Tag : industry news

Teladoc Raises $157M for Mobile Video Visits


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

Digital Healthcare Could Save U.S. $300 Billion


The United States spends 18% of its GDP on healthcare each year.

Though this percentage far exceeds that of other developed economies, government projections say it will only continue to rise in the coming years.

It is often said that the US desperately needs to reduce healthcare costs — and analysts at Goldman Sachs think a major spending reduction is not far off, thanks to the Internet of Things (IoT).

In a report published Monday, Goldman analysts predicted that digital healthcare will revolutionize the industry, both by increasing access to diagnostic, treatment, and preventative care, and by dramatically reducing costs.

The report focuses on what they see as the “first wave” of healthcare IoT: technologies that bridge “the digital and physical worlds to change physician and patient behavior.”

Though the space is still in early stages of development, Goldman sees massive opportunities in Telehealth, behavior modification, and remote patient monitoring.

Telehealth allows patients to seek expert medical advice without having to visit a doctor’s office, while behavior modification encourages patients to take on healthier lifestyles with clinically validated methodologies.

Remote patient monitoring enables healthcare providers to frequently keep track of high risk patients. This sits “at the bulls-eye of the healthcare cost challenge” according to the report, because chronic disease management accounts for about 1/3 of all US healthcare spending. And most of that spending can be attributed to heart disease, asthma and diabetes.

“These disease states also represent the most fertile ground for digital health since data and modification of treatment paradigms have demonstrated improved patient outcomes, lower adverse events, and reduced costs,” the report said.

All-in-all, the analysts see the opportunity for $305 billion in savings from digital healthcare in the near future. As much as $200 billion of that could come from chronic disease management, largely due to the elimination of redundant and wasteful expenditures.

On the other end of this, Goldman says the digital healthcare market could see as much as $32.4 billion in near-term revenues.

From the report:

Admittedly, these types of seismic shifts take time to materialize; however, we would caution the healthcare industry’s largest incumbents not to take the threat of digital health lightly…What has surprised us through conversations with physicians, major hospital networks, payors, and the start-up community has been the general willingness to explore digital health as a viable component in daily healthcare practice. In fact, we came across a number of large integrated delivery networks (IDNs) using remote monitoring and telemedicine to drive patient compliance, monitor developing conditions, and adjust treatment paradigms. These findings gave us confidence that digital health technology carries merit and is starting to find a place in larger systems, which could percolate throughout the system in the future.

“The advent of mobile and the advancement of sensors effectively allow for the miniaturization of medical equipment that formerly only a centralized institution could afford,” the report said. “In this way, we envision IoT enabling a hospital of the future based almost exclusively in ‘the cloud.'”

That is, while Goldman does not expect brick-and-mortar hospitals to disappear anytime soon, they see an important opportunity to bring as much care directly into the patient’s home as technologically possible.

Still wondering how digital healthcare can work? Check out this chart Goldman created to address the FAQ’s surrounding the field:

By:  | June 29, 2015 | This article originally appeared in Business Insider

Communities Struggle to Care for Elderly at Home


More people age at home, raising demand for support services

Aldea Campbell, 82, who lives alone in her 102-year-old house in Stockholm, Maine, descends narrow stairs to fill her wood-burning stove several times a night during the winter. Photo: Jason Paige Smith for The Wall Street Journal

STOCKHOLM, Maine—At least three times a night during much of the long, harsh northern winter, Aldea Campbell gets out of bed, steps into her slippers, and descends a flight of frighteningly steep, narrow wooden stairs to the cellar to fill her wood-burning stove. She’s 82, a widow, and has lived in her 102-year-old house near the Canadian border for almost six decades.

She burns wood because she can’t afford enough oil to get through the cold months. When her arthritis is bad, she gingerly maneuvers the steps sideways to keep from falling. But still, she slipped on the stairs twice last year, once badly hurting her tailbone. “It happened so fast,” she said.

Such predicaments are increasingly common in Maine: the grayest, most rural state in the U.S., with housing among the oldest in the nation. Maine has another distinction: it is among the first states to experience challenges from a growing number of seniors who are “aging in place”—remaining independent rather than relocating to nursing homes or moving in with grown children.

More elderly across the nation are aging at home for a variety of reasons: they prefer to and are healthy enough to stay; they can’t afford other options such as assisted living; and states in some cases have imposed policies to limit nursing home stays paid for by Medicaid, which is a major funder of long-term institutional health care for older Americans.

But aging in place is proving difficult in places where the population is growing older, supportive services are scarce, houses are in disrepair and younger people who can assist have moved away. As a result, elderly people who live at home are having to rely more on neighbors—who sometimes are elderly, too—and local nonprofits and public agencies are starting to feel the strain from increasing requests for help.

“It’s a huge issue—it couldn’t be bigger,” said Lenard Kaye, director of the University of Maine Center on Aging. “Ninety-nine percent of older adults say they want to stay right where they are until they’ve taken their last breath, but that doesn’t mean they are continuing to remain safe and remain well.”

Medicaid, a network of aging services under the federal Older Americans Act and state and community programs have long provided some assistance to elderly people who want to remain independent. But in general, people who choose to age at home “have always been on their own,” said Donna Wagner, dean of the New Mexico State University College of Health and Social Services and a researcher on aging. “I don’t think we’ve had a clear contract with the elderly,” she said.

Public and private entities are increasingly trying to offer more services but demand is outstripping supply because the population is aging, she said. In some poorer areas, services can be hard to find at all, she said. “This philosophy of remaining independent with the help of community-based services has been a little oversold,” said Ms. Wagner. “Lots of people have a hard time doing it.”

Maine, Pennsylvania, Kentucky and New York are among states now boosting programs that help the elderly live at home, while churches and communities are also implementing more initiatives.

There were 26.8 million households headed by someone 65 and older in 2013, up 24% from 10 years earlier, according to the U.S. Census. Households headed by a person 75 and older grew 13% to 12.2 million. Meanwhile, the number of older people living in institutions or with relatives has declined. Living alone has supplanted living with relatives as the most common scenario for women 75 and over, according to the Census’s official blog in July, describing a “gray revolution in living arrangements.”

The Centers for Disease Control and Prevention defines “aging in place” as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” These people may need assistance, but staying home, whether in the family residence or a downsized version, is a paramount goal. A 2010 AARP survey found 88% of respondents 65 and older said they wanted to stay in their current residence as long as possible.

Seniors remaining rooted isn’t new, but the accelerated growth of the senior population, with an estimated 10,000 baby boomers turning 65 each day, is fueling new questions about whether communities are prepared, Kathy Greenlee, the assistant secretary for aging at the U.S. Department of Health and Human Services, said in an interview.

“There is almost general agreement that this is a worthy goal,” Ms. Greenlee said. “The hard part is, how do we build the infrastructure that best supports it?” Challenges range from adequate housing to transportation, and “unfortunately they are very large issues,” she said.

Photos: In Maine, the Joys and Struggles of ‘Aging in Place’


See all the photos with captions: http://www.wsj.com/articles/communities-struggle-to-care-for-elderly-alone-at-home-1443193481

Policy makers are grappling with these issues particularly in the northeast, which has the oldest median age of any U.S. region, as well as housing rife with hazards.

Starting in 2017, Pennsylvania will contract with managed-care organizations that will help tens of thousands of seniors eligible for long-term care under Medicaid remain at home. The goal is to direct a far larger portion of funds away from more costly nursing homes to efforts—even something as basic as adding a ramp to a house—that help the elderly live safely at home, said Pennsylvania Human Services Secretary Ted Dallas.

The New York 2015-16 budget, which took effect on April 1, includes one of the state’s largest investments ever in assisting seniors at home: more than $65 million for programs, from transportation to respite services for family caregivers. Kentucky is, for the first time, planning a program to deliver meals five days a week to the homes of nearly 4,000 low-income seniors.

In Maine, where the median age was 43.9 years in 2013, compared with 37.6 for the nation—a new law authorizes the state to ask voters in November to borrow $15 million to build affordable homes for seniors and repair older dwellings occupied by the elderly. In August, the state also said it would put an additional $3.2 million into home services for the elderly to reduce waiting lists, such as the 900 people who were waiting for basic help, from meal preparation to housekeeping assistance.

While polls show people prefer to age at home, some seniors have few other options: 88% of U.S. residents in assisted living pay privately, and the national median monthly rent is north of $3,500, according to the Assisted Living Federation of America and Genworth Financial Inc.

The number of people 65 and over living in nursing homes fell nearly 20% in the 2010 Census, from 10 years earlier, in part as states limited costly institutional stays. Maine, for instance, in 1994 adopted tougher criteria for admissions, meaning people had to be frailer than before that year to qualify for nursing-home stays funded by Medicaid.

Nursing-home eligibility

Maine officials are now looking at whether they need to re-evaluate the eligibility criteria. “Frankly it gives me great pause today when I look at, on a case-by-case basis, some of the individuals being denied access to nursing facilities,” Maine Department of Health and Human Services Commissioner Mary Mayhew said in an interview.

The delicate balance of protecting seniors while helping them stay independent is perhaps most evident in isolated places like Aroostook County, Maine’s northernmost county.

A stunning but economically struggling region of rolling green hills, forests and potato farms, Aroostook is a long drive and a stark contrast from southern Maine, where more affluent retirees flock to quaint towns on the rocky coast. It is larger than Connecticut and Rhode Island combined, but has less than 2% of their population. The closing of a military base in 1994 and automation in logging and farming drained jobs and population to 69,447 residents in 2014 from a peak of 106,000 in 1960, according to Census estimates. Unemployment is among the highest in Maine.

Judy Moreau’s house in Portage Lake, Maine, needs repairs but the 70-year-old says she can’t afford it. She relies on her 80-year-old neighbor—who himself has a pacemaker—to drive her the 42 winding miles to the doctor. Photo: Jason Paige Smith for The Wall Street Journal

A shortage of opportunity has driven away the young. Between 2000 and 2013, Aroostook lost nearly 20% of its population aged 22 to 44 years old, according to Census estimates. Meanwhile, the number of people 65 and over grew about 11%.

“There’s such a state of out-migration that it’s difficult to fill certain positions, and that impacts the elderly,” said Aroostook County Administrator Douglas Beaulieu. Finding home-health workers in the county is a “constant challenge,” said Lisa Fuller, vice president of business development at VNA Home Health Hospice, a Maine organization.

More than 1,600 elderly households are on a waiting list to have insulation installed or broken or faulty heating systems fixed or replaced; potentially dangerous furnaces are a key worry, said Jim Baillargeon, senior manager for Aroostook County Action Program Inc., a local nonprofit organization. Many will be on the waiting list for years, he said.

Instead, the elderly in Aroostook often rely on other older people, making for a fragile support system. In the town of Mars Hill, 90-year-old Marion Miller lives alone and gets around using a walker after three falls. She counts on her son, Stillman, for day-to-day help. But he is 68, weakened from a heart attack in May, and said he worries about his ability to assist.

At the edge of the North Maine Woods, in Portage Lake, (pop. 391), Judy Moreau, who is 70 with heart problems, relies on her 80-year-old neighbor—who himself wears a pacemaker—to drive her the 42 winding miles to the doctor. Last year, the car veered into a ditch, leaving the pair shaken and flagging down passersby for help.

Many Aroostook seniors would be candidates for assisted living or downsizing into an apartment, but either can’t afford those options or can’t find them nearby, said Mr. Beaulieu. Many also resist moving out of pride, rugged Maine individualism and the hook of history: it is where they were born and raised, and where their ancestors and spouses are buried.

Closed school

A dearth of young people forced the school to close in the town of Stockholm (pop. 253) in 2004. But Mrs. Campbell, a retired factory worker, is determined to remain in the home and community where she has attended the same Catholic parish for 56 years and raised six children.

Her husband, who was a mechanic, died in 2003. Three of her grown children still live in the area, but she values her independence too much to move in with them. Publicly subsidized affordable housing complexes in Caribou, the closest large town, have waiting lists, as does the nursing home there.

Participants in a youth mission trip organized by Saint Anne and Saint Catherine of Alexandria parishes in Massachusetts work on the roof of Karen Hill’s home in Caribou, Maine, this summer. The mission group helps repair homes of the elderly in Northern Maine. Photo: Jason Paige Smith for The Wall Street Journal
Mrs. Campbell had help with minor repairs from a Massachusetts church group that recently visited the county to assist seniors. But her routine overall is a “struggle,” she said, particularly staying warm in a remote region where consumers rely on expensive heating oil to warm their drafty old homes in cold seasons that run from October to May.

Mrs. Campbell received public fuel assistance last year, but exhausted it by midwinter, forcing her to heat with wood. Her budget is strained in part because she is already paying off a loan she took to fix a crumbling chimney. Most homes that receive fuel assistance don’t get enough oil to make it through the winter, said a spokeswoman for the Maine State Housing Authority, which administers the fuel assistance, which is meant to be supplemental help.

Photo: Getty Images

Public agencies are feeling the strain. The Presque Isle Fire Department, in a small city in Aroostook County, is getting “a lot more” calls from elderly residents than ever before, said Adam Rider, deputy chief. Falls are a common issue, as are problems caused by older residents burning wood to save money on oil, he said.

In the town of Van Buren, across the river from Canada, Robertine and Fernand Levesque are also finding it increasingly arduous to stay in the community where they have lived all their lives.

Married for 59 years, the couple has one adult child who lives five hours away. Mrs. Levesque, who is 78, acts as caregiver to her husband, also 78, who once ran a chain-saw business catering to loggers but who now struggles to walk after a heart attack and stroke. With a monthly income of $1,091, they “hardly have anything left after paying bills,” and struggle to pay property taxes, let alone home repairs, she said.

Having “worked hard all our lives,” they were reluctant to seek help, but now rely on food stamps and recently put their name on a waiting list with a nonprofit agency for a new roof, Mrs. Levesque said. Their current roof is deteriorating; “every time it rains, I pray,” she said.

Still, she can’t imagine going to a nursing home. “I don’t want to go now for sure, and he doesn’t want to go,” she said. “I’ll take care of him here for as long as I can.”

By Jennifer Levitz | Sep 25, 2015 | This article originally appeared in The Wall Street Journal

Grand Rounds Raises $55M for Online 2nd Opinions


Grand Rounds, a company that works with consumers and employers to match patients with specialist doctors and helps provide second opinions, has raised $55 million in third round funding from a new, undisclosed global mutual fund investor as well as existing investors Greylock, Venrock, Harrison Metal and David Ebersman.

This round brings Grand Rounds’ total funding to $106 million. The company plans to use the funds to build out its technology, care team and analytics platform in response to increased employer demand.

“Whether and where we receive medical treatment are critical decisions, yet patients lack adequate support in navigating these choices,” Owen Tripp, co-founder and chief executive officer of Grand Rounds, said in a statement. “We provide patients the technology and information they need to make informed health care decisions, and comprehensive support from a physician-led care team. In an era of payer/provider consolidation, consumer-directed health plans and narrow networks, we empower patients and remove barriers to their care.”

Grand Rounds provides a software platform that’s designed to help ensure patients are getting the best care they can get in different situations. So, for urgent care, the app helps users find the highest-rated physician in their area that’s also in their insurance network. For more serious conditions, customers can use Grand Rounds to get a virtual second opinion, which might help them avoid unnecessary treatments or surgeries. Users are matched to experts using their medical records and analytic software.

This value proposition extends to employers too, who can pay for Grand Rounds for all their employees with the promise that better diagnostics and treatment plans will ultimately save money for the patient, and, therefore, their employer-funded health plan.

Grand Rounds changed its name from ConsultingMD after it raised its first $10 million from Venrock in 2013. The company raised another $40 million last June, with Greylock leading the round, and announced at the time that 1 million patients were using its services. Last month, former HHS Secretary Kathleen Sebelius joined the company’s board of directors.

“I see in Grand Rounds the potential to transform healthcare delivery in the United States,” Sebelius said in a statement at the time. “One goal must be getting the right care to the right patient each and every time, in part by giving consumers direct access — both in-person and virtually — to the brightest minds in US medicine. Through its partnerships with leading employers, Grand Rounds demonstrates that when it comes to health care, exceptional and economical are not opposed objectives.”

By Jonah Comstock | Aug 20, 2015 | This article originally appeared in MobiHealthNews

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


The Onkol in an undated image.

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.


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


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


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.