Thursday news roundup: bet on Oracle-Cerner closing next week, VA EHR progress reports mandated, Homeward-RiteAid rural care, Medtronic-DaVita kidney JV, Withings reenters RPM, Lightbeam buys Jvion AI

June 1, 2022 | by

The Oracle acquisition of Cerner will close as early as Monday next week, no later than mid-June. Mid-June is the prediction of Seeking Alpha. They based it on Oracle-Cerner already passing Australia’s Foreign Investment Review Board, no questions posed by the UK antitrust authority, and the US waiting period expiring in February. As rumored [TTA 25 May], European Commission regulators approved it today (Barrons, paywalled) which predicts the close will be next Monday. Hat tip to HISTalk for their alert yesterday.

Scrutiny of Cerner’s $16 billion EHR implementation with the Department of Veterans Affairs by Congress ramps up. New legislation due to be signed by the president shortly will require the VA Secretary to submit regular reports 30 days after the last day of each fiscal quarter on the VA’s Electronic Health Record Modernization (EHRM) program. Content will include spending, performance metrics, outcomes, safety, transitioning from VistA to Cerner Millenium, interoperability, and progress or issues with all. Text of Senate bill, FierceHealthcare  TTA’s previous article on Cerner EHR interoperability problems with DOD and VA

Bringing healthcare to rural America is Homeward with a freshly inked deal with RiteAid. Founded by former Livongo president Jennifer Schneider, MD, Homeward will set up distinctive purple mobile van clinics at up to 700 Rite Aid location parking lots in rural communities starting Q3 this year. Michigan will be the first market. Homeward will accept regional Medicare Advantage plans and Medicare.

The company is targeting the 60 million Americans who live in rural areas and have been losing access to basic medical care as local practices and clinics close. Their technology enablement will be for appointments, checkins, telehealth, remote patient monitoring, and scheduling home visits. Homeward announced its launch at the recent ViVE2022 in March including $20 million in funding from General Catalyst. Other Livongo alumni with the new company are Brian Vandenberg, former general counsel, Amar Kendale, former chief product officer, and Bimal Shah, MD, former chief medical officer at Livongo. Nice to know that they have moved to another healthcare chapter of real need, versus cruising the Caribbean in very large yachts. FierceHealthcare, Homeward release

Medical device giant Medtronic and DaVita are establishing a joint venture by next year to advance kidney care therapies and technologies, including new products to be used in clinics and in the home. The intent of the JV is to increase the availability of kidney care including dialysis. 10% of adults worldwide–700 million people–have chronic kidney disease. 2.6 million have kidney failure. The JV is expected to be formed in early 2023 with each company owning an equal share. Initial investment is not disclosed. According to the release:

  • Medtronic will contribute its Renal Care Solutions (RCS) business including the current product portfolio (renal access, acute therapies, and chronic therapies), product pipeline, and global manufacturing R&D teams and facilities.
  • Both companies will provide an initial investment to fund the new company (NewCo) and future certain operating capital.

FierceBiotech, Medtronic release

Withings reenters remote patient monitoring with Withings RPM. Their initial entry was with MedProCare back in 2019 but apparently in the repositioning of the company since the buyback from Nokia in 2018, it was back-burnered. The new RPM will be based on an app that will:

  • track time for CMS-compliant billing reports and uploadable to the provider EHR
  • support billing for CMS codes 99453, 99454, 99457, 99458
  • a digital patient-facing assistant
  • full connectivity to Withings devices such as scales, blood pressure monitors, and sleep monitors
  • implementation support by their Health Solutions teams

Withings RPM page, Outsourcing-Pharma

Looking hard for an M&A that relates to us in this very quiet market, Lightbeam Health Solutions, a population health software company, is acquiring Jvion Inc. Jvion has AI-enabled prescriptive analytics and social determinants of health (SDoH) solutions which will be combined with Lightbeam’s health analytics and outcomes for payers and providers. Terms of the acquisition and leadership transitions were not disclosed. Lightbeam release

Wednesday news roundup: Oracle-Cerner reportedly OK’d by EU, VitalTech RPM raises $14.1 M, Aging 2.0 interoperability challenge, what do rough times mean for investors and startups, employees cause 39% of healthcare IT breaches

May 25, 2022 | by

One regulatory hurdle down for Oracle’s $28 billion Cerner acquisition? The EU has reportedly given an unconditional EU antitrust clearance to Cerner, three sources informed Reuters. The formal announcement will be made 1 June. In the US, the long and winding road of Federal antitrust scrutiny and review began in February by the usual alphabet agencies–DOJ, FTC, and SEC–that show no sign of wrapping up [TTA 11 Feb]. Cerner continues to run into headwinds in its VA EHR implementation including spotty interoperability with the Military Health Service DOD version [TTA 18 May].

In a small confirmation that RPM is on the rise, Texas-based VitalTech raises $14.1 million in a Series B equity raise. The company offers an app-based remote patient monitoring platform for vital signs, med and nutritional reminders for use by home and hospital/acute care. Investors were not disclosed and the total offering has about $2.1 million remaining in unsold equity. Their undisclosed Series A funding dated back to 2019 and funded by Concord Health Partners and Stanley Ventures. SEC filing

The international Aging2.0 organization announced the Global Innovation Search (GIS), an opportunity for innovators around the world to showcase innovations that enable and promote a system-level approach to improving quality, continuity, and efficiency of care through interoperability. The eight finalists will participate in a Care Tech Pitch at OPTIMIZE, Aging 2.0’s annual conference on 21-22 September in Louisville, Kentucky. Applications close 12 June. The GIS is associated with the Louisville Healthcare CEO Council (LHCC) and will require the winner to relocate to Louisville. More information here.

What does this mess of a market mean for healthcare investors, startups, and companies looking for equity or VC investment? Industry figure Lisa Suennen, who has been to this rodeo before, has a POV in her Venture Valkyrie blog that HISTalk has summarized neatly, if not cheerfully. Major points: the downturn in funding will lag the market by 3-6 months, VCs will stuff the cash and wait for deals at lower valuations, few exits mean that portfolion companies will be burning through cash and dependent on existing investors, and there will be less-well-funded companies and funds which will go belly-up. This Editor’s disagreement is only that VCs lag downturns. In 2008, heading marketing in an early sensor-based monitoring company running out of funds, funding became scarce months ahead of the downturn.

39% of healthcare data breaches are caused by employees, according to Verizon’s latest cybersecurity Data Breach Investigations Report–more than any other industry at 18%. Incidents hit an all time high in healthcare, with 849 incidents and 571 breaches last year. 76% of breaches centered on basic web application attacks (attacks against a web-facing app–30%), system intrusions (malware, hacking–26%), and miscellaneous errors (mostly unintentional–21%).  Personal data was nearly 60% of the data compromised, while 46% was medical. Much more in the report. Healthcare Dive

Thursday news roundup: Cigna deploys over $12B for investment, Cerner’s Feinberg to Humana board, Teladoc on Amazon Alexa, admitting Livongo problems, and XRHealth VR therapy scores $10M

March 3, 2022 | by

Cigna’s opportunity piggybank just added $12 billion+. It’s a combination of selling off non-core businesses, share repurchasing authorization, and redeploying funds to areas such as capital investment and Cigna Ventures. This includes:

  • $5.4 billion after-tax from the sale of its international life, accident, and supplemental benefits businesses in seven countries
  • $450 million invested in Cigna Ventures, its innovation investment arm
  • An expected $7 billion for share repurchase this year from a $10 billion authorization. To date this year, Cigna has already repurchased $1.2 billion of shares.

The Cigna Ventures funding will go towards three announced areas: insights and analytics; digital health and experience; and care delivery and enablement. Originally formed in 2018 with $250 million, they now have seven VC partners and 15 direct investments, including Arcadia, Babyscripts, Cricket Health, Ginger, Omada, and RecoveryOne. 

Buried in the release is this: “…the company is not currently contemplating large-scale mergers or acquisitions” which would seem to put a tight lid on the long-rumored acquisition of parts or all of Centene [TTA 28 Jan]. (Too much wake turbulence?) But following on this, “The company intends to continue making strategic investments in innovation through targeted bolt-on or tuck-in acquisitions” which fits sell-offs, as well as investment in early-stage companies through Cigna Ventures. Also FierceHealthcare

Insurer Humana’s board expands to 14 with the addition of David Feinberg, MD, the current CEO of Cerner and future executive of Oracle, provided the merger is approved. He joins the current seven independent directors on the Humana board. Last week, Starboard Value LP, an activist investor hedge fund, reached an agreement with Humana to appoint two Starboard-backed board members starting next month and retire two incumbents. Humana limped through last year with a $14 million Q4 loss and Medicare Advantage losses to both traditional rivals and insurtechs. With over 25 years in healthcare management including CEO positions at Geisinger Health System and three divisions of UCLA Health, it’s a smart move. Release, FierceHealthcare

“Alexa, I want to talk to a doctor”–and that doc will be through Teladoc. Amazon customers with supported Echo devices, such as an Echo, Echo Dot, and Echo Show, will now be able to access Teladoc and a virtual care session 24/7. Initially it will be voice-only with audio/video to come. The release states that visits may be free through insurance or $75 direct pay. It did give a much-needed lift to Teladoc shares, which have been hammered by 76% in the past year, on the announcement and in the past few days, feeding the usual rumor mill that Amazon may be writing a check for Teladoc shares.

Teladoc has finally admitted via its annual report (SEC 10-K) that the Livongo acquisition has not been all beer and skittles. It impacted its indebtedness (page 35) and on page 52, significant insecurities on the integration of the two companies, well over a year after the acquisition.

Our failure to meet the challenges involved in successfully integrating the operations of the two companies or to otherwise realize any of the anticipated benefits of the merger, including additional cost savings and synergies, could impair our operations. In addition, the overall integration of Livongo post-merger will continue to be a time-consuming and expensive process that, without proper planning and effective and timely implementation, could significantly disrupt our business.

Healthcare IT News and HISTalk

VR physical therapy has remained a “we try harder” area of telehealth for several years, with a lot of initial promise in treating returning veterans with PTSD in de-escalating symptoms but having a hard time getting takeup. XRHealth, an early-stage company offering VR-driven physical, occupational, and speech therapies, gained a $10 million venture round backed by HTC, Bridges Israel impact investment fund, AARP, and crowdfunding on StartEngine.com and existing investors. According to Crunchbase, this is par for their course since 2016; their total of $35 million has been in pre-seed, seed, grant, crowd, and venture funding. Based in Brookline, Massachusetts with R&D in Israel, it is good to see them progress, having ‘been there and done that’ with two early-stage health tech firms.

However, their release does them a great disservice. It is, frankly, 90% nonsense in trying to position them out of the gate as “the gateway to the healthcare metaverse” and “growing the open ecosystem and providing greater access to care while reducing costs. Interoperability is key…”. This Editor had to go to their website to find out what they do. As a marketer and reporter, the First Rule of Press Releases is say what the news is, what the company does, and why it’s important in the first two paragraphs. The rest is reinforcement and expansion, with the spokesperson quote part of that and never in paragraph #2. Additional advice: don’t pick up a word now branded by Facebook (Meta). Hat tip to HISTalk

Thursday news roundup: Teladoc’s cheery 2021, uncertain 2022; DOJ deadline UnitedHealth-Change Sunday, Cerner’s earnings swan song, Humana feels the activist lash; funding/M&A for WellSky, Health Catalyst, Minded, Automata, MediBuddy

February 24, 2022 | by

Teladoc closed 2021 on Tuesday with record revenue of $2,032.7 billion, 86% over 2020. Visits were up 38% to 15.4 million with 53.4 million paid members. Q4 revenue was $554.2 million, 45% over Q4 2020, all of which exceeded investors’ expectations. Despite moving to a positive cash flow of $194 million, Teladoc is still not profitable, with full-year losses of almost $429 million and net loss per share of $2.73, somewhat lower than 2020.

The outlook for 2022 is less certain. For the full year, they anticipate a nice rise in revenues to $2.55 to $2.65 billion but a net loss of $1.40-1.60 per share, a little more than half 2021. Paid membership they project will grow to 54 to 56 million. The stock did take a bit of a bath due to market uncertainty with Ukraine-Russia and also a lowered forecast for first quarter. Teladoc earnings release, Healthcare Dive

DOJ has till Sunday 27 February to sue to stop the UnitedHealth acquisition of Change Healthcare. The acquirer and acquiree popped their 10-day notice on 17 February through their 8-K filing with the SEC. They had previously agreed to hold their closing until after 22 February. So if the DOJ is going to block the deal, as has been reported [TTA 17 Feb], they have from today to Sunday to do it–and courts aren’t open Saturday and Sunday. Healthcare Dive, Becker’s Health IT

Cerner’s 2021 swan song kind of… honked. Their net loss for the year was $8.8 million in 2021, compared with a net income of $76.9 million in 2020. Total net earnings topped $555 million in net earnings in 2021, down 29% from $780.1 million in 2020. Cerner release, Becker’s. Meanwhile, Oracle’s acquisition high hurdles continue [TTA 11 Feb] with the Feds, passing the first mark of the Hart-Scott-Rodino Act waiting period as of 11.59pm on 22 February. Still to go is the SEC review of Oracle’s tender offer for Cerner shares.  Becker’s Health IT

Humana joins Centene in insurers forced to change by activist shareholders. Starboard Value, a hedge fund, reached an agreement with Humana that Humana would add two independent board directors backed by Starboard. The first will be named on 21 April with the second to follow. They replace incumbents who will not stand for re-election. Starboard owns 1 million Humana or 0.79% of shares, but is well known for wielding them effectively to leverage change when the business hits a pothole–Humana’s $14 million Q4 loss and Medicare Advantage losses to both traditional rivals and insurtechs.

Humana is standing by its 2022 projection of 11-15%  growth but slowing performance in large areas such as Medicare Advantage. The company has stated that they will funnel funds back into Medicare Advantage through its “value creation plan”, which sounds very much like Centene’s “value creation office”. You’d think they’d come up with cleverer names and less anodyne ‘strategies’ for extracting savings from these lemons wherever possible, including selling off assets and “optimizing its workforce”. Reuters, Healthcare Dive

And quick takes from the US, UK, and India…

WellSky is acquiring TapCloud for an undisclosed amount. WellSky is a data analytics and care coordination automation company in the acute care and home care markets, with TapCloud a patient-facing engagement and communication platform. Release

Another data analytics company, Health Catalyst, is bolstering capabilities with its agreement to buy KPI Ninja, a provider of interoperability solutions and population health analytics. Purchase price and management transitions undisclosed, though from the release it appears that all KPI Ninjas will be onboarded.

Minded, a NYC-based mental health med management company, scored $25 million in seed funding from Streamlined Ventures, Link Ventures, The Tiger Fund, Unicorn Ventures, and private individuals. They provide direct-to-patient behavioral health medications through virtual evaluations with treatment plans without in-person visits, which are still unusual in psychiatry. At the present time, it is available only in New York, New Jersey, Pennsylvania, Florida, Texas, Illinois, and California.

The founders are an interesting mix: David Ronick, who previously co-founded fintech unicorn Stash, Gaspard de Dreuzy, the co-founder of telehealth company Pager, and Dr. Chris Dennis, a multi-state licensed psychiatrist. Their rationale for founding the company does resonate with this Editor, whose brother is a board-certified MD psychiatrist, and who knows well 1) the challenges of remote therapy and 2) the scarcity of psychiatrists in most of the US beyond urban and academic areas. Release, TechCrunch, Mobihealthnews

In the UK, London-based Automata, which automates lab technology to shorten turnaround time and scale up lab capacity, along with deploying automation with contract research organizations, research labs, and blue-chip healthcare institutions, announced a $50 million (£36.8M) Series B raise. The round was led by Octopus Ventures with participation from returning investors Hummingbird, Latitude Ventures, ABB Technology Ventures, Isomer Capital as well as strategic investors including In-Q-Tel. Mobihealthnews

From Bangalore, India, virtual health company MediBuddy $125 million Series C funding was led by Quadria Capital and Lightrock India, bringing their total funding to over $191.1 million, a hallmark of a largely bootstrapped company. MediBuddy uses a smartphone app for 24/7 real-time video doctor consults and at-home lab testing covering the family and in more than eight languages, important in India which has hundreds of languages and local dialects. Great smiles on the founders too! Mobihealthnews

Friday’s really quick takes: Oracle-Cerner starts Federal reviews, Curve Health, Signify buys Caravan, and a gaggle of single name companies!

February 11, 2022 | by

The long and winding road of Federal scrutiny–and other legal actions–begin for Oracle and Cerner. To be expected, the first hurdle is a review under the Hart-Scott-Rodino Act, by the Federal Trade Commission (FTC) and the US Department of Justice (DOJ). This should conclude by 22 February. The Securities and Exchange Commission (SEC) is also reviewing. As is routine in takeovers of public companies, there are seven civil filings by ‘supposed’ Cerner stockholders in either the District Court for the Southern or Eastern District of New York, their favorite venue, all claiming lack of information. Expect more. Kansas City Business Journal (which may be paywalled), Becker’s Health IT

New York-based newcomer Curve Health scored a $12 million Series A from Morningside Ventures with participation from Alumni Ventures and Recover-Care Healthcare, as well as returning investors Lightspeed Venture Partners, IDEO, Inflect Health, and others. Total funding is now $18 million (Crunchbase). Curve Health specializes in ‘virtual hospital’ telemedicine for skilled nursing facilities (SNFs) and community paramedicine, along with billing and health information exchange. Last July, they partnered with CareConnectMD, a California-based provider group that delivers value-based care for people living in nursing homes via its High Needs Direct Contracting Entity (DCE). Curve’s founder, Tim Peck MD, previously founded Call 9, a telemedicine/onsite service for nursing homes, which closed in July 2019 [TTA 15 May 2020] Release

Signify Health, a senior home care and value-based care provider, is acquiring ACO organizer and management services provider Caravan Health in a $250 million cash/stock deal with contingent additional payments of up to $50 million based on performance. Caravan’s founder and the current CEO will be joining Signify. It’s a move that may bolster Signify, which has had a few valuation challenges, because it expands Signify’s provider base and expands its current narrow episodes of care area (the former Remedy) into additional advanced payment models. Release, Mobihealthnews

Short short takes on single-word company news….

Expressable’s remote speech teletherapy platform closed a $15 million Series A funded by F-Prime Capital and including existing investors Lerer Hippeau, NextView Ventures, and Amplifyher Ventures. The new funding will go towards national expansion. FierceHealthcare  Hat tip to this Editor’s former colleague Amy VanStee, who recently joined them.

Balanced is a new digital platform for exercise coaching targeted to older adults. Users can modify based on assessed fitness level, input injuries, health conditions, and fitness goals. They added to an early seed round to total $6.5 million in seed funding, led by Founders Fund and Primary Venture Partners, with participation from Lux Capital and Stellation Capital. Cost for unlimited use is a gentle $20 per month. Given yesterday’s near-implosion of that expensive must-have of the aggressively fit and heavily dripping, Peloton, is fitness getting real?  Mobihealthnews

AndHealth, founded by the CEO plus veterans from CoverMyMeds, now has $57 million from Francisco Partners, with participation from the American Medical Association’s venture capital arm Health 2047, Kirkland & Ellis and Twofold Ventures. AndHealth specializes in Virtual Centers of Excellence (VCOE) programs for migraine and autoimmune disease reversal programs as an employer-sponsored benefit. Release

Berlin-based Ada extended its Series B by $30 million for a total of $120 million. Ada partners with major pharma for its AI-assisted symptom assessment app. TechEU

Nurx is merging into Thirty Madison. Nurx is primarily a provider of birth control, women’s and sexual health meds via telemedicine, while Thirty Madison specializes in telemedicine for chronic conditions. Thirty Madison was valued at over $1 billion after its Series C round in June. Nurx’s lines will be added to Thirty Madison’s menu which includes Keeps (hair loss) and Evens (GI issues). FierceHealthcare

The devil is in the (migrated) data: GAO watchdog barks at the VA’s transition from VistA to Cerner

February 9, 2022 | by

The US Government Accountability Office (GAO) released their “watchdog” report on the Department of Veterans Affairs’ first, failed implementation at Spokane’s Mann-Grandstaff VA Medical Center in October 2020. Their 52-page whopper of a report came to a simple conclusion: the VA didn’t ensure the quality of the data migrating from the EHR warhorse VistA and their Corporate Data Warehouse to Cerner Millenium. Thus clinicians couldn’t use Cerner two ways–one was training in how to use it (as noted in VA’s own analysis) so they could not find the patient information they needed–and the fact that even if they knew how to use it, the data migration apparently was incomplete. The GAO found that the VA did not establish performance measures and goals for migrated data quality based on Federal guidance. The result was inevitable. According to the report, “clinicians experienced challenges with the quality of migrated data, including their accessibility, accuracy, and appropriateness.” 

There is also a method called a stakeholder register which helps to identify and engage all key stakeholders. VA did not use this, so some areas were overlooked in the continuity of reporting and preservation of records. This affects not only patient records, but also scheduling.

The main takeaway is that GAO recommends to VA that they establish performance measures and goals that ensure the quality of migrated data and use a stakeholder register managed by the VA’s deputy secretary to engage all the relevant stakeholders in the migration in reporting needs. VA published its own analysis of its implementation and rollout failures in December. Healthcare IT News

News, deals, rumors roundup: Cerner’s DOD and VA go-lives, Akili’s ADHD therapy SPACs, Talkiatry’s $37M raise, Alto sings a $200M supper–and the Cigna-Centene rumors don’t stop

January 28, 2022 | by

While Cerner’s acquisition by Oracle is winding its way through regulatory approvals, their EHR implementations are moving forward through both the Military Health System (Department of Defense) and the Department of Veterans Affairs (VA).

  • Within the MHS, Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center, both in the San Antonio (Texas) Market, went live with MHS GENESIS on 22 January. The change most visible to patients is the transition from TRICARE Online to the MHS GENESIS Patient Portal which enables 24/7 access for visit notes, secure messaging, test results, appointment scheduling, and online prescription renewal. MHS covers military retirees, active military, and family beneficiaries. According to the MHS’s website, the goal this year is to get to halfway–to implement MHS GENESIS in more than half of all military hospitals and clinics. It’s been taking place since 2017 and, in true military fashion, it’s planned in waves. Coming up are Naval Medical Center Camp Lejeune in South Carolina on 19 March and William Beaumont Army Medical Center in El Paso in summer.
  • VA is moving far more slowly, just getting to its second hospital. The Columbus VA go-live has been pushed back from 5 March to 30 April, citing training slowdowns due to a spike in staff COVID cases. Walla Walla, Washington is set for after Columbus, but the date is to be confirmed. The first, failed implementation at Spokane’s Mann-Grandstaff VA Medical Center in late 2020 was the subject of Federal hearings and a complete redo in VA’s plans and procedures in cutting over from VistA to Cerner Millenium. TTA 28 July and previous. Federal News Network

Akili Interactive, which has developed tech-driven, game-based cognitive therapies for ADHD and other psychiatric and neurological conditions, has gone public through a SPAC via a merger with Social Capital Suvretta Holdings Corp. I, The transaction is expected to close in mid-2022. Akili will be listed on the Nasdaq stock market under the new ticker symbol AKLI.

The SPAC is expected to provide up to $412 million in gross cash proceeds and value the company at over $1 billion. Investors in the $162 million PIPE are Suvretta Capital Management’s Averill strategy, Apeiron Investment Group, Temasek, co-founder PureTech Health, Polaris Partners, Evidity Health Capital, JAZZ Venture Partners, and Omidyar Technology Ventures. The funds raised will support the commercial debut of EndeavorRx, a FDA-cleared and CE-marked prescription digital therapeutic for pediatric ADHD. The technology is termed the Selective Stimulus Management Engine (SSME) and will be rolled out for ADHD, ASD, MS, and MDD treatment.

TTA noted Akili last year in a trial of AKL-T01 at several hospitals for treatment of long-COVID-related cognition problems. Unfortunately, the writing in their SPAC release made this Editor feel like she needed a few treatments.

Mentalhealthtech (psychtech?) continues to attract funding. Psychiatric care startup Talkiatry topped off its July $20 million raise with an additional $17 million from Left Lane Capital for a $37 million Series A financing round. CityMD founder Dr. Richard Park, Sikwoo Capital Partners, and Relevance Ventures also participated. Talkiatry uses an online assessment for a preliminary diagnosis and then matches you with a participating psychiatrist.  It is in-network with payers such as Cigna, Aetna, UnitedHealthcare (Oxford Health Plan), Oscar, and Humana. Funding will be used to expand beyond NYC. Mobihealthnews

Digital pharmacy is also hot. Alto, which promises same-day filling and courier delivery, raised a $200 million Series E led by Softbank Vision Fund. Their total to date is over $550 million. Alto serves selected areas mainly in California, Nevada, Texas, and NYC (Manhattan, Queens, Brooklyn). Competitors Capsule had another raise of $300 million in April for a total of $570 million and Medly raised a $100 million Series B in 2020. Mobihealthnews

In the wake turbulence of Centene’s dramatic management shakeup last month [TTA 18 Dec], rumors continue to surface that insurer Cigna is interested in acquiring all, or possibly part, of Centene. Bloomberg News in publishing its article earlier this week cited ‘people familiar with the matter’ said that talks took place last year, but that they are not ongoing. Seeking Alpha picked this up, adding market activity boosting Centene. Perhaps the disclosure and the ‘denials’ align with what this Editor has heard–that it’s very much ongoing but under wraps.

A Centene buy makes sense, but only with Cigna. While Cigna is almost double the market value of Centene, it does not have the sprawling business model the latter has, nor do their businesses overlap much. However, some divestiture would be needed to do a deal, given the constrained regulatory environment in the US on the Federal and state levels. Any insurer merger is seen as anti-competitive, unless it is an acquisition of a smaller, struggling plan. 

It certainly would vault Cigna into the top rank of insurers with non-Centene branded exchange, Medicare Advantage and Medicaid plans, a provider network, an established MSO, and other lines of business including Magellan behavioral health management. Cigna might also value Centene’s international holdings, such as private hospitals Circle Health in the UK and Ribera in Spain. A sale would also create a quick and profitable ROI for Politan Capital Management, the activist investor company that initiated the retirement of 25 year CEO Michael Neidorff last month, rather than managing and reorganizing the sprawl of Centene’s businesses to make it more profitable.

Update roundup: Change Healthcare sale to UnitedHealth Group/Optum may hinge on divesting, Oracle on Cerner exec departure packages up to $22 million

January 26, 2022 | by

It looks likely that Change Healthcare will have to do some divesting in order to be bought by UnitedHealth Group. Bloomberg reported that ClaimsXten, part of Change’s Payment Integrity (PI) business, may be sold to facilitate the purchase. Sale price may be as high as $1 billion. Credit Suisse‘s analysis points out that ClaimsXten is only one part of the PI business, and more may have to be sold in PI or possibly in other lines of business. It also may not be enough to facilitate the sale though the move may be a hopeful one in the face of multiple challenges. UHG has already pushed the date forward to 5 April as we noted back in December, when it was barely noticed in the major shakeup at fellow payer Centene. Seeking Alpha

Cerner has disclosed additional details in an SEC Schedule 14D-9 on lead executive and associate compensation as part of the sale to Oracle, and it’s eye-blinking. Non-employee directors and executive officers will receive payments for their shares and cashed out compensatory awards in the Table of Equity Related Payments.  HISTalk calculated total ‘golden parachute’ packages and severances for the following:

  • President and CEO David Feinberg $22 million (company tenure – less than four months)–$17 million alone termed a ‘golden parachute’
  • EVP/CFO Marc Erceg $11 million (company tenure – less than one year)
  • EVP/CTO Jerome Labat – $11 million (company tenure – 19 months)
  • Former Chairman and CEO Brent Shafer — $21 million

Only two executives listed, CEO David Feinberg and CTO Jerome Labat, have waived ‘change of control’ separation payments as they will be continuing with Oracle [TTA 21 Jan].

If you’re an ordinary associate, from the wording, your vested shares will be cashed out (typical in change of control) and unvested shares will be rolled over to Oracle equivalents and not cashed out. Change of control benefits go only so far down the line. There is no language covering the status of unvested shares if you are one of the unlucky ones terminated due to the merger.

HISTalk also distilled a timeline from the background and board recommendation of how Cerner became open to purchase. There were risks from competition, retention of key technical employees, the risks in government contracting, and making their business goals.

Further insights on and thoughts about the Oracle acquisition of Cerner

December 22, 2021 | by

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

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

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

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

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

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

December 20, 2021 | by

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

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

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

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

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

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

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

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

December 17, 2021 | by

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

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

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

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

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

News and deal roundup: Best Buy’s $400M for Current, VA’s Cerner restart 2022, CVS-Microsoft product deal, and Athenahealth (finally) sold for $17B

December 3, 2021 | by

Whew! Best Buy revealed on its quarterly earnings call that they paid $400 million for Edinburgh/Boston-based RPM developer Current Health [TTA 13 Oct]. It’s near the end of the call transcript published on the Motley Fool. There will be no impact on their financial performance this year and will have a slightly negative impact on the Q4 non-GAAP operating income. Hat tip to HISTalk. 

Also today in HISTalk is a nifty summary of the Department of Veterans Affairs (VA) Cerner implementation timing and restaffing. There’s a graphic on the 2022-23 (FY 2022-24) rollout plus the new organization. VA has appointed a new Program Executive Director, Terry Adirim, MD, MPH, MBA, moving from Acting Assistant Secretary of Defense for Health Affairs, and established a new EHR Integration Council. VA release. VA also published a 10 page analysis on what went wrong with the initial tests and lessons learned, such as creating an EHR ‘sandbox’ for clinician training.

CVS Health and Microsoft continue with a new partnership, this time for digital health products. The five-year deal will include development in two areas: personalizing health recommendations that direct consumers to when and where they need a CVS, and operationally to leverage technology and machine learning for automation to reduce waste. Microsoft release, Healthcare Dive, HealthcareFinanceNews

And in the biggest non-surprise of the past few days, Athenahealth’s (or as they prefer, athenahealth) sale closed before the end of the year in a deal valued at $17 billion. The buyers were, as expected [TTA 19 Nov], Bain Capital and Hellman & Friedman, along with Singapore’s sovereign wealth fund GIC and a wholly-owned subsidiary of the Abu Dhabi Investment Authority. The 24 year-old Athenahealth, one of the EHR pioneers, was acquired by Elliot Investment Management’s PE arm Veritas and Evergreen Coast Capital in 2019 for about $5.7 billion. Its base is down to about 140,000 ambulatory care providers, having exited the small hospital market some time back. In the EHR market dominated by Epic and Cerner, surely Veritas and Evergreen are relieved to be at least getting some cash back. But there’s Misery Sharing, as they are both retaining a minority investment. (A small hint from a marketer–never lower-case the first letter in any part of your name. You make yourself unimportant and it hasn’t been ‘modern’ for a loooong time. It wasn’t lucky for British Airways, either. Perhaps the new majority owners will get this.)  Healthcare Dive, Business Wire

Google joins the behavioral health wars, adds new senior executive from Headspace

October 28, 2021 | by

Google, having disbanded Google Health as a unit and scattered their products and teams internally, has decided that behavioral health is worth spending on across business lines. Megan Jones Bell, Psy.D., formerly chief strategy and science officer of Headspace, recently purchased by Ginger, rejoins Google this week as their first clinical director of consumer and mental health. 

She will be overseeing Google’s approach to mental health, supervising a team of clinicians, as well as coordinating primarily consumer-facing products such as the controversial verification of health information on Google-owned YouTube, across Google Search, Maps, Fitbit, and Cloud, medical products like the Care Studio EHR search app, depression screeners, and for employee health and safety. FierceHealthcare, Becker’s HealthIT

At least initially, Google does nothing in a small way. At HLTH21, Google’s chief health officer Karen DeSalvo, MD boasted that “Our get up every morning, raison d’être, is impact. It’s helping billions around the world be healthier.” Then followed broad and ambitious statements about social determinants of health (SDOH) and advancing health equity. Both have become a standard script for executive speeches at these conferences, virtual and in-person.

When scattered across multiple lines of business, it’s a little difficult to track ROI. And perhaps, that is the real Googly Goal. This Editor is of the opinion [TTA 24 Aug] that health is only a part-time pursuit for Big Tech, and that the real game is monetizing data–on people and what can be sold to healthcare organizations. When Big Tech tries to solve the problem of health by itself–which surely sounds what Dr. DeSalvo is about–it stumbles. Just ask David Feinberg, who decamped for Cerner after many frustrations at Google.  

Breaking: Google Health shutting down, most employees scattered to other divisions (updated)

August 21, 2021 | by

Breaking  Google Health is disbanding, according to an ‘insider’ report in the (paywalled) Business Insider, reported secondarily in Becker’s Health IT and in specialized websites such as Apple Insider. This comes on the heels of the departure of Google Health head and Google VP David Feinberg MD after two years on 1 Sept. He will become CEO and president of Cerner starting 1 October. Healthcare IT News, Healthcare Dive

Reports about the internal memo sent to Google employees from what Apple Insider calls “Google research whiff” (?) Jeff Dean indicates that the teams working on various health projects will be split up to other areas. For instance, Google Health’s clinical group including the EHR tool team will now report to Dean. Based on 2020 numbers, 500 employees will be affected. 

Google Health’s track record since its founding in 2018 hasn’t been superlative, despite the prestigious name and bankroll. They bought a failing Fitbit for $2.1 billion closing only in January, after a bouncy romance starting in 2019  with more than the usual share of controversy, with scrutiny from DOJ to EU regulators. Becker’s reports that Google’s CMO, Karen DeSalvo, MD, leader of clinical initiatives, will now report to the chief legal officer. The AI team on medical imaging will report to Google’s search and AI team. The memo also noted relocation of staff to Search, Maps, and YouTube. 

(updated) In June, Google Health reorganized to shed its consumer focus and focus more on clinical applications such as its controversial Care Studio and health AI, including projects moved from sister company Verily. Even losing 130 or so employees to other areas of the company from a unit high of 700, this apparently was not enough to justify its separate existence. TTA 18 June, FierceHealthcare 

Healthcare ain’t beanbag, as they say in New York, and even Apple with its Watch and innumerable apps has found it rough going. Reports this week stated that Apple is scaling back a specific health team that was focused on an internal health app.

For Dr. Feinberg, former CEO of integrated health regional Geisinger and CEO at UCLA Health, the Cerner position is ‘top of the world’. He is being hired as Cerner’s third CEO in 42 years and will be combining both the CEO and president positions which previously were separately held. He reportedly has been hired to be a strategic CEO, which is a change for the company reflecting its directional change to be a software-as-a-service (SaaS) business rivaling Amazon Web Services, marking a transition away from legacy EHRs. Cerner has had some significant challenges, with the VA implementation sidelined until sometime in 2022, and quite a few executive changes, with the current CEO and chairman departing immediately after three years without an expected transitional period, and a new chairman coming from the board of directors.

As for Google, Dr. Feinberg might agree with “amar99”, one of the commenters on Apple Insider, who said in part: “Great, now can Google please leave Google?”

News and funding roundup: BioIntelliSense ‘stickers’ $45M, Exo ultrasound scans $220M, Enovation gets Scotland OK, WellSky snaps up Healthify, Cerner’s good quarter despite VA

August 4, 2021 | by

Sticker shock? BioIntelliSense, which has been flying under the radar for over a year [TTA 17 July 2020] since inking a deal with Philips to integrate their BioSticker sensors into their post-acute remote patient monitoring (RPM) systems, scored a $45 million Series B funding for a total of $82 million since 2018. Lead investor is Chimera (UAE) with participation from 7wire Technology Partners, Mary Tolan of Chicago Pacific Founders, James Murren, formerly of MGM Resorts International, as well as Pendrell Corporation, Royal Philips, and Fresenius Medical Care North America.

BioIntelliSense has two wearables: the BioSense on-body sensor for 30 days of continuous vital sign monitoring, and the new BioButton for up to 60 days of RPM. The BioButton is touted for Covid-19 monitoring. “Temperature checks have proven to be unreliable and even amplified testing (PCR) has proven to be ineffective in identifying the virus in the early days of infection.” The button will be connected to the BioMobile screening survey app which will feed the user the latest CDC health screener and then scan for ‘subtle physiological changes’ in temperature, respiratory rate and heart rate at rest. The app generates a non-PHI report indicating ‘cleared’ or ‘not-cleared’. The BioSticker is 510(k) FDA-cleared; the BioButton is not, but is being marketed as an enterprise solution for employee health clearance. Mobihealthnews

Hand-held ultrasound gets ultra-funding. The Exo hand-held ultrasound snagged a hefty $220 million in Series C funding for a total of over $320 million since last year. Their point-of-care tool includes nano-materials, sensor technology, and advanced signal processing and computation in a platform called Exo Works. Exo is in a crowded field pioneered by GE Healthcare’s Vscan [TTA 27 March] back in 2010, but including Butterfly IQ, Mobisante, and Philips Lumify. Mobihealthnews

Enovation also approved by Scotland. With our news from Alcuris last week that they were selected by Scottish Digital Telecare as a security-assessed supplier, Enovation (formerly Verklizan), notified your Editors that they also were selected. Our quote from their management is from Andy Grayland, Chief Information Security Officer, Digital Office for Scottish Local Authorities. “The Scottish digital telecare security-assessed suppliers scheme reviewed a submission from Enovation for an Alarm Receiving Centre application. The assessment panel was very impressed with pre-existing security security culture and standards within Enovation. Both this assessment scheme, and Enovation’s positive response to it, will help ensure that vulnerable telecare users across Scotland are protected against the threat posed by cyber criminals when using these services.” 

WellSky to acquire SDOH provider Healthify. WellSky is a provider of software, analytics, and services for community care. Healthify builds and manages accountable networks for SDOH services, working with health plans, providers, and community partners in all fifty states. Previously, Healthify had raised $25.5 million in five rounds from 2013 (Crunchbase). Healthify is the fifth company WellSky has acquired since 2018, the last CarePort Health for $1.4 billion in 2020 (Crunchbase). Terms were not disclosed. Closing anticipated in Q3. The release does not indicate management transitions or HQ location.  

Despite their VA troubles and layoffs, Cerner had a very good quarter indeed: revenue up 10%, adjusted EPS $0.80 versus $0.63, exceeding analyst expectations for both. They laid off 500 employees in the quarter and eliminated 300 open positions, which will deliver $70 million in annualized savings. plus half their owned space is now unneeded so up for sale. Their Department of Defense EHR rollout is going well with 42 commands and 663 locations with 41,000 activated users. The Coast Guard’s deployment will be completed this year. As to VA, “results of the VA’s strategic review focused on governance, training, and readiness rather than Cerner-caused problems.” More in the lead article in HISTalk 8/2/21. Cerner’s announcement, transcript of earnings call on Seeking Alpha

Cerner execs to VA Congressional committee: “We are committed to getting this right”

July 28, 2021 | by

Two Cerner executives had their say in testimony to the Senate Veterans Affairs Committee last week, and they hung on by, presumably, their fingernails in their commitment to having working tests and a workable rollout of the Cerner Millenium system. This will replace the warhorse VistA system in use for decades in the VA, but incompatible with the Department of Defense’s Cerner MHS Genesis and earlier EHRs in use in military care facilities.

The EHR implementation, which is at last report costing $16 billion, failed miserably at Mann-Grandstaff VA Medical Center in Spokane, Washington in late 2020 into this year. The three-month review of the program “raises more questions than it answers,” said Committee Chair Frank Mrvan, D-Indiana. Other members concurred in being less than impressed by Cerner. Ranking Member Matt Rosendale, R-Montana, wasn’t interested in “shoveling more money into a flawed program just to keep the paychecks flowing.”

However, Brian Sandager, senior vice president and general manager of Cerner government services, pointed out that wait times at Mann-Grandstaff, with nearly 70% of veterans seen within 15 minutes of their scheduled appointment time, with urgent care patients seen within 13 minutes of arrival. Opioid treatments were flagged for alternative treatments. HealthcareITNews   Our earlier coverage here.

Cerner Government Services has a great deal riding on the successful implementation of the VA contract, including their extensive government work with DOD on MHS Genesis and other healthcare organizations within the US Government, including those listed on their website: the US Coast Guard, CDC, HHS, and CMS.