News roundup #1: UHG-Amedisys extended, NeueHealth going private in NEA’s ‘deal deal’, Commure buying Memora Health, VA resuming Oracle rollouts–now mid-’26

January 8, 2025 | by

The end of year is a favorite time to slip in news that deserves wider notice. Sometimes it’s by design so as not to be noticed…and sometimes it’s timing. Or both. Here’s a potpourri of analyses of late December moves of note.

UnitedHealth Group and Amedisys home health agreed to extend their deal window to 31 December 2025. Amedisys filed regulatory paper on 26 December (file here) that moved the acquisition termination date to end of this year, or alternatively to 10 business days after a final court ruling blocking the merger. The latter is a distinct possibility since the Department of Justice back on 12 November filed a lawsuit to prevent the acquisition [TTA 14 Nov 24] on anti-trust grounds, joined by the attorneys general of four states. Amedisys, a major competitor to UHG/Optum, would be merged into Optum’s existing home health operations.

This long-running acquisition started back in June 2023 as an all-cash deal for $3.3 billion and went into DOJ review by August. The target closing at that time was end of 2024 as both companies knew that divestitures would be necessary. The penalty for non-completion was also upped to $325 million if needed divestitures to the VitalCaring Group proposed last July aren’t completed by 1 May. Even with a new Attorney General coming in after Senate confirmation, the wheels are already in motion for this antitrust action that throws a completion into doubt. Becker’s, Healthcare Dive

Gimlet EyeNeueHealth to be taken private by New Enterprise Associates (NEA) and other investors. The latest episode of the long-running NeueHealth (formerly BrightHealth) show dropped on 23 December. Existing investor NEA and 12 other investors with preferred shares in the company will take it private at an enterprise value of approximately $1.3 billion and roll over their shares for equity in the private company. Other holders of common stock will be cashed out, receiving $7.33 per share, a premium of 70% over the $4.31 closing on 23 December. The final price may change as common shares went up sharply the next day and remain up–today (8 January) opened at $7.49. Closing timing of this ‘deal deal’ is dependent on shareholder and regulatory approvals. Management will remain and roll over their shares into the company. Hercules Capital’s loan facility remains in place.  

Buried in the release is this caveat: “The merger agreement includes a 30-day “go-shop” period that will expire at 12:01 AM New York City time on January 23, 2025, which permits the Special Committee and its financial advisors to solicit and consider alternative acquisition proposals.” These proposals will be kept under wraps. But in this Editor’s view, outside offers are highly unlikely given the company’s death-defying history, continuing losses, and Ticking Time Bombs (see below). Their Q3 results had projected full-year 2024 adjusted EBITDA between $15 million and $25 million–but they lost $40 million in Q3 with the 2024 loss to date over $102 million.

As Ari Gottlieb dryly noted in his LinkedIn post, the company is $1.4 billion in debt. $7.33 per share is quite a comedown from the June 2021 IPO at $18 and an $11 billion valuation. The payout to the 36% of shares held by the other public shareholders is a paltry $21 million. Bottom line–NEA and the preferred investors are buying the company for $21 million–such a deal!

This Editor has previously and Gimletly noted NeueHealth’s high-wire act. It has truly Dodged Disaster with aplomb, skillfully creating its Own New Reality. But its Ticking Time Bombs remain: $300 million in CMS Repayment Agreements due on or before 14 March 2025 and $89 million owed to Texas from last year to cover risk liabilities for its shuttered ACA plans [TTA 14 Feb]. To be continued…   Release, Star-Tribune, FierceHealthcare

Commure bought digital health navigation platform Memora Health. Neither acquisition cost nor management transitions were disclosed on 20 December. Commure has one of the more interesting stories out there as the current company emerged from a General Catalyst-engineered estimated $6 billion merger between Commure and Athelas, with Athelas taking the upper hand in the reorganization [TTA 23 Oct 2024]. It should then be no surprise that Memora has significant investment from General Catalyst, which led its last round of funding in April 2023, making this another investor-arranged deal.

Commure’s primary products are the Strongline duress systems for worker distress and patient elopement and the Patient Keeper EHR, with Athelas in revenue cycle management and sensor-based remote patient monitoring. The combined company now features AI-aided workflows, RCM, duress systems, and a software development platform accessible to outside vendors. What Memora is primarily known for is automating practice follow-up texts before and after procedures. The Memora acquisition is positioned as reinforcing CommureOS’ clinical documentation, RCM, and real-time location services (RTLS). In October, Commure closed their acquisition of Augmedix, an AI-assisted physician scribe used by 20 health systems, for $139 million ($2.39/share), giving it a huge leg up into those providers. Augmedix IPO’d via a SPAC in 2021 at $4/share. About 400,000 physicians are claimed to be users of the Commure suite of products.  Release, Mobihealthnews, Endpoints, FierceHealthcare (Augmedix)

And what end of year would it be without a hopeful note from the VA about the Oracle Cerner rollout–now continuing in mid-2026? The Department of Veterans Affairs (VA) on 20 December officially targeted mid-2026 for four Oracle Cerner implementations, 18 months from now. It’s carefully hedged that they are beginning ‘early-stage planning’ for deployment in four Michigan facilities — Ann Arbor, Battle Creek, Detroit, and Saginaw. Meanwhile, improvements will continue at the five sites that use Oracle Cerner plus the sixth joint implementation with the MHS (Lovell). Interestingly, the current VA secretary, Denis McDonough, announced at an 11 December press conference that new implementations would start before the end of 2025 [TTA 19 Dec 2024]. This Editor assumes that the staff sharpened their pencils and recalculated right before Christmas. What’s also hopeful for Oracle and the VA are continuing  improvements in veteran outpatient trust and clinician satisfaction scores, as well as effectively eliminating outages for 200 days as of the release date. VA release, Healthcare Dive 

“I will survive” updates: NeueHealth survives Q2 with small net loss, Steward sells off Stewardship Health practices to private equity firm for $245M

August 16, 2024 | by

Mid-August’s pre-Labor Day news deluge was so chock-full of developments that your Editor missed these two survival specials:

NeueHealth, a New Reality casualty that’s decided to create its Own New Reality (or the equivalent of the Twinkie Defense), reduced its Q2 net loss, eked out positive EBITDA.  NeueHealth, which has made an art form of Dodging Disaster, notched Q2 revenue of $226 million with a net loss of $53 million and a slight positive adjusted EBITDA of $3.96 million. Diluted loss per share was reported as $8.65, more than $5.00 worse than Q1. Revenue and losses were reduced as expected from Q2 2023 as their business model drastically changed with the sale or closure of its health plans by close of last year. Their covered lives are slightly down (value-based consumers meaning patients) or way up (enablement services lives, a fancy term for non-clinical support services such as health education and care coordination).

Their forecasts for 2024 are oh-so-rosy, with total revenue of $950 million, segmented for NeueCare (primary care in Florida and Texas plus affiliates) at $320 million plus NeueSolutions (management services including ACO management) at $640 million, with adjusted EBITDA in the $15-20 million range.

CEO Mike Mikan touted the $150 million debt financing round from Hercules Capital, which in this Editor’s view had more hedges than France’s Bocage [TTA 26 June]. Stock, which had a brief bump to over $6.60 in July, languishes in the $5.00 range. There is no update on the 16 June NYSE non-compliance notice for a market cap below $50 million that had a 45-day deadline for a plan to remediate within 18 months. Market cap is presently at $41 million. There is also no update on their ticking time bombs: the CMS Repayment Agreements due on or before 14 March 2025 nor $89 million owed to Texas from last year to cover risk liabilities for its shuttered ACA plans [TTA 14 Feb]. It’s those Gordian Knots again! Yahoo Finance, NeueHealth release, Fierce Healthcare

A bright spot in the messy bankruptcy unwinding of Steward Health Care is the pending sale of Stewardship Health, its practice arm, to be reviewed today. The teed-up proposed buyer offering $245 million is a new company, Brady Health Buyer, set up by private equity company Kinderhook Industries, LLC, on behalf of its existing investment, Nashville-based Rural Healthcare Group.

  • Kinderhook is a $8.5 billion PE with investments across healthcare services, environmental/business services, and automotive/light manufacturing sectors.
  • RHG has 14 clinics in rural North Carolina and Tennessee.
  • Stewardship operates practices in nine states, has 5,000 doctors, and serves 400,000 patients.
  • They will have to move facilities from Steward hospital properties. There are no location or state overlaps with RHG.

Their prior sale arrangement to Optum preceded the bankruptcy and was withdrawn after a DOJ challenge. The only other offer from 57 potential bidders approached, other than Kinderhook/Brady/RHG, were their FILO lenders.

Judge Christopher Lopez, the bankruptcy court judge in Texas, is expected to rule on the sale today (Friday), along with a separate sale of up to six Massachusetts hospitals. Regulatory approvals are required. WBUR, Healthcare Dive

News roundup: AliveCor launches FDA-cleared Kardia 12L ECG, eVisit buys UPMC’s inpatient teleconsult, UPMC and MedStar invest; NeueHealth gains $150M loan–with caveats–and NYSE non-compliance notice

June 26, 2024 | by

AliveCor shrinks 12-lead ECG to a single cable with AI-assisted detection for 35 cardiac determinations. The just-cleared by FDA system for clinicians combines the Kardia 12L ECG System (left), a single cable with five electrodes that acquires 8 high-quality diagnostic bandwidth leads, with the KAI 12L AI-assisted diagnostic technology. KAI uses a deep neural network-machine learning AI model to interpret ECG data acquired and validated on more than 1.75 million ECGs from leading US medical centers. It can make 35 cardiac determinations–14 arrhythmias and 21 morphologies–that include acute myocardial infarction (MI) and the most common types of cardiac ischemia. The Kardia 12L is battery-powered, weighs about 1/3 of a pound, and fits into a typical lab coat pocket.

12-lead ECG is considered the standard of ECG readings. A pocket system of this type puts this in reach of clinics, rural health, urgent care offices, and employer clinics. It requires minimal self-guided training and doesn’t require patients to fully disrobe. Release, Mass Device

Telehealth provider eVisit acquiring UPMC’s inpatient teleconsult technology–along with investments from UPMC and MedStar Health. This ‘hat trick’ adds hospital inpatient telehealth capability to eVisit’s health system-focused telehealth triage, provider-to-provider consults, and scheduled telehealth visits. The teleconsults serve inpatient care across five services: stroke, neurology, critical care, psychology, and toxicology. Both UPMC and current client MedStar Health (from the 2023 Bluestream Health acquisition, TTA 27 Apr 2023) are also investing in eVisit, adding an undisclosed amount to eVisit’s 2021 $45 million Series B. (Another way of saying ‘unlettered raise’?) Release, FierceHealthcare

And would this month be complete without items from the Dean of Dodging Disaster, Creating its Own New Reality, the one and only NeueHealth? The first is that Hercules Capital is giving them a second term loan facility (Loan and Security Agreement) of up to $150 million over three years that is, to be polite, hedged with qualifications. 

  • Tranche #1 is available on closing: $30 million
  • Tranche #2, $25 million, will be available only for a limited time– 10 November through 31 December 2024. It is also dependent on Molina making its final payment to NeueHealth for the Medicare Advantage plans they bought–a payment dependent in turn on those plans achieving plan performance ratings ( the “2025 Stars Condition”).
  • Tranche #3 of $45 million will be available from 5 February 2025 to 15 September 2025. But it is contingent after paying off what is owed in connection with the ACO REACH Model for performance years 2023 and earlier, payment in full of the CMS Settlement (as defined in the Loan and Security Agreement) and the Company having at least $22.5 million of unrestricted cash and cash equivalents.
  • Tranche #4: up to $50.0 million and available until 21 June 2027
  • The loan matures on 1 June 2028

Release 24 June, SEC Form 8-K, FierceHealthcare

The second is that the loan could not have come at a more needed time, as NeueHealth received a non-compliance notice from the NYSE on 16 June. It fell below an average market capitalization of $50 million for 30 consecutive trading days, with their last reported stockholders’ equity also below $50 million. It has 45 days to submit a business plan to remedy it within 18 months. NeueHealth’s preferred stock had a value of $920.4 million as of 31 March 2024 but is excluded from the NYSE calculations of common stockholder equity. NeueHealth closed today at $5.23.

This is in addition to a $30 million loan from current 60% majority shareholder NEA [TTA 16 Apr].

Along with tying Gordian knots masterfully and playing multiple ends against the middle, one wonders what management does all day at their new offices in Doral, Florida? Avoiding Chapter 11? Golfing? Surfing?

Short takes: Medicare telehealth flexibilities may extend; ‘no interest’ in Transcarent sale; NeueHealth ekes out positive net income; Cigna and Oscar break up; DocGo, Ascension cyberattacked (updated)

May 10, 2024 | by

Two-year extension of telehealth flexibilities advances in Congress. A small telehealth victory was notched in the House, where the powerful Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act by a vote of 41-0. The bill would extend many of the Medicare and Federal program telehealth waivers and flexibilities established during the pandemic to the end of 2026. It is now expected that the House will bring the bill to the floor for a full House vote in the fall session. Ways and Means’ jurisdiction is over most financial and revenue-raising Federal measures, such as taxation, Social Security, and Medicare. Highlights of the bill:

  • Geographic and originating-site waivers
  • Ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to continue to furnish telehealth services
  • Expanded list of eligible Medicare providers, allowing physical therapists, occupational therapists, speech language pathologists, and audiologists to render telehealth services
  • Ability to offer audio-only services
  • Repeal of telemental health in-person requirement
  • Preservation of the Acute Hospital Care at Home Program through CY2029

Parts are controversial, such as the telemental in-person requirement, hospice recertification, and guardrails around durable medical equipment (DME) and clinical diagnostics requiring reports to prevent fraud, waste and abuse. The bill did not include remote prescribing of controlled substances. Expect further markups to be made before passage in the House, later in the Senate, and the joint bill. The American Telemedicine Association (ATA) applauded the bill with the main caveat being around telehealth controlled substance prescribing. Full text, FierceHealthcare, ATA release

Glen Tullman rules out a sale of Transcarent–but not an IPO. On the heels of a substantial $126 million in Series D funding and a  jumbo $2.2 billion valuation [TTA 8 May], Transcarent’s CEO Tullman, in an interview with MedCityNews, stated that he had “no interest” in selling the company. Transcarent is already run “like a public company”, has a strong leadership team already in place, and “we’ll make any exit decisions for the right reasons.” Mr. Tullman has already run four public companies and IPO’d three: CCC Information Systems (in auto insurance), Livongo, Allscripts (now Veradigm), and Enterprise Systems. Livongo was sold to Teladoc in 2020, with consequences. Veradigm, the former Allscripts, went public in 1999–25 years ago in a vastly different world. Their big bet in enterprise health navigation is now on AI for both physicians and members.

Back to the New Reality, Bizarro World edition. NeueHealth, which is achieving a world record in Dodging Disaster while paying out leadership bonuses, eked out a decent Q1. The former Bright Health Group managed to squeak out revenue of $245.1 million, operational net income of $5.7 million, and an adjusted EBITDA of $2.5 million compared to a Q1 2023 loss of $5.7 million. This doesn’t mean it was profitable because its net income for Q1 was a negative $28.5 million. Revenue dropped by 18%–$55 million–compared to Q1 2023. New Enterprise Associates (NEA) must be pleased, as they are now 60% owner of the operation with another loan of $30 million secured by penny warrants [TTA 16 Apr]. The full year guidance was reaffirmed at $1 billion in revenue with 70% coming from its NeueSolutions business (their management services for ACOs and IPAs), and adjusted EBITDA between $15 million and $25 million. What remains, of course, are the UXBs–the problems with their financial reporting as noted in their 2023 results and that ever-so-nasty $400 million in payments due to CMS in March 2025, as well as to Texas on their exited ACA plans. But NeueHealth has played both ends against the middle and tied up creditors in Gordian knots for a couple of years, so why not keep on keepin’ on for now? Release, earnings call transcript, FierceHealthcare   TTA 5 April

The much-touted partnership of big Cigna and insurtech Oscar Health is breaking up. The Cigna + Oscar joint program covers the small group business. As of the end of Q1, it had 61,428 members enrolled. The program, which had no forecast of profitability, will end in 2025. CEO Mark Bertolini’s statement was rather forceful in this regard. Oscar is shifting to marketing ICHRA, or individual coverage health reimbursement arrangements that permit small businesses to offer employees individual health plans subsidized by employer contributions. Cigna will continue to offer plans for the small and midsize group market. Becker’s

Cyberattacks strike DocGo, Ascension Health. DocGo reported a data breach in its 7 May Form 8-K filed with the SEC. It involved a limited but unspecified amount of protected health information (PHI) of patients using its ambulance services, but was confined only to that. No other report of the breach has been made. This followed a positive Q1 report of revenue up to $192.1 million, from $113 million in the same quarter 2023. Net income was $10.6 million versus last year’s net loss of $3.9 million. Adjusted EBITDA went up to $24.1 million versus $5.6 million. DocGo provides telehealth/RPM, mobile urgent care, disease management, and medical transportation services. It recently lost its lucrative but controversial NYC migrant service contract but retains city Health + Hospitals contracts and some smaller housing service contracts. Mobihealthnews Ascension Health, on the other hand, has had a serious disruption in some clinical operations affecting an undisclosed number of hospitals and systems, but was reported in Michigan. On Wednesday, Ascension detected unusual activity in select technology-network systems. They advised business partners to sever connections to their systems and have brought in Mandiant to assist in investigation and remediation efforts. Ascension is one of the largest health systems in the US, with 140 hospitals in 19 states plus the District of Columbia. Healthcare Finance, Detroit Free Press, Ascension website

Ascension Update: Reports since yesterday are now far more exact. Its EHR, MyChart, several systems for ordering tests and medications, plus some phone systems are unavailable across the system. Some appointments and surgeries have been postponed. There are emergency diversions of care in some locations. Ascension’s statements to media has been that ‘downtime procedures’ will be in place ‘for some time’. There is no timeline given for restoration. Becker’s, Healthcare Dive

 

The New Reality, Bizarro World version: NeueHealth gets $30M loan increase from NEA, now majority owner

April 16, 2024 | by

Because NeueHealth needs money now after a 2023 cratering–then paying 2023 performance bonuses to its top execs. New Enterprise Associates (NEA), one of NeueHealth’s remaining key funders, has decided to double down on its bet and extended $30 million to NeueHealth. It’s structured as a credit facility agreement effective 8 April, with NeueHealth able to access $20 million immediately and the remaining $10 million after 180 days. It’s secured by penny warrants ($0.01) of 1,113,563 shares of the company’s common stock to the lenders. According to FierceHealthcare’s Noah Tong, this brings NEA’s shares to more than 2.76 million shares since it first entered the credit agreement. These warrants which allow the purchase of shares at a nominal price are divided among various NEA entities. Investing.com, NeueHealth release, SEC Form 8-K

NEA is now majority owner at 60%, up 10 percentage points. It can also appoint one of its members to NeueHealth’s board, which will expand to 11 members.

Despite the disclosure in its March 10-K that additional funding was needed this year to continue as a going concern, the need for fast cash was urgent enough that the board of directors’ audit committee approved a waiver of shareholder approval on the warrant issuance, as waiting would jeopardize the financial viability of the company. NeueHealth stated the additional cash would be used for general business purposes.

The additional cash infusion is after shocking many observers in healthcare with CEO Mike Mikan’s $1.9 million bonus for performance, along with cash bonuses of $875,000 to CFO Jay Matushak and Executive Vice President of Consumer Care Tomas Orozco. NeueHealth’s 2023 was marked by exiting all their healthcare plans, owing tens to hundreds of millions to states on losing plans and CMS on repayment agreements, a name change from Bright Health, an HQ move, and finally a net loss of $627.7 million with an adjusted EBITDA loss of $8.5 million for 2023. TTA 5 April

Industry observer Ari Gottlieb to both Mr. Tong and in his own LinkedIn post noted that NeueHealth reported that they had, at the end of 2023, $90 million in unrestricted cash. He also noted that CalSTRS, the California State Teachers Retirement System, NeueHealth’s other major investor, did not participate. Mr. Gottlieb also speculated that Molina Healthcare, to which Bright Health sold their Medicare Advantage (MA) plans, may ask for further adjustments to the payment price as the MA plans’ performance was poor.

Has NEA lost its investors’ minds and cash–or are they seeing something we don’t see in NeueHealth?

Editor’s note: The reference to Bizarro World, for those unfamiliar with the Superman oeuvre, is explained here.

More New Reality: NeueHealth (Bright Health) CEO’s $1.9M bonus (updated), 2023 financials–and does Cano Health have a future?

April 5, 2024 | by

After 2023, how did NeueHealth’s CEO earn a bonus of $1.90, much less $1.9 million? As our Readers know from our last episode of ‘Facing the Music of the New Reality’ [TTA 14 Feb, 24 Jan], Bright Health Group at the top of 2024 rebranded with the oh-so-chic name of its value-based care medical practice division, moving its HQ from poky, cold, failing Minneapolis to Doral, Florida. All its health plans, launched some years back in a blaze of flashes, either were sold (Medicare Advantage to Molina) or collapsed in a heap of losses. Aside from owing money to Texas ($85 million) on ACA plans, Neue owes mucho money to the Center for Medicare and Medicaid Services on Repayment Agreements, reportedly around $400 million, due on or before 14 March 2025. But in a masterful move, using the Molina money to keep the investors at bay, NeueHealth has managed to pay off JP Morgan for a credit line, dodge all the bill collectors–and award its CEO Mike Mikan a $1.9 million bonus, up from $1.69 million in 2022. Now, like some other of the C-suite, Mr. Mikan took most of his 2023 compensation of $9.9 million in stock-based pay, most of which is (glub glub) underwater. But one has to wonder about a board of directors, including major investor New Enterprise Associates, that would reward Mr. Mikan for steering Bright Health into a brick wall, even if it came out the other side as Neue. And Neue still needs funding to continue as a going concern this year (see page 12 (page 18 of PDF) of their March 10-K). AOL News, Ari Gottleib on LinkedIn, FierceHealthcare 4 April update  Cash bonuses of $875,000 were paid to CFO Jay Matushak and Executive Vice President of Consumer Care Tomas Orozco.

Another surprise in their 10-K is on pages 115-116 of the document (PDF pages 121-122) of a ‘material weakness’ in their financial reporting that has existed since 2022, not remediated in 2023, but is planned to be remediated in 2024. “Our disclosure controls and procedures were not effective due to a material weakness in our internal control over financial reporting”.

Their Q4 and 2023 financials reported in March were also underwater, with net losses of $62.8 million for the quarter and $627.7 million for the year, with an adjusted EBITDA loss of $8.5 million. But for 2024, they present a bright (ahem) picture for NeueHealth’s two divisions: NeueCare (owned clinics and partnerships with affiliated providers) and NeueSolutions, a management services entity that organizes independent providers and physician groups into performance-based ACA Marketplace, Medicare, and Medicaid-based ACO models, including the advanced performance ACO REACH program. Projected revenue is $1 billion and adjusted EBITDA between $15 million and $25 million. NeueHealth release, FierceHealthcare 

Perhaps investors New Enterprise Association ($1 billion in) and CalSTRS are letting their chips ride on what most could see as a losing number–what is the alternative? At the risk of repeating myself, they’ve managed to play multiple ends against the middle and tie masterful Gordian knots (pick your analogy) around CMS and their investors, hoping to stay alive until 2025 and better times. Or, as Ari Gottlieb speculates, NeueHealth may file a Chapter 11 before the CMS payments are due in March 2025. And then what?

This Editor also notes that former GE CEO Jeff Immelt is on Neue’s BOD and is a venture partner in NEA. The late ‘Neutron Jack’ Welch was once heard to regret naming Mr. Immelt as his successor, given that once-mighty GE is now split into three relatively small companies after maximum losses and management turmoil at legacy GE.

(5 March updates in red) 

After a disastrous 2023, does Cano Health even have a future? The telenovela is not fin, but little has been heard from Cano since it entered Chapter 11 bankruptcy on 4 February. A 26 February story in local Florida news, the Sun-Sentinel, has a few updates:

  • Cano’s goal is to exit Chapter 11 by the end of Q2 (June)
  • Class A shareholders, who accepted a 1 to 100 reverse share split in December 2023, will be left with no value–including the ‘Cano 3’ of Barry Sternlicht, Elliot Cooperstone, and Lewis Gold who owned 35% of the shares.
  • They have $150 million in operating cash until then
  • In the reorganization, they have two tracks: continue as an independent company or sell
  • The focus will be on core operations, including Florida Medicare Advantage
  • They plan to close 80 locations. Their filing contains 72 ‘dark leases’ mainly in Florida. Cano has 95 medical centers operating in Florida so it is not clear whether the closures take into account the dark leases.

Cano is now operating in Florida only, having offloaded or closed operations in Texas, Nevada, California, New Mexico, Illinois, and Puerto Rico. According to the filing, they currently employ 3,000 people, including 2,800 full-time staffers including executives, clinical, and administrative staffers, including 300 doctors, nurses, and physician assistants. In addition, Cano has affiliate relationships with approximately 630 provider practices. 

If you wonder what happened to Cano’s former CEO….founder and former CEO Marlow Hernandez, with two other Cano former executives, started a new company called Soran Health based in Hollywood/Miramar, Florida. It provides patient and medical management services including care delivery systems.  Dr. Hernandez and the other former Cano executives were sued in January by Cano for allegedly breaching their non-compete agreements and taking proprietary information. While they have a website and a LinkedIn page, they are remarkably content-less, but listed by CMS as a group practice.

Facing the Music of the New Reality: Amazon Pharmacy & One Medical restructure; Walgreens shakes up health exec suites again, cashes out $992M in Cencora; new takes on NeueHealth; Cue Health, Nomad Health layoffs

February 14, 2024 | by

Amazon delivers a Dose of Reality in shrinking Pharmacy, One Medical. Using the “realigning some resources to help accelerate our efforts” meme, there are about 115 to 400 staff who will be ‘transitioned’ out of their present jobs, according to sources (Business Insider, Seeking Alpha). Areas affected were not disclosed. However, the Amazon division likely taking the hardest hit is One Medical, according to these sources.

  • Amazon has already announced that One Medical must reduce operating losses by $100 million this year. A large step they are taking is to close One Medical’s corporate offices in New York, Minneapolis, and St. Petersburg, Florida, reducing its San Francisco office space to one floor. They cited to industry publications that most employees are remote workers.
  • Unsurprisingly, Amazon is targeting major cost reductions. Fixed operating costs that are currently at 41% of total revenue will be reduced to 20% by 2028. Cost per patient visit will be reduced from $372 in 2023 to $322 in 2024, from $372 in 2023.
  • Legal, finance, and technology teams will report to Amazon’s healthcare business structure
  • Operating areas will increase from four to seven, reporting to a new head of operations
  • CFO Bjorn Thaler will move to a new position focused on growth initiatives, reporting to VP of Health Services Neil Lindsay

At the time of the acquisition, industry thinkers were wondering what Amazon would do with the money-losing One Medical clinics, for which they paid $3.9 billion but never turned a profit and lost $420 million in 2022, its last year of independent operations. Neither membership nor revenue has been reported since the 2023 closing. In 2022, One Medical had 700,000 patients, 8,000 company clients and 125 physical offices in 12 major US markets including NYC, Los Angeles, Boston, and Atlanta. Amazon has been promoting One Medical online and on TV, most aggressively to its Prime members with promotional membership pricing. 

Amazon has aggressively cut tens of thousands of jobs and costs since 2023 in its Audible, Prime Video, Twitch and Buy with Prime units, and completely shut down Halo, its entry in fitness bands and sleep trackers. It has also been aggressively challenged on patient privacy and cross-using information by the FTC, most recently around Amazon Clinic.

Not mentioned in reporting was the FTC and DOJ scrutiny One Medical’s acquisition received between Amazon’s offer and the closing. The two agencies declined to move at that time [TTA 23 Feb 23], but FTC is continuing to build its case against Amazon–and One Medical may be a factor. For context on Amazon’s situation, Readers may want to review last December’s assessment of Amazon to date, Has Amazon lost its ‘edge’ in healthcare? Or finally seeing reality?   FierceHealthcare, Healthcare Finance, Healthcare Dive

Walgreens’ Reality includes C-suite reshuffles, scaring up cash. The new president of US Healthcare and EVP reporting to CEO Tim Wentworth is Mary Langowski. She is currently CEO of Solera Health. Her prior experience at CVS was as EVP and chief strategy and corporate development officer. Moving to an advisor position is the current president, John Driscoll. US Healthcare includes VillageMD, Summit Health/CityMD and CareCentrix. In addition, Manmohan Mahajan was appointed as permanent CFO, having held the position on an interim basis from July. Elizabeth Burger was named as EVP and chief HR officer from a similar position at industrial Flowserve, replacing Holly May who departed in November and is now with Petco. Crain’s Chicago Business, FierceHealthcare

Slipping under this was a further sale of Walgreens’ position in Cencora, the former AmerisourceBergen, a highly diversified pharmaceutical distributor. The sale of approximately $942 million of Cencora common stock was subject to the completion of the Rule 144 sale, and included a concurrent share repurchase by Cencora of approximately $50 million for a total to WBA of $992 million. WBA’s position is now 13% versus 15%; partnership and board representation remains in place. From the WBA release, “Proceeds to Walgreens Boots Alliance will be used primarily for debt paydown and general corporate purposes, as the company continues to build out a more capital-efficient health services strategy rooted in its retail pharmacy footprint.”

Is NeueHealth creating its own Reality? At the end of January, Bright Health Group faded to black and relit as NeueHealth, its value-based care medical practice division, and moved its HQ from poky, cold, failing Minneapolis to Doral, Florida. It sold or closed all its health plans in a heap of losses, most of which have bills coming due via CMS Repayment Agreements which come due on or before 14 March 2025. Most of the industry is shaking its head in wonder that NeueHealth has made it this far.

The discussion in MedCityNews is worth reading. It includes Ari Gottlieb of A2 Strategy who points out that the company is $1.4 billion in debt to the likes of investors Cigna Ventures, New Enterprise Associates, and CalSTRS. They owe $89 million to Texas to cover risk liabilities for its shuttered ACA plans. Over $100 million remains in escrow from the Molina sale to cover obligations from its Medicare Advantage plans. Mr. Gottlieb predicts that NeueHealth will be drained and go bankrupt before the Feds come calling in March 2025. Another analyst, Tyler Giesting, director of healthcare and life sciences at West Monroe, takes a sunnier view that NeueHealth is in a sector, value-based care, that payers are interested in and will buy into, as long as the practices perform. This Editor will reiterate her wonder at NeueHealth’s management maneuvers. They’ve managed to play multiple ends against the middle and tie masterful Gordian knots (pick your analogy) to stay alive until, they hope, 2025 and better times. 

More Reality delivered in two layoffs in once-hot companies that thought pandemic les bon temps rouler would last forever:

  • San Diego-based Cue Health, a biotech company that produced Covid-19 tests, is laying off another 245 employees. This adds to the 884 workers in primarily San Diego laid off last year. Cue grew to over 1,500 employees when it got the first FDA approval for its 20-minute molecular test kits to supply the US government, the NBA, Google, and other large companies. Cue IPO’d in September 2021 at $200 million and $16/share, with a valuation of $3 billion. Its shares on Nasdaq are today at $0.25. The company also offers a test for mpox (monkeypox) and is seeking FDA approval for its RSV and Flu test kits. San Diego Union-Tribune
  • New York City-based Nomad Health, a healthcare staffing service that took advantage of the pandemic demand for travel nurses but had not fully transitioned into other temporary healthcare workers, released 17% of staff, from 691 to 572 employees. Nomad was reeling not only from lower demand but also correspondingly lower rates. It raised $200 million to date from investors such as Adams Street Partners and Icon Ventures. Forbes

And the final Reality is how healthcare companies, from providers to digital health, are phrasing what seems to be endless layoffs. Euphemisms such as rightsizing, org change, involuntary career events, corporate outplacing, and offboarding are all being used to sweeten for public consumption that a lot of people, hired so eagerly in 2020-22, are losing their jobs. From the Bloomberg article (paywalled), “They somehow seem to believe that if they use language that is more vague and less emotional, that people won’t get as upset,” said Robert Sutton, PhD, professor of management science and organizational behavior with Stanford University School of Engineering. Instead, euphemisms tend to have the opposite effect. Becker’s  This Editor has been both a survivor and a victim of same, being in marketing which is always vulnerable. Contract and consulting work, which anticipate a stronger market, are like the Sahara–few and dry water holes. Expect layoffs and a dead market for experienced talent to be a major factor in this year’s US elections, despite the reported low unemployment numbers (that no one believes anymore).

News roundup: Bright Health now NeueHealth; breached patient records double, RCM as vector for hacking; Amazon’s CCM marketplace; JPM reflects the new reality; fundings for Vita Health, Turquoise, CardioSignal

January 24, 2024 | by

Bright Health Group switches off, takes on NeueHealth name. Now that Bright Health has sold its remaining operating health plans to Molina Healthcare [TTA 3 Jan] with others closed down or insolvent like Texas [TTA 12 Dec 23], they have smartly pivoted to the name of their remaining value-based primary care operation, NeueHealth. (Inexpensive, too) Accordingly, on 29 January, their NYSE listing will convert from BHG to NEUE. The stock value closed today at $13.25, well down from its 52-week high of $79.04. NeueHealth’s operations are divided into NeueCare, which is comprised of their owned clinics and partnerships with affiliated providers, and NeueSolutions, which is a management services entity that organizes independent providers and physician groups into performance-based ACA Marketplace, Medicare, and Medicaid-based ACOs models, including the advanced performance ACO REACH program which covered 60,000 beneficiaries in 2023. Unsurprisingly, the company HQ is moving from chilly Minneapolis to much warmer Doral, Florida, nearer to three of their major clinic networks and 150,000 of its claimed 275-295,000 ‘health consumers’ forecast for 2023. 2023 revenue forecasts for NeueCare are $250-275 million and NeueSolutions $890 million. They have also stated that the corporate move will not affect jobs remaining in Minneapolis, which may be few.

As to the bills coming due for CMS liabilities and debt owed to New Enterprise Associates now that JP Morgan has been paid…not a word. We continue to hand it to Bright, now NeueHealth, for the Best Gordian Knots in Healthcare. Release, Healthcare Dive

Patient records exposed in data breaches doubled in 2023 versus 2022. According to an analysis by cybersecurity firm Fortified Health Security of HHS’ Office of Civil Rights (OCR), which tracks data breaches, in 2023 there were 116 million patient records exposed, topping the over 100 million of 2015, with over 655 breaches, a decrease from 2022’s peak of 721. Of that 116 million, over 112 million were from three health plan breaches: Anthem, Premera Blue Cross, and Excellus, Ten-year total? A stunning 489 million. What also increased over those 10 years by 143% were breaches stemming from business associates–vendors providing services to the covered entity. The just-published Horizon Report (free, available for download here) also reveals that the average recovery cost for a breach is $9.48 million. And health plans and systems are cutting IT staff?  Healthcare Dive

One way that hackers are finding their way into healthcare organizations is via ‘social engineering’, but not always of employees. They’re targeting business associates at revenue cycle management (RCM) companies serving health systems and hospitals. The American Hospital Association is warning members that hackers are cannily evolving their tactics to defeat security procedures such as multi-factor authentication and they have to anticipate hacker tactics. From Becker’s, hackers “steal the identities of revenue cycle employees or other finance staffers, calling IT help desks and correctly answering security questions. They then request to reset their passwords and enroll new devices, getting full access to the employees’ accounts and diverting payments to fraudulent bank accounts.” These are based in the US and then diverted overseas. The AHA recommends at minimum a call back to the employee on these new device enrollments, a call to the person’s supervisor, or as in the case of one health system, a physical appearance at the help desk. AHA article

Amazon enters the chronic care management field through a tried-and-true (for them) vector–e-commerce. Search for a health device like a glucose monitor, a blood pressure cuff, or pulse oximetry, and receive a ‘direction’ to a management service that they may be eligible for at no or low cost through their employer or private health insurance. The kickoff partner with Amazon is chronic care management company Omada Health in the diabetes prevention, diabetes, and hypertension categories. Omada claims 20 million eligible members across 1,900 enterprises. This mode may get better traction with Amazon shoppers than directly providing them with health services such as Amazon Pharmacy, One Medical (primary care), and Amazon Clinic (asynchronous telemedicine). Omada didn’t disclose the revenue model. Omada release, Healthcare Dive

Wrapping up the JP Morgan healthcare conference, the New Reality permeated it, even if some didn’t want to admit it. As this Editor projected back in December, the board is being cleared of the also-rans and never-should-have-beens. You see a general cleansing of the cant and hype infecting a sector, which is initially unnerving. We are cycling through this stage fairly rapidly to emerge…where, we don’t quite know yet. Unlike some other publications, MedCityNews can never be mistaken for an industry cheerleader (even if you have to read between the lines). Their extensive coverage confirmed this emerging view of 2024.

  • Katie Adams didn’t make it to SF for her article on nine JPM takeaways, but she sussed out that life sciences isn’t ready for AI, GLP-1 drugs won’t solve obesity, transactional telehealth for urgent and behavioral care is over, founders are trying to figure out fundraising timelines, and retail clinics are suddenly Not All That. And more.
  • Arundhati Parmar profiled a company—one of all too many–that cycled from high to low–Butterfly Health. They started in 2011 to develop the first point-of-care handheld ultrasonic probe using a semiconductor chip that connected to a smartphone, became a unicorn by 2018, went public via a SPAC in 2021 at over $19, cracked hard, and now trades around $1. Their new CEO used the JPM platform to explain that their 2023 revenue slide wasn’t so bad because they were working their way through the longer-than-they-ever-imagined adoption curve by cutting $200 million in costs out of the company and building up their cash reserve. They may survive, or not, given that competition has names like GE Healthcare, Philips, and Siemens. But their ideas around selling the technology of the semiconductor chip to healthcare companies outside of ultrasound and opening their POCUS to developers (like Apple) are clever. It sounds like a company that could fit into a PE portfolio, if only some wallets and checkbooks opened.

And another marker of the New Reality: Scripps Health in San Francisco, hit hard by a cyberattack in 2021, announced at JPM that they hired Todd Walbridge, recently retired from the FBI as their supervising agent in their San Diego cybersecurity hub, as senior director for corporate and system safety and security. He had worked with Scripps on their cyberattack during his diverse career with the FBI. Mr. Walbridge is not only in charge of cyber, but also of physical security as workplace violence and assaults on staff have soared. FierceHealthcare

And we’ll wind up with some fundings, modest ‘green shoots’ in winter:

  • Vita Health, based in Connecticut, secured $22.5 million from seven investors for their suicide prevention and therapeutic telehealth platform. An 2022 seed raise totaled $8.38 million. Release, Mobihealthnews
  • Turquoise Health, based in San Diego, gained a $30 million Series B investment from four investors for expansion of its healthcare pricing platform used by 160 healthcare organizations. 2021-22 seed and Series A raises totaled $25 million. Price transparency is a 2024 hot button issue from government to enterprises to payers. Release, FierceHealthcare  
  • CardioSignal raised another $10 million in a Series A from three investors, bringing total funding to $23 million. Based in Finland and Palo Alto, CardioSignal uses a smartphone’s accelerometer and gyroscope sensors to analyze precordial micro-vibrations caused by cardiac motion. The initial analysis is completed in one minute and after a transfer to their cloud site for additional analysis, is returned in about one minute. Release, Mobihealthnews

Follow up: Molina reduces Bright Health’s $510M California plan sale to $425M

December 20, 2023 | by

Not unexpectedly, Molina Healthcare is not going to pay the original purchase price for Bright Health’s California plans in Q1 2024. In July, Bright Health trumpeted a $600 million salvage deal with Molina, one of the few ‘pure’ health plan companies left. For Molina, they would pay $510 million plus a $90 million tax benefit for Bright’s two California Medicare Advantage (MA) plans–Brand New Day and Central Health Plan. One of the caveats of the deal was the ability to reduce the payment due in Q1 2024 based on the purchased plans’ financials and Star ratings. Unfortunately for Bright Health, neither financials nor ratings are good. Molina is reducing their payment accordingly to $425 million, unceremoniously, paying less for more membership in MA. Release

Why Bright is dimming rapidly. Bright’s health plans have failed or closed shop in multiple states [TTA 20 Apr] after disastrous 2022 performances. Most recently, their Texas plans were seized for liquidation. In these plans, the Center for Medicare & Medicaid Services (CMS) assesses risk adjustment payments that Bright owed to other plans in states where they did business [TTA 5 Dec]. That has been calculated as $380 million–$89.6 million alone in Texas. The bottom line: Bright owes money everywhere–not only to other payers for where they operated in 2022 but also to JP Morgan–$380 million to pay off its credit facility due in February. 

Ari Gottlieb of A2 Strategies on LinkedIn plus interviewed in Becker’s and MedCityNews, has been following this closely as this Editor has noted in his earlier coverage of insurtechs. His over/under is that Bright will pay off JP Morgan first, perhaps kick some over to their lender New Enterprise Associates (NEA), and leave CMS and payers owed in multiple states holding a bag of stale or soggy chips. He explains the escrow setup with Molina plus other factors such as management bonuses (!!!) for completing the transaction. A smart move in his eyes is that the Texas Department of Insurance, by liquidating the TX plans and blocking actions by Bright, may be able to claw back over $125 million out of NeueHealth, a Bright subsidiary.

Absent another Loaves-and-Fishes miracle, reserved for our Redeemer, this Editor cannot see how Bright doesn’t go dark in 2024. One possibility to this Editor: NEA ponies up more investment on top of their $60 million credit facility engineered in August. Given the coal scuttle that is the current state of M&A, they may see this as their only alternative with their investment cash, to push for a recovered and small Bright. Absent a Chapter 7 breakup, what company would buy the liabilities to payers and lenders for what is left–NeueHealth? Then have DOJ and FTC turning a microscope on them? Perhaps in June 2024, but not now.

You have to hand it to Bright Health. They have done a masterful job of tying states, CMS, other health plans, and even Molina into Gordian knots that buy time against what seems to be the inevitable.

Living to fight another day: insurtechs Bright Health, Clover Health, and Oscar Health report improved Q2s, H1s (updated)

August 10, 2023 | by

Have the upstart payers turned a corner–even if that means exiting the business? ‘Insurtech’ is the term given to the tech-enabled, health tech-friendly US payers which were supposed to deliver health insurance plans more efficiently (buy online!), more conveniently using apps and telehealth, lead in value-based care through strong networks, provider software, internal automation tools, and wrap it up with a ribbon of lower delivery cost to consumers, from those who needed individual exchange plans to Medicare Advantage. This utopian model cracked like the SPACs of Bright Health and Clover Health, and the IPO of Oscar Health, as this Editor noted last month, perhaps to the glee of traditional payers. But when survival is at stake, some surprising things can happen. All three are Not Dead Yet.

Bright Health Group succeeded last month in selling its remaining plans to ‘pure payer’ Molina Healthcare–their California Medicare Advantage plans Brand New Day and Central Health Plan. The deal: purchase 100% of the issued and outstanding capital stock of the two plans in a deal structured to be about $600 million. The Catch-22: stay solvent and absorb plan operational costs and losses (which are many) until Q1 2024 when the Molina deal will close. [TTA 6 July]

Last Friday (4 August), Bright secured a life preserver and line just as the waves started to crash–$60 million through a credit facility with an investment partnership of New Enterprise Associates (NEA). They also entered into a permanent waiver of default on its existing credit facility, which expires in February 2024. This has to refer to their prior $500 million credit facility with JP Morgan which was long overdue and now waived until the Molina close, apparently. Bright also is issuing penny warrants to NEA to purchase up to 1,656,789 shares of the Company’s common stock to the lenders under the new credit facility, approved by the board without the usual shareholder approval. This leaves an open question about who is really controlling the company. Release, Healthcare Finance, FierceHealthcare

There seems to be an even brighter (sic) picture in that their adjusted EBITDA for Q2 and H1 were actually in the black: $6.4 million for Q2 and $670,000 for H1. Even more bullishly, they project a full-year profitable adjusted EBITDA.

  • Reduced Q2 and H1 net losses: Q2 was $125 million versus $284 million in prior year. For H1 2023, the losses were $312 million and $488 million respectively.
  • Their other businesses in consumer care delivery, value-based care with providers in shared risk including ACO REACH (NeueHealth), and enterprise seemingly perform well. Their 2023 totals: consumer care $250-275 million, care solutions $900-925 million, and enterprise $1.15 -$1.2 billion.
  • Lives covered in value-based care are up to 371,000, an increase of 214% over last year’s 118,000–excluding any covered under their now exited commercial plans. Release,  Healthcare Finance

Looking at Clover Health, it was revealed this week that they survived a delisting off Nasdaq, which happens when the minimum closing share price requirement falls below $1 for at least 10 consecutive days. Now with closings for 10 days over $1, they are in Nasdaq’s good graces for now. They are exploring a reverse stock split or authorized share reduction, to be discussed at the 30 August shareholder meeting.

Clover then followed this up with a cheerful lead in their Q2 results that they had adjusted profitable EBITDA of $10 million versus last year’s $83.9 million loss. This is also remarkable as their revenue fell by over $333 million to $513.6 million due to a drop in non-insurance revenue of $384 million. Insurance plan revenue made up some of it by growing 17% to $314.4 million. In total, Clover recorded a net loss of $28.8 million. But for the year, adjusted EBITDA is projected to remain in the red between $70 and $120 million. Mobihealthnews, FierceHealthcare, release

Clover provides both Medicare Advantage (MA) plans in eight states plus a tool for practices, Clover Assistant, which assists in patient chronic care management through machine learning and aggregated data. They also entered value-based care in 2021 in the Medicare Direct Contracting (now ACO REACH) model which was a major loss generator in 2022 (Healthcare Dive) and has been cut back. Clover also survived an epically cracked SPAC out of the gate in January 2021 with the news that the Department of Justice (DOJ) had been investigating the company on investor relationships and business practices starting in fall 2020. A little over a month ago, the company finally settled seven shareholder lawsuits over its non-disclosure of the DOJ investigation at the time of the SPAC [TTA 28 June]. 

Now to NYC-based Oscar Health reporting its Q2, the first under its new CEO Mark Bertolini [TTA 30 March]. Their adjusted EBITDA went from red to in the black with a Q2 of $35.6 million, an improvement of $111.4 million versus prior year, and the second profitable quarter in a row with H1 adjusted EBITDA of $86.6 million, improving by $198 million from 2022. Revenue for Q2 was $1.5 billion with H1 at $3 billion. Net loss narrowed substantially to $15.4 million, an improvement of $96.7 million versus prior year, with H1 loss at $55.3 million, reduced by 70% from last year’s $187.3 million. The year will still be in the red with projected EBITDA loss of $75 to $175 million. The reasons for this gap–two profitable quarters, but an overall disappointing year–are not clear.

Bertolini touted factors such as improved medical loss ratios and rate increases. Oscar also pulled out of unprofitable Affordable Care Act marketplaces in Arkansas, Colorado, and California, as well as trimming MA plans in New York and Texas. On the earnings call, they announced that they were given state approval to resume MA enrollments in Florida and that they were relaunching +Oscar with help from ChatGPT to build automation tools in its Campaign Builder platform. In other news, their CFO is stepping down on 13 August, but remains on the board. He will be replaced internally by the chief transformation officer. Other staff are reportedly changing. Release, Healthcare Dive, FierceHealthcare

Update: you may also want to read Ari Gottlieb’s comments on these three companies on LinkedIn from the view of an expert financial analyst. Further comments on Bright’s perilous situation and Clover’s ‘legitimately good quarter’ here.

Bright Health to exit insurance business, selling California plans to Molina for up to $600 million–contingent on surviving to 2024

July 6, 2023 | by

Over the slow July 4th holiday weeks, Bright Health perhaps staved off the inevitable. Maybe. Molina Healthcare agreed to pick up all of Bright Health’s California Medicare Advantage plans, Brand New Day and Central Health Plan. The deal: purchase 100% of the issued and outstanding capital stock of the two plans. Molina’s valuation is $510 million plus a $90 million tax benefit. It is contingent on the usual government approvals, of course–and Bright Health surviving into Q1 2024 for the closing.

For Bright, of the $600 million, approximately $500 million will eventually go to JP Morgan to pay off their outstanding and overdue credit facility with the remaining proceeds to be used towards liabilities from its discontinued ACA (Affordable Care Act-individual plan) insurance business. Bright also announced a waiver extension and amendment to its credit facility.

There is no mention of a bridge loan from Molina or any other lender. As Ari Gottlieb of A2 Strategy pointed out in the Fierce Healthcare article, Bright Health must absorb any and all losses from the California plans, their operations, and survive into Q1 2024 for the deal to execute. Given their current situation, that is still a mountain for Bright to climb. According to Bright’s release, they do not intend to comment or disclose further developments until the transaction is closed.

As of today, the Bright plans cover 125,000 members in 23 California counties. They include Medicare Advantage prescription drug plans (PDP), dual eligible special needs plans (D-SNP), and chronic conditions special needs plans (C-SNP). There is a 60% overlap with Molina’s Medicaid footprint in California.

Molina using ‘on hand’ funds, and the deal depends on Bright Health staying solvent into 2024. In Molina’s release, they stated that “Molina intends to fund the purchase with available funds including cash on hand. The transaction is subject to federal and state regulatory approvals, the solvency and continued operation as a going concern of Bright Health Group throughout the pre-closing period, and other closing conditions. It is expected to close in the first quarter of 2024.” Molina is atypical–it is the largest ‘pure’ health plan group serving over 5 million members. Unlike UHG, CVS Health, and Cigna, it long ago shed healthcare-related service businesses to concentrate on plans and plans only. The deal adds about $1 to their $5.50 share price.

What’s left at Bright Health Group is NeueHealth, also called their Consumer Care Delivery business. That will now be part of a provider agreement with Molina to serve Medicaid and ACA Marketplace populations in Florida and Texas starting in 2024. Bright Health stopped nearly all plans at the end of 2022 and will cease coverage of members in their Texas ACA plans at the end of July.   Healthcare Finance, Becker’s   More on Bright Health’s health status here

Week’s end roundup: Theranica clears, Pixel Watch fall alert, Veradigm delays, Walmart adding 40+ clinics by 2024, Bright Health’s dim future, Ontrak founder charged with insider trading

March 3, 2023 | by

Theranica received FDA 510(k) clearance for its Nerivio device for migraine prevention in patients 12 and older. Theranica’s devices are based on a pain inhibition mechanism known as Conditioned Pain Modulation (CPM) where someone who suffers pain has a dysfunctional response to harmless stimuli. According to their product information, Nerivio wraps around the upper arm and uses non-painful remote electrical modulation (REN) to activate peripheral nerves to modulate pain. In addition to the device, the app allows users to customize their migraine treatments, receive reminders for preventive treatments, track patterns, and share migraine data with their doctor, as well as a guided relaxation routine. Theranica is based in Israel and New Jersey. Release, Mobihealthnews

Google’s Pixel Watch added fall detection to capabilities. It uses the motion sensors already in the watch and machine learning to detect a hard fall. If the wearer hasn’t moved within 30 seconds, it will vibrate, sound an alarm and display an on-screen notification that can be called off by pressing ‘I’m OK’ (left) or ‘I need help’. If the former, the alarms escalate until an automated call to 911 is made. The user has to activate the feature and Google claimes that the ML will help it avoid false positives. A very useful feature for older people, lone workers, and runners/walkers, but at the price point of $350 at Best Buy or $11/month via AT&T or Verizon, perhaps not all that attractive to cost-conscious users.    Engadget, Google blog post, Mobihealthnews

And in the Delays Must Be Catching Department, Veradigm, the former Allscripts, is delaying its Q4 and FY 2022 reporting due to a software flaw that affected its revenue reporting. Originally 1 March, the new date is yet to be determined, but they anticipate a reduction of $20 million dollars against what was previously reported from Q3 2021 into estimates for Q4 2022. Not exactly confidence-making for a company in the data management/software business. Coincidentally, the company which bought then-Allscripts’ large hospital/practice EHRs, now called Altera, Canadian giant Constellation Software, is also delaying its Q4/FY 2022 reporting, in this instance due to the Altera acquisition [TTA 15 Feb]. Veradigm’s release gives you the more complicated explanation.

Walmart Health’s Big Announcement is that it will be doubling the number of its Health Centers from the current 32 to over 75. By Q1 2024, Walmart’s plan is to open 28 new locations in the following metros: Dallas (10), Houston (8), Phoenix (6) and Kansas City MO (4). Missouri and Arizona are new states. All these will include the Epic EHR and the infrastructure improvements previewed earlier this week [TTA 1 Mar]. Release

Insurtech Bright Health may have a dim future. 18 months ago, Bright Health seemed to be the most promising insurtech out there, with a healthy Medicare Advantage plan base, family and individual plans, substantial growth, acquisitions of Zipnosis (‘white label’ telehealth triage for health systems) and development of the NeueHealth value-based care provider management network. Bright Health had a buttoned-up management team from UnitedHealth Group, investment groups, Target, CVS, and the Advisory Board. They raised $2.4 billion from prestige investors, including Cigna Ventures and Bessemer, went public on the NYSE in June 2021, and added $925 million in two post-IPO raises in December 2021 and October 2022 (Crunchbase). Fellow insurtechs Oscar and Clover struggled through their own financial and management challenges after an IPO and SPAC respectively. Oscar was sued last year by shareholders for misleading information; Clover lost $558 million in 2021, but reduced to $338.8 million in 2022 and promising a path to profitability. Healthcare Finance. 

Bright Health now appears to be a broken-bulb-filament away from default and bankruptcy. They ended 2021 with a $1.2 billion loss which is not unusual with companies of this type (see above). Bright exited individual and family plans in six states plus cut back MA expansion plans, also not atypical. Healthcare Finance This didn’t appear to help. By last December, their stock declined to below $1 triggering a notice of delisting from the NYSE if it’s not above $1 by May. The stock continues to trade below $0.50. They reported a 2022 loss of $1.4 billion, $0.2 billion up from 2021, on increased revenue. This week, it’s been reported they have told investors that they are facing credit insolvency, having run through $350 million in revolving credit, violated a liquidity covenant, and need $300 million to cover it by end of April. Further analysis in FierceHealthcare and on an interesting LinkedIn post by Ari Gottlieb, ‘Pay for Failure’.

And if there weren’t enough proof that the High Wide and Handsome Days Are Over, the Department of Justice (DOJ) indicted CEO Terren Peizer of Ontrak, a telemental health provider, with insider trading using Rule 10b5-1 trading plans. This rule was actually set up by the SEC to allow insiders to safely trade their shares by setting up a predetermined plan that specifies in advance the share price, amount, and transaction date, plus certifying that they are not aware of non-public information that can influence the price. The last is the rub. DOJ alleges that during mid-year 2021, Peizer was aware that the largest Ontrak customer, Cigna, was at high risk of departing on the heels of Aetna, and sold his stock. If convicted, Peizer may be facing up to 45 years in Club Fed plus disgorgement of funds. Ontrak trades on Nasdaq, today at about $0.60. FierceHealthcare

‘Insurtech’ Bright Health’s IPO second largest to date, but falls slightly short of estimates (updated)

June 30, 2021 | by

Bright Health Group’s IPO last Friday (23 June) fell a little short of the $1 billion+ raise and valuation projection two weeks ago, but not by much on a bad market day. Their $924 million raise was based on a float of 51.3 million shares at an opening price of $18 per share, with a targeted price range of $20 to $23. (Thursday 1 July’s BHG close: $16.85, a typical pattern.)

The raise compares favorably to Oscar Health’s blockbuster $1.44 billion IPO, Clover Health’s controversial but lucrative SPAC [TTA 9 Feb]. and Alignment Health’s $490 million.  Bright Health also acquired Zipnosis, a telehealth/telemedicine ‘white label’ triage system for large health systems, in April [TTA 6 Apr].

The IPO now creates a company value of $11.23 billion, down from the expected $14 billion. Bright Health is unique in its category in not only offering exchange and Medicare Advantage plans but also NeueHealth, 61 advanced risk-bearing primary care clinics delivering in-person and virtual care to 75,000 unique patients. FierceHealthcare, Reuters, Bright Health Group release. Also see TTA 18 June and 28 May.