Connecting JPM and CES dots: Babylon Health tripling revenue in ’22 to $1 billion–how? And Bosch tiptoes back into healthcare.

January 19, 2022 | by

Dig for dots with your Editor….Babylon Health used their JPM forum last week to announce that with some US agreements signed, they expect by the end of this month to top $80 million per month, closing in on $1 billion this year, based on signing US value-based care agreements. The US agreements add an estimated 88,000 organic new members, bringing global managed lives to over 440,000. The $1 billion in revenue is nearly triple their 2021 preliminary closing revenue of $321 million. Interestingly, the US agreements were not specified in the release.

Does this tie in with the Higi acquisition [TTA 7 Jan], or are there others? Looking back on the Higi buy, we see one of the investors coming over from Higi is Glen Tullman, CEO of Transcarent and Managing Partner of VC 7wireVentures. His comments about Babylon in that release glow:

“Babylon’s innovative value and risk sharing models fit well with market leaders and innovators, including Transcarent, because they believe that, with the appropriate use of technology, data science, and good old-fashioned clinical care, you can impact the member satisfaction and quality of care, while, at the same time, reducing costs. This is the formula everyone has been searching for and the combination of Higi and Babylon bring us all one step closer.”

Higi is not large enough (though they claim ‘millions’) to boost Babylon’s revenues into the stratosphere, but some of Transcarent’s business very well might.

  • Transcarent earlier acquired BridgeHealth, a surgical and value-based benefits provider claiming 1 million members.
  • In October, Transcarent inked an agreement with Walmart to provide services for self-insured employers linking them to Walmart’s, including drug prescriptions.
  • Transcarent is on a funding roll of its own, with its own announcement at JPM in landing a $200 million Series C.

We’ll see if this Editor’s dots connect correctly….

Remember Bosch and health tech? Bosch was one of the ur-companies in remote patient monitoring with Health Hero/Health Buddy plus other telehealth/telecare businesses. Once upon an early 2010s time, they were a major supplier to VA Home Telehealth along with Viterion, Cardiocom, and Medtronic. After multiple setbacks, rounded up by TTA here, they exited European telehealth/telecare in January 2015 and shuttered Health Buddy six months later. So it’s déjà vu all over again to see Bosch technology used in a three-way project with Highmark Health in Pennsylvania and their Pediatric Institute of Allegheny Health Network (AHN) in Pittsburgh. AHN will be using Bosch’s SoundSee sensor-based tech to capture patient breathing audio that is then analyzed via Bosch’s proprietary AI and machine learning to detect pediatric pulmonary conditions. Clinical studies at AHN will be starting this quarter. Bosch’s Intelligent IoT group responsible for SoundSee is located at Bosch Research in Pittsburgh. Bosch has patented SoundSee for multiple applications in industrial and healthcare monitoring. Release, FierceHealthcare

Buried in the release is Bosch’s other step back into health tech. Vivatmo me, a breath-gas analyzer device that allows patients to accurately determine levels of inflammation, documenting them via an app–a very interesting concept–has been commercially available from March 2020 in Germany and Austria. It may be introduced in the US.

The Theranos Trials, ch. 1: Holmes sentencing to be 26 September, three mistrial charges dropped, appeal dates set

January 15, 2022 | by

Yesterday, Elizabeth Holmes’ next few months were outlined for her.

Her sentencing for the four charges on which she was convicted [TTA 4 Jan] will be 26 September by the trial judge, Judge Edward Davila. The delay in sentencing due to the ‘ongoing proceeding’ of the Sunny Balwani trial (scheduled to start 15 March) was revealed in a joint filing by the prosecution and Holmes’ defense. The filing confirmed that the prosecution would file a motion today (Friday) to dismiss the three deadlocked charges and that she will remain out of custody on a $500,000 bond secured by personal property, increased by request of the prosecution.

Judge Davila also set a deadline of 4 March for filing post-trial motions he will hear, such as an appeal by Holmes’ defense, with the hearing set for 16 June.  Fox News, Yahoo!News

Meanwhile, the Silicon Valley Home Town Newspaper, the Mercury News, waxed on how difficult life will be for Holmes’ baby after her incarceration, even in a minimum-security Federal prison (colloquially known as Club Fed). It is highly unlikely that she will face the extreme hardships of women facing hard time, imprisoned thousands of miles away from their families, or losing their children to foster care because there are no family caregivers. The Federal Bureau of Prisons tries to place low-risk prisoners like her within 500 miles of home. There is visitation time. Also cushioning this is Holmes’ own family and an affluent partner, Billy Evans, who has stayed by her side. Reportedly, they live with their son at a home rented on an estate in an affluent San Jose suburb, Woodside. But after the appeals (and money) are exhausted, the long sentence will likely be served, and then will come the tough part for the child growing up without a mother. 

Short takes: rounding up revenue and acquisition action during JPM

January 14, 2022 | by

The  JP Morgan conference (JPM), which wrapped on Thursday, is traditionally a major venue for healthcare announcements, from revenue to staff to investments. Having never attended but harboring a secret desire to observe (as a poor churchmouse on the wall–no fly am I) the 1% doing their thing, this Editor cannot imagine how boring it must be in virtual format. 

Here are a few highlights: the important, kind of interesting, and not too tedious.

  • Teladoc projects full-year 2021 revenue to hit $2.03 billion, nearly doubling its 2020 revenue. 2022’s projection is about $2.6 billion. It’s revenue without profitability, however. Teladoc lost $84.3 million Q3 2021, which more than doubled its PY $36 million loss. As we noted in our earlier article, Teladoc, like every other telehealth company, saw its shares plummet in 2021 as patients returned to offices and telehealth claims plunged to 4%, mostly for behavioral health. FierceHealthcare
  • Transcarent, Glen Tullman of Livongo’s ‘encore’ company, has landed a $200 million Series C and is now valued at $1.62 billion. Transcarent’s market is self-insured employers and provides a care management model focusing on personalized health and care support for employees. Kinnevik and Human Capital led investors and were joined by Ally Bridge Group, General Catalyst, 7wireVentures, and health systems Northwell Health, Intermountain Healthcare, and Rush University Medical Center. Release
  • Boston-based Medically Home, which supplies hospital-to-home support and integrates technology services, nabbed a $110 million venture round from investors Baxter International Inc., Global Medical Response, Cardinal Health, Mayo Clinic, and Kaiser Permanente. To date, they have worked with 7,000 patients. Release 
  • DexCare, a platform-as-a-service (PaaS) that ‘orchestrates’ digital demand and health system capacity, closed a $50 million Series B funding led by Transformation Capital, with participation from Kaiser Permanente, Providence Ventures, Mass General Brigham, Define Ventures, Frist Cressey Ventures, and SpringRock Ventures. Release
  • Mental health/meditation app provider Headspace Health acquired startup Sayana to build out AI capabilities in mental health and wellness. Its self-care app leverages chat-based sessions with an AI persona. Terms were not disclosed, but Sayana CEO/founder Sergey Fayfer will join Headspace in a product leader role. Headspace acquired rival Ginger back in August [TTA 27 Aug]. FierceHealthcare, release
  • Rival Talkspace is also facing a shareholder lawsuit on securities fraud after going public in a $1.4 billion SPAC deal. According to FierceHealthcare, the charges filed 7 January center on non-disclosure in their financials of critical growth headwinds, including increased advertising and customer acquisition costs and worsening growth and gross margin trends. They also overvalued its accounts receivable from certain health plan clients. Coupled with management turmoil–their president/COO resigned after a ‘conduct’ problem at an offsite event–their share price has plummeted over 80%. Their projection of full-year 2021 revenue was cut to $112 million from $125 million. Talkspace, of course, has said the suit is meritless.
  • Aledade, well known to this Editor as an organizer of accountable care organizations (ACOs) and a management services organization (MSO) for physician groups in value-based care, bought Iris Healthcare. Iris provides advance care and palliative care planning for health plans and providers for seriously ill and high-risk patients via its network of 1,000 independent primary care practices and health centers. It will be folded into their new Aledade Care Solutions unit. FierceHealthcare, release

US/EU 2021 healthcare VC funding soared 65%, but health tech performance slumped 28%–and 2022 surprises

January 14, 2022 | by

This isn’t the usual Rock Health report of puppies and unicorns. Silicon Valley Bank is a source new to this Editor, but even in topline, the report is pretty bracing. Their coverage is broad and detailed–biopharma, health tech, dx (diagnostic)/tools, and device–on US and European venture capital (VC) funding from 2019 to 2021. There are some warning flags for the health tech sector through their report (summary page; report available for free download here).

What you’d expect: total health care soared in 2021 to over $86 billion–a 65% increase over 2020 (not 30%!). This was led by biopharma at $36.3 billion, then health tech at $28.2 billion. Dx/tools and devices had far more modest funding gains. 

For health tech: 

  • Funding was up 157% versus 2020–42 new ‘unicorns’, four times 2020
  • Provider operations companies comprised a record 35% of total seed/series A funding, up from 20% in 2020. The other hot areas were clinical trial enablement and alternative care. Surprisingly, healthcare navigation was next to last, perhaps indicating that these companies are further along in maturity.
  • Investors were numerous, but high frequency investors were Tiger Global, Andreesen Horowitz, General Catalyst, Casdin, and Gaingels.
  • SPACs slowed in 2021, trying to find the right match before their two-year window to complete a merger and reflecting greater SEC scrutiny of blank checks. Of those who ‘de-SPAC’ed in 2021, Talkspace and Owlet led in market losses, 80% and 73% respectively.
  • Post-IPO performance dropped 28%, led by insurtechs Oscar, Bright Health, and Alignment Health
  • There were 122 M&A deals. The $63 million median value was down 25% from 2020. marking a shift to vertical integrations in care continuums or horizontal to capture consumer bases.

2022 The Year of M&A and Acquire-to-Hire? The end of the report sounds a cautionary note to health tech ‘bulls’. Expect “massive” consolidation. Healthy investment will continue, but the opportunities will be for companies seeking expand product offerings, expand to other markets, or acquire to hire talent (!)–the latter something quite new.

Also FierceHealthcare

Connected care keeps expanding: Stryker acquiring Vocera Communications for $3B, Baxter’s close of Hillrom sale for $12.5B

January 12, 2022 | by

Medical device companies that have grown into or acquired tech and analytics are now buying into communications systems to connect it all. Massive medical/surgical/orthopedic device company Stryker is acquiring clinical communications/coordination workflow systems Vocera Communications for a snappy $2.97 billion. The deal is for $79.25 per share and is expected to close in this quarter. Vocera is expected to expand Stryker’s Advanced Digital Healthcare and connect devices and digital communications both for clinical caregivers and with families. Vocera is considered to be an innovator in communications systems that connect clinical and operational systems, and is presently in 2,300 medical facilities internationally. No management transitions were disclosed. Release.

Hillrom, another device company mainly in cardiac and hospital monitoring which last year had broadened its remote patient monitoring and connected care portfolio, was in turn acquired by medtech giant Baxter International last month. Hillrom had acquired Bardy Diagnostics and EarlySense about a year ago [TTA 4 Feb 21], and in 2019 Voalte Communications, directly competitive with Vocera. In 2015, Hillrom bought Welch Allyn which boosted it into digital health from primarily hospital furniture. The purchase price closed at $10.5 billion and including Hillrom’s outstanding debt obligations, the acquisition in total was $12.5 billion. From Baxter’s release, the “legacy” Hillrom and Welch Allyn brands will be introduced into international markets and integrated into Baxter’s technologies. The lack of mention of Hillrom, the ‘legacy’ references, and no mention of Hillrom management transitions in the release, is a sure sign that the brand will be sunsetted very quickly, along with its management team. Medtech Dive. Also a snappy tip o’ the cap to HISTalk.

What’s next for telehealth in the (almost) aftermath–and rating the US states on policies

January 8, 2022 | by

crystal-ballWhat’s in that cloudy crystal ball?  Last year, especially the first half, saw telehealth acquisitions, stock prices and valuations hit the roof. The roof proved to be high but sturdy, as they bounced right back down, not unexpectedly. 

But gee whiz, Fast Company’s article seems to be shocked, shocked at all this, calling it a bubble. This Editor sincerely doubts that any investor that tracked telehealth over the last 10 years would have NOT expected this ride on the rollercoaster after the urgent care and practice offices reopened starting in mid-2020 and worked slowly through 2021. The rebound, as with health insurance payers, took a few months to work through into 2021. Telehealth usage in 2021 receded steadily to single digits, and at last report to just above 4% of claims as of October 2021 (FAIR Health US claims data).  What remains is the continued dominance of mental health–62% for mental health codes. It’s turned out that Babylon Health‘s SPAC was the last of the major action for 2021, getting in under the wire in October. 

It’s obvious that investors will be more realistic in assessing telehealth companies, looking at the areas that sustained telehealth usage, such as behavioral health. Another surprising niche is LGBTQ telehealth–Grand Rounds’ buy of Included Health in May, which then led to the entire company, including Doctor on Demand, adopting the name [TTA 20 Oct].

The other move that telehealth companies are making is to take more of the patient than a few virtual visits. They’ve moved into offering primary care teams to patients in employer plans (Babylon360 and Teladoc’s Primary360). Amazon Care moved into in-home health and clinics with Crossover Health. Amwell acquired SilverCloud for expanding behavioral health capabilities internationally, and stuck a toe into care management with their Converge platform and acquiring startup Conversa‘s health coaching app. The flip side is retail health migrating into in-person and virtual primary care–CVS Health and Walgreens, via VillageMD.

What also held telehealth back for over a decade of less than 1% was reimbursement by Medicare, Medicaid, and private insurers. The pandemic broke through that barrier. While it has narrowed considerably, CMS will still reimburse audio-only telehealth for behavioral health services, addiction treatment, and in-home health visits. State policies on telehealth practices can positively influence telehealth growth for patients and physicians. Free-market organizations Reason Foundation, Cicero Institute, and the Pioneer Institute have reported on all 50 on several policy metrics: 

  • In-person requirements
  • Modality neutral (asynchronous or synchronous, technology including audio, video, store and forward, and remote patient monitoring.)
  • No state barriers
  • All providers can use telehealth
  • Independent practice (including nurse-practitioners)
  • No coverage or payment mandates
  • Cross-state compacts

Rating the States on Telehealth Best Practices

Short takes: 2022’s big kickoff with Babylon-Higi, Vera-Castlight buys; will funding slow down in ’22, eye-tracking telehealth for MS, vital signs tracking lightbulbs at CES 2022, and three catchups!

January 7, 2022 | by

Babylon Health closed out 2021 by acquiring health kiosk Higi for an undisclosed amount. Babylon had earlier invested in Higi’s Series B [TTA 30 May 20] and was reported in October to be exercising its $30 million option to buy Higi after closing their SPAC. Release

Vera Whole Health, an advanced primary care provider and clinic group based in Seattle, is acquiring Castlight Health, a data and care navigation platform. Vera will acquire Castlight in a $370 million all-cash deal. Strategic partners and investors include Anthem, Morgan Health (the JP Morgan Chase & Co business for the transformation of employee healthcare), Central Ohio Primary Care, and Clayton, Dubilier & Rice funds. Former Aetna chairman and CEO Ron Williams will become chairman. Release.

Which leads to the usual question…will funding in 2022 continue the hot streak of 2021? It’s one opinion, but Lee Shapiro of 7wireVentures, formerly with Livongo, is sensing a slowdown, citing increased interest rates (money), the US midterm elections (which don’t affect the rest of the world), less new money, and investors wising up on the length of time any healthcare or health tech investment takes to pay off. 2021 with 79 digital health M&As plus an abundance of SPACs that tailed off by end of year will be hard to match. Mobihealthnews

XRHealth, a telehealth clinic that provides treatments in patients’ homes based on virtual reality treatment, has integrated Tobii‘s eye-tracking technology into the XR platform and the Pico Neo 3 Pro Eye VR headset. XR Health provides rehabilitative and pain management therapies via VR. The Tobii system will enable treatment using the headset for multiple sclerosis (MS), Parkinson’s, and other neurological conditions. According to the release published in Multiple Sclerosis News Today, “detecting subtle changes in eye movement can help diagnose these diseases at an early stage, as well as assess disease progression and response to treatment. Tobii‘s eye-tracking technology is able to detect those changes in real time, providing data and insights to clinicians during therapy sessions.” Hat tip to Editor Emeritus Steve Hards

CES 2022 is on this week, far less splashy than before as an in-person/virtual hybrid event. Debuting at CES is the Sengled Smart Health Monitoring Light. Looking like a standard LED lamp bulb, it contains sensors that network and can take passive vital signs measurements of sleep quality, breathing, heart rate, and motion of occupants in the home. The more bulbs the better, of course. Whether or not they can detect falls, as the article touts, is likely an inference on motion. They feed into either Alexa or Google Assistant, plus Sengled’s app, using Frequency-Modulated Continuous Wave (FMCW) radar operating in the 2.4 GHz range. Expect it to be coming out towards the end of the year and probably twice the price of conventional LED smart bulbs. TechRadar Hat tip to Adrian Scaife via LinkedIn

Catching up…

Walgreens and VillageMD continue on the ‘go big or go home’ highway with nine more Village Medicals at Walgreens in San Antonio, Texas. Plans are to build 600 Village Medicals at Walgreens in more than 30 markets by 2025, growing to 1,000 by 2027. HealthcareFinance

Centene, the health payer conglomerate, finalized its $2.2 billion acquisition of Magellan Health, a major behavioral health management company. It will likely be CEO Michael Neidorff’s swan song, as an activist investor forced his retirement (at age 78 after over 25 years at the helm) this year and significant board changes. Magellan’s former COO and president Jim Murray will become Centene’s chief transformation officer, a new position, lead what they term the Value Creation Office as well as the Centene Advanced Behavioral Health division. Forbes, Centene release

And suitors with a spare billion or so may be lining up to buy IBM Watson Health. The first offers came in on 4 January with the winner to be announced possibly by end of the month. IBM spent over $4 billion over time to build up Watson Health, but now wants out, badly. Axios

The Trial of Elizabeth Holmes, ch. 17: looking inside the juror decision process

January 7, 2022 | by

How does a juror–and jury–process multiple counts, witnesses, a defendant, and an avalanche of information without drowning? ABC News interviewed Juror #6, Wayne Kaatz, an actor, voice talent, and scriptwriter. We rarely get a glimpse inside the jury box of a high-profile case. It’s well described, which isn’t surprising given that Mr. Kaatz is a writer, mostly for children’s programs. In short, “working class” show biz.

  • They grappled with the ultimately deadlocked three charges–and felt they had failed (Ch. 16)
  • Early on, they discarded the charges involving patients, considering Elizabeth Holmes ‘one step removed’ from them
  • They scored witnesses’ testimonies and Holmes on a 1-4 scale, from not credible to most credible. Adam Rosendorff, the lab director that the defense went after hard, scored a four. Holmes–a two.
  • They were sympathetic towards Holmes, finding her “likable”, with a “positive dream”. 
  • The decision to find her guilty on the four fraud counts centered on her “final approval” and that she “owned everything”.  

About the process, they selected a younger man as their foreman from the eight men and four women. They shared initial verdicts on paper scraps and laid out information on a timeline. The jurors got along well over the months-long trial culminating in 50+ hours of deliberation, working on puzzles and swapping sandwiches. 

Mr. Kaatz closed his thoughts: “It was an honor. It was a duty, I did it. I’m done.” Little drama, not ‘Law and Order’ or ‘Twelve Angry Men’. ABC News–and do read the interesting comments, but only halfway through before it devolves into hair-pulling on a wholly different event.

The Wall Street Journal’s follow-up (paywalled text, but audio is not) focuses on Juror #8 (Susanna Stefanek) finding the “smoking guns” as the altered pharmaceutical “endorsements”, singling out Pfizer’s, and the fictional financial projections.

Vox goes into Holmes as Hollywood will be seeing her, with Hulu and Apple treatments teeing up. The NY Times goes on about Holmes being a product of Silicon Valley culture–the puffery, the one-upmanship, and believing their own press releases. But for now, we can give it a rest…till Sunny Balwani’s trial starts.

Breaking–The Trial of Elizabeth Holmes, ch. 16: guilty on four charges of 11

January 4, 2022 | by

Breaking. Elizabeth Holmes, founder and CEO of Theranos, was found guilty on four charges of wire fraud of the 11 charges brought by the prosecution. The guilty charges are, according to the reports in the New York Times and the Mercury News (paywalled, but keep refreshing), all related to wire fraud against investors. Counts six through eight are fraud against specific investors. The TTA articles relating to each are linked.

  1. Count one of conspiring to commit wire fraud against investors in Theranos between 2010 and 2015
  2. Count six of wire fraud in connection with a wire transfer of $38,336,632 on or about Feb. 6, 2014. This was part of the $96 million PFM Health Sciences investment detailed in Chapter 9.
  3. Count seven of wire fraud in connection with a wire transfer of $99,999,984 on or about Oct. 31, 2014. This was the DeVos family trust investment (RDV Corp.) in Chapter 5.
  4. Count eight of wire fraud in connection with a wire transfer of $5,999,997 on or about Oct. 31, 2014, made by Daniel Mosley, a financial advisor to Henry Kissinger. Mr. Kissinger was an early investor and sat on the Theranos board (Chapter 6).

Each one of these charges carries time up to 20 years, but in Federal financial fraud cases, time is usually served concurrently. Judge Edward Davila of the US District Court, Northern District of California, will sentence at a later date to be announced.

It’s expected that Holmes will appeal. The issues of emotional and physical abuse, with Svengali-like control on her judgment, at the hands of Sunny Balwani were not enough for this jury to dismiss the key financial fraud charges. They clearly decided that Holmes was fully capable of engineering fraud, not just once but several times. But with the defense having seeded a backdrop of abuse, it may prove mitigating on appeal. (No, this Editor does not believe that Judge Davila will even refer to that during sentencing, having strictly advised the jury to not consider that during deliberations.)

Holmes was found not guilty on three fraud charges against patients and a fourth relating to advertising and marketing services to patients:

  • Count two of conspiring to commit wire fraud against patients who paid for Theranos’s blood testing services between 2013 and 2016
  • Count 10 of wire fraud in connection with a patient’s laboratory blood test results on or about May 11, 2015
  • Count 11 of wire fraud in connection with a patient’s laboratory blood test results on or about May 16, 2015. These two counts pertained to false results on HIV and prostate cancer.
  • Count 12 of wire fraud in connection with a wire transfer of $1,126,661 on or about Aug. 3, 2015 to Horizon Media for advertising and marketing services for the Walgreens launch.

Given the above, was The Verge (Chapter 15) correct in stating that patient fraud, with the concomitant distress and potential for injury, is less important than financial fraud? Or was the case less well made? 

No verdict was reached on an additional three charges relating to wire transfers in December 2013 by other investors. These apparently were the charges that the jury deadlocked on earlier today: 

  • Count three of wire fraud in connection with a wire transfer of $99,990 on or about Dec. 30, 2013. This was part of the investments made from 2006 to 2013 by private investor Alan Eisenman detailed in Chapter 8. Eisenman was a contentious and offputting witness, and will not have any satisfaction.
  • Count four of wire fraud in connection with a wire transfer of $5,349,900 on or about Dec. 31, 2013. This was an investment by Black Diamond Ventures headed by Chris Lucas, nephew of Don Lucas who was on the Theranos board (Chapter 6).
  • Count five of wire fraud in connection with a wire transfer of $4,875,000 on or about Dec. 31, 2013. This was an investment by the Hall Group.

One additional charge (nine according to the Times, 10 according to the Mercury News) was dropped. The Times article also provides a preview on the next trial–Sunny Balwani. Man of Mystery, or just a lucky sod who made a bundle of money from a dot.com?

The trial started on 8 September and concluded just before Christmas. Deliberations took about 50 hours. 

Also CNBC and ABC News. Let the opinion slinging begin!

We wish you a Merry Christmas and Happy New Year!

December 23, 2021 | by | 2 Comments

Editor Emeritus Steve and Editor Donna wish all our Readers, commenters, contributors, former Editors, and supporters a Very Merry Christmas (in Danish or not!) and a Happy New Year.

Thank you for staying with us through the lean years of telecare and health tech to the fat, the pandemic that just won’t end, in-office and remote work, endless acronyms such as IPO, SPAC, DHSC, CDC, and POTS, analogue and digital telecom, politics, regulation, and Way Too Much Data!

Take some time to enjoy the festive season with family and friends, no matter where you may be. And remember, it’s not about the presents and the hurry, but being together. 

(Here’s the famous Rockefeller Center Christmas tree and promenade, from better days when the tree wasn’t quite as walled off and skimpy as it’s been the past two years–and there were more people in the offices!)

 

 

Further insights on and thoughts about the Oracle acquisition of Cerner

December 22, 2021 | by

HISTalk, with its focus on health IT and generally short mentions without opinion on the news, in today’s issue includes some thoughts on the Oracle-Cerner deal, including a rare “Announcements and Requests” inviting reader thoughts on the acquisition’s effect on several issues. Also rare: a lengthy anonymous comment from a healthcare CIO.

A few highlights–your Editor recommends you go to the article for more:

  • Oracle’s free cash is far less than the purchase price at $23 billion. They will need additional financing to complete the Cerner acquisition.
  • Announcements and Requests: will customers on the fence between Epic and Cerner run towards the less uncertain choice? Will the Cerner VA and DOD business be affected? How does this affect Cerner’s implementations of cloud services, currently AWS versus Oracle’s Gen2, as well as healthcare’s usage of  InterSystems Cache versus Oracle’s relational databases? And will Oracle’s Voice Digital Assistant as the user interface to Cerner Millenium really fly?
  • From Change of Control: How key to the deal was CEO David Feinberg MD, who only joined in October? No matter what, he’s now a very wealthy man.
  • From On-Demand: Oracle is buying its way into healthcare. Cerner lost a lot of ground in executive changes and a less than effective CEO. (Editor’s note: This dates back to 2017–the illness and untimely death of Neal Patterson, the co-founder and CEO, at age 67 and president Zane Burke’s departure the following year after 20 years for the CEO spot at Livongo, which undoubtedly made him a wealthy man!)
  • From Anonymous Health System CIO’s Initial Thoughts: Their biggest problems are 1) people and process.”Cerner has struggled to maintain competent staff that understand healthcare and individual customer workflows. Throughout our implementations, we had major challenges with project management, availability of experienced staff, and the ability to help us make informed decisions.”  2) “If Oracle is going to help reduce the cost of healthcare, they also need to help find savings for their customers.” 

All these should be of concern to Cerner as they–and their people–try to maintain momentum until the acquisition closes. Customer uncertainty, staff competence, and Oracle’s lack of background in how healthcare operates (including a history of pulling some ‘fast ones’ around cloud licensing, as well as understanding clinician preferences such as Dragon as a voice assistant) are undoubtedly giving some investors–and hospital systems–pause. Hat tip to HISTalk. Our earlier coverage here.

One final comment from Editor Donna: Never underestimate the power of a CEO’s ego–especially one who is routinely compared to God, at least in TechWorld–in wanting One Last Coup to burnish his escutcheon, before that Long Sail Into The Sunset on his yacht Musashi.

Does the digital telecom switchover threaten the lives of the most remote old and disabled? (UK, updated)

December 21, 2021 | by

The UK’s recent preview of winter (which officially starts today), Storm Arwen followed by Storm Barra, was yet another exposure of the downside of the digital telecom switchover. As our UK Readers know, BT Openreach has been aggressively proceeding with the full conversion to VOIP by 2025 and closing the ‘broadband gap’ in rural and remote areas. Connecting them to the internet and more feature-filled VOIP service, including telecare services, has major advantages, especially where mobile service is sketchy or blank. 

Here’s the problem–power outages. According to the Energy Networks Association, 1 million homes and businesses in the northeast of England and Scotland lost power for days after Storms Arwen and Barra in late November, making it the worst storm in 15 years. Many of these homes were in rural villages and isolated areas. Power lines in these areas go down frequently in lesser storms that don’t have 100 mph winds and snow. When the power goes out, the VOIP goes out unless you have backup power. Phone lines no longer have their own power, as in the Public Switched Telephone Network (PSTN), equivalent to the US POTS (Plain Old Telephone Service or “copper”).

Add to this BT’s shortage of backup batteries. Digital phone systems in the US are usually installed with a backup battery, which isn’t cheap but sustains about 24 hours of basic voice service. Older models had special ‘brick’ batteries that you ordered from your phone provider that were around $50, newer models are powered by 12 D cell flashlight batteries that at least you can buy at the supermarket. Apparently, BT’s backup units are not only unavailable due to a global shortage, but also cost £85, a substantial charge to a pensioner–unless you live in a ‘not spot’ area without mobile service, in which case it’s free.

No power, no phone, no telecare, no PERS. But plenty of danger to thousands of older isolated adults, plus the frail, alone, and disabled. No connections to friends, carers, and emergency services for days, during a late fall snowstorm which made roads impassable. The storm may be early, but if this is a galloping start, there’s a whole winter to get through.

What about mobile service as a backup? Rural areas are, in bright sunny weather, plagued by spotty service. Supposedly nearly all areas in England have a minimum of 2G service sufficient to call 999. But when the cell phone masts go down, as they did in the storm, and the power to charge the phone is out, the backup is out of commission. One unnamed resident of Grizedale in the Lake District put a molto fino point on it. “It’s embarrassing that a supposedly world-leading country has such a shonky infrastructure. I had full 4G in the mountains of Transylvania a few years ago.”

Ofcom, the regulator, positioned the storms as exceptional. “Even in those circumstances, our rules are clear that there should be protections in place for people to call the emergency services” (999). Rules are one thing, reality another. Judge for yourself as we head into winter. BBC News Hat tip to Editor Emeritus Steve Hards.

Editor’s note for our US Readers: The situation is not that different for us. Nationally, POTS service is deteriorating and not being replaced by providers, forcing changes to VOIP. (I can personally speak to this–20 miles from NYC.) And if you believe that we’re well covered everywhere by cell phone service, you haven’t been to Lancaster County, Pennsylvania, much less further west in the area the locals call ‘Pennsyltucky’. That area also skews older–18.2% of state residents are age 65+. The US also has a wide variety of extreme weather–ice storms, blizzards, ‘snow bombs’, hurricanes, tornadoes, and tropical storms.

(Breaking) Sold! Cerner to Oracle for $28.3 billion. And is Epic next?

December 20, 2021 | by

That bombshell came in fast! From the rumor mill to reality, from last Thursday to today (Monday), Oracle and Cerner announced their deal today at 9.37am ET. It is a bracing all-cash deal at $95/share plus debt assumption totaling $28.3 billion, expected to be immediately accretive to Oracle’s earnings. Closing is anticipated sometime in 2022. It is subject to considerable regulatory (SEC and likely DOJ) and shareholder approvals. It’s Oracle’s largest deal ever, but so far their share price is not appreciative of the big move.

According to the Oracle release, Cerner and its EHR plus related systems will be organized as a dedicated Industry Business Unit within Oracle. No transition information was included, although towards the end it’s stated that “Oracle intends to maintain and grow Cerner’s community presence, including in the Kansas City area, while utilizing Oracle’s global footprint to reach new geographies faster.”

Both the Oracle and Cerner releases (headlining their home page in gigantic type) are written totally from Oracle’s POV–no shilly-shallying about how Cerner will guide them into the healthcare arena or a meeting of like companies, et al. It’s all about how Oracle will transform healthcare.

Changes will be coming to Cerner. Between the lines, they are not painted in the best light. From the Mike Cecelia (EVP, Vertical Industries) quote, “Oracle’s Autonomous Database, low-code development tools, and Voice Digital Assistant user interface enables us to rapidly modernize Cerner’s systems and move them to our Gen2 Cloud. This can be done very quickly because Cerner’s largest business and most important clinical system already runs on the Oracle Database. No change required there. What will change is the user interface. (Ed. emphasis) We will make Cerner’s systems much easier to learn and use by making Oracle’s hands-free Voice Digital Assistant the primary interface to Cerner’s clinical systems. This will allow medical professionals to spend less time typing on computer keyboards and more time caring for patients.”

There is also no mention of Cerner’s challenges with the VA. What are the implications with the Cerner implementations there and with DOD?

Do anticipate much industry speculation on David Feinberg, MD, who only this fall joined Cerner as CEO, and his role in this. The most logical is that he’ll shepherd the sale till the close and exit stage left, well-rewarded, with his future (only 59) still ahead, unless Oracle sees a role for him. In its way, it broke Cerner out of a corner that they were painted into with EHRs. At the end of the day, will there be a Cerner?

And what about Epic? A more complex picture, as Epic Systems is wholly private, on a roll, and dominated by Judy Feinberg, the founder and CEO. However, she is 78, and both personal and corporate considerations on future planning must loom large. What would Epic be worth to an acquirer? And who would it be? Amazon? IBM? (a terrible fit after the Watson Health debacle), Salesforce? Microsoft? Hmmmmm…. CNBC,  TechCrunch, HealthcareITNews   Our earlier coverage here.

News roundup: UnitedHealth Group pushes off Change closing again, Amazon’s new healthcare head, Centene’s shakeup of CEO, board, holdings

December 18, 2021 | by

Change won’t come easy, as this Editor predicted. Now the closing of the Change Healthcare acquisition by UnitedHealth Group has been pushed off to April 2022. Announced in January, it was delayed in August and October/November with the Department of Justice review of the merger under the Hart-Scott-Rodino Antitrust Act (HSR). This SEC filing by UnitedHealth is the first time a definite date target has been set. Change’s diversified health IT/data analytics/imaging/payments systems would be combined with OptumInsight. HealthcareFinanceNews

Amazon finally named a head of healthcare to oversee Amazon Care, Amazon Pharmacy, Halo and Alexa’s healthcare uses. Neil Lindsay, former head of Amazon Prime, was named senior vice president of health and brand within Amazon’s global consumer business, reporting to CEO Andy Jassy. Mr. Lindsay sits on the so-called ‘S-team’, Amazon’s most influential executive group. Take this as an indicator of the importance of healthcare to their business. The terseness of the information has been typical of Amazon. Becker’s Hospital Review, CNBC

Centene, one of the top 10 health plan companies in the US, had a major shakeup this week. Long-time CEO Michael Neidorff will retire and exit sometime in 2022. The board, now set at 14 members, retired three directors via a new age limit of 75. Five new directors will come on board, including Ken Burdick, former CEO of WellCare Health Plans, acquired by Centene in 2020, and Wayne DeVeydt, former Anthem CFO.

The shake-n-bake has been shaking since November, when activist investor Politan Capital Management started to press for changes. Other changes include a projected sale of non-core assets, including private hospitals Circle Health in the UK and Ribera in Spain, with combined revenue of $2 billion. The rather ‘shaggy’ list of Medicaid managed care, Medicare Advantage, and exchange plans–none of which carry the Centene brand–and a potpourri of other units and management services are being examined bottom up by a three-person “value creation office”, as are Centene’s extensive real estate holdings and leases, to extract savings wherever possible. One area mentioned was hybrid and at-home work, a major change to the Centene “cubie” culture.

Neidorff joined a tiny Centene as CEO in 1996 and is now 78. There is no update on the delayed Magellan behavioral health management acquisition. Healthcare Dive 14 Dec, 13 Dec. Centene releases on Neidorff’s retirement as “leadership succession plan” and governance/board changes.

Theranos, The Trial of Elizabeth Holmes closes, ch. 15: she believed! in the technology!

December 18, 2021 | by

The defense returned to their closing arguments on Friday. According to lead defense attorney Kevin Downey, not only did Holmes appoint a stellar board, but also the evidence showed that she believed intensely in the Theranos technology changing the world.

  • Holmes stayed till the end trying to save the company–because she believed in improving healthcare
  • She continued to improve the company and the technology, but after all that she didn’t realize…
  • …that the labs had problems until March 2016, when her very last lab director, Kingshuk Das, MD, invalidated 60,000 lab tests made on Theranos labs in 2014-2015.
    • This happened only after CMS sent a deficiency report notice to Dr. Das’ predecessor with the subject line  “CONDITION LEVEL DEFICIENCIES – IMMEDIATE JEOPARDY.” And that lab directors and techs had already told Holmes about problems with the Edison labs.
  • The proof of her sincerity? If she committed fraud, she would have sold her stock while it still had value, and jumped ship like a scared rat!

Interestingly, Downey made no mention of Sunny Balwani, except that Holmes fired him in 2016. No mention of all the time spent in her testimony depicting Balwani as a mentally and physically abusive Svengali, which led Holmes-as-Trilby to not be in control of herself as CEO, even after he departed.

The prosecution returned for rebuttals. John Bostic countered the defense claim of Holmes’ belief with “the disease that plagued Theranos wasn’t a lack of effort, it was a lack of honesty.” “We see a CEO of a company who was so desperate for the company to succeed, so afraid of failure, that she was willing to do anything.” Bostic also reminded the jury that they needed to put Holmes’ claims of emotional abuse by Balwani aside since there was “no evidence connecting the allegations of abuse with the actual charged conduct.” 

Judge Edward Davila, in winding up 14 weeks of trial, then charged the jury to avoid consideration of or speculation on the abuse, and to disregard both public opinion and Holmes’ place in society. They could consider whether Holmes had a “good faith belief” in the truth of her statements. The jury will return Monday morning to start deliberations. The fraud charges include conspiracy between Holmes and Balwani against patients and investors. Two more charges are related to patients receiving erroneous test results on HIV infection and prostate cancer. One is on fraudulent marketing and advertising. Six more charges are about investor fraud. 

AP, Mercury News (paywall–refresh to read)

Because it’s the weekend, your Editor will include two extra articles. The Verge article reads something like a screed against our legal system valuing money fraud over patient medical fraud. The NY Times article is on the latest Holmes makeover. During the trial, she changed from hard-edged, black turtleneck, red-lipsticked Lady Steve Jobs to suburban-junior-manager-working mom in off the rack wrinkled skirts, peachy pink lip color with curled but messy hair, carrying an inexpensive baby bag. All calculated by her defense to create an illusion of innocence and, this Editor would add, incapability of any dastardly acts, such as financial and medical fraud.

To be continued…

TTA’s earlier coverage: Chapter 14, Chapter 13, Chapter 12, Chapter 11, Chapter 10, (10-13 recap the Holmes testimony); Chapter 9, Chapter 8, Chapter 7, Chapter 6, Chapter 5, Chapter 4 (w/comment from Malcolm Fisk), Chapter 3, Chapter 2, Chapter 1

Oracle in negotiations to buy Cerner for $30B (sold!)

December 17, 2021 | by

2021 may go out with a bang! The Wall Street Journal (paywalled) reported late Thursday that software colossus Oracle was in discussions with EHR giant Cerner to buy it, lock stock dropdown menus and workflows. And soon, according to the WSJ‘s sources. The reported amount is $30 billion.

It would be Oracle’s most expensive purchase ever, much more than PeopleSoft (HR) in 2005 and NetSuite in 2016. Given their valuations, Cerner is a snack at $23 billion for Oracle at $280 billion. But Cerner gives Oracle four-star entree to healthcare and practice systems. Oracle has long seen healthcare as a growth area for cloud computing services targeted to payers, hospitals, and health systems, and has clients like Cleveland Clinic and Kaiser. Back in June 2020, they launched a cloud service collecting clinical data from sensors, patient apps, EHRs, and labs supporting therapy development. 

As our Readers know, David Feinberg, MD left Google Health to join Cerner as president and CEO on 1 October [TTA 21 August] in a $34.5 million compensation package [TTA 24 August]. An acquisition by Oracle, in such a short time, can be interpreted as either a coup he engineered for the shareholders (and for his benefit, as change of control usually vests the package!), or he can be viewed as a placeholder for the top spot on a previously moving deal. Both are mature companies. While Cerner has been losing market share to Epic and has had many woes with its $18 billion VA Cerner Millenium implementation [TTA 3 Dec, 28 July], it also generates $1 billion per year in free cash flow and Oracle can institute operational efficiencies to increase profit margins. In the view of some, Oracle is returning to an aggressive market strategy that most felt it left behind.

Oracle shareholders didn’t like it much today, with shares declining over 6% on Friday to $96.67. But Cerner’s liked it a lot, increasing price nearly 13% to $89.77. Kansas City-based Cerner also had 150 layoffs in November in its 28,000 employee staff. Oracle recently relocated from California to Austin, Texas, shrinking its office footprint. Seeking Alpha 17 Dec, 17 Dec AM; Kansas City Star, Becker’s HealthIT

Updated–see our short article on the sale for $28.3 billion here.