Perspectives: Virtual Care, AI, and the Future of Autism Therapy

June 17, 2026 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic concerns how technology can increase access to outcomes-based behavioral health care for underserved families, improving the progress and effectiveness of care for those children with autism. Our author, Jeff Beck, LCSW, is the co-founder and CEO of AnswersNow, which provides virtual support based on applied behavior analysis (ABA) therapy. Mr. Beck spent the first 15 years of his career working directly with children in low-income and rural communities.

Recent reporting in The New York Times is just the latest to detail allegations of fraud, abuse, and excessive billing across parts of the autism therapy industry. But this story was especially troubling because of the stories of the children and families caught in the middle. It’s a reminder that the challenges in autism therapy today are human ones with real and urgent consequences. 

At the center of these issues is healthcare’s longstanding fee-for-service reimbursement system, which incentivizes autism providers to bill for therapy hours rather than patient progress. Now, the ongoing surge in autism diagnoses and the continued scarcity of highly trained clinicians have created an even greater opportunity for those same providers to ramp up their billings and lock children into extended cycles of therapy without producing meaningful improvement.

The encouraging news is that technology is changing that calculus.

For years, healthcare leaders have talked about shifting from fee-for-service reimbursement toward outcomes-based care. In autism therapy, that means aligning families, providers, and payers around a holistic goal to help children make progress faster and more efficiently. The challenge has been how to measure outcomes, scale care, and manage costs.

Today, virtual care and artificial intelligence are making all three increasingly achievable.

Virtual Care Solves More Than Access

Telehealth is often described as a convenience. However, in autism therapy, virtual care is creating entirely new ways to deliver higher-quality care.

  1. Virtual care expands access. Traditional autism therapy relies heavily on centralized clinics, forcing families to travel long distances and organize their schedules around available appointments. In many communities, waitlists stretch for months or even more than a year. Virtual therapy removes geography as a barrier and allows families to receive support directly from home.
  2. Virtual care helps solve a workforce problem. The shortage of Board-Certified Behavior Analysts (BCBAs), our industry’s most highly trained therapists, is unlikely to disappear anytime soon. Virtual care allows a BCBA in one location to support families hundreds of miles away, dramatically expanding access without requiring a corresponding increase in the workforce. It also means that, rather than spending large portions of their day supervising less-trained staff, BCBAs can work more directly with children and caregivers. More one-on-one interaction can lead to more personalized care and stronger therapeutic relationships. It also has the added benefit of boosting clinician retention rates. 
  3. Virtual care can improve the therapy experience itself. Children often learn best in environments where they feel comfortable and secure. Sessions conducted in the home allow therapists to work within real-world routines and challenges rather than simulated clinical settings. And for some children, interacting through a screen can even feel more natural and familiar.

AI Makes Better Care More Scalable

AI can be a force multiplier, improving both the efficiency and availability of BCBAs. But it can also be deployed to enhance the therapy experience itself and measure progress over time. 

  1. AI enables more personalized therapy. Historically, creating individualized materials and activities required substantial clinician time. AI can now help therapists generate customized content aligned to a child’s interests, developmental goals, and learning style in real time. That allows clinicians to adapt more quickly and keep sessions engaging and relevant for faster progress by kids.
  2. AI helps reduce administrative burden. Highly trained clinicians routinely spend hours each week documenting sessions, reviewing records, writing notes, and developing care plans. These activities are necessary, but they reduce the time available for direct patient care. AI can take on many of these tasks, returning meaningful time to clinicians. 
  3. AI can improve how providers measure and manage outcomes. It can help identify patterns earlier, track progress more consistently, and support more informed treatment planning. Just as importantly, it generates the data needed to evaluate whether children are actually improving rather than simply accumulating therapy hours.

Of course, security and compliance are non-negotiable in this space, especially given the strict regulations health systems and payers face. The default industry standard should include a “compliance toggle” that allows enterprise partners and families to completely disable AI tools whenever their internal security protocols require it.

Building the Next Generation of Autism Care

Autism therapy is entering a period of necessary scrutiny, and bad actors should be held accountable. But the larger opportunity is to build something better.

  • Providers should view virtual care and AI as more than operational tools. Together, they make it possible to deliver higher-quality care with greater efficiency, personalization, and transparency.
  • More importantly, they create the foundation for a different model of care, one where success is measured by a child’s progress rather than the number of hours billed.

That shift will take time. But providers using technology to expand access, strengthen outcomes, and improve accountability will help define what better autism care looks like for the next generation of children and families.

Must Reads on AI: its societal and economic effects, and why its developers see it as replacing God

May 29, 2026 | by

Two Substack Must Reads for the weekend. Both are open and do not require subscription. Grab the cuppa and take a walk in the park after to consider them.

The “Messy Middle” by Molly Kinder in “Kinder Futures”
Why the years between today and post-AGI abundance will be the hardest political and economic problem of our generation, and why we can’t skip past them

This is the longer of the two essays that presents two realities: Reality 1 of today where AI is increasingly everywhere, but the societal effects have yet to be felt, and Reality 3 where it has been absorbed and we are in the bright sunlit uplands of abundance. The mess is in Reality 2, which she posits as year, perhaps decades, of societal upheaval and what we are already seeing–the near-destruction of the professional  ‘cognitive classes’. Yes, people like you and me as creative thought, ability, and specifically cognitive ability, become commodities. This cognitive displacement will affect governments, as the vast middle that pays most taxes suddenly finds income cut in half or more, forced into early retirement, and dependent on government for support. The essential jobs as determined during the Covid pandemic will be the least affected, but still affected because their income trajectory despite need has been declining and that won’t change. The trades survive because their practitioners are scarce for now. The effects on the middle and upper middle classes internationally will be brutal in her scenarios. Ms. Kinder does arrive at conclusions re the political backlash rearranging the current state (we are in it now) and a managed transition that you may not necessarily agree with. See the comments at the end.

The Tech Bros Want to Build God by George Shay in “Common Sense”

Why Pope Leo XIV May Be Right to Worry About Artificial Intelligence—But Not for the Reason You Think

Pope Leo’s first encyclical tackled AI and began, in the introduction, “Humanity, created by God in all its grandeur, is today facing a pivotal choice: either to construct a new Tower of Babel or to build the city in which God and humanity dwell together.” Further, “We must, then, avoid the “Babel syndrome,” namely the idolatry of profit that sacrifices the weak, a uniformity that neutralizes differences, and the pretense that a single language — even a digital one — can translate everything, including the mystery of the person, into data and performance. The risk of dehumanization — of building a future that excludes God and reduces the other to a means — is an ancient and ever-new temptation that today takes on a technical guise.” Like most encyclicals, it is written in exceedingly dense, very Catholic language (disclosure, your Editor is Roman Catholic). 

Mr. Shay’s take is considerably less dense and moves from a different philosophical ground. All too many of the ‘tech bros’, especially at a high level, speak of technology in almost religious terms. AI has become their highest expression of faith. They rejected traditional faith while young and redirected that impulse, that exists in nearly every human save the sociopaths, into technology. To the observant, that is nothing new–witness the well-known lives of Steve Jobs and Bill Gates. Instead, in the search for meaning, their salvation is technology.

FTA: “Instead of God creating man in His image, we now hear man preparing to create a machine in his own image.

Some of the rhetoric coming out of Silicon Valley is astonishingly explicit. Researchers and entrepreneurs casually discuss creating “machine gods” or engineering a “new species” superior to humanity. And importantly, they are not speaking metaphorically. They mean it quite literally.”

The ultimate question is ‘why’–and there is no AI that can answer that, despite how the visionaries position AI “in terms that resemble divinity”. 

Your Editor expressed two comments that are solely her observations. The first: “Perhaps those most enthusiastic about AI are those most frightened of the existence of God behind life, faith in that God, ethics beyond their own wants and needs, consideration of their fellow man, and their own mortality. Is it no mistake that most of those leaders in technology resemble flawed and strange little boys, even when they are 70? That is an unsettling thought.” The second is lengthy and saved for your reading of the article.

Holiday weekend roundup: VA asks for ‘cyberspeed’ 25% EHR budget bump, update on EHRM fraud indictment; Commure raises $70M; Innovaccer buys Caduceus, lays off staff; Doximity, OpenEvidence slugfest gets hot

May 22, 2026 | by | 2 Comments

A slower news week preceding the Memorial Day holiday in the US and the UK late May bank holiday.

Federal budgets for 2027 are in the Congressional washing machine, and the cycle is on ‘agitate’. VA Secretary Doug Collins has tagged a 25% increase in the EHR Modernization budget for FY 2027 over what is currently in the 2027 Military Construction and Veterans Affairs Appropriations bill –$4.2 billion versus $3.4 billion, an increase of $840 million. He testified on Wednesday 20 May to the Senate Veterans’ Affairs Committee and Thursday 21 May to the House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related. Apparently, the biggest problem VA has with the much-repaired and now standardized Oracle EHR is that every VA executive director wants it now, not later. An additionally funded EHRM would speed up the cutover for VA facilities to go from ‘dial-up’ to ‘cyberspeed’ internally, in communicating with other VA hospitals, community care, and in record sharing with the military system and civilian health facilities.

Difficulties reported to date (April for four sites in Michigan, VISN 10) are around transferring health records between VA and Department of War facilities. DoW healthcare also uses Oracle, but a different version suited for their needs that has been fully implemented. 

While the House has already passed the bill at the lower budget number and sent it to the Senate, the subcommittee chair John Carter (R-Texas) during the hearing said they’re “not through with the possibility of getting you some more money”. 

VA’s implementation timeline is 19 before the end of this year (13 new and the 2020-24 six), 26 new sites in 2027 and 28 VA Medical Centers in 2028. Even sped up, there are still 90 more to go and the deployment is not expected to be complete till 2031. FedScoop 21 May, 30 April

Update on the fraud indictment of the former EHRM director, John Windom. Surprisingly, there has been little to no mainstream media coverage of the Federal charges against John Windom, who was indicted on 25 March in the Federal District Court for the District of Columbia. The three counts related to accepting cash and gifts from vendors plus failure to report them could bring a maximum of 35 years. This article on conservative news website PJ Media is the most recent (re)telling of the tale and links to nearly all the same sources this Editor included in our 3 April article. It is more colorful than our reporting but brings up an important point I overlooked: where, oh where, are the indictments of some of the vendors who doled out cash, gifts, and maybe more, and in return got prime and sub-contracts. He knew, they knew to keep quiet–‘loose lips sink ships’. Because any Federal contractor–I worked for two, Viterion Digital Health and Collaborative Health Systems, then part of WellCare Health Plans–receives compliance training on working with their Federal agency counterparts. 

Perhaps there are investigations and indictments to come, as I’ve seen in Federal Medicare fraud cases that peel like an endless onion over years. According to the VA inspector general, Mike Missal, who served from 2016 until January 2025, evidence was being gathered internally back during the Biden administration. This fits the timeline of the US Attorney requesting a grand jury be summoned then sworn in on 30 October 2025. Mr. Missal was fired along with 16 other inspectors general by the incoming Trump administration.

Since Mr. Windom was deeply engaged in the choice of Cerner for the VA EHR in 2017-2018, and in the disastrous implementation of VA Mann-Grandstaff (VISN 20) in October 2020 and four more in 2022, resulting in the rollout’s termination in 2023, Oracle would be unwise to not prepare for a few questions about Cerner’s relationship with Mr. Windom, as I wrote at the time. 

The PJ Media article also references the comprehensive article in the 27 March Spokane Spokesman-Review, which has been on the Cerner/Oracle implementation story since the implementation failure in the region’s Mann-Grandstaff VA facility. Their check of the OEHRM website as of that date confirmed that Mr. Windom was still listed as the deputy director of the Federal Electronic Health Management Office, the joint VA-DOD initiative in the role he assumed in January 2022 after the Mann-Grandstaff problems detonated and the then-Secretary reorganized the department. (Heads did not roll, but they rarely do with SES members). FTA: “The Federal Electronic Health Record Modernization Office did not respond on Thursday (26 March) when asked if Windom remains employed there.” The article by Orion Donovan Smith is a recommended read.

In the funding/M&A department

Healthcare software integrator Commure received a $70 million funding from current investors. Commure’s lead investor is General Catalyst. Commure now has $750 million raised and a $7 billion post-money valuation for its AI infrastructure development. Its subsidiary, Athelas, provides AI-based revenue cycle management and clinical workflow tools. The General Catalyst funding of $200 million plus is an interesting scheme, in that GC fronts the cost of sales and marketing and, in return, receives a share of the revenue from new customers generated by that investment, up to a fixed cap. The new funding will be used for scaling its RCM and practice management platforms, advancing the ‘shared intelligence layer’ beneath Commure’s workflows, and expanding their AI infrastructure into global healthcare markets. Release, Mobihealthnews

Innovaccer acquires CaduceusHealth, a revenue cycle management (RCM) and management services (MSO) provider. Neither transaction cost nor management transitions were disclosed. Well-funded Innovaccer ($675 million through a Series F) has been growing in AI-centric healthcare IT services mainly through acquisition. CaduceusHealth is the fifth in their creating a “comprehensive agentic stack” for health systems and provider groups in their Flow suite. Innovaccer claims to serve over 200 health systems and payers, 95% of community pharmacies, and 80 million patient lives across the US. Release Unfortunately, their growth has been matched by a reduction in staff, with 340 layoffs in the US and India. It is their third layoff in four years as it applies its own AI to automate its own processes. (We are seeing a lot of this across the board, allegedly.) FierceHealthcare

We close with a major Must Read with the OpenEvidence-Doximity battle.

OpenEvidence and Doximity are slugging it out for the same market funding–and a third competitor has just sneaked into the ring. OpenEvidence is the upstart, founded four years ago, and the best valued ($12 billion) yet private healthcare AI company on the planet Earth and is generally thought of as the up-and-coming platform for physician information. Doximity is the mature company, public with a $3.6 billion market cap, proven revenue of $645 million, and (be still my heart) profitable with an EBIDTA margin of 55% and a stunning 49% free cash flow margin. It’s been dubbed ‘LinkedIn for doctors’ but is actually much more with tools for secure telehealth, news, reputation management, and free CME.

They are mutually litigious. Both OpenEvidence (OE) and Doximity tag-team each other in product offerings, use defamation tactics and key staff poaching, and in product development, copycat each other, with Doximity generally leading development and OE following shortly thereafter. Coming up is Doximity’s new product, an in-workflow e-prescribing, prosaically called Doximity Prescribe. Based on the pattern, how long will it be before OE develops a similar product?

Where they make their money is only indirectly from users. Both are supported by a fixed source–pharmaceutical advertising. They both slug it out for physician attention. While doctors love (or hate) both, if they become too similar, the balance will tip. Into this bout steps OpenAI with a new professional product, ChatGPT for Clinicians [TTA 30 April]. Lurking near the ropes is the AI-powered iteration of Wolters Kluwer’s UpToDate peer-reviewed medical content, integrated with Microsoft and Abridge, already in 70% of the largest enterprise health systems because it’s been around forever. OE’s vulnerability may be overpromising in claiming ‘no hallucinations’ of their AI-generated medical content–a claim that is structurally impossible, and results in deficits in completeness, communication quality, and systems-based safety reasoning.

Digging through all of this is the intrepid Sergei Polevikov on his Substack AI Health Uncut. Grab a cuppa and sandwich for this one. For most of the article (Part 1 of 2!), a subscription is required. Consider it money well spent for access to some of the best investigative reporting around with plenty of backup. OpenEvidence Prescribe Coming to Your Doctor’s Office This Month?

Perspectives: AI Hallucinations in Behavioral Health–Why Access Needs Better Infrastructure, Not Better Chatbots

May 21, 2026 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic is about the use of AI in the mental health area–how it is uniquely exposed to risk from LLMs and generative AI–and where best to use them. The author, Hari Prasad, is co-founder and CEO of  Yosi Health, a full-service technology ecosystem that connects patients with their providers through the entire care journey before, during and after the visit, modernizing the entire healthcare patient experience. 

One in three U.S. adults has now used an AI chatbot for health information in the past year, according to the most recent KFF tracking poll. Among adolescents and young adults, one in six has turned to a large language model specifically for mental health advice. That second number should stop every behavioral health leader in their tracks, because when those tools get it wrong, the consequences are not a bad product recommendation. They are clinical.

We are not witnessing patients casually Googling symptoms anymore. They are having extended, emotionally charged conversations with generative AI tools about medications, crisis management, and care decisions, often weeks or months before they ever speak to a licensed provider. And the technology they are confiding in has a well-documented failure mode that the industry still has not adequately addressed: the hallucination.

The Problem Is Not That AI Sounds Wrong. It Is That It Sounds Right.

An AI hallucination occurs when a model generates a response that is fluent, confident, and completely fabricated. In most consumer contexts, that is an inconvenience. In behavioral health, it is a patient safety event waiting to happen.

Consider the real scenarios already playing out: a generative AI tool confidently suggesting an incorrect dosage for a mood stabilizer. A chatbot offering therapeutic advice that directly contradicts evidence-based protocols for trauma. A model providing reassurance to a patient in acute crisis when the clinically appropriate response is immediate escalation. These are not hypothetical edge cases. They are the predictable output of systems designed to be helpful and conversational above all else.

What makes this uniquely dangerous is the packaging. These models are engineered to sound empathetic and authoritative simultaneously. A patient in a vulnerable mental state has no reliable way to distinguish a clinical fact from a statistically plausible guess. And once that trust is broken, the damage extends beyond the misinformation itself. A patient who receives hallucinated guidance during a moment of crisis may lose willingness to engage with the legitimate care system at all.

Why Behavioral Health Is Uniquely Exposed

Two structural realities make behavioral health the highest-stakes frontier for AI hallucination risk: subjectivity and scarcity.

First, subjectivity. Unlike a fracture that shows on an X-ray, mental health concerns are communicated through nuance, context, and subtext. Generative AI is exceptional at mimicking tone. It is incapable of the clinical judgment required to understand the weight behind a patient’s words. There is no lab value to cross-reference, no imaging to confirm. The entire diagnostic framework depends on the kind of human interpretive skill that cannot be approximated by next-token prediction.

Second, scarcity. As of late 2025, 137 million Americans live in a Mental Health Professional Shortage Area, and only about 27% of need is being met in those regions. Appointment wait times range from three weeks to six months depending on location and specialty. For the roughly 29.5 million adults with a mental health condition who received no treatment last year, the barrier was not awareness. It was access. When the pathway to a licensed professional is blocked by a three-month wait, an AI chatbot becomes the path of least resistance, not by preference, but by default.

This is the uncomfortable truth the industry must confront: patients are not turning to AI because they trust it more than their providers. They are turning to AI because the system has not given them a better option.

The Fix Is Infrastructure, Not Disclaimers

The standard industry response to AI hallucination risk has been to add disclaimers and guardrails to the models themselves. That approach treats the symptom while ignoring the disease. The reason patients are having clinical conversations with chatbots is that the operational infrastructure of most practices still makes it easier to talk to a machine at 2 AM than to get a timely appointment with a human being.

The real solution is to shift AI’s role from clinical logic to operational logistics. Practices need to deploy technology that removes the administrative barriers driving patients toward unregulated alternatives in the first place. That means rethinking three operational layers.

Deterministic intake over conversational intake. When an LLM “chats” its way through a patient intake, it introduces the same hallucination risk we are trying to eliminate. The alternative is structured, deterministic intake systems that gather discrete clinical data without improvising questions or advice. Symptoms, history, social determinants of health, all captured through validated frameworks and delivered into the EHR as clean, fact-based data. The clinician gets a head start. The patient gets accuracy.

Precision navigation over generic triage. AI’s greatest operational strength is processing complex variables at scale. That capability should be pointed at routing, not counseling. If a patient’s digital intake surfaces indicators of acute risk, the system should not offer a supportive quote. It should trigger immediate escalation to a crisis line or emergency clinician. The technology’s job is to get the right patient to the right level of care at the right time, not to play therapist in the interim.

Intelligent follow-up over passive waiting. The period between appointments is where behavioral health patients are most isolated and most vulnerable. This is where AI can add genuine value, not by providing care, but by acting as a monitoring layer. Structured check-ins, flagging of concerning patterns in patient-reported outcomes, and automated alerts to clinical teams when intervention thresholds are crossed. The AI serves as a tripwire, not a therapist.

From Advice to Access: The Shift That Matters

The practices getting behavioral health engagement right are not the ones deploying the most sophisticated AI interfaces. They are the ones using technology to collapse the administrative distance between a patient’s first expression of need and their first clinical encounter. When scheduling, intake, and insurance verification happen before the patient walks in, the clinical encounter starts on solid ground. That is what patient engagement actually looks like in 2026.

The hallucination problem is not an argument against AI in healthcare. It is an argument for precision about where AI belongs. Every time we deploy AI in the clinical layer without adequate safeguards, we introduce risk. Every time we deploy it in the operational layer to accelerate access, we reduce risk. The distinction is not subtle, and the stakes are too high to keep blurring it.

Behavioral health already has a trust deficit driven by stigma, scarcity, and systemic friction. The last thing this field needs is a technology layer that erodes trust further by giving patients confident answers that turn out to be wrong. The opportunity in front of us is to use AI to rebuild that trust by making the system itself faster, smarter, and more responsive. Not by replacing the clinician, but by making sure the patient actually gets to one.

Related article from TTA

Character.AI sued by Pennsylvania on its chatbots posing as licensed physicians and psychiatrists

 

Even famous doctors have their identity stolen: Dr. Eric Topol “authors” an apparently fake, AI-generated paper

April 23, 2026 | by

And now, it’s author names on research papers being spoofed. Eric Topol, MD, the noted physician, cardiologist, health tech maven, and director/founder of the Scripps Research Translational Institute, just experienced Grand Theft Auto on his identity. He was listed as the lead author of a paper entitled “Implementation Science for AI Integration in Digital Health Systems”, along with five other author/contributors. It was published in the “Journal of Digital Health Implementation” by Ellinger Publishing Media on 29 March.

Except, as Dr. Topol wrote in a post on his Substack blog, “Ground Truths“, he never wrote it.

From his post along with a screenshot of the ‘paper’ and a link:

“This is a FRAUDULENT paper, AI-generated. My name was used as an author and I had nothing to do with it, never saw it until today

The “Editors” Angelo Rossi Mori, David Mensah, and Zarnie Khadjesari and this “Journal” should be reported.”

Substack readers are often commenters, and your Editor is no exception. So she did some digging and commented on Dr. Topol’s post [Editor’s further notes in brackets]:

Dr. Topol, the link on your post [he provided a link to the publication] is not only going nowhere (to blank screen/’this site can’t be reached”), but also trying to reach the e-PubMed.co.uk site by entering it directly goes to the same screen. When I searched under Ellinger Publishing in Google and the same URL came to the top under them [see screenshot right below], the link equally does not work. The UK E-PubMed Central is now Europe PMC concentrating on UK/EU research and partners with the US NIH PubMed site on certain papers, from what I have read online.

Gemini came up with this about Ellinger: “Ellinger Publishing Media: An independent academic publisher specializing in open-access journals, specifically focusing on artificial intelligence, medicine, social sciences, and interdisciplinary research.” Again, links in the AI summary to e-pubmed.co.uk do not work. My conclusion is that this is a total spoof/hack using a URL similar to the former UK E-PubMed and this Ellinger Publishing is a fraud. I don’t know how you picked it up but it’s no longer reachable.

But, as they say on direct response TV…there’s more. I replied to my own comment, “The paper has a link [that goes to another website], Zenodo. It says clearly that it has been withdrawn from there too. Reason for removal—copyright infringement.”

https://zenodo.org/records/19337363

So what happened? Its withdrawal is as mysterious as its appearance.

At this point, we can draw only certain conclusions.

When research papers, apparently AI-generated, are being fraudulently posted with names as prominent as Dr. Eric Topol’s plus five other authors (who may or may not be real–have not checked), for content that is clearly academic-appearing (apparently a meta-analysis), anyone who publishes or has a public persona is in trouble. Big trouble. And with little defense against this happening.

But even worse, unless the Ellinger Publishing Media site itself has been hacked, this may well be a fraudulent publisher claiming open access journal status.

  • My prompt on Gemini, FWIW, indicates that Ellinger Publishing is a ‘vanity press’ for books, not a journal publisher; read for yourself here. So Gemini contradicted itself when asked the prompt differently.
  • The journal is fake as well. A search on Google on the name gives you a link to a website called Conference.Researchbib.com, but when you click on the link for the journal, it goes to the same E-PubMed UK ‘this site can’t be reached’ URL as above.

Open access journals per se are controversial enough since they exist to publish non-peer reviewed materials. For studies in progress, this is valid as a platform for further discussion and research. But it doesn’t and cannot carry the weight, the rigor of peer review. We all know that less than rigorous studies used by less than scrupulous companies have leveraged open access journals for sales/survival proof purposes.

Fraudulent open access journals on mysterious websites that spoof the names of once-authentic journal websites just take it one step further. One wonders how long has this been going on.

This Editor invites Readers to give their perspective on this matter.

Perspectives: What Healthcare Can Learn from Formula One About AI

April 21, 2026 | by

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. We welcome back Iris Telehealth for today’s topic on how telehealth and clinical dashboards should be like modern Formula 1 race cars’–displaying the relevant information for that patient visit and increasing clinician presence versus being overwhelmed by data and documentation load. The author, David Bartley, is Iris Telehealth’s Chief Solutions Officer, with over 20 years of experience leading healthcare product strategy across payers, providers, and population health organizations including MedeAnalytics, Cotivi (formerly Verisk Health), eviCore, Healthways and Humana.

Behavioral health organizations are already absorbing a level of administrative pressure that has nothing to do with clinical care. I’ve spoken with CEOs of rural mental health clinics who are deciding between keeping a clinician on staff and sustaining the administrative infrastructure required to stay compliant.

One told me he had seven people on staff doing nothing but collecting state reporting data — compliance work that consumed payroll he would rather put toward clinical capacity. That tradeoff is exactly what funding pressure forces, and it is where AI can do something genuinely useful: absorbing the administrative work so that the next available dollar goes toward a clinician, not a spreadsheet.

What’s keeping organizations from achieving this reality with AI? Well, most of the industry is measuring AI’s value primarily through operational metrics, like how many more patients a provider can see, how fast documentation gets processed, or how lean an operation can run. Those are important operational metrics — but on their own, they don’t tell us whether care actually improved.

The organizations that figure out how to use AI to deepen the quality of each encounter, rather than multiply the number of them, will move care forward.

Leading health systems are already building toward it. At Mayo Clinic, for example, investments in integrated, AI-enabled platforms are helping bring together multimodal clinical data and advanced analytics in ways that surface the most relevant insights at the moment of care. It’s a signal that the industry is moving beyond AI as an efficiency tool and toward AI as a clinical intelligence layer.

Surfacing what matters, exactly when it matters

When I think about what AI should look like inside a clinical encounter, I keep coming back to Formula One. A driver at race speed does not receive every data point the car is generating. They get tire temps, oil pressure, wind shear — the six or seven variables that matter most in that exact moment, surfaced at eye level in what is known as a heads-up display, so they can keep their focus on the track.

A telehealth dashboard should work the same way. Data like relevant patient history, active risk factors and behavioral signals worth exploring, all fixed at the top of the screen. Something buried in a clinical note from two years ago that has not been relevant for months could resurface the moment the conversation makes it useful again.  The goal of AI in behavioral health should not be to simply accelerate care delivery but to increase the signal-to-noise ratio inside each clinical moment.

The provider never has to look away from the patient to find it, and the patient never loses the sense that the person on the other side of the screen is fully present. In behavioral health especially, where the therapeutic relationship is the mechanism of care, the quality of that connection often determines whether treatment actually works.

The value of presence

A JAMA Network study published in October 2025, with data collected in 2024, on ambient AI scribes found that documentation load directly erodes the attention providers can bring to each encounter. Clearing that load only to fill the time with more appointments trades one problem for another.

Providers need time between encounters to process what they heard, notice what did not get said and carry genuine context into the next conversation. That kind of reflection is where clinical judgment actually develops and is exactly what gets squeezed out when efficiency becomes the primary design constraint.

Patients who feel that a provider is fully present are more likely to disclose accurately, follow through on treatment, and stay engaged over time. AI designed around that outcome becomes a powerful tool that actually earns its place in the workflow.

Formula One teams do not build heads-up displays to increase the number of races a driver competes in. They build them to make each race winnable. The industry would do well to borrow that distinction.

Oracle’s ‘beat the Street with a club’ Q3 performance

March 11, 2026 | by

Oracle had good news yesterday. Its Q3 2026 closed with strong earnings per share ($1.79 adjusted EPS versus expected $1.70), GAAP adjusted EPS at $1.27, and revenue topping $17.19 billion versus the expected $16.91 billion. All three were up versus prior year by 20% or more for the first time in 15 years. They had $8.9 billion in total cloud revenue, including infrastructure and SaaS, beating analyst estimates of $8.85 billion. Q4 revenue is also expected to grow in the 20% range versus prior year, while EPS in the 17-20% range. Oracle’s Q3 closed 28 February, making for an unusual quarterly structure.

For FY2026, Oracle projects revenue of $67 billion and capital expenditures of $50 billion. FY2027, starting 1 June, is pegged at a stunning $90 billion, again beating industry analysts’ consensus of $86.6 billion. 

In terms of financing and raises, Oracle last month had announced that they intended to raise an additional $50 billion dollars in debt and equity financing. Beyond this, they do not expect to issue any additional bonds in CY2026. There is a substantial backlog of what’s called “Remaining Performance Obligations” that more than quadrupled to $553 billion from a year earlier, but from the release, “Most of the increase in RPO in Q3 related to large scale AI contracts where Oracle does not expect to have to raise any incremental funds to support these contracts as most of the equipment needed is either funded upfront via customer prepayments so Oracle can purchase the GPUs, or the customer buys the GPUs and supplies them to Oracle.”

Overall, it looks like a good year for Oracle as they focus on cloud and AI infrastructure. But the stock, which rose late today by 8-10%, still is beaten down 50% from its high last September. There is still a lot of skepticism by Mr. Market about hyperscaling AI, how fast this can be done, profitably, and specifically about Oracle’s hefty debt burden. 

There is not one word about Oracle Health, either in their release or on reporting this Editor has reviewed about the investor call–or about layoffs which would impact Q4.  Yahoo Finance, CNBC

Oracle’s rock-and-hard place in Abilene TX: building out a data center with Nvidia chips that are already obsolete–and the financing it takes (updated)

March 10, 2026 | by

Another mystery solved, not looking good for Oracle. In yesterday’s update to pending record layoffs at Oracle, affecting Oracle Health, new reporting mentioned the breakdown of Oracle’s expansion agreement with OpenAI in building out a leased data center for OpenAI in Texas. Additional details have now come to light in reporting by Bloomberg (hat tip to Brody Ford and team), with separate reporting by CNBC.

The overall impression is not a good look for Oracle. This analysis combines both articles from their sources, plus additional background.

  • The location is part of a 1,000 acre site in Abilene. It is not just any datacenter build site. It is the first part of the $500 million Stargate Project, announced last year by the White House–a multi-year, public-private initiative with the objective of creating leading AI infrastructure within the US. The initial equity funders are OpenAI, Oracle, MGX, and SoftBank. OpenAI release 21 Jan 2025
  • Several parts are already built by the developer, Crusoe, and are up and running. But power for much of it won’t be on for another year.
  • Oracle has already filled the Abilene site with servers which are used by OpenAI for training and deployment. These facilities are on track.
  • Oracle, Crusoe, and OpenAI had been discussing since midpoint 2025 about expanding the facility by almost double, from 1.2 to 2 gigawatts of power demand. (See below for explanation of how big a gigawatt is.)

The differences between Oracle and OpenAI, two of the Stargate equity investors, apparently center on timing for opening the expansion site, which won’t be till next year; the use of a now older generation of Nvidia chips; and Oracle’s financing for the site. There are also differences with Crusoe, the developer.

  • Oracle had already committed to the site expansion, ordered the hardware, and already spent billions on construction and staff. The processing power would be based on Nvidia’s Blackwell chips.
  • The problem: Nvidia is now bringing out chips every year. It is already producing its Vera Rubin* chip, unveiled at January’s CES. Vera Rubin delivers five times the inference performance of Blackwell. Inference is critical to AI actually doing a job based on real world data.
  • OpenAI was not happy about being tied to Oracle’s commitment to Blackwell, already a less powerful and capable chip. There was also Oracle’s unhappiness over OpenAI’s often-changing demand forecasting.
  • Crusoe was also unhappy about the current Oracle facility’s downtime for days during the winter, attributed to weather affecting some of the liquid cooling machinery. This points to Oracle’s planning and building leading to reliability problems.

Three part unhappiness=plan cancellation. Meta is considering leasing the expansion site, brought to Crusoe by Nvidia, according to Bloomberg’s sources.

The ‘hard place’ that Oracle is in is this: the construction of data centers and their power sources is a 12 to 24 month taffy pull. At minimum. Things change in that time, like chips. Meanwhile, one ‘rock’ is that computing power for AI, whether Nvidia or AMD, is growing every year. First line AI companies like OpenAI (or Anthropic for that matter) want the latest, because that is critical to their business. Another ‘rock’ that Oracle has is that the datacenters are being financed via at least $100 billion in debt. Google, Amazon, Meta, and Microsoft are able to finance datacenter builds via their cash-generating businesses, even if this hyperscaling means that the cash cows become somewhat starved for feed. Oracle has to advance money in construction and equipment it must raise in debt markets for a return that may come in a year, two, or even more. [TTA 5 Feb] In other words, Oracle is in a tight spot compared to competition. The likely solution? Further downsize its businesses and employees to afford the Ellisonian Transformation as noted yesterday. 

The ‘rub’ of course is that what the OpenAIs and Anthropics want–the latest and greatest chip in their datacenters–isn’t possible in the brick-and-mortar world. Not even if you have tremendous cash flow out of your faucets and Blackbeard’s Chest in your bedroom.

Update 10 March: Oracle denies all of the above reporting. Here is Oracle’s reply on X.

Recent media activity about the Abilene site are false and incorrect. First, Crusoe and Oracle are operating in lockstep to deliver one of the world’s largest AI Data centers in Abilene at record-breaking pace. Two buildings are completely operational and the rest of the campus is on track. Second, Oracle has completed leasing for the additional 4.5GW to deliver on our commitments to OpenAI.

Unpacking this, Abilene is already a center for Oracle and OpenAI, as noted above. The expansion was only supposed to be 2 gigawatts, not 4.5, but Oracle and OpenAI have other sites that this could be referring to.

In effect, Larry Ellison, a 40% shareholder of Oracle, should bet the farms, the boats, and Lana’i to make these AI datacenters happen–if he really believes this is the future. Will he? And will they be revenue positive–quickly–to pay off the bet? Mr. Market’s stock price is still stuck on skepticism.

A corollary issue: there is major pushback against datacenters, rising up like daffodils in the early spring, but far less beautiful:

  • Extreme power consumption of datacenters causes rising rates for commercial and residential users. The Crusoe Oracle facility, according to the Bloomberg article, uses about 1.2 gigawatts and was seeking to expand to 2 gigawatts. One gigawatt is equivalent to one nuclear reactor and power to 750,000 homes.
  • Their massive, brutalist landscape footprint. If you like warehouses, you’ll love datacenters filling what used to be fields.
  • Their low employment after they are built, the scale of tax incentives that are being dished out, versus the capital investment required. This article from Futurism reports that one heavily subsidized datacenter facility run by Ark Data Centers in Ohio will employ upon completion exactly 10 people. Yet it is being heavily subsidized by Ohio through a 50%, ten-year sales exemption covering mainly new equipment–estimated to total $4.5 million. That is $450,000 per person over the 10 year span, or $45,000 per year subsidizing generally lower wage jobs in IT and security. One cited analysis, which could be exaggerated, indicated that in Virginia, one datacenter job took 100 times the capital investment for similar jobs in other industries. (Editor’s note: yes, these are single analyses and could be biased, nor factor in cash flow.)

Returning to Oracle, we await another shoe drop today on their earnings, projected layoffs, and their impact on Oracle Health.

*Named after the pioneering American astronomer, known for her work on galaxy rotational rates and the discovery of ‘dark matter’.

Breaking–Oracle to lay off thousands due to AI data center cash crunch, possibly as early as next week. What’s next? (Updated)

March 6, 2026 | by

We now know another piece of the puzzle on why so many Oracle Health top executives have departed. Bloomberg’s Brody Ford has followed up his earlier report on five departures  of key executives at Oracle Health [TTA 3 Mar] with the not-unsurprising news that there will be thousands of layoffs at Oracle, starting as early as this month. The reason why is Oracle’s aggressive expansion into data centers and the shortage of free or loaned cash available for that expansion, necessary to remain competitive in cloud computing with Amazon and Microsoft. (That situation, and the speculation around it, is explored in more detail in our article here.)

The pennydrop was as early as last September in a filing, according to Mr. Ford. It was estimated in the filing that $1.6 billion in restructuring costs will hit this FY, which ends in May. Oracle as of last May had 162,000 employees worldwide.

According to Mr. Ford’s sources, the layoffs will not be the ‘usual’ rolling layoffs, but wider reaching. He cites an internal announcement that “it would be reviewing many of the open job listings in its cloud division.” Some of the cuts will be targeting jobs Oracle needs fewer of because of AI. He cites the reception of Microsoft’s AI-related layoffs and Block, Inc, founded by CEO Jack Dorsey, laying off nearly half of its staff due to supposed leaps in AI (but more likely due to ballooning hiring not compatible with cash flow).

The scuttlebutt on Reddit indicate the cuts could be as high as 20% with the US operation hard hit, and strike as early as next week. Since Oracle has not been shy about cutting jobs over the years (see Mr. Ford’s article), this high number is a surprise. Another bit of information gleaned off Reddit is that the OHAI reporting line has changed from TK Anand to “Clay”–possibly co-CEO Clay Magouyrk, versus Mike Sicilia who testified before Congress two years ago when the VA implementation cratered?

Editor’s analysis and opinion: With five major executives leaving OHAI (Oracle Health and AI), she continues to believe that many of the cuts will hit the health area. Yet OHAI is the area that has taken tons of flak from current customers, from Congress on Veterans Health, from the VA, and from health systems. 

  • Oracle has major Federal contracts. The prominence of the VA contract and rollout timing makes cuts in this area problematic. Just because EHR problems have supposedly been fixed and that both the VA and Oracle are set to roll it out, VISN by VISN, does not mean that AI can do it. It is a long and customized implementation due to the sheer number of VA locations and diversity of functions [TTA 8 Feb]. And for that, you need people with deep experience and buckets of patience who know the system and can get along with their Federal counterparts. VistA in over two decades of implementation was so highly customized for both patient care and additional areas such as research that Oracle, in replacing it to VA satisfaction and to be better than VistA, has to accommodate a lot of, shall we say, discovery along the way.
  • In health systems, the discontent with Oracle was about declining vendor partnership and communication. This points to problems with people and continuity. This was highly apparent in the KLAS survey from October 2025 cited here. When half of the interviewees tell KLAS that they would not buy the system again, that is disastrous.

Apparently missing in action is Seema Verma, the general manager of OHAI.

When your current customers providing your business and cash flow are restive, yet what’s coming out of Oracle has been about 1) refocusing on cloud computing and AI datacenter contracts, not health, 2) massive job cuts to pay for them disproportionately affecting Oracle Health, 3) rumors about a sale of Oracle Health to pay for the datacenters, and 4) still paying a $1.4 billion dividend to shareholders that largely benefits Larry Ellison, holder of 40% of stock–what are the next pennies to drop? Stay tuned!

Sources for this article: Bloomberg, Investor.com

Updated 9 March. SimplyWallSt pegged the layoffs at 18%. One of Oracle’s data center contracts is with OpenAI, but they canceled a large planned AI data center expansion in Texas. Other potential tenants, including Meta, reportedly are interested in the site. Their analysis depicts Oracle as “trying to reconcile very large capital commitments to AI data centers, negative cash flow pressure, and debt and equity raises, with the operational reality of supporting customers such as OpenAI, xAI and Meta.” Yet they are aggressively pushing AI through promotion in healthcare, F1 racing, and construction. Their rock-and-hard place is making commitments versus not having the cash to quickly fulfill them. This returns to our 5 February report. Tuesday is the day that Oracle reports results.

Oracle’s Ellison set last quarter the company’s transformation as three steps: From the Fortune article:

  • Oracle making its database available inside its competitors’ clouds, including Amazon’s AWS, Alphabet’s Google, and Microsoft’s Azure.
  • “Vectorizing” the data to make it readable by AI models, which makes the data customers have in Oracle’s systems more valuable.
  • Building an “AI Lakehouse,” which vectorizes all a company’s data and not just what’s in Oracle databases or applications.

But what if you don’t want your data ‘vectorized’ to be read by AI models? Something called proprietary information and data comes to mind, like business and marketing plans. What about PHI and PII? Those could be the danger points to consider in this ‘transformation’. (Forgive me for being oh-so-tired of ‘transformation’–the last time Mr. Ellison trumpeted this was for…Oracle Health, which may be hollowed out to finance this.)

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

AI failing–at present–to lower costs, grow revenue, improve efficiencies. Yet it’s full speed ahead: Deloitte, PwC surveys

January 27, 2026 | by

When the business process outsourcing (BPO) leaders pour lukewarm water over AI, one hears the air leaking from a bubble. BPOs have been a key part of the hype around AI as a business solution. The McKinseys, Genpacts, Deloittes, and PwCs for years have touted AI and as a result, made large consultancy fees. AI now proliferates for every business problem. Whether it’s generative, (still kicking around) machine learning, NLP, LLMs, agentic, robotic process, and now sovereign AI (domestically developed and powered)–it’s been positioned as the solution for simplifying processes and reducing administrative burden. Of course, a fair chunk of this involves getting rid of those pesky human factors in overseeing whether these new systems and software actually work, or reducing them to the lowest cost possible, to pay for all the AI spend.

Unfortunately for the BPOs, their customers are telling them that AI Is Not Quite All That. In fact, for the money they have spent, it hasn’t performed. Yet. But they remain optimistic, a neat bit of cognitive dissonance or perhaps justification.

The Deloitte global survey of 3,235 business and IT leaders confirms the gloomy news to date–yet it’s full speed ahead. Only 20% have experienced revenue growth as a result of AI. Transformation is coming along slowly; 25% of those surveyed believe that AI is transforming their organizations, which corresponds to 84% not redesigning jobs or work around AI capabilities. In this area, there’s a lot of resistance. While 55% of workers are reportedly open to AI technology, only 13% of workers are highly enthusiastic about AI, 21 percent would prefer to avoid it, and 4% actively distrust it. There’s also a lot of pilot-itis. Only 25% report shifting 40% or more of their AI experiments into live use, though optimistically they project that will increase to 54% in three to six months.

Yet they’re justifying AI. Totally. 66% reported that it improves productivity and efficiency, which contradicts the low revenue growth. 58% of companies are already using it to some extent, with adoption to hit 80% within two years. 74% of companies plan to deploy agentic AI within two years, even though only 23% are using it now and 21% have a model for governance of autonomous agents–a high risk level. 42% believe their strategy is ‘highly prepared’ for AI adoption. Another part of AI adoption has surfaced–sovereign AI, to reduce dependency on foreign sourcing, vendors, and infrastructure. 83% reported that this was at least moderately important to them. The Register 21 Jan, Deloitte’s State of AI in the Enterprise report (PDF, January 2026) 

PwC’s larger survey of 4,454 business leaders in their 29th Annual Global CEO Survey contains gloomier and more detailed feedback for AI advocates. “Most CEOs say their companies aren’t yet seeing a financial return from investments in AI.” Only 30% reported increased revenue and 26% saw lowered costs. More than half–56%–did not see either lower costs and higher revenue. 22% reported an increase in costs due to AI.

Another finding is that isolated AI projects aren’t delivering value. Companies lack a clear strategy in building AI foundations such as clearly defined road maps and sufficient levels of investment​​.

A relatively small proportion of their surveyed CEOs say they’re applying AI to a large or very large extent to areas such as demand generation (22%); support services (20%); the company’s products, services, and experiences (19%); direction setting (15%); or demand fulfilment (13%). In a previous survey, only a tiny minority of workers–14%–are using generative AI daily. PwC’s report goes on to identify many other factors reshaping global business and influencing growth, in context confirming that depending on AI as a quick fix is not paying off.  The Register 20 January, PwC 29th Annual Global CEO Survey (January 2026).

Reality tends to bite. Many of last year’s corporate layoffs were attributed to heavy AI investments that weren’t paying off, but books needed to balance by year’s end and it was taken out of human capital. Layoffs are projected to continue across all industries in 2026. Books balance another way, though. The AI bubble is deflating from Inflated Expectations into the early stages of the Trough of Disillusionment. How long it will take to move to the Slope of Enlightenment is anyone’s guess–two years, five, a decade? The useful tool of the Gartner hype cycle strikes again–as it did with telehealth and health tech. Separately, we’ll be looking at OpenAI’s ChatGPT for Healthcare and Anthropic’s Claude for Healthcare.

Short takes: HHS forms NIH/CMS autism data project; Oscar Health beats Street w/Q1 $275M net; Centene’s $1.3B earnings; UHG has class action suit on earnings, 1K AI apps in production; Cedars-Sinai and Redesign Health partner on development; FDA, Lilly, Novo Nordisk win vs. compounders

May 8, 2025 | by

NIH, CMS to create autism data platform to enable research. The National Institutes of Health (NIH) and the Centers for Medicare & Medicaid Services (CMS), both under Health & Human Services (HHS), are partnering to enable NIH to build a real-world data platform. The purpose is to advance research around the root causes of autism spectrum disorder (ASD) that now affects 1 in 31 US children, according to HHS. The data gathered include claims data, electronic medical records, and consumer wearables focused on Medicare and Medicaid enrollees with a diagnosis of ASD. The first step establishes a data use agreement under CMS’ Research Data Disclosure Program.

Researchers will focus on autism diagnosis trends over time, health outcomes from specific medical and behavioral interventions, access to care and disparities by demographics and geography, plus the economic burden on families and healthcare systems.

The pilot program, intended to be a model for other conditions, will create a secure tech-enabled mechanism to enhance data sharing with timely, privacy and security compliant data exchange.  HHS release, FierceHealthcare

Payers, other than UnitedHealth, had an upbeat Q1.

  • Oscar Health, the feisty provider of ACA exchange individual and small group plans, notched a Q1 net income of $275 million with adjusted EBITDA of $329 million on revenue of $3 billion, up 42% from Q1 2024. Membership exceeded 2 million, up 41% from prior year. The ever-feisty CEO Mark Bertolini (center) railed on the earnings call against a shortened Federal enrollment period cutting off at 15 December versus January, as well as other enrollment changes. Oscar release, FierceHealthcare
  • Centene Corporation, one of the main rivals to UnitedHealth Group and a significant player in Medicaid state plans, had a decent Q1 turnaround with $1.3 billion in earnings and a  17% jump in premium and service revenues to $42.5 billion from $36.3 billion in Q1 2024. Their current membership versus Q1 prior year was down about 500,000 with the losses in Medicaid and traditional Medicare. They also increased their 2025 premium and service revenues guidance range by $6.0 billion to a range of $164.0 billion to $166.0 billion due to ACA exchange plans and Medicare Advantage (MA) revenue forecast performance. However, it’s projected by analysts that Centene will exit the Medicare Advantage market after this year in Alabama, Massachusetts, New Hampshire, New Mexico, Rhode Island and Vermont–about 3% of MA membership. CEO Sarah London criticized proposed cuts to Medicaid. Centene release, HealthcareFinance
  • UnitedHealth Group, after an anemic Q1 financial report driven by increased utilization and rising costs, cut its 2025 earnings per share (EPS) guidance by 12% to between $26 and $26.50 (Healthcare Dive). This just in: a shareholder group filed in Federal Court in the Southern District of New York on violations of securities laws affecting share price. It centers on the 2025 financial guidance provided prior to Brian Thompson’s assassination and how group CEO Andrew Witty did not account for: 1) the impact of that act but doubled down on the EPS forecast, 2) the increased scrutiny around the company for denials of claims even prior to the act, and 3) the general ill will generated as more information reached the general public. The affected group are those shareholders purchasing UHG stock between 3 December 2024 and 16 April 2025. Healthcare Dive, SDNY filing
  • Meanwhile, UHG has doubled down on AI development, totaling over 1,000 apps. According to a report in the Wall Street Journal, the company has these apps in production in their health delivery and pharmacy units, transcribing conversations from clinician visits, summarizing data, helping process claims, powering customer-facing chatbots, and in engineering to write software. According to chief digital and technology officer Sandeep Dadlani, half of the apps use generative AI and the remainder a more “traditional” form, without explanation of “traditional”. According to Dadlani in the article, “AI has a role to play in the claims evaluation process, but it will never be allowed to deny a claim”. Software, not necessarily AI powered but usually rules-based or using algorithms, ‘auto adjudicate’ 90% of UHG claims. UHG was sued in Federal Court as far back as 2023 in using an AI-powered application to evaluate and deny claims.

Redesign Health gets freshened up with a Cedars-Sinai partnership. Redesign Health is a combination funder and company builder which has launched over 60 healthcare-related companies, some clear successes such as Calibrate (weight loss) and Jasper Health (cancer care navigation), with others on the development curve such as Vault Health and Uptiv Health. They announced a partnership with the Cedars-Sinai health system in Los Angeles to add their clinical expertise and innovative research. Other strategic value additions through the new partnership are tapping into funding support, access to clinical environments within Cedars-Sinai’s network, and their dataset for validation of technologies and design. Redesign release

And in the pharma compounders versus Big Pharma war, the former have lost two battles. The compounder’s trade group, the Outsourcing Facilities Association (OFA), had separate lawsuits filed in Texas to force the FDA to reclassify both tirzepatide and semaglutide as still in shortage, which would permit compounding pharmacies to produce weight loss drugs with these active ingredients. The Texas judge found yesterday (7 May) for both FDA and Eli Lilly, the producer of Zepbound, that tirzepatide was no longer in shortage, which closed the door on the OFA. At the end of April, the same Federal judge ruled against the continued compounding of semaglutide, the active drug in Novo Nordisk’s Wegovy and Ozempic [TTA 27 Feb]. 22 May is the end date for the large compounding pharmacies for semaglutide, while smaller state-based compounders must cease immediately. Biospace 8 May, 25 April  Novo Nordisk’s new partnerships for Wegovy-based weight loss prescribing: TTA 1 May, 8 May

Teladoc responds to Blue Orca’s report on BetterHelp’s AI ‘therapy’ (updated)

February 25, 2025 | by | 2 Comments

Teladoc formally responds to the Blue Orca Capital research report [TTA 25 Feb]. Their letter (PDF) via its legal counsel (King & Spalding) yesterday refutes Blue Orca’s allegations in a report on their stock (TDOC) that a “meaningful” number of BetterHelp patients are receiving AI therapy from therapists in the form of text/asynchronous and live messages, calling them “vague and unsubstantiated”.

The policy stated by Teladoc, quoted directly from this letter (Editor’s notes):

  • BetterHelp expressly prohibits therapists from disclosing any member personal or health information to third-party AI. (Editor’s emphasis)
  • BetterHelp has a Trust and Safety team dedicated to the detection and prevention of non-compliant use of AI and, if anything, has structured its platform (and its incentives to therapists) to promote live video calls over asynchronous messaging. (Another point made by Blue Orca)
  • BetterHelp’s Privacy Policy provides further disclosures to members concerning its AI practices. (The Privacy Policy is at the end of Section 1 Data Collection and Processing, and is specific as to AI being used for ‘manual, repetitive tasks’ in processing and to “help therapists manage and document sessions more effectively”.)

Readers will note that this Editor called Blue Orca’s statements in its report about AI therapy “allegations”. I also noted that Blue Orca was a short seller. I later clarified what a ‘short seller’ is and that short sellers profit when the stock goes down. Short sellers are also prohibited by securities law from spreading false information about a stock for the purposes of profiting from its decline (Rule 10b-5 under the Securities Exchange Act of 1934.)

The Teladoc counsel letter to Blue Orca Capital addresses other allegations in the Blue Orca report about their changes in reporting practices in FY 2022 that supposedly inflated Teladoc’s profitability. These are outside the scope of both articles and will not be commented on here.

Disclosure: Teladoc reached out to this Editor, supplying information about their response including the King & Spalding letter.

This Editor hopes, and would like to see confirmation, that any BetterHelp therapist using third-party AI to respond to patients in providing direct therapy, versus Teladoc/BetterHelp supplied management tools, customer service information, or security tools, is disciplined and released. The integrity, privacy, and security of a telementalhealth platform is essential to its operation and the confidence of its patients–and should be publicly confirmed.

Update: In response to this article, a spokesperson from Teladoc Health further elaborated:

“To be clear, BetterHelp expressly prohibits therapists from disclosing any member personal or health information to third-party AI. BetterHelp has clear, rapid processes for members to report negative experiences, switch therapists, and cancel memberships, when requested. If a therapist is found to be practicing in an unethical manner, they are investigated and terminated from the platform. The overwhelming majority of members stay with their matched therapist, even though they are free to switch their therapist at any time.” 

News roundup: DOJ investigating UHG on Medicare Advantage billing upcoding; Teladoc’s BetterHelp therapists using AI?–a short seller alleges; Hims whacked by FDA ending compounded GLP-1s (updated); some fired FDA staffers in CDRH reinstated

February 25, 2025 | by

UHG’s annus horribilis gets more horribilis. News broke on Friday 21 February via the Wall Street Journal (paywalled) that UnitedHealth Group is reportedly under investigation by the US Department of Justice–again.  The DOJ is looking at UHG’s billing practices for members covered by UnitedHealthcare Medicare Advantage (MA) plans on diagnoses that were made to generate extra payments, a practice known in the industry as upcoding. This also involves the many practices that UHG owns or has relationships through Optum, about 10% of primary care practices. These practices are receiving visits from DOJ investigators, certainly something that would strike some fear into any doctor’s or practice manager’s heart. 

The WSJ reported that two providers cited in their article provided documentation, while another person said that the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) is involved in the probe.

It’s a real Mound of Misery for UHG.

  • MA plans and their set rates for additional benefits not covered under original Medicare have been under HHS/CMS scrutiny in the past year, and health plans have been running higher costs than anticipated as covered patients have returned back to care.
  • UHG’s OptumRx unit last year was reported as under investigation on antitrust grounds.
  • Optum’s Change Healthcare (contested by DOJ but approved) is still recovering from an unprecedented hacking and ransomwaring, with the huge expense of restoring systems plus notification and providing a reported 100 million with free credit monitoring services.
  • The proposed $3.3 billion deal with Amedisys for home care continues to be delayed by the DOJ antitrust suit.
  • Their UnitedHealthcare president was assassinated in New York, and his (alleged) killer is starting his trial here, a spectacle which will go into the summer. But the issue that supposedly tipped off the murder–claim denials and denials of care due to policies and the use of AI, isn’t going away–jumping in the fray is megainvestor Bill Ackman.

While Federal involvement with health plans comes with the territory, the adversarial relationship with DOJ far exceeds the norm. The share price reflects it, having cracked 26% in the past six months. Those accepting the 30,000 buyouts on offer may be grateful if they take them. CNBC, FierceHealthcare

Another backwash from the use of AI? Teladoc is receiving some bad publicity it can ill afford. There are allegations of their therapists using AI-drafted responses with patients–and this apparently is becoming more frequent. It’s been percolating on social media boards such as Reddit (see example here) for some time. The latest is a report from a short seller* of Teladoc, Blue Orca Capital, that alleges that BetterHelp therapists not only use ChatGPT for text responses outside of live sessions (messaging), but also during live chat sessions. This goes against Teladoc’s own stated policy against AI therapy as ‘dehumanizing’  in a lengthy blog post ranging from social media to job loss as a result as AI. Blue Orca includes first hand information from two BetterHelp patients, an allegation from a competitor that BetterHelp doesn’t care, and that therapists are actually incentivized on the word length of responses they give to a patient, overloading their schedule, and being available 24/7 to patients paying a reported $400/month. Given BetterHelp’s prominence in Teladoc’s earnings–according to them “accounting for 40% of the Company’s revenues and adjusted EBITDA since FY21”, adding in their other financial factors, their dim view is jarring if you like or own TDOC.  Developing. Hat tip to HIStalk 2/24/25

*Editor’s note: Blue Orca Capital, as a short seller, profits when a stock goes down. Blue Orca has a short position in TDOC. So our Readers should take their position into account. Short sellers are also prohibited by securities law from spreading false information about a stock for the purposes of profiting from its decline (Rule 10b-5 under the Securities Exchange Act of 1934.)

The Feds giveth and taketh away Hims’ weight loss business. Updated information. Friday’s good news was that FDA has reclassified the shortage of semaglutide, the active ingredient in GLP-1 drugs, as ‘resolved’, meaning It’s Over and it’s easier to get your Wegovy, Ozempic, Zepbound, etc. prescription. The bad news is that online prescribers that were authorized by FDA to use less expensive compounding to approximate or customize the branded versions of these drugs for weight loss, are now prohibited from doing so. They have till April or May to transition to branded injectable versions. This affects the bottom line of all these telemedicine prescribers such as Ro, Weight Watchers, Future Health (a heavy local radio advertiser), 23andMe, and Hims & Hers. Hims, the showiest in class, took a breathtaking 25% hit on their stock between Friday and Monday.

It is not only cost of branded drugs but also that so many competitors have jumped into the field, creating another shortage of the branded drugs, that looms. Suppliers of compounded drugs, the high volume compounding pharmacies (not your corner pharmacy that does compounding based on Rx), may be reluctant to continue supplying telemedicine prescribers in reasonable fear of FDA action or pharma lawsuits that could put them out of business.

Hims also publicly took the hardest line against the pharma companies, implying in their now infamous Super Bowl commercial that their obesity drugs are priced “for profits, not patients”, unlike Hims’, of course. Novo Nordisk, the Ozempic and Wegovy manufacturer, in turn has taken a hard stance against the compounders pointing out that a compounded version isn’t standardized nor FDA-approved for safety and efficacy.

A custom, compounded version of a drug can only be sold when there is a shortage or if the branded drug is in some way inappropriate for the patient requiring a customized version, e.g. with adjusted dosage, method of dosing, or added/deleted ingredients. Look for Hims and other telemedicine prescribers to start pushing this POV. FierceHealthcare, MedCity News

Some FDA reviewers reinstated after DOGE cuts. The ~230 probationary and other employees who were let go with severance then partially reinstated are reported to be reviewers in the CDRH (Center for Devices and Radiological Health). The 183 reinstated reviewers are actually funded by the industry through the Medical Device User Fee Amendment (MDUFA) agreements to help speed the review and approval process. There is considerable confusion about this because phone calls went out over the weekend but as of today (Monday) there is no written confirmation from HR or the Office of Personnel Management (OPM). It remains murky as do layoffs in the rest of HHS. FierceHealthcare, Endpoints

A year’s end newsletter to our Readers: a few wishes for Under the Tree, a few Quirky Predictions for 2025

December 19, 2024 | by

It’s hard for your Editor to believe, but this is actually the 15th year since Steve Hards was most kind and invited me to contribute a few articles to what was then simply Telecare Aware.

A lot has happened since then, professionally and personally. I’m grateful for the opportunity that TTA has given me to Cover the Healthcare Waterfront, relying on multiple sources from super-local to Mainstream News to the Usual Sources. 

Most of all, this forum (and it is one!) stays true to the course that now Editor Emeritus Steve set some years ago:

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.

In that, though I’ve occasionally gone far afield (and down some rabbit holes) into exclusively US issues such as how healthcare gets paid, its politics, and the financial landscape (from bubble to devastation to recovery), I believe they hold true in the UK and in other countries. 

So one wish I have from Santa for 2025 is for More Comments. I’m very interested in knowing what you think about topics that are covered and your take on them. Using hits as a guide, it is hard to predict. Sometimes it is breaking news, a major data breach, or Walgreens’ continuing soap opera. Perhaps you want more audio commentary or article audio files, which I’ve experimented with via Soundcloud. So…What do you think?

A second wish: for other writers to join me here as lead/topic providers or better, contributors, for news outside the US. Specifically, I believe Readers want to know what is going on in the UK and Europe, but ‘standard sources’ are either not focused on health tech, paywalled, or overly specific ‘inside baseball’. Steve and I have long recommended Roy Lilley’s newsletter and UK Telehealthcare.

So…if you know of reporting on UK or EU issues, please direct me there. Better yet, contribute an article! Or two! We are small and cannot pay, but if the facts are there and the writing is sound, you’ll be published and can republish elsewhere. (This is exclusive of Perspectives, which are non-promotional thought pieces contributed by companies’ marketing areas. And we thank them!)

A third wish: speaking of marketing, I am a marketing and communications consultant by trade. Yet I am very shy about putting my shingle out there and asking Readers for leads to companies that might need marketing help, short-term or long term. My LinkedIn profile has most of my CV and key information on what I’ve done and where I’ve worked, but for a full overview about my capabilities across branding, program, planning, and products, email me here. 

Now for the Quirky Predictions–I’ll keep it short and open to debate:

2025 will continue international rebuilding of companies in healthcare and health tech. But the tear-downs will continue to clear the table. Overall, there’s optimism in the air with a new administration. It doesn’t feel like a rerun of 2023 where everyone thought it was going to be Romping Unicorns post-pandemic and the Big Guns were snapping up Big Buys like Signify Health and Oak Street Health for Big Bucks. We know now how that worked out for Walgreens, CVS, Walmart, and even Amazon (which I predict will be rethinking–and retrenching). We are starting from a low level and hopefully leveling up from there.

That doesn’t mean that there won’t be more Shotgun Mergers by VCs that avoid the new merger guidelines and a few Chapter 7s and 11s (UK=administration) along the way. There will be more layoffs. Funding rounds for both healthcare and digital health will be moderate. Down rounds that reduce valuation will still be with us. Investors will push for more control–witness what is happening at Walgreens and CVS, and what happened at Centene.  There will be more big changes at Walgreens, CVS, Elevance, Centene, Cigna, and many others considered mainstays of healthcare–and don’t rule out Amazon and Walmart. But by the end of year, barring a Bird Flu Pandemic, space aliens landing from the Plague of Drones in US and international skies, or an Unraveling of Sanity, overall we will be doing a lot better.

Robert F. Kennedy Jr. will be turning up the heat on Health. He will be confirmed as head of Health and Human Services and will, within a year, refocus it along its name. Health rather than Sick Care. A lot of substances ranging from vaccines to PFAS to various dyes and additives in food will be questioned at FDA, restricted, and brought to the national consciousness. As a personality, he is extremely intelligent and dynamic–knows how to absorb the most complex information and move on it. He knows that Make America Healthy Again is his Main Chance and also to be true to his legendary father’s legacy. It will make a lot of drug and chemical companies rather…nervous. (I am less sanguine about Dr. Mehmet Oz as head of CMS and his ability to clean up that puzzle palace, but hopeful.)

Speaking of heat, I wouldn’t want to be a C-level at any of the major health plans that are in multiple lines of integrated business.  The assassination of Brian Thompson and earlier the massive Change Healthcare hack ripped the cast and bandages off the entire system. The sheer hostility to payers was startling enough for UHG CEO Andrew Witty to write a massively defensive op-ed in the NY Times–and the hostility has hardly dimmed with the jailing of Luigi Mangione who has turned into a folk hero to some. (Yeesh! I cannot think of anything less moral.) The incoming administration and Congress are restive and major changes will be coming from there. Already there is a bipartisan Congressional bill (the PBM Bill) requiring the divestiture of pharmacy benefit management (PBM) companies from insurers within three years. While it will not be passed by the 118th Congress, it will be reintroduced by the 119th after 3 January if you look at who is backing it. This is the kind of movement to simplify how healthcare is delivered and paid for that crosses ideologies and finds a wide spectrum of support from Bernie Sanders to RFK, Jr. and presumably the re-elected President. 

Once the PBM string is pulled, what then comes into focus is insurer ownership and control of providers. UHG/Optum owns or is affiliated (meaning ACO or partial ownership) with 10% of US practices. DOJ is already after UHG for the Change Healthcare acquisition on security grounds. The more aggressive posture around anti-trust will not change in this administration and only slightly moderate with a new FTC chair. (Lina Khan’s term has expired though she may try to hang on, but her bête noire Amazon is still in trouble with their One Medical Bad Bet.)  The few payer organizations that only offer health plans, like Molina, Oscar, and Clover, will start to look very smart indeed. Perhaps smaller and less controlling is actually…better. And more profitable.

Running in parallel: the lack of trust in Big Pharma and the cost of drugs from them. They’re next.

We will need to get much more realistic about AI, what it is capable of, and its social effects. It is spreading into everything like kudzu (try entering into most browsers) but what we will be finding out is that a lot of what is ‘AI’ sold to companies as labor-saving is half-baked. It doesn’t work well. Some of it falls into the ‘uncanny valley’ of unease as too humanoid. If a company or service relies on it for decision making, it may not make those decisions better than humans. Reportedly UnitedHealthcare uses AI for a claims decision model, something that is cited as flawed. Bad decisions incite human anger, and lack of human contact is like being in a perpetual voice jail.

There is also growing evidence that in writing and researching, over-dependence on AI prompts and drafts destroys the ability to remember and creatively connect both on the fly and under consideration, in the ability to move an argument logically to a conclusion utilizing persuasive writing and speech skills. This especially affects the young. I’m hearing reports on this from the hiring front, where young grads cannot write without AI assistance and are stunted in their verbal skills. AI in writing gets to be a crutch (I use a tool for grammar–and about 10% of the time it’s off.). And have we forgotten that AI is dependent on content….GIGO from the early computing days still applies. We don’t want to be the Eloi, do we? (Look up your H.G. Wells)

And one last prediction. The mass market weight loss fad hyping GLP-1 drugs (Wegovy, Ozempic, Mounjaro, Zepbound) will implode. These drugs are now readily available, less expensive (but certainly not cheap), and cheerily advertised on social media, radio, and TV by drug manufacturers and telehealth prescribers. These are promoted for weight loss alone, not for weight loss to better manage Type II diabetes or true obesity. What will pop the bubble? Side effects of slow digestion like stomach paralysis. Diarrhea, nausea, intestinal distress, even pancreatitis and suicidal ideation. Little known is that 80-90% of clinical trial participants experienced at least one adverse event. If you survive these, a weight gain rebound often happens once off the injections.

The telehealth prescribers like Ro and Hims make it so easy–and do they go through blood and other testing, and histories, to ensure that the patient is a suitable candidate?  Metabolic modifications ain’t beanbag.

A side business popping up: nutritional  supplements and ‘special drinks’ to prevent malnutrition (because of the low food intake) and muscle loss. (Another sign that GLP-1 is hitting a peak.)

Perhaps waiting in the wings are the class action lawyers, ready to jump on any massive side effects or, God forbid, deaths.

No ‘craze’–and this is one–is unalloyed bliss. If you have a diversified telehealth company like Teladoc and you get into this business, it may not make a difference (?)–but sole providers like Calibrate (among many) will feel the pain. And destruction. (Does anyone remember the much-touted Alli/Orlistat that reduced the fat absorbed by the digestive tract and those side effects?)

May you and your loved ones have a Merry Christmas, Happy Hanukkah, and a Happy New Year…however you and yours celebrate! We will be on a two-week break and return, along with many of you, on 6 January.

Rounding up last of 2024’s M&A/fundings: Redesign Health’s $175M, HEALWELL AI buys Orion Health, startup Tuva Health’s $5M

December 19, 2024 | by

The largest of the year-end fundings (so far) goes to Redesign Health. Best described as a designer and funder of startup health companies which are then spun off, Redesign gained a $175 million investment for a new fund from Declaration Partners, Euclidean Capital, and True North Advisors. Unlike your typical seed funder or incubator, Redesign takes an activist role in forming startups before spinning them off. Its model includes in-house experts to advise on formation, connecting the startup to existing relationships with healthcare organizations and demand generation systems, and access to networks of investors and talent experts. Redesign has used this model with more than 60 companies. These companies have had over 15 million patients and generated >$1 billion of revenue. The fresh funding will be used to start up new companies in eight areas, including ‘preparing for an aging population’. Release, MedCityNews 

Once spun off, the organizations are on their own. Some have been acquired: Jabra Enhance in hearing aids (GN Hearing) and Vault Workforce Screening (Sterling). One notably got into trouble–Calibrate, which was sold for $20 million in an October 2023 ‘reorganization’ to private equity firm Madryn Asset Management along with other investors [TTA 26 Oct 2023]. A pioneer in DTC telehealth programs for GLP-1 weight loss drugs, Calibrate was caught in the squeeze between scarcity of those drugs (Ozempic, Wegovy) and the entry of Teladoc, unable to fulfill its programs nor, at that time, to get insurance reimbursement. It is now benefiting from being in a very hot sector of weight loss drugs. Prior to the sale, Calibrate raised about $160 million in funding [TTA 15 Feb]. Interestingly, Calibrate is still listed in the Redesign portfolio including career openings.

Redesign itself had some rocky times earlier this year with their layoff of 77 from their New York-based staff of 200 to 250 (estimated). The cuts were from the areas that support new venture creation. The new funding is the first sign that Redesign is getting back into the business of forming new companies versus maintaining the portfolio.

New Zealand’s Orion Health to be acquired by Canada’s HEALWELL AI. The final price is NZ$200 million/CA$165 million (US$115 million) for 100% of Orion’s private shares. CA$86 million will be paid in cash and the balance will be paid in HEALWELL stock plus CA$20.5 million in a 3-year performance-based arrangement. Closing is anticipated to be April 2025, after Orion divests itself of non-strategic assets and the usual approvals by shareholders, regulators, and the Toronto Stock Exchange.

Orion Health’s products–Orchestral, Amadeus, and Virtuoso–are data exchange, patient record, and analytics platforms to benefit clinicians and patients. Their largest customers are in Canada, Australia, and New Zealand, plus the NHS in the UK, giving HEALWELL AI an international footprint. HEALWELL AI is based in Toronto and is an artificial intelligence company focused on preventative care through the early identification and detection of disease. Their release announcing the transaction is interesting because of the complexity of the funding (dare we say leveraged?). HEALWELL has $47.6 million in funding over six rounds (Crunchbase). It trades in the vicinity of CA$ 2.00 which gives it a valuation of CA$354 million. Mobihealthnews

Orion Health was last mentioned here with their win two years ago of Saudi Arabia’s health information exchange. The founder, Ian McCrae for the past 30 years, stepped down in August 2022 for health reasons. Replacing him was Brad Porter, his son-in-law. 

On the other end of the spectrum, Tuva Health emerges from stealth with $5 million. The round was led by Virtue, with participation from Box Group and Y Combinator, and notable health tech angel investors. New York-based Tuva has an open-source data model for healthcare analytics and data management to be used by healthcare providers, payers, life sciences companies, and research institutions as an open standard for healthcare data transformation. Their software gives users the ability to transform claims and EHR datasets into analytics-ready data tables via an open-source data model with built-in normalization, data quality testing, and enrichment. 1,500 experts are currently working in collaboration on the model. Their initial partnerships are with Oscar Health and CareAbout Health.  The principals and founders, Aaron Neiderhiser and Coco Zuloaga, are former senior executives from Health Catalyst and Strive Health. Release, FierceHealthcare