Weekend Must Reads: Polevikov on Walmart’s Ninth Try At Health with General Medicine, Zitron on the Collapse of the AI Bubble

November 5, 2026 | by | No Comments

Two short takes on two Must Reads to make time for this weekend. Neither are short and both are dense. Likely like you, I won’t be reading either at one sitting. But you should put them on the pile.

Walmart Has Failed at Healthcare 8 Times. Now It’s Trying for a 9th. Author: Sergei Polevikov, AI Health Uncut

Sergei ‘goes there’ again with a little-noted move by Walmart to kickstart something significant in the healthcare area. It has inked a deal with TJ Parker, the co-founder of PillPack (sold to Amazon), now CEO of General Medicine, to integrate the General Medicine ‘everyday healthcare store” with Walmart’s Better Care Services, its online healthcare hub. The store comprises not only pharmacy and low cost options for medications, but also specialty care referrals and online everyday testing. You can compare prices online. Walmart release

Readers will remember the eight times previously that Walmart Health, in various and telehealth iterations, collapsed into a heap with the most recent here [TTA 30 Apr 2024, 2 July 2024]. Will this be different? It might, as the heavy lifting is done by General Medicine. 

Of course, the price comparisons, particularly for branded medications, may not be as cheap as expected, but the prices may beat other retail comparison sites. I did some comparing of my own with a medication I am moving to that is not covered by my insurance. The company direct program price for 90 days is less than half of what is on offer with GM. But I had to get the referral from my physician after making my own case that the generic was possibly creating problems for me AND the most popular generic that I was on had a recent recall for sub-potency issues.

The article is available in part to non-paid subscribers. But this Editor recommends you do. Sergei is an unbought investigator in the healthcare field, and provides us with a service that is unavailable elsewhere–even here because we’re primarily a news site. It’s worth your spend because he’s the only one I think of, the ‘go to’, who marshals the numbers and puts together a credible narrative.

FYI you can meet Sergei at HLTH coming up next week. Details are in the article.

Running Dry. Author, Ed Zitron, Where’s Your Ed At?

Ed’s scathing takes on the business of AI are well known to our Readers. In this article, he goes into the fault lines that are widening with AI–and how the money spigots are starting to shut. What does that mean for Anthropic, OpenAI, and healthcare companies like Oracle? What does that mean for our Readers’ suppliers or startups?  As usual, not an easy or quick cuppa read.

He opens with:

As I’ve said for a while, all of this ends when the money runs out — when seemingly-unlimited data center debt becomes distressingly hard to raise, and when AI startups can’t rely on the perpetual availability of venture capital to keep them alive.

And it appears the well is running dry, just as it dawns on everyone that the underlying economics of AI, for labs and data center operators alike, don’t really make sense.

What is really going on with OpenAI when it puts off its IPO, and raises only one-third ($11 billion) of what it hoped for last week? What is really happening with Anthropic, rushing to an IPO but with clear evidence of slowing business and millstones of liabilities? TTA 5 Nov

“The bubble bursts when the money runs out.”  AI is no exception to any kind of startup, from telehealth, RPM, health IT, telecom, deregulated airlines, and tulips. 

And another worthwhile subscription (on sale today!)

 

More questions for Oracle as VA doctors and dentists question EHR rollout safety, demand a pause; Oracle’s $20B AI building raise

November 5, 2026 | by | No Comments

A surprise development not making the VA nor Oracle happy–and another monkey wrench for the committees. The National Association of Veteran Affairs Physicians and Dentists (NAVAPD), a national VA association that represents VA’s 20,000 doctors and dentists, sent a letter in mid-October to chairs and ranking members of the House and the Senate Veterans’ Affairs, Appropriations, Oversight and Government Reform and Homeland Security and Governmental Affairs panels. It recommends that the Oracle Health EHR rollout be paused until “critical concerns about patient safety, system performance, cost, and long-term feasibility are independently evaluated”.  In addition, they cite concerns involving clinical workflow disruptions, delayed referrals, patient safety incidents, and rising program costs.

The letter, disclosed on 29 October, specifies that actions be taken by the committees before deployments continue:

  • Pause further deployments: Suspend additional Oracle EHR implementations while continuing to fund patient care, system maintenance, and the correction of safety problems at existing sites.
  • Require an independent safety assessment: Evaluate patient safety and operational readiness at facilities already using the system, with meaningful input from frontline physicians, dentists, and nurses.
  • Strengthen transparency and accountability: Require regular reporting of patient safety incidents associated with the system.
  • Evaluate alternatives: Conduct an independent comparison of the costs, risks, and feasibility of continuing the Oracle program versus modernizing the VA’s existing Veterans Health Information Systems and Technology Architecture (VistA), including the potential use of AI-assisted software development tools.
  • Increase financial oversight: Require additional documentation and justification of proposed contract cost increases.

Surprisingly, the full text letter states that that the venerable VistA EHR still runs at all of VA’s 170 medical centers—including the sites transitioned over to the Oracle EHR. VistA is still used for longitudinal chart review. The letter also states that VistA is “currently best suited to meet our institutional mission.” which is not exactly a ringing endorsement of change. The dislike of a new EHR runs deep in this group but the workflow flaws are still many in the Oracle system. Another small surprise in the letter is this statement: “One recent analysis, which incorporates AI coding capabilities, estimates that modernization and maintenance of VistA would cost $1–2 billion over the next decade.” This is a group very much advocating continuing to use VistA with bolt-on, AI build/assisted software.

Even without this, it is already leading to a situation where VA clinicians use two EHRs for different purposes that don’t speak to each other.  Which wasn’t the intent.

A response was requested by 23 October. That was not disclosed.

The NAVAPD summary and full text letter to the committees. NextGov  Hat tip to our anonymous ‘eye on VA’.

So where is VA and Oracle now? The Oracle system has been rolled out to only 19 of 170 medical centers and associated clinics. The 2026 portion has ended with go-lives 24 October in the Alaska VA Healthcare System and the Louis Stokes Cleveland VA Medical Center. The Cerner, then Oracle rollout started disastrously in 2022. VA has also requested a $17 billion increase in budget for Oracle’s EHR development, from the original $10 billion, to cover both current costs and the three-year extension to May 2031 in the 2027 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act. Both Mike Sicilia and the mighty Larry Ellison have been subpoenaed and have agreed to appear before both House and Senate committees on 19 November and 10 December, respectively. TTA 17 Sept

Oracle raised $20 billion for its AI data center plans in the past two weeks. In its new role as Data Center Builder and Landlord, Oracle’s raise consisted of “concurrent offerings of US$10b in common stock and US$10b in senior notes to fund heavy AI and cloud infrastructure spending. This included multiple tranches of fixed rate, senior, unsecured bonds with coupons between 7% and 8.65% and a US$10b equity sale at US$116 per share.” The further analysis in Yahoo Finance from Simply Wall St isn’t simple but comes down hard on the risk that Oracle is taking on the buildouts, “You have to believe its huge AI and cloud buildout converts a US$638b backlog and multicloud database momentum into durable, cash generative usage.”  Most of Oracle’s contracts are with OpenAI. Meaning that if AI demand trails off, or (as Ed Zitron has opined) if OpenAI goes bust, Oracle is in trouble plenty [TTA 19 Aug].

Rounding up the funding and M&A action of early Q4–plus CVS’ split, Anthropic’s IPO

November 5, 2026 | by | No Comments

Your Editor has returned after a fair amount of travel away from the desk. She was also sidelined to attend to some health issues, including a nasty cold that hasn’t quite taken its claws out of her head and lungs yet, and some technical difficulties on our publishing site.

The big news today is CVS’ split that undoes their ‘big bang’ of 2018. Unusually, there’s a lot of early Q4 investment at the Series A level and a bit of M&A action. In AI World, Anthropic finally filed for their IPO while OpenAI is asking for more bridge money. Here’s our selective roundup:

  • Today’s bombshell was that CVS is splitting its lines of business into two publicly traded companies by H1 2028. The first new company will be CVS Health, consisting of Aetna and Caremark, the CVS pharmacy benefit manager (PBM), Oak Street Health, home health firm Signify Health and CVS’ specialty drug business. The second will be CVS Pharmacy, containing roughly 9,000 retail stores and pharmacies, plus the mail order pharmacy, walk-in clinics and Health100 technology services. According to CNBC, CVS Health will be run by current CEO David Joyner, while CVS Pharmacy will be led by Prem Shah, group president of CVS Health. Other executive assignments are TBD. The company’s market value is about $117 billion. Current shareholders will receive shares in both companies. Healthcare Dive

Both companies have done well in recent quarters, so perhaps this was the time to execute a plan that’s been an open secret for awhile. Will it resolve the charges of conflict of interest made against CVS, with the second-largest PBM? Questionable, as the reorganization places specialty drug alongside the Caremark PBM.

We note that the Merlo/Bertolini vision of an integrated healthcare giant lasted exactly ten years–and that Mark Bertolini now heads up Oscar Health, exactly the opposite of a CVS.

  • In late October, Vera Health raised $28.5 million in Series A funding to expand its evidence-based AI clinical search platform. It’s a word-of-mouth story, as it’s accumulated a claimed 800,000 clinicians using it worldwide from a few thousand a year ago. It’s now used across 190 countries, including approximately 1 in 4 physicians in Spain and Italy and 1 in 7 in France. Vera managed to do this with just 12 employees. The Series A was led by Threshold Ventures, with participation from Mantis VC and SV Angel. Existing investors Y Combinator and Gradient tripled down, bringing the company’s total funding to $32 million. Website/release, HIStalk, PYMNTS.com
  • Tegria acquired CloudWave for an undisclosed amount. Tegria is a global healthcare consulting and IT services company that partners with provider and payer organizations. CloudWave is a full-service cybersecurity and cloud services provider for community hospitals and health systems. Release
  • Administrative automation platform ClarityCare raised $16.5 million in a Series A funding, led by global venture capital firm Headline. New investors were Arthur Ventures and FJ Labs and existing investors were Maverick, firstminute, Top Harvest Capital, and Transpose Platform for a total funding of $20 million. According to their very flashy website, they run AI agents inside health plans, payers and TPAs to automate the administrative and clinical work needed to run cost containment operations. Spurring the funding is the CMS Rule CMS-0057-F which mandates a prior authorization decision timeframe of 72 hours for expedited requests, and seven days for standard requests.  Website/release, MedCityNews
  • Midstream Health garnered $20 million in a Series A for its autonomous financial operations platform. This round was led by Valtruis, and included participation from Andreessen Horowitz (a16z), Foundry and CommonSpirit Ventures. Its network covers over 250 hospitals nationwide and emphasizes recovery via monitoring of contracts, claims, rebates, other supply chain areas,  and payments. Release, MedCityNews
  • And closing today’s roundup, Anthropic PBC, which markets its AI tools as Claude, finally filed its SEC Form S-1 to go public on the Nasdaq, trading under ANT. No target date is given, nor pricing and number of shares. The company is presently closely held by founders Dario and Daniela Amodei. Anthropic’s revenue was $16.3 billion for the first six months of 2026, up 1,300% from $1.2 billion during the same period last year. It all looks lovely except that on-balance sheet liabilites total around $117.5 billion (balanced against roughly $112 billion in cash prior to its IPO). Bloomberg Tax and off balance sheet and long-term compute commitments of $895.4 billion. CNBC, Mobihealthnews

Given all this, the Anthropic IPO may not happen until 2027.

Filing for an IPO does not mean it will happen–see Oura. For instance, OpenAI filed initial SEC forms in June, but is delaying their IPO to sometime in 2027. They are currently seeking a bridge raise of $10 to $20 billion this year in advance of the IPO. FT. The WSJ reported that they have subscribers for about $11 billion of this. 

IPOs, IPOs–Oura’s stalls out, Anthropic’s restarts, possibly mid-November. To everyone’s amazement!

October 3, 2026 | by

Is it the market, or is it something else that’s putting off the ‘sure’ IPOs? The smart money was betting that the Oura health monitoring ring would have IPO’d on Wednesday (30 Sept) for about $2.1 billion. The employees holding restricted stock units (RSU) and investors would be counting their money by now. After all, Oura has been profitable this year after breaking even in 2025, and there was real enthusiasm when it filed its SEC S-1 right before Labor Day. But on 29 September, when the offering was scheduled to price, it was postponed. Indefinitely.

The Oura press release cited “that it is postponing its previously announced initial public offering on Nasdaq, despite strong demand, due to uncertainty in the IPO market”. No new date was given. Uncertainty is a factor, but there are others specific to Oura.

If you read Endpoints, they cited the Federal Reserve raising its rates a few weeks ago, depressing demand for the rich valuation Oura was seeking; the P(doom) around AI; and Apple introducing a new Watch with improved sensors and an option to order blood tests, as Oura has. There are rumors that Apple will also develop a faceless watch that will copy everything that Oura has. That’s a lot of putting off right there.

Ace investigator Sergei Polevikov in his AI Health Uncut of 29 September digs considerably deeper. Non-subscribers to his Substack platform will see some of this but his main points are that the oversubscribing level was weak at ~4x whereas ~20x for large offerings has been the norm since 2023. Three early VCs-Forerunner, Lifeline, and Elysian Park Ventures–were seeking to exit, never a good sign, and taking $1.53 billion with them. The IPO is also being built on Oura’s promise to deliver predictive health. Whether a ring–a piece of Finnish jewelry–can deliver that and more, reliably and interestingly to a growing user base, is a real question.

What 4x versus 20x says is that this IPO is a ‘nice to have’, not a ‘must have’. No one here has FOMO–fear of missing out.

There are hardware issues–and hardware is the vast bulk of its sales with service subscriptions only 19.8% of revenue.

Last but certainly not least, Oura’s benefit in going public on Nasdaq would largely have gone to the Taxman. Little known fact unless you’ve Been There, Done That: RSUs are treated as employee pay when they vest. The tax is withheld, just like wages. It becomes the employer responsibility, not the employee’s. In net settlement, Oura pays the tax in cash from its IPO proceeds and keeps part of the shares to cover the tax. (That doesn’t count what states do with RSUs nor how laws differ internationally.)

The line on the bottom for Oura after the IPO? The company nets only a paltry $6.2 million because of investor payoff and employee RSU taxation. That is over 98% of the proceeds going to everyone but Oura. 

Have other IPOs been like this? Not many. Evidently a lot of pay went to RSUs spread generously around, not just executive staff. This IPO evidently is to help three major VCs exit nicely–and a ~4x oversubscription wasn’t enough.

Another Ominous Parallel with an IPO that some of us remember: Peloton, once a fitness darling. There are similarities (the enthusiasm, the unfavorable hardware issues, the imbalance between hardware and subscription revenue, unsustainable growth beyond enthusiasts) and differences (the Oura Ring is under $400, a Peloton machine over $2,000, and Oura is profitable). But you’ll have to subscribe (and you should!!) to Sergei’s Substack to see all of his finely worked out and fully buttressed argument.

Oura is not exactly hurting for financing, having raised $1.5 billion over the past decade, with a jumbo $900 million Series E last October led by Fidelity, and an undisclosed corporate round this past July led by Eli Lilly, neither of which are exiting.  Crunchbase

Will Oura IPO this year or next? This Editor cannot see anything that was cited as changing the picture if the IPO were tomorrow or in the next few months.  Also Mobihealthnews

About the Anthropic IPO, the financial press is agog with talk that its engines may restart by mid-November. The date is rumored to be 9 November. Anthropic executives will meet with investors on 14 October to build a case for a $2 trillion offering, which would be an all-time record for an IPO.

Readers know that the IPO talk, explored since May, came to a screeching halt right around 9/11 with the talk of P(doom) [TTA 17 Sept] and Federal regulation. Some believe that these ‘external brakes’ were applied because neither Anthropic nor OpenAI were ready to IPO and it was easier to create Doom than to postpone directly. But here we have it at least for Anthropic, even if the fundamentals scream “warning”! Certainly the incentive to beat OpenAI to the IPO is still there. Anthropic, which was created by OpenAI bolters, surely want to ring that bell on either Nasdaq or NYSE (another small matter to finalize) before Sam Altman. Here we go again! Yahoo Finance

Developing: Walgreens’ Sycamore Partners owner on final approach to sell Boots operation to Canada’s Weston family for ~$9B

October 2, 2026 | by

Looks like it won’t be Walgreens Boots Alliance for much longer. Breaking yesterday in The Wall Street Journal is that Sycamore Partners, the private equity retail giant that owns WBA, is closing in on a buyer for the Boots UK and international operation. The discussed price is in the vicinity of $9 billion (£7 billion) for the Boots UK stores, brands, and other international operations in Thailand, Mexico, Germany and China. Talks are proceeding with a deal reportedly within the next few weeks (WSJ), with the Financial Times reporting as early as one week.

The prospective buyer, the Canadian branch of the Weston family, already is a giant in the Canadian food business with Loblaw, Real Canadian Superstore and other brands. They’re also experienced in the retail drug business with over a decade of owning Shoppers Drug Mart, a large national pharmacy chain. The family holding companies are Wittington Investments Limited and the public company George Weston Limited. Their last UK venture was Selfridges, which was sold in 2022 for £4 billion. Another branch of the family is an investor in Associated British Foods.

The Guardian helpfully adds that Boots has 1,800 stores across the UK and employs about 51,000 people, including about 6,000 at its headquarters in Beeston, three miles south-west of Nottingham. One wonders whether Boots will continue to sell Boots Beauty products such as No. 7 in Walgreens USA stores.

This summer, Sycamore tried and failed to sell Boots for $10 billion to Australia’s pharmacy group Sigma Healthcare. In London, a Weston buy has dashed hopes that Boots would be spun off and listed on the London Stock Exchange as reported in the FT. Those had multiplied after Boots in May appointed Alex Baldock, former boss of retailer Currys, as its new chief executive.

Walgreens bought Boots in two stages, with a 45% interest in 2012 and the remainder in 2014. The total price between cash and stock was in the vicinity of $15 to $16 billion. Yes, selling it for $9 billion along with associated debt is quite the ‘haircut’. 

Boots has been up for sale ever since the Sycamore Partners’ Walgreens Boots Alliance acquisition in March 2025 for a total value of $23.7 billion including debt, leases, and other factors [TTA 11 Mar 2025]. Sycamore took on an 83% debt level in doing so. Almost immediately, Sycamore split WBA into five parts, including Walgreens retail stores, Shields Health Solutions specialty pharmacy, CareCentrix, and VillageMD. Practices of the last have been either sold off in parts or shuttered, with Summit Health/CityMD remaining.

Yet, according to the FT, Boots is doing well. “The company reported in June that new beauty brands and the uptake of weight-loss jabs had driven up both its retail and pharmacy sales in the UK. Overall revenues rose by 3.2 per cent to £7.5bn in the year to the end of August 2025. Pre-tax profits jumped by a quarter to £337mn, driven by the reversal of impairment charges.”

What it means for Walgreens? Sycamore gets a quick cash infusion, allowing them to focus on revitalizing the US retail operation which had fallen on difficult times over the past three years. An indicator is a late September report that it slowed store closures from a projected 700 this year to less than 100, stabilizing total locations at about 8,000. Drug Store News Walgreens does not own a pharmacy benefit management (PBM) operation, a debit which now may be to its benefit as PBMs face financial and regulatory headwinds.

Both Sycamore and Weston were remaining mum about the deal to the press. Yahoo Finance UK, Axios

Perspectives: What Meta’s settlement reveals about youth mental health, access shortages, and where telehealth can support pediatricians

October 1, 2026 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic concerns youth mental health–and how specialized telehealth can provide remote psychiatric backup to assist pediatricians in making critical treatment decisions. The author, Andy Flanagan, is CEO of Iris Telehealth, where he draws on experience as a three-time CEO and senior leadership roles at Siemens Healthcare, SAP, and Xerox to guide the company’s mission of improving behavioral health outcomes for patients and clinicians.

Meta’s $16.7 billion settlement with a coalition of state attorneys general puts a number on something health systems have felt for years without a dollar figure attached. Youth mental health has become a public health infrastructure problem, and the infrastructure absorbing most of the impact isn’t behavioral health. It’s primary care.

New survey data from Iris Telehealth shows that when a child starts struggling with attention, mood, or behavior, 42% of parents try home strategies first. Another 23% bring the issue to a teacher or school counselor. Only 11% go directly to a mental health professional. Everyone else eventually lands somewhere else first, and for most families, that somewhere is a pediatrician’s office.

Pediatricians are absorbing psychiatric decisions that used to require a specialist referral, and telehealth can put that backup in the room with them instead.

Pediatricians have become the default specialist

Sixty percent of parents in our survey said their pediatrician or healthcare provider is where they get information on supporting their child’s behavioral or emotional health, ahead of friends and family, online resources, and school staff combined.

The same pediatrician parents go to for guidance is often the one prescribing the medication that guidance leads to. Among parents whose children have taken medication for a behavioral or emotional challenge, 44% said a pediatrician wrote it. Only 38% said a child psychiatrist did.

A prescription for a child’s mood or attention shapes how they sleep, eat, and function every day. Pediatricians are handling more of that decision themselves, and a child psychiatrist is rarely in the building to weigh in alongside them.

Fewer pediatricians will be available right when more families need one

The pediatricians absorbing this load today are about to become scarcer. A study published this year projects that pediatrician demand will grow 2% between 2025 and 2037, while the supply of pediatricians actually available to see patients drops by more than 10% over that same period.

Workforce adequacy, the measure of how well supply meets demand, falls from 92.3% today to 81.2% by 2037. Families in non-metropolitan areas and the South will feel that gap hardest, and general pediatrics is already projected to rank 14th out of 21 medical specialties for workforce adequacy by then.

At the same time, the number of families raising a mental health concern at a pediatric visit keeps climbing. A JAMA Network Open study of 1.8 million children’s insurance claims found that visits involving a mental health diagnosis rose from 5.7% in 2014 to 9.7% in 2023. Anxiety drove most of that increase, with related visits climbing more than 250% over the decade.

For a pediatric practice, that means fewer providers on staff and more children walking in with a mental health concern attached to their visit, a combination that leaves less time and specialized support for each one. Parents aren’t asking to skip straight to medication, either. Only 7% think it should be the first step, and 45% want skill-building tried before it. What they don’t have is a clear signal for when to move from that skill-building to professional guidance, the equivalent of a pediatrician tracking height and weight at every visit regardless of symptoms.

Integration bridges the pediatric access gap that primary care can’t close alone

Pediatricians shouldn’t have to become child psychiatrists. What they need is specialist support embedded directly into the visits already on their calendar. By integrating telebehavioral health clinicians into existing primary care workflows, health systems put expert guidance right at the point of care — specifically when specialists make critical prescribing decisions. The pediatrician is no longer left managing complex cases in isolation simply because the nearest child psychiatrist is half an hour away, or completely non-existent in their county.

AI plays a valuable, supporting role in this integrated model that’s strictly focused on efficiency. Used for triage support, ambient documentation, and identifying potential referrals, AI lightens the administrative burden that often makes specialist collaboration hard to sustain. It supports the clinical team, but it never makes clinical decisions.

While policy shifts, like Meta’s recent settlement over youth app safety, target the digital environment straining kids’ mental health, regulatory fixes don’t solve the immediate clinical access crisis. That requires accessible, expert care. Telebehavioral integration gives health systems the scalable infrastructure needed to support pediatricians today, starting with the very next patient on the schedule.

Oracle’s continued restructuring cuts 3K more jobs, adds $700 million while revenue grows 30%; House VA Committee subpoenas Ellison, Sicilia 19-0–and why Congress is mad at a 170% budget increase

September 17, 2026 | by

Oracle trumpets successes to Wall Street while continuing layoffs, tightening spending. Oracle’s downsizing continues while revenue is parked on the sunny side of the street. Its fiscal 2027 Q1 revenue (ending August 2026) grew 30% to $19.3 billion while non-GAAP operating income rose 31% to $8.2 billion and non-GAAP earnings per share came in at $1.92, also up 30%. Some was driven by cloud growth. For those following their data center builds, their remaining performance obligations, a measure of contracted future revenue, grew by $26 billion but much of it was prepaid or with customer supplying their own hardware, meaning no cash outlay for Oracle. Another way of looking at this is conversion to revenue over the next 36 months which is now estimated at 50%.

This perked interest by investors. Barclays has upped its Oracle price target to $252 from $250 and kept an “Overweight” rating on the tech stock. The stock price is currently around $154, down 54% from its high. The Street

This is despite that debt is high and building. Total debt climbed to $155.9 billion on a trailing twelve-month basis, up from $90.5 billion just two years ago. Net debt now sits at $118.9 billion.

More Oracle employees got their severance notes and cutoffs at the beginning of September. Restructuring has a price and it’s in people. Business Insider quoted ‘insiders’ that they started on 14 September with a chilly 6am note signed “Oracle Management” similar to the previous round: “After careful consideration of Oracle’s current business needs, we have made the decision to eliminate your role as part of a broader organizational change. As a result, today is your last working day.” Severance was 4 weeks’ base salary plus 1 week per year of employment. The count of the layoffs, LOBs, and states is unconfirmed by Oracle but estimated at 3,000, several hundred in Washington state. Not quite the ‘double digit percentages’ rumored in August but possibly so on some teams. This is on top of the earlier 21,000 global cuts, 13% of their workforce, originally posted as near 30,000 [TTA 31 March]. Oracle’s original restructuring cost estimate of $2.1 billion on severance payments and other costs linked to restructuring through 31 August was increased this quarter by over $700 million, bringing that total to $2.8 billion. NDTV, Quartz

Updated 22 Sept: It appears that the employee severance package for most people, in the tech context, is skimpy. It’s four weeks of base pay plus one additional week for each completed year of service, subject to a 26-week maximum. Microsoft’s maximum was up to 39 weeks. Moreover, Reddit employee threads state that the WARN period is deducted from the base pay (e.g. two weeks of WARN, two weeks of severance) and accrued vacation is lost if state law allows it. The article in TechTimes confirms that laid off employees forfeit unvested stock, but does not have how severance affects corporate bonus and the employee stock purchase plan.

Oracle’s new CFO Hilary Maxon denied in the next day’s all-hands that the layoffs did not mean that remaining employees would be doing more with less. CEO Mike Sicilia cheered the survivors on with “How does the work that I’m doing help deliver a better outcome for a customer?” Not an off-target ask, but if the work load does not change especially in healthcare or implementing an EHR, how does this situation not mean doing more with less? 2+2≠5

Rounding out a roller coaster two weeks for Oracle was a 19-0 House Veterans Affairs Committee subpoena for Larry Ellison and Mike Sicilia. It was voted on by the House Veterans Affairs Committee and issued before Labor Day, when Oracle did not attend the 2 September hearing citing scheduling conflicts. The hearing covered the $17 billion increase in budget for Oracle’s EHR development for current costs and the three-year extension to May 2031. It turned out to be rather raucous with accusations of “unreasonable” and “corruption.” The original $10 billion estimate was by Cerner and is running out [TTA 27 August]. The new budget request brings the total to $26.94 billion. Apparently the House members found out about it through news reports, While the House is not in session until 9 November, House committees can meet anytime, but both hearings are after the midterms. Sicilia is due on 19 November and Ellison on 10 December. FedScoop, Becker’s, Stars and Stripes, MedCity News, Healthcare IT News (updated for appearance dates)

Updated. Why Congress is Madder than Wet Hens is revealed in this FedScoop article and timeline. Simply and quickly, back in July 2022, when things started to go sideways in the EHRM implementation [TTA 28 July 2022], then-EVP for Industries Mike Sicilia told the Senate Veterans Affairs Committee that Oracle would absorb any “performance or workflow” issue costs above the original $10 billion ceiling. For Oracle, after the Transformational Big Vision kvelling faded, Cerner’s painful stumbles became Oracle’s VA Migraine. There are also other add-on costs for infrastructure related to the EHRM but not part of Oracle’s costs. 170% is a big surprise in the VA budget and it blindsided Congress.

Perspectives: Digital Health Capital Keeps Rewarding What Patients See, Not What Keeps Companies Alive

September 17, 2026 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic concerns the disconnect between what gets funded–patient-facing tech–versus the more complex infrastructure technology that healthcare organizations need to “keep the lights on”. The author, Ramkumar Pichandi, is the founder and CEO of Rytsense Technologies, where he leads the development of agentic AI and intelligent automation solutions for healthcare revenue cycle management. He is passionate about practical AI adoption that delivers real business outcomes rather than experimental technology–and he throws down the gauntlet here.

Digital health capital has a blind spot. It rewards what patients can see and touch, such as the app, the AI assistant, or the sleek intake screen, far more than it rewards the financial machinery that determines whether a company survives long enough to keep serving them. Carbon Health is the clearest recent illustration. In February 2026, the hybrid primary care company filed for Chapter 11 bankruptcy after raising more than $600 million over a decade and building roughly 90 clinics across eight states that together treated well over 800,000 patients a year. Nobody was complaining about the care. What forced the filing was a cost structure built for a larger company in a friendlier capital environment, and a balance sheet that no longer matched the business underneath it, according to court filings and reporting on the case. Patients experienced a functioning clinic right up until the day the financial layer underneath it gave out.

Carbon Health is not an outlier so much as the latest entry in a pattern that has repeated through several funding cycles now. Olive AI raised close to $900 million on the promise of automating revenue cycle work, then shut down in 2023 after its technology failed to deliver the savings it had promised hospitals. Pear Therapeutics and Babylon Health, two of the most recognized digital health brands of the pandemic era, went through bankruptcy the same year. The products differed. The failure mode did not: each company built something patients or providers could see and use, while the financial machinery underneath it stayed thin, brittle, or simply unbuilt.

This is worth naming plainly because the funding data suggests the pattern is still being set up, not corrected. Digital health investment is recovering in 2026, and AI is the reason why. U.S. digital health startups raised $7.4 billion across 244 deals in the first half of 2026, up from $6.4 billion a year earlier, according to Rock Health. Mental health platforms and GLP-1/weight-management startups remain the two most heavily funded clinical categories, and nearly 60 percent of all digital health investment in the first quarter came from a dozen mega-deals of $100 million or more, mostly consumer-facing. Capital is concentrating into fewer, larger bets, and visible keeps meaning patient-facing.

Meanwhile, the category that actually keeps healthcare companies solvent is losing ground with investors even as demand for it grows. Research from Galen Growth tracking healthcare buying behavior found that infrastructure’s share of health-system partnerships has climbed steadily, from under 19 percent of deals in the first half of 2022 to nearly 23 percent in the first half of 2026. Hospitals increasingly want the unglamorous layer underneath documentation, claims, scheduling, and care coordination, not another point solution. Yet over the same stretch, infrastructure’s share of venture financing dollars actually fell, and the number of infrastructure deals dropped by roughly 62 percent even as average deal size for the survivors doubled. Buyer demand for durable financial plumbing is rising, and the number of companies funded to build it is shrinking. That is not an absence of demand. It is a mismatch between what health systems need and what investors will write checks for.

The gap shows up most clearly in revenue cycle work, which is where a healthcare company’s survival is actually decided. Experian Health’s State of Claims research found that 41 percent of providers now report denial rates above 10 percent, up from 30 percent in 2022, and hospitals collectively spend close to $20 billion a year just overturning claims that were denied incorrectly. None of that shows up in a product demo. A denial queue does not make for a good conference stage moment the way a patient-facing app or an AI scribe does. It just quietly determines, months later, whether a company can make payroll.

That asymmetry is not really about technology. It is about what is easy to show and easy to fund. A patient portal or an AI assistant can be demonstrated in a five-minute pitch and photographed for a press release. A well-run eligibility check or a denial-prevention workflow is judged by what does not happen: the claim that does not bounce, the appeal that never has to be filed. Investors and journalists are simply better equipped to evaluate the former than the latter, and capital tends to follow what can be judged quickly. The cost of that bias never stays confined to the layer that was underfunded. It falls on the whole company, patient-facing product included, the way it did at Carbon Health.

None of this argues for less investment in patient experience or clinical AI; both remain genuinely important, and the returning capital in 2026 reflects real progress on that front. It argues for a more honest accounting of what digital health actually needs to survive its own growth. Until the layer that keeps the lights on gets judged by the same standard as the layer patients see, the industry should expect more companies that patients loved right up until the day they were gone.

AI’s hoofbeats as Horses, not Zebras: a Gimlety view of AI’s destructive capacity (updated)

September 17, 2026 | by

Gimlet EyeA longish holiday does provide some Perspective of the Gimlety View. What blew up during the last big summer holiday, as I was building my Vitamin D for the long winter while at the Jersey Shore, was the news made by one Jacob Coxon, a former researcher at Anthropic (developer of Claude), that advanced AI within 10 years has a more than 10% chance to have the ability to hack into enough systems, initiate bioweapons, nukes, and otherwise kill off Humanity. The humans who originally designed it would be unable to stop rogue (and roguish) frontier AI. This started with Coxon’s well-timed posting on X on 8 September and percolated through tech media right before the 25th anniversary of the mass murders on 9/11/01. Mass media, already overheated because of the anniversary, exploded like a pressure cooker. 

Axios, the techie bulletin board and for generalist media types a source for pithy quotes, on 9 September quoted a MIT 2025 study of “experts” giving a 21.5% chance of “AI possessing dangerous capabilities”, with a 21% chance of AI initiating “Cyberattacks, weapon development or use, and mass harm”.  It was a reasonably analytic article full of nuggets for a writer to run with.

This past week introduced us to the latest pop tech slang, P(doom), a cute term for the percent chance of AI Doomsday. P(doom) has now surfaced everywhere from Elon Musk to Anthropic’s CEO Dario Amodei. (Impress your friends and relatives at the next cocktail party or tailgating/cookout.)

The mass media in the following week ran with quotes by Coxon, old tech stalwarts, and politicians. Plenty of P(doom) predictions. Emblematic of the coverage was the Los Angeles Times recap published on, ironically, 11 September, a day of real, not theoretical, doom.

Readers know from my running coverage that this Editor is skeptical of AI both in a business sense (a financial time bomb) and of its utility in its current models. Automating many functions within healthcare? Sure. Providing deeper insights into imaging to speed diagnosis? Faster drug development? Bravo. Speeding market and marketing analysis, sussing out needs? Hey, hey! But equally I have been scathing of companies that buy AI services and believe vendor promises, without cross-checking for accuracy, dumping the skilled humans doing these jobs in mass layoffs. These people are the boots on the ground who should be doing the cross-checks and upgrading the models that come from developers usually unfamiliar with medicine and healthcare–and certainly without deep and specific knowledge the boots have. It turns out that the mass layoffs in many companies, from team managers, data analytics, customer services, marketers to operations, have been to fund so-called investments and token spending in AI tools. ROI has gone into a Missing Man Formation in the finance department, while services to customers and in healthcare, patients, go sideways–as does market share and revenue. CFOs, funders and Mr. Market are just waking up to this surprise that they forgot to teach at HBS. 

I’ve also been scathing in coverage of certain companies such as Open AI, Oracle, and somewhat so of Anthropic, Microsoft, Meta, and Google. These companies are pushing one to two year bricks-and-mortar data center development without responsibility for local effects on water, power, noise, and land use–something that a GM, Ford, Toyota, or Worldwide Widgets building a factory would face and mitigate. This thoughtless pushing is proving to be politically evenhanded in opposition; these companies have received epic wedgies and a few pitchforks in their metaphorical derrieres as a deserved result. But this is manageable; because of pushback, it’s diminishing as a ‘reason why’ except as a political club for unscrupulous politicians.

What’s a lot more devastating is that apparently all the forecasting is inflated beyond belief. There is no decent idea of metrics, of matching up capacity to future demand. Not by OpenAI, not by Anthropic as they prep for IPOs. This is an ancient problem that always, reliably, cyclically bites developing sectors in their nether regions. Not a hype cycle like we saw circa 2006-15 with telehealth, not bad management, but in other industries within recent memory, with ‘sky’s the limit’ booms followed by a crash and partial/total hull loss:

TNW discusses in a deeper dive the debt structure and why PIMCO could make this bet where banks could not [reference is to Oracle’s debt funding]. The question it raises is whether the furious pace of data center building is another cycle of overbuilding–and if it is, will it be absorbed in time? The ominous parallels: the 2000s building boom in an earlier iteration of data centers, the fiberoptic boom of the early 2000s that broke WorldCom, Global Crossing, Winstar, Corning, and 360Networks, cloud overbuilding that left Amazon Web Services with years of excess capacity (it helps to have a deep-pocketed and not all that transparent parent), and others. This Editor would also liken it to the early years of 1980s-90s airline deregulation (too many airlines, too much debt, too many seats) and about a decade in the cruise ship industry where too many cabins were chasing too few people. These took decades and multiple bankruptcies to settle. TTA 7 May

Writer Ed Zitron, who has few parallels in Gimlety-ness, analyzed how OpenAI could easily meet the Devil of Demise sooner rather than later in his article What Happens If OpenAI Dies?, one of our Must Reads of 19 August. OpenAI’s losses are terrifying, contrary to their PR spin, and will not change in the immediate future; based on the numbers, their growth is slowing. It has to become the most successful company since Caesar Crossed The Rubicon–or it croaks and may well pull down an economy with it. I will add from other reading that Anthropic, ahead of OpenAI, is painted in a similar corner.

Leaving aside P(doom), what we are hearing are hoofbeats from horses, not zebras. What’s happening is the AI boom cooling and billions in concentrated funding that has hit multiple headwinds. Both companies have trillion-dollar valuations and heavy debt. Technical and security concerns are popping up like weeds (see the Hugging Face sandbox breakout).  Failures might not be the end of the world but not a cheerful earful for a stressed economy.

In the short term, the two major AI companies have more of a challenge from F(doom)–financial doom–than P(doom).

Suddenly, we have three things happening in the past 10 days:

  • A short-term, low-level former Anthropic employee, Jacob Coxon, with few followers on X, suddenly bursting out and ‘going wide’ with a doomsday prediction. Quoted and covered everywhere in mass media with the things that at least some of his elders like Steve Wozniak and Geoffrey Hinton have been saying for over three years. (The Woz I’ve traced back to 2015!)
  • Dario Amodei, CEO of Anthropic, Sam Altman, still CEO of OpenAI, and Elon Musk (Grok/X) then calling for government safety regulation. Not guardrails. Government regulation by a Federal agency, NIST. CNBC, OpenAI blog, Amodei blog statement
  • Online ‘surveys’ stating that the public is now terrified of AI, with 63% rating Humanity’s Destruction from ‘moderate risk’ to ‘almost certain to happen’. (POLITICO) 

Private companies demanding government regulation of their business truly boggles the mind. This should raise red flags as to why, and why now, and who writes those regulations.

P(doom) supposedly has a ten-year horizon. F(doom) works far faster, may be more likely, and once it starts, there may not be an Anthropic or OpenAI to worry about.

Some Gimlety Speculation, IMO only:

  • Both Anthropic and OpenAI float on a sea of red ink and Other People’s Money (OPM). Their lenders want to monetize and exit their investment with an IPO. Both companies were racing to IPOs. Except neither company is logically, reasonably, in any financial sense, ready.  Yet Anthropic was due to IPO before end of 2026 with OpenAI racing to beat them.
  • Investors are also pushing for another OpenAI funding round to cash out secondary shares held by employees, according to CNBC today (16 Sept). Which, in a case of an IPO, means more shares for the investors.
  • Both the Coxon media pickup and the subsequent Amodei/Altman calls for regulation effectively stop the IPO clock. One can speculate about the timing and origins, but it is fortuitous timing for both companies. .

It is also being used as a political club in the upcoming midterms. Goosing the ‘terror’ narrative is calculated to pay off certain players.

  • The usual Senate suspects are demanding complete regulation of AI because “we are losing control”. There is a bipartisan bill in the House (Lawler/Gottheimer) drafted to regulate frontier AI, kicking the standards over to the National Institute of Standards and Technology (NIST), but the House is now out of session until 9 November, after the midterms, which leaves exactly two months before a new House is seated. There is a parallel bill in the Senate.
  • President Trump, somewhat on the back foot on this, calls their fears a ‘hoax’ and a ‘scam’ that will prevent US leadership in AI development. Yet Sam Altman along with Nvidia’s Jensen Huang will be attending the state dinner for Chinese President Xi Jinping’s visit to Washington next week,
  • The security threat is real. China is building a lot of data centers, well away of course from any international observation; Uyghurs don’t get to complain about data centers and water usage to Beijing. One doesn’t even know if they are real or empty buildings like their empty hinterland cities. Where are the chips coming from? Yet Chinese-engineered AI models may take the lower end of the market, much like steel.

There’s an old saying in medicine: when you hear hoofbeats, think first of horses, not zebras. It dates back to Dr. Theodore Woodward of the University of Maryland medical school and the 1940s in teaching his students to first rule in or out common diseases rather than searching first for exotic, rare diseases because they’re more interesting. (Apologies to those with rare diseases, and may AI be a savior in this.) Taking the analogy to business, the ‘horses’ are the shaky business models around AI development, capacity versus demand, the heavy debt of the two AI leaders, and data centers. Throw in the Chinese capacity and models. The ‘zebras’ are Humanity’s Extinction By AI. They’re there, but in the next county.

What’s running in that herd out there, who’s trying to paint the horses black and white, and why? Cui bono? The consequences can be severe.

Updated 17 September: Gary Marcus, Substacker and BBC commentator, in his latest ‘Marcus on AI’ takes an even more Gimletly view than your Editor. He points out the stratagems behind Altman’s and Amodei’s calls for regulation. It’s all ‘trust us’ to write the regulations and guarantee safety. We shouldn’t. Meanwhile, certain Senators go over the top on Doom with the aim of terrifying voters. We shouldn’t. A Must Read. And if you are working with AI, worth your subscription.

Silicon Valley Bank’s take on H1 investment: among the “have and have nots”, it was “the best half in years” for health tech

August 27, 2026 | by

Silicon Valley Bank (SVB), now part of First Citizens Bank, is back with a just-published roundup of 2026’s first half (H1) in healthcare investment in the US and EU. Last year was a year of contractions and skewed investments, what they called “barbells, bookends, and have-nots”, with fewer investors hotly chasing profitability and monetization. This year is considerably sunnier for health tech in terms of total investment, but SVB still calls the overall picture across four sectors: Biopharma, Healthtech, Dx (diagnostics)/Tools, and Device….

“Haves and have-nots. Winners and losers. The top of the heap and everyone else. Pick your metaphor….”

For health tech, it was the best H1 since H1 2022, with $7.2 billion versus $9.1 billion in investment, a tidy increase versus 2025 H1’s $6.7 billion. The major difference is that the number of deals is collapsing, with 203 deals this H1. If you look at 2025’s year total of 598 deals, if this deal track maintains, the 2026 full year number may not break 500. Again, the deal value is disproportionately and increasingly skewed to Series C+ deals, far more so than the past two years. Series B deals contracted and there was another uptick in Series A fundings. (Page 12)

SVB attributes the new health tech prosperity to AI-based technologies: clinical workflow automation, administrative efficiency and data infrastructure. Payviders (remember them?) also had their overdue day powered by AI: Devoted Health in the US with Medicare Advantage, and Alan in Paris (EU and Canada only). In SVB’s terms, “The bar for founders has risen toward durable growth, differentiated technology and a credible path to scale, especially those leveraging AI to address meaningful healthcare challenges.”

Exits, though, are hard to suss. There weren’t many this half for health tech. Kaia Health (Sword) in January, and in provider operations Ostro (Veeva) and Diligent (Serve). Kaia was the only one with a positive multiple on its valuation. Zelis and Virta Health might IPO this year or 2027. Or never. (Page 17). 

Looking at all four sectors, while investment dollars are growing, the number of deals continues to trend downward:

  • H1 2026 healthcare investment at $24.7 billion is slightly below H2 2025 at $25.8 billion. The absolute high water mark was $43 billion set at H1 2021, in the midst of the ‘Throw Money At Anything’ period. But the trend is still one of recovery. 
  • The big difference is that the number of deals continues its downward trend, sharply. H1 2026 had only 618 deals versus 2025’s H1 801 and H2 703. H2 is not projected to pick up this slack, again.
  • 75% of investment is in the US, with EU accounting for 25%; EU is slowly but surely increasing its share.
  • The falling investment sector is Dx (diagnostics)/Tools. Device remains steady and constant. (Health tech Readers should look over at device, since here resides WHOOP and its $575 million Series G for Giant) skewing this sector.

Most concerning is that healthcare VC fundraising has hit new lows, and the money is concentrated in a few across the seed, early, and late stages. Only a few years ago, founders had a wide choice of VC funders with fat wallets. Not nowadays. H1 2026 funding for VCs was only $10 billion. Full year 2025 was $16 billion and 2024 $26 billion. Many large “name” funds ($100 billion plus) closed this year, such as Lux, Santé, Frist Cressey Ventures, and Kleiner Perkins. What’s left in health tech? General Catalyst, Andreesen Horowitz, Redesign, Menlo Ventures. It’s a monotonous roster. Occasionally, there’s a crossover. Especially at early stages, founders have lost leverage in finding a simpatico fund. They have to show that they have a credible path to growth and profitability. (Pages 7-8)

Unlike SVB’s last report for 2025, they did not break out a fifth sector cutting across all four, Longevity and Healthspan. 

SVB will also be changing their name during Q4 2026 to First Citizens Innovation Banking. Preview page for SVB’s Healthcare Industry Trends published 25 August.  Hat tip to Megan Scheffel, head of SVB’s healthcare sector.

News roundup: Verma’s rumors, DEA’s new (?) telemedicine rule goes to OMB for review, Cityblock Health goes rural with Homeward buy, Scottish housing sensor tech could save millions–study

August 27, 2026 | by

Oracle’s Seema Verma rumored to be on a list for a new CEO position with a major lobbying group. The EVP and general manager of Oracle Health and Life Sciences is reportedly under consideration for a new job as CEO of PhRMA. A paywalled story in Endpoints News broke that she is among a group of “Republican policy wonks, former lawmakers” in the running, four months in, for this pharmaceutical lobbying organizational chief position. If the Reddit rumor boards are to be believed, she’s already half out the door. If the former Center for Medicare and Medicaid Services (CMS) administrator to 2021 departs Oracle, it will be the sixth Oracle Health senior level departure this year [TTA 3 Mar]. Those departures for various reasons shook Oracle Health. Verma, on the other hand, has had a relatively low profile at Oracle Health, though reporting to COO Mike Sicilia. If she does depart Oracle, enough time has passed since her CMS position to dispel the Federal-private industry ‘revolving door’ tag, though undoubtedly as EHR head she has been working with the VA. Developing

ATA Action was kind enough to flag for this Editor that the Drug Enforcement Administration (DEA) may finally be moving toward a new rule for telemedicine prescribing of controlled substances. Yesterday (25 August) the “Special Registrations for Telemedicine and Limited State Telemedicine Registrations” final rule was submitted to the Office of Management and Budget’s (OMB) Office of Information and Regulatory Affairs (OIRA) for review. While under review, the text is not public, but the OMB pending EO  is here with the limited text under the RIN: 1117-AB40   The text of the RIN includes that “DEA is currently reviewing the over 6,400 public comments submitted on the Special Registration for Telemedicine NPRM (Notice of Proposed Rulemaking) published on January 17, 2025.”meaning that they are still working with a year-old NPRM.  DEA has extended telemedicine prescribing rules several times, most recently at the end of 2025 to cover full year 2026. A final action to determine approval of the rule is due in November, according to the timetable.

ATA Action’s statement, per their email, is “ATA Action is actively engaged as the rule moves through OMB review, pressing the priorities we have consistently advanced: protecting patient access while maintaining safeguards against diversion — without unnecessary in-person mandates, duplicative state-by-state registration requirements, excessive reporting burdens, or implementation timelines that make participation impractical for legitimate clinicians and healthcare organizations.” They also cite geographic “red flags” that pharmacies face when a prescription results from a telehealth visit and state laws that are more restrictive than Federal law. 

Brooklyn’s Cityblock Health’s goes country with Homeward Health acquisition in an all-stock transaction. It is on the surface an odd match: an urban-focused value-based care provider that primarily serves complex needs and provides additional support for Medicaid and Medicare/Medicaid dual-eligible patients expanding into underserved rural markets. What it does promise Cityblock is growth from its present claimed 200,000 members in 10 states and annualized revenue of $2.2 billion, up 77% year-over-year. Homeward serves around 50,000 rurally-based Medicare Advantage (only) members and 5,000 providers in Michigan and Minnesota through a Michigan clinic, mobile clinics and telehealth. It partners with Blue Cross Blue Shield of Michigan and Aetna for Medicare Advantage. Further financial arrangements were not disclosed.

Homeward’s CEO Dr. Jenny Schneider will remain connected with Cityblock as a “trusted advisor” according to a Cityblock spokesperson and Homeward’s brand and operation will remain. According to her LinkedIn post announcing the acquisition, she previously served as a Cityblock board member. She and another Livongo alumnus, Amar Kendale, launched Homeward Health in 2022 to close healthcare gaps in rural America, accounting for over 61% of primary care shortage areas and a 23% higher mortality rate.

Both Medicaid and Medicare Advantage face challenges–funding cuts for Medicaid and with Medicare Advantage, payers reducing reimbursement rates based on rising costs and increased Federal scrutiny of higher costs, upcoding, overpayments, and bonus programs. 23% of Medicare Advantage enrollees are in a special needs plan (SNP) KFF

Cityblock touts its CORE—Care Orchestration and Resourcing Engine—as an AI-based operating system underpinning our outcomes-based care platform to use almost 10 years of member data to close care gaps for specific members, as well as AI tools “handling routine engagement and administrative work that have already freed up 44,599 hours of clinician time this year, including 42,148 calls handled by AI agents.” Homeward Health’s platform is also AI-native.

Cityblock simultaneously announced a Series E of $116 million led by General Catalyst for a total of close to $1 billion. General Catalyst is an investor in both companies. (Is this a return to the General Catalyst ‘portfolio condensation’ strategy that created Commure last year?–Ed.)

Interestingly, Homeward Health is organized as a public benefit corporation (PBC) and a B Corp, certified by B Lab as meeting their standards of social and environmental performance, accountability, and transparency. It’s doubtful that will carry over to Cityblock. MedCityNews, FierceHealthcare, Becker’s, Cityblock’s CEO Toyin Ajayi blog post 

Biggar, Scotland senior housing environmental sensor-based technology test saves thousands, but across Scotland could save millions. The test at the retirement home Langvout Court, part of Bield Housing & Care, was of environmental and activity sensors developed and implemented by Glasgow-based technology company Archangel and the Digital Health & Care Innovation Centre, funded by the UK Government’s Department for Science, Innovation and Technology through the Glasgow City Region 5G Smart and Connected Places Programme. The automated alerts were directed and coordinated with Bield staff. The sensors alerted the staff to a potential boiler breakdown during Storm Éowyn, high humidity levels and faulty extractor fans in buildings, and resident temperature and activity changes that could indicate changes in health. Annualized savings in the six-month test were estimated at £7,670 in heating costs and £2,825 in maintenance costs, along with improved tenant safety, reduced manual checks and stronger regulatory compliance, creating positive ROI in year one. FarrPoint, which independently evaluated the project, extrapolated that applying Langvout Court’s system across Scotland’s retirement housing developments could generate annual savings of £18.5 million. Archangel case study published in TechUK, release in Care Sector Hub

Revealed: Oracle’s extended VA EHRM contract increased by $17B as original ceiling reached this year; VA Indy EHR goes online

August 27, 2026 | by

The cost of Oracle’s extended EHRM contract with the Department of Veterans Affairs disclosed. The ten-year contract for the EHR Modernization (EHRM), originally due to expire in May 2028, was extended earlier this month by three years to May 2031 and, we now know, an additional $17 billion was added to the ceiling. The full contract for Oracle will total by May 2031 $26.94 billion. The original contract was just under $10 billion–a cost ceiling expected to be reached by end of 2026.

Background: Oracle’s current VA contract 36C10B18D5000, the Electronic Health Record Modernization Indefinite-Delivery/Indefinite-Quantity (IDIQ) contract with Oracle Health Government Services, the successor to Cerner Government Services, originally was structured with a 10 year base period without annual renewals. This started in May 2018. In early 2023, the contract was renegotiated. The base period was halved to five years with the remainder of the contract subject to annual renewals from May 2023 and expiring 10 years after the contract start, in May 2028. The Modification P00008 to the IDIQ contract adds another three one-year firm fixed-priced optional ordering periods, taking the duration of the contract to May 2031.

According to the released contract modification documents, VA projects that the original ceiling would be reached by Q1 in Federal FY 2027, which is between October and December 2026. The rationale is that “Due to unanticipated complexities in deploying this system, extensive site-specific customizations, as well as the other factors … VA has reached the current contract ceiling sooner than originally planned. VA anticipates using the remaining ceiling by the first quarter of fiscal year 2027 and thus requires an increase.” 

“Building upon the Trump Administration’s successful deployment of VA’s new electronic health record system at several VA facilities, VA and Oracle Health agreed earlier this month to renew their collaboration,” VA spokesperson Quinn Slaven previously said in an emailed statement to FedScoop.

As previously noted in our original article [TTA 12 Aug], in this Editor’s view, the three-year extension is a smart move on the VA EHRM team’s part.

  • The obvious one is that the VA EHRM rollout requires another three years from 2028 to 2031 to fully cover all locations. Releasing the main single-source contractor three years prior to its finalization is not an intelligent move unless another EHR company could take it up–and that has not happened. Things apparently are going smoothly in the newly formatted rollout. It was also obvious that the cost ceiling had to be increased.
  • The other is protection. Now you won’t read this elsewhere. Since the late winter, Oracle was rumored to be interested in selling, wholly or in part, Oracle Health AI (OHAI). Oracle Health sale rumors were confirmed this summer. In the event of a sale, the buyer would be obligated to honor the VA contracts and its terms.
  • The other possibility is if disaster strikes Oracle as a result of their AI landlord strategy, such as bankruptcy, the VA has some contractual protection in a Federal court. 

Orange Slices, NextGov/FCW

VA Indiana’s three-hospital system (Fort Wayne, Marion, and Indianapolis, VISN 3) cut over to the Oracle EHR on 22 August. X announcement (@VAIndyHealth)  The last two scheduled for 2026 will be Anchorage, Alaska (VISN 5) and Cleveland, Ohio (VISN 3) on 24 October.

This Week’s Must Reads: how lack of focus dooms startup financing, Commure’s Sea of Red Flags Flapping, and what happens if OpenAI expires?

August 19, 2026 | by

Grab a cuppa and sit down with these articles. (You may also want to subscribe to their authors.)

From Substack, UK author Martyn Eeles current Health VC newsletter, “The Strategic Clarity Problem”, advises founders of early-stage companies that doing more can result in less–financing. Too much activity in too many directions leads to confusion on investors’ parts. Paradoxically, it doesn’t enhance “potential” but detracts. It reads to investors, especially now, as lack of priorities and not strategic. Mr. Eeles recommends focus, focus, focus. Choose a strategy and stick with it. It doesn’t mean that a founder cannot show multiple future paths, just that the main path has to carry the company forward. (Sounds like good marketing!)

For instance, how you present your direction is vital in making activity sound focused and strategic. FTA:

A founder who says, “There are many use cases,” may sound ambitious. A founder who says, “There are many possible use cases, but this one is the wedge because it creates the clearest buyer urgency,” sounds more investable.

A founder who says, “We have lots of partnership conversations,” may sound active. A founder who says, “These two partnerships matter because they reduce implementation risk and create access to the customer segment we are prioritising,” sounds strategic.

The short (non-subscriber) version has a wealth of information for both founders and funders, complete with a nifty infographic that depicts nearly the entire article. but truncates at ‘The Choices Investors Want To See”.  This Editor would recommend the annual €60 subscription if you’re in the business. Mr. Eeles is managing partner at Clarma Capital, a European life sciences venture fund.

Our friend Sergei Polevikov writing in his Substack AI Health Uncut returns to the General Catalyst-powered Commure in Commure’s Long History of Red Flags. Even though General Catalyst doesn’t want him to.  Yes, the flags still flap around the gaggle of health tech companies financed by General Catalyst (GC). Commure itself is an agglomeration of GC companies: Athelas, Augmedix, RxHealth, and Memora Health. Commure originally had one marketable product, Strongline, a safety and duress badging/tracking system, three years ago before GC’s consolidation moves. What is questionable about Commure has now surfaced in STAT News +’ investigation (paywalled). From pricing dependent on recommendations to products that don’t work until they’re modified at the client if they eventually do work, to referral programs that are way too close to violating the Anti-Kickback Statute…Commure has it all on the Shady Side of the Street. GC keeps shoveling money in because they can, too. 

And once again, thinking the unthinkable, is Ed Zitron. Here he imagines the demise of OpenAI and reads the tea leaves. He notes:

  • the deceleration of revenue when it needs to accelerate (see below)
  • the COO and CRO left after less than a year on the job, likely walking away from generous stock options/awards–now, who does this?
  • it’s backed away from its IPO and likely will be beaten to it by Anthropic (Claude)
  • the economics are terrifying. OpenAI lost $20.9 billion in 2025 on $13.07 billion in revenue
  • it needs to meet compute obligations and for that needs $800 billion in cash
  • it needs to raise $100-200 billion annually just to survive

In short, it has to become the most successful company since Caesar Crossed The Rubicon–or it croaks. Expires. Meets the Devil of Demise and the Devil wins.

The consequences will be severe. FTA:

To not actively and meaningfully discuss the potential for OpenAI to collapse is actively irresponsible. To act like there are not significant, existential problems with this company’s economics is to intentionally avoid reality, and whoever is on the receiving end of said ignorance deserves better, be they an investor reading your analyst note or a reader burdened with incomplete journalism.

What follows may be an Enron-Lehman Brothers hybrid, one that leaves unbelievable destruction in its wake, an avoidable systemic risk empowered and enabled by a kneecapped media industry and sell-side analysts incapable of seeing further than two quarters in the future.

The time to stop this? Long past.

Zitron backs everything up with hard numbers laced with cross-references. It’s dense and needs close attention. Depending on your view,  you’ll choose a gallon of coffee, a fifth of bourbon, or a bottle of wine. What Happens If OpenAI Dies?

Another argument, shorter, and similar, is made by Gary Marcus in his Substack newsletter (free access), Marcus on AI,  BREAKING: OpenAI’s unraveling has begun.  Again, just as it was scheduled for its IPO and racing its main competitor.

It contains two citations from the Wall Street Journal writers who cover OpenAI, Berber Jin and Corrie Dribusch:

  • “The company grew revenue by just 18% to $6.7 billion from q1 to q2, while its losses sank further into the red”
  • Losses grew from Q1 to Q2 to $3 billion to $12.3 billion, while it added only $1 billion (to $6.7 billion)

Nvidia is in full CYA mode, given its exposure to OpenAI. Can Oracle be far behind?

News roundup: UHS-Talkspace $850M buy final, DocGo to buy Hicuity Health for $52M in stock/debt, R1 to buy Humata Health, PointClickCare EHR to integrate Anthropic’s AI

August 19, 2026 | by

As we near Labor Day, we enter the Atlantic Intertropical Convergence Zone, a/k/a The Doldrums. Given the calendar, monsoons, and the fifth UK/European heat wave plus forest fires, perhaps the Doldrums are an improvement.

Giant Universal Health Services (UHS) $835 million acquisition of Talkspace closed right on time–Q3. The buy, announced in March, is now complete with Talkspace becoming a wholly-owned subsidiary based in NYC. [TTA 12 Mar] UHS is acquiring Talkspace for $835 million or $5.25 per share, a 10% boost on their closing on 8 March. What Talkspace adds to UHG is a full range of behavioral health systems to complement its in-person providers and provide future growth. For UHS CEO Marc Miller, “We’ll now be the only company in the United States that will have a nationally scaled, end-to-end continuum in behavioral health. We’ll be able to offer something that nobody else offers.”

Talkspace was one of many cracked SPACs of the 2020-22 period, debuting in June 2021 with a valuation of $1.4 million. Six months later, shareholders sued for securities fraud, and within a year it became a dollar stock. But it survived and recovered. What Talkspace brings to UHS’s provider network and health services is a 50-state network plus Puerto Rico of virtual behavioral therapy and 6,000 therapists. Their primary markets are health plans, employers, employee assistance programs, schools and government organizations plus self-pay. Their 2025 closed well with a 22% revenue increase to $229 million and net income of $7.8 million. The release is opaque on workforce and management transitioning. UHS is based in King of Prussia PA and had 2025 revenues over $17 billion. Mobihealthnews, Healthcare Dive

Mobile health and transportation provider DocGo to buy Hicuity Health for debt and stock. The terms are interesting ones. From the release, DocGo is assuming $52 million in debt now held by Perceptive Advisors, which matures in December 2029. Perceptive will provide an additional $50 million in debt financing to DocGo. It’s staged in multiple tranches, the first of which is $12.5 million to fund a services agreement pre-closing between DocGo and Hicuity. DocGo will also in the interim provide management services to Hicuity. Hicuity will become a subsidiary of DocGo’s Ambulnz Holdings. Hicuity is a provider of high acuity clinical care including tele-ICU, virtual nursing, and telemetry monitoring services  for health systems, hospitals and post-acute facilities.

DocGo has had its own challenges dating back to 2023 with a NYC no-bid contract for illegal immigrant services that turned out to be an expensive fiasco [TTA 18 Sep 2023]. DocGo currently trades on Nasdaq, closing today at $0.4752, a low based on missing Q2 projections. Release, Mobihealthnews, TradingView

Revenue cycle management company R1 will acquire prior authorization automation developer Humata Health. Acquisition cost is not disclosed. The transaction is expected to close by the end of Q3. After closing, the Humata team will “enhance” R1’s R37 innovation lab, R1’s agentic AI development team. R1 plans to connect Humata’s technology to their Phare OS, an AI automation platform for pre-bill workflows for authorization, utilization review, coding and documentation. R1 is a private company, with RCM used by 1,000 providers, including 95 of the top 100 US health systems, and handles over 600 million payer transactions annually.  Release, Mobihealthnews

Senior post-acute and LTC EHR/software company PointClickCare to integrate Anthropic’s AI directly into its software platform. This strategic initiative is being done through Anthropic’s new partnership, Ode with Anthropic, to enable enterprises to deploy AI by providing a team of experienced AI engineers. Ode was formed earlier this year with Blackstone, Hellman & Friedman, and a consortium of global investors including Apollo Global Management, General Atlantic, GIC, Goldman Sachs, Leonard Green & Partners, and Sequoia. The release is remarkably devoid of specifics such as timing and client rollout. Mobihealthnews

UK’s Alertacall sold to Constellation Software’s Volaris Group

August 18, 2026 | by

A big UK announcement, made this morning via LinkedIn. Alertacall announced today (17 August) that the company was sold effective 1 July to Volaris Group, a Constellation Software company. Founder James Batchelor MBE announced it this morning via a LinkedIn article written by him. Volaris’ press release is on their website here. (Left: James and Mark Miller, executive chairman of Volaris Group)

Alertacall has been one of the earliest companies active in the UK telecare sector for social housing and retirement living resident engagement, founded 22 years ago–incidentally, a year before Telecare Aware was founded by Steve Hards. Since then, Alertacall has developed three two-way communication product lines–OKEachDay, Housing Proactive, and Beyond Warden Call–and now serves social landlords and retirement village operators with a total of 25,000 homes across over 60 housing providers. Alertacall holds The Queen’s Award For Enterprise in Innovation from 2023. In 2025, Mr. Batchelor was appointed an MBE (Member of the Order of the British Empire) for ‘Services to Technology For Older People’ in King Charles III’s Birthday Honours List 2025.

Volaris is an operating group of Constellation Software (CSI) that manages and acquires vertical technology companies. Its operating philosophy is to acquire companies in specific industries and, unusually, hold them forever with a motto of “Forever Invested”, versus the private equity M.O. of selling or IPO-ing them. We last visited CSI when they acquired Allscripts/Veradigm’s five hospital and large physician practice EHRs back in May 2022.to integrate into their Harris Group. CSI owns 1,300 businesses–Volaris over 240–and both are based in Toronto, Canada. Alertacall is headquartered in Windemere, in the Lake District of northwest England. 

James Batchelor’s very personal announcement/memoir about the start, build, and future of Alertacall, and some of his personal plans after 22 years, is a must read over on LinkedIn, as is the Volaris release. Why? The warmth and personalization in both is, particularly these days, also highly unusual. The highlights are that the company remains independent, led by its current leadership team, and James remains as CEO for (in his words) the short/medium term until “an experienced and passionate successor is found”. Yes, James and the Volaris team are actively looking for a successor! Alertacall now has assured financing, intellectual resources, and a forever home in an operating and technology-focused management company.

A TTA Hat Tip™ to the very busy TTA Editor Emeritus, BTW who has a ‘shout out’ in James’ article.

Why Readers can be assured that TTA is 100% Written by Humans

August 13, 2026 | by

Most of you will assume that by the selectivity, the sheer dogged opinionatedness that you find here, with occasional rashes of sarcasm, it would be one heck of a bot writing this.

Unfortunately for my free time, that bot hasn’t been created yet.

So here’s my personal Eight-Point Writers Guide to How You Know TTA‘s Not AI Authored.

  1. Selectivity. I write extensively on topics that intrigue me and hopefully intrigue you. I give more emphasis to companies that have a) breakthroughs, b) deserve attention for a variety of reasons, c) by their business move markets, d) fit into a trend that I’ve spotted.
  2. If it’s lifted from a press release or another article, it generally is closely paraphrased with ‘according to’ or put into quotes. That used to be taught in writing courses.
  3. I do try to connect dots I see. Yes, I get it wrong, sometimes. But I don’t go into outer space, where AI goes.
  4. A tendency to be Cassandra. I’m too cynical to be a cheerleader anymore, having been a part of the Hype Curve of Health Tech from 2006. Also, Doom frankly makes for a good lede. Part of my desire to write here is to warn busy people in health tech of the many Scylla and Charybdis that populate healthcare and health tech today*. 
  5. The occasional busted grammar and misspelling. I do use tools that flag obvious misspellings. I’ve found Grammarly useful but intrusive, trying to flag and rewrite, sell me on paid, and turned it off as a result. Some of this comes out of re-editing what I wrote at 11pm the previous night. I try to clean up my obvious messes, subject-object agreement, and fractured phrases. 
  6. Since I’m American (if being from NJ counts), I write in American English, such that it is. I like certain British turns of phrase, though I don’t use ‘redundancies’ when people are laid off or fired. When I was writing my thesis for my university London Semester Way Back When, my advising professor** instructed me, when I asked the question, to stick to American English and to note source material quoted from UK sources. I also worked with many Brits, Irish, and Australians in my travel industry years (as well as Editor Emeritus Steve here), so some of it rubbed off.
  7. Real anecdotes that have an eventual point. If you see the occasional red MD-80 or 737-300 on these pages, I’m hearkening to my three-plus year  ‘graduate school’ as ad manager of New York Air. The ‘wild west’ of airline deregulation, the airlines that started up in that time, the larger than life founders, including their involvement with government regulation, have many lessons to teach to the founders of the new ‘wild west’ of AI companies as well as those attempting to serve or buy from them. Most of us in healthcare lived through other boom/busts: Dot.Com, the Hype Cycle of early telehealth and health tech, and the barely-past-us Crazy Covid Telehealth Money. Not learning from what we lived through leads to mistakes in the business present. Lord Acton phrased it better, though.
  8. AI Slop has no sense of humor. Even painful humor.

Now what got me all cranked up here was a far more succinct view of AI Slop Writing, sent to me by Editor Emeritus and Founder of this website, Steve Hards. An editor’s guide to spotting AI writing by Alys Denby is published on her Substack/website, CapX. We are drowning in it, especially if you like to hang out on YouTube for airliner/ATC and history videos. Her guide is simple, easy to follow…and once you see it,  it’s hard to unsee. Key points she brings out:

  • Rhythm, e.g. too even paragraph length. What I call a certain monotony.
  • The overuse of short sentences
  • Repetitiveness
  • Too much passive tense
  • Ambivalent constructions
  • ‘Not this but this’ negative parallelism
  • Too many transitional phrases
  • A certain hollowness -‘banal generalizations’. I’d sum it up as the feeling that you’ve just read cotton candy.

Detection tools you can use: GPTZero, Pangram, and even Grammarly (paid). Just a few, not a recommendation. And yes, they are AI too. Kind of like white hat/black hat in cybersecurity.

Most of all, you can read and support authors who write their stuff in both news media and for your company. The use of AI for research is now common, but what’s essential is using the same critical review you’d use in any other research.

  • Use Real Human Writers for your company materials. Use real marketers for your planning who listen to sales and your customers. They can use AI to research, refine, and streamline production. Like any other tool.
  • Limit the amount of AI Slop Writing you use on social media. It’s filler. Cotton candy. It doesn’t present you well.
  • And use Real Graphics Designed by Real Graphic Designers.

And remember….even Pepper fainted from the stress! 

*Scylla and Charybdis are the mythological (?) monsters guarding the Strait of Messina between Sicily and Italy. Appropriate as my maternal ancestors were from that part of Sicily.

**Sir Patrick Duffy, Labour MP, Sheffield Attercliffe, Royal Navy veteran WWII, Brexiteer, RIP aged 105 in January. Had I but known.  Guardian obit