DHW Q&A: Bridging Gaps in Remote Care With Clear Arch Health

With Robert Flippo
MobileHelp / Clear Arch Health, CEO

In this Digital Health Wire Q&A, we sat down with MobileHelp CEO Robert Flippo to discuss the shifting remote patient monitoring landscape and how new technologies are enabling more people to age independently.

Clear Arch Health is MobileHelp’s healthcare division, which integrates RPM and personal emergency response systems (PERS) into a turnkey solution that’s easy to implement for both patients and providers.

Can you give us a quick introduction to Clear Arch Health and your overall strategy?

Our overarching goal from the very beginning has really been to improve people’s ability to age independently, starting with our consumer-facing MobileHelp personal emergency response business, and also with our Clear Arch Health remote patient monitoring platform.

To enable people to age wherever they want, which is usually in the home, you need a platform that’s both flexible and proactive. There’s the actual clinical monitoring component, where clinicians are managing patients, keeping track of vitals, checking on medications, etc. Then there’s also all the data that results from that.

A lot of people think about RPM as devices, but there’s a whole system behind those devices that’s analyzing that data to more effectively manage patients. Controlling that entire tech stack is what lets us help people age independently, and that’s the real mission here.

The longer people can remain independent, the happier they’re going to be.

How does your experience in PERS support the remote patient monitoring aspect of your business, and what sort of capabilities do you unlock by combining the two?

There’s a couple of pieces to it. First and foremost, the patients who are typically in need of PERS are also more likely to need chronic disease management using remote patient monitoring. So for the consumer, combining the two really simplifies the experience.

That’s hugely important when you think about this demographic. One of the major lessons we’ve learned from working with this population for over 15 years now is the importance of having a seamless platform that’s intuitive for someone that might be over the age of 75.

It’s easy for a lot of companies to get caught up with the shiniest tech and all of its bells and whistles, but the patients that we’re working with usually want the exact opposite.

This fundamental understanding of our customer base drives the design of everything from our hardware and installation to our customer service and manual. It’s powerful in its simplicity and fully turnkey. You plug our products in, and they work.

Can you give an overview of that hardware and the other components of the platform that you layer on top of it?

I’d say that a lot of people think of the hardware as the whole solution. It’s an important part, and it needs to be safe and reliable and all of those things, but at the end of the day it is just one component, like you said.

The flagship product for our remote patient monitoring service is a custom tablet solution that we’ve developed and manufactured for both RPM and personal emergency response. It’s purpose-built for our customers with loud speakers, sensitive microphones, and easy connectivity – but it’s also highly configurable.

Depending on the program that’s being developed, we can provide unique content for education, or a direct connection to nursing staff for video visits, but all of it is integrated with the EMR so that care teams can also have a seamless experience and access to the data.

When we deploy a program with a new client, the set-up, the training, and the ability to interact with patients directly are all just as important as the hardware. There’s at least as much service in this industry as there is technology. 

There’s recently been a major shift to RPM and home health in general. What are some of the biggest changes that you’ve seen over the last few years?

One of the biggest changes has been the willingness of CMS or Medicare to actually reimburse remote patient monitoring for chronic disease management.

Up until recently, home health agencies were tasked with taking care of patients after they were discharged from the hospital, and one of their primary incentives was to try and prevent readmissions – yet there wasn’t a specific line item that covered remote patient monitoring. RPM has now been proven to prevent readmissions, and reimbursement is following.

The other major change has been the flood of new entrants into the space, both from small startups and larger companies more at scale like we are. In my view, that’s actually created a lot of noise in the market, and it’s now more difficult than ever to separate out who the real players are and how they might be able to help.

What are the biggest trends you’re seeing in the aging in place segment that might not be getting the attention they deserve?

I don’t think that it’s so much a specific trend that people are overlooking, as much as the fact that we’re only just starting to see the beginning of what the possibilities are. At a certain point, these programs are generating so much data that the real challenge becomes getting the value out of it.

The introduction of new AI tools is giving us the ability to analyze that data in real time, which will let more people age independently by allowing us to pick up on situations that might be difficult to spot by a human looking at the raw data.

The reality is that there aren’t enough caregivers to take care of the population that’s going to be aging in place over the next 10 to 20 years, so if we don’t figure out how to use this technology to more effectively manage patients, we’re going to be in a tough spot. In my opinion, it’s not really an option that we succeed here, it’s a necessity.

Is there any advice that you would give to a provider organization or health system thinking about implementing their own remote patient monitoring strategy?

When you really dig into it, remote patient monitoring is probably more complicated than you’d originally think. The key to overcoming that is finding the right partner for your situation.

If you’ve seen one remote patient monitoring solution, you’ve seen one remote patient monitoring solution. Everybody’s situation is different, even within health systems. They’re generally solving for the same problem, but they all have unique requirements and capabilities, so finding a partner that can help navigate to the right solution and that’s flexible enough to implement it will give you a much higher probability of success.

For more on Clear Arch Health’s RPM platform, head over to their website.

TytoCare Lands $49M to Expand to Chronic Care

TytoCare is $49M closer to making virtual primary care a reality after landing a Series D extension to help expand its portfolio of remote diagnostic solutions.

One of telehealth’s biggest hurdles has been the difficulty of conducting remote physical exams, which is exactly what TytoCare’s Home Smart Clinic sets out to address.

The Home Smart Clinic is a modular handheld device with different attachments that allow patients to conduct their own ear, throat, heart, and lung screenings.

  • These exams can either be guided by a live video chat with a physician, or performed asynchronously with the results transmitted to the care team.
  • That’s also backed by Tyto Insights smart diagnosis support, as well as the Tyto Engagement Labs suite of user-engagement and tracking services.

CEO Dedi Gilad told STAT that the funding increased TytoCare’s valuation and provided enough runway to break even over the next few years as the company sets its sights on an eventual public offering.

The round will also accelerate TytoCare’s expansion into chronic conditions that require more management than the occasional virtual visit, such as asthma and COPD.

  • TytoCare recently received FDA Clearance for its first longitudinal care module for Wheeze Detection, which analyzes sounds recorded by the stethoscope attachment for signs of respiratory issues.
  • It’s also worth mentioning that TytoCare is taking full advantage of its massive remote exam data set to train the AI models that serve as the backbone of its diagnostic support, and the Wheeze Detection module was apparently trained on the largest lung sound database of its kind.

The Takeaway

We’ve covered plenty of studies highlighting telehealth’s limitations when it comes to accurate remote diagnosis, and TytoCare is leading the charge to make virtual care viable for more conditions. The Home Smart Clinic gives TytoCare a key advantage over competitors that rely solely on video to try to replicate the experience of a doctor’s visit at home, and the modular design is a solid foundation for bolting on new functionality down the road.

Option Care Health Acquires Amedisys for $3.6B

There’s a new home health giant on the block after infusion services provider Option Care Health shelled out $3.6B of stock to acquire in-home care and hospice company Amedisys.

The acquisition creates a massive entity specializing in nearly every type of home care, with over $6B in annual revenue between its 16k+ employees and 46 state footprint. 

It’s worth mentioning that the initial analyst reaction to the merger was… not great. The news sent shares of Option Care’s stock sliding over 20% as investors grappled with Amedisys’ reliance on Medicare reimbursement that hasn’t been friendly to home health.

Option Care is one of the largest providers of home and alternate site infusion services, with nearly all of its revenue (88%) stemming from commercial health plans.

Amedisys ranks among the nation’s top independent providers of home health services, offering everything from nursing to hospice. It’s also a major hospital-at-home player thanks to its 2021 acquisition of Contessa Health. A majority of Amedisys’ revenue (76%) comes from Medicare and other government plans.

Combining the two is expected to reduce costs by $50M right out of the gate, due primarily to tech-enabled efficiencies, an optimized geographic footprint, and realigning costs through combined purchasing volumes.

  • Revenue is also projected to increase by ~$25M through enhanced care coordination across each company’s respective patient base, as well as new programs. That’s about a 4% increase over the $622M the businesses generated last year.

Although a one-stop home health provider looks good on paper, the mixed response centered around Medicare’s recent reimbursement cuts for in-home therapies, with more cuts likely on the horizon in next month’s proposed rule for 2024.

  • That’s on top of the ongoing shift to Medicare Advantage and its meaningfully lower rates, not to mention the acquisition arrives just two months into Richard Ashworth’s tenure as Amedisys CEO.

The Takeaway

Regardless of the timing, combining Amedisys’ home health and hospice solutions with Option Care’s alternate site infusion services creates a juggernaut in-home provider at a time when healthcare continues to move away from the hospital. The combined business undoubtedly has a more diversified payor mix than either one independently, and the leadership team believes the synergies and joint negotiating power will more than offset any reimbursement headwinds. Time will tell.

Care-at-Home Enabler MedArrive Closes $8M

Care-at-home enabler MedArrive is pedal-to-the-metal after closing an $8M growth round to accelerate its expansion into new markets.

MedArrive got its start in Redesign Health’s startup studio, powering care-at-home programs for payors and providers by integrating physician-led telemedicine with in-person care from EMS professionals.

  • The three-year-old company is led by CEO Dan Trigub, former Head of Uber Health, who was drawn to the company’s mission of helping vulnerable populations while simultaneously improving healthcare workforce utilization.

To accomplish that goal, MedArrive leverages a national network of over 50k EMS professionals to reach Medicaid or dual-eligible beneficiaries with complex needs.

  • That’s a pretty impressive network given the age of the company, and MedArrive built it by working with local EMS agencies to access their excess capacity then drive volume through its payor partnerships. 

These field providers handle everything from health assessments to complex condition monitoring, and the in-home presence also opens the door for SDOH interventions like transportation, mobility, or nutrition assistance.

  • Although EMS professionals can’t diagnose patients or do HCT coding, MedArrive connects those dots through telemedicine-enabled physician oversight, as well as its own team of social workers, case managers, and nurse practitioners.

All of those services are offered as a white-labeled platform that helps payors and providers engage their hardest-to-reach patients, frequently high utilizers that rely on the ED to fill care gaps.

  • That’s extended even further through partnerships where MedArrive provides the last-mile component to companies like Brave Health (behavioral needs) and Ouma Health (maternal care).

The Takeaway

Despite a difficult funding backdrop, MedArrive now has a longer runway to keep expanding its EMS network as it pushes into new markets. MedArrive’s platform gives it a sturdy frame for adding more capabilities through partnerships, and the focus is now on demonstrating its results to differentiate its approach from competing offerings.

DispatchHealth Lands $330M for In-Home Care

It looks like 2022 isn’t finished with the megarounds quite yet, with DispatchHealth hauling in $330M in a mix of debt and equity funding to build out its suite of in-home services.

DispatchHealth launched in 2013 to bring urgent care into patient homes, but has since expanded its offerings to cover a wide range of high-acuity needs.

  • The company partners with health systems, payors, and employers to provide in-home resources that help keep patients out of the hospital, such as mobile medical teams and Advanced Care hospital-at-home solutions.
  • These services are integrated within its Last Mile Care Technology Platform, which tracks care patterns to optimize utilization, forecast equipment requirements, and triage patients to outside resources when necessary.

The latest round lifts DispatchHealth’s total funding to over $730M as it shifts its focus to building out its high-acuity ecosystem in the 50+ markets it already serves – reportedly covering 75% of Medicare Advantage members in the US.

  • It’s easy to imagine that DispatchHealth is probably high on the list of acquisition targets for companies like UnitedHealth Group or CVS that are actively looking to round out their care delivery strategies with in-home assets.
  • That makes it interesting to see that UHG subsidiary Optum Ventures led the recent funding, with Humana and Blue Shield of California also participating.

The Takeaway

Against a backdrop of economic uncertainty and a slowdown in private funding, DispatchHealth’s nine-figure raise shows that investors still have an appetite for startups with a solid track record of improving outcomes. We’ve been covering plenty of stories about hospital overcrowding and struggling margins, and DispatchHealth is making it clear that it believes the home is the right setting to tackle both issues at the same time.

Inbound Health Connects the Dots for Home Care

Providing patients with at-home care is one thing, but determining which patients would benefit from it is a whole different story. Inbound Health is emerging from stealth to connect the dots.

Equipped with $20M in launch funding, Inbound is spinning out of Minnesota-based Allina Health and Flare Capital Partners to help other health systems establish their own hospital-at-home and skilled nursing-at-home programs.

The first half of Inbound’s platform covers all the bases of a robust at-home care program, including virtual care teams, in-person nursing visits, remote patient monitoring, engagement tech, and a command center to keep it all straight.

  • To help identify patients that would benefit from the program, Inbound provides AI-enabled analytics to filter candidates both medically and functionally in their home life, then confirms the fit with their physicians.
  • To help get those pieces in place, Inbound steps in with operational oversight, a comprehensive supply chain, and of course: performance-based contracts.

The overall partnership structure is flexible, allowing health systems to leverage their existing capabilities while only relying on Inbound to bridge the gaps necessary to scale these programs across their service areas.

  • Since beginning as a temporary program at the start of the pandemic, Inbound has now served over 4k patients across 185 primary diagnoses, reportedly lowering the total cost of care by 30%+ while often achieving better clinical outcomes than facility-based care.
  • While other home care enablers like Medically Home and Contessa Health are pursuing similar strategies, Inbound aims to set itself apart with “full stack of capabilities” that benefit outcomes enough to develop unique episodic-based payor contracts.

The Takeaway

At-home care is undoubtedly a hot corner of the market, attracting plenty of attention with its promise of lowering costs while increasing patient satisfaction. By bringing everything under one roof and tying its own success to its partners’ success, Inbound seems like it’s on the right path to making that promise a reality.

The Future of Home and Community Care

A bit of a slow news week gave us a chance to circle back on a recent NEJM commentary by Optum’s leadership, which laid out the key components of a futuristic home care model and the steps that Optum is taking to make it a reality.

The vision is to unite modular point solutions around the patient to enable timely interventions and care coordination that is supported by data and technology for a seamless experience and optimized care delivery across providers and care settings.”

Sounds great, maybe a little boilerplate-ish, but the individual solutions tie it all together:

  • Patient Assessments – The “pivotal first step” to identifying, engaging, and stratifying patient populations through annual in-home comprehensive clinical examinations of medical, behavioral, and social needs. Ex. Optum HouseCalls
  • Care Transitions – Appropriately managing a patient’s transition from acute care facilities is essential to keeping recoveries on track, and comprehensive programs should include post-discharge engagement and 90-day follow-ups. Ex. naviHealth
  • At-Home Emergent Care – At-home emergent care is convenient for patients while helping avoid readmissions, and the authors cite a 2018 hospital-at-home study demonstrating better outcomes than inpatient care. Ex. DispatchHealth   
  • Home-Based Medical Groups – The cherry on top of the proposed model is a call for more home-based medical groups to treat patients with chronic conditions. Services might include primary care, therapy, and dialysis. Ex. Landmark Health

The Takeaway

Although the article was mainly intended to provide a framework for successful home care, it also gave us a great peek at Optum’s priorities. It was interesting to see the companies that the authors held up as prime examples for each solution, and it’s easy to picture each of them as potential acquisition targets considering how active Optum’s been in the M&A space.

CVS Acquires Signify Health for $8B

The Signify Health acquisition saga has officially reached its conclusion, with CVS Health emerging as the winning bidder over other high profile suitors such as Amazon and UnitedHealth Group.

CVS closed the transaction at $30.50/share or roughly $8B, which should be music to the ears of Signify shareholders after the stock hit a low of $11 earlier this year.

Signify offers in-home health risk assessments and provider enablement services to help organizations transition to value-based care.

  • The company has a network of 10k providers across all 50 states and acquired ACO management player Caravan Health earlier this year to further expand its reach with Medicare patients.
  • CVS CEO Karen Lynch said that Signify “will play a critical role in advancing our health-care services strategy and gives us a platform to accelerate our growth in value-based care.”

Through the acquisition, CVS is adding to its rapidly expanding menu of healthcare offerings that already includes over 9k pharmacies, 1k MinuteClinics staffed with nurse practitioners, and the third largest payor in the nation, Aetna.

  • Acquiring a home care company gives CVS a new avenue to serve their large customer base at a time when more consumers are heading online for the everyday items that used to bring them into stores.
  • As a bonus, Signify opens the door for CVS to provide proactive care in patient homes while keeping them out of the hospital, which has the potential to dramatically cut down on expenditures for patients covered by Aetna.

The Takeaway

With the acquisition of Signify, CVS has cemented its move away from its pharmacy chain roots. The news arrives as CVS’ retail healthcare competitors are pushing aggressively into outpatient services, following close behind Amazon’s acquisition of One Medical and less than a week after Walgreens scooped up home care company CareCentrix.

CVS has made it clear that it plans to compete in healthcare by establishing itself as one of the nation’s largest primary care providers, and with such a large footprint of conveniently located stores, they have all the right building blocks to make it happen.

Homeward Raises $50M to Rearchitect Rural Care

Homeward’s “no disruption is the best disruption” strategy is picking up steam with $50M in Series B funding to rearchitect healthcare for the 60M Americans living in rural communities by augmenting local providers rather than replacing them. 

It’s the company’s second capital raise in the five months since it debuted under the leadership of former Livongo execs Amar Kendale and Jennifer Schneider, bringing its total funding to $70M.

Homeward is an in-network provider with the ambitious goal of evolving both payment models and care delivery models in rural communities hardest hit by the hospital closure crisis.

  • To accomplish this, Homeward utilizes telehealth services, in-home visits and mobile clinics for physical exams, as well as cellular-based RPM technology to monitor patients in areas without broadband.
  • The Series B follows shortly after a partnership with Rite Aid to send Homeward’s mobile clinics to rural locations and provide primary care services to Medicare members, referring patients to regional health systems and local specialists for complex needs.

The fresh funding will help Homeward scale its on-the-ground and virtual care teams while expanding into new markets through value-based contracts with health plans, the first of which was just announced with Priority Health out of Michigan.

  • Priority’s 30k Medicare Advantage members will have access to Homeward’s full suite of services, including its physicians and mobile clinics. 

The Takeaway

Homeward is one of the first comprehensive providers to take on full risk in rural markets, and its Series B will allow it to reach these populations even faster through new partnerships. This expansion will likely be focused on only a small handful of payors, with Homeward reporting that seven health plans cover 90% of Medicare-eligible beneficiaries living in rural communities.

Mass General’s Hospital-at-Home Expansion

Mass General Brigham is living up to its reputation as a healthcare innovator after laying out plans for a “massive expansion” of its hospital-at-home program to help contain costs and manage the ongoing capacity crunch at its facilities.

The health system intends to grow its current program from 25 patients to upward of 200 hospital-at-home beds by 2025, with 90 fully-operational beds expected before the end of next year.

MGB’s hospital-at-home service provides hospital-level care at a patient’s residence, allowing those who are stable enough to be monitored remotely to recover from the comfort of their home. Patients have access to virtual meetings with their care teams, as well as in-person visits from physicians, nurses, and case managers.

  • As part of the expansion, MGB appointed its first-ever president of home-based care, Heather O’Sullivan, who most recently worked for one of the country’s largest home care providers, Kindred at Home.
  • Over the next year, O’Sullivan will oversee the hiring of 200 additional workers to bring MGB’s total home care staff to 1k employees, and will ramp up its fleet of remote care vehicles from 2 to 10 to enable more home testing and medical supply deliveries.

Dr. Gregg Meyer, EVP of value-based care for MGB, compared the hospital-at-home program to a house call from a doctor, which not only gives patients more convenience, but also lets providers observe SDOH factors that might impact recovery.

  • MGB cited a 2019 study showing that its hospital-at-home service led to a 38% cost reduction compared to traditional care, while other programs have lowered readmissions and helped alleviate hospital capacity issues.

The Takeaway

Mass General Brigham ranks among the most highly visible health systems in the world, and all eyes are now on the results of its hospital-at-home expansion. If MGB can successfully create a more convenient recovery experience while simultaneously reducing costs, it could cause plenty of other organizations to replicate the model. That said, hearing a health system like MGB refer to 200 patients as a massive expansion also serves as a good reminder that scaling these types of programs is far from an easy task.

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