TTA’s summer of bombshells 5: Babylon’s Chapter 7, Cano Health’s disaster, Feds delay UHG-Amedisys, DocGo takes flak, Access buys Oysta, Exor’s $2.8B buoys Philips, future unicorns, more!



The bombshells don’t let up as Babylon Health is now in US Chapter 7 bankruptcy as well as UK receivership. Cano Health is likely the next there. DOJ and FTC delay UHG’s Amedisys buy. DocGo’s big NYC contract gets flakked up. Amazon Pharmacy does diabetics a solid with automated couponing. And there’s some bright spots with a pick of future unicorns, a big Italian investment in Philips, and Access Group’s Oysta buy. Plus weekend reading on the next unicorns and how streaming TV is like healthcare.

Weekend reading: Forbes picks the next $1B startups, is TV streaming analogous to the future of healthcare? (Yes, there may be unicorns, and the fracturing of TV and healthcare)
Week-end short takes: Amazon Pharmacy automating couponing of insulin and supplies, Mendaera imaging/robotics wins $24M, Access Group acquires Oysta (UK)
Babylon Health files for US Chapter 7 bankruptcy, winding down Babyl Rwanda and ending care for 2.8 million users (Hull loss for Babylon. Parting out starts 12 Sept)
Mid-week roundup: DocGo in NY migrant service trouble, more DOJ scrutiny of UHG-Amedisys buy, Exor now $2.8B lead investor in Philips (DocGo’s big contract brings big headlines in NY, UHG’s Amedisys delay a taste of things to come)
Cano Health at precipice of bankruptcy after disastrous Q2, lays off 700 (Waiting to hear from the Cano 3)

The summer of bombshells continues into August. The largest crater is left by Babylon Health’s merger collapse and US shutdown. Some optimism in Q2 financial reports but layoffs at larger companies surprise. Few surprises in KPMG’s healthcare M&A report. Bright Health may survive, as Clover and Oscar pivot too. And last week’s Big News of HIMSS and Informa has settled into Not Much Change and perhaps better. At least for now.

Healthcare M&A hit a 3 year low in Q2 2023, to the surprise of none: KPMG (Many reasons why-and we add a few observations)
Babylon Health shuts US operations, goes into UK receivership (At the end of the runway and into the lights)
Mid-week short takes: Amwell lowers 2023 outlook, DocGo goes up, Imprivata + PFH win Ireland HSE contract, Oracle Health’s Nashville move, layoffs at 23andMe, Doximity
Living to fight another day: insurtechs Bright Health, Clover Health, and Oscar Health report improved Q2s, H1s (updated) (Bright still at brink, but Clover and Oscar pivoting)
Babylon merger with AlbaCore and MindMaze collapses, selling UK and transitioning US businesses, bankruptcy anticipated (The deal fell apart fast)
More details on the HIMSS-Informa partnership on HIMSS24-Global Health Conference & Exhibition (Net-net–not much change and perhaps improvements)

This week’s Big News was the confirmation of the HIMSS deal with Informa–not a sale but a ‘partnership’–developing. CVS having some profitability problems and restructuring, minus 5,000–as is Oracle Cerner. Meanwhile, Congress tightly reins in Oracle Cerner EHRM in appropriations bill. And now you can run to Amazon Clinic without (much) concern about your privacy!

Short takes: CVS’ $1.12M Q2 net income loss, forecast spurs 5,000 layoffs; Signify’s in-home kidney exams; Indonesia’s Halodoc $100M D; FeelBetter raises $5.9M; Medicare breach hits 612,000 beneficiaries (When you spend like CVS, something’s gotta give)
House appropriates $1.9B for Oracle Cerner VA EHR modernization, $5.2B for telehealth, plus other technologies; Oracle lays off more Cerner staff (Congress reins in VA+Oracle Cerner)
Done (and split) deal! Informa to “manage” HIMSS Global Health Conference & Exhibition (updated) (It’s a partnership. Really!!)
More thoughts on the pending sale of the HIMSS Global Conference (Developing)
Amazon Clinic announces 50-state rollout 1 August. Were the privacy issues fixed? (Maybe, at least in disclosures)

Another few bombshells go off while a heat wave descends. It looks like the annual HIMSS conference won’t be HIMSS anymore. Another ‘David’ faces ‘Goliath’ in the Dorsata vs. athenahealth lawsuit. The FTC/HHS-OCR noose tightens on third-party ad tracker use. Positive earnings news from Teladoc, GE Healthcare, Talkspace, a lot of fundings–plus Nextech sold for $1.4B.

Legal roundup: Dorsata sues athenahealth, provider group on trade secret theft, Nevada terms Friday Health Plans (Dorsata as another ‘David’)
Close of week short takes: Q2 earnings up for GEHC, Talkspace; UnitedHealth invests $11M in SDOH; fundings for two AI startups, K4Connect, UpLift, Family First
Informa PLC to acquire HIMSS Global Health Conference and Exhibition (A ‘landmark’ love-it-or-hate-it conference to change hands)
Mid-week news roundup: $105M senior debt to Headspace; Nextech bought for $1.4B; Teladoc’s Better(Help) Q2 boosts 10%; Peppermint’s online ‘clubhouse’ for seniors, PathAI lays off 87
FTC, HHS OCR scrutiny tightens on third-party ad trackers, sends letter to 130 hospitals and telehealth providers

It may be summer, but the bombshells keep dropping. FTC and DOJ dropped draft merger guidelines on antitrust–in addition to HSR premerger notification–that will have far-reaching consequences. We update the demise of Friday Health Plans (another 30K members in the lurch), the Cano Health telenovela, hacking from Russia to UK to US, buys, financing, class action lawsuits, and an order in the ongoing AliveCor-Apple antitrust suit that slaps Apple down hard.

Another antitrust shoe drops: FTC, DOJ publish Draft Merger Guidelines for comment–what are the effects? (New restrictions not good for founders, managers, VCs)
Mid-week roundup: Colorado terms Friday Health Plans; Cano 3 continue to savage board; Amazon Pharmacy layoffs; hacking attacks: QuickBlox, Barts Health; Phreesia buys MediFind; financing pops for K Health, Amino
Legal roundup: Teladoc class-action suit dismissed; NextGen EHR $31M Federal settlement; significant AliveCor-Apple antitrust ‘spoiliation’ update; class action suits filed against HCA, Johns Hopkins

We looked at the first half’s digital health funding (back to 2019), the trend to unnamed and down rounds, two up rounds, two layoffs, three mixed pictures of telehealth effectiveness, it’s an almost-wrap at MHS for Oracle, and Amazon’s dodgy approach to your privacy. Early-stage company financing and managing your financials? We have some advice.

News roundup: MHS Genesis EHR completes US rollout, telehealth selective savings by disease, CarePredict’s $29M funding, Amazon Alexa *Spying on You* (Confirming telehealth unevenly bends the curve)
Thursday short takes: Fold Health VBC $6M round, Vivalink’s RPM in Burma rural health, Vytalize adds two to board, layoffs at TytoCare, IntelyCare (The roller coaster continues)
“Hope is not a business model”–advice from two VCs, with a bit more advice on basic banking (We unpack good advice for early-stage companies)
Mid-week roundup: telehealth success in opioid use disorder treatment, Epic sees fewer followup visits from telehealth vs in-office, telehealth usage slightly lower, HCA data theft may affect 11 million
Rock Health’s first half funding roundup adjusts the bath temperature to tepid, the bubbles to flat (2020-22 an aberration)

A short week in the US with the holiday wasn’t short of news. Bright Health and Molina made a $600M deal for California plans–as long as Bright stays solvent thru Q1 2024. Insurtechs proved to be disruptive but not innovative enough. And a potpourri of news from FDA requesting comments on home care tech, Japan, Alertacall on funding. A new mental health company targeting seniors is born while an old one struggles.

Short takes: FDA seeks feedback on home care tech; Japan care homes piloting AI; Author Health’s $115M bet on senior mental health; Alertacall’s Batchelor on ‘right fit’ finance support; Headspace in the wrong (layoff) space again
Why the ‘insurtechs’ didn’t revolutionize health insurance–and the damage they may have done (Back to the legacy payers)
Bright Health to exit insurance business, selling California plans to Molina for up to $600 million–contingent on surviving to 2024 (A dicey proposition all round)

Wrapping up June before the US Independence Day holiday next week had its own fireworks. Most far reaching–the changes spearheaded by FTC for HSR premerger notifications that will only quadruple the work. Babylon Health completing its going private arrangement with AlbaCore. Amazon delays Clinic rollout for three weeks facing tough data usage questions from senators. More pleasant looks at rural telehealth on a bucolic Irish island and supermarket trolley heart monitoring. Happy 4th!

Ireland’s Clare Island as multimodal rural telehealth and telemonitoring testbed (Very rural health on Ireland’s west coast)
FTC, DOJ float enhanced information requirements for HSR premerger notification filing process–what will be M&A effects? (More dampers on a down market?)
Embedding ECG sensors to a supermarket cart (trolley) handle as ‘first-line’ screening for atrial fibrillation (Bringing monitoring to everyday life)
Mid-week roundup: Optum buying Amedisys home care for $3.3B; Clover Health settles 7 shareholder lawsuits around SPAC non-disclosures; Walgreens cuts 2023 outlook, stock plummets 11%
Amazon Clinic delays 50-state telehealth rollout due to Federal data privacy, HIPAA concerns on user registration, PHI–is it a warning? (Amazon better heed it)
Babylon Health to go private with AlbaCore in planned ‘Take Private Proposal’, combine with MindMaze (Merging two very different companies)

Of continued interest: 

Mid-week update: Cano Health CEO finally booted, interim named; further information on Oracle Cerner layoffs (The Cano telenovela continues!)

Perspectives: How robust patient scheduling and intake enable better patient access to cancer care – a UK case study 
‘Warning flare’ study: will pandemic-induced digital health solutions get renewed by hospitals in 2023-4, or will they churn? (Get cracking with your account relationships)
The Future of AI and Older Adults 2023’ now published (Laurie Orlov’s latest analysis)

VA awards four remote patient monitoring companies to share in $1B Home Telehealth contract (Medtronic wins again plus 3 newbies)
Watch your cash burn! Now 31 months average for startups between Series A and B. Now what do you do? (Cautionary advice for startups)

Perspectives: How AI and ML can accelerate the growth of telemedicine across the globe (Thoughtful take on the up-and-downsides of both)

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Week-end short takes: Amazon Pharmacy automating couponing of insulin and supplies, Mendaera imaging/robotics wins $24M, Access Group acquires Oysta (UK)

An automation innovation that will attract diabetics. Amazon Pharmacy, in an attention-grabbing move, is working with several manufacturers to automate coupons that discount diabetic drugs (insulin) and supplies. These will come from 15 diabetes care brands and include some of the most commonly prescribed products from Novo Nordisk, Eli Lilly, Sanofi, Dexcom, and Insulet, such as insulin vials, pens, continuous glucose monitors, and pumps. The coupons are sponsored by the manufacturers and can drive the cost for these supplies to start at $35 a month. The cost of insulin and diabetic supplies has been a major issue, and while manufacturers have offered coupons, actually obtaining them from manufacturer websites can be a complicated procedure. Amazon’s program was applauded by the head of the American Diabetes Association.  Amazon is also offering them for COPD, weight loss medications, and EpiPens. MedCityNews, HealthcareFinance

A notable Series A this week is San Mateo, California-based Mendaera, which developed a robotic system that merges real-time imaging, AI and robotics for minimally invasive care. Still in semi-stealth, their raise is $24 million led by Lux Capital with participation from Founders Fund, Operator Partners, and Allen & Company, LLC. Other investors include Intuitive Surgical and Auris Health founder Dr. Fred Moll and former U.S. Senator Bob Kerrey. They have moved into a new production facility in Silicon Valley. Release, Mobihealthnews

Access Group acquires Oysta Technologies. Oysta, a provider of care technology solutions for safe, independent living in the UK and Spain, will be part of Access Group’s Health, Support and Care (HSC) division that provides software for health, local government, and care organizations. In the UK, Oysta works with local authorities, social care providers, housing associations, care homes, and NHS Trusts. Acquisition cost was not disclosed. Oysta announcement, Access announcement   Hat tip to Adrian Scaife, Business Development Manager for Assure, via LinkedIn

Amazon gets all tangled up on their $3.9B One Medical buy as FTC widens antitrust scrutiny

Amazon’s ride towards being the #1 threat to healthcare hits an oncoming train. A report in stock analysis newsletter Seeking Alpha, picked up from other sources (the subscription Dealreporter), states that the Federal Trade Commission (FTC) hired outside economists to scrutinize Amazon’s $3.9 billion purchase of provider network One Medical (1 Life Healthcare). In a little-noticed action in early December, FTC also sent out subpoenas to current and former One Medical current and former customers as part of its investigation.

Both the Wall Street Journal and Bloomberg (paywalled) are reporting that this appears to be part of a larger FTC action in developing a wide-ranging antitrust lawsuit against Amazon on multiple anticompetitive business practices. In a recent example, FTC held up Amazon’s acquisition of iRobot (Roomba) during the summer, and in September, requested information from 1 Life and Amazon above and beyond the usual required Hart-Scott-Rodino Act (HSR) reports reviewed by the FTC and DOJ [TTA 15 Sept 2022]. This examination has been going on for some years, across two administrations, but may come to fruition as early as this spring. The main investigation is around Amazon favoring its own products, how it treats outside sellers on its platform, and copycatting the products of outside sellers. It may also cover Amazon Prime bundling practices. Prime also plays into its healthcare strategy. FierceHealthcare

Another factor: the highly profitable growth of Amazon Web Services (AWS) has taken a nosedive along with the cloud market, killing Amazon’s growth and value, according to Seeking Alpha’s analysis (may be paywalled). Amazon is also closing or pausing already built-out food stores–Fresh supermarkets and Go convenience shops–ending a long-term commitment to developing them.

When all of these factors are combined with Amazon’s 18,000 layoffs and huge 2022 net loss of $2.7 billion, it’s hard to believe that Amazon now has enough blue sky fisc to make the huge investment and long-term commitment that a largely new and cash-intensive business, delivering healthcare through real live providers in offices, will require. Amazon’s current health business is either transactional virtual retail (Pharmacy and the new non-face-to-face Amazon Clinic for virtual medical referrals) or hardware+subscription (Halo)–areas that Amazon knows well. But managing an entirely new and complex area that provides expensive and regulated provider services?

This Editor will go out on a wintry limb and predict that Amazon, facing FTC and state anticompetitive actions plus plenty of shareholder profit pressure , will cancel the deal with One Medical–leaving One Medical on another limb.

Disruption or giveaway: Amazon Care signs on employers, but who? Amazon Pharmacy’s 6 months of meds for $6. (updated)

Is this disruption, a giveaway, or blue smoke requiring IFR? An Amazon Care VP, Babak Parviz, said at the Wall Street Journal’s Tech Health virtual event that all is well with their rollout of virtual primary care (VPC). Washington state is first, with VPC now available nationally to all Amazon employees as well as companies. However, Mr. Parviz did not disclose the signed-up companies, nor a timetable for when in-person Amazon Care practices will be expanding to Washington, DC, Baltimore, and other cities in the coming months.

Mr. Parviz also provided some details of what Amazon Care would ultimately look like:

  • Clinician chat/video connected within 60 seconds
  • If an in-person visit is required, a mobile clinician arrives within 60 minutes, who can perform some diagnostic tests, such as for strep throat, provide vaccinations and draw blood for lab work. For other diagnoses, that clinician is equipped with a kit with devices to monitor vital signs which are live-streamed to remote clinicians.
  • Medication delivery within 120 minutes


The timing of the Amazon Care rollout has not changed since our coverage of their announcement in March. This Editor noted in that article that Credit Suisse in their overview was underwhelmed by Amazon Care as well as other efforts in the complex and crowded healthcare space. Amazon Care also doesn’t integrate with payers. It’s payment upfront, then the patient files a claim with their insurer.

Existing players are already established in large chunks of what Amazon wants to own.

  • Both Amwell’s Ido Schoenberg [TTA 2 April] and Teladoc’s Jason Gorevic (FierceHealthcare 12 May) have opined that they are way ahead of Amazon both in corporate affiliations and comprehensive solutions. Examples: Amwell’s recently announced upgrade of their clinician platform and adding platforms for in-home hospital-grade care [TTA 29 Apr], Teladoc’s moves into mental health with myStrength [TTA 14 May].
  • Even Walmart is getting into telehealth with their purchase of a small player, MeMD [TTA 8 May].
  • CVS has their MinuteClinics affiliated with leading local health systems, and Walgreens is building out 500 free-standing VillageMD locations [TTA 4 Dec 20]. CVS and Walgreens are also fully integrated with payers and pharmacy benefit management plans (PBM).

Another loss leader is pharmacy. Amazon is also offering to Prime members a pharmacy prescription savings benefit: six-month supplies of select medications for $6. The conditions are that members must pay out-of-pocket (no insurance), they must have the six-month prescription from their provider, and the medication must be both available and eligible on Amazon Pharmacy. Medications included are for high blood pressure, diabetes, and more. The timing is interesting as Walmart also announced a few days earlier a similar program for Walmart+ members. Mobihealthnews.

crystal-ballThis Editor’s opinion is that Amazon’s business plans for both entities and in healthcare are really about accumulating data, not user revenue, and are certainly not altruistic no matter what they say. Amazon will accumulate and own national healthcare data on Amazon Care and Pharmacy users far more valuable than whatever is spent on providing care and services. Amazon will not only use it internally for cross-selling, but can monetize the data to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Shouldn’t privacy advocates be concerned, as this isn’t being disclosed? 

News roundup: Amazon Pharmacy–retail, GoodRx threat, 81% of healthcare workers have remote IT issues, Epicor installs in Australia care homes, GrandCare for developmentally disabled adults

Rounding up lots of dogies here!

Amazon, to no one’s surprise, has formally entered the US pharmacy business with Amazon Pharmacy which can fill prescriptions for most common medications. There is a whole process of course to sign up (at right), and a separate program for Amazon Prime customers with discounts on Amazon Pharmacy with two-day delivery, PillPack, and at 50,000 pharmacies in 45 states. The Prime program is administered by Inside Rx, a subsidiary of Evernorth/Cigna.

Mr. Market downgraded pharmacy retailers CVS and Walgreens Boots stocks, again unsurprisingly. It isn’t just brick ‘n’ mortars feeling the heat; heavily advertised drug price comparison platform (lumped into ‘digital health’) and recent IPO winner GoodRx took a 20 percent hit as Amazon Prime also discounts, comparable to GoodRx Gold. The GoodRx network is about 70,000 pharmacies, including the largest retailers. Fierce Healthcare. Big hat tip to Jailendra Singh at Credit Suisse Equity Research for these analyses on Amazon Pharmacy and GoodRx.

81 percent of healthcare workers experience issues with systems and technology used in external care, out visiting and caring for patients, according to a ‘State of Mobility in Healthcare’ multi-national study (email signup required) by business mobility development company SOTI. 64 percent of UK healthcare workers (63 percent overall) are ripping out what is left of their hair due to IT/technology glitches leading to system failures within a normal working week. Only a quarter of respondents said that their systems were able to cope with COVID-19. Based on the Healthcare IT News EMEA edition article, UK respondents apparently reported a higher level of IT problems affecting their work. The bright spot is that 68 percent of UK healthcare workers/55 percent overall agree that investment in new or better technology could help save lives. The study had respondents in the US, Canada, UK, Germany, Sweden, France, and Australia.

Speaking of software, Epicor, a US-based software company, is providing to two Australian care home groups their Community Care workflow and information platform: Finncare, which is associated with services to the Finnish and Scandinavian communities, and MannaCare in the Victoria area. Healthcare IT News Australia

One of the Ur-companies (2005!) in the senior health monitoring sector, GrandCare Systems, announced that they are working with LADD, a Cincinnati Ohio-based non-profit that supports adults with developmental disabilities. LADD’s project, the Heidt Smart Living Home, will incorporate GrandCare’s communication, cognitive assists, telehealth, and social engagement tools, as well as innovations in accessibility, lighting, and sensory control, for residents. Release Hat tip to CEO Laura Mitchell via LinkedIn.