Pharmaceutical companies should do more to transfer vaccine technology to prevent the poorest countries falling behind in the distribution of Covid-19 vaccines, according to an expert.
The warning came from Dag-Inge Ulstein, the co-chair of the global council trying to speed up access to Covid vaccines for the world’s poor, known as the Act (Access to Covid-19 Tools) Accelerator. Ulstein, Norway’s international development minister, oversees the drive to ensure vaccines reach the poor – the Covax programme.
Increased transparency on the vaccine deals, including the number of vaccines, the delivery date and price.
Full value for money on the collective funds that the world has given to purchase these vaccines for the world’s poorest so they are purchased at cost price, and not to make a profit.
Increased production of vaccines can be boosted internationally by technology transfer and sharing by pharma companies to local and regional manufacturing firms.
Interoperability is a big discussion in health care, with
new regulations requiring interoperability for patient data. Most approaches
follow the typical RESTful API approach that has become the standard method for
data exchange. Yet Health Level Seven (HL7), with its new Fast Healthcare Interoperability
Resources (FHIR) standard for the electronic transfer of health data, is
leading to a rash of implementations that, to date, are not solving core interoperability
issues.
Data is still insecure, users can’t govern their own health
records, and the need for multiple APIs for different participants with
different rights (human and machine) in the network is adding unneeded
expenditures to an already burdened healthcare system. The way out is not to
add more middleware, but to upgrade the basic tools of interoperability in a
way that finally brings healthcare
technology into the 21st century.
A Timely Policy
Doctors, hospitals, pharmacists, insurance providers,
outpatient treatment centers, labs and billing companies are just a few of the
parties that comprise the overcomplicated U.S. healthcare system.
In digitizing medical files, as required by the 2009 Health
Information Technology for Economic and Clinical Health (HITECH) Act, providers
have adopted whatever solution was most convenient. This has led to the mess of interoperability
issues that HL7 seeks to remedy with FHIR.
Existing Electronic Medical Records
(EMR) systems do not easily share data. Best case, patients have to sign
off to share data with two incompatible systems. Worst case, information must
be turned into a physical CD or document to follow the patient between
providers. Data security is also notoriously poor. Hackers prioritized the healthcare sector as their main target in 2019; breach
costs exceeded $17.7 billion.
The New Infrastructure Rush
When common formats, by way of FHIR and HL7, provided
standards and solutions to empower global health data interoperability, the
industry erupted into a flurry of activity. Thousands of healthcare databases
are now being draped in virtual construction tarps and surrounded by digital
scaffolding.
Building a new, interoperable data ontology for the entire
healthcare system is a massive undertaking. For one, 80% of hospital data is
managed using the cryptic, machine-language HL7 Version 2. Most of the rest
uses the inefficient, dated XML data format. HL7 FHIR promotes the use of more
modern data syntaxes, like JSON and RDF (Turtle).
Secondly, databases have no notion of the new FHIR schema.
Armies of developers must build frameworks and middleware to facilitate interoperability.
This is why Big Tech incumbents including Google Cloud Healthcare, Amazon AWS
and Microsoft for Healthcare are jumping into the fray with their own
solutions.
The outcome, once HL7’s 22 resources are fully normative, will
be seamless information sharing, electronic notifications, and collaboration
between every player in the giant web of patients, providers, labs, and
middlemen. But it will come at a steep cost in the current traditionally RESTful
API-based manner that is being broadly pursued.
The Problem with APIs
The new scaffolding is expensive, takes data control away
from patients, and is not inherently secure. The number of unique APIs required
to support the access, rights and disparate user base in the healthcare network
are the reason.
Interoperability requires a common syntax and “language” to
enable databases to talk to each other. The average traditional API costs up to
$30,000 to build, plus half that cost to manage annually. That is not to
mention the cost to integrate and secure each API. A small healthcare
organization with only 10 APIs faces costs of $450,000 annually for basic API
services.
When you consider that most big healthcare organizations will
need to connect thousands of APIs, HL7’s interoperability schema really is the
best way forward. The traditional API tooling to manage the interoperability of
the well-framed data structures, however, is the problem.
Moreover, the patient, the rightful owner of their own
health record, still doesn’t have the ability to govern their own data. Because
change only happens in the database itself, the manager of the database, not
the patient, controls the data within.
In the best case, this puts an additional burden on patients
to give explicit permission every time health records move between providers.
In the worst case, a provider sees an entire medical history without a
patient’s consent–your podiatrist seeing your psychiatric records, for
example.
Finally, each API enables one data store to talk to the
next, opening opportunities for bad actors to make changes to databases from
the outside. The firewalls that protect databases and networks are penetrable,
and user profiles are sometimes created outside of the database itself, making
it possible to expose, steal and change data from outside the database.
In that light, HL7 is paving the wrong road with good
intentions. But there is another way.
Semantic Standards and Blockchain to the Rescue
If you eliminate data APIs, secure interoperability, with
data governance fully in the hands of the patient, becomes possible. Healthcare
data silos will be replaced with a dynamic, trusted and shared data network
with privacy and security directly baked in. The solution involves adding
semantic standards for full interoperability, blockchain for data governance
and data-centric security.
Semantic standards, such as RDF formatting and SPARQL
queries, let users quickly and easily gain answers from multiple databases and
other data stores at once. Relational databases, the ones currently in use in healthcare,
are all formatted differently, and need API middleware to talk to one another.
Accurate answers are not guaranteed. Semantic standards, on the other hand,
create a common language between all databases. Instead of untangling the
mismatched definitions and formatting inevitable with relational databases,
doctors’ offices, for example, could easily pull in pertinent patient records,
insurance coverage, and the latest research on diseases.
Patients, for their part, would use blockchain to regain control
of their data. Patients would be able to turn on aspects of their data to
specific caregivers, instead of relinquishing control to database business
managers, as is currently the case. Your podiatrist, in other words, will not
be able to see your psychiatric records unless you choose to share them.
The data ledger, which lives on the blockchain, will contain
instructions as to who can update (writer new records on) the ledger, who can
read it, and who can make changes. All changes are controlled by private-key
encryption that is in the hands of the patient; only those with authorization
can see select histories of health data (or, as in the case of an ER doctor,
entire histories, with permission).
Data security is controlled in the data layer itself,
instead of through middleware such as a firewall. Data can be shared without
API, thanks to those semantic standards, and data are natively embedded with
security in the blockchain. Compliance, governance, security and data
management all become easier. Data cannot be stolen or manipulated by an
outside party, the way it commonly is by healthcare hackers today.
The interoperability conundrum, in other words, is solved.
Fewer APIs means fewer security vulnerabilities; a common, semantic standard
eliminates confusion and minimizes mistakes. Blockchain puts patients in
control of who sees what parts of their health records. Eliminating the need
for API middleware also saves tens of thousands of dollars, at a minimum.
About Brian Platz
Brian is the Co-CEO and Co-Chairman of Fluree, PBC, a decentralized app platform that aims to remodel how business applications are built. Before establishing Fluree, Brian was the co-founder of SilkRoad technology which expanded to over 2,000 customers and 500 employees in 12 international offices.
The combination of Teladoc Health and Livongo creates a
global leader in consumer-centered virtual care. The combined company is
positioned to execute quantified opportunities to drive revenue synergies of
$100 million by the end of the second year following the close, reaching $500
million on a run-rate basis by 2025.
Price: $18.5B in value based on each share of Livongo
will be exchanged for 0.5920x shares of Teladoc Health plus cash consideration
of $11.33 for each Livongo share.
Siemens Healthineers Acquires Varian Medical
On August 2nd, Siemens Healthineers acquired
Varian Medical for $16.4B, with the deal expected to close in 2021. Varian is a
global specialist in the field of cancer care, providing solutions especially
in radiation oncology and related software, including technologies such as
artificial intelligence, machine learning and data analysis. In fiscal year 2019,
the company generated $3.2 billion in revenues with an adjusted operating
margin of about 17%. The company currently has about 10,000 employees
worldwide.
Price: $16.4 billion in an all-cash transaction.
Gainwell to Acquire HMS for $3.4B in Cash
Veritas Capital (“Veritas”)-backed Gainwell Technologies (“Gainwell”),
a leading provider of solutions that are vital to the administration and
operations of health and human services programs, today announced that they
have entered into a definitive agreement whereby Gainwell will acquire HMS, a technology, analytics and engagement
solutions provider helping organizations reduce costs and improve health
outcomes.
Price: $3.4 billion in cash.
Philips Acquires Remote Cardiac Monitoring BioTelemetry for $2.8B
Philips acquires BioTelemetry, a U.S. provider of remote
cardiac diagnostics and monitoring for $72.00 per share for an implied
enterprise value of $2.8 billion (approx. EUR 2.3 billion). With $439M in
revenue in 2019, BioTelemetry annually monitors over 1 million cardiac patients
remotely; its portfolio includes wearable heart monitors, AI-based data
analytics, and services.
Price: $2.8B ($72 per share), to be paid in cash upon
completion.
Hims & Hers Merges with Oaktree Acquisition Corp to Go Public on NYSE
Telehealth company Hims & Hers and Oaktree Acquisition Corp., a special purpose acquisition company (SPAC) merge to go public on the New York Stock Exchange (NYSE) under the symbol “HIMS.” The merger will enable further investment in growth and new product categories that will accelerate Hims & Hers’ plan to become the digital front door to the healthcare system
Price: The business combination values the combined
company at an enterprise value of approximately $1.6 billion and is expected to
deliver up to $280 million of cash to the combined company through the
contribution of up to $205 million of cash.
SPAC Merges with 2 Telehealth Companies to Form Public
Digital Health Company in $1.35B Deal
Blank check acquisition company GigCapital2 agreed to merge with Cloudbreak Health, LLC, a unified telemedicine and video medical interpretation solutions provider, and UpHealth Holdings, Inc., one of the largest national and international digital healthcare providers to form a combined digital health company.
Price: The merger deal is worth $1.35 billion, including
debt.
WellSky Acquires CarePort Health from Allscripts for
$1.35B
WellSky, global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquireCarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.
Price: $1.35 billion represents a multiple of greater
than 13 times CarePort’s revenue over the trailing 12 months, and approximately
21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12 months.
Waystar Acquires Medicare RCM Company eSolutions
On September 13th, revenue cycle management
provider Waystar acquires eSolutions, a provider of Medicare and Multi-Payer revenue
cycle management, workflow automation, and data analytics tools. The
acquisition creates the first unified healthcare payments platform with both
commercial and government payer connectivity, resulting in greater value for
providers.
Radiology Partners (RP), a radiology practice in the U.S., announced a definitive agreement to acquire MEDNAX Radiology Solutions, a division of MEDNAX, Inc. for an enterprise value of approximately $885 million. The acquisition is expected to add more than 800 radiologists to RP’s existing practice of 1,600 radiologists. MEDNAX Radiology Solutions consists of more than 300 onsite radiologists, who primarily serve patients in Connecticut, Florida, Nevada, Tennessee, and Texas, and more than 500 teleradiologists, who serve patients in all 50 states.
Price: $885M
PointClickCare Acquires Collective Medical
PointClickCare Technologies, a leader in senior care technology with a network of more than 21,000 skilled nursing facilities, senior living communities, and home health agencies, today announced its intent to acquireCollective Medical, a Salt Lake City, a UT-based leading network-enabled platform for real-time cross-continuum care coordination for $650M. Together, PointClickCare and Collective Medical will provide diverse care teams across the continuum of acute, ambulatory, and post-acute care with point-of-care access to deep, real-time patient insights at any stage of a patient’s healthcare journey, enabling better decision making and improved clinical outcomes at a lower cost.
Price: $650M
Teladoc Health Acquires Virtual Care Platform InTouch
Health
Teladoc Health acquires InTouch Health, the leading provider of enterprise telehealth solutions for hospitals and health systems for $600M. The acquisition establishes Teladoc Health as the only virtual care provider covering the full range of acuity – from critical to chronic to everyday care – through a single solution across all sites of care including home, pharmacy, retail, physician office, ambulance, and more.
Price: $600M consisting of approximately $150 million
in cash and $450 million of Teladoc Health common stock.
AMN Healthcare Acquires VRI Provider Stratus Video
AMN Healthcare Services, Inc. acquires Stratus Video, a leading provider of video remote language interpretation services for the healthcare industry. The acquisition will help AMN Healthcare expand in the virtual workforce, patient care arena, and quality medical interpretation services delivered through a secure communications platform.
Price: $475M
CarepathRx Acquires Pharmacy Operations of Chartwell from
UPMC
CarepathRx, a leader in pharmacy and medication management
solutions for vulnerable and chronically ill patients, announced today a
partnership with UPMC’s Chartwell subsidiary that will expand patient access to
innovative specialty pharmacy and home infusion services. Under the $400M
landmark agreement, CarepathRx will acquire the
management services organization responsible for the operational and strategic
management of Chartwell while UPMC becomes a strategic investor in CarepathRx.
Price: $400M
Cerner to Acquire Health Division of Kantar for $375M in
Cash
Cerner announces it will acquire Kantar Health, a leading
data, analytics, and real-world evidence and commercial research consultancy
serving the life science and health care industry.
This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.
Price: $375M
Cerner Sells Off Parts of Healthcare IT Business in
Germany and Spain
Cerner sells off parts of healthcare IT business in Germany and Spain to Germany company CompuGroup Medical, reflecting the company-wide transformation focused on improved operating efficiencies, enhanced client focus, a refined growth strategy, and a sharpened approach to portfolio management.
Price: EUR 225 million ($247.5M USD)
CompuGroup Medical Acquires eMDs for $240M
CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide. With
this acquisition, the US subsidiary of CGM significantly broadens its position
and will become the top 4 providers in the market for Ambulatory Information
Systems in the US.
Price: $240M (equal to approx. EUR 203 million)
Change Healthcare Buys Back Pharmacy Network
Change
Healthcarebuys
back pharmacy unit eRx Network
(“eRx”), a leading provider of comprehensive, innovative, and secure
data-driven solutions for pharmacies. eRx generated approximately $67M in
annual revenue for the twelve-month period ended February 29, 2020. The
transaction supports Change Healthcare’s commitment to focus on and invest in
core aspects of the business to fuel long-term growth and advance innovation.
Walmart acquires CareZone, a San Francisco, CA-based smartphone
service for managing chronic health conditions for reportedly $200M. By
working with a network of pharmacy partners, CareZone’s concierge services
assist consumers in getting their prescription medications organized and
delivered to their doorstep, making pharmacies more accessible to individuals
and families who may be homebound or reside in rural locations.
Verisk, a data
analytics provider, announced today that it has acquiredFranco Signor, a Medicare Secondary Payer
(MSP) service provider to America’s largest insurance carriers and employers.
As part of the acquisition, Franco Signor will become part of Verisk’s Claims
Partners business, a leading provider of MSP compliance and other analytic
claim services. Claims Partners and Franco Signor will be combining forces to
provide the single best resource for Medicare compliance.
Price: $160M
Rubicon Technology Partners Acquires Central Logic
Private equity firm Rubicon Technology Partners acquires
Central Logic, a provider of patient orchestration and tools to accelerate
access to care for healthcare organizations. Rubicon will be aggressively driving Central Logic’s
growth with additional cash investments into the business, with a focus
on product innovation, sales expansion, delivery and customer support, and
the pursuit of acquisition opportunities.
Anne Davis, Director of Quality Programs & Medicare Strategy at HMS
A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and freeing up resources for providers to treat the most critical patients. The acceptance of telehealth and expansion of covered services for the senior population demonstrate that this technology will endure long after COVID-19 subsides.
Prior to the pandemic, just 11% of Americans utilized telehealth compared to 46% so far this year, and virtual healthcare interactions are expected to top 1 billion by year’s end. While the technology has been a life-saver for many, usage depends heavily on the availability of audio-video capabilities, internet access, and technological prowess – potentially leaving vulnerable patients behind.
Seniors Face Physical, Technical and Socioeconomic Barriers to Telehealth
Despite telehealth’s surge, there is growing concern that the rapid shift to digitally delivered care is leaving seniors behind. Telehealth is not inherently accessible for all and with many practices transitioning appointments online, it threatens to cut older adults off from receiving crucial medical care. This is a significant concern, considering older adults account for one-quarter of physician office visits in the United States and often manage multiple conditions and medications, and have a higher rate of disability. This puts an already vulnerable population at a higher risk of severe complications from COVID-19.
Research published recently in JAMA Internal Medicine found that more than a third of adults over age 65 face potential difficulties accessing their doctor through telehealth. Obstacles include familiarity using mobile devices, troubleshooting technical issues that arise, managing hearing or vision impairments, and dealing with cognitive issues like dementia. Many of these difficulties stem from the natural aging process; it is imperative for provider organizations employing telehealth and telehealth vendors to improve offerings that consider vision, hearing, and speaking loss for this population.
While barriers associated with aging are a key factor within the senior population, perhaps the greatest challenges in accessing telehealth are socioeconomic. The rapid shift to digital delivery of care may have left marginalized populations without access to the technological tools needed to access care digitally, such as high-speed internet, a smartphone or a computer.
According to the JAMA study, low-income individuals living in remote or rural locations faced the greatest challenges in accessing telehealth. A second JAMA study, also released this summer indicated that “the proportion of Medicare beneficiaries with digital access was lower among those who were 85 or older, were widowed, had a high school education or less, were Black or Hispanic, received Medicaid, or had a disability.”
These socioeconomic factors are systemic issues that existed prior to the pandemic, and the crisis-driven acceleration of telehealth has magnified these pre-existing challenges and widened racial and class-based disparities. Recent initiatives at the federal level, such as the FCC’s rural telehealth expansion task force, are a step in the right direction, though more sustained action is needed to address additional socioeconomic challenges that are deeply rooted within the healthcare system.
Fortunately, Telehealth Hurdles Can Be Overcome
Recognizing that telehealth isn’t a “one-size fits all” solution is the first step towards addressing the barriers that disproportionately impact seniors and work is needed on multiple levels. Telemedicine consults are impossible without access to the internet, so the first step is to provide and expand access to broadband and internet-connected devices. With more than 15% of the country’s population living in rural areas, expanding broadband access for these individuals is especially crucial. In addition, older adults in community-based living environments need greater access to public wi-fi networks.
Access to mobile and other internet-connected devices is also essential. Products designed with large fonts and icons, closed captioning, and easy set-up procedures may be easier for older adults to use. For example, GrandPad is a tablet designed specifically for seniors and has an intuitive interface that includes basic video calling, enabling seniors to virtually connect with their caregivers.
To address affordability, the Centers for Medicaid and Medicare Services (CMS) allowed for mid-year benefit changes in 2020 to allow for payment or provision of mobile devices for telehealth. Many Medicare Advantage organizations are enhancing plans’ provisions of telehealth coverage and devices for 2021.
In addition to increasing access to broadband and internet-connected devices, providing seniors with proper educational resources is another crucial step. Even if older adults are open to using technology for telehealth visits, many will need additional training. Healthcare organizations may want to connect older patients with community-based technology training programs. Some programs take a multi-generational approach, pairing younger instructors with older students.
For example, Papa is an on-demand service that pairs older adults with younger ‘Papa Pals’ who provide companionship and assistance with tasks such as setting up a new smartphone or tablet.
From a socioeconomic perspective, careful consideration is needed to address the concerns that telehealth may reinforce systemic biases and widen health disparities. Providers may be less conscious of systemic bias toward patients based on race, ethnicity, or educational status.
In turn, providers must address implicit bias head-on, such as offering workplace training and incorporating evidence-based tools to adequately measure and address health disparities. This includes pushing for policies that enable widespread broadband access funding to better connect communities in need.
Health plans can support expanded access to care through benefit design, reducing costs for plan members. To match members and patients with the right resources and assistance, health plans and providers should launch outreach campaigns that are segmented by demographic group. Outreach initiatives could include assessments to determine each person’s ability and comfort level with telehealth.
The Path Forward
Without question, telehealth is playing a central role in delivering care during the current pandemic, and many of its long-touted benefits have been accentuated by the current demand. Telehealth, along with other digital monitoring technologies, have the potential to address several barriers to care for seniors and other vulnerable populations for whom access to in-person care may not be viable, such as those based in remote locations or with mobility issues.
In the post-pandemic era, telehealth can provide greater access and convenience, but if not implemented carefully, the permanent expansion of telehealth may worsen health disparities. Careful consideration and collaboration will be essential in embracing the value of telehealth while mitigating its inherent risks.
If implemented correctly, telehealth can provide continued access to care for our vulnerable aging population and can significantly improve care as well. Enhancing the ability to connect with healthcare providers anytime, anywhere can give seniors the freedom to gracefully age in place.
About Anne Davis
Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS, a healthcare technology, analytics, and engagement solutions company, where she’s focused on the company’s Population Health Management product portfolio.
Each year, Adverse Drug Events (ADE) account for nearly 700,000 emergency department visits and 100,000 hospitalizations in the US alone. Nearly 5 percent of hospitalized patients experience an ADE, making them one of the most common types of inpatient errors. What’s more, many of these instances are hard to discover because they are never reported. In fact, the median under-reporting rate in one meta-analysis of 37 studies was 94 percent. This is especially problematic given the negative consequences, which include significant pain, suffering, and premature death.
While healthcare providers and pharmaceutical companies conduct clinical trials to discover adverse reactions before selling their products, they are typically limited in numbers. This makes post-market drug safety monitoring essential to help discover ADE after the drugs are in use in medical settings. Fortunately, the advent of electronic health records (EHR) and natural language processing (NLP) solutions have made it possible to more effectively and accurately detect these prevalent adverse events, decreasing their likelihood and reducing their impact.
Not only is this important for patient safety, but also from a business standpoint. Pharmaceutical companies are legally required to report adverse events – whether they find out about them from patient phone calls, social media, sales conversations with doctors, reports from hospitals, or any other channel. As you can imagine, this would be a very manual and tedious task without the computing power of NLP – and likely an unintentionally inaccurate one, too.
The numbers reflect the importance of automated NLP technology, too: the global NLP in healthcare and life sciences market size is forecasted to grow from $1.5 billion in 2020 to $3.7 billion by 2025, more than doubling in the next five years. The adoption of prevalent cloud-based NLP solutions is a major growth factor here. In fact, 77 percent of respondents from a recent NLP survey indicated that they use at least one of the four major NLP cloud providers, Google is the most used. But, despite their popularity, respondents cited cost and accuracy as key challenges faced when using cloud-based solutions for NLP.
It goes without saying that accuracy is vital when it comes to matters as significant as predicting adverse reactions to medications, and data scientists agree. The same survey found that more than 40 percent of all respondents cited accuracy as the most important criteria they use to evaluate NLP solutions, and a quarter of respondents cited accuracy as the main criteria they used when evaluating NLP cloud services. Accuracy for domain-specific NLP problems (like healthcare) is a challenge for cloud providers, who only provide pre-trained models with limited training and tuning capabilities. This presents some big challenges for users for several reasons.
Human language very contexts- and domain-specific, making it especially painful when a model is trained for general uses of words but does not understand how to recognize or disambiguate terms-of-art for a specific domain. In this case, speech-to-text services for video transcripts from a DevOps conference might identify the word “doctor” for the name “Docker,” which degrades the accuracy of the technology. Such errors may be acceptable when applying AI to marketing or online gaming, but not for detecting ADEs.
In contrast, models have to be trained on medical terms and understand grammatical concepts, such as negation and conjunction. Take, for example, a patient saying, “I feel a bit drowsy with some blurred vision, but am having no gastric problems.” To be effective, models have to be able to relate the adverse events to the patient and specific medication that caused the aforementioned symptoms. This can be tricky because as the previous example sentence illustrates, the medication is not mentioned, so the model needs to correctly infer it from the paragraphs around it.
This gets even more complex, given the need for collecting ADE-related terms from various resources that are not composed in a structured manner. This could include a tweet, news story, transcripts or CRM notes of calls between a doctor and a pharmaceutical sales representative, or clinical trial reports. Mining large volumes of data from these sources have the power to expose serious or unknown consequences that can help detect these reactions. While there’s no one-size-fits-all solution for this, new enhancements in NLP capabilities are helping to improve this significantly.
Advances in areas such as Named Entity Recognition (NER) and Classification, specifically, are making it easier to achieve more timely and accurate results. ADE NER models enable data scientists to extract ADE and drug entities from a given text, and ADE classifiers are trained to automatically decide if a given sentence is, in fact, a description of an ADE. The combination of NER and classifier and the availability of pre-trained clinical pipeline for ADE tasks in NLP libraries can save users from building such models and pipelines from scratch, and put them into production immediately.
In some cases, the technology is pre-trained with tuned Clinical BioBERT embeddings, the most effective contextual language model in the clinical domain today. This makes these models more accurate than ever – improving on the latest state-of-the-art research results on standard benchmarks. ADE NER models can be trained on different embeddings, enabling users to customize the system based on the desired tradeoff between available compute power and accuracy. Solutions like this are now available in hundreds of pre-trained pipelines for multiple languages, enabling a global impact.
As we patiently await a vaccine for the deadly Coronavirus, there have been few times in history in which understanding drug reactions are more vital to global health than now. Using NLP to help monitor reactions to drug events is an effective way to identify and act on adverse reactions earlier, save healthcare organizations money, and ultimately make our healthcare system safer for patients and practitioners.
About David Talby
David Talby, Ph.D., MBA, is the CTO of John Snow Labs. He has spent his career making AI, big data, and data science solve real-world problems in healthcare, life science, and related fields. John Snow Labs is an award-winning AI and NLP company, accelerating progress in data science by providing state-of-the-art models, data, and platforms. Founded in 2015, it helps healthcare and life science companies build, deploy, and operate AI products and services.
– Cerner is striking a deal with patient communication
hub company WELL Health to change its patient communication technology for its
provider customers.
– Through Cerner’s HealtheLife, the new capabilities will
pull from a myriad of systems and apps to help improve communication and reduce
administrative time for clinicians and staff.
Cerner Corporation, a global health care technology company, today announced new capabilities designed to take the interaction between clinicians and patients beyond email to text message conversations, helping solve for a gap in communication in health care. The new features, in collaboration with WELL Health Inc. and to be integrated into Cerner’s patient portal, are designed to help improve patients’ engagement with clinicians through intelligent and automated communication.
New capabilities will unify and automate previously
disjointed communications, enhance patient engagement, and save clinicians time
Through Cerner’s HealtheLife, the new capabilities will
pull from a myriad of systems and apps to help improve communication and reduce
administrative time for clinicians and staff. Organizations can use the new
automation features to deliver critical health information, send flu shot
reminders, reschedule appointments, schedule virtual visits and prompt patients
to set up needed medical transportation. Additional benefits are expected to:
– Improve patient satisfaction, retention and acquisition
through timely communication and reduced hold queues, missed calls and email
delays.
– Save time spent scheduling and communicating with patients
by using automated workflows that reply and route based on patient responses.
– Reduce time spent on billing and payment collections by
auto-notifying patients when new bills are ready for payment.
“WELL Health is focused on what patients expect today – near real-time, personalized communication on their terms. We aim to move beyond the days of playing phone tag, leaving voicemails and expecting patients to continue showing up,” said Guillaume de Zwirek, CEO and founder, WELL Health. “WELL Health supports patients to text their health care provider like they would text a friend. For a provider’s staff, WELL Health is designed to unify and automate disjointed communications across the organization, helping to reduce unnecessary stress and limiting potential errors.”
Why It Matters
More than 5 billion people spend nearly
a quarter of their day on their mobile phones. In fact, in the last few years,
the number of active
cellphone subscriptions exceeded the number of people on Earth. Giving
patients the same person-centric digital experience in health care as they
receive from other industries has become increasingly important. Teaming with
WELL Health, Cerner will make technology more useable for health systems and
patients by meeting consumers where they are spending their time.
“Cerner is committed to making it easier for providers to create the engaging, comprehensive health care experiences that patients expect and deserve,” said David Bradshaw, senior vice president, consumer and employer solutions, Cerner. “By bringing patient data from different systems and streamlining in one unified view, we are strengthening our clients’ ability to build meaningful relationships with patients through a convenient, digital experience that has become a part of everyday life.”
– The World Health Organization (WHO) and the Wikimedia
Foundation forms collaboration to expand public access to reliable, trusted information
about COVID-19.
– The collaboration is part of a shared commitment from
both organizations to ensure everyone has access to critical public health
information surrounding the global coronavirus pandemic.
The World Health Organization
(WHO) and the Wikimedia Foundation, the nonprofit that administers
Wikipedia, announced today a collaboration to expand the public’s access to the
latest and most reliable information about COVID-19. The
collaboration will make trusted, public health information available
under the
Creative Commons Attribution-ShareAlike license at a time when
countries face continuing resurgences of COVID-19 and
social stability increasingly depends on the public’s shared understanding of
the facts.
Through the collaboration, people everywhere will be able to
access and share WHO infographics, videos, and other public health assets
on Wikimedia
Commons, a digital library of free images and other multimedia. With
these new freely-licensed resources, Wikipedia’s more than 250,000 volunteer
editors can also build on and expand the site’s COVID-19 coverage,
which currently offers more than 5,200 coronavirus-related articles in 175
languages. This WHO content will also be translated across national and
regional languages through Wikipedia’s vast network of global volunteers.
Why It Matters
By making verified information about the pandemic available
to more people on one of the world’s most-visited knowledge resources, the
organizations aim to help curb this infodemic and ensure everyone can access
critical public health information.
“Access to information is essential to healthy communities and should be treated as such,” said Katherine Maher, CEO at the Wikimedia Foundation. “This becomes even more clear in times of global health crises when information can have life-changing consequences. All institutions, from governments to international health agencies, scientific bodies to Wikipedia, must do our part to ensure everyone has equitable and trusted access to knowledge about public health, regardless of where you live or the language you speak.”
– Health technology leader WellSky has agreed to acquire
CarePort Health to power coordinated care transitions for acute and post-acute
care patients for $1.35B.
– By providing end-to-end visibility across the
continuum, WellSky and CarePort can improve outcomes, lower costs, and increase
patient satisfaction.
WellSky, a global health, and community care technology company, announced today that it has entered into a definitive agreement with Allscripts to acquireCarePort Health (“CarePort”), a Boston, MA-based care coordination software company that connects acute and post-acute providers and payers.
Financial Details
The agreed sale price of $1.35 billion represents a multiple
of greater than 13 times CarePort’s revenue over the trailing 12 months, and
approximately 21 times CarePort’s non-GAAP Adjusted EBITDA over the trailing 12
months. CarePort is included in Allscripts Data, Analytics and Care Coordination
reporting segment and represents approximately 6% of Allscripts consolidated
revenues. Reference should be made to the Allscripts quarterly earnings reports
and supplemental financial data for a reconciliation of non-GAAP Adjusted
EBITDA. William Blair and J.P. Morgan Securities, LLC acted as financial
advisors to Allscripts in connection with the sale of CarePort.
Acquisition Enhances Care Coordination Across Acute,
Post-Acute Continuum
As part of the acquisition, WellSky and CarePort will facilitate effective patient care transitions across the continuum — driving better outcomes for patients, providers, and payers. With the addition of CarePort, WellSky is uniquely positioned to manage the acute care discharge process, track patients across post-acute care settings, apply patient and population-level analytics, and support EMR-based care protocols.
CarePort’s EHR-agnostic suite of solutions connects the
discharge process with post-discharge care coordination — allowing providers
and payers to track and manage patients throughout their care journey. By
providing end-to-end visibility across the continuum, WellSky and CarePort can
improve outcomes, lower costs, and increase patient satisfaction.
“As part of the WellSky team, we will be able to accelerate our mission to connect providers across the continuum. Both of our organizations are aligned in our dedication to proactively bridging gaps in care. Together, we have the technology, analytics, and network to ensure that patients receive seamless care,” said Dr. Lissy Hu, CEO of CarePort. “Joining WellSky means that we can increase vital connections between acute, post-acute, and community care providers to make a meaningful difference in the lives of more patients in more places.”
With WellSky’s deep experience in post-acute care and
CarePort’s suite of care coordination solutions, this combination is a natural
fit. CarePort clients will gain access to a broader network of post-acute
providers and can leverage WellSky’s powerful predictive analytics suite, and
leading value-based care technologies. This combination of capabilities will
enable health systems, payers, and post-acute providers to more effectively
collaborate in a data-driven way and enhance patient outcomes.
“Together with CarePort, WellSky will establish new, meaningful connections between historically disparate settings of care. We have the exciting opportunity to bring care coordination to more providers in service of delivering more informed, personalized care,” said Bill Miller, CEO of WellSky. “Through this agreement, we’re ensuring our clients have the intelligent technology they need to do right by their patients, collaborate with payers, and succeed in value-based care models. It’s WellSky’s mission to realize care’s potential, and this moves us that much closer to achieving it.”
– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of July 2020.
While a pandemic ravages the country, technology valuations are soaring. The Nasdaq hit an all-time high during the month of July, sailing through the 10,000 mark to post YTD gains of nearly 20%, representing a 56% increase off the low water mark on March 23. More notably, the Nasdaq has outperformed the S&P 500 (including the lift the S&P has received from FANMAG stocks – Facebook, Amazon, Netflix, Microsoft, Apple, Google) by nearly 20% YTD.
At HGP, we focus on private company transactions, but there is a close connection between public company and private company valuations. While the intuitive reaction is to feel that companies should be discounted due to COVID’s business disruption and associated economic hardships facing the country, the data and the markets tell a different story.
While technology is undoubtedly hot right now given the thesis that adoption and value will increase during these virtual times, the other more important factor lifting public markets is interest rates. According to July 19 research from Goldman Sachs,
“Importantly, it is the very low level of interest rates that justifies current valuations. The S&P 500 is within 4% of the all-time high it reached on February 19th, yet since that time the level of S&P 500 earnings expected in 2021 has been pushed forward to 2022. The decline in interest rates bridges that gap.”
Additionally, Goldman Sachs analysts also estimate that equities will deliver an annual return of 6% over the next 10-years, lower than the long-term return of 8%. Future value has been priced into present value, and returns are diminished because the relative return over interest rates is what ultimately matters, not the absolute return. In short, equity valuations are high because interest rates are low.
What happens in public equities usually finds its way into private equity. To note, multiple large private health IT companies including WellSky, QGenda, and Edifecs, have achieved 20x+ EBITDA transactions based on this same phenomenon. From the perspective of HGP, this should also translate to higher valuations for private companies at the lower end of the market. As investors across all asset classes experience reduced returns requirements due to low interest rates, present values increase across both investment and M&A transactions.
As with everything in the COVID environment, it is difficult to make predictions with certainty. Because the stimulus has caused US debt as a percentage of GDP to explode, there is an extremely strong motivation to keep long-term interest rates low. For this reason, we believe interest rates will remain low for the foreseeable future. Time will tell whether this is sustainable, but early indications are positive.
Noteworthy News Headlines
A $10.2 million “sole source” contract to run a centralized Covid-19 database for the Trump administration drew sharp criticism from congressional Democrats, who demanded that the federal Centers for Disease Control and Prevention be reinstated as the primary repository of coronavirus data. The contract drew scant public attention when it was awarded in April to TeleTracking Technologies, a Pittsburgh company whose core business is helping hospitals manage the flow of patients. But it drew scrutiny after the administration ordered hospitals, beginning on Wednesday, to report coronavirus information, including bed availability, to the new database, housed at the Department of Health and Human Services in Washington, instead of to the C.D.C.
With the CDC sidelines, some states lose access to timely COVID-19 hospital data. Just as the number of people hospitalized for COVID-19 approaches new highs in some parts of the country, hospital data in Kansas and Missouri is suddenly incomplete or missing. Earlier this week, the Trump administration directed hospitals to change how they report data to the federal government and how that data will be made available. Missouri Hospital Association spokesperson Dave Dillon called the move “a major disruption.”
Hospital giant ACA makes $822 million profit off CARES Act stimulus money. HCA’s biggest profit driver and boost to surviving the pandemic and the influx of Covid-19 patients in the second quarter came from the federal government. In HCA’s second quarter, the government stimulus passed by Congress and signed into law by President Donald Trump turned into a windfall as of the end of the second quarter.
HIMSS pushes back 2021 conference to August. HIMSS canceled its 2020 global health conference in March just days before it was slated to start due to concerns about COVID-19. HIMSS officials are planning a press conference Friday to offer more details about the HIMSS21 conference.
Noteworthy Transactions
Noteworthy M&A transactions during the month include:
Workflow optimization software vendor HealthFinch was acquired by Health Catalyst for $40mm.
Payment integrity vendor The Burgess Group acquired by HealthEdge Software.
Ciox acquired biomedical NLP vendor, Medal, to support its clinical data research initiatives.
Allscripts divests EPSi to Roper for $365mm, equaling 7.5x and 18.5x TTM revenue and EBITDA, respectively.
Noteworthy Buyout transactions during the month include:
HealthEZ, a vendor of TPA plans, was acquired by Abry Partners.
As part of a broader wave of blank check go-public transactions, MultiPlan will join the public markets as part of Churchill Capital Corp III.
Also as part of a wave of private equity club deals, WellSky partially recapped with TPG and Leonard Greenin a rumored $3B transaction valuing the company at 20x EBITDA.
Edifecs partnered with TA Associates and Francisco Partners in another club deal valuing the company at a rumored $1.4B (excluding $400mm earnout) at over 8x revenue and 18x EBITDA.
Madison Dearborn announced a $410mm take private of insurance technology vendor Benefytt.
Nuvem Health, a provider of pharmacy claims software, was acquired by Parthenon Capital.
Noteworthy Investments during the month include:
Doctor on Demand, a telemedicine vendor, raised $75mm led by General Atlantic.
Truepill, an on-demand pharmacy, raised $25mm from investors including Optum Ventures.
Sema4, a big data genomics company, raised $121mm led by BlackRock valuing the company at $1B.
Heal, a physician house call company, raised $100mm from Humana.
Tempo, developer of smart at-home fitness platforms, raised $60mm.
Public Company Performance
HGP tracks stock indices for publicly traded health IT companies within four different sectors – Health IT, Payers, Healthcare Services, and Health IT & Payer Services. Notably, primary care provider Oak Street Health filed for an IPO, offering 15.6 million shares at a target price of $21/ share. The chart below summarizes the performance of these sectors compared to the S&P 500 for the month of July:
The following table includes summary statistics on the four sectors tracked by HGP for July 2020:
Ernie Ianace, EVP Sales and Marketing at VitalTech
“The numbers don’t lie,” is a famous old adage and quite appropriate with regard to the rapid rise and deployment of telehealth solutions in the medical community. It may have taken a global pandemic for society to recognize and investigate the rewards of its adoption, but statistics reveal that telehealth’s moment has indeed come. And it certainly seems like it’s here to stay.
How did we come so far, so fast? By undertaking forward-thinking policies and bold action, the health care industry nimbly and quickly adopted this technology to mitigate the immediate threat of COVID-19’s lethal contagiousness.
As it pertains to effectiveness, the federal government’s overwhelming response to shore up commerce, industry, and unforeseen unemployment levels has been met with mixed reviews. But the designated programs specific to the healthcare industry have been an undeniable success. Thanks to a sudden and massive infusion of funding and support for telehealth medicine, initiated by federal and state governments, the health care industry is witnessing a historic sea-change in its processes, procedures, and practices. The widespread, rapid adoption of telehealth solutions is the prime example.
Beyond the impact of funding, now in the hundreds of millions of dollars, the utilization of telehealth also benefited from additional measures which simultaneously boosted its appeal for trial and adoption. For the first time, health care providers were permitted to use telehealth to treat Medicare patients, opening the door for insurance companies and state governments to follow suit.
Subsequently, many of the nation’s largest private insurance providers then took it a step further—waiving copays for patient consultations via telehealth. For both the insured and uninsured, the elimination of out-of-pocket costs is likely to increase consumer trial and adoption of virtual physician visits. The bold and swift decisions to relax certain restrictions and requirements within the traditional health care model has created fertile ground for telehealth’s trial and adoption.
The use of telehealth as a practical solution has been available for some time, but its adoption by consumers faced difficulty, as many perceived virtual visits would not measure up to the value of in-person doctor appointments. But recent research and surveys on telehealth’s usage reveal this barrier may be crumbling. In April, Sage Growth Partner (SGP) and Black Book Market Research collaborated on a survey revealing that, prior to COVID-19, only a quarter of respondents had used telehealth. But amidst the backdrop of our current pandemic, nearly 60% of those surveyed say they are now likely to consider telehealth in addressing their personal health care needs. Additionally, other studies have concluded that after an initial trial of telehealth, a majority of consumers expressed high levels of satisfaction with their experience—and a strong likelihood of follow-up use.
Yet only viewing the benefits of telehealth through the narrow lens of a physician-patient consultation is to overlook its full value proposition across the health care industry as a whole. What are some other examples of how telehealth is changing the health care landscape for the better? Here are a few ways in which its adoption and use are improving our models of caregiving:
Protecting our Collective Health
Amidst the COVID-19 pandemic, an obvious benefit is the option to seek care remotely while maintaining isolation through the practice of social distancing. There are no crowded waiting rooms or hospital hallways to deal with, thereby lessening the risk of exposure and infection to patients and caregivers alike.
Meeting the Caregiver Demand
In some areas of the U.S., a steep demand for health advisors has spiked, due to postponement of elective surgeries and the need for ongoing treatment of patients with chronic health care conditions. Pack Health, Birmingham, Al. chronic care coaching provider utilizes certified Health Advisors to help patients get access to care options while helping them develop self-management skills to gradually improve their conditions. With a surge of over 50,000 new patients, the company rapidly transformed its onboard training program to a telehealth platform to meet the demand for new hires. In doing so, Pack Health was able to scale up staffing much faster and cheaper than ever before.
Impact on Rural Health Care
According to the consultants at Guidehouse, one in four rural hospitals are deemed high-risk for closing—and this was reported before the pandemic. Through the use of telehealth platforms, a large portion of the rural United States can now receive access to clinical care services and at-home monitoring services. In effect, telehealth can become a new tool to help alleviate rural America’s serious deficit of accessing critical care.
Impact on Mental Health Care
The rise in telehealth adoption is also having a positive effect for patients who require access to mental health services. Even before the pandemic, many people with various mental health needs chose not to seek treatment due to perceived social stigmas. Using telehealth as a solution, they can now obtain access to providers, care, therapy, and treatment in the privacy of their homes. Likewise, those patients already under the care of mental health professionals are able to keep routine appointments, in spite of COVID-19’s disruption.
As for telehealth’s future, it is certain to benefit in multiple ways from its current trial by fire. Perhaps there is no better proving ground for assessing its total value proposition than during a global health crisis that shows no sign of relenting. Being at the right place at the right time can be an invaluable proving ground and the future of the telehealth industry appears to be positioned for staggering growth. In April, Global Market Insights, market research, and consulting company released a report predicting the telemedicine market will reach $175.5B by the year 2026.
Furthermore, healthcare providers need to think of telehealth as only one component of comprehensive care. Patients need to have several different touchpoints throughout the healthcare continuum to ensure the best quality of care. Examples of these touchpoints include advanced biometric wearables, real-time data collection, and advanced analytics to provide actionable data for patients and care teams.
As technology continues to drive the rapid pace of improvements in digitalization, platforms, high-speed broadband access, and mobile devices, the widespread adoption of telehealth and telemedicine solutions will become even more commonplace. As a result, the ever-increasing capacity to improve our traditional health care delivery models may indeed be forever changed for the better.
About Ernie Ianace
Ernie Ianace is the Executive Vice President of Sales and Marketing at VitalTech® Affiliates, LLC. Based in Plano, TX, VitalTech is a rapidly growing provider of fully integrated digital health solutions and smart biomedical wearables that provide real-time monitoring for patient wellness and safety. The company’s connected care platform, VitalCare®, enables health systems, skilled nursing facilities, home health providers, physicians, and senior living facilities to streamline workflows while improving health outcomes, increasing patient safety, and lowering the cost of care.
