Tag Archives: ATA2023

Signify Premium Insight: A Broader, Interconnected High Acuity Services Ecosystem Emerges at ATA2023

Telehealth is undergoing a metamorphosis. From a market of relatively unsophisticated ‘one-size-fits-all’ low acuity solutions, a shift towards high acuity is under way.  

This shift was discernible at the American Telemed Annual Conference and Expo (ATA2023), held earlier this week in San Antonio, as vendors – both well established and new market entrants – showcased an array of specialist solutions reflecting that move up the value chain.  

The Signify View 

ATA2023 is a reliable barometer as any of telehealth’s current direction. First impressions were of a quieter than expected show floor. This is perhaps no surprise for vendors, who in the current business environment must be more selective than ever about where they spend their marketing budgets. The competing charms of HIMSS in Chicago (a favourite of the large US providers) loom next month, while ‘trendier’ exhibitions such as ViVe (in Nashville later this month) and HLTH in Las Vegas later in the year are also vying for marketing dollars. Teladoc was conspicuous by its absence from the ATA show floor, and Philips (along with many other vendors) opted for smaller booths than usual. 

But while the more sedate atmosphere in San Antonio confirms the end of telehealth’s frenzied, Covid-fuelled days, it also indicates a change in vendor focus. Mass market, low margin, low acuity solutions still have their place, but high acuity telehealth is forecasted to grow steadily to 2025 (see chart below). As a result, specialist solutions for a wider cross-section of healthcare needs are emerging, with several on show at ATA. 

Broader, Interconnected Ecosystem 

The main takeaway from ATA is that high acuity telehealth is now moving beyond its teleICU and Clinical Examinations and Medical Support roots. A broader, more interconnected ecosystem of different high acuity telehealth services is emerging (see graphic below) in which tele-sitting (observation), tele-nursing and solutions for non-ICU settings are gaining traction. Established players such as Philips, Amwell, Teladoc, AMD Global Telemedicine and GlobalMed are being joined by new vendors here, and ATA was an opportunity to engage with some of them and understand how (and where) their solutions fit. 

Telehealth’s Interconnected Ecosystem

Necessity the Mother of Invention 

Until relatively recently, high acuity telehealth vendors kept a narrow focus on solutions for teleICU, clinical examinations and medical support, in high demand during Covid. However, the post-Covid period has introduced fresh challenges for healthcare providers, not least significant cost pressures and chronic staffing shortages, and this is influencing the development of new patient monitoring methods and technologies. 

While ‘tele-sitting’ is not a new concept per se, the traditional, simple AV monitoring platforms it relied on were basic and error prone. Those monitoring patients were often unable to decipher between ‘normal’ behaviour and behaviour that could be cause for concern. This led to problems with ‘false positives’.  

AI has the potential to mitigate this problem, and care.ai, VitalChat and Andor Health were at ATA to promote their technologies in this respect. Established telehealth vendors like Amwell, AMD and GlobalMed are also moving into this space and building AI into their portfolios, often in partnership with AI vendors. For example, Amwell is integrating [AI developer] Solaborate’s Hello Care solution into its Converge platform, part of its shift from encounter- and cart-based monitoring to continuous ‘tele-sitting’. 

Leading platform vendors and monitoring service providers such as Caregility, Equum and HiCuity are now promoting tele-sitting as a key part of their portfolios, and Philips says it is also moving into this area via partnerships with several of these companies. 

Nursing the Industry Back to Health  

Chronic nursing shortages are also driving developments in ‘tele-nursing’, and this was high on the agenda in San Antonio in keynote presentations, panel discussions and vendor marketing. 

Although in its embryonic stages, vendors and service providers have high expectations for tele-nursing, and Philips, Caregility, Andor Health, AvaSure, GlobalMed, AMD and Amwell all see significant potential in it. Most already have clinical examinations and medical support platforms in place, and view tele-nursing as an attractive (and relatively easily achieved) new revenue stream. 

Increased demand for tele-nursing services will also play into the hands of companies like HiCuity, who offer only monitoring services. Discussions with HiCuity during ATA emphasised the point that, while core services such as teleICU are growing, greater growth is being seen in newer applications such as tele-nursing. 

Moving Beyond the ICU 

Another trend observed at ATA are moves to apply teleICU technology in non-ICU settings such as med-surg units, step down wards, general wards and neonatal ICUs. Vendors have been pushing the message for several years that this route offers significant upside, although progress in developing and realising the opportunity has been slow. Philips remains the master of the teleICU universe (and continued to push the predictive elements of its established eICU solution at ATA), but other vendors present in San Antonio have ambitions to dislodge its crown.  

Israeli start-up CLEW’s FDA-approved algorithms (which we explore in depth in this recent Insight), Turkish vendor Cieba’s eClinics Platform and AMD’s new AGNES Connect teleICU solution all generated lively discussion on the show floor. CLEW was very vocal about how it would erode Philips’ market share, the multinational countering this by insisting that it continues to win new customers and retain existing ones. If they are to seriously challenge Philips, it is clear that these ‘new’ market entrants will have to build trust among customers that they have a great solution and that they can scale.  

ATA also saw a focus on predictive tools for use in high acuity settings. PeraHealth (now owned by Spacelabs) and Ambient Clinical Analytics are two AI vendors active in this space. During the show PeraHealth demonstrated how its predictive AI embedded into Caregility’s solutions is helping hospitals predict deterioration in patients, thereby improving ward management efficiencies. 

New Expenditure Models in Focus 

Another talking point at ATA was how to make teleICU more accessible to smaller hospitals. teleICU implementation is notoriously expensive, with high upfront hardware costs and the possibility of workflow disruptions during implementation. This has often been a barrier for smaller hospitals, who would outsource their teleICU technology implementation and monitoring operations to service providers like HiCuity.  

However, teleICU vendors are now offering lower cost of entry to providers wanting to procure their own technology, moving from CAPEX to OPEX models where the cost of hardware implementation is absorbed in rolling monthly SaaS-based solutions. The increased general use of virtual workflows is also supporting this trend. To some extent this will present a challenge to these service providers as healthcare providers take advantage of this lower cost of entry to bring teleICU in house.  

Window into the Future 

In our ATA pre-show predictions (see them here) we said that vendors’ solutions would double down on supporting individual specialities, and in San Antonio this played out. 

One obvious by-product of the shift to high acuity is increased competition within the new, interconnected ecosystem we refer to as the different players position themselves. Whether GE will be part of this new ecosystem remains to be seen – it launched Mural, its teleICU/remote clinical surveillance solution, several years ago, but was notably absent from the floor at ATA this year.  

Moving from encounter-based, episodic models of care/platform to continuous monitoring platforms, and vice versa, will not be easy for some players in this new ecosystem. A shift in mindsets, and a reliance on ever more sophisticated technologies, will be required. But it is a path that must be taken, or risk being left behind.   

Signify Premium Insight: ATA2023: Signify Research’s Top Five Show Predictions

The annual American Telemed Annual Conference (ATA2023) convenes once again in San Antonio on 4 March. A lot has happened in and around telehealth since the 2022 edition of the show: billions of dollars-worth of acquisitions and a concerted move by big retail and big tech into primary care (opening new opportunities for telehealth vendors). And, having been at the sharp end of the 2020-2022 emergency COVID response, a chance at last for the industry to reflect on the challenges and opportunities that lie ahead. 

Products and profitability are key talking points in an industry adapting to the transition to value-based care (VBC) in the US and reimbursement codes introduced during COVID. This will form just some of the discourse among delegates in San Antonio, and here we present what we believe will be five of the main themes at ATA2023. 

Virtual Care Positioned as Key Tool in Providers’ VBC Strategies 

Population health management (PHM) requires a provider’s most critical and costly patient cohorts to be identified, and strategies implemented to manage these cohorts in the most (cost) effective way possible. The ‘last mile’ of PHM is patient outreach, engagement, activation and management, the heart of value-based care (VBC). At ATA2023, telehealth vendors will market their solutions as key tools in effective VBC strategy.  

The graphic below illustrates the various building blocks of a PHM system. The system takes patient and other data from different sources and the resulting data lake provides a clinician with a summary view of the patient. Different tools leverage the data lake to stratify populations, identify high risk populations, provide clinical decision support and care management tools to help identify patients’ most critical needs, and implement processes to manage patients.  

Complete Integrated Care/PHM Solution

The ‘last mile’ of PHM – where the VBC programme kicks in – is patient activation, co-ordination, consultation and management, and links provider and patient.  

Telehealth and population health are increasingly interlinked. Evidence of this is in the large acquisitions that retail companies have undertaken over the last year, that all had virtual care – video consultations and remote patient monitoring (RPM) technology – as core elements of broader PHM strategy for chronic care patient populations. 

In response, RPM vendors are starting to offer tools to identify cohorts, and telehealth platform vendors are looking to team up with PHM vendors with virtual care modules. We expect tight relationships to develop, not only between pure telehealth and PHM vendors, but also EHR vendors – all of which want virtual care, telehealth and RPM functionality in their toolsets to support PHM programmes.  

More Enhanced Support for Providers Looking to Scale RPM Use 

Reimbursement models for fee-for-service (FFS) RPM implementations in the US have resulted in rapid RPM uptake over the last two years. However, uptake has still fallen short of expectations. A focus at ATA2023 will be how vendors and service providers can collaborate to accelerate uptake, and how telehealth’s role in VBC can take the conversation beyond FFS reimbursement.  

Before COVID, no clear reimbursement structure existed in the US for providers using RPM to receive payments from commercial and government insurers. This changed during COVID when the CMS launched specific reimbursement codes around Medicare FFS and some Medicaid patient populations (see chart below). These primary care-focused reimbursement structures covered RPM technology provision, installation and monitoring itself, resulting in more chronic condition lives managed by RPM. Simultaneously, the ‘hospital-at-home’ reimbursement structure incentivising providers to manage some patients at home, that previously would have been looked after in hospital, has been another driver in RPM adoption. 

However, concerns about the long-term future of the ‘hospital at home’ reimbursement model, as well as wider supply chain logistics problems, has stymied RPM uptake. 

US RPM CPT Code Claims (Numbers of Claims by Code) 

A big focus now for RPM vendors will be to reverse this and truly scale RPM. At ATA2023, we expect to see greater emphasis on providers and tech vendors collaborating on scaling strategies, focusing not only on RPM technology itself but also unlocking supply chain bottlenecks and hospital-at-home workflows, as well as making RPM technology easier to implement and easier for patients to use. 

While reimbursement structures will continue to stimulate RPM technology uptake (and notwithstanding concerns around the future of hospital-at-home reimbursement), the broader move towards VBC in the US will also be a catalyst. Consequently, healthcare providers at ATA2023 will look at ways to prevent escalation of patient diseases, avoid hospital re-admission, and explore ways for RPM to handle certain procedures.  

Specialise, or be Left Behind  

Platforms and services must increasingly be tuned to the needs of specific conditions/use cases (e g behavioural health, chronic care, stroke assessment, etc.) Vendors’ solutions will double down on supporting individual specialties.   

The COVID crisis required providers to implement video consultation platforms as quickly and often as cheaply as possible. Just getting a solution in place was often prioritised over specialty suitability. Now, however, it is not enough for a provider to offer a generic virtual care solution. Demand is growing for tools and clinical decision support solutions tailored to specific use cases. 

Big vendors (for example, AmWell) have been acquiring to strengthen specialist expertise (for example, in behavioural health). At ATA2023 vendors will position themselves as having a broad array of services and IT to support more diverse patient virtual care requirements.  

Clear Pitch to Retail and Big Tech  

US primary care is being transformed as retail, pharmacy and big tech enter the playing field. For most of these new players, telehealth is a key tool in managing primary care populations. IT vendors at ATA2023 will be increasingly focused on this area.   

The likes of Walgreens, CVS and Amazon will all become mainstream primary care providers in the US this year (as we predict in this Insight). Billions of dollars are being invested by big retail and big tech firms to fuel their ambitions, and telehealth IT vendors are increasingly in their sights to supplement their expertise, capacity and portfolios. This was illustrated in CVS’ purchase of Signify Health last year for $8B, and Walgreen’s-backed VillageMD buying Summit Health for $9B.  

While this is not necessarily a greenfield opportunity for telehealth vendors, it is a potentially rich seam of business, and leading players such as AmWell and Teladoc will be exploring how they can take advantage of the new retail primary care trend. 

Some companies that retailers have acquired have developed their own technology. This is a challenge for off-the-shelf vendors to convince retail companies that they should be focusing their resources more on healthcare provision, rather than technology.  

Increase in AI and Automation Tools for Telehealth Use 

For telehealth consultation providers such as AmWell and Teladoc, reducing costs is key to future profitability. For traditional bricks and mortar providers, meanwhile, tools to support triage, signposting and operational efficiency will be in demand. AI-based tools that ultimately prevent a live consultation unless really needed, while still giving patients critical advice, are the end goal. Many vendors will push their credentials on this front at ATA2023.  

AmWell and Teladoc both experienced a major surge in virtual consultations during COVID, but this came without any commensurate profit rewards. Indeed, loss margins widened for some as physician payroll costs skyrocketed with more consultations and employer/insurer payments/reimbursements failed to adequately cover costs. 

In the medium-term, telehealth service providers must find a way to convert scale and market share into profit. One strategy is to reduce the need for a lower-acuity case to have a teleconsultation, without any deterioration in quality of care provided.  

AI-based healthcare advice, chatbots and algorithms will be key to this going forward, and telehealth’s main protagonists are already gearing for this: Google’s $100M investment in AmWell’s IPO in August 2020 a case in point as it seeks to leverage its AI expertise. Although the effects of AI have yet to significantly impact providers’ bottom lines, it will ignite lively discussion at ATA2023. 

Addressing the Challenges 

ATA2023 convenes at a time of global macroeconomic challenges, price inflation and even shortages of healthcare personnel, which are all putting unprecedented pressure on healthcare budgets and the ability to deliver quality care. More than ever, innovation holds the key to driving costs down streamlining healthcare processes. Vendors attending ATA2023 will want to convince providers that their telehealth solutions will help address their myriad issues today and in the medium-term, offer solutions for specialist use cases, and support the broader transition towards true value-based care (VBC).