What the new Congress means for telehealth

As the Republican tilt of Congress for the next two years takes shape, so too do the prospects for important telehealth policy.

Here's the good news for advocates: Newly elected Senate majority leader John Thune (R-S.D.) has a long history of supporting telehealth. As STAT's John Wilkerson reports, Thune's largely rural home state of South Dakota benefits from the expansion of virtual care services because people often live large distances from doctors.

In a key policy shift, lawmakers during the pandemic expanded the services people on Medicare could receive over telehealth. Those flexibilities are set to expire at the end of the year, and Thune supports making them permanent. There's a bipartisan bill progressing through the House of Representatives that would extend the flexibilities for two years.

But the lame duck policy agenda is up in the air as lawmakers may choose to only pass a stopgap bill to fund the government into the next session. As John reports in another story on what to expect now that Republicans control both houses of Congress, it's not clear what that would mean for extensions to expiring Medicare policies.

Sources in Washington over the last few months have told me this is one of the scenarios they feared might play out. By leaving telehealth extensions to the last second, the legislation was at risk of getting lost or modified in the lame duck shuffle. And this creates uncertainty for providers and Medicare enrollees who may be counting on telehealth access to services on Jan. 1 — 48 days from today.

Read John's story on Sen. Thune here and his story on Congress here.

Telehealth

Amazon boosts lesser-known mental health company

Amazon just added mental health-focused Rula Health to the list of services available through its portal linking users to treatment for health conditions. Rula Health joins better known Talkspace as the only mental health companies offered through the portal.

Rula is one of many services that connect people seeking insurance-covered treatment to providers who make slots available to the company's patients, mostly for virtual appointments. Rula's chief medical officer Doug Newton told me the company's key differentiator is that it provides more sophisticated tools for matching patients with providers and a higher level of care coordination for patients, who for example may need both therapy and medication management. He said the company requires providers to document in its medical record and carefully monitors the quality of care. Rula boasts over 10,000 providers and tens of thousands of patients.

Rula and similar companies, like Grow Therapy, Headway, and SonderMind sound similar on paper, so it will be interesting to see if the Amazon connection can give it an edge. A Google search for therapy is much more likely to turn up competitors, and Newton said Rula relies on relationships with insurers to get the word out, rather than advertising. A partnership with the retail behemoth could boost familiarity among consumers and the broader heath care ecosystem.

"It's not just getting patients, it's brand awareness," he said. "It just allows us to be able to get our name out there and actually be able to tell the story we have."

Business

Behind Forward Health's collapse, a brash techie

Concierge care company Forward Health this week announced it was shutting down, about a year after announcing it had raised $100 million and was pivoting its business to CarePods, tech-filled boxes meant to replace the traditional doctor's office. Over eight years, the company raised $545 million, according to Pitchbook. The shutdown was originally reported by The Information.

Led by Adrian Aoun, a former Google executive, Forward was originally a primary care service with an app and over a dozen clinics scattered across the country. The company hoped to help members take care of their long-term health with tech-powered proactive monitoring and action. While the final cause of death hasn't been revealed, Forward was trying to do a number of notoriously difficult things and probably burning money very fast. Forward's services were expensive and not covered by insurance, and so required a critical mass of people to believe it was worth spending a lot of money to maybe avoid a bad health outcome in the uncertain future. Subscriptions for its care programs cost $149 per month, and it hoped people would pay $99 per month for access to CarePods.

Aoun is famously provocative in interviews and appearances. Listening back to an interview I did with him in 2021, I was struck by the brashness and confidence of his pitch.

A sampling:

"I'm an engineer, right? Like when I sit down to work, I sit at a laptop, which is the sum combination of all human advancement in a two-pound device. At some point you've got to ask yourself, like, where did we go wrong? Why is my health care stuck in the stone ages?"
"I think of it almost like doctors are cobblers, right? A new pair of shoes comes in, you fix, you send it on. A new human comes in, you fix them, you send them on their way. Doctors, they're like they're cobblers, the highest paid, most educated, best cobblers you've ever met. But they're cobblers. And the reason isn't because doctors aren't smart, isn't because they don't mean well, it's because we haven't built them technology to be anything but a cog."

WEarables

Scrutinizing digital measures developed by Biogen

Earlier this week, I published an interview with Pfizer's Carrie Northcott about the company's use of digital measures in clinical trials. But descriptions of "digital measures" can be a little reductive, and so I quite appreciated this new paper in which researchers provide a detailed analysis of data captured by an app for measuring progression of multiple sclerosis. In MS, as with many neurodegenerative conditions, traditional in-clinic measurements are too coarse and infrequent to capture subtle changes in disease progression. Sensitive and frequently collected digital measures thus hold great promise to advance drug discovery and approval.

The app, called Konectom, was originally developed by Biogen and was transferred to a company called Indivi when the biotech giant shuttered its digital health group in 2023. The app contains a number of tests designed to assess cognitive and motor function. A test matching numbers to symbols measures cognitive processing speed; manual dexterity is assessed in drawing tests and a game where people pinch balloons; and gait and stability are measured using balance, walking, and U-turn tests. For these tests, however, 47 different measures might be extracted using the sensors in a smartphone. These can be as simple as the total number of balloons popped or as granular as the time difference between when the two fingers used to pinch touch the smartphone screen.

In the paper, investigators scrutinize each of the tests for viability, assessing their reproducibility and concordance with traditionally used clinical measures. Shibeshih Belachew, formerly of Biogen and now chief medical officer at Indivi, told me the work provides the foundation for unbiased selection criteria for digital measures.

Of the 47 measures evaluated, 16 were deemed promising, like the speed at which people draw a spiral and step regularity while walking. These measures must now be studied for a longer period in a larger population to see which may be useful for studying potential MS treatments. Belachew said some of this work would be published in 2025. Ultimately, Indivi hopes to validate measures across a number of devices to ensure "future-proof digital endpoints that will survive constant smartphone hardware technology evolution."

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