31,000 Medicare beneficiaries with home care services between 2012 and 2017 and those without home care services. This suggests a lower spend over time with home care services. Similarly, condition-specific subpopulation PBPM spending was low for home care services. The conditions compared were Diabetes with Chronic complications (-$227 vs +$324), chronic heart failure (-$175 vs +$432), and chronic obstructive pulmonary disease (-$155 vs +$410). Implications: The analysis recommends home care services as an efficient means to manage frail beneficiaries with chronic conditions against a difficult experience of a significant decline in their health and high-cost healthcare services. Homecare can save Medicare money by preventing unnecessary emergency department visits, hospitalizations, and readmissions. While additional research is mandated to concretely determine which home care services are causally linked to lower spending, the analysis shows a correlation between the delivery of home care services and reduced spending over time. Avalere Analysis Shows Home Care Services Reduce Medicare Spending Startup Aimed at Helping Patients Understand Doctor’s Orders Abridge Launches Event: (10/6) On October 6th, a new startup called Abridge was launched fueled by $15 million in funding. Abridge is an app that uses machine learning to record a patient's doctor's visit and then turns that recording into a patient focused transcript that simplifies details of their symptoms, conditions, procedures and medications.The app is designed to increase patient understanding of their diagnosis and adherence to their treatment plan. Description: Patient adherence has long been a problem in healthcare with the CDC noting that 20% of new prescriptions are never filled and over 50% of prescriptions are taken incorrectly. According to the CDC this lack of adherence is a combination of intentional factors such as inability to pay and unintentional factors such as a patients lack of understanding of how to use the medication. Abridge was built on the basis that everyone needs an easy way to remember and understand the details of their care. The new platform aims to help patients follow their provider’s advice and educate patients about their health, by recording the doctor’s visits and translating the conversation into an understandable transcript. Implications: With access to digital tools like Abridge, patients will be more comfortable and confident at their medical appointments and it will allow them to understand and question unfamiliar terms that may interfere with diagnosis and treatment. As a result patients will be better able to understand provider instructions and gain more insight into their plan of care. With Abridge’s automated speech-recognition technology at their disposal, patients will be able to take a more active role as an engaged consumer in their own care. This approach should lead to increased medication adherence and improved health behaviors both of which should contribute to higher quality outcomes at lower costs. Startup Aimed at Helping Patients Understand Doctor’s Orders Abridge Launches COVID-19 and Psychological Distress-Changes in Internet Searches for Mental Health Issues in New York During the Pandemic Event: (10/5) The Journal of the American Medical Association (JAMA) recently published a research letter looking at trends in internet searches for mental health issues in NY during the COVID pandemic. In order to better understand the pandemic’s impact on mental health the authors used Google Trends data to examine internet search histories for people living in NY state for the terms “suicide”, “anxiety”, “panic attack”, “insomnia” and, “depression” during the period from 3/22/20 (when NY state entered a COVID lockdown) through 5/14/20 (when portions of the state began a phased reopening). Description: To better understand the mental health concerns and the impact the pandemic had on mental health the authors used trends in search data as a proxy for increase or decrease in disease. According to the authors searches for anxiety significantly increased following the lockdown and remained on average 18% higher than expected prior to lockdown for a period of three weeks. Searches for the term panic attacks rose dramatically (56%) in the first week following closures and remained at elevated levels for five weeks. Similarly searches for the term insomnia rose 21% than historical data would predict during the lockdown and remained at those higher levels throughout the lockdown. Somewhat surprisingly, searches for the terms suicide and depression didn’t exhibit a significant increase from pre-COVID patterns, with the authors theorizing that this might be due to the impact of a feeling of solidarity with others facing the same situation. Implications: The study lends credence to the idea of using digital tools/data like internet search terms/trends in social media to get real time indications of changes in the mental health of a population. This type of data could be very useful both in tracking the longitudinal health of certain geographic populations as well as tracking the emotional health of a population in response to specific traumatizing natural or man made events (storms, fires, terrorism, etc.). By giving public health officials a more rapid view into changes in mental health, data like the above may empower a more proactive response from public health officials. This could, theoretically lessen the impact of such incidents on a population's mental health and thus lower the cost of care. COVID-19 and Psychological Distress—Changes in Internet Searches for Mental Health Issues in New York During the Pandemic Healthtech Startup Your.MD Raises €25m from FTSE 100 company Event: (10/05) European startup newsletter, Sifted recently ran an article that London-based healthtech startup Your.MD has raised €25m (~$29.5M USD) in fresh funds from Reckitt Benckiser (“RB”) to roll out its "health hubs" concept. Your.MD has developed a self-care app, Healthily, that helps users learn, assess, navigate, improve, and track specific behaviors that lead to better health. Description: Your.MD is using artificial intelligence to help users make better decisions around health. Unlike some others however, it does not make a diagnosis. Rather Your.MD is using AI to help users check their symptoms and advises users on what they should do next, whether it be talking to a doctor, ordering tests and medications, or finding a specialist. The company also views the app as a way to help lessen the strain on the healthcare system. The app provides a symptom mapper that shows users how their symptoms compare to others around the world. According to the company, it has seen a 350% increase in the number of users over the last 12 months, from 6m users from January to August 2019 to 26m the same period this year with part of the increase attributable to Your.MD’s COVID-19 symptom mapper, which had more than 4M visits. Implications: Firms like Your.MD which allow users to measure and monitor their own health help patients save time from unnecessary doctor consultations and empowers them to stay engaged and responsible in the management of their own health. In addition, Your.MD’s partnership with RB shows the strength of working with strategic investors, such as RB, which owns several over the counter brands such as Strepsils (similar to Cepacol), Gaviscon and Nurofen (Ibuprofen) which have broad consumer reach. As healthcare becomes more retail oriented this will become increasingly important. Healthtech startup Your.MD raises €25m from FTSE 100 company AdventHealth Adds to Long-Term Tele-ICU Partnership with Advanced ICU Care Event: (10/6) A recent article from PR Newswire noted that AdventHealth, a healthcare system based in Florida, rolled out its tele-ICU care services. This is an extension of its existing partnership with Advanced ICU Care, as it joins other AdventHealth hospitals that have telehealth-enabled ICUs. The partnership involves remote inpatient telemetry monitoring in addition to virtual ICU services. Description: AdventHealth Lake Wales, is a 160-bed acute care facility that strongly believes in whole person health as well as quality care. In 2014, AdventHealth created a partnership with Advanced ICU care, which is one the nation’s leading provider of high-acuity telemedicine. This partnership provides tele-ICU services that support frontline critical teams in the ICU. Tele-ICU services consist of an off-site command center in which a critical care team made up of intensivists and critical care nurses are connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic devices. Implications: The new tele-ICU installation will move AdventHealth Lake Wales towards achieving the AdventHealth three-tiered care goal for critical care which includes lowering mortality rates, supporting bedside providers and improving data capture to support best practice compliance. In addition, tele-ICUs can also help to support immediate and ongoing acute care needs. Given the influx of patients in need of critical care during the ongoing pandemic combined with the need to keep providers and caretakers out of harm's way, telehealth can play a vital role in delivering needed care safely. AdventHealth Adds to Long-Term Tele-ICU Partnership with Advanced ICU Care

  • SPACs Come to Digital Health, Funding Sets A Record, What CIOs Want & more - The HSB Blog 10/6/20

    Hims, A Direct-to-Consumer Health Company, is Going Public via SPAC Event: (10/1) On October 1st, 2020 Hims. Inc., a direct to consumer digital healthcare company, agreed to merge with a Special Purpose Acquisition Company (SPAC) formed by Oaktree Capital Management to go public. As a result of the transaction, Hims may raise up to $280M in cash, be valued at $1.6B and trade on the NYSE under the symbol HIMS. Description: Hims, Inc., is a direct to consumer company that sells health products targeted at Millennials. for both men’s and women’s health brands. Their focusing is on a variety of everyday issues and products such as skincare, hair-loss, sexual health and more recently primary care. Hims is fairly unique in that most of its products are sold via a monthly subscription and a high percentage (approximately 90% according to the company) is recurring. The transaction is expected to close by the end of 2020. Hims is the second digital health company to go public via a SPAC according to Fierce Healthcare, following acute care telemedicine company SOC Telemed’s July deal announced with Healthcare Merger Corp. Oaktree Acquisition Corp, is a SPAC formed by Oaktree Capital Management that went public in July with the intent of using the proceeds to make one or more acquisitions. A SPAC is a “blank-check” company that has the intention of buying or merging with one or more companies with the caveat that if the capital raised from investors is not invested within two years it must be returned to them. SPACs are also seen as an easier way for private companies to go public more rapidly and have less regulatory paperwork than the typical initial public offering (IPO) process. Implications: SPACs are an increasingly popular way for companies, typically those that may be earlier in their lifecycle, to come public with approximately 115 SPACs raising approximately $43B through October according to Bloomberg. SPACs also have the advantage of allowing companies coming public to make financial forecasts and raise greater amounts of capital. This can be especially attractive for competitive and financial purposes in an emerging industry such as digital health. As a result, SPACs could provide an avenue for some smaller and less mature digital health companies to go public and keep pace with many of the larger players in the space who came public via IPOs. (ex: Teladoc, Amwell, Oak Street Health, One Medical, etc). [As we were going to publication Clover Heatlh agreed to go public via a SPAC in $3.7B merger with Social Capital's Hedosophia Holdings III per Bloomberg]. Hims, a direct-to-consumer health company, is going public via SPAC Q3 2020: A New Annual Record for Digital Health (already) Event: (10/5) On October 5th, Rock Health released it’s Q3 2020 Digital Health Funding report which highlighted the surge in digital health funding so far this year. According to the report, the $4.0B that has been invested in digital healthcare companies in Q3 ‘20 means the U.S. digital healthcare companies are on pace to raise an estimated $12B this year, almost 46% higher that the record $8.2B raised in 2018. In addition, deal volumes rose nearly 22% compared to all of last year with the average deal size of $30.2B being 1 ½ times greater than the average of $19.7M seen in 2019. Description: The report noted that while the uncertainty and changes at the beginning of COVID caused a dip in funding, “since April the ...pandemic has accelerated digital health adoption by several years”. Through the third quarter of 2020, three categories of digital health investments have gained the most investment interest: on demand healthcare services, which deliver real-time or near-time health care services, saw 48 deals with approximately $2.0B invested; so called R&D catalyst companies, that support life sciences R&D, drug discovery and clinical trial management, saw 25 deals and just over $1.3B invested, while fitness and wellness companies that support fitness, nutrition and sleep, say 21 deals and just under $1.3B has been invested. While the trends in on-demand healthcare and fitness were similar to prior history, the rise in capital allocated to R&D catalysts or the life sciences was notable as it was only the 7th most funded category in 2019 according to Rock Health. Implications: As the pandemic drove patients and providers to seek new ways to access previously in-person services, opportunities for digital health exploded and funding followed close behind. While the levels of adoption have receded from their peaks, they are likely to remain significantly above pre-COVID levels. Latent resistance among both patients and clinicians was eventually overcome strictly as a matter of necessity and circumstance. However, as society seeks to deal with COVID longer term, digital health providers will face a more demanding business environment with providers dealing with depleted budgets, payers facing declining roles of commercially insured customers and government payrors facing increased demand for coverage amidst budget shortfalls of their own. As a result this period of easy money may be followed by a period of its own challenges including legitimization of business models, justification of economic returns and development of risk and regulatory controls that could ultimately lead to additional consolidation. Q3 2020: A new annual record for digital health (already) What Do CIOs Want to See from Telehealth Apps? More Than a Dozen Weigh In Event: (9/28) A recent article from Healthcare IT News highlighted the remarkable progress of telemedicine innovations since the start of the COVID pandemic and surveyed fourteen healthcare Chief Information Officers (CIOs) on what they'd like to see from telehealth platforms in the future. Description: People’s needs for telehealth services have skyrocketed and virtual care platforms are looking for ways to enhance their products in order to meet the needs of the consumer. Some features CIOs desire in virtual care include: remote monitoring tools tied into the telehealth app, real-time monitoring of vitals from home that can trigger immediate responses or alerts, more advanced AI bots that can be used to systemize the severity of a patient's concern, the ability to have simultaneous visits with multiple providers for one patient, voice recognition technology that transcribes what the doctor is saying into the EHR, and even using fictional characters during pediatric telehealth visits so children are more comfortable. Additional access issues that need to be addressed in virtual care settings include language barriers, difficulty navigating technology for telehealth appointments, and lack of availability of high-speed internet because of one’s physical location or economic situation. Implication: CIOs realize there is a demand for those seeking care through telehealth platforms, as a result, they want to integrate more optimal features into virtual care platforms. As we continue to embrace digital solutions with greater use of virtual and remote care, telehealth innovations will be taken to a new level in order to deliver timeliness, efficiency, and positive patient outcomes. A patient’s digital experience should afford synchronized communication efforts in one tool, however, the usage of all elements enlisted above will be dependent upon patient choice and clinical need. What do CIO’s want to see from telehealth Apps? More than a dozen weigh in Seizure Prediction Device Can Send Mobile Alerts Event: (9/29) Engadget released an article stating that researchers from Ben-Gurion University of Negev have developed a wearable electroencephalogram (EEG) device that can predict epileptic seizures up to an hour before the onset. The system is based on machine learning algorithms for analyzing EEG signals. Description: The device, Epiness, uses machine learning algorithms to analyze brain activity and detect potential seizures. It then sends a warning to the smartphone connected to the device. Sufficient warnings could give patients time to prepare for an onset seizure by taking medication. Those who don’t respond well enough to anti-epileptic drugs would have a chance to remove themselves from seizure-related injuries e.g driving. The algorithm has tested 97% accurate. Implications: Epiness would not only prompt patients to take appropriate medicine in advance to control their seizures, but it would also prevent seizure-related injuries that can occur during activities such as driving. This device is giving patients control of what is typically an unpredicted traumatic event. Warned patients can prepare for the onset event and care for themselves in a safe environment. Seizure prediction device can send mobile alerts Six Things to Know About Telehealth Medical Malpractice Concerns Event: (9/30) On September 29th, Bloomberg Law published an article entitled “Uptick in telehealth reveals Medical Malpractice Concerns”, addressing the issues that have arisen due to the increase in telemedicine platform usage. The article highlighted that telehealth platforms create a higher risk for data breaches and more challenges for clinicians when examining patients via digital health rather than in-person and thus must be sure to protect themselves when embracing digital health. Description: With the surge in telehealth use during the COVID-19 pandemic, The Department of Health and Human Services has temporarily relaxed regulations under the Health Insurance Portability and Accountability Act. This allows physicians to communicate with patients on various video-conferencing platforms. This raises concerns with the malpractice risks associated with virtual care since providers are now at a higher risk for data breaches of their patient’s health information. With the inability to examine the patient in-office, misdiagnosis is possible as well as improper prescription of the patient’s medication. Providers may be held liable for breaching the standard of care if patients experience any harm during “visits”, due to negligent act or omission, miscommunication, misdiagnosis, software malfunction or other technological risks. Implications: As a result of the rise in concern, physicians are urged to become acclimated to malpractice risks to avoid civil or criminal liability, which could ultimately lead to revocation of their license, suspension of the physician’s practice of medicine, monetary penalties, or imprisonment. The Bloomberg Law article suggests best practice for providers, which includes: 1) educating patients regarding their telehealth visit and providing informed consent that details potential risks and security measures, 2) the importance of documenting virtual visits and maintaining proper patient records to ensure confidentiality and standards of care are met, 3) becoming familiar with state laws associated with telemedicine. By following these guidelines, physicians can safely continue to use telehealth platforms and patients’ health needs can be addressed in the safest manner. Uptick in Telehealth Reveals Medical Malpractice Concerns

  • What Startups Missing in 'Consumer' Experience, AI in Pain Assessment & more - The HSB Blog 9/29/20

    What Startups are Missing When They Talk About the ‘Consumer’ Experience & To Boost Inclusivity, Words Matter in the Healthcare World Event: (9/22 & 9/23) Two recent reports in Mobihealthnews focus on the importance of including a health equity agenda and acknowledging the importance of langage to improve consumer experience and inclusivity in digital health tools. Digital health need to make sure they “have delivery systems that communities can trust and want to access” especially for groups of people who have been historically marginalized such as those in LGBTQ+ community and communities of color. Description: Two recent panels shed insights on lessons that could be learned from the dual crises of COVID and racial injustice which have had a disproportionate impact on underserved communities and communities of color. Participants noted that when designing digital solutions for marginalized communities, it is important to take a broad look at health care needs and meet communities where they are. Words and language used by clinicians have impact and can either boost inclusivity or cause exclusion. When designing healthcare solutions, people need to consider – does this work for marginalized communities and what does management and board teams look like from a diversity, equity and inclusiveness standpoint. Implications: Panelists noted that one of the challenges Silicon Valley has in changing health care at scale is that too often entrepreneurs are reflecting their own experiences onto the challenges of healthcare today. One solution would be to tailor efforts towards a specific population served rather than roll out a one-size-fits-all program. In addition, start-ups need to guard against the “Silicon Valley-ization of Healthcare” that focuses on transactions as opposed to relationships and driving outcomes. What startups are missing when they talk about the 'consumer' experience & To boost inclusivity, words matter in the healthcare world Pain and Dementia: Common Challenges for Care Managers [AI in Pain Assessment] Event: (9/21) On September 21st, AI technology pain assessment company, PainChek, released a report entitled “Pain and dementia: common challenges for care managers”, which investigates the complex challenges care managers face daily and the relationship between pain and dementia. In August, PainChek launched its new facial analysis technology in the UK, enabling care workers and clinicians to identify and manage pain in dementia impaired patients who struggle to communicate. Description: PainChek is working to raise awareness of the importance of effective assessment of pain in people with dementia after realizing inappropriate antipsychotic prescriptions were given to dementia patients in the UK. A UK Department of Health study found that of 180,000 patients living with dementia in the UK, 80% of them were inappropriately given antipsychotic prescriptions and at least 50% of people living with dementia in the UK’s 18,000 care and residential homes regularly experience pain. PainChek is using facial analysis technology which enables care workers and clinicians to identify and manage pain in dementia impaired patients who struggle to communicate and assist them with pain management. PainChek has been granted a US patent for pain assessment invention. Implications: Antipsychotic prescriptions are overprescribed to patients living with dementia and the use of AI assistive technology will help promote the move to value-based care, lead to improved patient experiences as well as better health outcomes for patients. One of the biggest challenges is assessing pain levels for people living with dementia. Using applications like PainChek will yield improvements in communication for patients living with dementia, helping improve the quality and appropriateness of care. Pain and dementia: common challenges for care managers [AI in pain assessment] Backed by Google’s Investment Arm, Home-Based Care Startup Ready Lands $54 Million Event: (9/16) On September 16th, Home Healthcare News announced that Ready, an on-demand health care startup has raised $54 million in Series C funding. Ready delivers home-and community-based services, aiming to provide a doctor’s office-type visit in the home. Description: Ready deploys “Ready Responders” — who are trained as EMTs, paramedics and nurses — to hundreds of patients’ homes per day. All responders are connected to Ready’s platform through their phones and are also equipped with iPads, testing and monitoring equipment. When Ready partnered with Ochsner Health System, there was a reduction in non- emergency ED visits by upwards of 70%. In addition, COVID-19 has accelerated Ready’s business in New York. Due to New York’s dire need for health care workers during the crisis, Ready launched a year earlier than anticipated, Ready’s original plan was to launch in New York in 2021, but New York’s dire need for health care workers and providers during the public health emergency sped up the process. Since Ready’s main payer is Medicaid, it was able to extend support to under-served communities throughout the pandemic. Implications: This funding will help Ready continue building out the infrastructure to scale the business, grow visit volume, enhance its product offerings and expand the range of conditions it can support. Even as the pandemic slows down, the company's market continues to grow as patients enjoy the convenience of in-home care. Given Ready's main payer is Medicaid, this service is expanding crucial care in areas of need. Backed by Google’s Investment Arm, Home-Based Care Startup Ready Lands $54 Million Amazon Expands Virtual Medical Clinic Across Washington State: 5 Details & Amazon Care: 5 Things to Know About Amazon's New Virtual Medical Clinic Event: (9/22) CNBC reported that in September 2019 Amazon launched the Amazon Care program, which offers employees virtual medical consultations with clinicians as well as in person nurse follow-ups for company employees and their dependents. Healthcare represents a $3.5 trillion sector for Amazon, which is looking for different avenues to bring technology into the work they already do. Description: The Amazon Care program was implemented to offer employees and their dependents virtual and in person medical consultations with physicians and nurse practitioners. Patients can also use the app to schedule in-home follow up visits, text a nurse on any health topic in minutes, and have medications prescribed delivered to their homes. CNBC noted the application serves to eliminate travel time, wait time, and connect employees and their families to the best trained medical professionals for optimal care. According to Amazon Care Director Kristen Helton, PHD, the program received a patient satisfaction score of 4.7 out of 5, which prompted the company to expand to all eligible employees in Seattle, Washington, where most of their corporate employees are based. Implications: With the rise of COVID, and the need to physically distance increased accessibility to virtual care is even more crucial for the well-being of employees and their families. This underscores the need for accessible and affordable employee healthcare plans which integrate virtual and in-person care like Amazon Care. For big tech companies like Amazon, Google, and Apple, among others, employee health programs represent a way to test new health-care products in an internal research and development lab. Amazon leads the way in making inroads into telemedicine, which represents a $130 billion market opportunity if the company expands its clinic beyond a pilot for its own employees. Although Amazon joined up with J.P. Morgan and Berkshire Hathaway in 2018 to form Haven, an exploration of new ways to manage healthcare expenses for their combined 1.2 million employees, that effort seems to have stalled. This new healthcare initiative may indicate that Amazon intends to pursue certain healthcare solutions on its own. Amazon Expands Virtual Medical Clinic Across Washington State: 5 Details & Amazon Care: 5 Things to Know About Amazon's New Virtual Medical Clinic Microsoft Teams Integrates with EHRs for Provider Telehealth Event: (09/22) A recent article in Healthcare Dive highlighted the fact that Microsoft Teams would integrate with EHRs providers for telehealth and that its industry specific cloud offering for healthcare, Microsoft Cloud for Healthcare, will be generally available at the end of October. Microsoft Cloud for Healthcare includes Microsoft 365, Dynamics, Power Platform and Azure and is aimed at managing patients and staff, deploying resources and promoting data insights. Microsoft also announced the AI-enabled speech-to-text software integration from Nuance. Description: Microsoft noted that its Teams platform, which has a workplace chat, file sharing and web conferencing and is HIPAA-compliant has seen rapid uptake amid the pandemic with telehealth meetings increasing 35% from April to July. Microsoft’s health system clients had pushed the tech giant to integrate with Epic and other EHRs while keeping privacy and security a top priority when creating the video platform for healthcare. In addition, Microsoft’s recent integration with AI-enabled speech-to-text software from Nuance allows patient data entry by automating physician notes taken during a virtual visit which transcribes notes into the correct EHR field, eventually doing so without human supervision Implications: Microsoft’s Cloud for Healthcare and Teams EHR integration allows it to link information and help hospitals with telehealth, care management and patient engagement through apps . This will make it easier for healthcare providers to access data and other services in a remote setting should another pandemic or crisis occur. The integration of Teams and Nuance potentially puts Microsoft at a competitive advantage over other existing large telehealth vendors like MDLive, Amwell and Teladoc, by eliminating the need to integrate a separate distinct telehealth solution and easing workflow via the automatic transcription of clinician notations directly into medical records. Microsoft Teams Integrates with EHRs for Provider Telehealth High-Tech Aids for Aging in Place Event: (9/23) On September 23rd, Kiplinger.com released an update on this year's technology to assist older users and their caregivers who cannot afford the high cost of assisted living/senior care.. Kiplinger’s highlighted six products across a range of devices not all of which are marketed direct-to-consumer. Two we are highlighting here are Smart Sole and Envoy at Home. Description: SmartSole provides a smart insole to fit into shoes with a built-in GPS. This is used to keep track of a loved one with dementia who may wander off and get lost. The device pinpoints the person’s whereabouts on a map, supplying addresses and outdoor locations to within 15 feet every five minutes. Envoy at Home is a remote caregiving service for older adults who live alone and can't afford a health aide. Using sensors, caregivers can monitor the person's wellness and safety, such as how long or frequent the patient's bathroom visits are, periods of inactivity, and whether they are taking prescribed exercise or rest. The caregiver can then receive reports and alerts on the patient. Implications: During COVID, many caregivers are socially distancing from their older loved ones and cannot be present to care for them as they are accustomed to or would like. SmartSole and Envoy at Home provide solutions to remotely care for older people living on their own. These solutions and devices like them, help older adults live independently at home longer and provide more flexibility for caregivers by allowing them to care for elderly parents from a safe distance. High-Tech Aids for Aging in Place

  • Cyberattacks on Telehealth Skyrocket, Privacy Concerns Hinder COVID Tracking-The HSB Blog 9/22/20

    Targeted Cyberattacks on Telehealth Vendors Skyrocketed Along with Adoption, Report Finds & Fewer than Half of Healthcare Institutions Met National Cybersecurity Standards Last Year Event: (9/10 & 9/17) According to two recent reports, not only has the number of cyberattacks targeting popular telehealth applications risen 30% since the pandemic began, but healthcare institutions are slightly less prepared to deal with them in 2019 than they were in 2018 or 2017. First, based on the “Listening to Patient Data Security: Healthcare Industry & Telehealth Cybersecurity Risks” report by Security Scorecard and Dark Owl, there has been a dramatic increase in attacks on telehealth which saw the increase in security alerts noted above compared to the healthcare industry in general which saw an overall 77% decrease in security alerts. In addition, the CynergisTek 2020 Annual Report noted declines in four of five core security functions outlined in that National Institute of Standards and Technology’s cybersecurity framework with assisted living facilities scoring highest (96%) and physician groups scoring lowest (20%). Description: Security Scorecard and DarkOwl compared security alerts sent to IT staff at 148 of the most popular telehealth applications for the period March through April of 2020 compared to the pre-COVID period of September 2019-February 2020. They found a 65% increase in patching cadence findings, a primary secret security approach to protect data and a parallel 56% increase in endpoint security attacks. They also found security issues were reported due to increased FTP attacks (which rose 42%) and RDP attacks (which rose 27%) both of which target increases in remote and virtual workers. The CynergisTek report showed that healthcare institutions compliance with IT security policies were sliding, scoring 44% in 2019, vs. 47% in 2018 and 45% in 2017. This included a decline in four of five core functions. Implications: With the growth in remote work and the explosion of digital health due to the pandemic, the number of “digital endpoints” exposing healthcare institution’s to cyber risk has increased significantly. As a result healthcare institutions need to be even more vigilant and conscious of the risks to patient data and IT system integrity/security. Healthcare companies must work on greatly improving and patching their critical security tools enhancing endpoint protection, improving identity access management, and data loss prevention. Targeted cyberattacks on telehealth vendors skyrocketed along with adoption, report finds & Fewer than half of healthcare institutions met national cybersecurity standards last year COVID-19 Tracking Tech – Weighing Personal and Public Health Benefits Against Privacy Event: (9/18) A recent survey conducted by SecureAge Technology shows that 67% of consumers and 91% of IT professionals said they'd support a nationwide rollout of contact-tracing apps or other technologies despite the fact that the clear majority of these groups believe COVID contact-tracing technologies put individuals' personally identifiable information at risk. The report notes many have strayed away from using these resources, afraid that their personal information may be compromised as COVID has caused an increase in technologies used to educate, contact trace, and symptom report for those who may have been exposed to the virus. Description: Public Health departments have begun rolling out applications to aid with contact tracing and educating individuals regarding COVID, but recent surveys are showing that there has been increased skepticism. Although these tools have been introduced to control virus transmission, the hesitation isn’t unfounded due to major technology firms like Google and Apple that have been facing scrutiny from the public and lawmakers over the collection and use of personal data for corporate gain. Additionally, published analyses suggest that many COVID apps made available for download make little effort to protect the data they are collecting. Despite the valuable aspects of these applications such as quarantine updates, healthcare contacts, location tracking, and educational tools, the cons have greatly overshadowed the pros. Implication: COVID applications are valuable in helping users understand their risk, so they can adjust their behaviors and seek testing if necessary, but proper education is necessary to maximize the use and to save lives. The information stored in these applications are critical and need to be protected at all costs to create a safe space for use. Public health groups need to better inform the public about the benefits of these apps and ensure that the information is given with proper consent and handled responsibility, especially amongst higher risk populations that may have varying levels of literacy. COVID-19 tracking tech – weighing personal and public health benefits against privacy Why Digital Therapeutics are Flourishing Under COVID-19 Event: (9/17) A recent report in Mobihealthnews highlighted the growth in adoption and acceptance of digital therapeutics during the COVID pandemic. The article noted that not only has COVID removed some of the stigma around the conditions being treated (mental health, psychiatric conditions, etc.) and the ability to treat them digitally, digital therapeutics is not facing some of the issues in trial design and recruitment that traditional trials are experiencing. As a result, there has been increased access to evidence-based interventions which show reliability and personability to patients. Description: Digital therapeutics are evidence-based therapeutic interventions driven by high quality software programs to prevent, manage, or treat a medical disorder or disease. As a result of COVID digital therapeutics executives and industry stakeholders have seen an increased demand for efficient and accessible treatments which can be done remotely without potentially exposing them to the virus and can be highly personalized. In addition, digital trials are decentralized, can be done from home and typically allow more flexibility in recruitment all of which have been advantageous vs. standard trial design during the pandemic. Implications: Digital therapeutics are likely to yield improvements in self-care particularly for patients who are isolated due to COVID as well as reduce the social stigma around many of their conditions. With a number of digital therapeutics already approved and companies such as Big Health, Click Therapeutics, Akili, and others focused on using digital technologies to reduce development costs and increase accessibility to care for many conditions they are likely to redefine how care is delivered in many areas. Why digital therapeutics are flourishing under COVID-19 The Rise of Venture Capital Investing in Mental Health Event: (9/16) On September 16th JAMA published an opinion piece about the increase in venture capital (VC) investment in mental health noting that the sector was ripe for innovation with fewer than ⅓ of the people in need of care receiving treatment and only a subset of those actually getting adequate care. The article went on to note that while VC investment has grown almost 23x since 2013 it was important to look at potential concerns and benefits associated with the influx of money. Description: The private sector is using health and wellness as an investment opportunity after realizing there is a supply/demand imbalance mismatch for those in need of mental health treatment. However, VC supported companies often rely on the ability to grow quickly and serve a large population to maximize their return on investment which could be at odds with medicine’s evidence-based approach and the one-on-one nature of mental health treatment. In addition, there have been concerns around the security of data, privacy of client information, the lack of informed consent and broad-based nature of the apps (vs. the need for personalized treatments). Implications: The rise in venture capital investment in mental health care offers an opportunity to scale treatments that work to address mental illness. However, while VC supported mental health companies can provide improvements in transparency with diagnosis, treatment process, and costs, concerns around developing evidence based treatment, appropriate quality controls, improved privacy safeguards and the continued need for solutions to treat severe mental illness, all need to be addressed further. The Rise of Venture Capital Investing in Mental Health (abstract) Telemedicine Projected to Account for 20% of Medical Visits in 2020, Report Says Event: (9/16) Telemedicine projected to account for 20% of medical visits in 2020 according to a new Doximity Report. The new report, published last week by the Doximity physician network, is based on a randomized survey of 2,000 American adults. Doximity network data reflects "physician adoption insights," and data from the Medical Expenditure Panel Survey and commercial insurance claims to gauge the telemedicine market. Description: The COVID pandemic has spurred widespread adoption of telemedicine along several fronts at health systems, hospitals, and physician practices—primarily over concern about the spread of the novel coronavirus in healthcare settings. Telemedicine visits for nonemergency care also have been shown to be efficient and effective from both the healthcare provider and patient perspectives. This has resulted in an overall increase in telemedicine visits. Since the Coronavirus pandemic began, the number of Americans participating in at least one telemedicine visit has increased 57%, according to the report. Implications: Although COVID numbers have recently appeared to improve, given concerns about an impending second wave and the successful increase in application during the pandemic the market for digital health and increased ways to apply it will continue to grow. COVID has accelerated the rate of deployment, overcome physician reluctance to apply its use and rapidly increased consumer acceptance. As a result. more than a quarter of survey respondents reported feeling telemedicine visits have the same or better quality versus in-person visits with Doximity predicting telemedicine will account for $106B of medical services by 2023 (up from $29B of medical services in 2020). Telemedicine Projected to Account for 20% of Medical Visits in 2020, Report Says U.S. HealthCare System on Life Support, Say Test Results from New Study Event: (9/14) A recent report from The Commonwealth Fund, entitled a 2020 Scorecard on State Health System Performance, which looked at 49 indicators of health care system performance was not encouraging. According to the report, the state of healthcare issues in the U.S. such as access to, and the cost of basic medical care and minority health outcomes have significantly worsened, especially during the recent pandemic. Also, resources linked to mental health treatment have lost funding, causing an increase in drug/alcohol abuse and suicide all over the nation. Description: The report, which drew primarily from 2018 data, and some preliminary 2019 data noted, among other things there is a nationwide crisis when it comes to overall health outcomes. The Black and Latinx populations are suffering the most as well as those residing in states that chose not to expand Medicaid services. The four main conclusions made from the data reviewed: 1) Americans are living shorter lives than in 2014, with Blacks twice as likely to die from treatable conditions than whites, 2) healthcare coverage gains have stalled with both out-of- pocket costs and insurance costs worsening, 3) increased healthcare prices have driven healthcare spending growth and the rise in consumer healthcare costs, and, 4) public health dollars are already being stretched while having to contend with unprecedented challenges due to the pandemic. Implications: The current state of the U.S. healthcare system highlights the need to combat extreme deficiencies to promote better healthcare outcomes. The global pandemic has brought to light the extent of the healthcare gap and lack of access to resources that has negatively impacted the nation, especially amongst minorities. If new solutions do not emerge, Americans will continue to see a downturn in overall health, especially as COVID-19 continues to spread throughout the world. U.S. health care system on life support, say test results from new study

  • MedPAC:What PHE Waivers Survive?, FCC's Telehealth Pilot & HHS on Rural Health-The HSB Blog 9/15/20

    MedPAC Commissioners Hint at Telehealth Policies that May Stick Post-COVID-19 Event: (9/08) A recent article in Healthcare Dive discussed MedPAC’s 9/4/20 public meeting which reviewed the expansion of telehealth delivery in Medicare. The key point of discussion was which changes in Medicare telehealth payment policies, waived during the COVID-19 public health emergency (PHE) would lawmakers and regulators allow to become permanent after the COVID-19 PHE ends. Description: During the pandemic Federal regulators relaxed many rules and payment policies surrounding telehealth to provide an alternative avenue of care, including the addition of 80 additional codes for Medicare covered telehealth services (from the then existing 100). When considering the issue some commissioners expressed concerns that expanding access could increase use of low-value services and also unwittingly widen the so-called digital divide with underserved populations (with two recent JAMA studies showing nearly 25% of older adults on Medicare lack access to computers with high-speed internet or a smartphone with a wireless data plan). In addition, commissioners appeared to dismiss the idea of continuing to allow the use of non-HIPAA compliant video platforms past the PHE but did appear inclined to continue coverage for audio-only services. Implications: The easing of regulations during the pandemic dramatically increased the speed and breadth of telehealth usage, rapidly expanding penetration and acceptance. While growth has slowed recently, how and which PHE waivers will be made permanent will dictate the pace of growth going forward. Given some commissioners were more willing to allow broader telehealth flexibility if they were delivered under some type of alternative payment model, blanket changes to the rules are likely to take longer than market participants expect initially and could be more limited in scope than many have suggested. For example, final payment policies and reimbursement at facility vs. non-facility rates may depend on CBO scoring. [Please contact us for our article “Not So Fast on the Future of Telehealth” published in PE Hub for more details] MedPAC commissioners hint at telehealth policies that may stick post-COVID-19 FCC Nears Launch of $100M Connected Care Telehealth Pilot Program: 5 Things to Know Event: (9/08) A recent article in Becker’s Hospital Review noted that the FCC had recently published application details on its $100 million Connected Care Pilot Program, which aims to enhance telehealth access for low-income Americans and veterans (originally introduced in 2018). Description: This three-year program provides $100M in grants to fund about 85 percent of telehealth programs’ connectivity costs, including patient broadband internet access services, provider broadband data connections and other network equipment. Under the program, users must have their own telehealth devices to participate and areas such as network deployment and construction of network and connectivity between healthcare providers will not be funded. Additionally, Connected Care is available in rural and non-rural areas, but is limited to nonprofit and public providers Implications: The funding and access to telehealth resources is extremely important for rural and underserved communities such as low income Americans and veterans. Making these resources readily available helps address the health disparities that exist in these communities and gives them better access to address their needs. Additionally, making this program available to nonprofit and public providers can help broaden usage of these resources to other vulnerable populations. FCC nears launch of $100M Connected Care telehealth pilot program: 5 things to know HHS Issues Plan to Improve Rural Health, Leaning on Telehealth Event: (9/04) On September 4th the U.S. Department of Health and Human Services (HHS) released an 84-page plan to address rural healthcare barriers, particularly due to the COVID-19 crisis. The plan details steps to expand telehealth services, emergency care consultations, and EMS training through a series of approximately $9M grants for up to 29 providers over the next four years. Description: Rural areas are not only plagued by a shortage of providers, but also suffer from lower incomes and higher incidence of chronic health conditions compared to urban areas. The 57 million rural residents are significantly more likely to die of heart disease, cancer or stroke compared to urban dwellers. The plan would allow rural health clinics and federally qualified health centers to furnish Medicare telehealth services and be reimbursed for virtual care at similar rates as comparable telehealth services under Medicare. The rural health plan would also allow Indian Health Service and facilities to receive compensation even if telehealth services are provided over state lines. Additionally, $12.4 million has been pledged to expand a pilot project to improve care for rural maternity and obstetrics patients, with expanded telehealth services. Implications: The health and geographic disparities in rural areas has been an existing, but heavily neglected issue for many years. HHS’s plans rely on telehealth and while telehealth has potential to help reduce geographic disparities in access to care, this may not be as helpful for addressing these issues in rural health. Telehealth relies on digital infrastructure that's largely not in place in non-metro regions and one-third of rural households say they don't have a broadband connection at home. HHS issues plan to improve rural health, leaning on telehealth Seattle Health Tech Startup Optimize.health Raises $15.6M for Remote Patient Monitoring Service Event: (9/09) A recent article from Geekwire noted that the Seattle health tech startup Optimize.health had raised $15.6M for remote patient monitoring service. The article noted that Optimize.health has raised more than $21 million in total funding to date. Description: Founded in 2015, Optimize sells a remote end-to-end patient monitoring service used by independent practices, hospital systems, and more. When health providers see that a patient at home needs support because a device such as a blood pressure cuff or a pulse oximeter indicates a potential health issue, the Optimize software provides a variety of communication methods for contacting the patients, including text messages and video calls. The company’s dashboard also provides a way to trigger a bill to the insurer for the clinician monitoring. The system integrates with Electronic Health Record (EHR) software. Implications: As COVID-19 outbreak continues, consumers are managing their health remotely. Optimize.health is allowing patients to receive regular care and updates through text message and voice calls in the comfort of their own home. This enables more accessible, convenient, and cost-effective healthcare. Seattle health tech startup Optimize.health raises $15.6M for remote patient monitoring service 5 CTA Members Leading the Digital Therapeutics Frontier Event: (8/25) In late August the Consumer Technology Association (CTA) launched a new initiative with 25 health technology companies to develop standards for the use of digital therapeutics. The goal of the initiative is to recommend best practices for the definition, application, use and performance requirements for the field to help educate the industry and, eventually, consumers to advance the adoption of the technology. As part of the launch, CTA profiled 5 of the companies in the initiative. Description: AppliedVR reshapes pain management care with its virtual reality platform aimed at alleviating a number of ailments, from labor pains to discomfort during infusions for cancer treatment. Ginger offers on-demand mental health support with trained behavioral health coaches, therapists, and psychiatrics with personalized skills building activities. GlucoseZone provides workouts, education and coaching to help users of the app reach their fitness and diabetes control goals. Healium leverages virtual and augmented reality (AR/VR) travel to allow users to biometrically alter their virtual environment through emotions and decrease their own stress. Implications: As the world continues to grapple with the effects of the COVID-19 outbreak, consumers have begun taking more control of their health care in the comfort and safety of their homes. Digital therapeutics, a relatively new branch of digital health, enables this socially distant health care delivery. The technology uses software applications to enhance clinician decision making, optimize the dose and delivery of other forms of medical treatment through patient monitoring, or even act as a stand-alone intervention. The standards from the CTA will help educate the industry and eventually consumers, to advance the adoption of the technology. 5 CTA members leading the digital therapeutics frontier A Buyer’s Guide to AI in Health and Care Event: (9/09) Last week, the NHSX, a unit of Britain’s National Health Service, published “A Buyer’s Guide to AI in Health and Care” proposing 10 questions on how to make the right decision purchasing products using Artificial intelligence (AI). AI has become desirable in advanced medical settings because it has the capability to interpret and classify test results more rapidly than physicians, allowing physicians to direct attention to more complicated issues facilitating improvements in the health of patients. Description: When purchasing products that use AI, consideration should be given to the type of problem you want to solve, the appropriate scale for addressing the problem, ensuring regulatory standards are met, and what the intended uses are for the product(s). The Buyer’s guide, linked below, does not provide a comprehensive treatment of commercial contracting, but proposes questions that are classified under the following categories: problem identification, product assessment, implementation considerations, and procurement, and delivery. Implications: Since there is a shortage of clinicians in health care, a range of AI-powered innovations will allow physician time to be freed up for analysis of more complex cases and grant more time for direct patient care. This will help decrease costs, improve outcomes and create more positive health experiences. “A Buyer’s Guide to AI in Health and Care” points out important questions to consider when purchasing products that use AI to assure they are safe and effective for the organization being served. A Buyer’s Guide to AI in Health and Care

  • Telemedicine Access Hardest for Those Who Need it Most, Post-COVID Visits Plunge-The HSB Blog 9/8/20

    Access to Telemedicine Is Hardest for Those Who Need It Most Event: (9/3) A recent article in WIRED magazine noted the practical and technological issues that many older Americans, particularly Black and Latinx Americans have in accessing and using digital health technologies. Description: While virtual care exploded during the COVID crisis, accounting for as much as 44% of Medicare visits at one point, studies indicate that as much as 41% of Medicare recipients don’t have an internet-capable computer or smartphone at home, with elderly Black and Latinx people the least likely to have access compared to whites. Another study in JAMA noted that approximately 13M elderly adults have trouble accessing telemedicine services, and approximately ½ of those people may not be capable of having a telephone call with a physician due to problems with hearing, communications, dementia, or eyesight, including 71% of elderly Latinx people and 60% of elderly Black people. Implications: Although growth in virtual and telemedicine visits has exploded during the COVID pandemic, the increase in the digital delivery of healthcare services exposes and magnifies the disparities in care and access for the underserved, and is especially acute for the elderly in those groups. Providers and payers must look at methods of bridging the “digital divide” when expanding use of virtual care/remote access. They must pay attention to visual and non-visual cues to ensure understanding and incorporate other accommodations (such as automatic captioning and amplification) for elderly Black and Latinx populations. Access to Telemedicine Is Hardest for Those Who Need It Most Telehealth grew wildly popular amid Covid-19. Now visits are plunging, forcing providers to recalibrate (subscription required) Event: (9/1) In a September 1st article, STAT News looked at the nationwide slowing of telehealth visits and, noting that although telemedicine visits are higher than pre-pandemic levels the downturn is causing providers to adjust offerings based on patient preferences and needs. Description: As telemedicine visits have decreased from 69% of total encounters in April to just 21% of total encounters in July, providers are trying to figure out at what level the ultimate balance between in-person and virtual visits will stabilize and how visits will break down across service lines. For example, the University of Pittsburgh Medical Center launched a program to determine when patients should be seen remotely or in-person. They have found that while telemedicine visits have declined about 60% from April, most mental health visits are continuing to occur virtually while specialists are seeing more patients return to their offices. Implications: Following the pandemic providers are going to have to adjust the level of virtual visits by investigating what mix of virtual and in-person visits best suits their patient population. They need to determine what mix of the two will be most cost-efficient and profitable for them. In addition, the leveling off of virtual visits may create challenges for large telemedicine companies that are planning to expand based on the initial surge in demand and easing in the regulatory environment. This is due to the uncertainties about whether they will be able to sustain those numbers as patients return to in-person visits and what will happen with an unpredictable regulatory landscape. Deloitte survey shows consumers are more engaged with their health through technology Event: (8/26) A recent article in Healthcare Finance highlighted that two Deloitte surveys (the Deloitte 2020 Survey of US Health Care Consumers and The Health Care Consumer Response to COVID-19 Survey) show consumers are more engaged with their health through technology as a result of the COVID-19 pandemic. Description: Consumers are actively engaging in their health care, which has allowed them to discuss cost information, track health conditions, access and use their medical record data, disagree with their doctors about treatment and cost, and engage in healthy/preventative behavior. The Deloitte COVID-19 consumer survey found among consumers who had virtual doctor visits 80% would choose to have another virtual visit, provided the positive patient-physician experience which was defined as one where the healthcare provider was accessible and willing to listen. Implications: While consumers are more open to virtual visits since COVID Deloitte’s survey found consumers still want to have a personalized physician-patient relationship with a provider who listens, shows they care, takes their time, and communicates with them. The enhanced use of technology has also exacerbated health disparities, especially along racial lines. As a result organizations need to extend access to care deeper into the communities they serve addressing both clinical issues as well as issues around the social determinants of health (SDOH). Deloitte survey shows consumers are more engaged with their health through technology Carewell Secures $5M For Caregiver Advocacy, Home Health E-commerce Site Event: (9/2) Carewell, a North Carolina startup recently closed $5 million in seed funding to expand its e-commerce and home health advocacy site for home health products. Description: Carewell was started to support and educate families caring for loved ones, particularly those who are doing so for the first time. The online shopping platform consists of vetted product recommendations as well as a subscription service for caregivers who consistently need products and resources. Additionally, the company is looking to expand and create new categories of products that will continue to serve its customers. Implications: The demand for at-home care for seniors has exploded during the pandemic, with Carewell seeing revenue doubling and nearly 40,000 unique customers making purchases since February. With a disproportionate percentage of COVID deaths attributable to skilled nursing homes and senior living facilities, alternatives to institutionalized care and services which enable them are likely to see growing demand and interest. Carewell Secures $5M For Caregiver Advocacy, Home Health E-commerce Site Using technology to self-manage diabetes results in healthy lifestyle choices Event: (8/28) The University of Texas Health Science Center at San Antonio conducted a study to monitor how adults living with Type 2 diabetes use current healthcare technology to self-monitor their lifestyles and current health behaviors. Research found that allowing participants to track their behaviors, led to them making healthier lifestyle choices to manage their diabetes. Description: Using self-monitoring technology allows participants to understand the importance of making healthier lifestyle choices and helps to make sense of why certain decisions must be made to control blood glucose levels. A separate study conducted by Omada and Evidation Health also showed a reduction in participants’ A1C levels for those who used these digital chronic care management tools (please see 2nd link below). Implications: Being able to self-manage diabetes via healthcare technology platforms can lower A1C levels, reduce diabetes complications, improve quality of life, and lower medical experiences. Programs like Omada and Evidation Health allow people to improve quantitative and qualitative measures while monitoring their diabetes and making healthier lifestyle choices on their own. Using technology to self-manage diabetes results in healthy lifestyle choices Patients using Omada's diabetes management tool see reduction in A1c levels, according to research How 5G Can Enable Life-Saving Technology Event: (8/27) A recent article in CES Tech updated the progress on 5 companies selected into the latest cohort of Verizon’s 5G First Responder Lab, launched in partnership with Responder Corp. in 2019. The 5G First Responder Labs goal is to empower first responders by delivering the life-saving capabilities they need to serve their communities. The 5 companies accepted to this round using Verizon's 5G Wideband network are Biotricity, Rave Mobile Safety, DispatchHealth, Vuzix, and Visionable. Description: Biotricity is offering a patient-monitoring platform that allows medical professionals to remotely identify potential urgent alerts. Vuzix, whose Blade Edge smart glasses were a CES 2019 Innovation Award honoree, is creating augmented reality smart glasses to connect on-site first responders with experts to receive real-time feedback. Visionable’s collaboration platform will virtually connect medical professionals to provide follow-up care to patients remotely. Implications: As the world faces the COVID-19 pandemic, the spotlight is on health care-related technologies. As 5G technology continues to develop and get rolled-out it will enable greater use of more innovative and powerful virtual and remote care technologies closer to the site of care. This will improve emergency care, broaden access specialists, and enhance care in rural and underserved communities. How 5G Can Enable Life-Saving Technology

  • Uber Forays Into Rx Delivery, Lyra Health Hits $1.1B Valuation & more-The HSB Blog 9/01/20

    Uber Health forays into prescription drug delivery Event: (8/20) Uber and on-demand prescription platform NimbleRx, announced they are entering a partnership in the on-demand prescription drug delivery business. Description: The Uber-NimbleRx partnership comes with big drugstore chains CVS Heath and Walgreens. With almost 30% of people never picking up their prescription medication from the pharmacy, the partnership with Uber allows effective and timely delivery of medications. Nimble has completed over 15,000 deliveries via partnership with Uber Health (currently a HIPAA- secure service with 1,500 partners for non-emergent medical transport). Implications: Uber Direct provides easy delivery of medications which will promote medication adherence. Adults who lack transportation to medical care are much more likely to have chronic conditions, moreover, with absence of receiving medication, their conditions may escalate. NimbleRx offers next-day delivery to 40% of the population in the U.S and same-day delivery to an additonal 30%, with the increase in demand due to the pandemic, the new partnership will work to better meet the needs of patients. Uber Health forays into prescription drug delivery Lyra Health hits $1.1 billion valuation, as Coronavirus boosts need for teletherapy Event: (8/25) Lyra Health, a provider of mental health care benefits for employers became the latest healthcare technology startup to hit unicorn status by raising $110 million in Series D funding at a $1.1 billion valuation. Background: Lyra, which offers an easy-to-use digital platform to connect people with mental health providers, has around 1.5 million members so far, adding more than 800,000 people since the start of the pandemic. Lyra’s solution combines one-on-one video sessions with digital exercises to reinforce cognitive behavioral therapy sessions. Implications: Around one in four U.S. adults suffer from a diagnosable mental health condition. Depression is one of the leading causes of disability worldwide. Because of COVID, economic uncertainty, and conversations around racial injustice, people are suffering from anxiety and depression even more. According to Rock Health, the digital health industry has raised $588M in the first half of 2020, which is 29% more than 2019, 42% more than 2018, and is on track to set annual records for overall funding and number of deals. Lyra health hits $1.1 billion valuation, as Coronavirus boosts need for teletherapy PatientPop raises $50M and adds three to board of directors Event: (8/25) PatientPop, a healthcare tech company trying to automate many of the touch points of doctor-patient interactions, has raised $50 million in Series C funding. Background: PatientPop helps practices attract patients online through a customized website and search engine optimization. It also offers a fully-digital experience with online scheduling, telehealth options and electronic medical record integration. Implications: PatientPop will use these funds to continue to provide practices with the tools they need to enhance patient care in-person and online. Allowing providers to quickly adapt their digital strategy and presence to attract and retain patients, by deploying appropriate technology and tools to successfully operate their practices during COVID, will help maintain and replace volumes lost during the pandemic. PatientPop raises $50M and adds three to board of directors BJC HealthCare's experience-based strategy for digital transformation: Insights from CIO Jerry Fox Event: (8/25) BJC’s healthcare team in St. Louis is working on experience-based strategies for developing digital solutions that will improve health experiences for stakeholders (patients, families, and caregivers). Description: With the growth of COVID and the increase in virtual visits, BJC healthcare partnered with Washington University School of Medicine to transform user experience. This includes improving patient-provider telehealth platforms for scheduling, processing payments, and interactions, targeting patient experience, enhancing workflows that eliminate barriers for clinicians delivering care, and support for non-clinical care givers to enhance productivity and experience. Implications: Curating technology to ensure that stakeholders (clinical and non-clinical) have optimal experience and outcomes has grown as digital care has increased. With the growing use of technology platforms during COVID, expectations are changing and expanding, pushing digital teams to ensure that they are meeting the growing needs of their users. BJC HealthCare's experience-based strategy for digital transformation: Insights from CIO Jerry Fox Tenet California hospitals launch telehealth ER screenings: 5 things to know Event: (8/25) Tenet Health Center Coast, part of Tenet Healthcare, launched a new telehealth emergency room screening resource for patients suspected to have COVID or other medical emergencies, who are unsure of whether to seek medical attention or not. Description: This Tele-ER service helps address concerns and challenges with going to the hospital during the pandemic. Patients can communicate with ER physicians for registration via video conference, smartphone, or computer to assess whether they need to come in for in-person care, diagnostic procedures, labs, or if the visit can be conducted virtually. The service is covered by Medicare. Implications: The availability of this tele-ER platform will have a significant impact on healthcare delivery, especially during this COVID pandemic, where many patients have delayed care due to concerns of visiting healthcare facilities. With reimbursement provided through Medicare and commercial insurance services like this could expand the breadth of telehealth delivery while aiding accessibility of care particularly for seniors who are at risk. Tenet California hospitals launch telehealth ER screenings: 5 things to know USPS service delays are hitting some mail-order pharmacies and telehealth platforms harder than others Event: (8/19) Recent reforms and services changes created by recently appointed Postmaster General Louis Dejoy have led to widespread service delays. These service delays are hurting certain mail-order pharmacies and telehealth platforms which rely on the USPS to fulfill orders given its relative cost-effectiveness to other methods. Description: There have been many service disruptions for telehealth platforms due to recent reforms and administrative changes which have resulted in long-term concerns about prescription drug shipments handled by the USPS. Timely delivery and access to medications are extremely important for Americans especially during the pandemic, in order to avoid hospitalization, unnecessary emergency room visits, and increased costs if there is a need to use different carriers. Implications: Changes in post office policies have created broad service issues for certain telehealth and online pharmacy platforms leading to later than anticipated or complete lack of delivery for platforms relying on first-class mail delivery. These USPS delivery issues have led to service issues, complaints, and replacements or refunds of as much as 5%. This could dramatically increase costs and threaten these companies’ business models as customers turn to other providers for their medications. USPS service delays are hitting some mail-order pharmacies and telehealth platforms harder than others

  • Hazards of Digital Mental Health, Telehealth Visits Skyrocket for Older Adults-The HSB Blog 8/24/20

    The hazards of digital mental health Event: Mobihealthnews examined the lack of scientific evidence backing digital mental health apps, noting “investors and entrepreneurs alike are pouring record time and resources into digital health” including almost $600 million into behavioral health. With the explosive growth in digital mental health services, concerns have arisen due to unclear evidence of whether or not their products actually work. Background: Many digital health companies are introducing products to the market without showing if their solutions work, publishing their raw data or publishing for peer review. This leaves many health professionals uncertain when recommending digital health treatments to patients. This is due in part to the fact that only 18% of psychiatrists use measurement-based care due to lack of time, training, and the sense scales don’t capture the diverse phenotypes of mental illness. Implications: The success of many digital mental health companies is determined by their financials and operation rather than how effective the treatments are for patients Healthcare researchers, clinicians, and technologists have to collaborate and use measurement-based care to ensure there are effective digital mental health products out in the market as care increasingly moves to virtual settings. The hazards of digital mental health Telehealth visits have skyrocketed for older adults, but concerns remain Event: The University of Michigan released its National Poll on Healthy Aging (NPHA) noting in 2019, many older adults expressed at least one serious concern around the usage of telehealth services. Since COVID-19, telehealth has become a much more popular option among older adults due to underlying health risks and closed medical facilities. Background: After states mandated reductions in elective and non-emergency healthcare, the University of Michigan conducted a poll finding that 30% of older adults participated in telehealth services by June 2020. Comfortability in using telehealth services increased by 11%, and privacy concerns have dropped significantly. Older adults have a growing interest in telehealth, but lack experience or access which remain barriers to receiving care. Implications: Many older adults have limited experience and aptitude with digital health technologies and may need additional help to gain comfort with the quality of communication and privacy. Some older adults continue to express concerns about telehealth visits, particularly regarding the quality of care compared to in-person visits and the inability for a physical exam. Until these issues are addressed, some older adults may be hesitant to engage in telehealth visits. Telehealth visits skyrocket for older adults, but concerns remain Large U.S. employers focusing on virtual care, mental health services in 2021 Event: The Business Group on Health published its 2021 Large Employers' Health Care Strategy and Plan Design Survey noting the Covid-19 crisis has caused employers to re-evaluate and expand the benefits offered to their employees. These benefits include virtual mental health and emotional well-being services which are projected to increase in the upcoming year. Background: In the past, employers covered nearly 70% of healthcare benefits for their employees. Due to the increase in virtual health usage, employers are set to expand their virtual health options, offering telehealth services, mental health services, and minor, acute conditions. Additionally, 45% of employers have included mental and behavioral health training for managers to ensure mental health issues are recognized and dealt with during this unprecedented time. Implications: The increase in the use of telehealth services has opened the doors for more virtual solutions with both employees and providers seeing benefits and embracing these solutions. This report reinforces the importance of employee health during the pandemic, noting that with 2021 rapidly approaching, employers should focus on further expanding telehealth platforms and providing additional training on awareness and usage. Business Group on Health Large Employer Healthcare Strategy & Plan Design Survey Uncovering the real value of the benefits you offer Event: A recent article in Benefits Pro, highlighted that employees’ well-being not only improved from utilizing health benefits, but also from being offered health benefits by in effect providing them peace of mind. Citing Fidelity Investments report, “Uncovering the real value of the benefits you offer,” the article pointed out “if 2020 has shown us anything, it’s that this is not a typical year and arguably, we are approaching the most important annual enrollment we will ever experience in our lifetime.” Background: Fidelity’s Health Solutions Group took a more holistic view of value that can guide employers to make more informed decisions on how to improve their benefits offering. In part, they found not all benefits actually have to be used to be effective, and employers offering mental health, life insurance, and remote added value by demonstrating they had the employees’ best interests in mind. HSAs, telemedicine and parental leave, however, need to actually be utilized to improve well-being Implications: Understanding the difference between awareness and utilization of benefits can help employers dig deeper into which benefits they should focus their attention on. One in four companies have changed employee health benefits since the COVID-19 pandemic began in March, complicating the upcoming 2020 annual enrollment period Employee benefits offered vs. used: What's the difference? The “at-home” shift continues to accelerate Event: Salesforce announced they would let employees work from home until August 2021, offering additional benefits to purchase office supplies to work from home and more paid time off. At the same time last week, retailers such as Home Depot, Target, and even digital laggard Kohl’s reported that eCommerce sales came in above expectations. Background: Salesforce CEO Marc Benioff has been one of the most forward-thinking CEOs in terms of COVID, laying out an 8 point plan to deal with COVID and developing the “work.com” website to help companies bring employees back to offices safely. In terms of retail sales, while eCommerce sales have benefitted from COVID lockdowns, many had expected this to begin to level off as a number of states had permitted physical stores to reopen during the quarter (May-July). Implications: The “At-Home” (work at home, shop at home) shift is not slowing down and may in fact be accelerating further solidifying the secular change to a hybrid delivery model of customer engagement (in-store, online, mobile). While some providers are focusing on an “outbound care” delivery model (bringing the care to patients) the vast majority continue to focus on an “inbound care” delivery model, (having patients come to offices, clinics, and physical facilities) and risk missing another paradigm shift. Salesforce will let its employees work from home until August 2021 Earnings roundup: Online sales double for Home Depot

  • Thoughts on the TDOC/LVGO Merger

    On Wednesday August 5th, two of the larger public names in the digital health space, Teledoc (TDOC) and Livongo (LVGO) announced they were merging, while we understand the stated logic behind the merger, we were a bit puzzled by several issues, our thoughts on each of them are below: Timing: there is a tremendous amount of runway for both of these industry-leading companies to grab before they are likely to stunt the growth of the other. No matter how well-executed or how experienced the integration teams, a merger is likely to distract attention from the sales and execution engines of companies with dramatic sales potential +70% est. for LVGO and +40% est. for TDOC. While telehealth has been moving at blinding speed due to COVID we still would expect consolidation of industry leaders when digital health growth begins to slow and applications for the technology begin to narrow. We see no signs whatsoever that this is the case. Valuation: At Tuesday's close TDOC is paying approximately 36x sales for LVGO a very steep price for a company whose stock has already risen over 200% YTD. While telehealth is a large and untapped market (estimated at ~ $100B pre-COVID to as much as $250B in a recent McKinsey estimate post-COVID) and significant amounts of care remain to be moved to digital, the deal is expensive under even the best of assumptions. At 36x sales, the deal would be more expensive than most recent acquisitions in software, which already tend to be expensive, and which we view as the most appropriate comparable. Best of Breed vs. All-In-One: In announcing the merger TDOC noted that the merger would create what amounted to a one-stop-shop for digital health needs, allowing employers and providers to work with numerous disease states and care models. However, our work indicates that about one-third of large employers prefer a best-of-breed approach to employer benefits and have found superior results from their plans. Given the lackluster results that many employers have gotten from their health benefits, our belief is that the trend will be towards this approach as opposed to an all-in-one solution. Go-to-Market Strategy: Although LVGO has been working to increase direct selling efforts, historically they have gone to market via channel partners and resellers such as Caremark, Express Scripts and Anthem, etc. (for YE 2019 over 60% of the company’s revenues came from these channels). TDOC has traditionally used large health plans as it’s distribution network such as Aetna and BCBS. We see it as highly disruptive to continuity of sales and sales management to attempt to modify (even modestly) growth strategy in the midst of a hyper-growth market. This combined with the fact that successful sales and marketing people will be highly sought after given how hot the market is, these types of changes could end up impacting growth (our understanding is that RSU’s vested 6 months after the IPO or with a change in control). Strategic positioning: While we believe that the deal makes sense for TDOC, as we see the basic delivery of telehealth being commoditized over time, there is likely more risk for LVGO based on their competitive positioning and the difficulty recreating the chronic care delivery model they have created. Given the opening that the declaration of a public health emergency (PHE) created for the use of non-HIPAA compliant vehicles like Zoom, Google Hangout, Microsoft Teams, etc.over time we see potential for other large video platforms to partner with/usurp the provision of basic connectivity. In addition, over time we expect video technology to change so that patients will no longer have to install separate telehealth apps on devices increasing ease of use and substitution. Consequently, we expect a stand-alone LVGO with a focus on chronic disease to have greater competitive advantage than TDOC. This is evidenced by LVGO’s sales growth rate in the 50% range vs.TDOC’s organic sales guidance in the 20%-30% range. Rollup risk: The LVGO acquisition will mark TDOC’s 11th acquisition since 2013 and the 2nd this year (recall TDOC agreed to buy InTouch in January 2020). First, as noted above, given the red-hot nature of the digital health market we have no doubt that both teams are already working all out to capture as much share as possible, a fact that is further compounded by the demands of COVID (physician shortages, supply chain issues, etc). When combined with the difficulties inherent in managing the merging of any two organizations, no matter how good or experienced the integration teams are, leads us to believe there is more downside than upside risk. In addition, we see roll-ups in emerging industries and in healthcare in particular as a difficult way to make money. While there are exceptions (i.e, Quest), they tend to be just that, exceptions, rather than the rule (i.e, physician practice management). We find this to be the case, particularly as roll-ups grow in size, with an early study by Booz & Company finding that once roll-ups got past $500M in value they often lose value.

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