TTA’s Autumn Leaves: Oura puts off IPO, Anthropic’s IPO November (?); Sycamore Partners nearing Boots sale; telehealth support for pediatricians in youth mental health, Oracle’s Congressional spanking, more!

 

2-5 October 2026

Here we are past the first week of Fall (or Autumn). The leaves may be turning, but the healthcare/AI  IPOs aren’t, with the Oura health monitoring ring postponing its IPO indefinitely and the Anthropic AI rumored only for early-to-mid-November. Another turning is for Boots, with Sycamore Partners breaking up the Walgreens Boots Alliance combine for $9 billion. And this week’s Perspectives discusses the burden pediatricians are taking on in youth mental health and how telehealth can support this need.

For Readers: Your Editor will be on publishing leave due to travel to 21 October. ‘Best Of’ Alerts will be out weekly on Fridays and Saturdays after this week till then. Some past highlights:

  • Humanity’s Rumored Doom in 10 years at the hands of AI are Zebras, not Horses.
  • Oracle’s simultaneous strong Q1, 3,000 layoffs, and its two top execs subpoenaed by the House VA Committee for a whacking over the 170% increase in budget to cover the next three years (Congress is Fed Up).
  • How infrastructure tech needed by healthcare organizations can’t get arrested on funding, while whiz-bang consumer apps can.

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

IPOs, IPOs–Oura’s stalls out, Anthropic’s restarts, possibly mid-November. To everyone’s amazement!

Developing: Walgreens’ Sycamore Partners owner on final approach to sell Boots operation to Canada’s Weston family for ~$9B

Perspectives: What Meta’s settlement reveals about youth mental health, access shortages, and where telehealth can support pediatricians

More of Interest 

Oracle’s continued restructuring cuts 3K more jobs, adds $700 million while revenue grows 30%; House VA Committee subpoenas Ellison, Sicilia 19-0–and why Congress is mad at a 170% budget increase (Updated for how Congress really feels)

(Related) Revealed: Oracle’s extended VA EHRM contract increased by $17B as original ceiling reached this year; VA Indy EHR goes online

AI’s hoofbeats as Horses, not Zebras: a Gimlety view of AI’s destructive capacity (updated) (P(doom) may be conquered by F(doom), or Why Worry?

Perspectives: Digital Health Capital Keeps Rewarding What Patients See, Not What Keeps Companies Alive (Infrastructure tech can’t get funding)

Silicon Valley Bank’s take on H1 investment: among the “have and have nots”, it was “the best half in years” for health tech

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Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Telehealth & Telecare Aware – covering news on latest developments in telecare, telehealth and eHealth, worldwide.

TTA’s Summertime Wrap: Taking apart Humanity’s AI Doom; Oracle’s layoffs, financials, and House subpoenas; and how infrastructure health tech can’t get funding

17-30 September 2026

It’s hard to believe that the last Alert was before Labor Day, and here we are staring at the chronological End of Summer, bracing for a cold winter again. The 25th anniversary of 9/11 (real doom) was followed by Humanity’s Rumored Doom in 10 years at the hands of AI. My essay takes it apart and puts it back together. (Pro Tip–trust no one). We also caught up with Oracle trumpeting its Q1, laying off another 3,000, and its two top execs subpoenaed by the House VA Committee. This week’s Perspectives is about how infrastructure tech needed by healthcare organizations can’t get arrested on funding, while whiz-bang consumer apps can.

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

For Readers: Your Editor will be on a second publishing leave to 1-2 October. ‘Best Of’ Alerts will be out 1x weekly only on Fridays after this week till then. I’ll be resting up for what may prove to be an epic Q4!

Oracle’s continued restructuring cuts 3K more jobs, adds $700 million while revenue grows 30%; House VA Committee subpoenas Ellison, Sicilia 19-0 (The Oracle soap opera grinds on)

Perspectives: Digital Health Capital Keeps Rewarding What Patients See, Not What Keeps Companies Alive (Infrastructure tech can’t get funding)

AI’s hoofbeats as Horses, not Zebras: a Gimlety view of AI’s destructive capacity (updated) (P(doom) may be conquered by F(doom), or Why Worry?

Most recent headlines 

Silicon Valley Bank’s take on H1 investment: among the “have and have nots”, it was “the best half in years” for health tech

News roundup: Verma’s rumors, DEA’s new (?) telemedicine rule goes to OMB for review, Cityblock Health goes rural with Homeward buy, Scottish housing sensor tech could save millions–study

Revealed: Oracle’s extended VA EHRM contract increased by $17B as original ceiling reached this year; VA Indy EHR goes online

Must Reads

This Week’s Must Reads: how lack of focus dooms startup financing, Commure’s Sea of Red Flags Flapping, and what happens if OpenAI expires? (Doom…DOOM!)

Why Readers can be assured that TTA is 100% Written by Humans (A handy guide to detecting AI Copy Slop and why it’s not here)

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Support not only a publication but also a well-informed international community.

Contact Editor Donna for more information.

Help Spread the News

Please tell your colleagues about this free news service and, if you have relevant information to share with the rest of the world, please let me know!

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Telehealth & Telecare Aware – covering news on latest developments in telecare, telehealth and eHealth, worldwide.

Oracle’s continued restructuring cuts 3K more jobs, adds $700 million while revenue grows 30%; House VA Committee subpoenas Ellison, Sicilia 19-0–and why Congress is mad at a 170% budget increase

Oracle trumpets successes to Wall Street while continuing layoffs, tightening spending. Oracle’s downsizing continues while revenue is parked on the sunny side of the street. Its fiscal 2027 Q1 revenue (ending August 2026) grew 30% to $19.3 billion while non-GAAP operating income rose 31% to $8.2 billion and non-GAAP earnings per share came in at $1.92, also up 30%. Some was driven by cloud growth. For those following their data center builds, their remaining performance obligations, a measure of contracted future revenue, grew by $26 billion but much of it was prepaid or with customer supplying their own hardware, meaning no cash outlay for Oracle. Another way of looking at this is conversion to revenue over the next 36 months which is now estimated at 50%.

This perked interest by investors. Barclays has upped its Oracle price target to $252 from $250 and kept an “Overweight” rating on the tech stock. The stock price is currently around $154, down 54% from its high. The Street

This is despite that debt is high and building. Total debt climbed to $155.9 billion on a trailing twelve-month basis, up from $90.5 billion just two years ago. Net debt now sits at $118.9 billion.

More Oracle employees got their severance notes and cutoffs at the beginning of September. Restructuring has a price and it’s in people. Business Insider quoted ‘insiders’ that they started on 14 September with a chilly 6am note signed “Oracle Management” similar to the previous round: “After careful consideration of Oracle’s current business needs, we have made the decision to eliminate your role as part of a broader organizational change. As a result, today is your last working day.” Severance was 4 weeks’ base salary plus 1 week per year of employment. The count of the layoffs, LOBs, and states is unconfirmed by Oracle but estimated at 3,000, several hundred in Washington state. Not quite the ‘double digit percentages’ rumored in August but possibly so on some teams. This is on top of the earlier 21,000 global cuts, 13% of their workforce, originally posted as near 30,000 [TTA 31 March]. Oracle’s original restructuring cost estimate of $2.1 billion on severance payments and other costs linked to restructuring through 31 August was increased this quarter by over $700 million, bringing that total to $2.8 billion. NDTV, Quartz

Updated 22 Sept: It appears that the employee severance package for most people, in the tech context, is skimpy. It’s four weeks of base pay plus one additional week for each completed year of service, subject to a 26-week maximum. Microsoft’s maximum was up to 39 weeks. Moreover, Reddit employee threads state that the WARN period is deducted from the base pay (e.g. two weeks of WARN, two weeks of severance) and accrued vacation is lost if state law allows it. The article in TechTimes confirms that laid off employees forfeit unvested stock, but does not have how severance affects corporate bonus and the employee stock purchase plan.

Oracle’s new CFO Hilary Maxon denied in the next day’s all-hands that the layoffs did not mean that remaining employees would be doing more with less. CEO Mike Sicilia cheered the survivors on with “How does the work that I’m doing help deliver a better outcome for a customer?” Not an off-target ask, but if the work load does not change especially in healthcare or implementing an EHR, how does this situation not mean doing more with less? 2+2≠5

Rounding out a roller coaster two weeks for Oracle was a 19-0 House Veterans Affairs Committee subpoena for Larry Ellison and Mike Sicilia. It was voted on by the House Veterans Affairs Committee and issued before Labor Day, when Oracle did not attend the 2 September hearing citing scheduling conflicts. The hearing covered the $17 billion increase in budget for Oracle’s EHR development for current costs and the three-year extension to May 2031. It turned out to be rather raucous with accusations of “unreasonable” and “corruption.” The original $10 billion estimate was by Cerner and is running out [TTA 27 August]. The new budget request brings the total to $26.94 billion. Apparently the House members found out about it through news reports, While the House is not in session until 9 November, House committees can meet anytime, but both hearings are after the midterms. Sicilia is due on 19 November and Ellison on 10 December. FedScoop, Becker’s, Stars and Stripes, MedCity News, Healthcare IT News (updated for appearance dates)

Updated. Why Congress is Madder than Wet Hens is revealed in this FedScoop article and timeline. Simply and quickly, back in July 2022, when things started to go sideways in the EHRM implementation [TTA 28 July 2022], then-EVP for Industries Mike Sicilia told the Senate Veterans Affairs Committee that Oracle would absorb any “performance or workflow” issue costs above the original $10 billion ceiling. For Oracle, after the Transformational Big Vision kvelling faded, Cerner’s painful stumbles became Oracle’s VA Migraine. There are also other add-on costs for infrastructure related to the EHRM but not part of Oracle’s costs. 170% is a big surprise in the VA budget and it blindsided Congress.

AI’s hoofbeats as Horses, not Zebras: a Gimlety view of AI’s destructive capacity (updated)

Gimlet EyeA longish holiday does provide some Perspective of the Gimlety View. What blew up during the last big summer holiday, as I was building my Vitamin D for the long winter while at the Jersey Shore, was the news made by one Jacob Coxon, a former researcher at Anthropic (developer of Claude), that advanced AI within 10 years has a more than 10% chance to have the ability to hack into enough systems, initiate bioweapons, nukes, and otherwise kill off Humanity. The humans who originally designed it would be unable to stop rogue (and roguish) frontier AI. This started with Coxon’s well-timed posting on X on 8 September and percolated through tech media right before the 25th anniversary of the mass murders on 9/11/01. Mass media, already overheated because of the anniversary, exploded like a pressure cooker. 

Axios, the techie bulletin board and for generalist media types a source for pithy quotes, on 9 September quoted a MIT 2025 study of “experts” giving a 21.5% chance of “AI possessing dangerous capabilities”, with a 21% chance of AI initiating “Cyberattacks, weapon development or use, and mass harm”.  It was a reasonably analytic article full of nuggets for a writer to run with.

This past week introduced us to the latest pop tech slang, P(doom), a cute term for the percent chance of AI Doomsday. P(doom) has now surfaced everywhere from Elon Musk to Anthropic’s CEO Dario Amodei. (Impress your friends and relatives at the next cocktail party or tailgating/cookout.)

The mass media in the following week ran with quotes by Coxon, old tech stalwarts, and politicians. Plenty of P(doom) predictions. Emblematic of the coverage was the Los Angeles Times recap published on, ironically, 11 September, a day of real, not theoretical, doom.

Readers know from my running coverage that this Editor is skeptical of AI both in a business sense (a financial time bomb) and of its utility in its current models. Automating many functions within healthcare? Sure. Providing deeper insights into imaging to speed diagnosis? Faster drug development? Bravo. Speeding market and marketing analysis, sussing out needs? Hey, hey! But equally I have been scathing of companies that buy AI services and believe vendor promises, without cross-checking for accuracy, dumping the skilled humans doing these jobs in mass layoffs. These people are the boots on the ground who should be doing the cross-checks and upgrading the models that come from developers usually unfamiliar with medicine and healthcare–and certainly without deep and specific knowledge the boots have. It turns out that the mass layoffs in many companies, from team managers, data analytics, customer services, marketers to operations, have been to fund so-called investments and token spending in AI tools. ROI has gone into a Missing Man Formation in the finance department, while services to customers and in healthcare, patients, go sideways–as does market share and revenue. CFOs, funders and Mr. Market are just waking up to this surprise that they forgot to teach at HBS. 

I’ve also been scathing in coverage of certain companies such as Open AI, Oracle, and somewhat so of Anthropic, Microsoft, Meta, and Google. These companies are pushing one to two year bricks-and-mortar data center development without responsibility for local effects on water, power, noise, and land use–something that a GM, Ford, Toyota, or Worldwide Widgets building a factory would face and mitigate. This thoughtless pushing is proving to be politically evenhanded in opposition; these companies have received epic wedgies and a few pitchforks in their metaphorical derrieres as a deserved result. But this is manageable; because of pushback, it’s diminishing as a ‘reason why’ except as a political club for unscrupulous politicians.

What’s a lot more devastating is that apparently all the forecasting is inflated beyond belief. There is no decent idea of metrics, of matching up capacity to future demand. Not by OpenAI, not by Anthropic as they prep for IPOs. This is an ancient problem that always, reliably, cyclically bites developing sectors in their nether regions. Not a hype cycle like we saw circa 2006-15 with telehealth, not bad management, but in other industries within recent memory, with ‘sky’s the limit’ booms followed by a crash and partial/total hull loss:

TNW discusses in a deeper dive the debt structure and why PIMCO could make this bet where banks could not [reference is to Oracle’s debt funding]. The question it raises is whether the furious pace of data center building is another cycle of overbuilding–and if it is, will it be absorbed in time? The ominous parallels: the 2000s building boom in an earlier iteration of data centers, the fiberoptic boom of the early 2000s that broke WorldCom, Global Crossing, Winstar, Corning, and 360Networks, cloud overbuilding that left Amazon Web Services with years of excess capacity (it helps to have a deep-pocketed and not all that transparent parent), and others. This Editor would also liken it to the early years of 1980s-90s airline deregulation (too many airlines, too much debt, too many seats) and about a decade in the cruise ship industry where too many cabins were chasing too few people. These took decades and multiple bankruptcies to settle. TTA 7 May

Writer Ed Zitron, who has few parallels in Gimlety-ness, analyzed how OpenAI could easily meet the Devil of Demise sooner rather than later in his article What Happens If OpenAI Dies?, one of our Must Reads of 19 August. OpenAI’s losses are terrifying, contrary to their PR spin, and will not change in the immediate future; based on the numbers, their growth is slowing. It has to become the most successful company since Caesar Crossed The Rubicon–or it croaks and may well pull down an economy with it. I will add from other reading that Anthropic, ahead of OpenAI, is painted in a similar corner.

Leaving aside P(doom), what we are hearing are hoofbeats from horses, not zebras. What’s happening is the AI boom cooling and billions in concentrated funding that has hit multiple headwinds. Both companies have trillion-dollar valuations and heavy debt. Technical and security concerns are popping up like weeds (see the Hugging Face sandbox breakout).  Failures might not be the end of the world but not a cheerful earful for a stressed economy.

In the short term, the two major AI companies have more of a challenge from F(doom)–financial doom–than P(doom).

Suddenly, we have three things happening in the past 10 days:

  • A short-term, low-level former Anthropic employee, Jacob Coxon, with few followers on X, suddenly bursting out and ‘going wide’ with a doomsday prediction. Quoted and covered everywhere in mass media with the things that at least some of his elders like Steve Wozniak and Geoffrey Hinton have been saying for over three years. (The Woz I’ve traced back to 2015!)
  • Dario Amodei, CEO of Anthropic, Sam Altman, still CEO of OpenAI, and Elon Musk (Grok/X) then calling for government safety regulation. Not guardrails. Government regulation by a Federal agency, NIST. CNBC, OpenAI blog, Amodei blog statement
  • Online ‘surveys’ stating that the public is now terrified of AI, with 63% rating Humanity’s Destruction from ‘moderate risk’ to ‘almost certain to happen’. (POLITICO) 

Private companies demanding government regulation of their business truly boggles the mind. This should raise red flags as to why, and why now, and who writes those regulations.

P(doom) supposedly has a ten-year horizon. F(doom) works far faster, may be more likely, and once it starts, there may not be an Anthropic or OpenAI to worry about.

Some Gimlety Speculation, IMO only:

  • Both Anthropic and OpenAI float on a sea of red ink and Other People’s Money (OPM). Their lenders want to monetize and exit their investment with an IPO. Both companies were racing to IPOs. Except neither company is logically, reasonably, in any financial sense, ready.  Yet Anthropic was due to IPO before end of 2026 with OpenAI racing to beat them.
  • Investors are also pushing for another OpenAI funding round to cash out secondary shares held by employees, according to CNBC today (16 Sept). Which, in a case of an IPO, means more shares for the investors.
  • Both the Coxon media pickup and the subsequent Amodei/Altman calls for regulation effectively stop the IPO clock. One can speculate about the timing and origins, but it is fortuitous timing for both companies. .

It is also being used as a political club in the upcoming midterms. Goosing the ‘terror’ narrative is calculated to pay off certain players.

  • The usual Senate suspects are demanding complete regulation of AI because “we are losing control”. There is a bipartisan bill in the House (Lawler/Gottheimer) drafted to regulate frontier AI, kicking the standards over to the National Institute of Standards and Technology (NIST), but the House is now out of session until 9 November, after the midterms, which leaves exactly two months before a new House is seated. There is a parallel bill in the Senate.
  • President Trump, somewhat on the back foot on this, calls their fears a ‘hoax’ and a ‘scam’ that will prevent US leadership in AI development. Yet Sam Altman along with Nvidia’s Jensen Huang will be attending the state dinner for Chinese President Xi Jinping’s visit to Washington next week,
  • The security threat is real. China is building a lot of data centers, well away of course from any international observation; Uyghurs don’t get to complain about data centers and water usage to Beijing. One doesn’t even know if they are real or empty buildings like their empty hinterland cities. Where are the chips coming from? Yet Chinese-engineered AI models may take the lower end of the market, much like steel.

There’s an old saying in medicine: when you hear hoofbeats, think first of horses, not zebras. It dates back to Dr. Theodore Woodward of the University of Maryland medical school and the 1940s in teaching his students to first rule in or out common diseases rather than searching first for exotic, rare diseases because they’re more interesting. (Apologies to those with rare diseases, and may AI be a savior in this.) Taking the analogy to business, the ‘horses’ are the shaky business models around AI development, capacity versus demand, the heavy debt of the two AI leaders, and data centers. Throw in the Chinese capacity and models. The ‘zebras’ are Humanity’s Extinction By AI. They’re there, but in the next county.

What’s running in that herd out there, who’s trying to paint the horses black and white, and why? Cui bono? The consequences can be severe.

Updated 17 September: Gary Marcus, Substacker and BBC commentator, in his latest ‘Marcus on AI’ takes an even more Gimletly view than your Editor. He points out the stratagems behind Altman’s and Amodei’s calls for regulation. It’s all ‘trust us’ to write the regulations and guarantee safety. We shouldn’t. Meanwhile, certain Senators go over the top on Doom with the aim of terrifying voters. We shouldn’t. A Must Read. And if you are working with AI, worth your subscription.

TTA’s August-Sept Wrap: how health tech fared in H1 investment, Oracle’s VA EHRM contract $ bump, Verma’s rumors, Cityblock buys Homeward, sensors could save Scots millions, more!

28 August-early September 2026

It’s the last of the August Doldrums, so it’s a good time to look back, courtesy of SVB, on What Happened in Healthcare Investing this first half. (For once, health tech didn’t take a beating with its best H1 in years.) Oracle just can’t help being in the headlines, this time with a nice (and expected) budget bump in its extended VA EHRM contract, and with its Oracle Health EVP, the well-known Seema Verma, possibly under consideration by PhRMA. The only notable transaction was another acquisition in the General Catalyst family, Cityblock Health and Homeward Health. DEA may get a controlled substances telehealth rule yet. And the Scots have discovered and tested sensor-based facility monitoring that could save millions. Aye! (Will Harry and Meghan’s Cotswolds lair have it? Save on security!)

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

For Readers: Your Editor will be on publishing leave to mid-September. ‘Best Of’ Alerts will be out 1x weekly on Fridays after this week till then. I’ll be resting up for what may prove to be an epic September-October!

Silicon Valley Bank’s take on H1 investment: among the “have and have nots”, it was “the best half in years” for health tech

News roundup: Verma’s rumors, DEA’s new (?) telemedicine rule goes to OMB for review, Cityblock Health goes rural with Homeward buy, Scottish housing sensor tech could save millions–study

Revealed: Oracle’s extended VA EHRM contract increased by $17B as original ceiling reached this year; VA Indy EHR goes online

Last week’s headlines 

This Week’s Must Reads: how lack of focus dooms startup financing, Commure’s Sea of Red Flags Flapping, and what happens if OpenAI expires? (Doom…DOOM!)

News roundup: UHS-Talkspace $850M buy final, DocGo to buy Hicuity Health for $52M in stock/debt, R1 to buy Humata Health, PointClickCare EHR to integrate Anthropic’s AI

UK’s Alertacall sold to Constellation Software’s Volaris Group (Happily, remaining independent)

Recent Headlines and Must Reads

Why Readers can be assured that TTA is 100% Written by Humans (A handy guide to detecting AI Copy Slop and why it’s not here)

News potpourri: OpenAI sued for practicing unlicensed medicine”, Cleveland Clinic med drone delivery, Solventum separates out health info systems, Unlimited Technology RCM in 3.8M data breach, Samsung Galaxy Buds FDA cleared for hearing assist

VA moves to secure Oracle for its EHR Modernization through mid-2031 (More reasons beyond Captain Obvious)

Breaking report: Oracle drawing up plans to lay off employees in “double digit percentages” by 1 September (We’re waiting for this shoe to drop next month)

Chutes & Ladders, Oracle Edition: Surprise! Project Jupiter data center build overages, “social costs” multiply. Pentagon inks $7B, 10 year deal for software.

This week’s Must Read: the dangerous financing of AI data center buildouts–and how they resemble the 2020 health tech boom (Remember the SPAC boom that cracked and left nearly all companies and billions in the dust?)

A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

 

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Support not only a publication but also a well-informed international community.

Contact Editor Donna for more information.

Help Spread the News

Please tell your colleagues about this free news service and, if you have relevant information to share with the rest of the world, please let me know!

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

Telehealth & Telecare Aware – covering news on latest developments in telecare, telehealth and eHealth, worldwide.

News roundup: Verma’s rumors, DEA’s new (?) telemedicine rule goes to OMB for review, Cityblock Health goes rural with Homeward buy, Scottish housing sensor tech could save millions–study

Oracle’s Seema Verma rumored to be on a list for a new CEO position with a major lobbying group. The EVP and general manager of Oracle Health and Life Sciences is reportedly under consideration for a new job as CEO of PhRMA. A paywalled story in Endpoints News broke that she is among a group of “Republican policy wonks, former lawmakers” in the running, four months in, for this pharmaceutical lobbying organizational chief position. If the Reddit rumor boards are to be believed, she’s already half out the door. If the former Center for Medicare and Medicaid Services (CMS) administrator to 2021 departs Oracle, it will be the sixth Oracle Health senior level departure this year [TTA 3 Mar]. Those departures for various reasons shook Oracle Health. Verma, on the other hand, has had a relatively low profile at Oracle Health, though reporting to COO Mike Sicilia. If she does depart Oracle, enough time has passed since her CMS position to dispel the Federal-private industry ‘revolving door’ tag, though undoubtedly as EHR head she has been working with the VA. Developing

ATA Action was kind enough to flag for this Editor that the Drug Enforcement Administration (DEA) may finally be moving toward a new rule for telemedicine prescribing of controlled substances. Yesterday (25 August) the “Special Registrations for Telemedicine and Limited State Telemedicine Registrations” final rule was submitted to the Office of Management and Budget’s (OMB) Office of Information and Regulatory Affairs (OIRA) for review. While under review, the text is not public, but the OMB pending EO  is here with the limited text under the RIN: 1117-AB40   The text of the RIN includes that “DEA is currently reviewing the over 6,400 public comments submitted on the Special Registration for Telemedicine NPRM (Notice of Proposed Rulemaking) published on January 17, 2025.”meaning that they are still working with a year-old NPRM.  DEA has extended telemedicine prescribing rules several times, most recently at the end of 2025 to cover full year 2026. A final action to determine approval of the rule is due in November, according to the timetable.

ATA Action’s statement, per their email, is “ATA Action is actively engaged as the rule moves through OMB review, pressing the priorities we have consistently advanced: protecting patient access while maintaining safeguards against diversion — without unnecessary in-person mandates, duplicative state-by-state registration requirements, excessive reporting burdens, or implementation timelines that make participation impractical for legitimate clinicians and healthcare organizations.” They also cite geographic “red flags” that pharmacies face when a prescription results from a telehealth visit and state laws that are more restrictive than Federal law. 

Brooklyn’s Cityblock Health’s goes country with Homeward Health acquisition in an all-stock transaction. It is on the surface an odd match: an urban-focused value-based care provider that primarily serves complex needs and provides additional support for Medicaid and Medicare/Medicaid dual-eligible patients expanding into underserved rural markets. What it does promise Cityblock is growth from its present claimed 200,000 members in 10 states and annualized revenue of $2.2 billion, up 77% year-over-year. Homeward serves around 50,000 rurally-based Medicare Advantage (only) members and 5,000 providers in Michigan and Minnesota through a Michigan clinic, mobile clinics and telehealth. It partners with Blue Cross Blue Shield of Michigan and Aetna for Medicare Advantage. Further financial arrangements were not disclosed.

Homeward’s CEO Dr. Jenny Schneider will remain connected with Cityblock as a “trusted advisor” according to a Cityblock spokesperson and Homeward’s brand and operation will remain. According to her LinkedIn post announcing the acquisition, she previously served as a Cityblock board member. She and another Livongo alumnus, Amar Kendale, launched Homeward Health in 2022 to close healthcare gaps in rural America, accounting for over 61% of primary care shortage areas and a 23% higher mortality rate.

Both Medicaid and Medicare Advantage face challenges–funding cuts for Medicaid and with Medicare Advantage, payers reducing reimbursement rates based on rising costs and increased Federal scrutiny of higher costs, upcoding, overpayments, and bonus programs. 23% of Medicare Advantage enrollees are in a special needs plan (SNP) KFF

Cityblock touts its CORE—Care Orchestration and Resourcing Engine—as an AI-based operating system underpinning our outcomes-based care platform to use almost 10 years of member data to close care gaps for specific members, as well as AI tools “handling routine engagement and administrative work that have already freed up 44,599 hours of clinician time this year, including 42,148 calls handled by AI agents.” Homeward Health’s platform is also AI-native.

Cityblock simultaneously announced a Series E of $116 million led by General Catalyst for a total of close to $1 billion. General Catalyst is an investor in both companies. (Is this a return to the General Catalyst ‘portfolio condensation’ strategy that created Commure last year?–Ed.)

Interestingly, Homeward Health is organized as a public benefit corporation (PBC) and a B Corp, certified by B Lab as meeting their standards of social and environmental performance, accountability, and transparency. It’s doubtful that will carry over to Cityblock. MedCityNews, FierceHealthcare, Becker’s, Cityblock’s CEO Toyin Ajayi blog post 

Biggar, Scotland senior housing environmental sensor-based technology test saves thousands, but across Scotland could save millions. The test at the retirement home Langvout Court, part of Bield Housing & Care, was of environmental and activity sensors developed and implemented by Glasgow-based technology company Archangel and the Digital Health & Care Innovation Centre, funded by the UK Government’s Department for Science, Innovation and Technology through the Glasgow City Region 5G Smart and Connected Places Programme. The automated alerts were directed and coordinated with Bield staff. The sensors alerted the staff to a potential boiler breakdown during Storm Éowyn, high humidity levels and faulty extractor fans in buildings, and resident temperature and activity changes that could indicate changes in health. Annualized savings in the six-month test were estimated at £7,670 in heating costs and £2,825 in maintenance costs, along with improved tenant safety, reduced manual checks and stronger regulatory compliance, creating positive ROI in year one. FarrPoint, which independently evaluated the project, extrapolated that applying Langvout Court’s system across Scotland’s retirement housing developments could generate annual savings of £18.5 million. Archangel case study published in TechUK, release in Care Sector Hub

Revealed: Oracle’s extended VA EHRM contract increased by $17B as original ceiling reached this year; VA Indy EHR goes online

The cost of Oracle’s extended EHRM contract with the Department of Veterans Affairs disclosed. The ten-year contract for the EHR Modernization (EHRM), originally due to expire in May 2028, was extended earlier this month by three years to May 2031 and, we now know, an additional $17 billion was added to the ceiling. The full contract for Oracle will total by May 2031 $26.94 billion. The original contract was just under $10 billion–a cost ceiling expected to be reached by end of 2026.

Background: Oracle’s current VA contract 36C10B18D5000, the Electronic Health Record Modernization Indefinite-Delivery/Indefinite-Quantity (IDIQ) contract with Oracle Health Government Services, the successor to Cerner Government Services, originally was structured with a 10 year base period without annual renewals. This started in May 2018. In early 2023, the contract was renegotiated. The base period was halved to five years with the remainder of the contract subject to annual renewals from May 2023 and expiring 10 years after the contract start, in May 2028. The Modification P00008 to the IDIQ contract adds another three one-year firm fixed-priced optional ordering periods, taking the duration of the contract to May 2031.

According to the released contract modification documents, VA projects that the original ceiling would be reached by Q1 in Federal FY 2027, which is between October and December 2026. The rationale is that “Due to unanticipated complexities in deploying this system, extensive site-specific customizations, as well as the other factors … VA has reached the current contract ceiling sooner than originally planned. VA anticipates using the remaining ceiling by the first quarter of fiscal year 2027 and thus requires an increase.” 

“Building upon the Trump Administration’s successful deployment of VA’s new electronic health record system at several VA facilities, VA and Oracle Health agreed earlier this month to renew their collaboration,” VA spokesperson Quinn Slaven previously said in an emailed statement to FedScoop.

As previously noted in our original article [TTA 12 Aug], in this Editor’s view, the three-year extension is a smart move on the VA EHRM team’s part.

  • The obvious one is that the VA EHRM rollout requires another three years from 2028 to 2031 to fully cover all locations. Releasing the main single-source contractor three years prior to its finalization is not an intelligent move unless another EHR company could take it up–and that has not happened. Things apparently are going smoothly in the newly formatted rollout. It was also obvious that the cost ceiling had to be increased.
  • The other is protection. Now you won’t read this elsewhere. Since the late winter, Oracle was rumored to be interested in selling, wholly or in part, Oracle Health AI (OHAI). Oracle Health sale rumors were confirmed this summer. In the event of a sale, the buyer would be obligated to honor the VA contracts and its terms.
  • The other possibility is if disaster strikes Oracle as a result of their AI landlord strategy, such as bankruptcy, the VA has some contractual protection in a Federal court. 

Orange Slices, NextGov/FCW

VA Indiana’s three-hospital system (Fort Wayne, Marion, and Indianapolis, VISN 3) cut over to the Oracle EHR on 22 August. X announcement (@VAIndyHealth)  The last two scheduled for 2026 will be Anchorage, Alaska (VISN 5) and Cleveland, Ohio (VISN 3) on 24 October.

TTA’s August Ice Cream Run 3: less activity is more for startups, hard looks at Commure and OpenAI, acquisitions by UHS, DocGo, R1–and UK’s Alertacall sold

20-24 August 2026

Enjoy the August Doldrums, because this fall might be awfully…eventful. Our Must Reads are rather Doomful, between exposés on General Catalyst and Commure’s business practices, plus OpenAI’s accelerating troubles that look like Sam Altman is flirting hard with the Devil of Demise. A positive Must Read is on early-stage funding–how doing less will get your company more. Our news roundup highlights several acquisitions and Anthropic partnering with EHR PointClickCare. Speaking of sales, UK’s Alertacall has been sold after great success, and will remain independent.

On the hot subject of AI writing and AI Copy Slop, find out how to spot and avoid it in our thoughts on why TTA remains stubbornly 100% Written By Humans. Grab the cuppa for this one. Else you’ll faint like Pepper!

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

This Week’s Must Reads: how lack of focus dooms startup financing, Commure’s Sea of Red Flags Flapping, and what happens if OpenAI expires?

News roundup: UHS-Talkspace $850M buy final, DocGo to buy Hicuity Health for $52M in stock/debt, R1 to buy Humata Health, PointClickCare EHR to integrate Anthropic’s AI

UK’s Alertacall sold to Constellation Software’s Volaris Group

Last week’s headlines

Why Readers can be assured that TTA is 100% Written by Humans (A handy guide to detecting AI Copy Slop)

News potpourri: OpenAI sued for practicing unlicensed medicine”, Cleveland Clinic med drone delivery, Solventum separates out health info systems, Unlimited Technology RCM in 3.8M data breach, Samsung Galaxy Buds FDA cleared for hearing assist

VA moves to secure Oracle for its EHR Modernization through mid-2031 (More reasons beyond the obvious)

Breaking report: Oracle drawing up plans to lay off employees in “double digit percentages” by 1 September (We’re waiting for this shoe to drop)

Recent Headlines and Must Reads

News roundup #2: Function Health’s jumbo $450M raise from General Catalyst, Hinge Health’s $105M Cylinder buy, and Throne Science’s $10M Series A

News roundup #1: AI governance ‘in’ with Feds, ATA; Centene’s shrinking but more profitable future; repositions and partnerships for DispatchHealth, WHOOP; Te Whatu Ora Health New Zealand modernization

Chutes & Ladders, Oracle Edition: Surprise! Project Jupiter data center build overages, “social costs” multiply. Pentagon inks $7B, 10 year deal for software.

This week’s Must Read: the dangerous financing of AI data center buildouts–and how they resemble the 2020 health tech boom (Remember the SPAC boom that cracked and left nearly all companies and billions in the dust?)

A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

 

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This Week’s Must Reads: how lack of focus dooms startup financing, Commure’s Sea of Red Flags Flapping, and what happens if OpenAI expires?

Grab a cuppa and sit down with these articles. (You may also want to subscribe to their authors.)

From Substack, UK author Martyn Eeles current Health VC newsletter, “The Strategic Clarity Problem”, advises founders of early-stage companies that doing more can result in less–financing. Too much activity in too many directions leads to confusion on investors’ parts. Paradoxically, it doesn’t enhance “potential” but detracts. It reads to investors, especially now, as lack of priorities and not strategic. Mr. Eeles recommends focus, focus, focus. Choose a strategy and stick with it. It doesn’t mean that a founder cannot show multiple future paths, just that the main path has to carry the company forward. (Sounds like good marketing!)

For instance, how you present your direction is vital in making activity sound focused and strategic. FTA:

A founder who says, “There are many use cases,” may sound ambitious. A founder who says, “There are many possible use cases, but this one is the wedge because it creates the clearest buyer urgency,” sounds more investable.

A founder who says, “We have lots of partnership conversations,” may sound active. A founder who says, “These two partnerships matter because they reduce implementation risk and create access to the customer segment we are prioritising,” sounds strategic.

The short (non-subscriber) version has a wealth of information for both founders and funders, complete with a nifty infographic that depicts nearly the entire article. but truncates at ‘The Choices Investors Want To See”.  This Editor would recommend the annual €60 subscription if you’re in the business. Mr. Eeles is managing partner at Clarma Capital, a European life sciences venture fund.

Our friend Sergei Polevikov writing in his Substack AI Health Uncut returns to the General Catalyst-powered Commure in Commure’s Long History of Red Flags. Even though General Catalyst doesn’t want him to.  Yes, the flags still flap around the gaggle of health tech companies financed by General Catalyst (GC). Commure itself is an agglomeration of GC companies: Athelas, Augmedix, RxHealth, and Memora Health. Commure originally had one marketable product, Strongline, a safety and duress badging/tracking system, three years ago before GC’s consolidation moves. What is questionable about Commure has now surfaced in STAT News +’ investigation (paywalled). From pricing dependent on recommendations to products that don’t work until they’re modified at the client if they eventually do work, to referral programs that are way too close to violating the Anti-Kickback Statute…Commure has it all on the Shady Side of the Street. GC keeps shoveling money in because they can, too. 

And once again, thinking the unthinkable, is Ed Zitron. Here he imagines the demise of OpenAI and reads the tea leaves. He notes:

  • the deceleration of revenue when it needs to accelerate (see below)
  • the COO and CRO left after less than a year on the job, likely walking away from generous stock options/awards–now, who does this?
  • it’s backed away from its IPO and likely will be beaten to it by Anthropic (Claude)
  • the economics are terrifying. OpenAI lost $20.9 billion in 2025 on $13.07 billion in revenue
  • it needs to meet compute obligations and for that needs $800 billion in cash
  • it needs to raise $100-200 billion annually just to survive

In short, it has to become the most successful company since Caesar Crossed The Rubicon–or it croaks. Expires. Meets the Devil of Demise and the Devil wins.

The consequences will be severe. FTA:

To not actively and meaningfully discuss the potential for OpenAI to collapse is actively irresponsible. To act like there are not significant, existential problems with this company’s economics is to intentionally avoid reality, and whoever is on the receiving end of said ignorance deserves better, be they an investor reading your analyst note or a reader burdened with incomplete journalism.

What follows may be an Enron-Lehman Brothers hybrid, one that leaves unbelievable destruction in its wake, an avoidable systemic risk empowered and enabled by a kneecapped media industry and sell-side analysts incapable of seeing further than two quarters in the future.

The time to stop this? Long past.

Zitron backs everything up with hard numbers laced with cross-references. It’s dense and needs close attention. Depending on your view,  you’ll choose a gallon of coffee, a fifth of bourbon, or a bottle of wine. What Happens If OpenAI Dies?

Another argument, shorter, and similar, is made by Gary Marcus in his Substack newsletter (free access), Marcus on AI,  BREAKING: OpenAI’s unraveling has begun.  Again, just as it was scheduled for its IPO and racing its main competitor.

It contains two citations from the Wall Street Journal writers who cover OpenAI, Berber Jin and Corrie Dribusch:

  • “The company grew revenue by just 18% to $6.7 billion from q1 to q2, while its losses sank further into the red”
  • Losses grew from Q1 to Q2 to $3 billion to $12.3 billion, while it added only $1 billion (to $6.7 billion)

Nvidia is in full CYA mode, given its exposure to OpenAI. Can Oracle be far behind?

TTA’s August Ice Cream Run 2: Oracle talks layoffs (again) and VA extends EHRM contract; OpenAI sued for ‘doctoring’; big vendor data breach; med drone delivery; and a tart take on AI Copy Slop

14-17 August 2026

Still in the ‘dog days’ of August weather, despite the back to school and Halloween (!) stuff in the stores. We should enjoy our last days of ‘traditional’ summer (versus ‘local’ or ‘smart’ summer) but the merchers won’t let us. In other news, there was a lot of news around Oracle Health this week, from pending layoffs to the VA extending its contract to 2031. We also have our (likely first, but not last) lawsuit claiming OpenAI doctoring harmed a ‘patient’, meds and supplies delivered by drone, a big vendor data breach, affordable hearing assistance, and yet another likely spinoff. And on the hot subject of AI writing and AI Copy Slop, your Editor has more than a few thoughts after reading an excellent article by Alys Denby. Grab the cuppa for this one. Or you’ll faint like Pepper!

Please feel free to comment on the articles and pass along this Alert. Let me know if this is worth it to you! Also check out my personal page on Substack.

Why Readers can be assured that TTA is 100% Written by Humans

News potpourri: OpenAI sued for practicing unlicensed medicine”, Cleveland Clinic med drone delivery, Solventum separates out health info systems, Unlimited Technology RCM in 3.8M data breach, Samsung Galaxy Buds FDA cleared for hearing assist

VA moves to secure Oracle for its EHR Modernization through mid-2031 (More reasons beyond the obvious)

Breaking report: Oracle drawing up plans to lay off employees in “double digit percentages” by 1 September

Last week’s headlines

News roundup #2: Function Health’s jumbo $450M raise from General Catalyst, Hinge Health’s $105M Cylinder buy, and Throne Science’s $10M Series A

News roundup #1: AI governance ‘in’ with Feds, ATA; Centene’s shrinking but more profitable future; repositions and partnerships for DispatchHealth, WHOOP; Te Whatu Ora Health New Zealand modernization

Recent Headlines and Must Reads

Chutes & Ladders, Oracle Edition: Surprise! Project Jupiter data center build overages, “social costs” multiply. Pentagon inks $7B, 10 year deal for software.

Catching up to Masimo’s ‘unfinished’ business: Danaher completes $9.9B acquisition of Masimo. $634 million damages from Apple upheld, but Kiani lawsuits continue

This week’s Must Read: the dangerous financing of AI data center buildouts–and how they resemble the 2020 health tech boom (Remember the SPAC boom that cracked and left nearly all companies and billions in the dust?)

A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

Vinegary Must Reads This Week: Silicon Valley’s ‘Cargo Culture’; the clinical query tool explosion between OpenEvidence and general AI

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Advertise on Telehealth and Telecare Aware
Support not only a publication but also a well-informed international community.

Contact Editor Donna for more information.

Help Spread the News

Please tell your colleagues about this free news service and, if you have relevant information to share with the rest of the world, please let me know!

Donna Cusano, Editor In Chief
donna.cusano@telecareaware.com

VA moves to secure Oracle for its EHR Modernization through mid-2031

It’s an extension that likely has a very good and smart reason behind it. This short article in a specialized Federal services publication, OrangeSlices PBC (public benefit corporation), that broke the story early AM today (12 Aug), has a few tidbits that anyone who is following the VA’s EHRM will find of interest. 

The first is the three-year extension of the current VA contract 36C10B18D5000, the Electronic Health Record Modernization Indefinite-Delivery/Indefinite-Quantity (IDIQ) contract with Oracle Health Government Services, the successor to Cerner Government Services. The proposed Modification P00008 to the IDIQ contract adds another three one-year optional periods, taking the duration out to May 2031.

Some history is in order here.

  • The contract originally had a base period of 10 years starting in May 2018 with a value of $10 billion, later revised upwards to $16 billion.
  • It was rewritten and renegotiated in early 2023 after the failure of the initial five-location rollout. The ten-year base period was halved to five years, ending in 2023, with a renewal instead of five successive one-year optional ordering periods ending in May 2028.
  • This renewal took place only after much debate, a hail of flak from both the House and Senate Veterans Affairs’ full committees and tech subcommittees, and calls to dump Oracle and start all over again. The contract redo was designed to bring Oracle to heel.  It subjected both Oracle and the VA to lengthy accountability metrics that culminated in multiple modifications and testing. [TTA 18 May 2023]
  • The EHRM rollout was radically modified by geography to VA Health Centers mostly within the same VA region, or VISN, then with additional implementations every two months. The rollout resumed in April 2026, with five more locations added in August and October to complete 13 for 2026 and another 27 in 2027. [TTA 8 Feb and the updated VA rollout schedule]

The three-year extension brings the contract to the projected final VA rollout and conclusion in 2031. According to the article, 36 sites are scheduled to go live between August 2026 and January 2028. Subtracting 2026 (5) and 2027 (27), that leaves four in 2028 before the contract’s original expiration. There are at least another 120 to be covered within VA’s existing VISNs.

The contract modification has an anticipated award date of on or about 17 August 2026. SAM.gov (published Tuesday 11 Aug)

The second is why this three-year extension is a very smart move on the VA EHRM team’s part.

  • The obvious one is that the VA EHRM rollout requires another three years from 2028 to 2031 to fully cover all locations. Apparently all is going smoothly but releasing the main single-source contractor three years prior to its finalization is not an intelligent move.
  • The other is protection. Now you won’t read this elsewhere. Since the late winter, Oracle was rumored to be interested in selling, wholly or in part, Oracle Health AI (OHAI). Oracle Health sale rumors were confirmed this summer. In the event of a sale, the buyer would be obligated to honor the VA contracts and its terms.
  • The other possibility is if something truly awful happens to Oracle as a result of their AI landlord strategy, such as bankruptcy, the VA has some contractual protection in a Federal court. 

Whether Oracle can even sell OHAI is an open question. But for VA to tighten the contract to confirm an obligation to continue the VA EHRM to the end (or near end) is commendably businesslike–to not leave the VA and our veterans who served in the lurch with their medical records, scheduling, research, and much more. That would be unacceptable.

Update: Just posted in NextGov/FCW and FedScoop. The last notes that the House-passed fiscal 2027 Military Construction and Veterans Affairs appropriations bill would give $3.4 million for EHRM.

Breaking report: Oracle drawing up plans to lay off employees in “double digit percentages” by 1 September

30,000 global layoffs (18%) in March were evidently not enough. Oracle’s transformation into an AI infrastructure landlord with the corresponding debt (closing FY26 at $100 billion, projected by an analyst to exceed $120 billion in their FY27) is coming at a huge cost. This afternoon (US Eastern Time), Business Insider broke the news that Oracle is planning another significant round of layoffs to reduce payrolls by 1 September. 

FTA: “The cuts could reach double-digit percentages on some teams, according to the document. The company has requested managers provide lists of affected employees, with the intention of reducing payroll by the time the second quarter begins on Sept. 1, according to one of the people with direct knowledge.” Note: the Oracle FY27 began on 1 June 2026, thus Q2 27 starts on 1 September.

The Business Insider writer claims to have seen an internal document confirming this. Considering that today is 12 August, there is not much time between now and 1 September. Oracle currently has around 141,000 employees. If there were, for instance, a 10% (double digit) overall layoff, that would be 14,000 people. No hard numbers are included in the BI article.

The BI article does not have information on whether this will affect only the US, North America, or global Oracle sites. The last round of layoffs were global in scope.  Oracle ran into expensive buzzsaws in countries such as Germany; many European countries have layoff notice and benefit requirements. In the last layoff, India was hard hit.

The scuttlebutt on The Layoff rumor board has other tidbits that may be true or sheer speculation:

  • The actual date may be 15 September. But historically Oracle layoffs happen around Labor Day (US 7 September). (Ed.–It could be both!)
  • Managers are preparing lists for upcoming layoffs. One poster scores his or her part time remote manager who remained after the last layoff round.
  • Nothing is showing up in Federal/state WARN notices yet. However, WARN does not cover remote, dispersed employees nor offshore employees.
  • There are about $300 million in restructuring costs included in the FY 27 SEC 10-K filing. This is a comparatively low amount that has to cover earlier layoff costs, which may indicate that this upcoming layoff will be lower than March’s.

The money continues to flow out, not in. Oracle’s high-profile data center buildouts, notably Project Jupiter, are being hit with increasing “social costs”. Despite initial permitting, local groups have been successful in mobilizing for changes. Redesigns in cooling and power draw are expensive. Data center locations and builds are one of the few US issues that cross political lines [TTA 29 July]. Unlike Microsoft, Oracle no longer has the cushion of free cash flow to pay the bills. Oracle also has crushing performance obligations to meet with OpenAI and Meta [TTA 16 July].

What’s the healthcare impact, other than AI?  For the business segments in the former Cerner, now is Oracle Health AI, the news has been dismal–and concerning to entities such as the Federal Government.

  • The Oracle EHR, bought in the palmy days of June 2022 for $28 billion, is now down to a ‘sloppy second’ versus Epic in the acute care (20%) and the health system (27%) segments. The EHR is not prospering as an alternative, as much as many in healthcare don’t care for Epic.
  • There is no one reportedly lining up to buy OHAI. In June, London-based investors Nelson Advisors confirmed the rumors that the division was up for sale. The ‘usual suspects’ all have regulatory and competitive road blocks. The alternative may be private equity purchase or investment, including the Federal Government. PE is not jumping up and down to lay the money down. In other words, OHAI is a hard-to-sell asset.
  • Even if an OHAI sale freed up anywhere near the purchase price, an unlikely outcome, it would make only a dent in the stunning amount of debt. Whether it would improve Oracle’s low credit rating is doubtful.

There are also ongoing and new Federal commitments to meet:

  • There are the EHRs managed by the Veterans Health Administration EHR Modernization (EHRM) and the Military Health System (MHS), two separate but mandatorily interoperable systems. MHS is rolled out but modifications continue, while VA’s EHRM is only getting started, with extensive Federal oversight and guardrails in place. That rollout is expected to continue into 2031. These are both hot potatoes that show no signs of cooling off.
  • In Oracle’s traditional software business, Oracle’s latest commitment is to the Department of War (a/k/a Department of Defense). In late July DoW announced a software contract with Oracle which could be worth up to $7 billion over ten years as part of the cross-agency Enterprise Software Initiative. 

The layoffs can only increase the perception of Oracle as losing the staff to meet their commitments, as unstable and in trouble. This is a developing story. A TTA ‘hat tip’ to an observer who wishes to remain anonymous.

Chutes & Ladders, Oracle Edition: Surprise! Project Jupiter data center build overages, “social costs” multiply. Pentagon inks $7B, 10 year deal for software.

The Unexpected in the Terra Incognita of data centers whip up The Perfect Pricey Storm for Oracle. Oracle knows how to build software, not huge data center buildings. Buildings have messy things like power supply, coolant, and permitting at the local and state levels. There is also The Unexpected that any experienced builder will factor in even when unknown, whether it’s overruns for wiring, racks, chips, out of spec cement, etc., that delay Opening Revenue Day. The Unexpected increasingly includes what is termed “social costs” that start around genuine concerns such as power draw, transmission lines, water usage, disruptions, even heat foci (a Cornell Tech study found a 10 degree rise on current data centers). Many local “interests” use these tentpoles to support the classic tactics of dissuade, delay, and (ramping up) the difficulty. When the pockets like Oracle’s aren’t deep and labeled ‘debt’, this hurts.

In the New Mexico west bordering Texas, where it’s underpopulated and land is cheap, Oracle’s 1,400-acre, 2+ gigawatt Project Jupiter super data center build for OpenAI is hitting roadblocks, primarily around power. The original plan to power it with gas from its own natural gas plants hit environmental potholes. Then Oracle switched to natural gas fuel cells from Bloom Energy. They use little water, pollute less and are reasonable in carbon emissions. But the cost? $8 billion, a few billion more than the gas plants. They also have other sticky requirements; to not degrade, the cells must continuously run, which scuppers Oracle’s plan to switch off to far cheaper solar on sunny days. TTA 7 May

New Mexico and to a lesser degree west Texas have rising environmental concerns. New Mexico in particular is generally hostile to big business and fossil fuels. The natural gas pipeline needed to supply the cells that runs through New Mexico is on its second rejection by the New Mexico Environment Department. The next hearing isn’t till 19 October. The cherry on this cake? The state Attorney General is investigating complaints from local residents that their names were used fraudulently in support of said fuel cells. The greenhouse gas emissions are also claimed by environmental groups to be equivalent to New Mexico’s two largest cities, a claim that evades logic for Albuquerque alone. These groups now are pushing for a data center moratorium, a growing national cause that ignores that the data center is partly built, the water being used is non-potable from outside the area, and that the builder, Oracle, is working hard to respond to critics in the local areas by plowing money into local concerns.

Oracle isn’t the only one, but the one with the least resources. Oracle, Microsoft and OpenAI projects in Wisconsin are having costly difficulties with power authorities on building transmission lines and cost sharing. This may add another overrun of $100 million to Oracle/OpenAI’s Port Washington, Wisconsin data center. Oracle’s low credit rating also hurts them, where Wisconsin’s state power regulator is requiring financial guarantees in cash or lines of credit in case the project fails. This will cost Oracle $100 million–annually. In Texas, Big AI such as Meta and Google are having more success in partnering with local power utilities in building permanent infrastructure and renewable sourcing, including closed water systems to prevent toxic wastewater runoff into land and local water systems.

So why is Oracle making a chancy bet at the Data Center Infrastructure Landlord Table? Concluding from The Information: “even though the cost to build and power a gigawatt of AI is bordering on at least $60 billion, Nvidia servers powered by its Grace Blackwell chips, renting out at $3.50 an hour, could generate around $12 billion to $13 billion a year, including operating costs.” Your Editor reads this simply as a 4-5 year payback. However, that statement rests on a mountain of assumptions–that hourly rental costs remain high, that build costs remain somewhat stable or lower, that land and construction stay relatively cost static, that the small coterie of AI customers keep paying their bills, and that local groups do not succeed, as they seem to be doing, in increasing costs, demanding moratoria, and delaying online dates.

There are many reasons why Oracle’s bonds are hovering just above ‘junk’, as Mr. Market keeps reminding us. Computing UK. Add to that list that data center cost assumptions have gone spectacularly sideways and the expectations within Oracle didn’t account for (drum roll) The Unexpected.

Oracle did have some very good news last week from the Federal Government for its first Ladder in awhile. The Department of War (a/k/a Department of Defense) is contracting with Oracle for software in a deal that could be worth up to $7 billion over ten years. The exact contract has a base value of $3.31 billion for the first five years of the agreement and a total value of $6.99 billion if the additional option years are exercised.

The DoW Enterprise Software Initiative (ESI) puts contracting into a centralized framework to expedite procurement, versus the typical individual procurement process by separate agencies. The DoW ESI covers procurement for intelligence agencies and the Coast Guard. According to CNBC, “The contract covers the use of Oracle software in on-premises data centers for branches of the military, the U.S. intelligence community and the Coast Guard, according to a statement. The Central Intelligence Agency was Oracle’s first customer. A five-year base period for the contract includes perpetual and subscription-based software licenses, maintenance and consulting, according to one description.” DoW in its own release expects savings of $441 million when compared to the cost of buying Oracle products separately. (And come on, fellow writers. It’s the Department of War at the top of the release, not the Department of Defense, whatever arguments including historical you may have about it.) Oracle release, Federal News Network

This week’s Must Read: the dangerous financing of AI data center buildouts–and how they resemble the 2020 health tech boom

For this week’s Must Read–now that we are past World Cup and mostly past America250–here’s another bracing essay from Ed Zitron’s Where’s Your Ed At in The Subprime Data Center Crisis. Get a couple of cuppas and some time–it’s dense.

Mr. Zitron compares how data centers are financed today to the pre-2008 boom in collateralized debt obligations (CDOs) that insured mortgage bonds. CDOs, by raising money around these bonds near-endlessly, subsidized an artificial boom in housing demand stimulated by  historically low interest rates. Those of us around (nearly all our Readers) know how badly that wound up in 2008, with the circular grift crash taking down Lehman Brothers and other financial institutions and putting us into a four-year recession. It also made financing nearly unavailable for health tech companies just getting out of their Series A or B.

CDOs aren’t financing data centers, but Special Purpose Vehicles (SPVs) are. The SPV raises debt financing for a data center and sells it to institutional investors, asset managers or banks. The SPV makes the payments to the contractors and suppliers such as Nvidia for chips. How they pay interest on the debt is via a special account. Finally, when the data center starts to generate revenue, the SPV uses those funds to first pay for the operating expenses of the data center, then creditors (based on their seniority in the debt), then whatever is left goes to the holding company, such as CoreWeave. It reveals how companies like Meta, Google, Amazon, and Microsoft are financing their data center builds. (It does appear on this Editor’s reading that Oracle, by directly taking on debt, is taking a different route.)

It’s a complicated scenario. The analogy he draws is that the financing for data centers is equivalent to the subprime mortgages of 2008. It’s  compounded by the apparent fact that capacity being built in the pipeline far outstrips demand by a factor of 15, based on an industry report cited by Mr. Zitron. In addition, the demand is not from profitable companies. He cites that “70% to 90% of that demand is from Anthropic and OpenAI’s unprofitable services.”

It also assumes three factors govern AI expansion in a grab for world savings looking for safe bets:

  1. AI data center demand is infinite and all compute will be used.
  2. AI data centers all have “locked-in customer demand.”
  3. That these are “safe” investments, backed by the richest companies in the world.

Exactly what demand is out there? Companies and countries are guessing and making huge financial bets. Mr. Zitron basically calls it an AI bubble inflated by AI companies and abetted by the media because no one is accurately measuring the demand versus capacity.

It’s a scenario that screams ‘red flags’ and ‘Danger, Will Robinson’.

Read, you decide. 

But the scenario Mr. Zitron outlined raised the goose pimples on this Editor’s neck.

Those of us in healthcare have been to this rodeo before. And the bronco riders were all taken to the ER. Or the morgue.

If the term SPV sounds a little familiar to Readers, to this Editor, the term and the structure strongly resemble Special Purpose Acquisition Companies (SPACs) which for a time in 2020-2022 were the It Girl of getting around the typical IPO process for many a health tech company, such as Babylon Health. Admittedly, SPACs and SPVs work differently. SPACs raised money from investors, IPO’d themselves to raise more money, and then in an ‘blank check’ transaction, sometimes with additional investment, acquired a private company, thus taking it public. All in 3-6 months! Simple, right? None of the muss and fuss, due diligence, or SEC scrutiny of an IPO. And as a device, it’s still being used.

Yet look at the outcome in healthcare. Nearly all of the healthcare SPACs ‘cracked’ after 2023 with stock values cratering within months or a year, Hims being one of the very few exceptions and maybe the only one. 30% went bankrupt. 26% were acquired well below their IPO price. And the remainder survive, some having flirted with the Devil of Demise, all below their IPO and valuation. For a tidy summary of the rolling SPAC collapse, read TTA 10 April 2025 and 26 June 2024. 

But what CDOs, the current AI bubble, and the 2020-2022 health tech/telehealth bubble have in common is a complicated way of financing designed to skirt regulations and proper market analysis, coupled with a healthy dose of illusions. Each bubble is based on a set of assumptions that envisioned endless geometric growth and future profitability, coupled with a “desire to believe” that negated logic and the entry of outright fraud. In 2020, we had a real lack of accurately gauging demand for health tech and telehealth services, especially in direct-to-consumer and telementalhealth services. The healthcare SPAC bubble also misread the viability of companies and their business models, many of which had more in the realm of hopes and founder dreams than validity in the marketplace. SPACs evaded scrutiny and created great headlines for this Editor. It was endless. Apprehensions were brushed away. It was also unsettling to this Editor who had a very small role in a long-ago iteration of a financing and business boom/bust–airline deregulation–at two airlines.

When the 2023 crash came, wiping out billions in investment, it was pretty much confined to healthcare and health tech. It’s still being worked through in the consolidation of health tech (not all bad and to be expected), in bankruptcy court (23andMe), and the outright frauds in Federal courts (Done Global). To quote myself from June 2024: The investment scene in health tech and AI strongly resembles the Wild West days of airlines post-deregulation 30 years ago. Investor money in, now fleeing for the exits, whether the bankruptcy court or passing the hot potato to others with money.

AI, of course, dwarfs the SPAC-driven health tech boom by a 1000X factor. And has the capacity to take down a world economy.

A gloomy view on Oracle going forward: debt, cash flow, and dependence on OpenAI

Oracle is beginning to turn into one of those cautionary case studies. And that’s not good news for healthcare. From their faltering EHR to the hacking of their software, Oracle’s news hasn’t been cheerful. While still profitable in the quarterly reports, the debt load and its obligations in their chosen wrenching changeover from a software developer/seller to an AI infrastructure landlord have been followed by speculation. The latest speculation from June is selling their EHR business [TTA 2 June]–if they can find a buyer. The EHR is a distant second to Epic in every metric [TTA 27 May] and Oracle has an immense obligation to the Federal Government for both the Military Health System (MHS) and VA’s EHR Modernization that won’t complete projected rollout until 2031.

A recent analysis published in Seeking Alpha (may require free account, PDF here) will give one further pause.

The debt load is a crusher. There’s anywhere from $72 to $100 billion in debt on Oracle’s books, and that preceded the PIMCO financing of $16.3 billion that included equity. Their credit rating from major raters is one step above junk: BBB-negative from S&P Global Ratings and Moody’s Baa2 Negative outlook. [TTA 7 May] Oracle has already projected it needs more: an additional $40 billion in fiscal 2027 through a mix of debt and equity.

Net debt is soaring. Oracle ended FY 2026 with net debt of $97.6 billion. This represents a ~20% increase versus the $81.4 billion of FY 2025. Looking forward, this analyst is projecting that the net debt by end of FY 2027 will be in the range of ~$120 billion.

There’s another little problem called cash flow. Years of positive free cash flow, even during the pandemic recession, turned sour in their FY 26 to a negative $23.7 billion. The analysis states that Oracle is now heavily dependent on external cash–debt–to finance its AI infrastructure building. S&P also noted that capital expenditure has been geometrically increasing: $6.9 billion (2024), $21.1 billion (2025) and $55.7 billion (2026). The guidance for fiscal 2027? Between $90 and $95 billion. That is over a 70% increase. Cash flow clearly can’t pay down the debt they already have, a fact that banks factored in to cut off the lending spigot.

Its performance obligations are also crushing. $553 billion has been reported for OpenAI alone [TTA 7 May].  This article reports remaining performance obligations of $638 billion, about half of which is for OpenAI. Despite the disparity in numbers (perhaps completed obligations?), in this analyst’s view, something happens to OpenAI–for instance, a pullback in the confidence of markets to finance their aggressive expansion (and, this Editor would add, an IPO)–Oracle would be hit hard. To paraphrase an overworked analogy, if OpenAI stumbles and sprains its ankle, Oracle would break both legs.

But..but…isn’t demand supposed to be increasing, infinitely?  Increased demand is critical to continued financing. Yet there are leading indicators that demand is leveling off. Corporations are increasingly limiting internal use of AI by employees to tamp down soaring token usage costs and control budgets. These companies have also found that AI tools often do not work as well in replacing humans as they were cracked up to be. And now seemingly every software offering is ‘powered by AI’. The newness is wearing off.

The chip cycle is speeding up–not good news for AI infrastructure builders.  Nvidia is now in full production of its Vera Rubin chip, which is dramatically faster than the previous generation Blackwell chip. Our March reporting picked up that Oracle had forward commitments with Nvidia to use the older Blackwell chip for the OpenAI data centers, and OpenAI wasn’t happy about that. It’s not a simple matter of going to Nvidia and returning old chips and getting new ones–that isn’t done. Vera Rubin is also twice as expensive on a per-rack basis than Blackwell–$7.8 million versus $4 million. Add to this the long taffy pull of building (online is 12-18 months minimum), power, water, and labor costs…it adds up, as any builder will tell you.

Given the above factors, it shouldn’t be any surprise that Oracle stock is down 30% since last December and continues to decline.

Extra: The article also contains a short history of financial cycles. There are parallels drawn comparing the AI boom we are in to similar technology-driven boom and bust cycles, dating back to the building of canals in the 1700s, railways in the 1800s, and electrification in the early 1900s.  

Editor’s note: Any analysis of Oracle’s financial health is based on this article, previous articles, multiple sources, and Oracle’s disclosures. Our interest is primarily in the well-being of Oracle Health and the markets it serves. We do not engage in stock picking and none of the above should be construed as financial advice.

Chutes, and chutes: Microsoft’s $3B Oracle cloud leasing deal goes sideways, Defense Health Agency to replace Leidos as system integrator for MHS’ EHR, Centene offering voluntary buyouts to most employees

While SpaceX has debuted to well over a $2.3 trillion (that’s with a T) market cap, it seems that even giant companies are still facing expensive headwinds.

The Microsoft-Oracle cloud deal has gone sideways, if not entirely off. Microsoft’s goal was to lease space on Oracle Cloud Infrastructure (OCI) to expand its capacity and to move some of its workloads there. Microsoft Azure would be prioritized for customers. The problem was that Oracle’s public cloud infrastructure does not have the Federal Risk and Authorization Management Program (FedRAMP) security framework that Microsoft needed for some of these workloads, and Oracle was not willing to add it. OCI does have a FedRAMP framework for its Federal Government work. A source for the Business Insider article said that it was potentially worth up to $3 billion. BI’s source within Oracle said that adding FedRAMP to the public OCI would be a “massive engineering lift”.

To Reuters and to Business Insider, an Oracle spokesperson swiftly responded that the report was “inaccurate” but did not specify the inaccuracies, and that the two companies continue to have “a  tremendously collaborative and fruitful partnership.”–a statement which can be read as a non-denial.

It highlights a shortage of computing capacity in cloud services, where Microsoft and other companies are scratching for more data center bandwidth, and turning to competitors to lease. Microsoft already leases capacity from Amazon for its GitHub code development business and is searching for more. Amazon and Google’s public clouds have FedRAMP and seem like logical alternatives if they have spare capacity. Google alone signed a $920 million per month deal with SpaceX for AI compute capacity that extends from October 2026 to June 2029. SpaceX also has a similar deal with Anthropic.

Oracle could certainly have used the cash flow.

The Defense Health Agency (DHA) will be transitioning away from Leidos as the lead systems integrator for the Military Health System (MHS) EHR and related systems by July 2027.  MHS GENESIS originated from the 2015 EHR contract award to the Leidos Partnership for Defense Health, with Cerner (now Oracle Health) for the EHR and Accenture as members. Leidos served as the lead systems integrator to onboard all the parts of the entire MHS GENESIS system, which grew to include Henry Schein for dental records, Philips North America for tele-critical care, Amwell for telehealth, and Solventum Health Information Systems (formerly 3M) for clinical documentation and coding.

Now that it is fully implemented, DHA will take over the integration role, transitioning Philips and Amwell away from Leidos by the end of this July, Oracle Health by November, and both Schein and Solventum by July 2027. Reasons cited on DHA’s SAM.gov notice were “reduced cost transparency, duplicative layers of management and administration, limited government visibility into pricing structures, and constraints on the government’s ability to directly manage performance and enforce service level agreements.”

While Leidos issued an emollient statement that they hoped to remain working with the DHA, this definitive and apparently drastic move indicates DHA unhappiness with the structure and a desire to directly establish relationships with the vendors as sole-source contractors. Unhappily for Leidos, it has affected its market value and how analysts view its future position in the Federal health IT market. Washington Technology (PDF of article), Yahoo Finance  Hat tip to a Reader who wishes to remain anonymous

Major health insurer Centene is offering voluntary buyouts to most employees through a Voluntary Separation Plan (VSP). The insurer currently employs 61,000 people across multiple plans. It is both the largest state Medicaid (12.4 million members) and Affordable Care Act (ACA, 3.5 million members) marketplace provider. But its memberships in both are shrinking. As of March, Medicaid membership was down 4% and ACA membership was down a stunning 54% (2 million members). The latter drop is puzzling, since insurers have exited or cut back on their ACA Marketplace plans, notably Aetna for this year and Cigna after this year.

ACA plans are offered on a state, then county-availability level. 2026 is the first time since 2018 that the average number of insurers participating in the ACA marketplaces has dropped, according to KFF cited in MedCity News. The ACA premium tax credit subsidies expired at the end of 2025, effectively causing premiums to double for nearly everyone. Many members dropped out of exchanges; those who remained were sicker (higher risk) and in lower-level plans that cost less in premiums. Centene also expects that its ACA membership will fall by another 40% by the end of 2026, per their company statement at a Barclays conference in March. CNBC

While Centene has grown membership in other plans, such as employer-sponsored plans and Medicare prescription drug plans (PDP), its total membership has decreased.  Centene currently has almost 26.3 million at-risk members, down from 27.9 million in the prior year, a 6% decline. Yet revenue is projected to remain relatively flat, with a forecast of about $189.5 billion at the midpoint of 2026, a decline of roughly 3% from 2025. Share price has recovered from last year’s nadir by over 50%

According to (paywalled) Bloomberg News (quoted in Insurance Business), “a [Centene] spokesperson did not specify how far Centene intends to shrink its headcount, but said layoffs could follow if the company fails to reach its target through voluntary departures.” In her message to staff last Monday, CEO Sarah London wrote, “When our membership shifts, we need to shift our organization accordingly.” To Healthcare Dive, a spokesperson said that “Centene is positioning the company to lead the future of healthcare — working to deliver a simpler and better experience for our members and partners while meeting the realities of today’s healthcare environment.” 

Now what could that mean? That “shift” in London’s terms requires a repositioning and further reorganizations. Those have not been disclosed or even hinted at–yet.  Certainly, that will be a subject at Centene’s Q2 earnings call in July for investors and shareholders.

In this Editor’s view, rarely does shrinking to profitability work except as an interim strategy to stem losses. Because health plans operate on an annual basis, and enrollment periods start up in the fall, it’s likely that changes won’t be disclosed until then, though internal reorganizations will start to happen. It is hard to operate plans on a ‘bare bones’ basis for long, the nature of the health plan ‘beast’. Lack of service and low customer satisfaction affect vital quality ratings such as STAR (CMS) and HEDIS (NCQA), which influence both CMS payments and plan buyers.

This leads to other alternatives that may be open to Centene. The company could be acquired, broken up, or the larger plans spun off.

  • A full sale presents regulatory and Federal antitrust problems to any plan, and would take a long time for approval both at the state and Federal level. Perhaps longer than Centene can afford.
  • Payers aren’t attractive to private equity except on a hit-and-run basis. Politan Capital, since its major moves to reorganize Centene in 2022-23 after accumulating $900 million in shares, is now down to $70 million.
  • What might be faster: selling off individual or groups of plans to a smaller company such as Molina, or to larger Cigna (once rumored as an acquirer, now divesting whole lines of business), Elevance, or Humana. Centene has always been a ‘family of brands’ such as Wellcare and HealthNet, and the Centene ‘brand’ is nonexistent.

It cannot be emphasized enough that Federal antitrust and the states present significant regulatory barriers on all these alternatives. The plans are what is left to sell. Centene has already sold off most, if not all, of its non-plan management services, such as Magellan and the Collaborative Health Systems ACO/MSO, to generate cash after the Politan Capital-led reorganization.

Another factor: at the state and Federal levels, since ACA, Medicaid. and Medicare Advantage plans are funded and approved by them, eventually the layoffs will attract attention and questions by CMS and state departments of banking and insurance (DOBIs). The VSP may be a way to get around them.

Details for the VSP, eligibility as a % of the workforce, and acceptance goal numbers have not been publicly disclosed. Employee posting sites such as The Layoff and on Reddit indicate that the ‘bonus’ for signing the agreement is an additional four weeks on a package based on your tenure by service years and grade level, plus paid-for COBRA and outplacement. The consensus in the comments is that the information provided to eligible employees is somewhat vague. The word “estimated” is used in terms of the buyout. In addition, ‘eligibility’ apparently does not guarantee that the applicant will be accepted for the VSP (an exit date mentioned is 1 September) nor that an involuntary layoff for a lesser package will take place before then. Recent hires with tenure under two years apparently are not eligible. Opt-out date is 2 July. Unsurprisingly, a third-party administrator has by reports been brought in for this. For employees, another consideration is that accepting a voluntary separation means that in many states, it is treated as ‘quitting’ and you are ineligible for unemployment payment. Most on these boards believe that involuntary layoffs will happen anyway.

It is certainly a difficult decision to make for most people. Best wishes from this Editor to everyone. The impact on healthcare is not going to be subtle, which is why this is discussed at length. (Disclosure: this Editor was briefly a Centene employee after the company she worked for, WellCare Health Plans, was bought by Centene. She is a holder of Centene stock converted from her prior company. The above is strictly her opinion and protected speech, and should not be used as investment advice.)