TTA’s autumn leaves: Amazon Rx kiosks for One Medical, VillageMD shrinks in TX, Rock Health’s odd take on Q3 investment, Trilliant Health’s dizzying what-ails-healthcare analysis

October 10, 2025 | by | 1 Comment

 

Friday 10 October 2025

Several quick looks at Amazon’s test of pharmacy dispensing kiosks in One Medical clinics, VillageMD’s Texas selloff, and Rock Health’s strangely ambivalent report on Q3 digital health investment. Today’s deeper dive is a Must Read–Trilliant Health’s diagnosis on what ails US healthcare and why a “return to first principles” is badly needed, detailed in a 100+ page free report.

Editor Donna will be taking a short additional hiatus; back w/o 27 October.

Editor Donna’s selective roundup: One Medical’s Amazon Rx kiosks, VillageMD sells off Texas, digital health investment’s Q3 boost

Will “expensive, complex and inefficient” US healthcare respond to six major demographic, cost, supply trends–and recuperate? Or further sicken?

From our last Alert: Editor Donna is back. Here’s the catchup.

Congratulations to James Batchelor MBE (Well Deserved!)

And a read with even more relevance now: Should free-falling UnitedHealth Group be broken up? Or break itself up to survive, before it becomes another GE? (updated) (Not a rant, more a ‘get going’ to avoid disaster!)

* * *
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Support not only a publication but also a well-informed international community.

Contact Editor Donna for more information.

Help Spread the News

Please tell your colleagues about this free news service and, if you have relevant information to share with the rest of the world, please let me know!

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Telehealth & Telecare Aware – covering news on latest developments in telecare, telehealth and eHealth, worldwide.

Editor Donna’s selective roundup: One Medical’s Amazon Rx kiosks, VillageMD sells off Texas, digital health investment’s Q3 boost

October 9, 2025 | by

Amazon keeps trying to integrate healthcare and make One Medical work, using Pharmacy as leverage. Like CVS, Walmart, and Walgreens, Amazon succumbed in 2022 to the Gold Rush of buying up a health clinic network and attempting to integrate primary care delivery into its retail model–after stumbling badly and failing with Amazon Care (2019). While the former have either ditched (Walmart), pivoted (CVS–Oak Street), or spun off their primary care providers (Walgreens–VillageMD/Summit Health), Amazon is testing yet another integration with One Medical, their first being with Amazon Prime.

In its latest tweak, Amazon is delivering limited onsite pharmacy services via a dispensing kiosk to a group of five One Medical offices in the Los Angeles metro. Now Amazon never calls it a test–one has to get about halfway down their release to discover those kiosks won’t be installed till December–but it’s obviously one, with a rollout to other undetermined One Medical offices promised in the sweet bye-and-bye of 2026. The kiosks will dispense common prescription meds in a four-step process: prescription written, sent to Amazon Pharmacy, patient opts for in-office kiosk pickup and payment using their mobile phone to check it out in the Amazon Pharmacy app, and checks it out using a QR code at the kiosk.

Using these five locations (Beverly Hills! West LA!) is an adequate feasibility test, but doesn’t address the piously phrased rationale of 25% of neighborhoods as “pharmacy deserts” and where even in non-desert areas, 51% of patients report delays in filling prescriptions.

The kiosks will be storing basically common Rx meds such as antibiotics, blood pressure medications, and inhalers. 

Where this picture isn’t as revolutionary as my friend Sergei Polevikov maintains in his latest Substack essay (subscription required–and you should; also partially on LinkedIn), it’s another kick in the head for the traditional pharmacy retailers and the PBMs. They are already getting boot impressions by the Hims & Hers virtuals and Big Pharma on GLP-1 and ‘favored nation’ DTC deals. On one side, it reduces friction by making it onsite and easy. But suppose the kiosk doesn’t have my med or it’s out of stock. What do I do once the script is sent and I need to change it? This is also appealing to a younger and/or tech-savvy segment who live on their phone and Amazon apps. Suppose I’m an older patient and apps/QR codes do nothing but confuse me? For Amazon, what about the cost of kiosk installation, cleaning, stocking, monitoring, just like those telehealth kiosks from Forward (CarePods), Higi, and way back HealthSpot Station. They were the future–for five minutes. Apparently there’s also a little regulatory issue of self-dealing referral (hat tip to LinkedIn commenter Ajay Kumar Gupta).  Also Healthcare Dive

VillageMD continues to shrink. The formerly free-standing and co-located Walgreens clinic unit, spun off into a standalone company by Sycamore Partners while I was on medical leave (FierceHealthcare 28 Aug), has sold 32 Texas primary care clinics to Harbor Health, a primary care group and payvider in the Austin area. This adds San Antonio, El Paso, and Dallas as well as more Austin locations. Forbes From a significant almost-national primary and specialty care group, VillageMD is devolving into pieces for sale. One wonders about the extensive Summit Health/CityMD operation, very much tied in with Hackensack Meridian Health that dominates northern New Jersey, and disruption. (Disclosure: my family and I are Summit Health patients)  In other news, Tim Wentworth was replaced as CEO by Mike Motz, from another Sycamore portfolio company. Wentworth remains as director for the time being, undoubtedly working out his retention and various payouts. 

Rock Health breaks the cheerful news that Q3 digital health is an improvement over a dismal 2024 a/k/a 2019. YTD is $9.9 billion, exceeding the $8.4 billion raised through 2024 Q3. Deal size is also trending up: $28.1 million, increasing from $20.4 million in 2024. Where it’s still wobbly is middle-stage investment and anything with a Series letter. Rounds of $100 million plus thrived, with 19 of them accounting for 40% and $3.8 billion of 2025 YTD total funding. I won’t be doing my usual dive into their numbers due to time constraints, but Healthcare Dive summary will do. Rock Health’s Q3 report, usually putting the best foot forward, is weirdly downbeat, calling it ‘signals out of sync’. 

Way out of sync is the continuation of the partial Federal government shutdown, with no mercy on telehealth services and the donkeys doing what donkeys do…refuse to move. 

I’ll be on a short hiatus with no new articles until the week of 27 October.

Will “expensive, complex and inefficient” US healthcare respond to six major demographic, cost, supply trends–and recuperate? Or further sicken?

October 9, 2025 | by

A new and exhaustive report diagnoses the US healthcare patient, pronounces it sick, and the proposed cure involves a “return to first principles”. A new report from researcher Trilliant Health outlines the unsustainability of the current status quo. As of 2023, the US system is the most expensive in the world in absolute terms. It grew from $2.8 trillion in 2012 to $4.9 trillion in 2023 with relatively flat demand and utilization (with 2022 and 2023 skewed because of Covid). In terms of GDP, it was 17.6%, a stunning number that will grow by almost 3 percentage points in the next ten years. The report outlines six trends that are anticipated to affect healthcare, based on data analysis of consumer demand, healthcare supply, and yield–the pricing where they intersect plus regulation and market incentives (e.g. reimbursement). This is a 30,000 foot view of an incredibly detailed report (details below):

  1. Price sensitivity and affordability concerns are reshaping demand. Prices have increased 54.5% from 2009 to 2023, compared to a 45.7% increase in overall consumer prices. Average annual insurer commercial plan premiums are up 85.7% between 2010 and 2024.
  2. Stakeholders are slow to adapt to changing demographic and lifestyle trends. US life expectancy is flat, and the average person is living 12.5 years in poor health. This is compared to residents of the 38 OECD countries, who on average live four to eight years longer and in better health. Avoidable mortality rates per 100,000 are over 100 points higher. Chronic disease mortality among those aged 18-44 increased by 6.4% in the past six years, led by chronic liver diseases. US population is also shifting to the ‘sunbelt’ stages, fleeing California and New York State.
  3. The healthcare delivery system incentivizes specialty care intervention instead of primary care prevention. This is driven by the rise of chronic conditions including “long Covid”, GI diseases, and behavioral health, as well as the low supply of primary care physicians. Retailers and Amazon, after a ‘gold rush’ starting about five years ago, are either exiting, pivoting, or scaling back. Somehow behavioral health volume increased by 43.7% between 2018 and 2024, despite psychiatry not even showing up in their physician specialty analysis. New drug development also is increasingly targeting chronic and rare diseases, with about one-third targeting cancer.
  4. Fraud, waste and abuse are pervasive in U.S. healthcare. To no one’s surprise, rates by CPT codes vary widely and wildly, insurance payers have favored systems, and hospital administration gets more money than direct patient care. Expensive EHRs aren’t delivering on workflow and patient portals. Brokers and PBMs add to cost and complexity.
  5. The transition to alternative care settings and therapies is accelerating. In-patient care innovations tend to start in the hospital and then migrate outward to outpatient settings such as ambulatory surgical care centers. Behavioral health, for instance, has migrated to telehealth. Patients with mental health needs who are well managed and include telehealth tend to have have far more in-patient utilization than unmanaged patients, regardless of utilization level. GLP-1 utilization increased 744.6% between 2018 and 2023, and is increasingly being prescribed and delivered via virtual care providers such as Hims & Hers, Ro, LifeMD, and WW in deals with the pharma companies. Rural health continues to shrink and cut inpatient services.
  6. If the industry cannot deliver value for money and employers will not demand it, the government is prepared to force it. Their effectiveness in this is perhaps a debatable point, since CMS’ value-based care programs such as MSSP and REACH have not really reformed the system, contained costs, nor spread as practices. The profitability of insurers has also deflated. The Trump Administration’s moves with Pfizer on ‘most favored nation’ pricing for Medicaid and direct sales fit here. Coupled with drug manufacturers’ selective desire to bypass PBMs and go direct, there’s a trend here to cut out the middleman.

As to telehealth, once seen as a cost and supply panacea, since 2020 and the pandemic, volume declined by 32.2%, driven by a 52% decrease in non-behavioral care. What remains is behavioral health, 66.9% of visits in 2024. Even that has declined versus prior year from 70.5%. (Slide 84). Another panacea was supposed to be EHRs but they tend to be closed systems, non-interoperable, and another increaser of complexity.

Their conclusion is that healthcare is at a crossroads–no surprise–and that healthcare is now locked into a “doom loop” (Slide 110). Prices increase, the financial strain on patients, providers, payers, and employers increase, patients enter the system sicker, access decreases, and the inefficiency increases geometrically. Their call (Slide 111) is for a return to see what is what is essential and necessary. “At its core, the healthcare system is intended to connect patients with providers for medical care.” Our currently redundant and complex system (see the nightmare that is Slide 8) cannot do that.

The Trilliant Health report is available for download here. Release.

TTA returns: government shutdown effects, favored nations deal, funding overview, Veradigm still treading water, 23andMe bought back, and more!

October 3, 2025 | by

 

 

 

 

3 October 2025

Hello, Editor Donna is back, trying to catch up after a long and unanticipated leave that is not quite finished. We look at the effects of the US government ‘shutdown’ (not much except in telehealth), Pfizer’s ‘favored nations’ deal on drug prices (moving power away from the PBMs) and multiple big deals. We’re also gobsmacked that Veradigm still can’t get its reports together and Wojcicki bought back 23andMe. Sadly, one of our telehealth pioneers, John Boden, has also passed. More next week.

Editor Donna is back. Here’s the catchup.

From our last Alert: 

No, this shouldn’t happen to you–an unwanted hiatus for Editor Donna (an oops and a break that could have been worse)

Congratulations to James Batchelor MBE (Well Deserved!)

And a read with even more relevance now: Should free-falling UnitedHealth Group be broken up? Or break itself up to survive, before it becomes another GE? (updated) (Not a rant, more a ‘get going’ to avoid disaster!)

* * *
Advertise on Telehealth and Telecare Aware
Support not only a publication but also a well-informed international community.

Contact Editor Donna for more information.

Help Spread the News

Please tell your colleagues about this free news service and, if you have relevant information to share with the rest of the world, please let me know!

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Telehealth & Telecare Aware – covering news on latest developments in telecare, telehealth and eHealth, worldwide.

Editor Donna is back. Here’s the catchup.

October 3, 2025 | by

A summer hiatus that’s turning out to be a bit longer than expected. Recuperating from a broken left arm and resuming a mostly “normal life” including some vacation has taken appreciably more time than your Editor thought when last posting in late June. (In fact, where the heck did June go?) Getting back into the issues surrounding healthcare technology and healthcare in general has also taken awhile. So this article will be a mix of ‘this and that’ of tying off some stories that were hot in June. Starting with the current drama…

The US Federal Government shutdown and telehealth. It was uniquely constructed to not affect vital citizen services such as Social Security, Medicare, Medicaid, and even access to our national parks–and to be laid at the feet of one party, not the one in control. Life is going on as the shutdown continues. It may end tomorrow with a congressional resolution (CR) kicking the can down the road for a few weeks, it may end in November with the same.

Most affected from our perspective: Medicare telehealth flexibilities extended from the pandemic now revert to pre-pandemic rules, except for practices under the CMS Medicare Shared Savings Program (MSSP), practices in the end-stage renal disease (ESRD) program, and mental health. Audio-only reimbursement is terminated as is telehealth beyond the rural health program. Health and Human Services (HHS) has furloughed 41% of employees, over 32,000, though the short-term effect is expected to be minimal.

Continuing: programs such as Medicare, Medicaid, OIG’s Health Care Fraud and Abuse-related activities, parts of other agencies such as NIH direct medical, the Indian Health Service (IHS), FDA medical device and drug reviews, emergency preparedness, and other mandatory services. FierceHealthcare, Healthcare Dive   ATA Action is advocating for immediate restoration of Medicare’s telehealth flexibilities, in place since 2020, and the Acute Hospital Care at Home program. One hopes that Senator Schumer and Representative Hakeem Jeffries take note.

Such a deal? Under the shutdown wire, the Administration’s ‘most favored nation’ deal with Pfizer benefits state Medicaid programs and consumers who go on Pfizer’s website and buy drugs direct. In return, Pfizer gets a three-year relief from tariffs on their drugs from the Section 232 probe into the effects of pharmaceutical imports on national security. Details beyond this are scant, but the industry’s lobbying group, PhRMA, has been pressing for allowing drugmakers to sell DTC, bypassing insurers and pharmacy benefit managers (PBM). For commercial and individual insurance, the effect is nil for now. Healthcare Dive unpacks it.

Big deals continue. This week, VC giant General Catalyst, of which this Editor took a very dim view back in February, closed its $515 million acquisition of Summa Health, a non-profit integrated healthcare system based in Akron, Ohio. The acquisition through its HATco subsidiary was announced in January, but had to be boosted by $30 million and meet additional conditions to pass muster with Ohio’s attorney general. How acquiring one regional system advances their goal of “health assurance”, defined as “a more affordable, accessible and proactive system of care”, is To Be Determined. FierceHealthcare

Evolent Health is exiting the ACO business, selling it to competitor Privia Health for $100 million. The sale adds Evolent Care Partners’ more than 120,000 lives in MSSP, as well as commercial programs and Medicare Advantage. Privia now adds more states and their covered lives will total 1.5 million when the sale closes in Q4. The Medicare ACO business continues to contract to a few players; value-based care and Federally subsidized incentives in MSSP and ACO REACH turned not to be all that.  Healthcare Dive

There’s a rundown of other acquisitions and sales rounded up in HISTalk 1 October, indicating a certain liveliness in the market: specialty care coordinator Switchboard acquiring Conduce Health (undisclosed amount), Sunstone Partners taking a majority stake in healthcare cybersecurity/compliance firm Clearwater, AI voice agent developer Assist Health tagging a $76 million Series B round, and others.

In amazement….

  • Veradigm still can’t get itself current with its financial filings and submit itself for Nasdaq relisting as of this week. Revenue is still flat, they repurchased $180 million in convertible notes, and got itself a new CEO, Donald Trigg, in what has been a revolving door position. The last interim CEO ankled in April.  Veradigm release   Insult to injury: a data breach in July (announced to customers 22 September). This affected at least 70,000 patients in Texas and South Carolina, plus customers in California. HIPAA Journal
  • 23andMe was sold back for $305 million to its co-founder and CEO, Anne Wojcicki. She set up an entity, TTAM Research Institute, a non-profit public benefit corporation (PBC), to buy the company for $305 million. Unlike Regeneron’s $256 million bid, Wojcicki’s TTAM is acquiring Lemonaid along with the main Personal Genome Services and Research Services businesses. TTAM is a clever acronym of the spelled-out 23andMe. The Bankruptcy Court of Missouri approved the sale on 7 July and it closed on 14 July, after no further bids from Regeneron. Interestingly, none of the articles mention Wojcicki’s backers. 23andMe release, CNBC, HIPAA Journal.

To this Editor, selling a company back to the CEO who had full financial control over the company but augured a $6 billion valued company into Chapter 11–nosediving after bad investments, a major data breach and turmoil around its data and privacy–is beyond absurdity. I’m surprised that the bankruptcy judge even permitted it given the history, but she legitimately bested Regeneron’s offer by $50 million. It also included the nearly-finished Lemonaid. Supposedly all business is now ongoing. It’s her risk, her money, as noted in our last article on 3 June. And now her responsibility to make a go of it.

And a sad goodbye. Longtime Readers will remember John Boden, one of the pioneers (2001) of healthcare tech care management software for supporting older adults and a national expert in eldercare through his ElderIssues firm. He frequently commented on Steve’s and my articles, along with many insightful and funny emails. He was also a former Marine pilot (VMA-6, Vietnam) who wrote about his experiences in ‘Klondike Playboy’. John “Went West” on 4 December last year after a few years of retirement. Editor Steve discovered this during my hiatus. Our sympathies to his wife, children, extended family, and his VMA-6 shipmates. Legacy obituary

Thank you for your patience! My articles will be ramping up slowly as therapy continues. I’ll also be catching some additional vacation after next week.