This week’s Big Data Breach affects 1.4 million patients at multiple healthcare organizations.

The multi-national data security alliance Five Eyes warns of AI supercharging hacking attacks. The three-page statement details how AI accelerates cybersec attacks and the need for ‘defence in depth’ with threats increasing in months, not years. It offers a five-point plan to reduce vulnerabilities and to use AI to defend against attackers. However, with most healthcare organizations overwhelmed with implementing AI tools, suppliers like Xsolis a vector for attack, and employees going outside for AI tools, the threat level has been amped 100x. The MIT Sloan article also warns that Anthropic’s Mythos, which is reportedly capable of autonomously finding and exploiting software vulnerabilities end-to-end with no human involvement, could be used for cyberattacks and chemical/biological attacks. Five Eyes is drawn from the US, UK, Canada, New Zealand, and Australia cybersecurity agencies. DataBreaches.net

In more cheerful news, Whoop announced that the FDA closed an investigation into their wearable’s Blood Pressure Insights feature. This started with a letter from FDA’s Center for Devices and Radiological Health (CDRH) in July 2025 challenging Whoop on the basis that the company did not have an approved application for premarket approval (PMA) or 510(k) approval of that feature.  Apparently, Whoop backed off of original claims that the BPI offered medical-grade health and performance insights and moved to general wellness claims ‘not intended for medical use’. It didn’t dissuade funders from a gigantic $575 million Series G in April. [TTA 9 Apr] MassDevice 

Centene, which in last week’s Chutes announced a voluntary separation plan (VSP) to most employees with 2 years or more in the company, added a board member. Lauren Tyler will be joining immediately to serve on Centene’s audit committee and compensation and talent committee. Ms. Tyler is a 20 year-plus JP Morgan veteran who was global head of human resources for asset and wealth management, global firmwide chief auditor, and global head of investor relations. That is an interesting skill set given what is happening at Centene and the need to compensate by downsizing for the crash in Medicaid and ACA members, as noted in the Release, Healthcare Dive

Raises have perked up again after a few weeks off.

Assort Health just raised a $120 million Series C. It was led by Menlo Ventures, with participants including Lightspeed Venture Partners, Felicis, First Round Capital, Chemistry, Joe Montana (!), Tau Ventures, and Quiet Capital. Assort provides an AI-assisted patient  voice agent along with an impressive AI model, Synapse, for specialty workflows that automate scheduling, intake forms, referrals, document processing, medication refills, real-time eligibility, lab requests, and payments. San Francisco-based Assort to date has raised $222 million and is now valued at $1.2 billion. Release

xCures scored a $46 million Series B. It was led by Innovius Capital, with participation from iGrow, GKCC, Spring Mountain Capital, and existing investors. Total funding is now over $76 million. xCures’ business model is focused on gathering scattered clinical patient data, assembling and structuring patient medical records into usable decision-ready data through its Clinical Clarity Engine. It is delivered to users via a web UI or a developer-friendly API. To date, they have 300 million medical records sourced from more than 550,000 healthcare locations nationwide. The new funds will be used for expansion of the Clinical Clarity Engine’s capabilities. Release, Mobihealthnews

The always controversial Ed Zitron goes there. Way out there to challenge your preconceptions. If you’ve ever awakened at 3am wondering where in blue blazes AI is going, agonizing over where it fits in your platform or services, who is it really benefiting other than OpenAI and Anthropic, why VCs are so stingy because your tech isn’t AI All Over, and why despite the hype billions are going down a rabbit hole seemingly with no bottom [TTA 2 June, 25 June] –this article (not premium paywalled) is for you.

“Cargo Culture” refers to the cargo cults of the South Pacific. They originated after native contact with Westerners, usually Americans who landed in ships or built airstrips, mostly during WWII. When the Americans left, the indigenous peoples tried to recreate the “magic” of goods coming off the ship or from airplanes by creating a religion and ritual around these ‘miracles’ without, of course, the corresponding methods of delivery. Your Editor also found an IT version of this called “cargo cult programming“defined in a Wikipedia entry as “computing slang to describe the inclusion of code that serves no purpose in a program, indicating a lack of understanding of the program structure by the programmer.“

Mr. Zitron’s “Cargo Culture” refers to Silicon Valley. The endlessly reinforced belief system of the interlocked software, venture capital, and private equity businesses was built on decades of mythology of endless growth and endless Christensenian “disruption”. They want to believe that there will always be hypergrowth tech companies, always another ‘disruptor’. And the money to fund them will be equally endless. (Forgotten are the failures like Theranos and the billions down the drain.)

The reality, as he painstakingly explains, is that Silicon Valley and tech are, right now, fresh out of ideas. Worse, the software industry is declining. There’s no Google Search or iPhone waiting to be plucked from the ether. There is no New Big Transformative Idea. Company growth is incremental at best, declining or failing at worst. But instead of adjusting, the mythology is ingrained, and to doubt is heretical.

Any dissension, whether corporate or media, means you are Voted Off The Island.

The AI Bubble fits neatly and virally into Silicon Valley’s Cargo Culture and need for a disruptor. It’s a viral product, it was different, it meets a need for automating processes. It makes search a lot quicker. But will LLMs and agentic AI actually change anything other than make it faster, or reduce the need to perform your own logic in building a case/article–at amazingly high expense? Other than the spend, what’s exponential about it? Everyone’s buying a lot of GPUs–heck, Oracle at Larry Ellison’s behest is betting the company on moving out of software, including that ever-so-sticky EHR–and becoming a data center constructor and lessor to Open AI and Meta lest Microsoft eat his lunch. After a certain point, the beliefs become circular and self-reinforcing. 

Mr. Zitron argues the points at length. It’s minimum a 30-minute read and not an easy one. Stay with it. It challenges a lot of premises. It will make you think differently the next time you’re pitched on a company’s miraculous AI software–or if you are a developer, understanding your customer’s needs and likely confusion. It is 100% guaranteed to make you think about Silicon Valley, their modus operandi, and how it’s inflated the whole AI bubble.

Sergei Polevikov shines a light on a recent Nature Medicine study comparing specialized clinical LLMs against the generics–and finds that the generics win. The peer-reviewed study pitted specialized clinical tools like OpenEvidence and Wolters Kluwer’s UpToDate ExpertAI against general-purpose AI tools–ChatGPT-5.2, Gemini 3.1 Pro, and Claude Opus 4.6–using three different benchmarks*. The specialized tools lost every time. What was worse was OpenEvidence’s unprofessional overreaction on social media, namely X. Instead of responding directly to Nature Medicine as a comment, then publishing a peer-reviewed paper refuting the Nature Medicine team findings, citing their own research from independent studies, conducting fresh research, even better admitting that some of the research team’s findings were valid and appreciated, their ‘Twitterstorm’ only created more PR blowback. Social media amplified the damaging reach of one academic study. (Having managed a few ‘crisis communications’ as a marketer, the worst thing that you can do is bang back in anger, though cooling corporate tempers might require a Titanic-sized iceberg of ‘splainin’.)

Mr. Polevikov’s free excerpt of his lengthy article, OpenEvidence Goes Hippocratic AI, is published on LinkedIn, but why not kick in a few $$, support his independent journalism, and subscribe to AI Health Uncut (Substack)?

The Hippocratic AI reference is to that company’s ‘bare knucks’ approach to any criticism of their platforms. 

*FTA Nature Medicine: (1) 500 MedQA questions testing medical knowledge, (2) 500 HealthBench items measuring alignment with clinicians and (3) the real clinical queries (RCQ) benchmark, built from 100 de-identified queries from physicians to a general-purpose language model in a live clinical environment. 

Bain and Company dug into the Big Question surrounding AI–is there any real ROI there? How can companies get there?

• Nearly 40% of companies that measured AI cost savings landed below 10%. Another 29% achieved 11-20%. Neither are huge savings.
• Yet 90% of companies are increasing their AI budgets, again. How they’re funding it? 44% of companies are funding it from prior automation savings that have consistently come in below target.
• The operating reality is far more human, with only 7% of companies running fully autonomous agents in production today.
• Data access and integration are the number one barriers to AI progress

Despite all this, Bain (of course) states that companies shouldn’t wait, that they need to close the gap between the business case and the operating reality. Their conclusions sound sensible, but to this Editor, they won’t necessarily bend the cost savings curve. And they sound like expensive, time-consuming work, further reducing initial cost savings:

1. Pay down your workflow debt before deploying AI. Fix that before you automate it because it will be far more difficult afterwards.
2. Validate the investment case and name a governance owner before programs launch.
3. Use AI to solve the data problem; don’t wait for the data problem to be solved first. Automate one high-value, repeatable workflow and replace it with AI.
4. Redesign the operating model, not just the process.
5. Measure outcomes at the enterprise level, not the program level. Leaders must decide that they have a personal responsibility to create the organizational conditions for AI success. 

Your AI Budget Is Growing. Your Returns Aren’t. Here’s Why.

Our second report is on innovation in the women’s health sector. Silicon Valley Bank (SVB) examines trends in the venture-backed women’s health sector, which has grown into the full spectrum of women’s health needs. The sector is (finally) starting to thrive. Highlights:

• $2 billion in venture capital was invested in women’s health in 2025. While this marked a dip from 2024’s peak, projections show a rebound in both deal volume and total funding for 2026.
• $6.2 billion since 2019 has been invested into companies addressing women-specific conditions. 210 new startups dedicated to solving women-specific health challenges were launched from 2019 through 2025. 
• The median pre-money valuation for AI-enabled women’s health companies is up to $35 million.
• Women’s health startups using AI to personalize care are commanding valuations triple those of their non-AI counterparts.

The downloadable SVB report is here.

One of those women-founded companies, Ladder Health. announced seed funding of $7 million this week. The seed round was (happily) oversubscribed and led by Nina Capital, with participation from Mairs & Power Venture Capital, South Dakota First Capital, and incubating partner 25madison Health. Other investors in this round include Hatteras Venture Partners, Create Health Ventures, Jumpstart Capital, White Oak Enterprises, Groove Capital, and 7Rock Ventures. (Whew!) Ladder Health delivers speech, occupational, physical and feeding therapy through a virtual-first, AI-enabled platform available evenings and weekends. Their service is targeted to areas where pediatricians and developmental therapies are in short supply, wait lists are long, and to underserved Medicaid beneficiaries. It is currently available in three states, North Carolina, Massachusetts, and Maryland across 80 providers. The additional financing will support expansion in those states and others, as well as investment in the care platform. Ladder is based in NYC. It was developed in conjunction with clinical experts at Boston Children’s Hospital. Release, MedCity News

And lest we forget. Luigi Mangione, the accused murderer of UnitedHealthcare CEO Brian Thompson on the dark morning of 4 December 2024, is still in the preliminaries of his New York State trial for intentional second-degree murder. His defense team from Agnifilo Intrater had filed to use a psychiatric defense based on Mangione suffering from an “extreme emotional disturbance” (EED), but that was withdrawn one day after it had been filed with Manhattan Supreme Court Judge Gregory Carro. It was a surprising development, as the admission could have reduced the charges to manslaughter, though it is tantamount to admitting the crime.

Based on reports, Mangione may be able to introduce EED through his own testimony, or that of the prosecution. Much of the evidence found in his backpack when Mangione was picked up at the Altoona, Pennsylvania, McDonald’s was excluded from the NYS trial, as well as two charges of terrorism and first-degree murder. He has pleaded not guilty to state murder and weapons charges.

Mangione’s trial is scheduled to start on 8 September. He faces additional trials in the Federal Southern District of NY as well as Pennsylvania state charges. Law.com discusses the EED strategy. CNN, Beckers

Pepper faints again, reading Amazon’s response–it’s ‘archived’ data that “only impacts certain legacy Iora Health and One Medical Seniors patients”. 

Amazon One Medical published a notification on its One Medical Seniors (the former Iora Medical) website summing up the following:

• They learned on 13 June that a third-party file storage system used to store archived patient information had been accessed by an unauthorized person
• Data had been exfiltrated between 8-11 June
• It’s apparently “legacy” information only and affecting only certain old Iora/Amazon One Medical Seniors records
• The clinics affected are legacy Iora clinics located in Atlanta, Cape Cod, Charlotte, Piedmont Triad, Denver, Houston, Phoenix, Tucson, and Seattle.
• They took immediate action including the revocation of all user access and rotating credentials for all employees with access to the system. 
• Neither Amazon One Medical (non-Seniors) patients, Seniors patients outside these markets, nor their EHR and medical services have been affected.

Patients are given a number to call and an email to write if they have questions. It is not known if patients were notified in other ways, for example through the patient portal, email, or standard US Mail. There is no public indication that Amazon One Medical has contacted ShinyHunters or is negotiating with them, whoever they are.

ShinyHunters is notorious for taking credit for other attacks on healthcare organizations, always going big, then going home after gaining their ransom. Their last target was Medtronic, hacking 9 million patient records plus terabytes of corporate information in April [TTA 30 April]. After the leak information was pulled from their website, the conclusion was that Medtronic paid up. ShinyHunters also attacked dental benefits administrator DentaQuest earlier this year. Other big game: Zara, Carnival, 7-Eleven, Pitney Bowes, The Canada Life Assurance Company, and Hallmark. 

Amazon One Medical is staying mum, but this will be updated as additional information is disclosed. Cybernews, Healthcare IT News, HIPAA Journal

The doldrums of M&A and fundings lightened a bit this week.

Personal health data consolidator Validic acquired by ChartSpan. The care management services company will broaden its portfolio through integrating Validic’s IoT platform into its remote care management and health programs. These include chronic care management, advanced primary care management, remote patient monitoring, and custom programs for health systems, payers, and wellness programs. Acquisition cost was not disclosed. BIP Capital led the financing for ChartSpan, as they did with their $15 million Series A in 2019. Validic’s last raise was $12 million in 2022 led by Kaiser Permanente Ventures. Validic, founded in 2010 and still led by founder Drew Schiller, will be integrated into ChartSpan. No mention of how the workforces will be integrated. Validic is headquartered in Durham, North Carolina, ChartSpan in Greenville, South Carolina. This continues the consolidation of complementary health tech businesses.   ChartSpan blog, Mobihealthnews

Short takes on recent raises:

Cadence Solutions, another clinical intelligence and services company in chronic care management, raised $100 million in a Series C. The round was led by Spark Capital. Other participants were Thrive Capital, General Catalyst, Coatue, B Capital, Corewell Health Ventures, Memorial Hermann, and Duke Health. Cadence’s total funding since 2021 is $241 million. In 2021, they were valued at $1 billion though their current valuation is not public. The fresh funding will be used to expand across new health systems, advance Cadence’s AI agents, and grow value-based care models. Cadence also announced new affiliations with Duke Health and Texas Health Resources, now serving 20 leading health systems including Memorial Hermann in Houston and Hartford HealthCare. The model is a little different than similar remote patient monitoring (RPM) services. These health systems ‘white label’ Cadence’s clinical teams, who follow the health systems’ protocols in monitoring the device information and adjusting care in real time. Cadence now serves more than 100,000 active patients. Cadence release, Mobihealthnews, MedCity News

Prosper AI gained a $30 million Series A. Funding was led by Andreessen Horowitz/a16z, with participation from Base10 and continued support from Emergence Capital, Y Combinator, and Company Ventures. Prosper AI developed a series of voice agents for administrative workflow tasks such as answering patient calls, scheduling appointments directly in the EHR, verifying insurance benefits, automating patient billing, and contacting insurers on the phone when additional information is needed. The breadth of the agentic AI claims to lower administrative costs by +40% and up to 50% of end-to-end patient conversations. The company claims 150,000 healthcare providers and has added more than 40 care organizations as customers since their last funding round in September 2025.  The new funds will be used to expand its engineering and customer-facing teams, deepen integrations across the largest EHR platforms, and accelerate adoption across provider groups and health systems. Prosper release, Mobihealthnews

Brazil’s Telepatia raised a $33 million Series A, mainly from Andreessen Horowitz/a16z. Additional participants were Palantir CTO Shyam Sankar, Rappi founder Simón Borrero, and Nubank founder David Vélez. Telepatia combines AI-powered documentation, clinical decision support, and healthcare assistants to help clinicians improve productivity, reduce medical errors, and increase adherence to clinical protocols. It is targeted to healthcare systems in Latin America that have shortages of physicians and nurses. Telepatia has already been adopted by 25 hospital systems in Brazil, Colombia, and Mexico, reaching 14 million patients, improving protocol adherence from 84% to 99%, and helping prevent 60,000 medical errors in real time,” according to a16z’s announcement post. Mobihealthnews, The SaaS News

Patients are using portals for messaging and other tasks, but using them along with increased physical visits. A five-year study by NYU Langone Health researchers of the Epic MyChart system, published this week in the Journal of the American Medical Association (JAMA), found that:

• 12% of Americans now use patient portals for messaging about appointments, test results, and ongoing treatments
• Online portal messages more than doubled between 2020 and 2025 (153%)
• Telephone calls decreased by 6%
• Americans with an active Epic health record went from 94 million in 2020 to 140 million in 2025.
• 30% of the 42 million active patients on Epic sent a portal health app message to their clinician during the first three months of 2025.
• Individual patient messages doubled, moving from an average of 2.2 per year in early 2020 to 5.4 per year in late 2025.
• In-office visits returned to an average of between two and three per year per patient

The study is the largest review conducted of Epic EHR records: more than 140 million patient records from 2,067 hospitals and 47,100 health clinics in the US. NYU Langone release

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic concerns how unapproved ‘off the books’ AI tools, also known as ‘shadow AI’, are becoming widespread in healthcare organizations. Difficult to track, they may save an individual’s valuable time but open the organization to data breaches and misuse of private data. The author, Errol Weiss, is chief security officer of Health-ISAC (

Health Information Sharing and Analysis Center). His information security experience includes the NSA and senior positions at Citigroup and Bank of America

Ask a hospital executive how their AI adoption is progressing, and you’ll hear about pilot programs, governance committees, and carefully vetted vendor deployments.

While illustrative, that answer is incomplete because most healthcare organizations have little visibility into how much AI is actually being used without approval. Clinical staff, administrators, and operations teams are independently adopting AI tools to draft documentation, optimize scheduling, assist with coding, and communicate with patients without waiting for approval.

There’s little point in blaming them: With technology advancing at a breakneck pace, today’s state-of-the-art will be obsolete next month. Who has the time to wait for months-long review processes?

For at least the past 40 years, whenever employees found IT’s procurement bureaucracy too slow, they simply implemented or signed up for software or cloud services by sidetracking corporate procedures and got on with their work. This is known as “shadow IT”, and organizations have come up with entire playbooks and best practices to limit its effects.

But its successor, “shadow AI”, requires a different approach simply because this new revolution in technology doesn’t work the same way as most software does. It doesn’t help that shadow AI usage is already widespread: A December 2025 Wolters Kluwer survey of more than 500 healthcare professionals found that 40 percent had encountered unauthorized AI tools in their workplace, nearly one in five admitted to using them, and one in ten had used an unauthorized tool for direct patient care.

Why governance keeps losing the race

The fact is, the people using these tools are behaving rationally. Healthcare staff operate under continuous and heavy workloads, so if a tool cuts a two-hour documentation task to 40 minutes, you’re fighting a losing battle if you expect employees to ignore the benefits of AI. Per the Wolters Kluwer data, half of those using unapproved tools cited faster workflows as their primary reason, and a quarter pointed to better functionality than anything their employer had sanctioned.

Meanwhile, the institutional approval machinery moves at its own pace. Enterprise approval channels were designed for software whose deployment cycles took quarters, and accounted for contracts, security reviews, and integration planning. A consumer AI tool requires a browser and an email address.

This is harder to contain than shadow IT ever was

Shadow IT, for all its headaches, could at least be tracked. An employee signing up for an unapproved file-sharing service needed to create an account and upload a file, leaving a trail security teams could identify and act on. Network telemetry and endpoint management tools like EDR could be used to track data stored on shadow IT devices. The behavior looked similar for most tools, so organizations eventually built the muscle to spot it. 

In contrast, AI tools encourage different user behavior because they work differently — the user interface is more conversational, dynamic and useful in different ways. Staff who would never think to upload a patient’s file to a third-party service may not feel so hesitant about typing a patient’s diagnosis into a chatbot because it doesn’t register as a data transfer; it registers as asking for help.

Regardless, the compliance risk and data exposure are similar. When information about a patient is uploaded to an AI model not constrained by a contractual agreement, the organization has no control over where that data is sent, how long it is stored, and whether it will be used to train future tools and AI models. There is no file to retrieve and no audit trail to close.

The costs are real: IBM’s most recent breach research found that shadow AI added an average of $670,000 to breach costs, and healthcare already carries the highest breach costs of any sector.

Govern the current instead of damming it

What can leaders do to keep shadow AI usage under control? One obvious answer is to flat-out ban such tools, but the problem with doing that without offering alternatives is that employees will find other ways to use them. It also turns compliance teams and clinical staff into adversaries, which is the exact opposite of what an organization wants to accomplish.

It’s more useful and realistic to establish a governance framework that gives this energy a sanctioned channel. Here are a few steps to consider:

• First, get the lay of the land. Map where and how much shadow AI your organization has.
• Next, build a process that lets clinical and administrative teams submit AI tools for review and receive a decision much faster — think days, not weeks.
• Pair this with a clear policy definition of shadow AI, and educate your employees on why a consumer chatbot and an approved enterprise tool are not interchangeable.

Vendors and contractors are a part of this problem, too. They move through many hospital workflows and touch patient data, leaving the hospital organization to own the compliance exposure regardless of whose employee created it. Vendor assessments and contracts must change to account for how AI tools affect end-user behavior and control what data leaves your supply chain.

Thankfully, no organization needs to solve all these problems alone. Through information-sharing communities, security teams can compare and share notes on how their peers are detecting unsanctioned AI use, and which governance models hold up under real conditions.

Shadow AI grows because there’s a gap between what staff need and what the organization provides. That gap widens every month that governance stands still. Leaders must act now to shape the gap. Those who wait will eventually be mapping it from breach forensics instead.

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

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

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

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

Oracle could certainly have used the cash flow.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Presenters are from UKTelehealthcare (Gerry Allmark and Ross Barrie, the organization’s new CEO), Tunstall, TakingCare, Kuradocs, Kyndi, Mole Valley Life, and Legrand. The Tuesday 23 June event will be from 10 am to 12 noon BST (UTC+1). Agenda and registration are here on the Events page. When you register, you may also submit a question for the panel.

From the event: 

One of the most significant shifts underway in healthcare right now is the move towards supporting people to stay at home for longer, using technology to deliver the right care, at the right time, without the need for a hospital bed.

This webinar will bring together leading thinkers and practitioners to explore how digital tools and remote monitoring are helping to prevent unnecessary admissions, support earlier discharge, and reduce the pressure building on our acute services.

The session will examine:

• • What is working on the ground across the UK
  • The technologies enabling people to be safely managed in their own homes
  • The care pathways being adapted to make this possible
  • The role of clinical and non-clinical teams in delivering these services
  • The real-world impact on patients and the wider healthcare system

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic concerns how technology can increase access to outcomes-based behavioral health care for underserved families, improving the progress and effectiveness of care for those children with autism. Our author, Jeff Beck, LCSW, is the co-founder and CEO of AnswersNow, which provides virtual support based on applied behavior analysis (ABA) therapy. Mr. Beck spent the first 15 years of his career working directly with children in low-income and rural communities.

Recent reporting in The New York Times is just the latest to detail allegations of fraud, abuse, and excessive billing across parts of the autism therapy industry. But this story was especially troubling because of the stories of the children and families caught in the middle. It’s a reminder that the challenges in autism therapy today are human ones with real and urgent consequences. 

At the center of these issues is healthcare’s longstanding fee-for-service reimbursement system, which incentivizes autism providers to bill for therapy hours rather than patient progress. Now, the ongoing surge in autism diagnoses and the continued scarcity of highly trained clinicians have created an even greater opportunity for those same providers to ramp up their billings and lock children into extended cycles of therapy without producing meaningful improvement.

The encouraging news is that technology is changing that calculus.

For years, healthcare leaders have talked about shifting from fee-for-service reimbursement toward outcomes-based care. In autism therapy, that means aligning families, providers, and payers around a holistic goal to help children make progress faster and more efficiently. The challenge has been how to measure outcomes, scale care, and manage costs.

Today, virtual care and artificial intelligence are making all three increasingly achievable.

Virtual Care Solves More Than Access

Telehealth is often described as a convenience. However, in autism therapy, virtual care is creating entirely new ways to deliver higher-quality care.

1. Virtual care expands access. Traditional autism therapy relies heavily on centralized clinics, forcing families to travel long distances and organize their schedules around available appointments. In many communities, waitlists stretch for months or even more than a year. Virtual therapy removes geography as a barrier and allows families to receive support directly from home.
2. Virtual care helps solve a workforce problem. The shortage of Board-Certified Behavior Analysts (BCBAs), our industry’s most highly trained therapists, is unlikely to disappear anytime soon. Virtual care allows a BCBA in one location to support families hundreds of miles away, dramatically expanding access without requiring a corresponding increase in the workforce. It also means that, rather than spending large portions of their day supervising less-trained staff, BCBAs can work more directly with children and caregivers. More one-on-one interaction can lead to more personalized care and stronger therapeutic relationships. It also has the added benefit of boosting clinician retention rates. 
3. Virtual care can improve the therapy experience itself. Children often learn best in environments where they feel comfortable and secure. Sessions conducted in the home allow therapists to work within real-world routines and challenges rather than simulated clinical settings. And for some children, interacting through a screen can even feel more natural and familiar.

AI Makes Better Care More Scalable

AI can be a force multiplier, improving both the efficiency and availability of BCBAs. But it can also be deployed to enhance the therapy experience itself and measure progress over time. 

1. AI enables more personalized therapy. Historically, creating individualized materials and activities required substantial clinician time. AI can now help therapists generate customized content aligned to a child’s interests, developmental goals, and learning style in real time. That allows clinicians to adapt more quickly and keep sessions engaging and relevant for faster progress by kids.
2. AI helps reduce administrative burden. Highly trained clinicians routinely spend hours each week documenting sessions, reviewing records, writing notes, and developing care plans. These activities are necessary, but they reduce the time available for direct patient care. AI can take on many of these tasks, returning meaningful time to clinicians. 
3. AI can improve how providers measure and manage outcomes. It can help identify patterns earlier, track progress more consistently, and support more informed treatment planning. Just as importantly, it generates the data needed to evaluate whether children are actually improving rather than simply accumulating therapy hours.

Of course, security and compliance are non-negotiable in this space, especially given the strict regulations health systems and payers face. The default industry standard should include a “compliance toggle” that allows enterprise partners and families to completely disable AI tools whenever their internal security protocols require it.

Building the Next Generation of Autism Care

Autism therapy is entering a period of necessary scrutiny, and bad actors should be held accountable. But the larger opportunity is to build something better.

• Providers should view virtual care and AI as more than operational tools. Together, they make it possible to deliver higher-quality care with greater efficiency, personalization, and transparency.
• More importantly, they create the foundation for a different model of care, one where success is measured by a child’s progress rather than the number of hours billed.

That shift will take time. But providers using technology to expand access, strengthen outcomes, and improve accountability will help define what better autism care looks like for the next generation of children and families.

Veteran telemedicine robotics company VSee separates from its Labs subsidiary, moves to a single CEO.

Traditional PERS alert units are still a feature of senior housing and private homes. The problem is that many of these older systems, built for wireless 3G systems, don’t work so well anymore. Because wireless companies such as AT&T and Verizon shut down 3G services four years ago, these legacy PERS devices may appear functional but fail to connect to monitoring centers. Another issue is rural cell networks and landlines. The latter are being withdrawn in many areas to internet service, or moving from copper to fiber. Providers need to test their devices on the local 4G LTE cell networks for their customers in those areas to ensure that they work. PERS Insider, Saving Advice

Also noted in PERS Insider is South Korea’s “Talking Buddy”. It is a conversational AI chatbot service developed by Naver Cloud that places wellness calls to seniors. It can remind the client of the usual, such as eating, sleeping, hydration, and medications, but it also can be programmed for post-operative follow up. It can have reasonably interactive chats and in one case, identified a senior in distress, contacting a social worker. It was developed from a fever checker in the pandemic period. In the original New York Times/Japan Times article is a profile of Rowan’s SuperBrain, a tablet-based program designed by neuropsychiatrists that prompts users with early cognitive impairment through a series of brain exercises designed to stimulate memory and association. South Korea is facing a ‘tsunami’ of dementia patients, with an estimated 2 million expected by 2044. The disease carries stigma, especially among highly self-reliant Korean seniors who fear dependence.

South Korea is also expanding telehealth to foreign patients who visit the country for medical procedures. Korea is becoming a desirable destination for medical tourism, with about 2 million annual visitors. The Medical Overseas Expansion Act was amended to include telehealth services for these short-stay patients. These include remote pre-visit consultations and follow-up care at clinic or hospital-level medical institutions, continuous observations, counseling, education, diagnosis, and prescriptions. Healthcare IT News

Novellia garners $18 million Series A. The funding round for the New York-based company was led by Spark Capital with participation from Khosla Ventures, Acrew Capital, Bling Capital, and TMV, bringing Novellia’s total funding to $28 million. Their platform is targeted to patients with serious or chronic conditions, helping them to pull all their data from various health providers, add information, digitize paper records, and overall control their health history. Novellia most recently introduced a mobile app platform. The fresh funding will be used to scale Novellia’s AI-powered technology, adding emerging therapeutic areas such as GLP-1 and cardiometabolic, and the opportunity to share their information with medical researchers. This last feature is another revenue stream for Novellia, which then shares anonymized insights to pharma companies and diagnostics firms for R&D. Release, Mobihealthnews, MedCityNews