Chutes & Ladders this week: Carbon Health’s Ch. 11; Centene’s 2-way beat, TrumpRx.com debuts; Doc.com files for $24M Nasdaq listing, $55M for Alaffia Health, big Series Ds for Midi Health and ElevenLabs

February 7, 2026 | by

One busy week in the game! Chutes first…

Primary care/telehealth provider Carbon Health filed for Chapter 11 dual-track bankruptcy reorganization. San Francisco-based Carbon filed on Tuesday 2 February a pre-packaged Chapter 11. The unusual dual track refers to a simultaneous sale of the company and a court-supervised restructuring backed by up to $19.5M in debtor-in-possession (DIP) financing. The DIP financing, via Future Solutions Investments, is currently approved up to $9 million. DIP financing ensures that operations continue and that employees and vendors are paid.

The bankruptcy was filed in the US Bankruptcy Court for the Southern District of Texas, with liabilities estimated between $100 million and $500 million. According to the company release, “the Chapter 11 plan is premised on a debt-for-equity exchange, and a post-petition marketing and sale process for all or a portion of the Company’s assets.” At this point, there is no projected date for emergence out of bankruptcy.

Carbon started as an app-based telehealth provider in 2015 in SF and now has 93 affiliated primary and urgent care clinics across eight states from California to New Jersey. It is structured as a management services organization (MSO) with a proprietary technology stack to support patient telehealth and the clinics. The company attributes the shortfalls and need for reorganization to post-Covid demand changes and a tight capital market for healthcare. (Editor’s note: operating primary care practices through a MSO model, where you make money selling services, is certainly interesting but presents many hurdles to consistent profit. I’ll cite my experience working for an MSO engaged with Medicare payment model ACOs and IPAs.)

It’s been a tough market for provider groups even when financing was easy, as VillageMD’s difficulties with Walgreens have demonstrated. Primary care provision to patients is too sporadic and competitive to allow for mistakes. Then when consistency and depth are needed, chronic care management becomes all about risk management. Not care. Beckers, FierceHealthcare, ElevenFlo

Between a Chute and a Ladder…

Centene’s horrible 2025 closed with a Q4 net loss of $1.1 billion, but a better forecast for 2026. The Q4 compared to a net profit of $283 million in FY 2024. A major factor was that the health benefits ratio (HBR) of 94.3% for Q4 2025 was sharply up from 89.6% in Q4 2024, as well as expenses relating to rising No Surprises Act billing disputes. The ladder was that the revenue topline of $49.7 billion, up 22% versus prior year, reportedly beat Wall Street expectations as did the full year.

For 2026, CEO Sarah London and CFO Drew Asher are promising a more stable ride. Medicaid profitability has improved plus year-over-year growth with breakeven in the Medicare Advantage market. This rosy outlook contrasts with UnitedHealth Group, Molina Healthcare, and Elevance, and has led to more questions by analysts about its validity.

A crotchety Mr. Market didn’t like the news today (Friday) and whipped the stock down 4% to $38. A year ago, CNC traded above $66. Centene’s primary markets are Medicaid, Medicare and the ACA. They continue to shrink non-core businesses, announcing that it is divesting the remainder of Magellan Health it still holds, resulting in an impairment of $513 million, or $389 million after-tax. (Disclosure: this Editor worked for a company Centene bought and holds CNC stock) Financial release, Healthcare Finance News, Healthcare Dive

On to the Ladders…

TrumpRx.com online site debuts. This provides some relief on pricing for 40 heavily prescribed and expensive drugs from five pharmaceutical manufacturers: AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer. The pricing is ‘most favored nation’ (MFN) which means it is in line with the lowest paid by other developed nations. According to the White House release that outlines availability, “Depending on the manufacturer of a given drug, patients with valid prescriptions will be able to access savings through user-friendly coupons that can be printed or downloaded onto their phones or through channels set up by the manufacturer and integrated into TrumpRx.gov.” In return, the manufacturers are exempted for three years from pharmaceutical tariffs. Many of these drugs are already available at reduced prices through the drug companies’ DTC outlets, such as Zepbound and Wegovy. While for those in commercial plans or Medicare Part D there may not be much difference in pricing, the trend here is that manufacturers continue to unabashedly create outlets for drugs that bypass the beleaguered PBMs.  Healthcare Dive

It was also a Big Week for a future IPO and company financings.

Mexican telehealth Doc.com files for Nasdaq listing. Their filing is for 3 million shares of its Class A common stock priced at $8, for a total value of $24 million. (SEC Form 1-A) The stock will list under DOCC. Doc.com is a little different in claiming to use both blockchain to secure transactions and AI for workflows and operations to provide telehealth services that connect underserved markets with doctors, nurse-practitioners, psychologists, mental health specialists, and even veterinarians. It’s currently offered in Latin America and the US (as of last year), headquartered in NYC. Current financing is $300.7 million raised in January 2024 from Silver Rock Group private equity, and a $700,000 debt financing. (Crunchbase).  2025 annual report, Mobihealthnews

Alaffia Health scores a $55 million Series B. Lead investor was Transformation Capital with participation from previous investors including FirstMark Capital, Tau Ventures, and Twine Ventures. Their total raise is $73 million. Alaffia has developed agentic AI for health plan claims operations. The AI tools offered scale clinical review capacity for health plans and evaluate claims against the complete patient medical record, for a claimed 20%+ average savings on high-cost facility claims and 5x+ ROI for leading health plans. The fresh financing will be used for the usual R&D, developing additional agentic AI, and growth. Alaffia release, MedCityNews

Midi Health is a new unicorn, closing a $100 million Series D financing and a valuation over $1 billion. Even more unusual, it’s another strong raise for a women’s health company, this one in telehealth for women in perimenopause and menopause. Last week, Pomelo Care raised a $92 million Series C to move from the maternity segment into menopause and older women’s health. The Series D was led by Goodwater Capital with participation from new investors Foresite Capital and Serena Ventures, as well as continued support from Advance Venture Partners, GV (Google Ventures), Emerson Collective, SemperVirens, and McKesson Ventures.  MedCityNews

ElevenLabs closed its own Series D at $500 million, topping $781 million in funds for its generative AI in text-to-speech and an $11 billion valuation. Its scope is apparently near-universal for developers and companies in multiple industries. For healthcare systems, it has platforms for private practitioners and clinics that provide HIPAA-compliant, intelligent voice agents that triage, route urgent calls and respond to patients. The agents can sync with EHR and HIS systems as well as nurse-call and messaging systems. It can also update records, log triage outcomes and book appointments automatically integrated with EHRs. The fresh financing will assist in their international expansion and ElevenAgents, its enterprise platform for voice and conversational AI. Mobihealthnews, ElevenLabs release

Chutes & Ladders: UnitedHealth’s disastrous day and industry portents; Sword Health buys Kaia for $285M and gains German entry, $250M Series D for OpenEvidence, Pomelo’s $92M Series C, NOCD buys Rebound Health

January 29, 2026 | by

Chutes go first…

UnitedHealth Group’s 2025 financials not only triggered a one-day drop in its stock of 19.6% ($282), but cracked the Dow Jones Industrial Average (DJIA) by 409 points– close to 1% (0.8%). Revenue hit a record–$447.6 billion–but profits suffered another drop to $12.1 billion from $14.4 billion in 2024. Worse, it was the lowest annual profit since 2018, not even adjusted for inflation. Their care organization within Optum services, Optum Health, went from a 2024 operational gain of $7.8 billion to a loss of $278 million in 2025. 2026 projections for UHG include a revenue contraction for the first time in years. Healthcare Dive, Yahoo Finance

But the stock free-fall hinged on the Center for Medicare and Medicaid Services (CMS) rule move announced on Monday to essentially keep Medicare Advantage (MA)  average rate payments flat at less than 1%, versus an expected 4-6%. This was topped by another rule excluding patient diagnoses that aren’t linked to actual medical care that inflated MA patient risk adjustments, flattening risk scores and payments. The adjustments would save taxpayers about $7 billion. Another major hit is that UHG projects a 2026 loss of 1.3 to 1.4 million MA members. The stock price recovered about 11% today to close at $294.02.

UHG’s stock drop was the 6th worst since 1987’s Black Tuesday. The rule changes also swatted other insurers with major MA markets such as Centene, CVS Health (Aetna), Elevance, and Humana. 

Congress is also going hard after health insurers, with hostile House Ways and Means committee and House Energy and Commerce subcommittee hearings last week skewering CEOs from UnitedHealth, CVS, Cigna and Elevance over their compensation, rampant vertical integration with pharmacy benefit management (PBMs) and providers (including rate setting), prior authorization, and care denials. Fun fact: non-insurance business can be as much as one-third of revenue for the insurer giants. Only the Blue Shield of California CEO (Ascendiun), a non-profit, who basically agreed with all the criticisms of healthcare and threw himself on the mercy of the court, somewhat escaped. It was a Bad Day on Capitol Hill that may portend Boot Hill for some CEOs. Healthcare Dive, Becker’s 

Other portents for the industry aren’t great either. ACA individual plan subsidies, which had ballooned beyond recognition in the past few years, are not expected to return, and members are fleeing. Many insurers such as Aetna have already exited the exchanges. Health policy reforms are iffy in a midterm election year. Medicaid state payments are still in unknown territory. A bit more favorable is that margins are stabilizing and commercial plans remain positive. Healthcare Dive

All of which means that in a hot midterm year, there will be renewed bipartisan calls to restrict insurers on practices of their painstakingly integrated service businesses–and increased calls for divestitures. By last year, it was clear that UHG was becoming a victim of its own size and a strategy rapidly becoming obsolete. This Editor in May 2025 (just before her extended hiatus) in an extended brief advocated a voluntary breakup of UnitedHealth Group before it wound up like GE, wrecked by its own problems. The finalized acquisition of Amedysis in August, dangling with DOJ since 2023, was the swan song. Or honk. The days of big UHG accretive buys, Optum acquiring practices, and Optum Ventures making big bets in digital health are over, and darn well should be.

A very tart take–but requiring a subscription–is in yesterday’s (27 Jan) AI Health Uncut. Sergei Polevikov details the multiple fraud cases that UHG is fighting, the devastation that Change Healthcare’s suspension of provider payments for months in 2024 wreaked, insider trading, and more.

And here are the Ladders, which are finally showing up in healthtech after a thoroughly depressing 2025…

MSG physical therapy/mental health/telehealth provider Sword Health today (28 Jan) announced the acquisition of Kaia Health for $285 million. (Updated) Kaia is also in MSK management for employers, payers, and public health systems, but adds a pulmonary therapy for COPD, Kaia Breathe. The Sword brand will replace Kaia in the US, while Kaia’s prescription app footprint in Germany (DiGA) will open the digital health Rx reimbursement pathway there for Sword. Clearly that was a very big asset of interest to Sword. At present, Sword has 700,000 members across three continents and 1,000+ enterprise clients. Their financing to date is $500 million raised from Khosla Ventures, General Catalyst, Transformation Capital, and Founders Fund. Kaia had funding of about $123 million but hadn’t had funding since their April 2021 Series C, which is a prolonged time and indicates that they were having trouble with that ol’ devil Profitability. (Crunchbase) Sword release, Mobihealthnews

OpenEvidence, the medical information search engine for doctors that is 2026’s ‘hot number’, scored a $250 million Series D, led by Thrive Capital and DST Global. The AI-enabled (what isn’t?) free search engine trained on journals and clinical medical data only, coupled with an AI chatbot agent, claims scorching growth, from 3 million clinical consultations/monthly in December 2024 to 18 million/monthly in December 2025, all from verified US physicians. The Miami-based company also claims daily average usage by 40% of US doctors in 10,000 hospitals and medical centers. Its funding and valuation are scorching too, totaling $700 million from a Murderer’s Row of major investors, doubling its valuation to $12 billion, making it the most valuable healthcare AI company on Planet Earth. (This gives OpenAI and Anthropic something to ‘shoot’ for.) The fresh funding will be invested in R&D and compute costs associated with their multi-AI agentic architecture. “Medical superintelligence” may be an overstatement, but in discussions around physician marketing and engagement, OpenEvidence is showing metrics that dust the traditional providers such as Doximity, Medscape, and Epocrates. FierceHealthcare, Mobihealthnews, release

Pomelo Care’s $92 million raise will take it beyond maternity care. At present targeted to fertility, maternity, and pediatric care for women and children, the company is expanding into midlife women’s health, including perimenopause and menopause symptoms and mental health support. The Pomelo app enables access to a dedicated care team and customized care plans. Currently, the NYC-based company founded by Marta Bralic Kerns and named after the doughy citrus fruit has access to 25 million covered lives through health plan payers and employers. The Series C was led by Stripes with participation from Andreessen Horowitz, PLUS Capital, Atomico, BoxGroup, and SV Angel. Valuation is now up to $1.7 billion. MedCity News, Mobihealthnews, Forbes

On the other end of the barbell, NOCD, a virtual care provider for obsessive-compulsive disorder (OCD), purchased trauma care provider Rebound Health. The two companies are forming under a parent entity, Noto. Rebound provides for trauma patients a mobile app that provides structured self-help support. The overlap/extension for the two companies is in treatment of PTSD and Complex PTSD. NOCD has raised $84 million since its founding eight years ago but Rebound Health only $150,000 in a pre-seed round (Crunchbase). Acquisition cost was not disclosed but could not have been much. Behavioral Health Business

Week-end short takes: Change Healthcare/UHG breach notification starting (updated); fundings for Pomelo Care, Marigold Health, Humata Health

June 21, 2024 | by

Change Healthcare finally starting notifications, but not yet to consumers. A press statement today from Change/UnitedHealth Group confirmed that the long process of notifications has started with hospitals, insurers, and other customers. Individuals and practices will not be notified until late July. Change confirmed that the Blackcat/ALPHV cyberattack exposed names, addresses, health insurance information, and personal information like Social Security numbers, but at the individual level investigation isn’t finalized. At this point, they have reviewed over 90% of impacted files and have not seen signs that doctors’ charts or full medical histories were taken. Technically, UHG has made the 21 June deadline stated in the Hassan/Blackburn Senate letter [TTA 19 June] but not within the 60-day HHS-OCR window, which opens them up to an HHS fine. After paying a cyberransom of $22 million in bitcoin and uncounted (to us) millions in rebuilding systems, HHS’ fine may look like the lesser cost of doing business. The Change website also contains a very carefully worded ‘HIPAA Substitute Notice’ that reads like a consumer data breach notification. AP via Yahoo! News UK   One wonders if there’s a fair amount of ‘buyer’s regret’ going on at UHG in fighting so hard to buy Change. Due diligence would have helped over that year-plus.

Update: The Centers for Medicare & Medicaid Services (CMS) announced earlier this week that the provider financial assistance program will be ending 12 July as billing activities have largely resumed. It has advanced over $2.55 billion in payments to Medicare Part A providers and $717.2 million to Part B providers. FierceHealthcare

Fundings this week:

Virtual maternity support platform Pomelo Care scored $46 million in Series B funding. Lead investors are Andreessen Horowitz (a16z) and First Round Capital with participation from Stripes, BoxGroup, Operator Partners, and SV Angel. Pomelo’s markets for virtual fertility, pregnancy and newborn care from preconception through a baby’s first year services are employers, health plans and providers. The company claims 3 million covered lives across 46 states through their commercial and Medicaid health plan partners. Release, Mobihealthnews

Telemental health provider Marigold Health now has an $11 million Series A. Marigold is structured as an anonymous social network where people with mental health and substance use conditions provide peer-based support. Lead investors for the Series A are Rock Health and Innospark Ventures. Additional participants are the Commonwealth Care Alliance (CCA), Wavemaker360, Stand Together Ventures Lab, Epsilon Health Investors, Koa Labs, VNS Health Plan and KdT Ventures. Their substance use disorder (SUD) programs are currently available to 25,000 members in Delaware, Rhode Island, and Massachusetts. The new funding will be used for expansion to at least four additional states by the end of 2025. Release (Marketwatch), Mobihealthnews

Humata Health, which has developed AI-based technology to automate prior authorizations for payers and providers, closed an unlettered $25 million funding round. Lead investors are Blue Venture Fund (representing the majority of BCBS plans) and LRVHealth (representing nearly 30 health systems and payers), with participation from Optum Ventures, .406 Ventures, Highmark Ventures, and VentureforGood. The funding will be used to broaden its generative AI technologies, expand their provider base, and begin to partner with payers and delegated entities. Humata bought the base prior authorization technology from Olive AI out of its bankruptcy [TTA 31 Oct 2023]. Its founding chairman and CEO is Jeremy Friese, MD, who had been Olive AI’s president for their payer business after selling Verata Health, also in the prior authorization automation area, to Olive.  Release, FierceHealthcare