Tag : aging in place

Teladoc Raises $157M for Mobile Video Visits

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Dallas, Texas-based video visits telehealth company Teladoc has raised $156.8 million in its IPO and is set to begin trading under the symbol “TDOC” on the New York Stock Exchange today. At the last minute the company increased both the price of its shares to $19 and the number of shares it was selling to 8.3 million.

In the company’s previous filing, Teladoc priced its shares between $15 and $17 and planned to sell 7 million shares.

Teladoc also previously offered its underwriters the option to purchase 1.05 million shares, but underwriters now have the option, for a period of 30 days, to purchase up to nearly 1.24 million shares of common stock. If the underwriters purchase the additional shares, the IPO’s total amount raised would hit $180.3 million.

When Teladoc debuted on the NYSE this morning it began trading at $28 a share, well above its $19 IPO price.

Teladoc offers patients an alternative to a standard, in-person doctor’s visit. When a patient needs a doctor but doesn’t want to make an appointment, he or she can use their Teladoc app to schedule a remote visit. The visit includes a one-on-one consultation with a doctor over phone or via video chat. The patient’s employer or health plan may also subsidize the visit if they have an agreement with Teladoc, but the visit’s price tag is close to that of a deductible — about $40.

News first broke about Teladoc’s IPO in late April, but its initial filing was private. In June, the first public draft of its S-1 filing was published to the SEC’s site, revealing a bevy metrics about the private company, including its financial performance to date and details surrounding the acquisitions it has made in the past few years.

Teladoc posted a net loss of $6 million on topline revenues of $19.9 million in 2013, and a net loss of $17 million on topline revenues of $43.5 million in 2014. For the first three months of 2015, Teladoc posted revenues of nearly $16.5 million and a net loss of $12.7 million.

Shortly after Teladoc published its first public draft of the filing, the company disclosed that they had acquired Scottsdale, Arizona-based Stat Health Services, which offers the online doctor visit service Stat Doctors. At the time, they wrote that they expected to acquire the company for $30.5 million, comprised of $13.7 million of cash and $16.8 million of stock.

That same day, American Well filed a suit against Teladoc for alleged patent infringement. American Well’s lawsuit, filed today in Massachusetts District Court, alleges that Teladoc’s technology platform willingly infringes on a 2007 American Well patent. The suit asks for triple damages plus court fees, as well as an injunction against Teladoc continuing to do business.

By Aditi Pai | July 1, 2015 | This article originally appeared in Mobile Health News

U.S. Startups Aim to Help Seniors ‘Age in Place’

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The Onkol in an undated image.
REUTERS/HANDOUT

Shari Cayle, 75, called “Miracle Mama” by her family ever since she beat back advanced colon cancer seven years ago, is still undergoing treatment and living alone.

“I don’t want my grandchildren to remember me as the sick one, I want to be the fun one,” said Cayle, who is testing a device that passively monitors her activity. “My family knows what I’m doing and I don’t think they should have to change their life around to make sure I’m OK.”

Onkol, a product inspired by Cayle that monitors her front door, reminds her to when to take her medication and can alert her family if she falls has allowed her to remain independent at home. Devised by her son Marc, it will hit the U.S. market next year.

As more American seniors plan to remain at home rather than enter a nursing facility, new startups and some well-known technology brands are connecting them to family and healthcare providers.

The noninvasive devices sit in the background as users go about their normal routine. Through Bluetooth technology they are able to gather information and send it to family or doctors when, for example, a sensor reads that a pill box was opened or a wireless medical device such as a glucose monitor is used.

According to PricewaterhouseCoopers’ Health Research Institute, at-home options like these will disrupt roughly $64 billion of traditional U.S. provider revenue in the next 20 years.

Monitoring devices for the elderly started with products like privately-held Life Alert, which leapt into public awareness nearly 30 years ago with TV ads showing the elderly “Mrs. Fletcher” reaching for her Life Alert pendant and telling an operator, “I’ve fallen and I can’t get up!”

Now companies like Nortek Security & Control and small startups are taking that much further.

The challenge though is that older consumers may not be ready to use the technology and their medical, security and wellness needs may differ significantly. There are also safety and privacy risks.

“There’s a lot of potential, but a big gap between what seniors want and what the market can provide,” said Harry Wang, director of health and mobile product research at Parks Associates.

NURSE MOLLY

Milwaukee-based Onkol developed a rectangular hub, roughly the size of a tissue box, that passively monitors things like what their blood glucose reading is and when they open their refrigerator. There is also a wristband that can be pressed for help in an emergency.

“The advantage of it is that the person, the patient, doesn’t have to worry about hooking it up and doing stuff with the computer, their kids do that,” said Cayle, whose son co-founded Onkol.

Sensely is another device used by providers like Kaiser Permanente, based in California, and the National Health Service in the United Kingdom. Since 2013, its virtual nurse Molly has connected patients with doctors from a mobile device. She asks how they are feeling and lets them know when it is time to take a health reading.

Another startup, San Francisco-based Lively began selling its product to consumers in 2012. Similarly, it collects information from sensors and connects to a smart watch that tracks customers’ footsteps, routine and can even call emergency services. Next year it will connect with medical devices, send data to physicians and enable video consultations that can replace some doctor’s appointments.

Venture firms including Fenox Venture Capital, Maveron, Capital Midwest Fund and LaunchPad Digital Health have contributed millions of dollars to these startups.

Ideal Life, founded in 2002, which sells it own devices to providers, plans to release its own consumer version next year.

“The clinical community is more open than they’ve even been before in piloting and testing new technology,” said founder Jason Goldberg.

Just this summer, Nortek bought a personal emergency response system called Libris and a healthcare platform from Numera, a health technology company, for $12 million. At the same time, Nortek said some of its smart home customers like ADT Corp want to expand into health and wellness offerings. The goal is to offer software that connects with customers’ current systems as well as medical, fitness, emergency and security devices.

“In the smart home and health space today you see a lot of single purpose solutions that don’t offer a full connectivity platform, like a smart watch or pressure sensor in a bed,” said Mike O’Neal, Nortek Security & Control president. “We’re creating that connectivity.”

A July study from AARP showed Americans 50 years and older want activity monitors like Fitbit and Jawbone to have more relevant sensors to monitor health conditions and 89 percent cited difficulties with set up.

“They (companies) have great technology, but when you can’t open the package or you can’t find directions that’s a problem,” said Jody Holtzman, senior vice president of thought leadership at AARP.

Such products may help doctors keep up with a growing elderly population. Research firm Gartner estimates that in the next 40 years, one-third of the population in developed countries will be 65 years or older, thus making it impossible to keep everyone who needs care in the hospital.

(Reporting by Kylie Gumpert, Editing by Michele Gershberg and Diane Craft)

By Kylie Gumpert | Sep 18, 2015 | Original article appeared in REUTERS

A conversation on longevity at Medicine X

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Photo of Beskind courtesy of Stanford Medicine X

There were big-time laughs, and the expected misty eye or two, at today’s Medicine X session on aging and longevity. Natrice Rese, a retired personal support worker, began the conversation with a moving ePatient Ignite! talk about how life for many older adults is less than “golden.” She told the audience how difficult time spent in a nursing home or care facility can be: “So many people wait to be fed, wait to be dressed, wait to be undressed, wait to be taken outside… When you’re dependent on care from others, your life is reduced to a waiting game.”

Her mother found herself in one such place at the age of 85, and Rese recalled how her mom pulled her aside one day and said, “Don’t come near these places – it’s not good here.” Her mother was in the throes of Alzheimer’s and unable to offer further details, but “her words stay with me today,” Rese somberly told the audience.

Rese said her mom’s comments ultimately reinforced her desire to work to make sure older adults feel appreciated and are able to “create memories that matter.”

Fellow panelist Barbara Beskind is certainly doing that – and more. The 91-year-old former occupational therapist made headlines when she landed a job at Silicon Valley design firm IDEO. Appearing at the conference alongside Dennis Boyle, a partner and founding member of the firm, she goes to the office every Thursday and is now working on a variety of projects related to aging – including a redesigned walker.

Younger designers “can’t put themselves in the shoes of the elderly,” Beskind told USA Today earlier this year. “People who design for the elderly think they need jeweled pill boxes or pink canes. We need functional equipment.”

“I admire you,” Rese told Beskind during a panel discussion, after hearing about Beskind’s contributions. “You shouldn’t be one of a few – you should be one of many.”

Beskind’s talk was preceded by a presentation from Christopher Scott, PhD, senior research scholar at the Stanford Center for Biomedical Ethics, who offered details on longevity research. Earlier this year, he described the central features of work in this area as including “an embrace of big data, a pivot away from studies hoping to find aging genes, a recognition that aging is best thought of a collection of diseases, not just one disease;” he said today that the theme of the research is how to “live long and live well.”

Suggesting that people read Ezekiel Emanuel’s recent provocative essay called “Why I hope to die at age 75″ (“He’s very skeptical that new technologies will give us the future that we deserve and are aiming for,” said Scott), as well as an “absolutely stunning” series of New York Times pieces written about the end of life by the late neurologist Oliver Sacks, MD, Scott encouraged the audience to ask themselves several important questions. How would you imagine old age to be 50 years from now? Should there be limits on technology that could enable people to live much longer than they do today? And, how do we want to live our lives between now and our individual endpoints?

Other questions were later posed to the panelists by moderator Paul Costello and Twitter users. When asked how we, as a society, can shift our focus from disease care to quality of life, Kyra Bobinet, MD, MPH, senior instructor-research of health engagement in Stanford’s Behavior Design Lab, noted that patients’ voices need to be turned up in volume: “It’s a breakdown in democracy that this isn’t happening.” Earlier she referenced the disparity between what people say they want as they get older (in crude terms: that they don’t want to rot away) and what actually happens in many cases. “We need to design a way to close the gap,” she said.

The session ended on a lighter note, with the panelists taking a crack at giving advice to their 25-year-old selves. “Slow down” and know that relationships are all that matter, said Bobinet. “Try to live without fear,” suggested Costello. Have better posture, and know that taking a brisk walk for 30 minutes each day will keep you young, commented Beskind. But big laughs were reserved for Scott’s answer: “Stay away from Bombay Sapphire gin.”

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

By Michelle Brandt | September 25, 2015 | This article originally appeared in SCOPE Blog, Stanford Medicine

How House Calls Can Cut Medical Costs

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For infirm older patients, Medicare finds that personal visits can keep people out of the hospital

[highlight]By Laura Landro | Sep 27, 2015 | This article originally appeared in The Wall Street Journal[/highlight]

Cleveland Clinic physician William Zafirau makes a periodic call on Al Teisler, who went home from a rehab facility early this year. PHOTO: DON GERDA/CLEVECLINIC2015

For many chronically ill older patients, house calls are replacing some hospital stays.

Across the U.S., home-based primary-care practices are sending doctors, nurses and other clinicians on regular house calls to older, infirm patients. The goal is to prevent costly hospital stays and admissions to long-term-care facilities, while improving the quality of care, especially for the sickest 5% of Medicare beneficiaries, who account for 50% of the federal program’s costs.

Unlike traditional visiting-nurse services, which step in for a few weeks after a patient is discharged from the hospital, the home-based primary-care model calls for continuing appointments. The patients, often frail and homebound, typically are struggling to manage multiple serious illnesses, such as dementia, congestive heart failure, stroke and cancer.

Evidence has mounted that primary care at home, though not inexpensive to provide, can be more economical than a constant cycle of emergency-room visits and hospital stays. According to a study published last year in the Journal of the American Geriatrics Society, Medicare costs for patients in a home-based primary-care program in Washington, D.C., were 17% lower than those for a control group, averaging $8,477 less per beneficiary over two years. Another study in the same journal, of Veterans Affairs home-based care, showed that it not only reduced costs but also led to higher patient satisfaction.

A promising program

The Centers for Medicare and Medicaid Services in June announced promising results from a Medicare demonstration project called Independence at Home, which includes 17 medical practices serving more than 8,400 beneficiaries. Providing home-based care with teams directed by physicians and nurse practitioners, the practices saved over $25 million in the first year. Under a so-called shared-savings incentive payment model—where care providers that meet a cost-cutting goal earn a bonus payment—nine practices whose expenditures were at least 5% less than their spending targets received incentive payments totaling $11.7 million.

The project is part of the Obama administration’s goal, announced earlier this year, of tying 50% of Medicare payments to alternatives to the traditional fee-for-service model by 2018. “Payers are rapidly moving to a system of value-based care, one in which providers will be paid only for services that meet certain quality standards,” says Bruce Leff, associate professor of medicine at Johns Hopkins University School of Medicine.

Independence at Home, which was recently extended for two more years, “is targeting the sickest beneficiaries, who are very costly and have large gaps in care coordination and many hospital admissions per year,” says Patrick Conway, the acting principal deputy administrator and chief medical officer of the Centers for Medicare and Medicaid Services. The teams are “getting into the home, adjusting medications, understanding the patient’s environment and detecting early if the patient’s disease is suddenly getting worse, so they can prevent hospitalizations and readmissions.”

The largest share of incentive payments, or nearly $8 million, was awarded to five medical practices of the Visiting Physicians Association, which reduced costs by an estimated 16.4% due to lower admissions, readmissions and emergency-room visits. VPA, a leading provider of house-call medicine and geriatric home health care, uses mobile lab, radiology and medical equipment, and provides hospice and palliative-care services at home.

Providing home-care services “is a very expensive proposition in the fee-for-service world,” says Robert Sowislo, executive vice president for governmental affairs at U.S. Medical Management, Troy, Mich., which provides management services for VPA. “But having the shared-savings model makes it more economically feasible to expand across the U.S.”

Better patients

Mr. Sowislo says patients are more engaged in their care when doctors and other clinicians come to the home, “so they are following doctors’ orders more carefully.” They often reach out to program staff, which is on call 24/7, instead of calling 911 when they have concerns, he adds.

Cleveland Clinic, one of the participants in the project, was able to reduce costs in the first year, in part by lowering hospitalizations, 30-day readmissions and emergency-room visits. But partly because it had a relatively small number of patients the first year, it wasn’t able to meet certain thresholds to qualify for an incentive payment.

Cleveland Clinic house-call physician William Zafirau says the clinic has since expanded the number of patients it is treating at home and hopes to meet the criteria for incentive payments when data for the second year of the program is released in a few months.

Cleveland Clinic physicians in the program usually see six or seven patients a day, driving within a 20-mile radius. Dr. Zafirau says stable patients are seen by a doctor every two to three months, but sicker patients may get visits once or twice a week. The doctors do everything from cleaning wounds to monitoring infections and removing ear wax.

A success story

One of Dr. Zafirau’s patients, Al Teisler, 90, was hospitalized last November due to a plunge in blood pressure, and was diagnosed with an enlarged prostate. He was discharged to a rehabilitation facility for a couple of months, and “couldn’t wait to get out of there,” says his wife, Marge, 85.

But when he got home, he still needed a walker and a catheter for his bladder, “and navigating around was becoming a real challenge,” she says. Mr. Teisler was offered home visits, which included a monthly appointment with Dr. Zafirau, weekly visits from a nurse to check on his blood-thinner medications, and regular sessions with physical and occupational therapists to strengthen his arms and legs.

Mr. Teisler no longer has the catheter and is strong enough to do the physical-therapy exercises on his own. The doctor now comes about once every six weeks, and Mr. Teisler feels well enough for his wife to drive him to a facility where he gets his blood thinners checked. “He’s able to get around much better,” she says.

If there is a concern, Ms. Teisler calls the home-care program, and she says she always gets a response almost immediately. “They really seem to care,” she says.

Eiran Gorodeski, director of the Center for Connected Care at the Cleveland Clinic, says home visits often are more productive than office visits for elderly patients. “It’s hard to understand in a brief visit what barriers patients have, either because they don’t recognize the problems or they are too embarrassed to tell you,” Dr. Gorodeski says.

While doctors can see only a limited number of patients each day in their homes, compared with an office setting, the shared-savings concept means “you can make a living doing house calls,” he says.

Christiana Care Health System, in Wilmington, Del., also didn’t qualify for an incentive payment in the first year of the Independence at Home project. But Omar A. Khan, associate vice chairman of the department of family and community medicine, says Christiana learned valuable lessons, such as the importance of focusing on making sure patients’ medication lists are in sync after a hospital discharge to avoid problems that could lead to a readmission.

Dr. Khan says Christiana hopes to qualify for shared-savings payments in the future. But the most important thing, he says, is that patients “appreciate a system of care built around their preference to be at home as long as they can.”

Ms. Landro is a Wall Street Journal assistant managing editor in New York and writes the Informed Patient column. She can be reached at laura.landro@wsj.com.