Fortnightly Healthtech Update #29

I came across Tytocare a few years ago and lost track of it. Now, University of Miami hospital is using it for remote monitoring of discharged patients. It’s quite an elegant, yet simple, telehealth solution, enabling loved ones to help in collecting diagnostic information at home. See it in action here. My only observation is Tytocare should sharpen it’s demo script. Not only does mom avoid a late night ER visit, but she most likely avoids a large bill too.

Gabbi, healthcare advice for women, by women.

Docs say “Reimbursement is the key” to growing remote patient monitoring. Which is stating the obvious really, because nobody is going to keep working at something they don’t get paid for. (Side note, it troubles me to keep seeing articles that say the pandemic is the catalyst for the telehealth revolution. Wrong. The pandemic AND providers getting paid for using telehealth is the catalyst). Anyway, back to the article…What is a tad discouraging is that the word “reimbursement” appears in the article four times. The word “value” – as in value-based care – zero times. So, the thinking is still very much focused on getting paid for doing stuff, not for delivering better outcomes at lower cost. We’re not going to get the best from telehealth if we see it as just another way to deliver healthcare as usual. It needs to be more than that. It needs to be a way to deliver better outcomes at lower cost.

Related to that, a UnitedHealth study found that primary care docs paid by capitation outperformed docs paid using traditional fee-for-service on quality metrics. Capitation with quality metrics is pretty much value-based care by another name. So value-based care can get us where we need to go, we just need to get out of first gear already.

And related to that….With a focus on value-based primary care for Medicare patients, Oak Street health IPO’s for $328m. Notably, the article illustrates the advantage of the value-based care model for both providers and patients. For Oak Street, it’s revenue held steady during the pandemic because it’s not dependent on appointments to bring in the cash. Unlike traditional fee for service, it’s subscription healthcare. So, as appointments dropped, Oak Street was able to use vans that were normally used for patient transport for food deliveries to its population instead. Which is exactly what it’s population needed to stay healthy at that time. It’s an all too rare example of aligned incentives in healthcare. Another, more expansive article here. It’s what value-based primary care looks like in my perfect world. 

As opposed to….docs are partly dependent on patients to buy their own devices for remote patient monitoring. In a world where providers are at financial risk for the health of their population – such as an ACO – this wouldn’t happen. In that world, providers would invest in the devices directly  for its patients to avoid acute care costs further down the road. In the fee for services world, that’s less likely to happen because there is no financial incentive to do so.

PhysIQ is on a bit of a tear right now. In May, we saw a contract with the DoD, now it’s part of a plan to monitor discharged patients by NorthShore University HealthSystem.

Digital health continues to grow into mental health as well as physical: Quartet Health is working with SilverCloud Health to use it’s digital cognitive behavioral therapy tools. Also noteworthy, Ginger just added a series D funding round for $50m.

And a sign that telehealth is moving beyond the early adopter phase, Teledoc acquires Livongo. Interesting to wonder if this would have happened without the kick to telehealth from COVID. But investors were less than thrilled, in the short-term at least.

One Medical, a direct primary care startup, beats estimates, and will also offer telehealth only to enter new markets. More on the business model here.

There are a few companies out there developing radar-based vital sign monitoring. Circadia HealthNeteera, and MIT’s Emerald device to name a few. But apparently Google has papers lodged at the European patent office for something similar specifically for babies

Where Apple goes, Samsung often tends to follow: Samsung gets FDA clearance for EKG tracking on its watch.

New to me, smart apparel company Formsense looks for COVID-19 applications.

Lessons learned from a 15 year old ACO type model in Germany. One quote which you think would apply well to the US: “The message of taking responsibility for their own health resonates with communities that value self-reliance.”

More telehealth goodness: AHA study shows that telehealth home monitoring for infants that required cardiac surgery reduced mortality by 40%.