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Spotlight on Hypertension | Teladoc Slows the Bleeding November 4, 2024
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Together with
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“You’re either an AI product or you’re a product that now calls yourself AI.”
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knownwell CEO Brooke Boyarsky Pratt
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Digital hypertension management solutions received a mixed report card from the Peterson Health Technology Institute’s latest evaluation, which found significant differences in performance depending on the treatment approach.
The 71-page report assessed clinical and economic evidence across three solution types:
- Blood Pressure Monitoring – extend hypertension care beyond in-person visits using home monitoring devices that stream data back to providers. Ex. AMC Health, Health Recovery Solutions, VitalSight (Omron)
- Medication Management – employ dedicated virtual care teams to coordinate medication adjustments as a supplement to the patients’ main primary care team. Ex. Cadence, Ochsner Digital Medicine, Story Health
- Behavior Change – deliver educational content, alerts, reminders, and virtual interactions with coaches or care teams to improve hypertension self-management. Ex. Dario, Hello Heart, Lark, Omada, Teladoc (Livongo).
PHTI’s signature chart delivers a great summary of the findings:
The analysis found that all approaches across all payor types increase total healthcare spending over a three-year time horizon, because the cost of the solutions exceeds the savings from improved clinical outcomes.
The good news – at least for Medication Management and Behavior Change solutions – was that improvements in blood pressure over a 10-year window reduced patients’ risk of cardiovascular disease and prevented enough deaths to justify the cost.
- PHTI found that only Medication Management solutions demonstrated significant blood pressure reductions compared to usual care, and recommended that this is the “most pressing area of integration” for most practice settings.
- BP Monitoring showed “slightly greater, but not clinically meaningful declines,” but failed to breakeven at current RPM reimbursement levels.
- Behavior Change approaches produced only “limited incremental declines,” which doesn’t support broad adoption for most patients but could still play a role for underserved populations with difficult access to usual care.
Those findings naturally led to pushback from some of the companies named in the report.
- Omada said that the analysis “inadequately groups companies with very different offerings” and “narrowly focuses on select clinical metrics,” while underweighting user experience and patient-reported outcomes.
- PHTI responded to the critics by saying that “patients expect that clinically-focused digital solutions are improving their health. We can talk about competing on user experience… but we need to prove that they work.”
The Takeaway
There’s a high bar for digital solutions that need to justify their cost above standard care, and PHTI just raised that bar even higher for hypertension management. Not all approaches are created equal, and while some companies might not agree with PHTI’s findings, reports like these are a maturity milestone for digital health as a whole.
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- Teladoc Slows the Bleeding: Teladoc beat expectations during its first quarter under new CEO Chuck Divita, even with BetterHelp dragging down performance. The downward revenue trend continued with a 3% decline to $641M, although Q3’s net loss of $33M was a decent improvement from the $57M hit recorded this time last year. BetterHelp is still “a business in transition,” and it only seems to be transitioning further behind the competition as revenue slid another 10% due to climbing acquisition costs in a crowded DTC mental health market.
- Time’s Best Inventions of 2024: Time magazine’s Best Inventions of 2024 list saw strong representation from healthcare high-flyers, which accounted for 37 of the “200 innovations changing how we live.” Medical care breakthroughs like Northwell Health’s iNav cancer screener shared the spotlight with home care solutions like Withing’s BeamO remote check-up tool, and the list naturally wouldn’t have been complete without AI trailblazers like ambient documentation startup Abridge and care management platform Laguna Health.
- Good News for Transparency: Federal transparency rules appear to finally be moving the needle on hospital competition. A Turquoise Health analysis of commercially negotiated rates at 200+ hospitals uncovered significant price convergence across common healthcare services between 2021 and 2024. The highest rates – above the 75th percentile – declined about 6% annually, while the lowest increased 3.4% per year. Turquoise noted “pervasive price convergence” across 83% of the markets it examined, especially in outpatient services.
- CMS Moves Ahead on Medicare Cuts: CMS issued its final rule for the 2025 Medicare Physician Fee Schedule, which maintained the 2.83% cut to the conversion factor for physician services. The cuts were widely criticized when they were announced in July, but CMS apparently resisted calls to reduce them. The fight against the cuts now moves to Congress, which has used legislation to reverse Medicare reimbursement reductions as recently as this year.
- Dyania Series A: Clinical data abstraction startup Dyania secured $10M in Series A funding to advance its AI that automates manual patient chart reviews to pre-screen patients for clinical trial enrollment and observational studies. Dyania’s proprietary LLM-based Synapsis AI platform is initially being used at large health systems to enable enterprise-wide trial pre-screening, drive more efficient clinical research, and streamline labor-intensive registry reporting processes.
- Politics of Avoidance Limit AI: A solid literature review on AI in healthcare warned that “politics of avoidance” could limit its ability to impact public health. The authors make the case that the U.S.’ treatment-focused healthcare model underweights the importance of social determinants of health, and that the current AI craze runs the risk of overshadowing more effective interventions like community health programs. These well established interventions address the root causes of public health issues, which are frequently ignored by today’s AI solutions.
- Francisco Partners Acquires AdvancedMD: Francisco Partners scooped up medical software company AdvancedMD for $1.1B to accelerate the expansion of its SaaS solutions within small ambulatory physician practices. AdvancedMD unifies practice management, patient engagement, revenue cycle, and an EHR within a single cloud-based platform serving 13k practices. Current AdvancedMD President Amanda Sharp is taking over as CEO after starting with the company 19 years ago as an accounts receivable clerk.
- HealthJoy Teams Up With Cost Plus Drugs: Mark Cuban Cost Plus Drug Company and HealthJoy are teaming up to help employees combat rising prescription drug costs. HealthJoy’s care navigation platform will now point its 1M+ members directly to Cost Plus Drugs when it identifies generic alternatives to their medications, which is projected to slash its employer customers’ generic pharmacy costs by up to 50%.
- Small Hospitals Making EHR Moves: KLAS’ 2024 Acute Care EHR Market Share Report found that 42% of the small independent hospitals (under 200 beds) still use legacy systems, while most new considerations are centering around Epic Community Connect, Meditech Expanse, and Oracle Health. Small acute care organizations face unique financial constraints that can delay EHR upgrades, although KLAS highlighted progress being made at 184 such hospitals who approved new EHR implementations between 2021 and 2023 (nearly 14% of the market).
- Health Sector Economic Indicators: Altarum’s latest Health Sector Economic Indicators showed that national health spending was up 7.2% year-over-year in August, representing 17.5% of GDP. Growth among major spending categories was highest for home healthcare at 11.6%, while hospital care grew the slowest at 6%. Home healthcare utilization jumped 10% YoY to make it the fastest-growing category – as it’s been since August 2023 – followed by physician and clinical services (6.8%), prescription drugs (6.6%), and hospital care (2.6%).
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