Small and Large Telemedicine Companies See Opportunity with the VA

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Goliath companies are still formidable opponents.  But at least David is now in the fight.

The VA is trying to reinvent itself from being the poster child of inefficiency to the model of the next generation. The vehicle for that change is “T4 NG”, Transformation Twenty-One Total Technology Next Generation (a typical government acronym). It will award up to $12 billion in what are called IDIQ (indefinite delivery, indefinite quantity) contracts, half of which will be awarded to small businesses, so called SDVOSBs (service disabled veteran owned small businesses). One of the first contracts to be awarded was recently announced, a $258 million maximum contract spread among four potential vendors to provide telehealth services to veterans.

Each potential contractor is offered the opportunity to develop a platform of telehealth services and technologies from which VA health providers, doctors, care coordinators, and others can choose to enroll patients for telemonitoring, such as diabetes care, COPD management, or mental health coordination. The contractor that builds the “better mousetrap” could win big.

While many of the these contracts will ultimately be awarded to giant corporations that have extensive histories with government contracts, some will present opportunities for new ideas and new companies to break out with their first big contract. An example of this David and Goliath contest is the competition between two identified vendors for their portion of the $258 million. Golliath is the medical device giant Medtronics and David is 1Vision, LLC. Medtronic, a global company that moved its headquarters from Minnesota to Ireland to save hundreds of millions in taxes boasts a workforce of over 85,000 employees.

When I called 1Vision, located in West Virginia, I got Jeremy Fort, the General Operations Manager on the phone directly. He was quick to point out that 1Vision was a merger of an IT and cybersecurity companies with government contract experience and their on-the-ground experience. But yes, they were still a small business. But he was quick to point out their advantages. “We might be the only contractor that has visited every VA facility in the nation,” he said. Mr Fort further noted that they have a connection to emergency medicine in that they were the ones who brought EZ IO, the intraosseous infusion device, to the attention of the military, securing a huge contract for that start up. “We have experience contracting with the government,” he said.

But making it to the final list of four vendors has no guarantee of success. In fact, it is a huge gamble for this small company. Many of the small companies who make it this far only go on to bankruptcy. In order to make a single dime of profit they need to develop a host of software and management applications to offer to patient care coordinators at the various VA sites around the country. Although Fort declined to say how much they had to invest to get their product in front of the potential users, it was no doubt significant, but he assured me that they had the financial backing to see it through to completion. It goes without saying that if they succeed, they will catch the eyes of larger investors who would likely offer to buy the company.

They have six months to develop their product line of services. Then it’s up to them to offer it to the hundreds, if not thousands of end users, in the VA system. And that’s where having a good, if not best product, is just the first step in the competition. Medtronic is the “incumbent” contractor for the past five years. They are already in the VA system. So it will be up to 1Vision and the other three competitors to prove that they have a better line of products and services. And that might prove easy or difficult, depending on what inroads Medtronic has already made in the system. The challenge in many cases is tailoring the product to operate within the VA’s cybersecurity framework.

So if you have a good telemedicine idea or a product that is fully developed, and you’d like to present it to the VA, this might be your opportunity. Research the small and large companies that are pitching to the government for the opportunity to revolutionize the VA. They’ll have a lot of money to spend over the next few years. As they say in the military, it’s a target rich environment.


Co-Founder / Executive Editor Dr. Plaster has been an emergency physician for more than thirty years, working exclusively night shifts for the past twenty years in emergency departments across the country. During that period he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of M. L. Plaster Publishing Co.

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