TTA’s Unofficial Summer kickoff: breaking up UnitedHealth to save it, post-GLP-1 weight gain, soft robots, NZ telehealth controversy, Midi Health widening women’s health, AssistIQ, Ambience, more!

30 May 2025

Brrrr….it’s unofficially summer as we leave May behind. Our big article this week is your Editor’s think-piece on breaking up UnitedHealth Group in order to save it–and healthcare. We also look at post-GLP-1 weight gain–and what it means for providers, in-person and telehealth, ‘soft’ robotics out of Scotland, NZ’s telehealth war with GPs, and what’s doing at companies like Midi Health, AssistIQ, Ambience, Auxira, and Yosi Health. And plenty of weekend reading and viewing!

Weekend reading/viewing (for me too): Rural telehealth blackouts and value-based care’s ‘utopia’ (Set aside the time)

Short takes: Midi Health’s longevity care for women covered by (some) insurance, NZ government 24/7 telehealth scored by GPs, Auxira tele-cardiology follow-up launches (Two disappointments that look like advances)

News roundup: GLP-1 weight regain real, soft robots walk off 3D printer, Ambience’s AI coding beats doctors by 27%, Get a Second Opinion debuts, $11.5M for AssistIQ (Reality bites GLP-1s and a soft robot wee bairn)

Job Posting: Yosi Health seeks Demand Generation Manager and Manager, Data Analytics & Reporting

Should free-falling UnitedHealth Group be broken up? Or break itself up to survive, before it becomes another GE? (updated) (Not a rant, more a ‘get going’ to avoid disaster!)

From last week: The major news the week before US Memorial Day was the Hinge Health IPO, the first for digital health in two years–but the downside was that it was at a lower valuation. Denouements abounded with most 23andMe genetic assets bought by Regeneron, without a drink of Lemonaid. WeightWatchers’ time may have passed, new heads for Calibrate and Oak Street, and two more ‘arranged marriages’, Smarter Technologies and Fuze Health. An update on the VA EHRM in the budget. Masimo’s recovering, as is Ted of Strata-gee

News roundup 22 May: an inflight ‘save’ and AliveCor’s KardiaMobile, rolling out the VA/Oracle EHR in ‘waves’, Fuze Health formed from LetsGetChecked/Truepill, hacking and ransomware 92% of PHI data breaches (A renaming of a 2024 ‘arranged marriage’–can it be saved?)

News roundup: Hinge Health public @$32/share, lower valuation. Is WeightWatchers game over? Calibrate replaces CEO, new prez for Oak Street, NMC gets ‘Smarter’ rolling up 3 portfolio companies, another splash of investor ‘cold water’ (The first health tech IPO in 2 years and ‘smushing’ when they can’t)

Update: Masimo’s website status and an analysis of the Sound United sale (Getting up and running post-attack, but what happened?)

23andMe sold to Regeneron for $256M in court-supervised bankruptcy, sans Lemonaid. And is it worth it? (We come up with a number, it’s likely)

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Should free-falling UnitedHealth Group be broken up? Or break itself up to survive, before it becomes another GE? (updated)

Breaking up is hard to do. But should be done if UHG wants to survive and thrive.

Our proposition: UnitedHealth Group has become a victim of its own giantism, conflicts, and focus on financials–and its failure will drag down healthcare.

How big? By far, it is the largest US health insurance company based on 2023 enrollments with a 15% market share, 29 million members, and $371.6 billion in revenue. It leads by far Elevance Health (formerly Anthem, 12%), CVS Health/Aetna (12%), Cigna (11%) and Health Care Service Corporation (7%). A more realistic picture of its size is that it is now is the US’ fourth-largest firm by revenues, just behind Walmart, Amazon, and Apple. (Visual Capitalist 17 Dec 2024, based on American Medical Association data). Their growth has been led by acquisition into Optum, their health services division. It houses their owned physician practices as the largest owner of practices in the US with 90,000 physicians, their ACO relationships, data analytics, Change Healthcare, the largest billing and claims management company, home care/hospice, the third largest PBM Optum Rx, a venture investment arm, and much more. Optum is the massive symbol of the integration envisioned by former and current CEO Stephen (Steve) Hemsley. Other health plan companies have health services units, for instance PBMs–CVS has Caremark and Cigna Express Scripts, both larger than OptumRx, and analytics–but not to the vertical and horizontal integration depth and extent of UHG’s continuing search for revenue and profit.

The road this vision took under Mr. Hemsley and later Sir Andrew Witty took diversions along the way that have escalated into a cadence of legal troubles, a near-perfect storm of corporate misery, that have damaged them among customers, shareholders, and regulators. A list of the recent highlights (bold type links are new information; standard type links refer to earlier TTA articles):

  • The contentious two-year-long purchase for an eye-blinking $7.8 billion or $13 billion of Change Healthcare that finally closed in 2022. While opposed by the Department of Justice (DOJ), the District Court disagreed and said it wasn’t anti-competitive or prevented competitive entry. 
  • Change Healthcare was a House That Jack Built that collapsed spectacularly in February 2024 with the ALPH-V/BlackCat ransomware attack. It was evident that Optum didn’t conduct basic due diligence on Change Healthcare’s multiple systems, built up over multiple acquisitions, nor set to work fixing them after the closing, leaving the largest claims/payment system vulnerable. UHG’s response managed to anger patients, providers, and HHS. It took Optum most of 2024 to fix it at a loss of at least $2.3 billion
  • DOJ has been investigating certain relationships between the company’s UnitedHealthcare insurance unit and its Optum services unit, specifically around Optum’s ownership of physician groups. This started in March 2024.
  • The $3.3 billion acquisition of Amedisys home health has taken over two years (since June 2023) and has taken multiple rounds of divestitures–and still DOJ is grinding its Paul Bunyan-sized ax against it, filing their suit in Maryland along with four state attorneys general in November 2024.
  • DOJ’s insider trading investigations may have started as early as October 2023. The $300 million Hollywood (Florida) Firefighters Pension Fund filed a class action lawsuit in mid-December 2024 alleging that the sales were made while the Department of Justice (DOJ) was considering an anti-trust action against UHG that would revisit the so-called ‘firewall’ between it and Change Healthcare. Named in the lawsuit were Brian Thompson, head of UnitedHealthcare, Andrew Witty, and Steve Hemsley. (Sir Andrew resigned from UHG’s board effective 20 May, Becker’s and SEC Form 8-K)
  • DOJ is reportedly investigating UHG for criminal Medicare Advantage fraud, according to the WSJ earlier this month, reported in HealthcareFinance.
  • The latest accusation: kickbacks to nursing homes to reduce patient transfers to hospitals and thus costs, based on an investigative report from the UK Guardian reported in FierceHealthcare last week.

The Brian Thompson assassination earlier in December uncapped a boiling volcano of resentment against the health care system that crossed political lines, then focused on UHG itself and its claims treatment. Next it revealed something that UHG undoubtedly didn’t want known–that UHG’s AI-powered claims review system had a 33% rate of claims denial on marketplace plans across 20 states, the second highest in the US (first was BCBS Alabama, a single-state plan) (KFF). This eruption unleashed a tsunami of heartrending social media stories of denied care and approved then denied care by UnitedHealthcare, including one for a patient delivered to a surgeon post-operation.

  • Instead of examining their methods, UH doubled down on featuring ever-so-trendy AI. Revealed recently to the WSJ, half of their 1,000 + AI-powered apps use generative AI and the remainder a more “traditional” form, without explanation of “traditional” according to chief digital and technology officer Sandeep Dadlani, Their software, not necessarily AI-powered but usually rules-based or using algorithms, ‘auto adjudicate’ 90% of UHG claims. And this wasn’t new. UHG was sued in Federal Court as far back as 2023 in using an AI-powered application to evaluate and deny claims.

This is above and beyond the business conditions that have affected every insurer: high utilization costs resulting from accelerated care activity, more (and more expensive) benefit offerings, and higher costs associated with Medicare Advantage beneficiaries, along with a minor reduction in MA benchmark rates.

One healthcare observer’s–and marketer’s–opinion, drawn from her experience not only in healthcare but also outside it.

UHG has pursued profit and growth to justify an immense share price and return to its shareholders. It has become unmoored from its business customers, instead trapped in an ever-widening gyre of increasing its revenue, profit, share price, and dividend every quarter, every year, to satisfy investors. It remains profitable, yet its share price has collapsed from over $600 on 3 December 2024–the day before the Thompson murder–to $378 on 12 May, the day prior to Witty’s resignation, to today’s close of $295. This is despite massive share purchases by Mr. Hemsley and other UHG executives, presumably to demonstrate confidence. Last week, three major investment banks downgraded their recommendations on UHG.

It’s time to sell off businesses and refocus on either being an insurer or being a healthcare services company. Not both. 

  • If UHG chooses to be an insurer, refocus on a service mission, not the shareholders. Respect their members (and commercial businesses) who pay the premiums. Focus on member health, first preventative, then managing chronic care. Stop treating patients and providers as always trying to game the system or grift them. People depend on insurance at the time of need, when they are sick, and treatment is complicated. Make it easier for both members and their providers.
    • Bring back humans evaluating prior authorizations and claim approvals–and get better tools with a final review by humans. Treat providers in and out of network better.
    • Get back to being the insurer of choice for individuals and groups. Contract for the services you need, not own them and try to manage them too. UHG would not be the first insurer who has faced this–both Molina and Centene have divested all or many of their service businesses.
  • If UHG chooses to be Optum, it needs to focus on their services and how well they integrate. Divorcing Optum from UnitedHealthcare resolves a lot of conflicts around interest but there are still others.
    • Owning and controlling practices creates multiple conflicts and a closed system. The feedback from doctors in Optum-owned practices that this Editor has seen is that they are micro-managed down to the penny, escalating administrative costs and taking focus from patient care. Optum practice locations that this Editor has seen have a ‘bad look’–underused, often repurposed locations.
    • Abandon the Amedisys acquisition and rethink (or spin off) the entire home care business for the same reason as owning practices.
    • Refocus their ACOs from ‘captives’ to management services provisioning that more naturally integrates with Optum services–or get out of the business.
    • Expand analytics into providing the best and most convenient tools for hospital and practice management, which likely will require some acquisitions.
    • Optum Rx is facing its own challenges from new competitors and eroding market share–and simplification can help management focus on it. If Change Healthcare is kept, rework and reform how they process and pay claims across healthcare; harden it against the cyberattack/ransomware that cost the economy and healthcare billions. Optum Ventures and its role should also be examined for conflicts with the main business.

UHG is a company now demonstrating the end stage of integration: too many complex parts, too much administration needed to keep the juggernaut going, too many inherent conflicts, no central theme, too little focus, culminating in failure to customers and shareholders. It has become toxic in reputation to its own members, providers, and to businesses who sign commercial contracts. It’s become a falling knife, a rolling failure such as GE before its breakup or (returning to my airline days) Texas Air Corporation, once the world’s largest airline holding company. Unlike GE or TAC, UHG’s business size and outsized vertical integration choking off alternatives have created multiple situations, such as Change Healthcare’s failure, which can damage the entire healthcare system. It’s time that their new CEO and their C-levels sit down and have a long think about what their future, and the future of their role in being a healthcare leader, should be. Think…smaller.

Update 28 May: The American Hospital Association (AHA) has also provided comments to the Trump Administration, DOJ, and FTC, as part of the administration’s 10:1 deregulation initiative*, addressing payer vertical integration and its effects on providers. Payer control, concentrated among four payers that control half the market (UnitedHealth, Elevance, Aetna, Cigna) , far outstrip those of health systems, and have led to higher premiums and constraints on care. The AHA is demanding review of regulations within the Affordable Care Act (ACA) that permit insurers to circumvent medical loss ratio (MLR) requirements through high-priced practice acquisitions yet enjoy exclusions in the Stark Law (physician self-referral) that health systems cannot. Their comments also included simplification of prior authorization processes and other utilization management practices, and swiped at the increased Premarket Notification process for M&A, something that the new administration is already reviewing. FierceHealthcare published 27 May.

*For every new regulation passed, canning 10 rules, regulations or guidance documents

News roundup: 9 additional VA centers named for Oracle 2026 EHR rollout; ATA Action acquiring, expanding with DTA; Dr. Oz to lead CMS while HHS cuts; DOJ seeks death penalty for Mangione

VA moving forward with the 2026 Oracle Cerner rollout of (lucky?) 13 centers. In March, the Department of Veterans Affairs (VA) announced that the EHR Modernization (EHRM) for 2026 would be expanded to a total of 13 sites, adding nine to the four in Michigan announced in December. True to form, ‘later this year’ was less than one month later, yesterday. The additional nine are in Ohio (4), Indiana (3), Kentucky (1), and Alaska (1): 

Cincinnati VAMC-Fort Thomas (Fort Thomas, KY)
Chillicothe VAMC (Chillicothe, OH)
Cincinnati VAMC (Cincinnati, OH)
Dayton VAMC (Dayton, OH)
Louis Stokes Cleveland VAMC (Cleveland, OH)
Fort Wayne VAMC (Fort Wayne, IN)
Marion VAMC (Marion, IN)
Richard L. Roudebush VAMC (Indianapolis, IN)
Alaska VA Healthcare System (Anchorage, AK)

The four locations in Michigan are VA Battle Creek Medical Center, VA Detroit Healthcare System, VA Ann Arbor Healthcare System, and VA Saginaw Healthcare System. This is almost two years after all installations replacing the venerable VistA were halted in April 2023, with the priority to fix the five troubled current deployments and the 2024 MHS joint installation at Lovell FHCC. This series is termed ‘market based’ with the locations relatively close to each other for greater efficiency, versus the earlier far-flung centers. In addition, “VA will adopt a standard baseline of products, workflows and integrations aligned with subject-matter-expert recommendations.” VA release, HealthcareDive

ATA Action acquires Digital Therapeutics Alliance (DTA), launches Advancing Digital Health Coalition. The advocacy arm of the American Telemedicine Association (ATA) will be combining with the DTA, a 501(c)(6) non-profit trade association with a mission of advancing digital therapeutics globally. The new organization will continue to take policy roles in advancing telehealth, ATA Action’s focus, but expanding into policies governing digital health tools in diagnostics, remote patient monitoring, and AI, leveraging DTA’s established relationships at the FDA and international regulatory agencies. Kyle Zebley will remain executive director of ATA Action. Andy Molnar, CEO of DTA, will transition to head of digital health at ATA Action. ATA Action is also launching the Advancing Digital Health Coalition, a membership non-profit which will extend the work of the DTA into advocacy for innovative digital health technologies transforming patient care, including digital therapeutics, prescription drug use related software (PDURS), and remote monitoring devices. Timeframe was not disclosed. ATA-DTA release, Advancing Digital Health Coalition release, FierceHealthcare, Healthcare IT News

Over at the Feds, Dr. Mehmet Oz was confirmed today (Thursday) by the US Senate to head the Centers for Medicare and Medicaid Services (CMS). The vote was 53 to 43.  Former TV personality and PA Senate candidate Dr. Oz, a cardiac surgeon, graduated from the University of Pennsylvania, earning both an MD and an MBA from Wharton. He became a professor at the Columbia University – Vagelos College until 2022. The now-whitehaired Dr. Oz will be CMS Administrator over a downsizing organization, which will be 300 staff lighter and with a Congress that needs to find billions in savings. Within Health and Human Services (HHS), Secretary Robert F. Kennedy Jr. has presided over 10,000 in packaged out layoffs, with another 10,000 laid off this week for an ultimate 25% downsizing across all agencies to 62,000. Reports indicate confusion, which is sadly typical of mass layoffs for organizations of size. HealthcareDive, MedTech Dive 27 Mar, MedTechDive 3 April, HealthcareITNews

The US Department of Justice (DOJ) will seek the death penalty against Luigi Mangione. The Federal murder charges brought in December have been increased by Attorney General Pam Bondi. She has directed Acting US Attorney for the Southern District of New York, Matthew Podolsky, to seek the death penalty for this murder as an act of political violence, premeditated and threatening the public. Currently, the Federal government has a moratorium on executions which she has committed to reviving. The accused murderer of Brian Thompson, CEO of UnitedHealthcare, is currently incarcerated at Brooklyn’s Metropolitan Detention Center, facing first-degree murder as an act of terrorism charges brought by New York State. He and his attorney are requesting that Mangione have access to a laptop for reviewing case documents, an unprecedented privilege. Mangione also faces charges in Pennsylvania on gun and false identification charges from his flight from NYC. The DOJ will be waiting some time for Mangione, as the New York charges have precedence. New York has not yet set a trial date, which is certain to be a circus given his fan girls.  DOJ release, FierceHealthcare, NY Post

News roundup: DOJ investigating UHG on Medicare Advantage billing upcoding; Teladoc’s BetterHelp therapists using AI?–a short seller alleges; Hims whacked by FDA ending compounded GLP-1s (updated); some fired FDA staffers in CDRH reinstated

UHG’s annus horribilis gets more horribilis. News broke on Friday 21 February via the Wall Street Journal (paywalled) that UnitedHealth Group is reportedly under investigation by the US Department of Justice–again.  The DOJ is looking at UHG’s billing practices for members covered by UnitedHealthcare Medicare Advantage (MA) plans on diagnoses that were made to generate extra payments, a practice known in the industry as upcoding. This also involves the many practices that UHG owns or has relationships through Optum, about 10% of primary care practices. These practices are receiving visits from DOJ investigators, certainly something that would strike some fear into any doctor’s or practice manager’s heart. 

The WSJ reported that two providers cited in their article provided documentation, while another person said that the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) is involved in the probe.

It’s a real Mound of Misery for UHG.

  • MA plans and their set rates for additional benefits not covered under original Medicare have been under HHS/CMS scrutiny in the past year, and health plans have been running higher costs than anticipated as covered patients have returned back to care.
  • UHG’s OptumRx unit last year was reported as under investigation on antitrust grounds.
  • Optum’s Change Healthcare (contested by DOJ but approved) is still recovering from an unprecedented hacking and ransomwaring, with the huge expense of restoring systems plus notification and providing a reported 100 million with free credit monitoring services.
  • The proposed $3.3 billion deal with Amedisys for home care continues to be delayed by the DOJ antitrust suit.
  • Their UnitedHealthcare president was assassinated in New York, and his (alleged) killer is starting his trial here, a spectacle which will go into the summer. But the issue that supposedly tipped off the murder–claim denials and denials of care due to policies and the use of AI, isn’t going away–jumping in the fray is megainvestor Bill Ackman.

While Federal involvement with health plans comes with the territory, the adversarial relationship with DOJ far exceeds the norm. The share price reflects it, having cracked 26% in the past six months. Those accepting the 30,000 buyouts on offer may be grateful if they take them. CNBC, FierceHealthcare

Another backwash from the use of AI? Teladoc is receiving some bad publicity it can ill afford. There are allegations of their therapists using AI-drafted responses with patients–and this apparently is becoming more frequent. It’s been percolating on social media boards such as Reddit (see example here) for some time. The latest is a report from a short seller* of Teladoc, Blue Orca Capital, that alleges that BetterHelp therapists not only use ChatGPT for text responses outside of live sessions (messaging), but also during live chat sessions. This goes against Teladoc’s own stated policy against AI therapy as ‘dehumanizing’  in a lengthy blog post ranging from social media to job loss as a result as AI. Blue Orca includes first hand information from two BetterHelp patients, an allegation from a competitor that BetterHelp doesn’t care, and that therapists are actually incentivized on the word length of responses they give to a patient, overloading their schedule, and being available 24/7 to patients paying a reported $400/month. Given BetterHelp’s prominence in Teladoc’s earnings–according to them “accounting for 40% of the Company’s revenues and adjusted EBITDA since FY21”, adding in their other financial factors, their dim view is jarring if you like or own TDOC.  Developing. Hat tip to HIStalk 2/24/25

*Editor’s note: Blue Orca Capital, as a short seller, profits when a stock goes down. Blue Orca has a short position in TDOC. So our Readers should take their position into account. Short sellers are also prohibited by securities law from spreading false information about a stock for the purposes of profiting from its decline (Rule 10b-5 under the Securities Exchange Act of 1934.)

The Feds giveth and taketh away Hims’ weight loss business. Updated information. Friday’s good news was that FDA has reclassified the shortage of semaglutide, the active ingredient in GLP-1 drugs, as ‘resolved’, meaning It’s Over and it’s easier to get your Wegovy, Ozempic, Zepbound, etc. prescription. The bad news is that online prescribers that were authorized by FDA to use less expensive compounding to approximate or customize the branded versions of these drugs for weight loss, are now prohibited from doing so. They have till April or May to transition to branded injectable versions. This affects the bottom line of all these telemedicine prescribers such as Ro, Weight Watchers, Future Health (a heavy local radio advertiser), 23andMe, and Hims & Hers. Hims, the showiest in class, took a breathtaking 25% hit on their stock between Friday and Monday.

It is not only cost of branded drugs but also that so many competitors have jumped into the field, creating another shortage of the branded drugs, that looms. Suppliers of compounded drugs, the high volume compounding pharmacies (not your corner pharmacy that does compounding based on Rx), may be reluctant to continue supplying telemedicine prescribers in reasonable fear of FDA action or pharma lawsuits that could put them out of business.

Hims also publicly took the hardest line against the pharma companies, implying in their now infamous Super Bowl commercial that their obesity drugs are priced “for profits, not patients”, unlike Hims’, of course. Novo Nordisk, the Ozempic and Wegovy manufacturer, in turn has taken a hard stance against the compounders pointing out that a compounded version isn’t standardized nor FDA-approved for safety and efficacy.

A custom, compounded version of a drug can only be sold when there is a shortage or if the branded drug is in some way inappropriate for the patient requiring a customized version, e.g. with adjusted dosage, method of dosing, or added/deleted ingredients. Look for Hims and other telemedicine prescribers to start pushing this POV. FierceHealthcare, MedCity News

Some FDA reviewers reinstated after DOGE cuts. The ~230 probationary and other employees who were let go with severance then partially reinstated are reported to be reviewers in the CDRH (Center for Devices and Radiological Health). The 183 reinstated reviewers are actually funded by the industry through the Medical Device User Fee Amendment (MDUFA) agreements to help speed the review and approval process. There is considerable confusion about this because phone calls went out over the weekend but as of today (Monday) there is no written confirmation from HR or the Office of Personnel Management (OPM). It remains murky as do layoffs in the rest of HHS. FierceHealthcare, Endpoints

News roundup: UnitedHealthcare names new president, Neuroflow buys Quartet Health, Owlet intros Owlet 360

The inevitable conclusion to a tragic event. UnitedHealth Group veteran Tim Noel was named this week to the CEO position of UHG’s UnitedHealthcare health insurance division. Mr. Noel replaces Brian Thompson, who was murdered on 4 December 2024 as he entered the New York Hilton to join that morning’s UHG Investor Day. Mr. Noel is a UHG veteran in several positions since 2007, most recently as head of Medicare and retirement plans at UnitedHealthcare, including Medicare Advantage, covering 13.7 million lives. The division’s plans cover over 50.7 million lives and is the largest US insurer. His promotion was unusually not announced in a press release, nor was his photograph or bio supplied to press–the new policy. 

He will certainly have his work cut out for him in lifting a shaken unit as well as negotiating the skyrocketing costs of Medicare Advantage. The comparisons will be inevitable, as well as reminders of Mr. Thompson’s death and the revival of public anger at UnitedHealthcare as the trials of Luigi Mangione proceed forward this year. For Mr. Noel, this diminished announcement must have a mixture of regret and sadness. Healthcare Dive, CNBC, Healthcare Finance News, FierceHealthcare

Behavioral health analytics and management workflow platform provider NeuroFlow acquires Quartet Health. Quartet, which is also in behavioral health but focusing on enablement and delivery, will expand NeuroFlow’s capabilities in referral and care navigation. Transaction cost nor management transitions were disclosed. NeuroFlow is based in Philadelphia, Quartet in NYC. NeuroFlow will be supporting Quartet’s existing payer and provider customers including Independence Blue Cross. Closing is expected in the next few days. NeuroFlow Release

Last week, Iris Telehealth separately acquired innovaTel telepsychiatry, owned by Quartet Health since 2021. Quartet’s announcement covers both acquisitions. Quartet had raised $267 million over seven rounds of funding. NeuroFlow has only $58 million in funding listed on Crunchbase. It is not known why Quartet sold itself and innovaTel. Behavioral Health Business

Telehealth ‘for the bassinet set’ Owlet announces subscription service Owlet 360. The $5.99/monthly service, initiated and billed through the Dream App, uses data generated by Owlet’s Dream Sock, Dream Duo or Cam 2. It provides information to parents comparing their baby’s information with data collected from other Owlet babies–a surprising 1.7 million. The additional information on their app is designed to expand parents’ knowledge of their baby and his or her environment:

  • Monitoring key health metrics by tracking daily and weekly trends for pulse rate, oxygen level, movement, and comfort temperature.
  • Compare health and sleep data to the vast Owlet infant health data set, offering meaningful context and reassurance.
  • Understand sleep and gain daily insights and guidance on sleep patterns.
  • Track comfort temperature to let parents know if their baby is too warm or too cold and to adjust the sleeping environment.
  • Watch, share, and save more video clips of precious moments or important notifications, like when their baby is moving or crying is detected.
  • View sleep environment insights like temperature and humidity trends in the room.

Basic monitoring information on pulse rate, oxygen, wakings, and sleep trends remains free of charge. Release

2024 earnings roundup, after a dramatic year: UnitedHealth Group and Masimo

UnitedHealth Group’s annus horribilus closed out with a decent, but not up to earlier projections, financial report.

Having opened in February with the massive (and massively expensive) ransomware/hack of Change Healthcare, UHG didn’t have a lot of bright spots. Elevated utilization rates increased expenses; changes in Medicare Advantage reimbursements and the STAR ratings metholodogy changes reduced bonus payments.

Then, in the early, dim morning of their 4 December investor day in NYC, UnitedHealthcare’s CEO Brian Thompson was murdered while entering the New York Hilton Hotel. The manhunt and the controversy set off by the perpetrator’s so-called ‘manifesto’ exploded into a hurricane of severe public criticism on how plans process claims and treat members, a traditional and social media/online storm that only diminished around Christmas and the rise of other news. In literal fear for their lives, health plan executives took the lowest profiles they could manage. 

UHG’s earnings, while positive overall, reflected this uncertainty with lower Q4 revenue causing them to miss Street estimates. Share price fell over 6% today (Thursday). 

  • UHG’s Q4 revenues were $100.8 billion versus $94.4 billion in the prior year, up 6.8%. Profit of $5.5 billion was flat versus prior year. UHG’s 2024 revenues were $400.3 billion, 7.7% higher than 2023’s $371.6 billion. 
  • Health plan unit UnitedHealthcare’s 2024 revenues were $292 billion, up 6%, with operating earnings of $15.2 billion. US commercial members grew by 2.1 million.
  • Their 2024 medical cost ratio — the percentage of premiums spent on medical care — rose to 85.5%, far higher than 2023’s 83.2%, exceeding analysts’ projections of 84.96% and far above the targeted 80%.
  • Optum’s revenue, affected by the Change Healthcare hack and ransomware payments, still rose to $253 billion, up $26.3 billion or 12% versus prior year. The Optum Insight unit, which includes Change, had revenues of $18.8 billion, declining 1% because of the $867 million loss due to business disruption.

UHG release, FierceHealthcare, CNBC 

UHG also announced:

  • The Optum Rx unit will now pass through 100% of rebates negotiated with drugmakers to their clients–insurers, states and unions. This is up from 98% since 2% have preferred other rebate models. FierceHealthcare
  • UHG and Amedisys filed last week in the US District Court of Maryland to have the November Department of Justice suit dismissed. They cited that the DOJ did not adequately prove that the $3.3 billion acquisition would be anti-competitive. For one, the DOJ did not adequately define or provide detail on the geographic markets that would become be non-competitive. FierceHealthcare  They extended their deal deadline to the end of 2025 last month.
  • Change Healthcare stated yesterday that it has ‘substantially’ completed notifying affected consumers of their breach. Interestingly, if you use a search engine to try to find the breach notice, you’ll have a great deal of trouble–because the source code contains a hidden “noindex” code on the notice. ‘Noindex’ code tells search engines to ignore the web page–and has been there, apparently, since 20 November 2024. UHG has also not publicly disclosed a more exact number of those affected beyond the long-ago estimate of 100 million. TechCrunch   The state of Nebraska has sued UHG, Optum, and Change over the breach [TTA 19 Dec 2024

Masimo, ending a dramatic year of its own, now firmly in the control of Politan Capital Management despite flying lawsuits with former CEO Joe Kiani and an SEC investigation announced last month, issued its preliminary 2024 closing financials and their 2025 guidance. What’s hot–their consumer and professional medical devices, including smartwatches, that measure vital signs including pulse oximetry. What’s not–their audio business under Sound United, which is on the block.

  • 2024 healthcare revenue was up smartly by 9% to $1.395 billion. 
  • 2025 healthcare revenue is projected to increase 8-11% in the range of $1.5 billion to $1.53 billion. Non-GAAP operating profit is projected for 2025 at $398 million to $406 million.
  • Non-healthcare revenue (a/k/a Sound United) was $699 million. That declined 10% decline on a reported basis. 
  • Non-GAAP EPS for 2024 was $4.10. 

For 2025, Masimo is ending reporting for the Sound United business nor providing 2025 guidance since they are selling it. The only guidance they are giving is on the healthcare business. If one does the math–selling off Sound United will take out $700 million from their revenue. One more thing…updated results will be postponed until their investor call, delayed until Tuesday, 25 February. Mass Device, Masimo release

News roundup: Precision’s $102M raise, more on BCI; Withings clears BPM Pro 2; Nebraska 1st state to sue Change/UHG, related insider trading update; VA Oracle go-lives may resume; ATA intros CODE; ClearDATA HITRUST certified

One more funding. A competitor of Elon Musk’s Neuralink, Precision Neuroscience. closed their Series C at $102 million. This round was led by General Equity Holdings, with participation from firms including B Capital; Duquesne Family Office, the investment firm of Stanley F. Druckenmiller; and Steadview Capital, bringing their total funding to $155 million. The total brings them according to their release as one of the best-funded brain-computer interface (BCI) company after Neuralink, whose funding is unknown. The funding will be used to advance its clinical research and expedite development of its cutting-edge brain implant. 

Precision is the developer of the Layer 7 Cortical Interface to treat motor paralysis. At the time of their last funding in January 2023, this Editor noted that their difference was to treat neurological illnesses and events such as stroke, traumatic brain injury, and dementia. Their focus remains largely there: severe spinal cord injury, stroke, ALS. So far, the investigational device has been tested its device in 27 patients through research partnerships and was designated by FDA as a Breakthrough Device.

More on BCI in this must-read article by Timmy Broderick for STAT. The upcoming issues around BCI now center around the engagement of CMS (Centers for Medicare and Medicaid Studies) for coding, coverage, and payment for devices after the investigational stage; privacy issues about neural data; and continued support after implantation. This last one is acute as these companies are young. There has already been the example of Second Sight’s bankruptcy, leaving subjects stranded with useless retinal devices in their eyes. BCI to this Editor will develop through 2025–and be a major focus of investment by 2026-2027.

Withings gains FDA clearance, intros BPM Pro 2. A professional-level product for hypertension and chronic heart failure (CHF) targeted to care teams to connect with their patients, the FDA clearance covers blood pressure and pulse rate measurement in adults with arm circumferences of 9 to 17 inches (22 cm to 42 cm) or 16 to 20 inches (40 to 52 cm). What is really interesting about the connected (Wi-Fi, cellular, BT) device is that care teams can program the device through the Patient Insights feature for the patient to interact with the device in real time. Through a small screen, it asks questions that help to track the patient’s condition, reinforce medication adherence, and assess their satisfaction. It also has a Retake Measure feature to retake a reading if results exceed predetermined thresholds and increases accuracy. Withings plans to upgrade the device to take a 1-lead ECG to detect atrial fibrillation; this is a separate clearance and expected to become available in 2025. The device is not yet CE Marked. Withings was named a CES 2025 Innovation Awards Honoree in the Digital Health category. (Photo, Withings website) Release, Mobihealthnews, MedCityNews

UHG’s Mound of Misery multiplies with Nebraska’s Change Healthcare lawsuit, plus separate but related insider trading. 

  • Nebraska became the first state to sue UnitedHealth Group, Optum, and Change Healthcare over those affected by the late February ALPHV/BlackCat hack of Change’s systems. In Nebraska alone, it affected 575,000 individuals. (It is actually hard to find someone who was not affected by the hacking of the leading exchange for major claims clearing and payments.) Nebraska’s attorney general Mike Hilgers is suing because of the company’s carelessness in handling data and, even worse, in its slow notification of those affected. Our Readers will recall that Change/UHG initially tried to push off notification on healthcare providers. When HHS threw the ball back to Change [TTA 5 June], notices didn’t go out until August-September. The charges in state law center on consumer law: financial data protection and consumer protection statutes, deceptive trade practices, and Federal standards on privacy (HIPAA, and HIT protection. The lawsuit was filed by the AG in the District Court of Lancaster County, Nebraska. Nebraska Examiner
  • The Change acquisition and later problems were possibly the catalyst for stock sales by senior/C-level UHG executives, including UnitedHealthcare CEO Brian Thompson. The $300 million Hollywood (Florida) Firefighters Pension Fund initiated a class action lawsuit alleging that the sales were made while the Department of Justice (DOJ) was considering an anti-trust action against UHG that would revisit the so-called ‘firewall’ between it and Change.  The complaint specifically mentions that UHG executives were aware of it as early as October 2023. The Wall Street Journal revealed the investigation on 27 February 2024–the same time as the Change breach was revealed, cracking the stock almost immediately. Executives including Thompson ($15 million), UHG CEO Andrew Witty, and board chairman Stephen Hemsley ($102 million) were named. The class action covers the period for stock purchased between 14 March 2022 and 27 February 2024. UHG has until 1 March 2025 to answer the complaint. Healthcare Finance News  (This is likely to affect the settlement of the Thompson estate–Ed.)

VA confirms that additional Oracle EHR implementations may go live in 2025, after 18 months of dead stop. The Oracle Cerner EHR is reportedly ‘running better’ at the current six sites where it is operating: five VA only (including 20 community clinics and about 100 support sites), and the sixth at Lovell jointly with the Military Health System (MHS). The restart of EHR Modernization (EHRM) was confirmed earlier during budget hearings by Kurt DelBene, assistant secretary for information and technology and chief information officer. Crash and lag downtimes are reduced by half and incident tickets by 60% since the last updates in August.  Timing remains indefinite for 2025 (FY ends 30 September 2025) but current VA Secretary Denis McDonough confirmed that primarily VA staff will continue to work on it under the Trump Administration. “The overwhelming majority of VA professionals who work on EHRM will be working on EHRM on January 21st, just as they were on January 19th,” McDonough said at an 11 December press conference. Federal News Network

Short takes:

  • The American Telemedicine Association (ATA) launched its new ATA Center of Digital Excellence (CODE) last week. CODE is constructed as an alliance with leading health systems for the development and implementation of digital health best practices that prioritize patient-centered care, equitable access, and improved clinical and operational outcomes. Tools span enhancement of workflows and patient engagement to improve healthcare accessibility. ATA release
  • ClearDATA’s CyberHealth platform and cloud managed services have earned Certified status by HITRUST for information security. ClearDATA provides healthcare specific managed cloud security, compliance and operations solutions. HITRUST, the Health Information Trust Alliance, is a non-profit that sets standards for data organizations through the HITRUST CSF framework. Release

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

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

Breaking: UnitedHealthcare CEO Brian Thompson murdered in NYC

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

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

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

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

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’

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

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

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…)