What You Should Know:

• Today, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” – a temporary rule that extends telemedicine flexibilities adopted during the COVID-19 public health emergency (PHE).
• ·         The temporary rule will take effect on May 11, 2023, and extends the full set of telemedicine flexibilities adopted during the COVID-19 public health emergency for six months – through November 11, 2023. For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding the prescription of controlled medications established during the COVID-19 PHE will be extended for one year – through November 11, 2024.

Background

On March 1, 2023, DEA, in concert with HHS, issued notices of proposed rulemakings (NPRM) to allow for prescribing of certain controlled medications via telemedicine without an in-person medical evaluation of the patient under circumstances that are consistent with public health, safety, and effective controls against diversion. The NPRMs received over 38,000 comments from the public and DEA, in collaboration with SAMHSA, is actively reviewing input in order to develop a permanent rule.

The United States only represents five percent of the world’s population; however, Americans consume 80 percent of the world’s opioids.¹ The U.S. is the world’s leader in the use of opioid medications to cope with physical and emotional difficulties. And the recent Walgreens and Wal-Mart multi-state opioid settlement agreement disclosures have only hammered home the point. America continues to have an opioid addiction problem. 

In light of all these circumstances, the recent CDC announcement that it was softening guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers seems to stand in stark contrast to the current reality. With such significant, impactful reparations coming from the original guidelines and accompanying grim statistics, does it make sense to soften them so soon? The answer may surprise many, but for some, it’s yes. 

Relaxed CDC guidelines call for new investment in data and technology 

With the proper precautions, tools, and technologies to harness the data needed, loosening the guidelines will likely not significantly harm the outlook for SUD patients. Why? The more stringent restrictions didn’t blunt the crisis at hand. If anything, it even got worse. 

So, while the new guidelines place more decision-making power on physicians prescribing opioids, guidance without continuous monitoring and feedback can potentially worsen the crisis. And providers could easily find themselves further in the deep end if nothing else changes. They need a new path forward. 

Therefore, unlocking the correct data–at the individual patient and population levels–is critical to reversing this crisis. If providers could easily and securely access dynamic and actionable behavioral health data, they could develop more effective treatment plans based on a patient’s complete history. They could better assess addiction risk and make the best judgment on the type of care delivered. 

Severe SUD disparities prevent facilities from tackling significant challenges 

Nonetheless, behavioral health practices are years behind other healthcare fields when it comes to technology and tools, leaving them largely unprepared for the 

challenges of a nation in the throes of a mental health crisis compounded with record opioid addictions. The reasons are numerous, but a conspicuous absence from the incentives provided by the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 certainly left behavioral health at the back of the pack for technology access and funding. A June 2022 report from Medicaid and CHIP Payment and Access Commission (MACPAC) further illuminated the issue, explicitly citing an extension of the financing through state Medicaid programs to drive health IT adoption as a decisive step to addressing gaps in access, outcomes data, and oversight. 

Data-driven SUD care enables high-powered opioid-ready interventions 

With many deficiencies and a growing opioid patient population, data insights unlocked through technological investment are the most effective path forward. And there are several data processes, best practices, and tools that facilities can utilize to build a solid future-ready data foundation ready to meet the challenges ahead. 

To start, providers should use an advanced data approach that absorbs, connects, and cleans data from multiple sources. When data is missing or of lower quality, leveraging advanced data science algorithms that account for the missing pieces can correct systematic errors in SUD and mental health data. Then, artificial intelligence and machine learning can take it to the next level by detecting meaningful patterns and insights in this data. And by implementing these powerful technological capabilities and innovations, behavioral health providers can more quickly and effectively make up for incomplete values and standardize disorganized data. 

Further, prescriptive analytics can deliver refined insight into risk and the best care protocol even with dirty or incomplete data (as with many SUD providers). Dynamic algorithms can quickly transform crude data into a product. In this way, providers can leverage predictive modeling to identify patterns demonstrating people at risk of developing substance abuse or opioid relapse. And the infrastructure for predictive capabilities already exists, including patient engagement solutions, electronic surveys, and analytics. Industrializing, standardizing, and making these capabilities available to all providers will augment individual patient care and the industry’s alignment to measurement-based care. 

Beyond raw data, implementations such as the social vulnerability index (SVI) can enrich patient-level information, providing the foundation for dynamic analytics. Moreover, care coordination and implementing innovative models and tools such as Accountable Care Organizations (ACOs) and Health Information Exchanges (HIEs) 

are imperative to driving the best patient outcomes and ensuring visibility across the patient care experience. 

This cooperation and new data implementations will empower a holistic patient treatment model, allowing everyone involved to make informed and educated decisions about patient care, including prescription opioids. And by harnessing the power of their data assets and proven advanced analytic capabilities that are already solving some of the most challenging SUD patient health complications, providers can also empower ongoing operational and clinical improvements. 

New data approaches and tech power the future of SUD and opioid treatment 

SUD providers have a significant opportunity to advance patient care, particularly when it comes to substance abuse and opioid addiction, by harnessing the power of increasing and ever-available data. Through data unlocked via novel technologies and approaches, facilities can identify predisposed patient populations, early warning factors, and signs of addiction. 

These information insights, enabled by data science, predictive algorithms, and other technology-first implementations and tools such as SVI, ACOs, and HIEs, will be crucial to combating the opioid epidemic in the coming years. By leveraging this toolbox, SUD providers can create more opioid challenge-worthy treatments from the start. The coming years and softened guidelines cause concern across the SUD community. It’s evident, however, that the needle barely moved even with more binding restrictions, without impactful analytics and insight. Consequently, dynamic and actionable data-driven modeling and the technical foundations to support it remain necessary course corrections that can provide substantial progress. 

About Jeremy Bloom, CEO of NorthSight Recovery

Jeremy has more than ten years of healthcare experience. During this time, he has held various senior and executive leadership positions where he gained expertise in organizational management, regulatory guidelines, and care delivery. Mr. Bloom has built alliances with key local and national stakeholders and has assisted in developing many programs, including psychiatric crisis centers, inpatient facilities, outpatient facilities, and patient-centered medical homes. Mr. Bloom is passionate about healthcare innovation and developing systems that take a data-driven approach to measure outcomes and costs to improve the overall delivery of healthcare services.

References

1. “Opioid Crisis: Table of Experts.” The Phoenix Business Journal, January 5, 2018, p. 16.

What You Should Know:

– Bicycle Health, a telehealth provider of integrated medical and behavioral health treatment for opioid use disorder (OUD) is teaming up with Wellpath, the premier provider of localized, compassionate care to vulnerable patients in challenging clinical environments, and the Federal Bureau of Prisons (FBOP).

– The collaboration will enable patients to access Bicycle Health’s evidence-based, life-saving clinical care model delivering virtual Medication for Opioid Use Disorder (MOUD) services to individuals living in the FBOP’s Residential Reentry Centers (RRC).

Opioid Use Disorder Treatment to Federal Bureau of Prisons

The collaboration will enable patients to access Bicycle Health’s evidence-based, life-saving clinical care model delivering virtual Medication for Opioid Use Disorder (MOUD) services to individuals living in the FBOP’s Residential Reentry Centers (RRC). Medications like buprenorphine – an FDA-approved medication that limits painful opioid withdrawal symptoms, helps prevent overdose, and supports long-term recovery – have been widely successful at curbing opioid use. The Substance Abuse and Mental Health Services Administration has found that MOUD treatment regimens are significantly underutilized in criminal justice settings. The primary goal of this collaboration is to improve availability and clinically appropriate utilization of MOUD among this underserved patient population.

Bicycle Health’s virtual treatment model, which has shown patient retention rates that are appreciably higher and no-show rates that are significantly lower than in-person averages, will deliver life-saving clinical and behavioral care to a population in need. The collaboration between Bicycle Health and Wellpath will provide improved access to MOUD in RRCs across 42 states, with plans to expand. Bicycle Health and Wellpath plan to grow the service to meet the recovery needs of formerly incarcerated patients – to improve their health, the overall health of the community, and reduce recidivism.

What You Should Know:

– Curebase, a company committed to democratizing access to clinical trials, announced the release of its integrated software and services package for digital therapeutics (DTx) trials that accelerates enrollment and allows sponsors to launch their studies faster. 

– Available now, the new Curebase offering includes the first one-stop-shop decentralized clinical trial (DCT) platform bundled with site and trial execution services for the DTx market.

Making Healthcare Readily Available Via All-in-One Software and Trial Execution Package

This unique blend of eClinical software and technology-driven services enables sponsors of DTx studies to leverage the following Curebase capabilities: 

Technology and virtual site models: The company’s fit-for-purpose DCT platform was developed to support remote and hybrid digital therapeutic trials by offering flexible virtual site models, extensive patient data capture capabilities, and experienced digital recruitment strategies.

Site services: Curebase’s in-house clinical research coordinators (CRCs) have deep experience interacting with patients for DTx studies as well as principal investigators (PIs) who have run successful studies for Curebase clients. This provides DTx trial sponsors, using the new Curebase offering, access to a valuable clinical studies knowledge base and investigators/virtual site staff experienced in digital therapeutic studies.

Start-to-finish execution: DTx logistics and details can be overwhelming to sponsors. As part of its DTx offering, Curebase provides trial management services, such as Institutional Review Board (IRB) submissions, project management, CRO services, data management, patient recruitment, and more. These exhaustive capabilities make it easy for DTx sponsors to find everything they need in one place to set up, recruit for, and execute digital therapeutic studies.

For most DTx sponsors, launching a study is a time-consuming and complicated process involving multiple components, such as finding a software vendor, locating sites, engaging a principal investigator, and clinical research organization (CRO). The new Curebase digital therapeutics offering includes features, workflows, and tools built into the company’s eClinical platform specifically made for and used in DTx studies. This also includes virtual site models, CRO services, and recruitment tactics tried and tested in digital therapeutic studies, allowing DTx sponsors to quickly launch a study with the confidence of proven execution.

Curebase has completed 17 studies, enrolled more than 3,500 patients, and prescreened tens of thousands for DTx sponsors. These trials have tested DTx products in depression, anxiety, gastrointestinal problems, cancer, heart issues, rare diseases, and more. Much of this experience is evidenced and represented in Curebase’s membership and collaboration with the Digital Therapeutics Alliance (DTA), which is utilizing the company’s expertise to develop guidance and standards for DTx studies.

“Our new offering streamlines vendor selection and trial execution for DTx companies,” said Whitney Stewart, director of clinical project management at Curebase. “That translates to more trial completions and getting more products closer to the hands of patients.”

DTx products deliver evidence-based therapeutic interventions through software programs to treat, manage, or prevent mental health disorders, substance abuse, diabetes, chronic pain, and other physical or behavioral problems. These products can be used independently or with medications, devices, or other therapies to help patients attain better outcomes.

Not only does the Curebase DCT model accelerate the enrollment process, but it also allows DTx trial sponsors to scale studies to include more geographically and ethnically diverse groups of participants, which can lead to more effective digital therapeutics. 

What You Should Know:

– Fitbit announced that they are partnering with behavioral analytics company Pretaa to improve outcomes for the millions of Americans affected by substance abuse. Pretaa analyzes information from wearable devices worn by those recovering from substance abuse and (with patient consent) notifies their care providers, friends and family members when they might need additional support.

– Research indicates that the onset of the pandemic was associated with an increase in overdose deaths nationally, driven by a number of factors including less access to interventions and increased stress due to isolation. 

– As part of the partnership, Pretaa will incorporate Fitbit data into their analytics platform to help providers have a more holistic view of their patients. The goal is to help providers and caregivers deliver more personalized care via actionable information.

What You Should Know:

– The U.S Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), awarded nearly $1.5 billion to support states, tribal lands, and territories’ efforts to address the opioid crisis and support individuals in recovery.

– The grants are part of SAMHSA’s State Opioid Response and Tribal Opioid Response grant programs. The grant programs provide funding to states and territories to increase access to treatment for substance use disorder, remove barriers to public-health interventions like naloxone, and expand access to recovery support services such as 24/7 Opioid Treatment Programs.  

 Address the Overdose Epidemic and Support Recovery

The funding will also allow states to increase investments in overdose education, peer support specialists in emergency departments, and allow states to invest in other strategies that will help save lives in hard-hit communities.  The full funding includes:

– Investing over $104 Million to Expand Substance Use Treatment and Prevention in Rural Communities to Beat the Overdose Epidemic. 

– Investing $20.5 Million to Increase Access to Recovery Supports. 

– Releasing New Guidance to Support and Facilitate Greater Access to FDA-approved naloxone products. 

– Announcing Additional Funding for Law Enforcement Officials on the Front Lines of the Overdose Epidemic. 

– Releasing New Guidance for Employers to Create Recovery-Ready Workplaces. 

– Deploying Financial Sanctions to Disrupt Global Drug Trafficking Operations. 

What You Should Know:

– Bicycle Health, a provider of virtual opioid addiction treatment, and Tele911, a telemedicine company specializing in reducing medically unnecessary ambulance transports of stable 911 patients to hospital ERs, today announced a partnership to increase access to opioid use disorder care for patients in emergency situations.

– The partnership between the two organizations will ensure that patients experiencing health crises stemming from or in addition to opioid use disorder are directed to a suitable level of care for their needs.

OUD Care to Emergency Patients

As part of this collaboration, paramedics on scene with stable patients who call 911 and experience an opiate overdose or are experiencing symptoms of opioid use disorder, substance abuse, addiction, or have symptoms related to OUD will be evaluated by a Tele911 emergency physician, who will make an appropriate care decision depending on the patient’s needs. A Tele911 Licensed Social Worker will refer the patient to Bicycle Health for continued support and care.

Onboarding patients in emergency situations through the partnership with Tele911 will ensure that even the most vulnerable populations can discover and access Bicycle Health, helping to close the treatment gap when they need it most. Bicycle Health’s care model combines telehealth visits, medication management, behavioral health support, and regular in-home diagnostics to create a sustainable option for long-term treatment and recovery from OUD. Compared to traditional in-person care, Bicycle Health’s model yields increased retention numbers, meaning 86% of insured patients are still in treatment after 30 days.

What You Should Know:

– Cybercriminals are leveraging illegal bots to steal pharmacy accounts and resell prescriptions on a secondary market for in-demand substances, like Oxycodone, according to recent research from Kasada’s threat intelligence team.

has recently shared research by its threat intelligence team about a new, illegal use of bots -.

– Researchers have also identified an acceleration in this activity: over the past 60 days, the number of stolen pharmacy accounts available for sale has increased by 5x.

Using Bots to Steal Pharmacy Accounts and Resell Prescriptions

In April 2022, Kasada threat intelligence first observed the use of credential stuffing to attack pharmacies, steal active customer accounts, and exploit the distribution of prescribed medications. Credential stuffing is an automated attack where cybercriminals use lists of stolen or leaked usernames and passwords to try and log in to various accounts. Once they are successful, they take over accounts (ATO) and either sell them or exploit them by making fraudulent transactions.

This illegal activity puts medications in the hands of people who don’t have a prescription from a doctor. As such, it enables substance abuse. It also takes prescribed medications away from the people who legitimately need them. Sellers offer access to legitimate prescriptions for controlled and highly addictive substances, such as Oxycodone. The price for a stolen account ranges from the cost of an insurance co-payment to several hundred dollars. Based on the volume of transactions over the past 30 days, it is estimated that a single operator can make over $25,000 per month selling stolen pharmacy accounts. Stolen accounts often come with a guarantee – if the login or card on file doesn’t work, the provider will replace it with a new account.

“This is one of the boldest, most egregious and dangerous uses of bots we’ve ever observed,” said Sam Crowther, founder and CEO of Kasada. “Because the automated tools used for these attacks are so readily available and affordable, and because the sale of stolen usernames and passwords has never been more lucrative, it is easy to see why this type of theft is growing in popularity.”

Kasada’s modern, proactive approach to stopping bots adapts as fast as the attackers working against it, in contrast to reactive bot management systems that rely on static and poorly obfuscated defenses. The company recently announced enhancements to its anti-bot platform, maintaining the company’s position at the forefront of defending against the latest and stealthiest automated threats. Its latest release also addresses the growing prevalence of Solver Services, which are API-as-a-service tools created to bypass the majority of bot management systems and conduct automated attacks such as credential stuffing.

4 Ways Hackers Use Bots to Commit Account Takeovers to Sell Stolen Prescriptions

Researchers also identified the following four key ways hackers are using bots to commit ATO to sell stolen prescriptions:

1. Credential Stuffing to Conduct ATO Attacks – Automated account cracking tools, including OpenBullet2, are loaded with bots and configurations similar to those used for scalping. These tools perform a credential stuffing attack on a pharmacy’s website or mobile app. By stuffing stolen usernames and passwords, the attacker can exploit the fact that consumers reuse the same credentials on different websites. A small percentage of the stolen credentials “work” and allow the attacker to successfully takeover accounts (performing ATO) with legitimate login credentials.

2. Data Extraction – Once an account is taken over, the attacker automates the process of extracting the prescriptions and other information associated with the account. Data linked to the account includes customer information, such as name, birth date, phone number, and the payment source on file.

3. Storefront Integration – The extracted information is integrated with eCommerce marketplaces that can be found across the corners of the Internet. It’s notable that these acts of online fraud aren’t restricted to the dark web, but are on the Internet for anyone to find. Stolen accounts are put up for sale using a non-identifiable seller profile. Shoppers can choose the pharmacy and medication of their choice, accepting a range of payment methods, including cash transfer and crypto. The sellers typically offer a guarantee such that if the account doesn’t work, they will provide a new account at the same pharmacy at no additional charge.

4. Using a Stolen Pharmacy Account – Once an account is purchased on the secondary market, the purchaser is free to use the account to obtain the medication at the specified pharmacy. This can be done using online ordering (use the credit card associated with the account and reroute the shipping address). Alternatively, the purchaser can visit a pharmacy to pick up the prescription using the information lifted from within the account to pass authorization checks, such as birthdate. What’s done with these pharmaceuticals after purchasing? Likely a combination of two activities that create a dangerous – and difficult to trace – impact on our society. The purchaser can consume them, or resell them for a premium, furthering the underground economy for stolen pharmaceuticals and widening the access of controlled substances to those who shouldn’t be taking them.

Despite the growing prevalence, roughly half of those with mental health needs go untreated, a complex trend largely driven by inadequate insurance coverage, stigmatization, and lack of access. While Covid-19 initially exacerbated difficulties in access, the swift public emergency declarations that led to the easing of regulations proved a catalyzer for remote models that had previously struggled to gain adoption. However, it is unclear how long these accommodations will continue, particularly those with potential pitfalls, such as the ability to prescribe stimulants to new patients without at least one in-person visit, which has led to certain companies coming under scrutiny in recent months.

The vast array of stakeholders in behavioral and mental healthcare has resulted in a wide and extensive range of solutions, as can be seen in HGP’s two market maps: provider technology which spans care delivery, care documentation, and care evaluation, and consumer and member technology which includes both provider-guided and self-guided solutions. Rising demand for digital health solutions, increased awareness, and loosened regulations have led to a flurry of deal activity across all mental and behavioral health sectors, with average quarterly investment volume increasing 60% from pre-COVID to post-COVID, and average quarterly investment value skyrocketing 300%. Driving these trends are rising valuations, maturing companies raising larger rounds, and eager investors looking to deploy capital into the booming sector.

While the market for mental and behavioral health is large and ever-growing, the ultimate question is whether there is enough market share to go around to support the $4.6 billion invested since 2020.  Already, there are signs that the market is cracking.  Customer acquisition costs are rising as companies fight for members, access to clinicians is exacerbated by supply constraints, pricing is under pressure due to intense competition, and in many end-markets sales cycles are prolonging.  The public market already reflects these challenges – Accolade, Amwell, Lifestance, Talkspace, and Teladoc have seen their stock prices plummet. Part of the disruption experienced by the public companies is due to private-equity-backed companies playing by a different set of rules – the private companies can afford growth at all costs whereas the public comps must demonstrate an ability to operate at scale. 

Due to the growth philosophy, many emerging growth companies operate with sub-scale gross margins and significant operating losses.  Meanwhile, investors are shifting away from growth-at-all-cost models.  Companies funded over the last two years will almost inevitably need to tap investors for more capital, and a key unknown is whether private investors, like their public counterparts, refocus their investment criteria toward stronger operating metrics that make the next round of capital less forgiving than the post-COVID boom. 

Notable transactions in the consumer and member tech category include:

• Pear Therapeutics, software-based medicine provider, made its mark in 2017 as its tool became the first digital therapeutic approved by the FDA with claims to improve clinical outcomes. The Company has since raised a total of $271mm, and ultimately went public in 2021 via a reverse merger. With increased competition, companies in the space are eyeing FDA approval as a key point of differentiation.
• Meditation and mindfulness have been recently embraced as effective methods for coping with stress, a trend that was further accelerated with Covid-19 as Americans rushed to download mindfulness apps. While new apps continue to pop up seemingly every day, the Headspace merger with teletherapy provider Ginger.io signals a shift towards comprehensive bundled solutions that better address the full continuum of mental health needs.
• Substance abuse disorders were exacerbated by Covid-19, with 1 in 3 Americans reporting an increase in usage during the pandemic. Diminished stigma in the space has attracted investors and led to companies tackling specific disorders such as opioids, alcohol, tobacco, and eating. Companies such as opioid addiction-focused Ophelia, which raised $50mm in 2021 at a post-money of $275mm, are removing barriers for patients seeking treatment.
• The mental health crisis was acutely felt amongst children and adolescents, as the pandemic brought changes such as remote learning and a wave of new stressors. Brightline, which offers a digital health solution designed to support kids and teens, has raised $202mm and is valued at $705mm, and is one of the many companies aiming to provide family-oriented solutions.
• Cerebral first made headlines as one of the exclusive members of the mental health unicorn company cohort, raising $126mm at a $1.13B valuation in June 2021, and another $300mm at $4.8B valuation, just 6 months after the previous round. However, the company is now facing intense backlash over its prescribing practices.
• The telehealth space has seen a surge of new entrants, but giants such as Sondermind, which raised $242mm in 2021 at a $1.64B valuation, and AbleTo, which was acquired by Optum for $470mm in April 2020, continue to dominate the space, but not without feeling the pressure from the new players.

Notable transactions in the provider tech category include:

– LifeStance, a provider of virtual and in-person outpatient mental health care, made its initial splash in May 2020 with its $1.2B buyout, which was quickly followed by its IPO in June 2021. The stock has plummeted since its IPO, ending Q1 2022 ~70% down from it’s 52-week high, a reaction that highlights Lifestance is among the public companies feeling pressure from both competitors and investors disappointed with the reported operating losses.

– Among those competitors upping the pressure for public companies is Quartet Health, which is focused on providing an infrastructure and care navigation platform for mental healthcare. Quartet has not only raised significant funds, the latest Series E valuing it at $991mm, but is also making strategic M&A moves, with its acquisition of InnovaTel.

– In an area as complex and dynamic as behavioral health, continuing education is key. Platforms such as Motivo, which has raised early venture rounds, are aiming to provide tools for both aspiring providers and clinical experts, while also helping address the licensed provider shortage. Funding in this sector is early and minimal as compared to other sectors, as few education platform are focused solely on mental and behavioral health.

– Several companies such as Eleos Health, which raised a $20mm Series A in April 2022, and Ellipsis Health, which raised a $26mm Series A in July 2021, are providing novel technology that leverages voice AI and voice analysis that results in actionable clinical insights as well as increased efficiency.

– A cornerstone of the mental and behavioral health tech market is PM/ EMR systems, which offer providers tools that streamline practice management, data capture, and billing. The category has many notable players, including Therapy Brands which was recapitalized by Kohlberg Kravis Roberts in May 2021 at a $1.2B valuation, Netsmart which was recapitalized by GI Partners and TA Associated in December 2018, and Qualifacts and Credible which merged in August 2020.

HGP qualified US-based companies for the market landscapes based on $1mm+ institutional funding or M&A since 2018. Thanks to Andrea Stone from the UT Health School of Biomedical Informatics for her contribution to this research.

About Healthcare Growth Partners (HGP)

Healthcare Growth Partners (HGP) is a Houston, TX-based Investment Banking & Strategic Advisory firm exclusively focused on the transformational Health IT market. The firm provides  Sell-Side Advisory, Buy-Side Advisory, Capital Advisory, and Pre-Transaction Growth Strategy services, functioning as the exclusive investment banking advisor to over 100 health IT transactions representing over $2 billion in value since 2007.

Since the passage of the Medicare Improvements for Patients & Providers Act in 2008, the U.S. healthcare system has been moving towards value-based care (VBC) which encourages health providers to improve care quality by reimbursing them based on successful outcomes rather than individual medical services. The overarching goal of VBC is to improve the patient experience, improve population health, and reduce per capita health costs.

As part of this VBC model, hospitals and health systems must store, track, and analyze a large amount of quality-related data for compliance and reimbursement purposes. Hospitals report the data to the Centers for Medicare & Medicaid Services (CMS), which uses that data to create the Overall Hospital Quality Star rating for each hospital. Rating is based on five areas: mortality, safety of care, readmission, patient experience, and timely/effective care.

Most of the data required by CMS focuses on physical issues, such as the rate of readmission for COPD patients, hospital return days for heart failure patients, or the rate of emergency department visits for patients receiving outpatient chemotherapy. While there is a wealth of research on behavioral health and physical condition comorbidities, behavioral health is still primarily treated in a silo, rather than being viewed as a critical route to improving quality measures.

With that in mind, healthcare organizations need to adopt a model of integrated care if they want to make real quality measure improvements that have a significant financial impact. Integrated care enables a holistic team-based approach to treating common mental health conditions by integrating behavioral health professionals into the care team, while simultaneously increasing the confidence and competence of physical health providers in treating these disorders. Integrated care models directly engage patients in decisions about their care and focus on prevention and early diagnosis of disease, with each provider contributing unique responsibilities and perspectives to reach a shared treatment decision. The collaborative care model is considered the gold standard of integrated care, proven to improve physical function and double the effectiveness of depression care and validated in over 90 different randomized controlled trials.

We’ve compiled the essential book for supporting integrated care, through published and validated research:

1. Impact of Behavioral Health Treatment On Total Cost of Care: An Evernorth Analysis 

Key Findings:

– Outpatient mental health care can help reduce overall health costs by as much as $3,109 per person over two years.

Health services provider Evernorth analyzed proprietary data to understand the effect that mental health treatment has on health care costs and patient outcomes. Analysts found that outpatient mental health care, such as visits to a psychologist, can help reduce overall health costs by as much as $3,109 per person over a two-year period. In particular, regular outpatient behavioral health care can reduce emergency department visits and inpatient hospitalizations. This means that outpatient behavioral health treatment pays for itself, and more.

This reduction in costs is especially important for patients with mental and physical comorbidities, who have between 2.8 and 6.2 times greater total health care costs. Behavioral health conditions may worsen physical symptoms or make it more difficult to comply with a treatment plan. This can lead to an increased use of health services, many of which may be preventable. Therefore, efforts to reduce health costs should include an integrated approach that addresses both behavioral and physical health needs.

2. Potential economic impact of integrated medical-behavioral healthcare: Updated projections for 2017, from Milliman. 

Key Findings:

– Integrating medical and behavioral healthcare could potentially save an estimated $38 billion to $68 billion annually.

– Integrated care for individuals with mental health or substance use disorder diagnoses could help save 9–17 percent of total additional spending.

For patients with physical health needs, costs are typically 2–3 times higher when that patient also has a behavioral health condition. The integration of medical and behavioral healthcare (IMBH) is a significant part of the effort to reduce care costs while improving patient outcomes. 

In April 2014, Milliman completed a report for the American Psychiatric Association (APA), projecting the potential annual savings that effective IMBH programs could generate. In 2018, Milliman issued an updated report with more recent data.

Analysts looked at the health care costs of individuals enrolled in commercial insurance, Medicare, and Medicaid in the United States. The data included individuals with no mental health (MH) or substance use disorder (SUD) diagnoses, those with MH diagnoses and no SUD, those with SUD alone, and those with serious and persistent mental illness.

Total U.S. spending for individuals with either mental health (MH) or substance use disorder (SUD) diagnoses is estimated to be $752 billion annually. This accounts for about 34 percent of total health care spending. Analysts calculated that effective IMBH programs could help save 9–17 percent of total additional spending. Integrated care could potentially save an estimated $38 billion to $68 billion annually.

Some of the highest health care costs came from individuals with chronic medical and comorbid MH/SUD conditions. These costs were mostly attributed to medical services, not behavioral services. The biggest opportunities for reducing added costs came from managing endocrine and metabolic disorders, arthritis, hypertension, and hypercholesterolemia with an integrated care model.

3. Evaluating the impact of integrated behavioral health intervention: Evidence from Rhode Island, from Brown University. 

Key Findings:

– Rhode Island’s Integrated Behavioral Health (IBH) program helped reduce unnecessary emergency department visits by 7 percent.

– IBH helped reduce office visits by 6 percent.

In this study, researchers evaluated the Integrated Behavioral Health (IBH) program in Rhode Island for its effect on health care use and costs. IBH was implemented across 11 primary care practices in the state under the Care Transformation Collaborative of Rhode Island in 2016.  

Data included claims from Rhode Island’s All Payers Claims Database for 42,936 unique patients who had visited participating primary care providers between 2015 and 2018. Analysis shows that, under IBH, emergency department visits and office visits declined by 7 percent and 6 percent, respectively. 

The study authors suggested that IBH helped discourage unnecessary emergency department visits. In addition, IBH may have helped the primary care practices increase the volume and quality of their services, reducing the need for emergency visits as well as office visits.

4. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. Intermountain Healthcare. 

Key Findings:

– Integrated, team-based care can reduce health care costs by an average $115 per patient.

– Patients with team-based care have an average of 23 percent fewer emergency department visits.

Researchers with Intermountain Healthcare compared the patient outcomes, health care use, and costs between 27 TBC medical practices and 75 traditional practices. The study included 113,452 adult patients who received care from 2003 through 2013, making this one of the largest studies of its kind.

The analysis found numerous benefits associated with the TBC model:

– TBC patients had an average of 18.1 emergency department visits, compared to 23.5 visits for traditional patients—a reduction of 23 percent.

– Average payments to providers were $3,400 for TBC patients compared to $3,515 for patients of traditional providers, demonstrating that TBC can reduce health care costs.

– More patients in the TBC model followed diabetes care protocols, such as regular blood glucose testing, than in the traditional practices.

– The TBC practices screened many more patients for depression.

These findings show that integrated, collaborative, team-based care helps get patients more proactive treatment and better clinical outcomes for chronic conditions. This approach lets providers deliver higher quality care while reducing costs, creating better outcomes for all stakeholders.

5. Use of technology for care coordination initiatives for patients with mental health issues: a systematic literature review. ODH and Otsuka America, Inc. 

Key Findings:

– Patients who receive integrated, collaborative care for depression were more adherent to treatment at 12 months.

– Patients with Alzheimer’s disease who received collaborative care supported by health technology had fewer symptoms at 12 months.

To better understand how technology can be used to improve mental health care and collaborative care, researchers set out to compare the use of technology in care coordination with care as usual (CAU) for mental health patients. The analysis included 21 studies. Most studies used health technology, such as electronic health records (EHRs), to coordinate care among patients and providers. The uses included computer-based cognitive behavior therapy, telemedicine, and Web-based communication.

The review found a variety of benefits to collaborative care supported by health technology:

– Patients receiving collaborative care for depression were more adherent at 6 months and 12 months, and were more satisfied, than patients receiving CAU.

– Among veterans receiving treatment for substance abuse, those who received coordinated care using Internet-based interventions decreased average days of alcohol use from 2.8 to 1.5.

– Of veterans involved in a study of individualized telemedicine technology, 94 percent reported satisfaction with their technology device after 12 months.

– One study of collaborative care delivered via telephone and coordinated with EHRs showed higher quality of life and improved mood in highly anxious patients compared with CAU.

– For patients with Alzheimer’s disease, a technology-supported collaborative care program led to fewer symptoms at 12 months and a more favorable opinion of their primary physician than CAU.

While there are still challenges and barriers to using health IT for care coordination, it can help improve communication among providers and between providers and patients. Health technology allows providers to conduct more structured patient assessments and to better monitor patient health and progress. The use of technology can also help patients feel more comfortable discussing their mental health issues and being more involved in their health care decisions.

Bringing Integrated Care Into the Future

These studies are a small sample of the body of research showing that integrating behavioral health and physical health leads to better patient outcomes, such as higher treatment compliance and reduced emergency visits. These improved outcomes lead to improved quality measures, which means lower costs. 

About Tom Zaubler, MD

Tom Zaubler, MD, is the Chief Medical Officer at NeuroFlow, a behavioral health integration company. Tom has 20+ years of institutional experience as the former director of psychiatry for Atlantic Health System (Morristown Medical Center, N.J.). He runs an independent counseling practice, Pegasus, and is a public advocate for the collaborative care model.

What You Should Know:

– XRHealth, the gateway to the healthcare metaverse,  announced today that they raised $10M in funding to expand virtual healthcare treatment in the Metaverse. The funding was backed by HTC, Bridges Israel impact investment fund, AARP, and crowdfunding on StartEngine.com and existing investors.

– XRHealth’s platform is FDA and CE registered and provides an immersive experience for users, transporting them to a virtual world for comprehensive therapeutic care. Patient care is covered by Medicare and is available under most major insurance providers.

At-Home Drug-Free Alternative to Traditional Healthcare

Founded in 2016, XRHealth is the first company to create virtual reality clinics that provide remote care to patients throughout the United States and is covered by most major health insurance companies as well as medicare. One of the unique features that VR therapy provides is virtual support groups, where patients with similar conditions can connect anonymously and remotely with leading physicians moderating the group.

How It Works

The XRHealth VR telehealth clinicians will provide an initial patient assessment, ship a VR headset to patients who do not currently have access to one, train them on how to use the technology, provide ongoing telehealth and remote monitoring, using video call and VR technology, and manage the insurance billing for patients. As the patient is using the XRHealth VR technology for therapeutic treatment, the clinical staff can control the unit remotely and see exactly what the patient is viewing and adjust the settings and treatment in real-time, remotely.

After the initial training session, the patient can then use the headset independently while data from the therapy is stored and analyzed in real-time so that clinicians can monitor patient status regularly while in compliance with the HIPAA privacy rules. Once a week, a report will be generated to the payer/provider that referred to the patient.

XRHealth support groups are tailored for patients with the following conditions: Multiple Sclerosis, Parkinson’s, breast cancer, menopause, an injury that affects motor function, anxiety, chronic pain, fibromyalgia, substance abuse, post-stroke rehabilitation, brain injury, and others. Patients have found that particularly during self-distancing, they could receive care while in the comfort of their home.

“XRHealth is putting Virtual Clinics into users’ pockets at a critical time in the changing landscape of the medical delivery and the technology industry,” says Eran Orr, Chief Executive Officer of XRHealth. “We are leveraging these changes to create a new form of healthcare that is accessible at any time of day, from any location in the virtual environment of the metaverse, where treatment can be personalized and adjusted based on real-time analytics.”

Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States. Cardiovascular disease-related deaths—which occur every 36 seconds—cost our country about $219 billion each year, according to the Centers for Disease Control and Prevention (CDC). People with poor cardiovascular health are also at increased risk of severe illness from COVID-19, so the time to act is now. There’s no time like the present to look at major risk factors—from obesity and smoking to high cholesterol and blood pressure—and how to avoid them. 

While acute care and medications exist to treat heart disease and other cardiovascular conditions, too often we look at how to manage ailments that already exist, rather than how to prevent them in the first place. While heart disease does affect a massive group of the population, like many diseases, it does discriminate, and without looking at the full spectrum of a patient’s life, it’s impossible to get to the root cause. In recent years, natural language processing (NLP) technology has been used to analyze social determinants of health to uncover helpfully, or potentially dangerous, information about patients that may help us understand more about the disease. 

Related: 8 Use Cases for Natural Language Processing (NLP) Technology in Healthcare

Social determinants are elements that directly impact a person’s health beyond diseases or drugs, such as access to healthy food, personal safety, housing, employment, literacy, family, employment, and personal freedom. These are often more important than clinical treatment when it comes to managing chronic diseases, like heart disease, and a slew of other medical conditions. The challenge here is that social determinants can often only be read from free-text notes in a healthcare setting—not in structured data. In order for medical professionals to realistically compile and use this information, they need NLP. 

Here’s why: doctors aren’t social workers, and in most cases, there’s no structured way to ask about social determinants. Without structured data, a lot of the pertinent information about social determinants will be in patient notes. Doctors will manually write about a patient’s social history, home environment, and similar types of health contributors. Structured data in electronic medical records (EMRs) would only consist of lab results, billing codes, and what medications the patient is taking. But if there’s substance abuse, unemployment, homelessness, or illiteracy, those will be in the notes. NLP is the automated way to connect the tissue between these disparate and siloed data sources to understand how these health events are related. 

In addition to the challenges of connecting free-text and structured data, sometimes, medical professionals simply don’t know what they’re looking for. Let’s say you want to do longer-form studies about what happens to patients with heart disease. Do their symptoms improve if they take vitamins and exercise regularly? They may—and if that’s what you’re looking to prove, that’s great. But NLP is the only viable way to correlate all potential variables—sleep, relationships, safety, employment, obesity, etc.—to get real answers. It would be impractically time-consuming to read line-by-line and try to connect the dots, even if all the information you needed was in the text. But what if you need to consider diagnostic imaging reports, or social media behavior, too? You need software to contract the relationship between these things.

There are also questions about the quality of data. Fortunately, cardiology is well-known for using data-centric governance models. The American College of Cardiology cardiac catheterization and angioplasty initiated its data registry in 1994. That was a preliminary step after which the CathPCI registry of the National Cardiovascular Data Registry (NCDR) started its duties 25 years later, taking the charge of 90% of cardiac-related data in the US. This regulatory body governs the quality enhancement process with regard to the procedures and outcomes in many healthcare organizations. Quality data is critical for providing accurate analytics. 

Despite this, data integration is still a problem in large research projects where information is collected from different entry points and data is available in different formats, and some are missing, or inaccurate. Once again, NLP is an excellent source for researchers working in the cardiology field to mitigate this issue. With existing datasets in this specialty, researchers and data scientists can more easily glean insights or uncover new findings with increased accuracy. Having curated and standardized data can make researchers’ jobs much easier and save years of headaches.

Social determinants are a huge part of public health and are often undercounted when exploring chronic illnesses, like heart disease. A woman who is dealing with domestic abuse at home isn’t going to be prioritizing her diet and exercise regimen to manage her heart health. A man who is unemployed and lost his health insurance may start missing important follow-up appointments in order to defray costs. Being aware of these social indicators and using them to inform care—whether prevention or management of heart disease and other illnesses—is vital for patients’ overall health outcomes. Technology like NLP has made it easier to start correlating social determinants to heart health and has the potential to vastly improve prevention and treatment if applied correctly and ethically.

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.

We’re now in a new year and new presidential administration. At least three companies are producing effective COVID-19 vaccines, which are being administered to healthcare workers, teachers, and the elderly. By summer, hopefully a large majority of the population in most countries will be vaccinated. From where the world now stands, we can see an end to prolonged isolation, trauma, fear, grief, and economic torpor. 

But out of the woods, we are not. 

The virus mutates, perhaps more rapidly than expected. Maybe the existing vaccines will handle all variants. One can hope. 

Of course, as everyone knows, hope is not a strategy, so strategy divided up into carefully analyzed tactics are a very good idea about now. One of those tactics needs to be dealing effectively with the mental health fallout from almost a year of living in the world COVID-19 has created.

What does that fallout look like?

Back in August, the CDC compared anxiety and depression from 2019 to mid-2020 and found the former had tripled and the latter had quadrupled. Similar studies by the Boston University School of Public Health and Johns Hopkins found that depressive symptoms and psychological distress were higher than during Hurricane Katrina and similar devastations. 

If you have a fairly mobile job like software developer or marketing manager—the kind of job that requires little more than a cell phone and an internet connection—your sense of stability may not be all that upended. However, if your job is customer-facing and garners hourly wages, your life has probably been shaken up dramatically, making those already most vulnerable even more so. 

According to mental health professionals, however, what you do for a living may not be the primary concern when it comes to how people respond to COVID-19. The invisibility of the virus makes it more pernicious. When a tornado or hurricane pass, life can return to normal, but a virus enables some to deny its very existence and others to fear and resent both the virus deniers and the virus itself. 

“You can’t see it, you can’t taste it, you just don’t know,” said Charles Benight, an academic who specializes in post-disaster trauma. “You look outside, and it seems fine.”

Evaluating the COVID-19 pandemic from a behavioral health perspective elevates two questions: How will the economy get back to normal if people are still afraid to engage in normal daily activity? AND What does COVID-19 reveal about our existing mental health system?

It’s the Virus, Stupid

As a campaign consult for presidential candidate Bill Clinton in 1992, James Carville boiled the keys to winning down to three short messages, one of which was, “It’s the economy, stupid.” 

In 2021 we might say, “It’s the virus, stupid.” Getting the American economy back up and running requires managing the virus in both real and perceived ways related to public and mental health. 

Even while the federal government can fund programs that provide counseling and treatment on an individual basis (the stimulus bill Congress passed in December includes $4.25 billion for substance abuse and mental health treatment), the primary concern related to the economy is creating confidence in the safety of the public sphere. 

“Consumer confidence matters,” writes Christos Makridis in Forbes. “… concerns about getting infected are closely linked with spending behavior, including going out to eat, going to the gym, and traveling. For example, 22 percent of those who are very confident that they can protect against the virus went out to eat in the past 24 hours, whereas only 11 percent of those who were less than very confident went out.”

In other words, remove the anxiety and fear from basic decisions like going out to eat and people will more often go out. This comes as a surprise to no one. So how do we do that?

In a nutshell, by pressing forward with a comprehensive program that promotes masks and social distancing while rolling out vaccines as rapidly as possible. These efforts require at least several more months of hunkering down.

But a full psychological recovery from COVID-19 is a much longer project and dovetails with how the virus may have exposed the disconnection and ad-hoc nature of our existing mental health system.

A Leaky Boat in a Typhoon

Those who spend every day working in America’s behavioral health sector have been telling us for a long time that the system, as it is sometimes called, has few systemic traits. The sizeable homeless populations in virtually every American city attest to the fact that the mentally ill and addicted fall through the cracks all the time. 

So, a boat that was only kept afloat by the furious bailing of committed crew members is now in a powerful typhoon. 

“If history is any indicator,” says the American Psychiatric Association’s Joshua Morganstein, “we should expect a significant tail of mental-health effects, and those could be extraordinary.” 

In a position paper on the repercussions of COVID-19, the Lancet says, “The economic breakdown that is likely to occur in the aftermath of the pandemic could exacerbate healthcare disparities and will probably disproportionately affect socially disadvantaged patients … Sooner or later, health systems will be faced with widespread demand to address these COVID-19-related mental health needs.”

Also, note a few complicating factors unmentioned in the previous perspectives, namely that the country has been roiled by months of protests, political unrest and questionable tweets. 

Admittedly, leaning on a broken mental health system to reduce fear and anxiety enough that citizens feel comfortable enough to fully engage economically is not a great place to be. Still, with the existing federal funding, states can take the lead in creating consumer confidence. 

The first course of action is probably to expand facilities and providers. In many of America’s more rural areas—Alaska and Oregon, as well as most of the Rocky Mountain states and much of the deep south—services are few and far between.

The Center for American Progress calls for the continuation of expanded funding even after the virus abates, and also a more concerted effort to make sure all citizens have health insurance and that insurance includes mental health care. 

These are only a few of the numerous recommendations made for improving America’s healthcare system. Of course, those recommendations have been made countless times before. Will this time be different? Maybe, because of dollars. This time it looks like the healing of America’s economy has to also include also healing America’s psyche

Irv Lichtenwald is president and CEO of  Medsphere Systems Corporation, the solution provider for the CareVue electronic health record.

What You Should Know:

– FCC announces initial 14 pilot project selected for $100M Connected Care Pilot Program that will support connected care service across the country and focus on low-income and veteran patients.

The Federal Communications Commission (FCC) today announced an initial set of 14 pilot projects with over 150 treatment sites in 11 states that have been selected for the Connected Care Pilot Program.  A total of $26.6 million will be awarded to these applicants for proposed projects to treat nearly half a million patients in both urban and rural parts of the country. 

Connected Care Pilot Program Background

Overall, this Pilot Program will make available up to $100 million over a three-year period for selected pilot projects for qualifying purchases necessary to provide connected care services, with a particular emphasis on providing connected care services to low-income and veteran patients.  

The Pilot Program will use Universal Service Fund monies to help defray the costs of connected care services for eligible health care providers, providing support for 85% of the cost of eligible services and network equipment, which include:

1. patient broadband Internet access services

2. health care provider broadband data connections

3. other connected care information services

4. certain network equipment

These pilot projects will address a variety of critical health issues such as high-risk pregnancy, mental health conditions, and opioid dependency, among others. Here is the list initial list of healthcare providers that were selected into the Pilot Program:

Banyan Community Health Center, Inc., Coral Gables, FL.  Banyan Community Health Center’s pilot project seeks $911,833 to provide patient-based Internet-connected remote monitoring, video visits or consults, and other diagnostics and services to low-income and veteran patients who are suffering from chronic/long-term conditions, high-risk pregnancy, infectious disease including COVID-19, mental health conditions, and opioid dependency.  Banyan Community Health Center plans to serve an estimated 20,847 patients in Miami, Florida, 85% of which are low-income or veteran patients.

Duke University Health System, Durham, NC.  Duke University Health System’s pilot project seeks $1,464,759 to provide remote patient monitoring and video visits or consults to a large number of low-income patients suffering from heart failure, cancer, and infectious diseases.  Duke University Health System’s pilot project plans to serve an estimated 16,000 patients in North Carolina, of which 25% are low-income.

Geisinger, consortium with sites in Lewiston, PA; Danville, PA; Jersey Shore, PA; Bloomsburg, PA; Coal Township, PA; and Wilkes-Barre, PA.  Geisinger’s pilot project seeks $1,739,100 in support to provide connected care services and remote patient monitoring to low-income patients in rural communities in Pennsylvania.  Geisinger’s pilot project would serve an estimated 1,000 patients and would focus on chronic disease management and high-risk pregnancies, while also treating infectious disease and behavioral health conditions.  Through its pilot program, Geisinger plans to directly connect all participating patients, 100% of whom are low-income, with broadband Internet access service. 

Grady Health System, Atlanta, GA.  Grady Health System’s pilot project seeks $635,596 to provide Internet connectivity to an estimated 1,896 primarily low-income and high-risk patients who are unable to utilize video telemedicine services due to lack of a reliable network connection in Atlanta.  The program will focus on using connected care services such as patient remote monitoring and video visits/consults to treat vulnerable patients with conditions such as congestive heart failure, COVID19, hypertension, diabetes, heart disease, and HIV. 

Intermountain Centers for Human Development, consortium with sites in Casa Grande, AZ; Nogales, AZ; Coolidge, AZ; and Eloy, AZ.  Intermountain Centers for Human Development’s pilot project seeks $237,150 in support to treat mental health conditions, opioid dependency, and other substance abuse disorders.  The pilot project plans to serve 3,400 patients in Arizona, including rural areas, of which 90% are low-income.

MA FQHC Telehealth Consortium, consortium with 76 sites in Massachusetts.  MA FQHC Telehealth Consortium’s pilot project seeks $3,121,879 in support to provide mental health and substance abuse disorder treatment through remote patient monitoring, video visits, and other remote treatment to patients in Massachusetts, including significant numbers of veterans and low-income patients.  The pilot project will expand access to these services by leveraging program funding to increase bandwidth at its sites, and to provide patients with mobile hotspots.  This project would serve 75,000 patients through 76 federally qualified health centers in Massachusetts, including rural areas, with an intended patient population of 61.5% low-income or veteran patients.

Mountain Valley Health Center, consortium with 7 sites in Northeastern California.  Mountain Valley Health Center’s pilot project seeks $550,800 in support to provide telehealth capabilities and in-home monitoring of patients with hypertension and diabetes.  Mountain Valley’s pilot project plans to serve an estimated 200 patients in rural Northeastern California, of which at least 24% will be low-income patients and 10% will be veteran patients.

Neighborhood Healthcare – Escondido, Escondido, CA, Neighborhood Healthcare – Valley Parkway, Escondido, CA, Neighborhood Healthcare – El Cajon, El Cajon, CA, Neighborhood Healthcare – Temecula, Temecula, CA, Neighborhood Healthcare – Pauma Valley, Pauma Valley, CA.  Neighborhood Healthcare’s pilot project seeks $129,744 to provide patient broadband access to primarily low-income patients suffering from chronic and long-term conditions (e.g., diabetes and high blood pressure).  Neighborhood Healthcare’s collective project plans to serve an estimated 339 patients, 97% of which are low-income patients, in five sites serving Riverside and San Diego counties.

OCHIN, Inc., consortium with 15 sites in Ohio, 16 sites in Oregon, and 13 sites in Washington.  OCHIN’s pilot project seeks $5,834,620 in support to lead a consortium of 44 providers in Ohio, Oregon, and Washington, encompassing 8 federally qualified health centers (FQHCs) serving rural, urban, and tribal communities.  OCHIN’s pilot project will provide patient broadband Internet access service and wireless connections directly to an estimated 3,450 low-income patients to access connected care services, including video visits, patient-based Internet-connected patient monitoring, and remote treatment and will deliver care to treat high-risk pregnancy, maternal health conditions, mental health conditions, and chronic and long-term conditions such as diabetes, hypertension, and heart disease. 

Phoebe Worth Medical Center – Camilla Clinic, Camilla, GA; Phoebe Physicians Group Inc – PPC of Buena Vista, Buena Vista, GA; Phoebe Physicians Group – Ellaville Primary Medicine Center, Ellaville, GA; Phoebe Physicians dba Phoebe Family Medicine & Sports Medicine, Americus, GA; Phoebe Putney Memorial Hospital, Albany, GA; Phoebe Putney Memorial Hospital dba Phoebe Family Medicine – Sylvester, Sylvester, GA.  The Phoebe Putney Health System projects seek $673,200 to provide patient-based Internet-connected remote monitoring, video visits, and remote treatment for low-income patients suffering from chronic conditions or mental health conditions.  These projects plan to serve an estimated 4,007 patients, approximately 1,000 of which will be low-income patients in six sites serving southwest Georgia. 

Summit Pacific Medical Center, Elma, WA.  Summit Pacific Medical Center’s pilot program seeks $169,977 in support to provide patient-based Internet-connected remote monitoring, other monitoring services, video visits, diagnostic imaging, remote treatment and other services for veterans and low-income patients suffering from chronic conditions, infectious diseases, mental health conditions, and opioid dependency.  Summit Pacific Medical Center’s pilot project would serve an estimated 25 patients in Elma, Washington, 100% of which would be low-income or veteran patients.

Temple University Hospital, Philadelphia, PA.  Temple University Hospital’s pilot project seeks $4,254,250 to provide patient-based Internet connected remote monitoring and video visits to patients, including low-income patients, suffering from chronic/long-term conditions and mental health conditions.  This pilot project plans to serve an estimated 100,000 patients in Philadelphia, Pennsylvania, 45% of which are low-income patients. 

University of Mississippi Medical Center, Jackson, MS.  The University of Mississippi Medical Center’s (UMMC) pilot project seeks $2,377,875 in support to provide broadband Internet access service to patients, enabling remote patient monitoring technologies and ambulatory telehealth visits to low-income patients suffering from chronic conditions or illnesses requiring long-term care.  UMMC’s pilot project would impact an estimated 237,120 patients across Mississippi and serve up to 6,000 patients directly.  Of these patients, UMMC estimates that 52% would be low-income.

University of Virginia Health System, Charlottesville, VA.  The University of Virginia (UVA) Health System’s pilot project seeks $4,462,500 in support to expand the deployment of remote patient monitoring and telehealth services to an estimated 17,000 patients across Virginia, nearly 30% of whom will be low-income.  The UVA Health System pilot project will support patient broadband and information services, including systems to capture, transmit, and store patient data to allow remote patient monitoring, two-way video, and patient scheduling. 

What You Should Know:

– GigCapital2 Inc has agreed to merge with UpHealth Holdings Inc and Cloudbreak Health LLC to create a public digital healthcare company valued at $1.35 billion, including debt, the blankcheck acquisition company said on Monday.

– The combined company will be named UpHealth, Inc. and will continue to be listed on the NYSE under the new ticker symbol “UPH”.

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. The deal is valued at $1.35 billion, including debt. the combined company will be named UpHealth, Inc. and will continue to be listed on the NYSE under the new ticker symbol “UPH”.

Following the merger, UpHealth will be a leading global digital healthcare company serving an entire spectrum of healthcare needs and will be established in fast growing sectors of the digital health industry. With its combinations, UpHealth is positioned to reshape healthcare across the continuum of care by providing a single, integrated platform of best-in-class technologies and tech-enabled services essential to personalized, affordable, and effective care. UpHealth’s multifaceted and integrated platform provides health systems, payors, and patients with a frictionless digital front door that connects evidence-based care, workflows, and services.

“We are excited to partner with UpHealth and Cloudbreak through our Private-to-Public Equity (PPE)™ platform. The combined UpHealth has all the hallmarks we look for in a successful partnership, including a world-class executive team and an exceptional business model with scale, strong growth, and profitability margins in the digital healthcare industry. We are particularly excited about the opportunity to provide our Mentor-Investor™ discipline in partnership with an exceptional global leadership team, as well as participate in a high-tech integrated platform that comprises a variety of cutting edge disciplines, such as the Artificial Intelligence platform being developed by Global Telehealth in conjunction with the tech-enabled Behavioral Health divisions. We are confident UpHealth is at the inflection point and positioned for accelerated growth.” – Dr. Avi Katz – Founder and Executive Chairman of GigCapital2

Combined Company Offerings

Upon closing the pending mergers and the combination with Cloudbreak, UpHealth will be organized across four capabilities at the intersection of population health management and telehealth:

1. Integrated Care Management: Thrasys Inc. (“Thrasys”) has reinvested $100M of customer revenue to develop its innovative SyntraNet Integrated Care technology platform. The platform integrates and organizes information, provides advanced population-based analytics and predictive models, and automates workflows across health plans, health systems, government agencies, and community organizations. The platform plans to add at least 40 million lives to UpHealth in the next 3 years to support global initiatives to transform healthcare.

2. Global Telehealth: will consist of a U.S. division and an international division that, together, are anticipated to grow revenues by an additional $47 million in 2021.

The U.S. division of Global Telehealth following the combination, Cloudbreak, is a leading unified telemedicine platform performing more than 100,000 encounters per month on over 14,000 video endpoints at over 1,800 healthcare venues nationwide. The Cloudbreak Platform offers telepsychiatry, telestroke, tele-urology, and other specialties, all with integrated language services for Limited English Proficient and Deaf/Hard-of-Hearing patients. Cloudbreak’s innovative, secure platform removes both distance and language barriers to improve patient care, satisfaction, and outcomes.

The international division of Global Telehealth following the combination, Glocal Healthcare Systems Pvt. Ltd (“Glocal”), is a global provider of virtual consultations and local care spanning the care continuum. It has designed proven, affordable and accessible solutions for the delivery of healthcare services globally. The platform provides a full suite of primary and acute care services, including an app-based telemedicine suite, digital dispensaries, and hospital centers. The platform has signed several country-wide contracts with government ministries across India, Southeast Asia, and Africa.

3. Digital Pharmacy: MedQuest Pharmacy (“MedQuest”) is a leading full-service manufactured and compounded pharmacy licensed in all 50 states that pre-packages and ships medications direct to patients. The company also offers lab services and testing, nutraceuticals, nutritional supplements, education for medical practitioners, and training for organizations, associations, and groups. MedQuest serves an established network of 13,000 providers. The MedQuest platform is poised for strong growth via targeted product expansion and expansive eCommerce capabilities for the entire provider network. UpHealth and MedQuest have mutually executed a merger agreement, the closing of which is awaiting regulatory approval for the transfer of licenses expected by the end of 2020 or early 2021.

4. Tech-enabled Behavioral Health: TTC Healthcare, Inc. (“TTC Healthcare”) and Behavioral Health Services LLC (“BHS”) offer comprehensive services specializing in acute and chronic outpatient behavioral health, rehabilitation and substance abuse, both onsite and via telehealth. UpHealth’s Behavioral Health capabilities have dramatically expanded use of telehealth for medical and clinical services and are leveraging UpHealth’s platform to increase volumes across its services. UpHealth and TTC Healthcare have mutually executed a merger agreement, the closing of which is awaiting regulatory approval for the transfer of licenses expected prior to the end of 2020.

Global Financial Impact and Reach

UpHealth will have agreements to deliver digital healthcare in more than 10 countries globally. These various companies are expected to generate approximately $115 million in revenue and over $13 million of EBITDA in 2020 and following the combination, UpHealth expects to generate over $190 million in revenue and $24 million in EBITDA in 2021.