Breaking: suspect in UnitedHealthcare CEO’s murder arrested in Pennsylvania, to be arraigned tonight (updated)

December 10, 2024 | by | No Comments

The suspect in the assassination-style murder of UnitedHealthcare CEO Brian Thompson was arrested this morning (Monday 9 Dec). Luigi Mangione, aged 26, was located today at a McDonald’s restaurant in Altoona, PA after an employee recognized him from wanted posters and media coverage. Altoona is a small city about 95 miles east of Pittsburgh.

One of the four fake IDs in his possession was used to check into an Upper West Side hostel. This was a fake NJ Motor Vehicle Commission driver’s license (Real ID!) with a false name and address in Maplewood NJ, a suburb of Newark near NYC. Police also found in his possession a ‘ghost gun’ with a suppressor that is consistent in appearance to the one used in the shooting. Updated: The gun was assembled from parts, possibly from a kit or separately purchased as replacement parts, with a 3D printed receiver. A receiver is the business components of a firearm–the firing pin, bolt, and breech block.

Mangione was due to be arraigned this evening at the courthouse in Altoona on gun charges. He will likely be extradited to Manhattan.

According to his LinkedIn profile (which is still up), Mangione was a University of Pennsylvania graduate with a six-year combined undergraduate and master’s degree in engineering, specializing in computer and information science. He is listed as currently employed at TrueCar, a car researching and dealer service, as a data engineer, but the Daily Mail reports that he left that position in February 2023 and suffered a spinal injury sometime last year. He was from Towson, Maryland and his LinkedIn profile had him living in Honolulu. The family owns and develops resort and golf club property in the Baltimore suburbs, operates the Lorien Health Services nursing homes, is in the travel business, and owns WCBM-AM, a 50,000 watt talk radio format station.

Luigi Mangione’s manifesto (not fully published) and social media postings reflect a distinct anger towards corporate America, according to the NYPD, and medicine and insurance companies as ‘parasites’, possibly personal because of the treatment of a sick relative. He also admired the writings of the murderous Unabomber, who terrorized individuals and academia for 20 years. The shell casings of ammunition found at the New York Hilton crime scene engraved with ‘delay’, ‘deny’ and ‘depose’ were the first indication that the shooter committed this murder in the name of a cause best known to him. New York Post updates, Pittsburgh Post-Gazette  This story is, of course, developing.

Brian Thompson’s private funeral was today (Monday) in Minnesota.

Updated Tuesday: Mangione and his local attorney Tom Dickey are contesting extradition to New York. This was determined during his court hearing at the Blair County Courthouse in Hollidaysburg, PA, near Altoona. Mangione, the suspect in the murder of Brian Thompson, raged on the way into the hearing this morning but remained quiet once in court. The Manhattan district attorney will request extradition via a ‘Governor’s Warrant’ from NY Governor Kathy Hochul, which will be sent to PA Governor Josh Shapiro. This processing could take up to 45 days. In the meantime, Mangione will be held on the gun charge and the false IDs at a state prison in Huntington. Over $8,000 in cash was also found in his backpack when arrested, which he maintains was planted by police. The three-page handwritten ‘manifesto’ positions himself as a hero and scores the corruption and greed of “United” that “they continue to abuse our country for immense profit because the American public has allwed (sic) them to get away with it.”

The extent of Mangione’s back injury was severe. According to the landlord of the co-living space Mangione inhabited for six months in 2023, “his lower vertebrae were almost like a half-inch off, and I think it pinched a nerve.” A former high school classmate said he lost touch with his family and ‘went missing’ after back surgery did not go well earlier this year.

The McDonald’s employee who called Altoona police to check this particular guest eating hash browns has been threatened on social media. 

TTA’s Holiday Countdown: a horror in midtown Manhattan, M&A action everywhere, BT and telecoms hacked, on-the-outs VillageMD’s CEO out, Wojcicki hangs on to 23andMe, more!

December 6, 2024 | by | No Comments

 

 

Our kickoff towards the holiday season very sadly starts with the shocking murder of UnitedHealthcare’s CEO en route to a meeting in midtown Manhattan. There’s an abundance of other news. Black Basta and Salt Typhoon are hacking telecoms, there’s a brace of M&A action from healthcare staffing to RPM to PR, and technology action includes Neuralink and mood prediction to sleep activity. But the sad trombone continues to play for 23andMe and VillageMD.

Weekend short takes: Merative’s $25M funding, Risant closes on Cone Health, Aya buys Cross Country staffing for $615M, Supreme Group acquires Amendola PR
BT Group hacked by Black Basta, China’s Salt Typhoon breached 8 telecoms in dozens of countries, government records 
News roundup: VA’s 2025 EHR budget + vendor breach, Neuralink robot arm study, linking mood prediction to sleep, CoachCare buys Revolution Health RPM/CCM, Seen Health’s $22M launch, Spectrum.Life in Deloitte Ireland’s Fast 50
Breaking: UnitedHealthcare CEO Brian Thompson murdered in NYC
Wojcicki: I’m transforming 23andMe to be ‘viable’ and thriving–but had ‘no idea why her board resigned’ (Sad Trombone 1)
VillageMD’s co-founder/CEO resigns as Walgreens continues the brush-off after billions in losses (Sad Trombone 2)

From the short holiday week in the US, the stories range from Potential Big International Fraud to Neuralink’s Big Brain Implant Potential. Yet another CVS head departs. Congressional VA EHR controls also depart in new bill. And help fund the adventures of NeuroNinja, a comic superhero who just happens to be living with Parkinson’s. 

Short takes: Teladoc intros hospital bed fall risk detector, Veradigm’s AI scribe, Lucid’s pill-sized esophageal cancer diagnostic, Cortica’s $80M raise for autism treatment, LG NOVA startup winners
News roundup: Oak Street’s Pykosz departs CVS, Musk’s Neuralink gains Canadian clinical trial, VA healthcare improvement bill omits EHR oversight measures, 23andMe’s Mirador precision medicine partnership (Another CVS head departs, stage left)
Help fund the NeuroNinja comic–a superhero with Parkinson’s! (An unusual approach)
Breaking: Federal agents seize Steward Health’s CEO, international head’s mobile phones in widening US investigations (It’s big, it’s developing, it’s international)

An unusual pre-Thanksgiving week focused on significant developments on ongoing Major Stories but little new. CVS Health bends the knee to investor Glenview. Controlled substances telehealth gets a 3rd extension. Revere Medical out of Steward ashes snaps up a broken MSO. Oura partners with Dexcom CGM and gets paid for it! What’s kind of new? HHS comes up short on cybersecurity leadership while accurate EHR notes are short in new VA study.

Government updates: GAO scores HHS on cybersecurity issues; patient issues largely omitted from EHR notes in VA study (Coming up consistently short)
News roundup: CVS Health cedes 4 new board seats to Glenview, Oscar’s strong Q3, telehealth controlled substance prescribing in 3rd extension, new Revere Medical to buy CareMax assets, Oura picks up $75M Dexcom financing and partnership (Further developments on Big Stories)

Cue the music…it’s the good, bad, and a ration of ugly this week. An under-the-radar company makes big buys in primary care and MSO. Veradigm might finally get itself sold. DOJ drags UHG to court over Amedisys–after the election. 23andMe continues to perhaps Destination Oblivion. Forward meets Oblivion after eight years. And Ali Parsa, one year after Babylon’s failure, serves up a new AI venture that gets a Gimlety view.

Bad News Roundup updates: UHG/Optum defends Amedisys buy fast via a website, digging deeper into Forward’s fast demise, former Masimo CEO Kiani booted–and sued (One lesson after another)
Bad News roundup: DOJ drops the hammer on UHG-Amedisys, 23andMe lays off 40% and closes therapeutics, Lyra Health lays off 2% in restructuring, Forward primary care + kiosks shuts down abruptly (We aren’t past it yet)
Babylon Health’s Parsa founds new AI medical assistant venture, Quadrivia, one year after Babylon Health’s failure (Parsa’s new AI-powered deal)
M&A action news: Astrana Health buys up Prospect Health for $745M after Centene MSO unit buy, Veradigm nears $1B+ sale, Sword Health lays off 17% of clinicians prepping for IPO using AI instead, Cigna is not buying Humana–really! truly! (M&A comes alive, with a new player)

The Big Race is over, 45 is now 47 come January, and health tech (plus related) news faces future. HLTH’s future is with UK’s Hyve Group. Cerebral faces an expensive DOJ/DEA Judgment Day for its Bad Behavior during the pandemic. 23andMe, CVS, and Walgreens face future survival. And what if in future healthcare sets a goal of zero failures, like aircraft makers and airlines?

News roundup: Cerebral forfeits $3.7M on federal Rx charges, Aetna president named, Stewardship Health sold to Rural Healthcare, Oura buys data company Sparta Science, Brook Health-Linus Health remote cognitive assessment 
Weekend reading: 23andMe’s up in the air future, including genetic data; Walgreens debates What To Stop and Start; what if healthcare pursued a zero-failure rate? (Some reckonings and a future view)
Surprise! HLTH conference group sold to UK’s Hyve Group Limited (Las Vegas barely a wrap)

A post-HLTH deluge of news–as the US rolls up to a major national election. CVS replaces its CEO and debates breaking up. Amwell takes on a new CFO. Decent-sized raises seem to have returned. Cigna isn’t buying Humana–as of now. And has Teladoc turned a corner?

News roundup: Teladoc’s improved Q3, PursueCare resuscitates Pear’s apps, AMA removes 16-day RPM requirement in 2026, PatientPoint intros Innovation Network, PeopleOne’s $32B raise, Cigna-Humana again a no-go (Earnings season and post-HLTH announcements)
Some thoughts on the takeaways from HLTH (Not that many, strangely)
News roundup 23 Oct: views on a CVS breakup and CEO replacement, Amwell’s interesting new CFO, CopilotIQ/Biofourmis merge (updated), raises by HealthEx, Counsel Health, Oshi Health (Will changes at top fix problems?)

As the weather chills, so do prospects for some very well known companies–and investment. Walgreens plans to shrink its retail footprint by 1,200 over the next three years, “monetize” VillageMD. CVS is exiting most of its infusion business. UHG stock, earnings hammered on Change Healthcare hack, Federal payment cuts. Masimo v. Apple patent slugfest continues with wins for both. DEA kicks the can on telehealth waivers into next year–maybe. FTC and DOJ chill M&A with more demanding Premarket Notification rule for M&A. The spot of good news–baby monitoring Owlet has its mojo back.

News roundup 16 Oct: Walgreens shuts 1,200 stores–500 in ’25, CVS exiting core infusion biz, Masimo v. Apple update, DEA recommends 3rd telehealth extension, Change hack costing UHG $705M, Owlet back in NYSE compliance (So many denouements..and only one good)
FTC drops the hammer on premerger notification requirements–what will be M&A and investment effects? (We told..and tell you so, no frills)

It’s unconfirmed, but CVS may be considering a breakup. Teladoc’s latest reorg puts its COO out to pasture. IPOs may revive by next year for ‘overdue for exit’ companies. In CEO Land, one former CEO strikes back at the Senate holding him in contempt, while another one, having lost her board, now can easily take 23andMe private. ATA announces 2025 Nexus and call for papers. And some new fundings and products…and why can’t VA stop stubbing its toe on Oracle EHR issues, or staff diving into politicians’ health records?

News roundup: Omada Health files S-1 for IPO in 2025–and a look at 2024 healthcare IPOs, Philips debuts new smart baby monitor, ActiveAlert launches in UK, ATA Nexus 2025 calls for speakers, abstracts (An small IPO revival?)
Breaking: another exit at Teladoc, with COO resigning effective 31 December (Something about ships? Spirals? Musical chairs?)
Industry news short takes: fundings for Qure.AI, Centivo, Rippl, Surescripts; M&A closings for GE Healthcare-Intelligent Ultrasound, LetsGetChecked-Truepill. And is Hinge Health going public soon?
Two ‘oops’ at VA: OIG finds VA, Oracle performance misalignments, makes 9 recommendations; VP candidates’ EHR records improperly accessed by VA employees (Enough already!)
Two follow ups: Steward Health CEO resigns–and sues the Senate HELP committee, Wojcicki will take 23andMe private (Time to take the yachts for a long trip?)
Now CVS Health may be reviewing ‘options’–including a possible breakup–report (PBM and health plan troubles)

Steward’s CEO will likely face prosecution on criminal contempt of Congress for not showing up at a hearing, Stefano Pessina’s net worth down by 97% as Walgreens tanks, and Joe Kiani, after founding Masimo 35 years ago, is booted from the board and ankles–now it’s up to Politan.  

What’s next for: Steward CEO now in criminal contempt of Congress; Walgreens’ Pessina’s fortune vanishes by 97%; Masimo’s Kiani now a man without a company

 

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Breaking: UnitedHealthcare CEO Brian Thompson murdered in NYC

December 4, 2024 | by | No Comments

No other words other than shocking, awful, and terrible. Brian Thompson, CEO of UnitedHealthcare, was murdered by gunshot around 6.45am this morning 4 December, outside the New York Hilton on Sixth Avenue (Avenue of the Americas) between 53rd and 54th Streets.

We know very little at this point. Reports indicate that a masked man approached outside the hotel and shot Mr. Thompson several times including in the chest near the 54th Street side entrance, then fled down Sixth Avenue towards Central Park nearby on a bicycle. Mr. Thompson was taken to Mount Sinai Hospital as critical and pronounced dead. The shooting is being depicted as ‘targeted’ and as an ‘assassination’. The suspect was described as a white male wearing a cream-colored jacket, black mask, black gloves, black and white sneakers, and a grey backpack. (Other than the cream jacket in winter, totally unremarkable) Witness reports indicate that the suspect was waiting outside the hotel and was not a guest. (The Hilton is a standard place to meet people near Rockefeller Center and the business district.)

Mr. Thompson was in NYC scheduled to speak at UHG’s Investor Day conference today at the Hilton, the site of many meetings and conferences. UnitedHealth Group CEO Andrew Witty halted the meeting around 8am.

A personal note. For this Editor working two blocks away years ago at what was then the Burlington Building, in account management for the Campbell-Ewald ad agency on Eastern Airlines, the Hilton was an ‘all hours’ safe haven during long crazy hours, to meet a friend, grab a drink, or just to get out of the office. Nearby tonight is the Rockefeller Center Christmas Tree lighting. Thousands will be there. He will not be.

We at TTA extend our sympathies to Brian Thompson’s family, friends, co-workers, and everyone he touched. We hope the NYPD swiftly locates and arrests the suspect, bringing him to justice. This is developing.

Daily Mail, New York Post

Early news roundup: Envision exits Ch. 11, splits; Walgreens’ new CIO; Philips’ $60M from Gates Foundation; more on Walmart-Orlando Health partnership; Cigna may sell MA business

November 8, 2023 | by

Staffing firm Envision Healthcare exits Chapter 11 bankruptcy, splits off AmSurg clinics. One of the Big Bankruptcies earlier this year has been reorganized, cutting $8 billion in debt by 70% and spinning off its AmSurg surgical clinics to new ownership. The hospital and physician staffing company was hurt as early as 2020 with shortages of available staff, then the pandemic which cut patient volumes, and conflicts with payers around out-of-network billing charges. The last put the company in conflict with the ‘no surprises’ patient protection billing law that took effect this year. One particular legal spat with UnitedHealthcare tied up both companies for years, but was won by Envision after an independent arbitration panel this past spring awarded Envision $91 million, finding that UHC breached its in-network contract. KKR, which had taken Envision private in 2018, lost $3.5 billion in equity, one of their largest corporate investment losses. Henry Howe, the company’s chief financial officer, takes over as interim CEO on 1 December as current CEO Jim Rechtin leaves to join Humana. Healthcare Dive  Background: TTA 12 May, 16 May   

Walgreens fills its chief information officer vacancy with the interim CIO. Neal Sample was appointed last Wednesday (1 Nov) as CIO and EVP, reporting to new CEO Tim Wentworth and joining the executive and IT governance committees. Sample was appointed last month as an IT advisor after CIO Hsiao Wang left suddenly on 2 October. Both Wentworth and Sample worked with each other at Express Scripts, with Sample holding both COO and CIO positions there, then departing for the CIO position at Northwestern Mutual. Walgreens release, Retail Dive

Philips receives an additional $44 million from the Gates Foundation for further Lumify Ultrasound System development. The total of $60 million in grants starting in 2021 was for the development of AI-enabled applications to improve obstetric care in low- and middle-income countries. The Lumify handheld ultrasound system assists frontline health workers, such as midwives, in interpreting obstetric images and identifying possible complications during pregnancy in hours versus weeks of training. The system’s Kenya trial was successful. The additional funding will be used to expand global adoption in underserved rural communities. Philips release  This follows Gates Foundation grants to GE Healthcare ($44 million) and Butterfly Network ($5 million) for easily deployed ultrasound and imaging systems to support low-income countries’ rural maternal health and respiratory scanning. Mobihealthnews

More on Orlando Health’s partnership with Walmart. Briefly noted here last week in Walmart’s release and reporting on Walmart Health’s new partnership with Centene’s Ambetter plan in Florida was the Orlando Health hospital partnership. This will coordinate care for patients admitted to the health system’s hospitals or who need specialty care. It is a first for Walmart as it has not previously partnered with local health systems on specialty and hospital care as an extension of its clinics. Eight of its 48 clinics are in the Orlando area. Becker’s Health IT 1 Nov, 6 Nov

Cigna is exploring a sale of its Medicare Advantage (MA) business. According to the exclusive report by Reuters (may be paywalled), Cigna is in early stages, at this point consulting with an investment bank. Cigna is not much of a player in the difficult state-by-state, county-by-county MA business, with 599,000 members as of 30 September, which is about 3% of their 19 million total insurance members. But it has been problematic, with Cigna recently paying CMS $172 million to settle allegations that it violated the False Claims Act by submitting incorrect data to obtain higher payments. By comparison, UnitedHealthcare and Humana have nearly half (47% or 14.5 million) of the national 30.8 million MA members (KFF). Becker’s

Close of week short takes: Q2 earnings up for GEHC, Talkspace; UnitedHealth invests $11M in SDOH; fundings for two AI startups, K4Connect, UpLift, Family First

July 28, 2023 | by

Winding up this week on nothing but positive news.

GE Healthcare was up smartly on revenue. For Q2, GEHC reported revenue of $4.8 billion, up 7% versus Q2 prior year, and a 9% organic revenue growth.  The adjusted earnings before interest and taxes (EBITDA) was $711 million versus $719 million prior year, with net income slightly down at $418 million versus $485 million prior year. Adjusted earnings per share was $0.92. Orders were up 6%. GEHC is adjusting its earnings upward by one percentage point for the full-year guidance on organic revenue growth and 10 cents in adjusted EPS at the midpoint. GEHC spun off from GE in January. Mobihealthnews

Talkspace had a far more mixed picture. Their Q2 revenue climbed 19% versus prior year to $35.6 million. This was due to an 82% increase in B2B revenue partially offset by a 41% consumer revenue decline. The other good news was that they narrowed net loss to $4.7 million from the prior year’s $23 million. Adjusted for EBITDA, the loss was $4 million. Another positive factor was that operating expenses were reduced 32% to $24.2 million. They are seeing an increase in revenue for 2023 to $137 million to $142 million and moving towards breakeven by end of Q1 2024. Another entrant in the crowded telemental health space, Talkspace went public in 2021 through a SPAC, trading as high as $11.95. Late last year, it flirted with delisting on Nasdaq, but is currently trading at $1.70. Mobihealthnews

UnitedHealthcare’s big bet on social determinants of health (SDOH) involves $11.1 million in grants to 66 nonprofits across 12 states. Part of their Empowering Health initiative, the grants help organizations that aid uninsured individuals and underserved communities in areas such as food insecurity, nutrition, social isolation, memory loss, behavioral health issues, health literacy efforts, and more. Since its start in 2018, UnitedHealthcare invested $62 million in grants that serve more than 11 million people in 30 states and the District of Columbia. MedCityNews, UnitedHealthcare news

Digital health and AI fundings are also ramping up–a little–in the $9-15 million range:

  • Two generative AI startups, Hippocratic AI and GenHealth AI, had early funding rounds in the $15 million range. Hippocratic AI is a safety-focused large language model (LLM) for healthcare competing with GPT-4, outperforming it on 105 of 114 healthcare exams and certifications. Their second seed round funding of $15 million from Cincinnati Children’s and HonorHealth adds to their May $50 million seed. GenHealth AI raised $13 million in a venture round from Obvious Ventures and Craft Venture. Their form of generative AI they call a large medical model (LMM) trained on medical-event data called DOOG-E. Two Washington veterans joined their board: Dr. Don Rucker, former national coordinator for health IT in the Trump administration and currently on the 1upHealth board, and Aneesh Chopra, the first chief technology officer of the US in the Obama administration.
  • Senior housing focused K4Connect received a venture round of $9 million from AXA Venture Partners and Bryce Catalyst with existing investors Forté Ventures, Intel Capital, the Ziegler-LinkAge Fund, and Topmark Partners, for a total of $41 million. K4Connect is positioned as an operating system (FusionOS) that integrates multiple senior living technologies. Mobihealthnews
  • Telementalhealth provider UpLift raised $10.7 million in Series A funding from Ballast Point Ventures with participation from Front Porch Ventures, Kapor Capital, and existing investor B Capital for a total raise of $22 million. UpLift is a direct to consumer therapy model which promotes both insurance coverage, affordable rates, and medication management. Another Series A funding of $11 million went to Family First, a technology platform for enterprises that supports caregivers’ mental health and wellbeing, The round was led by RPM Ventures and Eos Venture Partners.  Mobihealthnews

Thursday’s short takes: Walmart’s delivery drones expand, AWS lands Geisinger for AI and cloud, UHG-Kaia Health partner for virtual MSK therapy

May 26, 2022 | by

Look, up in the sky! If you live in Arizona, Arkansas, Florida, Texas, Utah, and Virginia, you might be seeing a Walmart delivery drone sooner than you think. By end of 2022, the DroneUp delivery service will be expanding to 34 sites in six states, including Orlando and Tampa, covering 4 million households. What stores in those states will fill these orders between 8am and 8pm haven’t been disclosed, but Walmart estimates that delivery may reach 1 million packages. They will be limited in weight to 10 lbs, promise a 30-minute turnaround, and the delivery fee will be a modest $3.99. “Certified pilots” will be flying these drones. A side business for DroneUp is aerial photography for city and state governments’ construction projects. Color this Editor skeptical, as she wonders how many packages will be dropped and drones shot at. Also, they need to stay clear of restricted airspace. Walmart release, Epoch Times, The Verge

Amazon Web Services (AWS) continues its foray into healthcare with a prime partnership with Geisinger Health, a regional (PA) integrated health system.  They will be transitioning to AWS as their strategic cloud tech provider including their EHR, over 400 applications, plus workflows, after a multi-year review. Geisinger has estimated that post-implementation, they will save several million dollars. Their EHR migration will be one of the largest AWS migrations to date. AWS for Health is rivaled by Microsoft with Teams, Azure IoT, and chatbots for clients such as Humana, plus Google’s partnerships with healthcare giants such as Mayo. FierceHealthcare, Geisinger release

UnitedHealthcare and Kaia Health are partnering for a musculoskeletal (MSK) virtual therapy program. United Healthcare members recovering from surgery or injury will be assessed and referred to the Kaia program when appropriate. These members will then be able to download the Kaia app for physical therapy, tailored to them via “artificial intelligence”. Progress is monitored by that person’s smartphone camera to record motion in real-time and offer suggestions via coaches either 1 to 1 or through the app’s chat feature. At this point, UHG will offer it only to their self-funded employer clients. FierceHealthcare

Thursday legal news roundup: Oscar Health accused of IPO securities fraud; Venezuelan cardiologist moonlights as cybercriminal, faces slammer; Change Healthcare sues former employee now at Olive AI

May 19, 2022 | by

To use a cliché, what a difference a year makes. In March 2021, insurtech Oscar Health successfully raised $1,4 billion in its IPO with shares at $39. Heady times didn’t last long, with shares tumbling to $5.67 as of this writing. Now the shareholder lawsuits have begun, with the complaint stating that negative effects of COVID-19 on Oscar’s business were not disclosed, specifically the growing cost of the pandemic on testing and treatment costs they would cover, and “Oscar would be negatively impacted by an unfavorable prior year Risk Adjustment Data Validation (RADV) result relating to 2019 and 2020 [and] that Oscar was on track to be negatively impacted by significant SEP membership growth”. The lack of forward-looking disclosure at an IPO is a violation of the Securities Act. The initial lawsuit has been filed in the US District Court for the Southern District Court of New York by shareholder Lorin Carpenter. Multiple law firms have invited shareholders to join in the suit — example from PR Newswire. Also named in the suit are Oscar Health co-founders CEO Mario Schlosser and Vice Chairman Joshua Kushner, plus several investment banks.

Oscar started the year with a Q1 loss of $0.36 per share versus an estimate of a loss of $0.40, but this is less than half of last year’s loss of $0.98 per share. They are also exiting the Arkansas and Colorado markets in 2023. Healthcare Dive

Cardiologist, master cybercriminal, a new Dr. Mabuse? Accused of the creation, use, and sale of ransomware is one Venezuelan doctor and practicing cardiologist, Moises Luis Zagala Gonzalez, a dual citizen of Venezuela and France. The charges by the Department of Justice (DOJ) in the Eastern District of New York also detail his “extensive support of, and profit sharing arrangements with, the cybercriminals who used his ransomware programs.” SaaS can’t hold a candle to the RaaS–ransomware-as-a-service–operation he created to sell what he dubbed ‘Thanos,’ allegedly named after a fictional cartoon villain responsible for destroying half of all life in the universe. Turns out that Iranian state-sponsored hackers and fellow ransomware designers really liked it too. If convicted, he faces 10 years in Club Fed–five years for attempted computer intrusion, and five years for conspiracy to commit computer intrusions. Designing criminal software really does test the limits of moonlighting. DOJ release, TechCrunch

Change Healthcare sues former employee at competitor Olive AI. While their merger with UnitedHealthcare is tied up in the US District Court in DC [TTA 23 Mar], Change Healthcare is not letting any courtroom grass grow under their feet. They are suing a former employee, Michael Feeney, with violating the non-compete clauses of his employment contract. The suit was filed in Tennessee Chancery Court, its HQ state. Mr. Feeney has countersued in his state of residence, stating that the non-compete violates Massachusetts law. He was VP, strategy and operations at Change handling physician revenue cycle management. At Olive AI, he is currently SVP, provider market operations. Information is a bit scarce on this and the free article this Editor has found reads machine-translated. If you have access to the Nashville Post or Modern Healthcare it’s probably more decipherable.

As to the lawsuit affecting non-competes due to the tight labor market–don’t count on it. It’s a conflict between the state the company is in enforcing non-competes, versus a state which restricts (or negates) them that is the former employee’s state of residence and work. What wins out will be the interesting part and affect many of us in the US.

UnitedHealthcare pilots predictive analytics model for SDOH, sets out plan to transform into ‘high-performing health plan’

July 15, 2021 | by

UnitedHealthcare and its parent UnitedHealth Group (UHG) have been busy in the past few weeks. Of most interest to our Readers with an interest in data analytics is UnitedHealthcare’s pilot of a social determinants of health (SDOH) initiative that uses de-identified claims data to identify members at high health risk due to social factors. UnitedHealthcare call center staffers then contact members to further determine needs and to assist them with appropriate community resources. These can include assistance with childcare, obtaining internet access, financial assistance with medical bills, healthy food options, and local support groups. Staffers are also trained to extend the conversation beyond the first call.

SDOH factors can impact up to 80% of a person’s health, according to research performed by the Robert Wood Johnson Foundation.

The predictive analytics model for SDOH was developed with Optum from data gathered from 300 markets and across 100 metrics. Call center staff are also clued to members with needs through keywords or phrases that indicate a need for assistance: “I’m hungry” or “I’m struggling to make ends meet”. The initiative also allows employers to design interventions for their employees.

The pilot is for two employer products, Advocate4Me Elite and Advocate4Me Premier. About half of the contacted members in the pilot have accepted assistance. UnitedHealthcare plans to roll the program out to other fully insured employer plans later this year. Release, FierceHealthcare

UnitedHealth Group, the parent of UnitedHealthcare and Optum, published its annual corporate Sustainability Report. where SDOH has a considerable part. It’s a roadmap for transformation into a high-performing health plan that is part of a modern, high-performing health system–a very high bar for UHG as the largest US health plan. This builds on six points detailed on page 9, most of which SDOH affects:

  • Expanding access to care
  • Improving health care affordability
  • Enhancing the health care experience
  • Achieving better health outcomes
  • Advancing health equity
  • Building healthy communities

SDOH has become significant enough to become the subject of a House bill, HR 2503, the Social Determinants Accelerator Act of 2021, to support community groups in coordinating health and social services through grants, technical assistance, information exchange. It, of course, would not be complete without a federal inter-agency technical advisory council. There is a similar bill in a Senate committee and funding made available to the Centers for Disease Control and Prevention’s Social Determinants of Health Program. FierceHealthcare

Cigna’s $69 million acquisition of Express Scripts clears US Department of Justice hurdle

September 18, 2018 | by

As reported on 8 Sept, the DOJ announced on Monday that they have formally cleared the Cigna acquisition of pharmacy benefits manager Express Scripts. This puts together a major payer with a PBM manager, the latter area considered to be challenged for profitability as the PBM drug rebate model may be substantially less profitable in the future. Federal policy pressure is ramping up from Health & Human Services (HHS), with Secretary Alex Azar only last week promising disruptive change and more transparency in drug pricing.

CVS (PBM-Caremark) with Aetna is in the works and Anthem is creating its own PBM called IngenioRx. UnitedHealthcare has its own OptumRx for some years. 

Another point of pressure on the entire PBM category is the Amazon-Berkshire Hathaway-JP Morgan combine, sometime in the future when the hype and speculation on What Amazon Will Do turns into actual plans beyond their acquisition of tiny, specialized player PillPack for an exorbitant $1bn [TTA 4 July]. 

The DOJ investigation took six months, reviewed more than 2 million documents, and more than 100 industry people were interviewed.

Cigna and Express Scripts now must negotiate over 50 state departments of banking and insurance–over 50 because some states have two. Both companies already have shareholder approval, and the lack of overlap in their businesses limits the possibility of divestitures. Their advocacy website is here. But state DOBIs can be unpredictable, as Cigna found out with Anthem. (Their contentious breakup is still being contested in court–and Cigna could use the contractual breakup money to ease the Express Scripts debt estimated at $15 bn. Forbes.  Bloomberg, Healthcare Dive

Disrupting the pathways of Social Determinants of Health: the transportation solution

February 21, 2017 | by

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].

More and more people are starting to have conversations around the Social Determinants of Health.  And for the first time, the c-suite within healthcare companies are talking about transportation.  People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members.  It is great that people are becoming aware of transportation and talking about it. — Todd Thomas, VP Strategic Business Development at Veyo

Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems.  In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation.  The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price.  None had any initiative to adapt to new technologies or evolve their business models.  Medical professionals and companies across the US had come to expect poor service as the norm.  It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be.  And ultimately closed a huge care gap for transportation-dependent patients. (more…)

Fitbit, Qualcomm Life get in step with UnitedHealthcare’s Motion

January 4, 2017 | by

[grow_thumb image=”https://telecareaware.com/wp-content/uploads/2017/01/UHC-Motion-Qualcomm-Infographic-Short-12-06-2016.jpg” thumb_width=”150″ /]Another step towards maturity in the fitness tracker and employee wellness business? Today’s news out of CES was the announcement by Qualcomm Life and UnitedHealthcare to expand the proprietary UHC employee wellness program, Motion. Qualcomm Life’s 2net is the platform that will eventually integrate with medical-grade connectivity multiple fitness trackers. The first will be Fitbit’s Charge 2.

The Motion program was tested in 12 states with select employers. It will expand to UnitedHealthcare’s self-funded employer health plans covering five or more eligible employees, plus companies with fully insured health plans with 101 or more eligible employees, in 40 states.

Employee incentives are up to $1,500 per year or $4 per day, but requirements are strict, based on Frequency, Intensity and Tenacity, or FIT.  The frequency requirement is six times per day with 300 steps within five minutes at least one hour apart; intensity of 3,000 steps within 30 minutes and tenacity of 10,000 total steps each day. The employers receive premium savings based on combined FIT results. Infographic above and left.

Through a Gimlet Eye…It gives a head start to Fitbit in a BYOD program, and a testing platform for a more clinical use of a new tracker, moving beyond the casual athlete who discards it in a few months and another sign confirming our 2017 View. For Qualcomm Life, it’s yet another pivot to stay in the Healthcare Game as apparently, their much-touted HealthyCircles care coordination platform has faded to black. For UHC, it’s a value-add for employers to sell a health plan. But employee wellness programs have yet to prove real health outcomes and real savings. The problem with all wellness programs, especially at the ‘frequency and intensity’ that UHC wants employees to achieve before they earn anything, is that they concentrate on making the well weller. How would it help the marginally fit or heaven forbid, those trying to regain their fitness with a chronic condition? One last point for employers: to get FIT, it involves a lot of employee time away from a desk or a station! ZDNet, UHC/Qualcomm release

Another bit(e) from Fitbit: Quietly at the end of year, Fitbit moved to terminate one of its multiple patent infringement-related suits against the now moribund Jawbone. (more…)

DOJ sues to derail Aetna-Humana, Anthem-Cigna mergers on anti-trust grounds (updated)

July 21, 2016 | by

Breaking News. The anticipated shoe has dropped. With all the US news concentrating on the Republican convention, the US Department of Justice, late today, without much fanfare beyond the presser, lobbed lawsuits at Aetna and Anthem to stop their respective acquisitions of Humana and Cigna. US Attorney General Loretta Lynch was joined by Principal Deputy Associate Attorney General William Baer, who had been the DOJ’s point person for this anti-trust review.

According to CNN’s report, Mr Baer said “the two mergers would leave consumers at risk by reducing benefits and raising premiums. He also stressed that the most vulnerable would be hit the hardest and that competition would be reduced. “These are so-called solutions that we cannot accept,” Baer said. He added that the mergers are a “convenient shortcut to increase profit for these two companies,” and that the DOJ had “zero confidence” that they would benefit consumers.”

Reuters reported that Aetna and Humana expect “to vigorously defend the companies’ pending merger,” Anthem’s response was “more muted”, as industry observers expected, as it has been more problematic not only in size and with Medicare Advantage divestiture, but also with reports of disagreements on management and governance.

If these mergers were successful, the Big Five in US health insurance would be reduced to the Big Three, with the $48 bn Anthem-Cigna matchup besting UnitedHealthCare for the #1 pole position with 45 million covered persons.

Why is this important to those of us in telehealth, telemedicine and telecare? We are still seeking ‘who pays for it’ (remember our Five Big Questions/FBQs?) and when five becomes three, and things are unsettled….negotiations grind to a halt. (This Editor will reference the post-2008 years where health tech US deals and development came to a screeching stop as we waited to find out what was in that mystery ACA bill. Recovery/reset took years….)

Earlier reports via Bloomberg News and Reuters noted that both sets of insurance companies faced substantial opposition from the start. (more…)

Care Innovations goes East–down home to Kentucky

October 14, 2015 | by

Intel and GE’s joint venture, Care Innovations, is opening an IT and product development center in Louisville KY’s Norton Commons live/work community. According to reports, the 10-person office was opened to develop “software for medical monitoring systems that allow people to measure their vital signs in own homes and that will analyze the data for health care providers”, which sounds like a description of Health Harmony as mentioned further in the article. Also cited by CEO Sean Slovenski was the recent acquisition of several major clients in Mississippi, Louisiana, Kentucky and Tennessee. Headquarters will remain in Roseville, California, northeast of Sacramento and far east of Silicon Valley. Why Louisville? It’s the headquarters of Humana, currently in the early stages of a merger with Aetna. Mr Slovenski is an alumnus of Humana who undoubtedly recognizes that there’s always talent which shakes loose with any merger, often proactively. He has reorganized the company top to bottom since the days in the doldrums under Louis Burns, and added initiatives such as the Validation Institute plus academic relationships with the Jefferson School of Population Health, Xavier University and the University of Mississippi. Louisville is also a lot closer to Washington DC (1.5 hour flight time) and all those wonderful Federal programs with lots and lots of funding.  Louisville Business First, release.

Speaking of the Aetna-Humana merger, it now has a strong boss man to make sure it works–Rick Jelinek, CEO for a year of OptumHealth, 19 years at predecessor now unit UnitedHealthcare including leading the Medicare Advantage and Medicaid businesses. The stakes are high in that the merger will create the second-largest managed care company in the US. Mr Jelinek also will lead Aetna’s enterprise strategy division, and will report directly to Aetna’s CEO. The timeline, unless the Feds put on the brakes, is to close in second half 2016. The combined operating revenue is projected at about $115 billion, with about 56 percent from government-sponsored programs, such as Medicare and Medicaid. The plan, according to Louisville Business First, is to headquarter the combined Medicare, Medicaid and Tricare businesses in Louisville. But, as they say, the meal is still being prepared, and assuredly not everyone at either company will find a seat at this table, or one they want to sit in.

A ‘Game of Thrones’ analogy to potential health insurer mergers

June 18, 2015 | by

The Wall Street Journal has likened the merger action pending among America’s largest insurers to the series ‘Game of Thrones’, said thrones occupied by Aetna, Cigna, Humana, UnitedHealthcare and Anthem. These more aptly remind this Editor of the final stages of airline deregulation, except that none are in a non-medieval bankruptcy court. Their actions reflects the payers’ urgent concerns that now is the time to reinforce a national presence, that revenues in a Obamacare environment (well, we’ll see the effect of that US Supreme Court subsidy decision due imminently) can do nothing but go down and that Medicare Advantage, commercial accounts, health system relationships (ACOs) and health IT systems are the place to be. What is missing: the fate of those independent, state and regional Blue Cross-Blue Shield (collectively, the ‘Blues’) which are not part of Anthem, many of which are ‘non-profit’ (note the quotes); the positive effect of competition on pricing and a fair consideration of the negative effects of monopoly. Ah, but there are no flung axes, regicide or poisonings to be found here. The real theme of ‘Game of Thrones’ is the effect of the powerful on the powerless (we the insured), which the WSJ writer doesn’t address…..Insurers Playing a Game of Thrones (if you hit a paywall, search on the title)