Chutes go first…
UnitedHealth Group’s 2025 financials not only triggered a one-day drop in its stock of 19.6% ($282), but cracked the Dow Jones Industrial Average (DJIA) by 409 points– close to 1% (0.8%). Revenue hit a record–$447.6 billion–but profits suffered another drop to $12.1 billion from $14.4 billion in 2024. Worse, it was the lowest annual profit since 2018, not even adjusted for inflation. Their care organization within Optum services, Optum Health, went from a 2024 operational gain of $7.8 billion to a loss of $278 million in 2025. 2026 projections for UHG include a revenue contraction for the first time in years. Healthcare Dive, Yahoo Finance
But the stock free-fall hinged on the Center for Medicare and Medicaid Services (CMS) rule move announced on Monday to essentially keep Medicare Advantage (MA) average rate payments flat at less than 1%, versus an expected 4-6%. This was topped by another rule excluding patient diagnoses that aren’t linked to actual medical care that inflated MA patient risk adjustments, flattening risk scores and payments. The adjustments would save taxpayers about $7 billion. Another major hit is that UHG projects a 2026 loss of 1.3 to 1.4 million MA members. The stock price recovered about 11% today to close at $294.02.
UHG’s stock drop was the 6th worst since 1987’s Black Tuesday. The rule changes also swatted other insurers with major MA markets such as Centene, CVS Health (Aetna), Elevance, and Humana.
Congress is also going hard after health insurers, with hostile House Ways and Means committee and House Energy and Commerce subcommittee hearings last week skewering CEOs from UnitedHealth, CVS, Cigna and Elevance over their compensation, rampant vertical integration with pharmacy benefit management (PBMs) and providers (including rate setting), prior authorization, and care denials. Fun fact: non-insurance business can be as much as one-third of revenue for the insurer giants. Only the Blue Shield of California CEO (Ascendiun), a non-profit, who basically agreed with all the criticisms of healthcare and threw himself on the mercy of the court, somewhat escaped. It was a Bad Day on Capitol Hill that may portend Boot Hill for some CEOs. Healthcare Dive, Becker’s
Other portents for the industry aren’t great either. ACA individual plan subsidies, which had ballooned beyond recognition in the past few years, are not expected to return, and members are fleeing. Many insurers such as Aetna have already exited the exchanges. Health policy reforms are iffy in a midterm election year. Medicaid state payments are still in unknown territory. A bit more favorable is that margins are stabilizing and commercial plans remain positive. Healthcare Dive
All of which means that in a hot midterm year, there will be renewed bipartisan calls to restrict insurers on practices of their painstakingly integrated service businesses–and increased calls for divestitures. By last year, it was clear that UHG was becoming a victim of its own size and a strategy rapidly becoming obsolete. This Editor in May 2025 (just before her extended hiatus) in an extended brief advocated a voluntary breakup of UnitedHealth Group before it wound up like GE, wrecked by its own problems. The finalized acquisition of Amedysis in August, dangling with DOJ since 2023, was the swan song. Or honk. The days of big UHG accretive buys, Optum acquiring practices, and Optum Ventures making big bets in digital health are over, and darn well should be.
A very tart take–but requiring a subscription–is in yesterday’s (27 Jan) AI Health Uncut. Sergei Polevikov details the multiple fraud cases that UHG is fighting, the devastation that Change Healthcare’s suspension of provider payments for months in 2024 wreaked, insider trading, and more.
And here are the Ladders, which are finally showing up in healthtech after a thoroughly depressing 2025…
MSG physical therapy/mental health/telehealth provider Sword Health today (28 Jan) announced the acquisition of Kaia Health for $285 million. (Updated) Kaia is also in MSK management for employers, payers, and public health systems, but adds a pulmonary therapy for COPD, Kaia Breathe. The Sword brand will replace Kaia in the US, while Kaia’s prescription app footprint in Germany (DiGA) will open the digital health Rx reimbursement pathway there for Sword. Clearly that was a very big asset of interest to Sword. At present, Sword has 700,000 members across three continents and 1,000+ enterprise clients. Their financing to date is $500 million raised from Khosla Ventures, General Catalyst, Transformation Capital, and Founders Fund. Kaia had funding of about $123 million but hadn’t had funding since their April 2021 Series C, which is a prolonged time and indicates that they were having trouble with that ol’ devil Profitability. (Crunchbase) Sword release, Mobihealthnews
OpenEvidence, the medical information search engine for doctors that is 2026’s ‘hot number’, scored a $250 million Series D, led by Thrive Capital and DST Global. The AI-enabled (what isn’t?) free search engine trained on journals and clinical medical data only, coupled with an AI chatbot agent, claims scorching growth, from 3 million clinical consultations/monthly in December 2024 to 18 million/monthly in December 2025, all from verified US physicians. The Miami-based company also claims daily average usage by 40% of US doctors in 10,000 hospitals and medical centers. Its funding and valuation are scorching too, totaling $700 million from a Murderer’s Row of major investors, doubling its valuation to $12 billion, making it the most valuable healthcare AI company on Planet Earth. (This gives OpenAI and Anthropic something to ‘shoot’ for.) The fresh funding will be invested in R&D and compute costs associated with their multi-AI agentic architecture. “Medical superintelligence” may be an overstatement, but in discussions around physician marketing and engagement, OpenEvidence is showing metrics that dust the traditional providers such as Doximity, Medscape, and Epocrates. FierceHealthcare, Mobihealthnews, release
Pomelo Care’s $92 million raise will take it beyond maternity care. At present targeted to fertility, maternity, and pediatric care for women and children, the company is expanding into midlife women’s health, including perimenopause and menopause symptoms and mental health support. The Pomelo app enables access to a dedicated care team and customized care plans. Currently, the NYC-based company founded by Marta Bralic Kerns and named after the doughy citrus fruit has access to 25 million covered lives through health plan payers and employers. The Series C was led by Stripes with participation from Andreessen Horowitz, PLUS Capital, Atomico, BoxGroup, and SV Angel. Valuation is now up to $1.7 billion. MedCity News, Mobihealthnews, Forbes
On the other end of the barbell, NOCD, a virtual care provider for obsessive-compulsive disorder (OCD), purchased trauma care provider Rebound Health. The two companies are forming under a parent entity, Noto. Rebound provides for trauma patients a mobile app that provides structured self-help support. The overlap/extension for the two companies is in treatment of PTSD and Complex PTSD. NOCD has raised $84 million since its founding eight years ago but Rebound Health only $150,000 in a pre-seed round (Crunchbase). Acquisition cost was not disclosed but could not have been much. Behavioral Health Business
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