Short takes: states curbing healthcare cyberattack liability, North Korean hospital ransomwareiste indicted, Walmart leases out 23 clinics to Humana’s CenterWell, Nuro robot delivery revives, $100M Series E for Spring Health

August 1, 2024 | by

News that class-action specialist law firms won’t like. States are considering limiting hospital cyberattack liability if they adopt cybersecurity measures. Currently, four states–Tennessee, Connecticut, Ohio, and Utah–have laws that curb liability for cyberattacks and data breaches. A fifth state, Florida, is considering it with the governor, Ron DeSantis, pushing for a tougher version to encourage strong cybersecurity adoption. The state lawmakers’ rationale centers on the admission that cyberattacks on hospitals are inevitable and that when hospitals have security in place, they are not negligent. On the opposite side, law firms that specialize in consumer class-action lawsuits argue that hospitals would rather profit than put into place expensive protection for consumer data. 

This Editor’s view tends to be even stronger than that of Governor DeSantis. How can state regulators actually know that a hospital has strong, effective cybersecurity? Hospitals not only have to spend money to constantly update their monitoring, but also have to hire the humans to implement it. In other words, what people or agency on the state level can assess that a hospital or health system has adequate cybersecurity in place and is acting in good faith to protect consumers against predatory data breaches or ransomware? The article in Politico is unfortunately very scant on how these laws work, the liability limitations, and the mechanisms for judging hospital cybersecurity. More to come on this. Also DataBreaches.net–this Editor’s go-to spot for research.

A North Korean ransomwareiste indicted, but he’ll be hard to serve if convicted.  A grand jury in the Federal District Court for the District of Kansas has indicted Rim Jong Hyok of ransomware attacks on 17 hospitals and systems across 11 states plus attacks on government entities from May 2021 through April 2023. The US Department of Justice (DOJ) charge is that Mr. Rim was working for the North Korean intelligence agency, the Reconnaissance General Bureau (RGB), in a cyberhacking group known as Andariel. Andariel developed the Maui ransomware type and used it to attack healthcare and governmental entities.  The ransoms collected from the hospitals were then used to fund cyber attacks and data exfiltration on government agencies, military bases, and multiple companies supporting the US military. The State Department is offering a reward of up to $10 million to locate Rim and others infiltrating US systems. It is highly unlikely that even with a conviction, Rim will serve any US time, but a conviction could initiate sanctions and other national measures. FierceHealthcare, US District Court indictment, US State Department ‘Rewards for Justice’ release

Walmart gives Humana a crack at reopening in-store clinics. After their well-publicized failure in retail health, Walmart is leasing out nearly half of their former Supercenter clinics over to Humana’s CenterWell healthcare services operation. By first half 2025, 23 of the 51 closed Walmart Health clinics in Florida, Georgia, Missouri, and Texas will convert to CenterWell Senior Primary Care and Conviva Care Centers. The focus will be on senior coordinated care with a staff of board-certified physicians, nurse practitioners, medical assistants, social workers, and other staff. Clinics are planned for Tampa/St Petersburg, Orlando, Jacksonville, Atlanta, Dallas/Fort Worth, and Kansas City. Medicare Advantage plans and Original Medicare will be accepted, though no mention is made of the ‘duals’ who are on both Medicare and Medicaid. Walmart will continue to operate pharmacy and optical locations. The CenterWell/Conviva network at present serves 318,000 seniors in about 300 centers across 15 states. Financial terms of the agreement were not disclosed. In retrospect, they should have done this several years ago. CenterWell release, MedCityNews

Another revival–the Nuro robot vehicle delivery service. Some years back, these driverless cars were envisioned to carry everything from pharmacy deliveries to groceries to prepared food, but the robot vehicles had problematic fully autonomous driving software that proved to be unsuitable for crowded urban areas as well as satisfactorily retrofitting or specially designed EVs. Now in another AI-assisted generation with the R3, about 100 retrofitted Toyota Priuses able to go up to 45 mph will be tested in the California Bay Area in Mountain View, Palo Alto, Los Altos, and Menlo Park. Other vehicles to be upgraded to the new software are from Chinese EV manufacturer BYD, which has become famous for exploding cars in its home market. Timing after the California Motor Vehicle approval now is set for Uber Eats deliveries in test in early fall. TechCrunch

Telemental health fundings continue on a roll with Spring Health. Their $100 million Series E has increased their valuation from $2.5 billion to $3.3 billion. This round was led by Generation Investment Management with participation from existing investors, including Kinnevik, William K Warren Foundation, RRE, and Northzone. Their $71 million Series D was in drought-ridden April 2023. Their total funding now is $466.5 million. Spring Health’s concentration is in mental health support and care management as part of employer benefits and for payers, covering 10 million lives through 450 directly contracted employers, strategic payer relationships, and 27,000 groups that access the solution through a channel partner. As noted in Rock Health’s H1 report [TTA 30 July], the competitive telemental health category still leads by far as the most funded clinical category, with about $700 million in raises, over double that of cardiovascular and oncology, and will likely surpass 2023. Release, Mobihealthnews, FierceHealthcare

Cigna-Humana deal fizzles after two weeks after term discussion fails, shareholders nix

December 13, 2023 | by

That was mercifully fast. After all the speculation and rumors [TTA 2 Dec], Cigna and Humana called off their talks on 10 December after not coming anywhere near terms on the financials. According to the Wall Street Journal, it was also evident that shareholders disliked it nearly immediately by driving down the share prices of both companies by 10%.

Their sources indicated that it would be a share and cash deal by Cigna for Humana, which added to shareholder displeasure. Cigna will be instead buying back up to $10 billion in stock to drive up their valuation. Reportedly, the repurchasing of least $5 billion of stock will take place between now and H1 2024. Cigna will also concentrate on smaller ‘bolt-on’ acquisitions and the sale of its Medicare Advantage business as previously announced. In the past five days, Cigna shares plumped by nearly $50 and Humana’s by about $10.

The WSJ‘s sources stated that Cigna continues to believe in a combination with Humana, something that the two companies have danced around for years, dating back even before the proposed payer megamergers of 2015 which saw Humana’s acquisition by Aetna (and Cigna’s by Anthem, now Elevance) disapproved both by states and at the Federal antitrust level. The two would, at least on paper, be a good fit, with Cigna’s strength in commercial plans plus Evernorth’s services added to Humana’s in Medicare Advantage, Medicaid, and home health services under CenterWell. It would have created a strong rival to UnitedHealth Group and CVS Health at $300 billion in revenue. What may have proved to be the antitrust stumbling block were their respective strengths in pharmacy benefit management (PBM) though with different focuses.

Even more than the increasingly hostile Federal antitrust environment between DOJ and FTC, it also points to the paucity of funding for mergers and acquisitions–M&A down 14% so far this year to about $1.2 trillion according to Dealogic.

In about three years, healthcare funding has gone from money thrown by VC and PE investors at what we recognize now as shaky propositions (Cerebral, Babylon Health, Olive AI, Pear) to no interest (or funds available) in what would be quality matchups. The pendulum swings–and swings back. We hope. Healthcare Dive

Cano Health’s dismemberment: Texas, Nevada primary care centers sold to Humana’s CenterWell for $66.7M, more to come

September 29, 2023 | by

Are we nearing the final episodes of “Cano Health”, the telenovela? New CEO Mark Kent has gotten busy in the past five weeks since his permanent CEO appointment. The first and most important action he has taken is to generate cash in the nick of time to comply with their debt covenants coming due in September. The sale of their Texas and Nevada operations to CenterWell Senior Primary Care, a unit of Humana, for $66.7 million, includes $35.4 million in cash to be paid at closing. According to their release, this brings their unrestricted cash reserves up to $109 million, which will enable it to remain in compliance with the covenants under its debt instruments due at the end of Q3, including the financial maintenance covenant under the Credit Suisse credit agreement. $80 million will be drawn down to repay a portion of its $120 million revolving credit facility by the end of Q3 2023–September.

Cano’s Texas and Nevada clinics serve approximately 15,000 patients. CenterWell’s acquisition fits their corporate growth strategy in adding 25 to 50 clinics per year. FierceHealthcare

In August, Cano admitted that their liquidity was insufficient to cover the next 12 months, initiating a 17% staff downsizing and exits of their California, New Mexico, and Illinois operations by the fall, reducing their coverage by 5,000 members and 17 medical centers. They also announced a restructuring of their core Florida operations [TTA 15 August].

But…there’s more. Axios reports that Kent and Cano are continuing to work with financial advisers JPMorgan and Oppenheimer on a full-bore breakup of the company. JPM is advising on a whole-company sale, while Oppenheimer is advising on a breakup. Remaining are the Puerto Rico operation and their Medicaid business in Florida. Axios 

Earlier this month, Cano declared that it would work with the NYSE to regain compliance with the Listing Rule that requires stocks to trade above $1.00. Cano was notified on 11 September since it traded below $1.00 for 30 days. The Cano stock closed today (28 Sept) at $0.28. Actions mentioned in their release include their announced business strategy of reorganizing their business and a reverse stock split that has to be approved by shareholders at a meeting to be determined. However, their largest shareholder, InTandem Capital Partners, LLC, which controls ITC Rumba, LLC, is in favor of the reverse stock split. NYSE has a six-month deadline for this. 

Once again, not a peep from the Cano 3 (resigned directors Barry Sternlicht, Elliot Cooperstone, and Lewis Gold). Perhaps they have resigned themselves to writing off their 35% of near-worthless shares in their collective portfolios.

Given the above timelines, Q3 reporting due next month, and end of year looming, CEO Kent will need to be Clark Kent (the Daily Planet disguise of Superman) to pull Cano Health either to survival as a smaller entity, as stated in their press releases, a sale in toto of what remains–or a complete parting-out.