Chutes & Ladders: UnitedHealth’s sideways ’26, longtime exec Cianfrocco departs; CHAI’s concept failure and future; KeyCare’s $27M Series A

March 4, 2026 | by

Having put a strained 2025 in the rear view mirror, it’s time for UnitedHealth Group to drive on. 2026, as previously noted on the Day the Stock Cracked [TTA 29 Jan] will be the first year that UHG expects to report less, rather than increased, revenue to $439 billion. Yet their adjusted earnings per share (EPS) is projected to be over $17.75, versus $13.23 in 2025, a decline from 2024. This is all assuming, of course, that medical utilization further stabilizes from the ‘hangover’ of the pandemic and thus the medical loss ratio improves. See pages 5-6 of UHG’s 2025-6 report (PDF). Even with a hard Q4, UHG issued a stock dividend of $2.21 per share for Q4, to be paid on 17 March, making shareholders happy. BusinessWire release  UHG was also the most profitable payer at over $12 billion, twice as much as Cigna and Elevance. FierceHealthcare

Despite all that, what didn’t make UHG employees happy was that Bloomberg News reported from inside sources that employee ‌pay raises this year ‌would be a scant 0% to 2%, ​depending on performance. Moreover, their sources stated that an undisclosed number of employees would be laid off. Yahoo Finance  This shouldn’t be unexpected. Scuttlebutt on TheLayoff.com pinpoints layoffs to hit around 19 March and 30 April. (Mind you, it’s only rumor–yet social media such as this site and Reddit often predict correctly.) But in November-December 2025, layoffs came for dozens of employees in Optum healthcare technology and services marketing, working remotely on the East Coast and in the Midwest.  But never fear–an independent audit has found opportunities for improvements through ’23 action plans’ to be completed 100% by this March. Areas to be improved are policy governance and maintenance and many more. Fast Company

And sometimes, a 24 year run is enough. Last Friday, one of the leading women in healthcare, Heather Cianfrocco, announced her departure from UHG, effective in March. She had been promoted only last April or May (reports differ) to a very top parent company position, EVP of governance, compliance and information security. She had been head of Optum for a year, replaced by Patrick Conway, the CEO of Optum Rx. In 24 years in the UHG universe, Ms. Cianfrocco had held senior positions in UHG’s major divisions including Medicaid, Medicare and clinical strategy. She led Optum Health starting in 2020, moving to CEO of Optum Rx in 2021. Interestingly, she announced her departure via a post on LinkedIn. Notably, she did not say she was retiring. Perhaps a Ladder To Be Determined later?  Healthcare Dive, Becker’s Payer

Perhaps it’s time to start breaking up, selling off, and spinning off. We know what happened to other giant companies on their long and troubled road to failure and breakup. It can be caught in time, if the C-levels wake up.  Should free-falling UnitedHealth Group be broken up? Or break itself up to survive, before it becomes another GE?

Another Chute, but hardly surprising, is that the Coalition for Health AI (CHAI) never delivered on the promise of establishing a nationwide network of AI assurance labs. FierceHealthcare has an unusually long exploration of CHAI’s development, from its showy start in March 2024 (a scant two years ago) to its still showy but confusing present. It documents the now-admitted failure of the AI lab network, now described as a ‘mistake’ by CHAI’s head Brian Anderson, MD, but it is still attempting to define responsible AI and its use in healthcare.

Money is continuing to pour in from well-heeled partners such as health systems and revenue-sharing startups. It has also had a scattering of initiatives. FTA: an ecosystem of AI governance providers, AI model cards and an AI outcomes registry; announced working groups on generative AI, prior authorization, Medicaid work requirements and a faith-based approach to AI alongside the Vatican.  It now seems to be coalescing around a voice for healthcare providers about AI through partnering with the National Association of Community Health Clinics (NACHC) and the Joint Commission.

We briefly covered CHAI at its 2023 start and were skeptical that major player members such as Google wouldn’t use their lobbyist influence on CHAI to get their way on AI in its infancy [TTA 6 Dec 2023]. TTA later noted that two HHS members (at the time), Micky Tripathi and Troy Tazbaz, left the CHAI board despite their non-voting status, discovering they had conflicts of interest [TTA 11 July 2024]. CHAI’s been off our radar till this very long article, which should be reserved for lunch or a longish break. It’s not precisely bite-sized nor linear.

We have one Ladder on tap–KeyCare’s $27.4 million raise. It’s a second Series A (!) that adds to a $27 million Series A raised in 2022, bringing its total raise to $55 million. KeyCare is built on the leading EHR system, Epic, acting as an integrated virtual primary care extension partner for health systems. It is not only a 24/7 virtual care model with clinicians that provide urgent, preventive, chronic, and primary care, but also connects that care back to the patient’s home health system. The Chicago-based company states that it will invest further in AI-enabled technology, expand operational capacity to meet growing demand from health system partners, and continue scaling its platform to improve patient experience and provider efficiency, 

This round was led by HealthX Ventures with participation from previous investors 8VC, LRVHealth, BOLD Capital Partners, and Ikigai Venture Partners. Strategic partners listed are WellSpan Health, Allina Health, University of Chicago Ventures, Edge Ventures, and Exact Sciences. 

Breaking–Oracle Health loses five executives sent there to fix Cerner: report. And what is it telling us?

March 3, 2026 | by | 2 Comments

An interesting follow up on last month’s rampant speculation of an Oracle Health sale. Bloomberg News’ Brody Ford broke the news coursing through Reddit’s Oracle threads last week about the departure of two more Oracle Health executives, SVP Product Management for Clinical and Healthcare AI Suhas Uliyar and EVP of Health and AI Sanga Viswanathan. This follows on three earlier departures at the SVP level: Quais Taraki, general manager of Oracle Health and AI; Ofer Michael, cloud product development; and Max Romanenko, engineering for Oracle Health and AI. The departures of Messrs. Uliyar and Viswanathan have not been publicly disclosed by Oracle; the reporting is from internal sources. Oracle did not comment to Mr. Ford on these departures. Becker’s Hospital/Health IT

What they all had in common, according to Mr. Ford’s report, was that all five were long-time, senior leaders in Oracle’s cloud infrastructure areas, and had specifically been transferred to modernize the 2022 $28 billion bet to “transform healthcare” that was second-place EHR Cerner. Mr. Uliyar in fact had dual positions in Health and in the OCI cloud platform. Messrs. Taraki and Romanenko have since gone to EDB, a database software and AI company.

Mr. Ford’s article goes into greater detail, such as Larry Ellison, Oracle’s 81-year-old (but still quite active) CEO with a passion for longevity research, stating that Oracle had almost completely rewritten Cerner’s software code and had expanded into other hospital systems including accounting and HR. Read his post on LinkedIn. Article for Bloomberg subscribers here. 

Again, it is well known that Oracle purchased the antique EHR that was Cerner in order to sell other Oracle systems into the hospital and large healthcare system market, plus to increase its foothold into the Federal government through the VA and MHS EHR modernization contracts. Our Readers know how that has fared: MHS, with Leidos in a smaller system transitioning from AHLTA, has succeeded, while the far larger VA EHRM, transitioning from VistA, has struggled spectacularly. [TTA 8 Feb latest update]

Oracle’s success with health systems hasn’t been stellar. According to KLAS in a 21 August 2025 premium report (while your Editor was on leave), Oracle Health has lost 57 acute care customers since 2022, including 12 health systems with more than 1,000 beds. Other findings were equally unattractive. In other words, falling behind. From KLAS:

  • Oracle Health has made big promises but has not enhanced the customer experience.
  • Customers report that communication has been lacking and that the vendor partnership has declined.
  • Several large, well-known customers have left Oracle Health.
  • Clinical AI Agent has caught customers’ attention as the first among recently promised enhancement to be delivered.
  • Customers still have lingering questions about Oracle Health’s road map.

Quoted from Becker’s Health IT’s report:

  • About half of those interviewed told KLAS they would not buy the EHR again.
  • Customers cited improvements in code quality and were optimistic about Oracle Health’s Clinical AI Agent, which they say has reduced documentation time and allowed physicians to see more patients each day. Early adopters of the tool described it as a meaningful advance, though broader adoption is still in its early stages.
  • KLAS found mixed reactions to other new and updated products, such as Oracle Health’s revamped EHR and its patient accounting system, RevElate. Some leaders described these efforts as promising, while others expressed skepticism about their ability to address long-standing challenges.

Strictly anecdotal, but when this Editor attended last month’s HealthIMPACT, it was a given that Epic was the hospital system that was the standard, and Oracle Health had fallen away somewhere in the mists. It wasn’t a Hertz and Avis rivalry anymore.

So what does this scatter of tea leaves mean? Returning to Mr. Ford’s article, Oracle expects Oracle Health bookings and revenue to accelerate in 2026, based on a December earnings call.  Mike Sicilia, who is co-CEO, is the face on the calls, but from early 2024, Seema Verma has been general manager and EVP of Oracle Health, reporting to Mr. Sicilia–and has been notably quiet. Remaining in the mix is Oracle Health’s product development head, Oracle veteran TK Anand. One can imagine the pressure on both of them to sell the heck out of the updated EHR and associated systems, especially new ones such as documentation and accounting.

Fun fact: Mr. Ellison, co-founder of Oracle, remains its largest individual shareholder with about 40% of common stock, and his cash flow is dependent on Oracle dividends even though Oracle is ‘torching through cash’ to finance AI datacenters. $1.4 billion was paid in dividends at the end of January. Yahoo Finance

But ditching five senior managers, long time techs with deep knowledge of Oracle cloud and product development, either indicates that their ‘job is done’ — or something else. Why do rumors of layoffs persist when major problems with health systems cluster around communication and partnership? Why when the VA EHRM, which required tremendous fixes, where lack of communication and contacts were repeatedly cited in the VA’s OIG and Federal GAO reports, is about to go into rollout?

Is there a turnaround in the offing for Oracle Health?

Or has Larry Ellison’s focus moved towards AI and building out datacenters for OpenAI, Meta, and Nvidia?

Has Ellison tired of pouring more cash into a second-place EHR?  Has it served its purpose in getting healthcare data? Is Oracle Health, in parts or wholly, being leaned out in preparation for sale or spinoff to finance datacenters?   Stay tuned….

Chutes & Ladders: Amwell’s ’25 loss, ’26 hopes; Teladoc’s flat 2025; Walgreens and Cigna layoffs; telehealth stable at 7%; Humana CenterWell buys MaxHealth clinics; Honest Health raises $140M

February 27, 2026 | by

Chutes first…

Legacy telehealth continues to struggle to find its place–and profitability.

Amwell expects to turn the positive operating cash flow corner in 2026…maybe. American Well closed out its 2025 with total revenue of $249.3 million, about 2% lower than 2024. Subscriptions were $132.4 million (53%) with Amwell Medical Group (AMG) visits earning revenue of $94.3 million. Losses narrowed versus last year with a net loss of $95.0 million versus 2024’s $212.6 million, and adjusted EBITDA of ($39.9 million) versus prior year’s ($134.4 million). Another bit of good news is that 2025 closed without debt and $182 million in cash. Telehealth visits totaled 4.5 million.

Their Q4 2025 revenue took a hit–$55.3 million was down 22.1% versus prior year, attributed to lower revenue from their Defense Health Agency (DHA) contract. It started with partner Leidos in 2023 but was reduced last year in several areas due to DOD budget cutbacks.  Their 2025 EBITDA loss improved to $10.3 million with a net loss $25.2 million.

The narrower losses were attributed to consolidating products such as inpatient tools, a large hardware business. and a virtual psychiatric care offering into a single technology enabled care platform that consolidates virtual care and digital health programs, plus integrates third-party services.

2026 is another year of retrenching. Projections are: revenue in the $195 to $205 million range, about $50 million lower than 2025; AMG visits between 1.32 and 1.37 million, and adjusted EBITDA in the range of between ($24 million) to ($18 million). Amwell also is projecting that operating cash flow will go positive during Q4 2026. Key to this is that the annual DHA contract renews this summer. Amwell release, Healthcare Dive, Yahoo Finance

Teladoc is also struggling to grow in a chaotic market, but like Amwell is paring down and going for the cash flow. Revenue was essentially flat (down 2%) at $2.53 billion in 2025 from $2.57 billion in 2024. 2025 operating free cash flow was also down 2% to $166.9 million. Net loss was reduced to $200 million from last year’s $1 billion with adjusted EBITDA $281.1 million. BetterHelp, their behavioral telehealth unit, fell 9% year over year to $950.4 million in revenue. Teladoc ended the year with $781.1 million in cash and cash equivalents.

The 2026 revenue forecast is also flat in the $2.5 billion range with adjusted EBITDA in the $266 – $308 million range, and still in the loss column with a net loss per share between $1.10 and $0.70, which doesn’t make shareholders or analysts happy. Teladoc is moving from subscription models to to visit-based revenue in integrated care to compensate for enrollment reductions at some client health plans in government programs plus reductions in ACA subsidies. The BetterHelp behavioral health unit is looking at another revenue reduction of up to 7%. Teladoc release, Healthcare Dive

Layoffs continue at Walgreens and Cigna. 

  • Walgreens is laying off 628 employees in Illinois and Texas. These were tracked through WARN notices: 469 positions in Illinois, its home state, by 1 June, plus 159 jobs in Texas because a distribution center is being closed. Walgreens also confirmed to press that it will be closing dozens of stores in 2026. This was expected after last September’s acquisition by Sycamore Partners. And there is more to come. 1,200 stores will be closing over the existing three-year plan, with 500 shutting down in FY 2025. Fast Company, Healthcare Finance News, Healthcare Dive
  • Cigna is cutting 2,000 jobs globally by the end of February. It’s a not insubstantial 3% of its 73,500-person workforce, which is 90% in the US. Affected business units, roles, or geographies are unknown, though no WARN notices have been sent to the Connecticut Department of Labor, where Cigna’s HQ is located. Cigna is well in the black with $6 billion in profits in 2025 and a projected 2026 revenue of $280 billion. Membership stands at 18.1 million, down 5% from 2024, largely due to Cigna’s sale of its Medicare business, including Medicare Advantage and supplements, to Health Care Services Corporation’s (HCSC) HealthSpring unit. Cigna earnings report, Becker’s

What’s up on that ladder?

Telehealth use in primary care has stabilized since 2023 at about 6 to 7%, according to a study by Epic Research. (Yes, that Epic). The study from July 2022 to October 2025 showed the decline from 8% to today’s range. Two other findings were also interesting:

  • Telehealth has consistently remained more common among patients from metropolitan areas compared to those from more rural areas–the opposite of what one would assume.
  • Telehealth use varied substantially by preferred language; many non-English groups had much higher rates than the rates among English-speaking patients. The study tracked patients speaking primarily Chinese, Portuguese, Russian, Persian, and Spanish. Many of their rates are above 10%.

Epic’s data comes from its EHR in health systems representing more than 300 million patient records from 1,800 hospitals and more than 42,000 clinics from 50 US states, Canada, Lebanon, and Saudi Arabia. Healthcare Dive

FAIR Health, which takes a different sample of US commercial insurance claims, has also been steady for the past couple of years. In October and November 2025, telehealth visits accounted for 5% of claims, logically lower because of the methodology. Mental health related diagnoses account for 63% of telehealth visits, with 15.2 % urban and 7.7% rural, which corresponds to Epic’s findings. Primary care does not even register in their tracking.

Humana’s health services operating arm CenterWell acquired MaxHealth. MaxHealth is a West and South Florida-based primary care network  that provides care to 120,000 patients, with 80,000 patients in value-based care programs. The 82 owned and affiliated clinics consist of 54 owned primary care clinics, 4 owned specialty/ancillary clinics, and 24 downstream affiliate clinics. The purchase was from private equity firm Arsenal Capital Partners and the cost was not disclosed. MaxHealth clinics will join CenterWell Senior Primary Care. Release, Healthcare Dive

Honest Health raised $140 million. The unlettered capital raise for this value-based care enablement company was led by NewSpring Healthcare with participation from existing investors and institutional partners, including Rubicon Founders, Oak HC/FT, Welsh, Carson, Anderson & Stowe (WCAS), and Durable Capital Partners. Nashville-based Honest Health is physician-led and its CEO Rob Bessler MD is a physician entrepreneur who previously founded Sound Physicians. The new funds are intended for expansion into new markets, deepening partnerships with health systems, and improving technology-enabled care coordination. Release, Pulse 2.0

Veradigm won’t face SEC enforcement action, cuts 15% of staff, forecasts further retrenching for 2026 growth

February 26, 2026 | by

“Reset, Recover, and Reignite” is their plan forward. Veradigm, the former Allscripts, has since 2022 earned several adjectives, such as ‘tumultuous’, ‘troubled’, ‘problematic’, ‘puzzling’, and even ‘mysterious’. It’s now the fourth year since their failure to provide audited reports for 2022 due to financial software problems, an embarrassment for a software and once-leading health IT company. Then it was the same failures in reporting FY 2023, then 2024, with the final blow a delisting from Nasdaq two years ago on 29 February 2024. Despite being solvent, it couldn’t close a sale to one of three major bidders a year ago. This was topped by an SEC enforcement investigation and a July data breach. It was not until last March that Veradigm provided a 2022 financial report…still unaudited.

Some good news arrived last week. The Securities and Exchange Commission (SEC) informed Veradigm that the investigation, pending since January 2024, has been concluded. The SEC does not intend to recommend an enforcement action based on the available information. Former CEO Richard Poulton and former CFO Leah Jones, both of whom resigned in December 2023, received similar letters, according to the filing. Veradigm SEC Form 8-K. Healthcare Dive

The current CEO, Donald Trigg, who’s remained in place since September, held an update call last week. The highlights of the call were reported in both Healthcare Dive (25 Feb and 19 Feb) and HIStalk on Monday.

  • Veradigm will next release its annual reports for 2023 and 2024 in a Super 10-K, which is a single annual report that includes data that would have been included in overdue previous reports. The plan is to be current on its filings this year and apply to relist on Nasdaq shortly thereafter. Interim CFO Lee Westerfield called this “a major event”.
  • There was no mention of a timetable for filing 2025 results. The preliminary 2025 results show flat revenue and a significant decline in cash due to debt financing and share repurchases: revenue between $584 million and $589 million, down 1% at the mid-point of estimates for the previous year.
  • The company’s overall strategy is to reset its business strategy, recover its market position with independent physician practices, and increase profitable growth. According to CEO Trigg, Veradigm will focus on market impact and growth. CEO Trigg stated on the call that Veradigm was previously run as “a holding company as opposed to an operating company”; presumably, it is now the latter.
  • 15% of the company’s workforce was cut last year.
  • They will discontinue six unnamed low-revenue products.
  • Their Chicago headquarters office will close by mid-2027. It closed three unnamed locations in 2025 and will close two more in 2026. There are two operating hubs: Pune, India, and Raleigh, North Carolina.

To be continued….   TTA’s back file on Veradigm here.

Hollywood Ending, Part Deux: Joe Kiani goes on from Masimo as tech CEO plus board chair of three companies

February 26, 2026 | by

Cue the swelling music from Max Steiner, or a modern score from George Antheil. Joe Kiani, the former CEO/founder of Masimo, has moved on from his booting (with extreme prejudice, one can say) from that company after 35 years in September 2024. He has resurfaced in the press after the Masimo sale to medical device/services giant Danaher last week [TTA 18 Feb]. So what has this 61-year-old serial entrepreneur and investor, too young by his own admission to retire and enjoy his money, been up to since? Plenty!

The Forbes article this Editor is digging into is a quick PR-ish skim. The first paragraph accepts his story that he resigned from Masimo after the proxy loss, but a simple crosscheck would have disclosed a more complicated “I quit. No, you’re fired” situation, which is explained below from our coverage at the time. Mr. Kiani has clearly moved on from Masimo with new interests both inside and outside of healthcare. The article briefly touches on his new life, but as usual, we dig a bit further.

  • He is executive chairman of Willow Labs. Willow has developed app-based metabolic coaching for diabetes and healthy living, via app-driven Nutu Nudges. Interestingly, looking at the Willow website, Joe Kiani founded it in 1998, nine years after Masimo as a spinout. Its impressive base of 127 patented technologies include those licensed from Masimo, such as the Masimo Rainbow Signal Extraction Technology® (SET). Like Masimo, Willow is located in Irvine, but at the University of California campus. It was renamed from Cercacor in 2024. Joe Kiani bio on Willow.  Orange County Business Journal
  • His other major gig is as CEO of Like Minded Labs, a media technology company based out of Santa Monica. Cofounded by Joe Kiani, its main product is Coresee, a video conferencing platform that can stream to thousands of viewers at a speed up to 4K at 60 fps. He became CEO in July 2025. Bob Chapek, a former Masimo director and short-lived CEO of the Walt Disney Company, also joined the board then. Release

The article alludes to his other investments in 10 companies. Mr. Kiani joined the board of Clairity as board chairman in January. Clairity is a medtech company with an FDA de novo authorized AI platform, Clairity Breast, that predicts a woman’s five-year risk of developing breast cancer from mammogram imaging. The Boston-based company provided its first patient with a risk score earlier this week. Release.  His other board chairman position, announced this past Monday, is with SMSbiotech, based out of San Diego. SMSbiotech is developing adult stem cell technologies for safe, affordable, and ethically grounded regenerative medicine initially targeting COPD. MassDevice

CEO of one company, board chairman of three. You wonder where he will find the time! Cue the music, end credits!

A look back at the stock dispute. After the proxy fight loss, Joe Kiani resigned as Masimo CEO on 19 September 2024, but Masimo formally put him on immediate leave then terminated him for cause on 24 October 2024. ‘For cause’ is germane because it affects post-departure stock options and grants that would boost his undisputed 7.5% common stock holding (4.1 million shares) to 13.2% or approximately an additional 3.2 million shares. (More details based on Ted Green’s Strata-gee deep dive–TTA 30 Apr 2025) This is now being fought in the courts. At the buyout price of $180/share, the undisputed shares amount to $735.4 million, considerably more than Forbes‘ estimate of $500 million, unless he sold shares since 2024. The disputed shares amount to $580.8 million. Not precisely chump change.

UnitedHealth Group’s CEO Hemsley held investments in competitive companies: WSJ

February 19, 2026 | by

Now this is rich, in many senses of the word. UHG’s current CEO and chair, Stephen Hemsley, through his investment company, holds stakes in companies competitive with UnitedHealth’s broad scope of healthcare businesses. Mr. Hemsley founded Cloverfields Capital Group LP in 2019, while he was chairman of UHG’s board but no longer CEO, which ended in 2017. According to the Wall Street Journal report, Cloverfields not only cloaked investments through affiliated entities in several early-stage healthcare companies: Claritas, Monogram Health, Nexben, and Solera Health–but also did not disclose Mr. Hemsley’s role in written communications nor in public announcements. 

There’s nothing unusual here, as board members have other businesses or work elsewhere, and investment groups routinely form acquisition entities. What is unusual is that Mr. Hemsley never disclosed these interests as part of UnitedHealth’s disclosures for board members, nor, when reassuming the CEO position last May after Sir Andrew Witty’s resignation. For instance, Humana discloses board chairman Kurt Hilzinger’s role at Court Square, a private-equity firm that invests in healthcare companies. Court Square lists the names of the healthcare companies in which it has invested.

UnitedHealth’s statement to the WSJ is interesting indeed. FTA:

In response to questions from the Journal, UnitedHealth said Cloverfields is a family office as well as an investment adviser, and that Hemsley “maintains a diversified portfolio of public and private investments, some of which are in the health care sector.” In the “vast majority” of cases, the company said, he owns 5% or less of these healthcare companies, and he doesn’t have a controlling interest in any of them.

After Hemsley resumed his CEO role last May, the company said, he “transferred all his personal ownership interests in health care-related companies to a newly established trust” and recused himself from corporate decisions related to those interests. It said Hemsley is prohibited from participating in decisions made by the trust’s independent trustees, which “aligns with established models for avoiding potential conflicts of interest.”

UnitedHealth hasn’t publicly disclosed anything about the private healthcare investments tied to Hemsley, or about the trust. It didn’t respond to a request to share trust documents or a question about whether the trust is “blind,” which would prevent Hemsley from knowing which assets were being bought or sold. (Editor’s emphasis)

[later]

“Mr. Hemsley continues to comply fully with UnitedHealth Group’s conflict of interest and trading policies, as well as all applicable SEC and other regulatory requirements,” UnitedHealth said in the statement.

UHG is, as expected, pedaling very quickly to cover the non-disclosure of Mr. Hemsley’s interests as board chair. But the fact that Cloverfields is not an independent investment entity but acts as a family office makes this worse, not better. “Vast majority” of cases below 5%–what is above 5%? 

UHG is also in the VC business through Optum Ventures, which has invested in 60+ small healthcare companies between 2018 through 2025. This is another conflict. 

It didn’t start with Cloverfields. Mr. Hemsley invested $10 million for a 1.6% stake in the Center for Autism and Related Disorders (CARD). Despite the name, it is a for-profit company and at that time was owned by Blackstone. It provides autism therapy through clinics,  modeled on Applied Behavior Analysis (ABA). UnitedHealth in 2017, while he was CEO, extended commercial coverage of autism services and still does business with CARD. The company filed for Chapter 11 bankruptcy reorganization in June 2023 and now is privately owned by the founder and her business partner.

Conclusion: The answer is obvious–that every Cloverfields healthcare investment in which Mr. Hemsley or his family/office have an interest should be 1) fully disclosed, and 2) placed in a blind trust until he is no longer CEO and board chairman. Then he can do as he pleases. Not only this Editor’s opinion, but a legal one included in the WSJ article.

Even more of an argument for breaking up UnitedHealth Group. This Editor’s take and two others. A payer should not be a ‘black box’ that no one really understands or manages. Wasn’t Change Healthcare a hard enough lesson?

Also Becker’s

Rock Health’s sunnier 2025: up 35% due to AI, but a tale of ‘have and have nots’

February 19, 2026 | by

Rock Health’s 2025 digital health roundup, published in January, was upbeat–as usual, and in no way Hemingwayan. Their calculation of US digital health fundings was up 35% versus 2024, rising to $14.2 billion from 2024’s $10.5 billion. This was a higher number and a stark contrast to Silicon Valley Bank’s (SVB) tracking of US and EU healthtech investments as a 1) lower number and 2) flat 5%, growing from 2024’s $13.2 billion to $13.9 billion [TTA 14 Jan].

Let’s do some unpacking:

  • The number of digital health deals went down from 509 to 482, a decline of 5.3%.
  • In terms of current dollars, 2025’s funding of $14.2 billion was, as projected, a snap back to 2020’s $14.4 billion, as 2024 was to 2019. In constant/inflation-adjusted dollars, applying a cumulative inflation of 25%, 2025 is well under 2020 but better than 2019; 2020’s $14.4 billion then is equivalent to $18.3 billion today.
  • Where Rock Health and SVB agree is the ‘barbell’ profile of what gets funded.  
    • Mega funds like General Catalyst and Andreessen Horowitz (a16z) do mega deals: 26 mega deals and 15 newly-minted unicorns (up from six last year), for a funding average by these two in D+ of $266 million, versus Series A of $24.1 million. 
    • The funding also skews towards “AI-enabled” companies and secondarily, wellness
    • Something that made this Editor go ‘hmmm…’:Rock Health’s usual analysis of letter deals across all funders is, unusually, missing in their 2025 report. The only comparison made is from GC and a16z, two mega funders. Inadvertently, Rock Health has drawn a bright line on the contraction of venture and private equity funders not only in available funds, but in sheer numbers. Discussed here intermittently, especially in the context of SVB’s failure and rescue, but at more length here in this 2023 commentary.
  • What they have picked up that SVB didn’t was the continuing significant number of unlabeled, non-letter financings–35% of deals, but down from 44% in 2023. Before 2021, unlabeled financings were fairly rare and in single digits.
  • The other significant pickup was that over 600 companies they track have not raised anything since 2021-2022. That could be a sign of health–that they are profitable and operating successfully on their cash flow–or barely staggering through and cannot get financing. 
  • M&A revived in 2025 with 195 deals in 2025, up 61% from 2024’s crater. Digital health companies were the majority acquirers (66%) with private equity at 10%. Rock Health attributes this to ‘tapestry weaving’ (creating more continuous solutions to flesh out platforms), legacy acquisitions by AI companies (a/k/a smush togethers, something New Mountain Capital excels at), and ‘acqui-hires’ to get top talent and tech.
    • They note of NMC: “Now, they’re weaving the largest “M&A tapestry” in digital health thus far: Matt Holt, NMC’s former managing director and president of private equity, is reportedly leaving to combine five NMC portfolio companies into a $30B holding company called Thoreau.”, a $30 billion deal broken out in a graphic. The five companies are Datavant, Swoop, Machinify, Smarter Technologies (itself a combine of SmarterDx, Thoughtful.ai, and Access Healthcare in RCM), and OfficeAlly. Whether this pending move (December) will actually work or turn into a petite version of Change Healthcare, we can only surmise.
  • IPOs haven’t really revived in digital health. Rock Health counts five IPOs in 2025, but only two are really digital health, Hinge Health and Omada Health, same as 2024. Both were at relatively flat valuations. The other three are more legitimately classified as biotech–Heartflow, Carlsmed, and Profusa. IPOs may improve in 2026, with Doc.com’s filing for a Nasdaq listing earlier this month and Devoted Health now at a post-F financing.
  • There is zero here about bankruptcies and reorganizations. No reference to the utter implosion of 23andMe and its shocking sale back to founder/CEO Anne Wojcicki.

The impact of ACCESS and ELEVATE. There is also a good graphic analysis of two CMS models that may support digital health more comprehensively than previous value-based care models such as ACO shared savings. The first CMMI model, ACCESS, will be debuting in July and is a 10 year voluntary payment model for Original Medicare outcomes in chronic care management. It reduces barriers for digital health to profitably work with CMS because it offers direct patient enrollment and waiving copays. The other from CMS is ELEVATE, launching in September, which funds up to 30 proposals with $100 million over three years to raise health and prevention for Original Medicare beneficiaries.

Rock Health’s 2025 wrapup

2026 remains Anyone’s Guess. It feels better…but….

Editor’s Note: Our Readers know that this Editor considers Rock Health a bit of a cheerleader for Sand Road. They play both sides of the fence as a venture fund/accelerator. There’s nothing wrong in that. SVB, like other financial institutions, funds a broad swath of healthcare and makes no bones about it. That is why their analysis, which also included EU and a bit of Asia, made its broader and tarter take on 2025 even more interesting.

What’s missing is year-to-year consistency in Rock Health’s analyses, notably what digital health sectors were funded and the Series letter breakdown across all funders.

Hollywood Ending: Masimo patient monitoring selling to Danaher for $9.9B, will be standalone operating company

February 18, 2026 | by

The long Masimo drama has a Hollywood Ending, at least for shareholders. The sale announced on Tuesday 17 February is a rich one–$180 per share, cash. (Masimo was trading in the ~$130/share range last week, making this a close to 40% boost.). Both boards have approved the transaction, expected to close in H2 2026. At that time, Irvine California-based Masimo, which specializes in pulse oximetry and patient monitoring devices, will operate as a standalone company within Danaher’s Diagnostics segment along with Radiometer (blood analysis), Leica Biosystems, Cepheid, and Beckman Coulter Diagnostics. Danaher, based in Washington, DC, has not made any transitional management announcements. It is subject to the usual regulatory review and a formal Masimo shareholder vote. 

For those who like to run the numbers, Danaher claims it is paying “18x estimated 2027 EBITDA, or 15x 2027 estimated EBITDA including the full benefit of expected annual synergies. Masimo is expected to generate EBITDA of more than $530 million in 2027.” It is being financed with cash on hand and debt financing–no share payouts or contingencies. It expands the Danaher Diagnostics portfolio into pulse oximetry. Still, it came as a surprise to industry analysts such as JP Morgan and puts it up against industry giant Medtronic, according to Reuters.

Masimo had considered other partners prior to Danaher, but apparently kept it well under wraps. This ends a roller coaster ride that started in 2022, and included a Bad Buy, patent infringement lawsuits, topped by a messy proxy fight. A guide to what transpired:

  • A not-quite-all-there diversion into consumer health monitoring devices including watches. Masimo extended their patents into devices, which could be broadly understood, but then initiated a flurry of legal actions against Apple. Consumer health, interestingly, was then used to justify the Sound United buy.
  • Founder/now-former CEO Joe Kiani then diverted into consumer audio with Sound United, at a cost of over $1 billion. Sound United was a catchall of major higher-end brands such as Polk and Denon. Shareholders revolted, cracking Masimo’s market cap by roughly $5 billion. The mistake was corrected last year with a sale to Samsung’s HARMON division for $350 million, a loss of over 60%. [TTA 7 May 2025]
  • Joe Kiani’s closely-held management of the company and board was soon challenged by activist investor Politan Capital. The proxy fight in September 2024 wasn’t even close, with the Kiani director slate losing big with shareholders. Kiani, a friend to former president Biden, was booted out of his 35-year directorship and CEO spot before the election and tied up with legal actions.
  • Late last April, their websites and systems for manufacturing and operations were brought down with a major cyberattack. With great irony, it struck right at the time of the annual shareholder meeting. Weeks later, their websites for both US and Canada were still disorganized.
  • The court battles continue. In the Federal Central Court of California, Masimo’s suit was approved to proceed before Labor Day 2025. This charged ’empty voting’ conspiracy and collusion between Kiani and shareholder RTW Investments in the proxy fight. Apparently Masimo earlier dropped the charges against Kiani but the court upheld them. MPO  Other lawsuits by Kiani center on his severance package and dismissal. The SEC in late 2024 announced an investigation of RTW’s involvment in the ’empty voting’ scheme, but as of today there is no update on its status.
  • Last November, Masimo scored a solid win in Federal Court when a jury awarded them $634 million of Apple’s money, The infringment was made by features in the Apple Watch’s workout mode and heart rate notifications. Of course, Apple plans to appeal based on the 2022 patent expiry. There is also a separate International Trade Commission (ITC) action banning Apple from importing the Apple Watch 9 and Ultra 2. For Masimo, an additional insult upon injury is that Masimo also accused Apple of hiring away key employees. Reuters

For Politan, known as a ‘take no prisoners’ activist investor, this is a major success–to take over, turn around a troubled company in approximately two years, and sell it profitably to a large company like Danaher. Danaher also buys it with Politan firmly in control, happy shareholders, and nearly all the soap opera wrapped up or due to soon. Masimo CEO Katie Szyman has a track record of smoothly transitioning smaller companies to larger ones, for instance her previous two companies, Edwards Lifesciences to BD. Masimo’s chair, Michelle Brennan, is retired from a senior global management post at J&J. Not bad for a year’s work. TTA 22 Jan 2025

This is quite unlike the rolling troubles Politan Capital has at its other big healthcare investment, Centene.

MedTech Dive. Danaher release. TTA’s back file on Masimo, starting in 2023, is here. 

News bites: Amazon Pharmacy’s same-day delivery zooms, One Medical’s lab results app, OpenEvidence’s valuation shock, NYU Langone-Isaac Health, HealthMark buys Purview, Harbor Health buys Rippl, big raises for Solace Health, Talkiatry

February 13, 2026 | by

Amazon Pharmacy growing same-day prescription delivery to 6,500 cities and towns by end of 2026. This adds nearly 2,000 locations. Amazon currently delivers to all 50 states and DC with either same day or next day delivery. Same day is adding locations in two new states, Idaho and Massachusetts. The release rather amusingly lists the horses they use on Mackinac Island, Michigan (no cars or e-anything), e-bikes in Manhattan, EVs in the suburbs, and One Medical kiosks in Los Angeles, which debuted last October. Amazon also touted their savings outside of insurance, an item much in the news with TrumpRx.com–up to 80% on generic medications and 40% on brand-name medications through Prime Rx at no additional cost. What does this mean for telehealth competition? A drop in stock price for Teladoc, Hims & Hers (added to by a GLP-1 pill patent infringement suit by Novo Nordisk), and battered Doximity (Doximity Dialer). Yahoo Finance, TechCrunch  

Amazon’s clinic network, One Medical, premiers a ‘beta feature’ that analyzes personal lab results. The Health Insights feature, developed in partnership with Lifeforce, is on the Lab Results tab. After answering a questionnaire, the patient can see an AI-generated:

  • Personalized wellness score based on their biomarker profile
  • Detailed analysis of individual biomarkers categorized by health domain
  • Evidence-based lifestyle recommendations around nutrition, physical activity, stress management, and sleep
  • Scientific references supporting each recommendation

This Editor noted that One Medical is gradually transitioning to an Amazon identity and logotype. Release

Shocked, shocked at OpenEvidence’s $12 billion valuation? According to Katie Adams in MedCityNews, mais non. We noted at the end of January, when OpenEvidence collected $250 million in a Series D, that it was this year’s “hot number”. Certainly it’s “IT” with the docs as a reference source, claiming daily average usage by 40% of US doctors in 10,000 hospitals and medical centers. More than 757,000 clinicians use their free search engine trained on journals and clinical medical data only, coupled with an AI chatbot agent. It does a job that Doximity, Epocrates, and Medscape aren’t doing. It also dispenses with going through organizations as it permits direct signup. Pharma likes the model and votes with its shrinking dollars, giving OpenEvidence a $100 million revenue run rate. So do investors, who’ve socked $700 million into the company since 2021. There’s nothing like being the ‘up and comer’, as was said on a recent analyst call this Editor was on.

Isaac Health partners with NYU Langone for virtual dementia care. The NYC-based health system, with a strong base in neurology and brain health, seeks to reduce the time for a referral and testing for cognitive impairments. With Isaac, the patient is scheduled quickly, usually within a week, for a virtual consult. Isaac is integrated with NYU Langone’s systems to combine virtual with in-person care. If the patient is not comfortable with technology or the visit, a trained helper can be sent to the home to help manage the virtual visit. Isaac release,  MedCityNews

M&A and raises, in contrast to 2025, remain busy

HealthMark Group buys Purview. Purview’s cloud-based systems provide quick access to ingestion, analysis and sharing of medical imaging data, providing access to imaging records quickly. HealthMark Group is a provider of clinical information exchange solutions for healthcare providers. Acquisition cost was not disclosed, but Annapolis MD based Purview is listed as having less than 10 employees on Crunchbase with no funding listed, while HealthMark Group was refinanced last July by TA Associates private equity, retaining an interest from Ridgemont Equity Partners.   Release, 

Austin, Texas-based Harbor Health is acquiring dementia care platform Rippl. Harbor Health combines a clinic network in Texas with health plans. Most of the clinics are in Austin with expansion to El Paso, San Antonio, and Dallas via last year’s acquisition of 32 VillageMD clinics [TTA 9 October 2025]. Rippl’s platform is designed to support care at home for those with dementia via early detection of physical and behavioral issues. Rippl is also obtaining additional financing from seven investors including General Catalyst and Google Ventures. Acquisition cost was not disclosed. Harbor Health release

And to close, two hefty later-stage raises:

  • Solace Health notched a surprising $130 million Series C. It provides healthcare navigation via advocates for patients requiring guidance on a new diagnosis, needing referrals, understanding insurance coverage, and care coordination. Costs are covered by Medicare, most Medicare Advantage plans and some health insurance carriers. The round was led by IVP, with participation from Menlo Ventures, SignalFire, Torch Capital, Inspired Capital and RiverPark Ventures. This topped last year’s $60 million Series B for a total $211 million financing since 2021. Valuation entered unicorn territory of over $1 billion. MedCityNews, Mobihealthnews 
  • Talkiatry raised $210 million in a Series D, but presently no plans for an IPO. Their total financing now tops $400 million. Talkiatry was an early entrant (2019) in virtual psychiatry and therapy, and employs over 800 psychiatrists and 300 therapists, delivering 3 million patient visits to date. Another asset is that it is in-network with over 100 payers. The round was led by Perceptive Advisors with four other participants. MedCityNews

Must Read: an excellent analysis on Carbon Health’s bankruptcy–and the Ominous Parallels

February 12, 2026 | by

Carbon Health isn’t an outlier. It’s part of a trend that founders and senior managers must beware. This Editor didn’t know much about Carbon Health when news of its bankruptcy made the news [TTA 7 Feb]. It was of interest because of its telehealth roots and its growth into a current combination of bricks-and-mortar primary care with telehealth. The liabilities were king sized but the way out they chose was unusual, a combination of a sale and a reorganization.

In context and by comparison, Carbon Health follows a path of inevitable failure trod by two other companies, Olive AI and IBM Watson Health. 2022, an ‘in the money’ year for some, was the finis year for all these companies.

  • Olive AI started to fall apart in late 2022, was closed or parted out a year later, and was a classic case of a company that was overfunded, all over the healthcare map, and finally ran out of time and money. (It was also funded heavily by General Catalyst, another red flag.)
  • IBM Watson Health was originally a company that everyone wanted to like with playing chess on Jeopardy. As it grew, it became less lovable and, just like Olive AI, started to pursue multiple lines of business without a solid track record on their main lines as it gobbled up smaller companies. It started to go sideways as early as 2020, it repeatedly failed in high profile pilots with major healthcare organizations, parts were sold off, then the remainder sold by IBM by July 2022. Most of it still does business as Merative, maintaining a very low profile.
  • Carbon started to fail in 2022 as the pandemic tide receded, their overextension was revealed, and their growth plans collapsed; despite buckets of cash extended by CVS and other investors, it was well on the road to bankruptcy. Their creation of and practice dependence on a proprietary EHR in retrospect was mind-boggling.

Get the cuppa and settle in. Stuart Miller of Haverin Consulting, writing on Substack (free article), draws the Ominous Parallels among the three companies first on a seven-point comparison grid: peak valuation (always inflated), core promise (always 35,000 feet), growth strategy (always hyper), strategic overreach (always too complex), technology gap (always aggravated by overreach), demand dependency (always a fadeaway), and outcome (inevitably, failure). He then illustrates what your company should avoid. What are the lessons smart founders and funders should be minding? If you’re a potential partner, investor, or a board member, what are the yellow and red flags? The deal breakers? The simple questions the company should be able to answer?

The subscriber version goes into far greater detail and is recommended if you have earnest money or your future at stake in digital health companies.

So why is there a ‘100% Written by a human’ flag in the header?

February 11, 2026 | by

And why is it even necessary? If you are a wide consumer of online media, including LinkedIn (oy!), all too many articles and videos are either AI-generated or heavily edited by AI. It’s not just grammar and spelling cleanup anymore (tools which this Editor happily uses, along with her own rolling edits). It has little to do with em versus en dashes or the stringing together of clichés in a Perfectly Processed Article.

TTA, whether written by your Editor Donna, Editor Emeritus Steve, or a guest post, is not written by AI. And we won’t be. (My 6 month layoff should be proof therein!). No AI slop here whether generative or agentic, except as In The News.

Steve Hards put it very well some years back. From the sidebar:

Telecare Aware’s editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.

We don’t cover everything and don’t plan to. This perhaps makes us far less marketable than some of our sources, which don’t deviate much from the press releases or the packaged interviews because it pumps up the volume with only a few people writing. Yes, just like Joe Friday on Dragnet (=UK, Jack Regan on The Sweeney who was about 50x rougher than Joe at his worst), we start with just the facts, a/k/a the 5 Ws: who, what, when, where, and why. Sometimes that’s all that’s needed or wanted. But usually, there’s more to the story. I then fill out the background and then opine on What This All Means and why it’s interesting. And yes, we are opinionated, especially when there are broken promises, fraud, or lies, which I no lika.

In increasingly processed and reprocessed media, this Editor (Donna) wants to acknowledge the exceptions. They dive deep and make some major machers (Yiddish for ‘big shot’ or ‘movers and shakers’) uncomfortable. #1 in afflicting the comfortable–Sergei Polevikov. His Substack ‘AI Health Uncut’ goes where no one else does and is so jammed with facts/original research it is often a hard read. It’s linked on the sidebar and yes, requires a moderate subscription fee. #2 to me is MedCityNews‘ EIC Arundhati Parmar, with an honorable mention to Katie Adams. (See this Must Read from last February)

AI content has its place, but not here. For better or worse, irredeemably, Written 100% by a Human. For our Readers, thanks for staying with us especially after last year’s long hiatus. And thank you, Legrand, for continuing to advertise. (Your company can too.)

Do you want to try out writing for something like this? Contact Editor Donna.

(Editor’s Final Thoughts: Two handy guides to spotting (or fixing when you must) AI-generated content: Optimizely and in plain sales-oriented language, Troy Harrison’s blog.)

Chutes and Ladders w/o 9 Feb: Biofourmis’ ex-CEO faces 7 major Singapore fraud charges (updated), Doximity’s 17% drop; Devoted Health’s big $366M raise, Garner Health garners $118M, Synthpop’s $15M Series A

February 11, 2026 | by

Chutes go first…

The worst kind of Chute to go down is one that lands in a coal-scuttle full of fraud and criminal charges–in a country known for its punishments. Biofourmis’ former CEO is facing seven counts in Singapore. Rajput Kuldeep Singh, one of the founders and former CEO, has been charged in Singapore with three counts of abetting the falsification of accounts, three charges of fraud by false representation or abetment thereof, and one charge of forgery for the purpose of cheating. These are connected to the Singaporean company, Biofourmis Holdings Pte Ltd., between 2021 and 2022. Headquarters moved to Boston after its Series B in 2019.

Mr. Rajput (surname is first) is accused of falsely invoicing US$16.5 million to Singapore’s Ministry of Health (MOH), and later false representations such as inflated revenue figures, falsified financial statements, a misrepresentation on payment by the MOH, and subsequently a forged employee stock option plan offer letter. This was purportedly intended to deceive DBS Bank into transferring funds from the bank.

The penalties are high in a country that canes offenders for spitting on the sidewalk. The Singapore Police Force announced the charges in a 3 Feb release. Each fraud charge against Mr. Rajput carries a maximum 20 years plus a fine. Falsifying accounts and forgery max out at 10 years plus a fine. Even if convicted of one charge, Mr. Rajput is looking at perhaps a decade of time in a Singapore prison–on multiple charges, perhaps the rest of his adult life. Mr. Rajput is a 34-year-old Indian national. Presently, he is out on bail of S$600,000 (US$475,000) and through his legal representation Eugene Thuraisingam Asia, indicated in court on Feb 4 that he intends to claim trial. Singaporean law moves fast–the pre-trial scheduled to start on 1 April. The Online Citizen (Singapore) Here’s the original article in the Straits Times.

Update on extradition: Should Mr. Rajput remove himself to the US and try to evade extradition, his attorneys will tell him that it may be futile, but will string out things. Extradition is covered by a foundational 1931 bilateral treaty that originated with the UK (as Singapore was a colony then) and has been honored since with modifications and expansions (e.g. the Extradition Act of 1968 and Amendments 2022). The mechanism is straightforward. A request has to be made by the Singapore ministry for law and subsequently heard in a US Federal court. The charges must be valid under existing bilateral laws and meet the requirement that the charges carry a sentence of 2 years+. The extradition back to Singapore must then be approved by the Secretary of State. Fraud, embezzlement, and the taking of money under false pretenses are all covered. Singapore is also an active cooperator with the US whereas many countries with treaties are not. Another complicating factor is that Mr. Rajput is an Indian national and may hold multiple passports.

What about Biofourmis? It merged in October 2024 with CopilotIQ, a smaller RPM/nursing company in home health that took over Biofourmis’ business in in-home delivery of complex care for health systems, payers, and pharmaceutical companies. It was announced by CopilotIQ. This oddity didn’t square with other financial reporting indicating that Biofourmis was the acquiring party, yet was reasonable considering that CopilotIQ’s CEO and his management were running the combined company. Yet Biofourmis was a much larger company, a unicorn with over $400 million acquired in 10 rounds of financing.  Another oddity: Mr. Rajput transferred his 96.6 million shares (!!) in Biofourmis to 19 existing investors immediately prior to the merger, according to filings with ACRA, Singapore’s Accounting and Corporate Regulatory Authority. Today, the single company runs as two separate brands. In 2024, Mr. Rajput returned to Singapore (and Boston) to found a new company, OutcomesAI, an AI-enabled nurse assistant and voice agent which raised $10 million last October. To be continued….

Doximity, a/k/a LinkedIn for doctors plus virtual visit capability, took a 17% crack on Friday after a wild overnight ride. This is despite the company clocking a decent Q4 2025 beating analysts’ revenue expectations. Sales were up 9.8% versus Q4 2024 to $185.1 million. EBITDA guidance for 2025 is in line at $356 million at the midpoint. What was the problem? Q1 2026. The company guidance is $143.5 million at midpoint, which is below analyst estimates of $151.3 million. It doesn’t seem like much, but the volatility indicates that Doximity has growing competition for the 80% of US doctors who are members. Epocrates and Medscape have for years been the main competition for partner dollars, but the new kid on the block, OpenEvidence, which just clocked a healthy Series D for its medical info search engine, is putting all three in the shade. The pie is also shrinking. Pharma companies are overall spending less and Doximity is spending more on a suite of new tools: DocsGPT, Doximity Dialer, and Doximity Scribe. Share price has stayed flat since Friday. Considering it once traded over $80…. Yahoo Finance, TIKR

Now for the Ladders…climbing them with a ‘barbell’…

Devoted Health raked in $366 million of Series F and post-F funding. This insurtech survivor, a combination of Medicare Advantage (MA) plans with in-house telehealth and in-home care, raised a split Series F: $48 million in November 2025 and at the end of January a Series F-Prime of $317 million. These very late rounds are rare in this constrained funding market. Both were led by long time investor The Space Between (TSB) [TTA 3 Jan 2024], in partnership with Centricus, a London-based global investment firm. This Editor counted 18 additional investors, which is a tell–even when you’re “redefining how healthcare is experienced and delivered” and they are 466,000 members strong, up 121 percent and across 29 states, with 98% of members in 4+ Star plans, they had to knock on a lot of doors for the raise. This raise is also about half of what it would have been in the 2020-22 Silly Money days. One wonders if an IPO is next. Devoted Health release

Garner Health’s latest raise is a $118 million Series D today (Tuesday). The employer-focused provider of health data analytics incentives to guide employees to the best-performing doctors in the employer’s existing health plans now has a total raise of $200 million and a valuation topping $1.3 million. The round was led by Kleiner Perkins with participation from Redpoint, Maverick, Kaiser Permanente Ventures, Mercy, Plus Capital, and other existing investors. Garner is claiming revenue increasing over 130% versus their prior year. Release

On the other end of the barbell, Cambridge MA-based Synthpop (not a music genre) had an early raise of $15 million that closed last week. The new Series A brought their total funding to $23 million. It was led by Ansa Capital, with Defy.vc and Peterson Ventures participating in the round with Storm Ventures and strategic investor Bruce Broussard. Marco DeMeireles, co‑founder and managing partner at Ansa Capital will be joining Synthpop’s board. Synthpop uses AI processes to coordinate document intelligence, payer-aware reasoning, and conversational voice agents to automate up to 80% of healthcare business processes, integrating directly with EHR, billing, and e-prescribe platforms. It was founded in 2023 by CEO Elad Ferber and CTO Jan Jannink, PhD, who have considerable previous founder experience. Release

What’s happening now with the VA on the Oracle EHRM rollout?

February 8, 2026 | by

Planning for April–but are the problems that derailed it three years ago solved? The US Department of Veterans Affairs is still stoutly maintaining an April start date for resumption of its EHR Modernization (EHRM) rollout. In last week’s updated schedule issued by the EHR Modernization Integration Office (EHRM-IO), the new strategy is to keep the rollouts within a fairly tight geographic area in the same VA region, or in VA-speak, VISN, and roll out every two months. Thus the first four systems are VISN 10 in Michigan: Detroit, Saginaw, Ann Arbor, and Battle Creek (system) in April. Two months later in June, an additional four in VISN 10 will roll out: Dayton Ohio, Chillicothe Ohio, Cincinnati, and Cincinnati-Fort Thomas Kentucky. Another three in VISN 10 will start in August and the last two for the year, Louis Stokes-Cleveland in VISN 10 and Alaska (Anchorage) in VISN 20, will be started in October.

And the reservations are… At the end of January, the VA’s Office of Inspector General in their FY 2025 report on VA’s Management and Performance Challenges detailed five major challenges in the agency. While healthcare services was #1, that section concentrated on staffing and community care delivery coordination, touching on the veteran scheduling/appointment problems that are part of the EHRM, including the Veterans Self-Scheduling (VSS) process.

Most of the EHRM discussion was in #4, information systems and innovation. The VA was scored on using existing systems and incorporating emerging technologies to manage veterans’ medical records, benefits determinations, financial disclosures, and education documents. EHRM and its major performance incidents were detailed first, along with Caseflow (claims and appeals) lacking an enterprise governance structure. The system failures also affected patient care, with clinicians being unaware of critically important patient data and communication breakdowns between VA and community care providers leading to delayed diagnoses and treatment. The OIG also noted a background of decades old cybersecurity and data-integrity problems, with critical vulnerabilities that allowed staff bypass of security protections that left about 3.3 million veterans’ records unencrypted at one facility. In implementing the OIG’s recommendations on the EHRM: 

Regarding VA’s ongoing electronic health records overhaul, VA strengthened the contractor agreement by enhancing performance credit clauses (provisions that establish financial penalties if the contractor fails to meet performance standards) and tighter incident metrics. It created limited real-time system dashboards to help monitor performance at sites going live with the system. However, there remain 32 OIG recommendations that are not fully implemented as VA resumes system deployments. (Editor’s emphasis)

The original ten-year Cerner agreement to replace the venerable but non-interoperable VistA eight years ago (May 2018) was a $10 billion contract, later revised to over $16 billion. After the failures of four years ago, it was rewritten at the five-year point in 2023 to, frankly, bring Oracle Cerner to heel. The 2020 and 2022 implementations were disastrous: Mann-Grandstaff (VISN 20) in October 2020 and four more in 2022. The only 2024 implementation was joint with the DOD Military Health System at the Lovell Federal Health Care Center in Chicago, which went relatively smoothly. A year ago, continuing the rollout looked questionable [TTA 26 Feb 2025]. Now VA has committed to a timeline for 13 health systems/centers this year. Not accomplishing it, and smoothly, will be a bottle of black ink all over VA–and Oracle.

Further complicating matters is Oracle Health’s uncertain status. Will it be cashed out to build AI Datacenters? It depends on an uncertain funding environment and the generosity of banks. And doesn’t relieve the new owner of this Federal contract. [TTA 5 Feb]

Chutes & Ladders this week: Carbon Health’s Ch. 11; Centene’s 2-way beat, TrumpRx.com debuts; Doc.com files for $24M Nasdaq listing, $55M for Alaffia Health, big Series Ds for Midi Health and ElevenLabs

February 7, 2026 | by

One busy week in the game! Chutes first…

Primary care/telehealth provider Carbon Health filed for Chapter 11 dual-track bankruptcy reorganization. San Francisco-based Carbon filed on Tuesday 2 February a pre-packaged Chapter 11. The unusual dual track refers to a simultaneous sale of the company and a court-supervised restructuring backed by up to $19.5M in debtor-in-possession (DIP) financing. The DIP financing, via Future Solutions Investments, is currently approved up to $9 million. DIP financing ensures that operations continue and that employees and vendors are paid.

The bankruptcy was filed in the US Bankruptcy Court for the Southern District of Texas, with liabilities estimated between $100 million and $500 million. According to the company release, “the Chapter 11 plan is premised on a debt-for-equity exchange, and a post-petition marketing and sale process for all or a portion of the Company’s assets.” At this point, there is no projected date for emergence out of bankruptcy.

Carbon started as an app-based telehealth provider in 2015 in SF and now has 93 affiliated primary and urgent care clinics across eight states from California to New Jersey. It is structured as a management services organization (MSO) with a proprietary technology stack to support patient telehealth and the clinics. The company attributes the shortfalls and need for reorganization to post-Covid demand changes and a tight capital market for healthcare. (Editor’s note: operating primary care practices through a MSO model, where you make money selling services, is certainly interesting but presents many hurdles to consistent profit. I’ll cite my experience working for an MSO engaged with Medicare payment model ACOs and IPAs.)

It’s been a tough market for provider groups even when financing was easy, as VillageMD’s difficulties with Walgreens have demonstrated. Primary care provision to patients is too sporadic and competitive to allow for mistakes. Then when consistency and depth are needed, chronic care management becomes all about risk management. Not care. Beckers, FierceHealthcare, ElevenFlo

Between a Chute and a Ladder…

Centene’s horrible 2025 closed with a Q4 net loss of $1.1 billion, but a better forecast for 2026. The Q4 compared to a net profit of $283 million in FY 2024. A major factor was that the health benefits ratio (HBR) of 94.3% for Q4 2025 was sharply up from 89.6% in Q4 2024, as well as expenses relating to rising No Surprises Act billing disputes. The ladder was that the revenue topline of $49.7 billion, up 22% versus prior year, reportedly beat Wall Street expectations as did the full year.

For 2026, CEO Sarah London and CFO Drew Asher are promising a more stable ride. Medicaid profitability has improved plus year-over-year growth with breakeven in the Medicare Advantage market. This rosy outlook contrasts with UnitedHealth Group, Molina Healthcare, and Elevance, and has led to more questions by analysts about its validity.

A crotchety Mr. Market didn’t like the news today (Friday) and whipped the stock down 4% to $38. A year ago, CNC traded above $66. Centene’s primary markets are Medicaid, Medicare and the ACA. They continue to shrink non-core businesses, announcing that it is divesting the remainder of Magellan Health it still holds, resulting in an impairment of $513 million, or $389 million after-tax. (Disclosure: this Editor worked for a company Centene bought and holds CNC stock) Financial release, Healthcare Finance News, Healthcare Dive

On to the Ladders…

TrumpRx.com online site debuts. This provides some relief on pricing for 40 heavily prescribed and expensive drugs from five pharmaceutical manufacturers: AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer. The pricing is ‘most favored nation’ (MFN) which means it is in line with the lowest paid by other developed nations. According to the White House release that outlines availability, “Depending on the manufacturer of a given drug, patients with valid prescriptions will be able to access savings through user-friendly coupons that can be printed or downloaded onto their phones or through channels set up by the manufacturer and integrated into TrumpRx.gov.” In return, the manufacturers are exempted for three years from pharmaceutical tariffs. Many of these drugs are already available at reduced prices through the drug companies’ DTC outlets, such as Zepbound and Wegovy. While for those in commercial plans or Medicare Part D there may not be much difference in pricing, the trend here is that manufacturers continue to unabashedly create outlets for drugs that bypass the beleaguered PBMs.  Healthcare Dive

It was also a Big Week for a future IPO and company financings.

Mexican telehealth Doc.com files for Nasdaq listing. Their filing is for 3 million shares of its Class A common stock priced at $8, for a total value of $24 million. (SEC Form 1-A) The stock will list under DOCC. Doc.com is a little different in claiming to use both blockchain to secure transactions and AI for workflows and operations to provide telehealth services that connect underserved markets with doctors, nurse-practitioners, psychologists, mental health specialists, and even veterinarians. It’s currently offered in Latin America and the US (as of last year), headquartered in NYC. Current financing is $300.7 million raised in January 2024 from Silver Rock Group private equity, and a $700,000 debt financing. (Crunchbase).  2025 annual report, Mobihealthnews

Alaffia Health scores a $55 million Series B. Lead investor was Transformation Capital with participation from previous investors including FirstMark Capital, Tau Ventures, and Twine Ventures. Their total raise is $73 million. Alaffia has developed agentic AI for health plan claims operations. The AI tools offered scale clinical review capacity for health plans and evaluate claims against the complete patient medical record, for a claimed 20%+ average savings on high-cost facility claims and 5x+ ROI for leading health plans. The fresh financing will be used for the usual R&D, developing additional agentic AI, and growth. Alaffia release, MedCityNews

Midi Health is a new unicorn, closing a $100 million Series D financing and a valuation over $1 billion. Even more unusual, it’s another strong raise for a women’s health company, this one in telehealth for women in perimenopause and menopause. Last week, Pomelo Care raised a $92 million Series C to move from the maternity segment into menopause and older women’s health. The Series D was led by Goodwater Capital with participation from new investors Foresite Capital and Serena Ventures, as well as continued support from Advance Venture Partners, GV (Google Ventures), Emerson Collective, SemperVirens, and McKesson Ventures.  MedCityNews

ElevenLabs closed its own Series D at $500 million, topping $781 million in funds for its generative AI in text-to-speech and an $11 billion valuation. Its scope is apparently near-universal for developers and companies in multiple industries. For healthcare systems, it has platforms for private practitioners and clinics that provide HIPAA-compliant, intelligent voice agents that triage, route urgent calls and respond to patients. The agents can sync with EHR and HIS systems as well as nurse-call and messaging systems. It can also update records, log triage outcomes and book appointments automatically integrated with EHRs. The fresh financing will assist in their international expansion and ElevenAgents, its enterprise platform for voice and conversational AI. Mobihealthnews, ElevenLabs release

Summing up the speculation: will Oracle sell off Oracle Health/Cerner to finance $300B OpenAI datacenter buildout?

February 5, 2026 | by

Even Oracle can’t get all the money it wants for AI. The speculation has been building since late last week, kicked off by a report from financial analyst TD Cowen that percolated through financial media first. It centers on the five-year, $300 billion contract Oracle has with OpenAI (ChatGPT) that requires extraordinary financing to fulfill. According to the report (not publicly available), the capital expenditure needed is estimated at $156 billion to build or lease datacenters. To raise this, TD Cowen projects that the former Cerner, now Oracle Health, would have to be sold, as well as a potential cut of 20-30,000 jobs, about 10-15% or more of the current workforce, saving $8 billion to $10 billion in cash flow.

Why doesn’t Oracle go to the markets and banks, hold out the cup to finance this capital expenditure, and let them fill it? US lenders are apparently growing shy on lending for more AI datacenters, while Asian lenders are willing to lend funds albeit at premium rates. In TD Cowen’s analysis, Oracle is having great trouble financing this massive buildout. Investor nervousness shows in Oracle’s credit default swap (CDS) spreads tripling, as well as pressure on their stocks and bonds.

Let’s look at some factors why across several reports:

  • Oracle’s already raised $58 billion in the past two months: $38 billion for facilities in Texas and Wisconsin, and $20 billion for New Mexico. 
  • Since September, lenders have doubled their interest rates on these Oracle projects to near non-investment grade levels.
  • Oracle’s credit default swap (CDS) spreads have tripled,
  • Private datacenter operators can’t get financing, so Oracle can’t fill the gap with leases, even though a few months ago Oracle was able to lease 5.2GW of US data-center capacity across Texas, Wisconsin, Michigan, and New Mexico specifically for OpenAI.
  • On top of OpenAI, Oracle is also building datacenters for Meta and Nvidia in a $523 billion total commitment

Oracle is tightening the purse strings to reduce capital needs. They now require for new customers 40% upfront on building infrastructure. Another strategy being explored: requiring customers to buy their own hardware in BYOC (bring your own chip) arrangements which moves that expense off Oracle’s books and onto the customer’s. 

It appears to this Editor that Oracle is caught in a squeeze play. If the company doesn’t build the datacenters, it risks falling behind its massive strategy to dominate the AI datacenter business. Yet the price of this is to abandon its massive investment in healthcare, a linchpin strategy, and the customers there. And there are Federal consequences: the completely incomplete VA implementation scheduled to resume this year and the complete, but still in progress, Department of Defense system.

Let’s look at what the effect may be on Oracle Health. Oracle bought Cerner back in December 2021 for $28.3 billion–after Cerner’s troubles with the VA EHR implementation and in the midst of the Department of Defense rollout. Oracle now is a fading number 2 in health system EHR implementations. It was all Epic, all the time for the health systems attending HealthIMPACT, the conference this Editor attended over the past two days. If Oracle Health is sold, it represents a major strategic reversal for Oracle and personally for CEO Larry Ellison. Both have pumped and promoted changing healthcare through data and systems integration for the past five years. Perhaps Oracle and Ellison have gotten the data “milk” they want and will sell the ‘cow’ now that Old Bossy is not in great shape. Can the ‘cow’ on the block even get the $28 billion paid for it?

Sell, but to whom? Microsoft is the most probable since it is massively integrated into healthcare in multiple systems. The other two under speculation are Google and Amazon. What they have in common are recent and money-losing experiences with healthcare, closing down and selling various ventures. Google Health was shut down and scattered to the winds in August 2021, and Alphabet’s Verily, pivoting like  Nureyev over a decade, is now a ‘precision health’ entity. Amazon, in the midst of layoffs, has done well with Pharmacy, but One Medical. bought during the 2022 Practice Gold Rush, remains a lump of undigested matter in Amazon’s e-commerce digestive tract. Their agita with integrations such as with kiosks for Pharmacy [TTA 9 Oct 2025] and with Prime deserve Pepto-Bismol. Unlikely: any health insurer, for both cash and regulatory reasons. Spinoff? That won’t raise cash.  To be continued….

Sources for this article: CIO, The Register, and Fred Pennic at HIT Consultant, who broke it in the health tech press.

A short and personal remembrance of Challenger, 40 years ago

January 29, 2026 | by | 2 Comments

On another blog, the writer (a Gen Xer) invited reminiscences of where we were when we learned that Challenger exploded, the loss of the astronauts, and ultimately how we dealt with the discovery that NASA was not infallible in allowing a manned shuttle to launch when it provably should not have. 28 January 1986. Many X-ers posted their early memories, as well as those of us who were Boomers, working and in the adult world, including those who had ties to NASA, Morton Thiokol (the O rings), Lockheed, and other NASA vendors. Ultimately, Challenger had a great effect on us. This article is adapted from my comment there.

On that date, this Editor was nowhere near healthcare. She was in the airline business in advertising. New York Air was a a post-deregulation airline, largely forgotten today, headquartered at LaGuardia Airport NYC. Despite being red in color, it, the people, and her time there remains evergreen in memory.

On that day, we had a small crisis to deal with that had links to Challenger. Permit this short indulgence and diversion, if you would like to read on. (more…)