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News 4/29/22

April 28, 2022 News 4 Comments

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Teladoc Health reports Q1 results: revenue up 25%, EPS -$41.58 versus -$1.31. The loss was driven by a $6.6 billion impairment charge from its $18.5 billion acquisition of Livongo in 2020. Teladoc had warned in early March 2022 that it would write down up to $4 billion of the Livongo acquisition.

Teladoc also cut its full-year revenue and earnings outlook.

TDOC shares dropped 40% on Thursday. They are down 82% in the past 12 months versus the Nasdaq’s 9% loss. The company’s market cap is $5 billion, with Teladoc having lost $39 billion of shareholder value in 14 months.

From the earnings call:

  • The company says it remains confident in its whole-person care strategy, which it describes as “the future of digital health.”
  • Performance of its BetterHelp direct-to-consumer mental health service was less than expected, which the company believes is due to smaller competitors going after potential customers and taking advantage of pandemic-relaxed controlled substance prescribing regulations. Three-fourths of the company’s projected revenue reduction is attributed to BetterHelp.
  • Sales to employers slowed as companies focused on COVID and return to offices. Teladoc also blames “noise in the marketplace” from smaller point solutions.
  • Teladoc reports 54 million paying members, with 731,000 of those enrolled in chronic care programs.
  • CEO Jason Gorevic says that increased customer acquisition cost, mostly due the cost to buy advertising in search results and social media,  was caused by smaller private competitors that have been “recently well funded with a rash of venture capital money” that are making “economically irrational decisions.”

Reader Comments

From Down Underware: “Re: Australian Medical Association. Wants hospitals to eliminate fax machines to improve communication and patient safety.” Banning fax machines would most likely cause communication and patient safety to tank in the absence of solid interoperability. The market will gratefully accept a substitute that checks these boxes and is documented to improve cost and outcomes:

  • Faxes are universal. You only need someone’s fax number, not their permission or prearranged terms, to send them something and then walk away.
  • They are cheap, easily maintained, and never go down.
  • They can be used anywhere there’s a copper telephone wire even in the absence of broadband or cell coverage.
  • Issues of sending and reading protocols don’t exist – the piece of paper on one end pops out as piece of paper on the other end that doesn’t need to be printed as an extra step. What is sent is exactly what is received, with no chance of misinterpretation or sender technology changes that render the information unreadable.
  • Delivery is immediate and verifiable.
  • The recipient is more likely to notice a new paper popping out of the fax machine than an on-screen alert.
  • Fax machines don’t host viruses, there’s not much hacking risk, a malicious fax can’t take your network down, and incoming faxes are as secure as the physical location they are sitting in.

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Acquisitions, Funding, Business, and Stock

A report says that a European antitrust review of Oracle’s planned acquisition of Cerner is likely to surface no concerns.

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A former engineering VP of mental telahealth vendor Cerebral sues the company, saying that they fired him after he complained about its plan to prescribe stimulants to 100% of its ADHD patients. Matthew Truebe says he told the company that patients were setting up multiple accounts to buy extra drugs, as evidenced by 2,000 duplicate addresses in the shipping database. He also says the company ignored his concerns about thousands of patient records that were exposed in a breach.

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Syllable, which sells intelligent voice systems for health system call centers and practices, raises $40 million in a Series C funding round.

Microsoft chairman and CEO Satya Nadella says in the company’s earnings call that its Nuance acquisition gives it a platform layer for AI-driven applications in healthcare and contact centers. He says the company will aggressively innovate with Nuance and expects to increase its impact on healthcare, specifically with physician burden.


Sales

  • Prisma Health (SC) chooses Philips for patient monitoring, enterprising imaging, and analytics.

People

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Intelerad hires A. J. Watson (Doubleclick) as chief product officer and Paul Johnson (Amwell) as chief delivery officer.

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Well Health hires Sarah Shillington, MS (TigerConnect) as SVP of customer experience and Ashu Agte, MS (Autodesk) as SVP of engineering.

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Susan Worthy (Optum) joins Amwell as chief marketing officer.

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Adventist Health promotes Jennifer Stemmler to chief digital officer.

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Salesforce hires Maura King, MBA (Workday) as RVP of enterprise healthcare providers.

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Bruce “Skip” Lemon joins Impact Advisors as VP.


Announcements and Implementations

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A Panda Health survey of 100 C-level health system executives finds that more than half of them get more than 11 calls and emails each week from digital health vendors, leading 95% of them to conclude that it’s hard to decide which products are worth investigating. Half of the health systems don’t have a strong digital health strategy, and three-fourths of those that have bought digital health solutions are not confident that they chose wisely. Two-thirds say that it takes them at least six months to get to contract signing, with most of the time spent vetting integration capabilities and comparing product functionality.

Tenet Healthcare admits that its recent computer downtime was caused by a cybersecurity incident. The for-profit hospital operator scolded a South Florida TV station early this week for interviewing a patient who worried about the possibility of downtime-caused medication errors, calling it “preposterous” to suggest that paper-based downtime procedures are less safe.

1upHealth announces SQL on FHIR, which allows organizations to make decisions using SQL tools such as Microsoft Power BI and Tableau without coding in FHIR.

Privately insured patients who receive a new diagnosis from a telehealth visit are no more likely than their in-house visit counterparts to visit the ED or be hospitalized within 14 days, a study finds. However, three of 21 conditions were exceptions – upper respiratory infections, bronchitis, and pharyngitis, which researchers think is because those patients required COVID-19 evaluation.

A CoverMyMeds survey of 400 nurses identifies these medication-related technology needs:

  1. A centralized location for medication information.
  2. Knowing the medications that a patient’s insurance covers.
  3. A seamless way to provide medication information to prescribers, such as prior authorization requirements, symptoms, allergies, medication history, and plan formulary.
  4. A better way to perform prior authorization requests proactively instead of waiting for pharmacy rejection.
  5. Ways to reduce pharmacy telephone time, ideally with solutions that provide information at the point of prescribing.
  6. Easy access to a patient’s medication history, including the active meds list that less than half of patients remember, as well as a list of medications that have been tried unsuccessfully as needed for prior authorization requests.
  7. Real-time formulary and benefit updates.
  8. Efficient ways to identify covered alternative medications.
  9. Clearer job expectations, with one option being creating a centralized team to manage prior authorization and insurance interactions.
  10. Moving tasks to EHR workflow, as half use non-EHR applications at least once per day and 20% use their smartphones after the patient leaves.

Government and Politics

The federal government’s Cerner system – spanning the DoD, VA, and Coast Guard — goes down twice this week, once because of a system update that was delivered at lunchtime and the second due to load imbalance, VA and Cerner officials explain at a congressional hearing. Cerner executives told lawmakers that it may commission an independent review of its system to make sure it is stable enough to deploy further.

The Texas Medical Association says in a comment to ONC that 42 of the proposed USCDI Version 3 data elements are not backed by a standard, which will create a lot of work, limit data transfer, and require rework once standards are developed. It cites an example of a hospital that is blasting out ADT information to meet CMS requirements, but a small primary care practice had to hire people manage the flood of information that is not human-readable or and often isn’t useful.


Other

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A NEJM article questions whether the time and money that is spent on hospital quality improvement is worth it, as entire industries are created as soon as a measure’s score is tied to payments. The definition of quality remains hard to pin down, it says. It notes the irony of CMS suspending quality reporting requirements early in the pandemic so that “the healthcare delivery system can direct its time and resources toward caring for patients.” Experts say that QI is a billing-driven, box-checking exercise that still can’t answer basic questions about preventable deaths or overutilization of services. The article says that Medicare Share Savings Programs have been expensive to operate and have done little to reduce costs or improve quality in their patients. It also notes that profitable hospitals can afford to hire teams to optimize coding (averaging 50 to 100 employees who do nothing but support measurements), while safety-net hospitals and those serving the highest-risk patients bear the brunt of financial penalties. The administrative costs of quality measurement cause community doctors to retire and small practices to be acquired by hospitals.

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This is not an early draft of Prince’s Love Symbol, but rather parietal art from the scientifically unsound early days of the pandemic, when stores like my local Walgreens above decided that the virus could be stopped dead in its tracks by making aisles one way to prevent masked customers from facing each other for five seconds. The permanently embedded tape marks obviously aren’t the only reason this ratty carpet needs to go. Also featured in this Walgreens is a Pompeii-like abandoned back section whose surviving sign suggests that it was once a health center, now occupied by carelessly parked carts of inventory awaiting displaying or disposal. The pharmacy metal doors were locked down when I dropped by this week, which has happened three times in maybe eight total visits — once because the power was out, once because the employees had locked themselves out of the pharmacy, and this time because the pharmacist had a death in the family and the store couldn’t find coverage. On the other hand, once the garage-like doors were again rolled up, a patron could obtain a COVID shot, frozen White Castle hamburgers, a rectal thermometer, and a Paw Patrol life jacket within a 10-step radius.


Sponsor Updates

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  • AdvancedMD employees join Catholic Community Services of Utah to serve 2,000 meals to community members.
  • The Sheffield Teaching Hospitals NHS Foundation Trust adds Agfa HealthCare’s enterprise imaging solution.
  • Healthcare Triangle publishes the results of a new survey, “Acceleration of Blockchain Adoption in Pharma & Life Sciences.”
  • Nordic posts a new monthly episode of its “DocTalk” series titled “Cloud Approaches for Modernization.”
  • Imprivata secures additional funding from Thoma Bravo to finance its acquisition of SecureLink.
  • Wolters Kluwer Health’s Lippincott Nursing Education solutions have been selected as 2022 SIIA CODiE award finalists in seven categories.
  • Medhost celebrates Patient Experience Week.
  • Texas Association of Community Health Centers offers its members remote patient monitoring from CareSignal.
  • Newman Regional Health (KS) uses Meditech to transform sepsis treatment.
  • Nordic Consulting joins the ServiceNow Partner Program.

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Currently there are "4 comments" on this Article:

  1. Undifferentiated startups and Teladoc are going to lose money until what, enough go out of business or get consolidated? It seems like best way to make money in telehealth is to sell cloud servers for these people to burn their money on.

  2. Lots of former ESi (Enterprise Systems, Inc) folks in today’s feed. Some good some bad. ESi:HBOC, Livongo:Teledoc, any correlation??

  3. Could it be that Teladoc stock prices are dropping because customers realize that it’s not as great as the hype? Don’t know about the other Teladoc offerings but our organization’s use of Teladoc software for telehealth has had challenges due to Teladoc functionality. Basic stuff like being able to set your background to look professional so patients don’t realize that you’re seeing them while sitting in front of a closet. And that’s one of the minor issues.

  4. RE: Faxes

    I have a rather anemic understanding of the market, but don’t the majority of the major health systems use a fax-to-PDF service like RightFax? If that’s the trend (saving faxes digitally vs immediately print old school), maybe there is a security vulnerability associated with faxing after all.

    On the other hand, and this is just what I encountered when I still had a fax machine, you can absolutely be spammed with junk faxes. I’d argue that the impact of that spam is far, far greater on old school fax machines than the more modern solutions. DDoS take on another aspect when you have to go buy more ink….

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