What’s both a Ladder and a Chute?

Click Therapeutics put together a healthy Series D of $50 million to commercialize its digital therapeutic for the treatment of the experiential negative symptoms of schizophrenia. That’s a cheerful earful, except for the reported 27% of their employees who just got chuted with a pink slip. In the reported range of 100-250 employees, that means 27 to 67 employees being told ‘no work for you’ after bringing the company to the commercialization point. That is a deep cut.

Boehringer Ingelheim and Click jointly developed the digital technology, which received Breakthrough Device Designation by the FDA in 2024 as an investigational technology. It provides an an adjunct to standard antipsychotic therapy through interactive psychosocial intervention techniques.

With the $50 million funding, Boehringer turned over commercialization to Click. What is odd here is that companies with investigational tech and large partners usually keep the staff lean. Commercialization and funding then means that hires change from researchers to marketers, sales, and compliance, for a net gain. The next question is…when?

Austin Speier, chief strategy officer, commented to Behavioral Health Business: “While we are incredibly excited about the potential of CT-155, that shift means making hard changes to our team to match our new commercial mission. These were not decisions we made lightly, and we are deeply grateful to everyone who helped us reach this stage.” CT-155, as it is formally known, does not yet have FDA clearance. It has a Phase III study, CONVOKE (NCT05838625), a Phase III, multicenter, randomized, double-blind, 16-week study evaluating the efficacy and safety of CT-155 versus a digital control app. Neither the BHB and FierceBiotech articles nor Click’s release reveal a timeline for FDA clearance and marketing. Which means that final FDA approval may be more distant than the funding and turnover make it appear.

Indian RCM provider IKS Health seeks to add TruBridge’s RCM for $675 million. Talks are reportedly in an advanced stage with an all-cash offer funded by a $675 million debt facility from banks like Citi, Deutsche Bank, and JP Morgan. It covers both purchase price and refinances TruBridge’s existing debt. No formal offer has been tendered to TruBridge’s board or shareholders. Surprisingly, this has gained little notice in the US healthcare press.

TruBridge provides HIT, an EHR, and RCM for health systems and practices. It is both established from the late 1990s, when RCM was new, and fairly large–it serves 1,500 healthcare organizations and employs 3,500 people with revenue of $347 million. It IPO’d in 2002 as CPSI on Nasdaq, converting to TruBridge in 2024. IKS Health is HQ’d in Mumbai but has a US HQ in Texas. It has 13,350 employees and a global base of 600 clients. It’s public on the National Stock Exchange of India Limited (NSE) and BSE Limited (BSE). In addition to RCM, it offers care coordination, risk and optimization, and utilization management tools for value-based care. Digital Health News (India)

Also in RCM, TELCOR is buying Sample Healthcare. Amount and transitions are undisclosed. Like TruBridge, TELCOR started in the late 1990s. It serves both hospital and independent labs’ RCM for billing plus point-of-care and laboratory data. It has a 57% market share in the US for point-of-care solutions and serves over 2,700 hospitals and laboratories. Sample will add an AI-driven workflow engine that will be marketed as a separate product. It received seed funding out of Y Combinator in 2024. It’s easy to determine that Sample is a tuck-in acquisition for TELCOR.  TELCOR release.

On schedule, the VA’s EHR Modernization resumes after a three-year-plus hiatus.

The only exception to the hiatus was a joint Military Health System/VA implementation at Lovell in Chicago, which has had its own bumps after its start in March 2024. VA previously had five disastrous implementations, VA Mann-Grandstaff (VISN 20) in October 2020 and four more in 2022. After many actions to fix them, the VA halted implementations in April 2023. Even in 2025, in its agency report, the VA’s Office of Inspector General in their March 2025 report, and their January 2026 report on VA’s Management and Performance Challenges for FY 2025 found a distinct lack of VA staff confidence in the EHRM and its performance to date [TTA 8 Feb].

Strategically, confining the rollouts to one VISN and a small group at a time is smart because of the geographical adjacency and not scattering efforts all over the US. After these 13 however, there are 157 more. VA has pegged a full completion by 2031.

In its press release announcing the April go-lives, the VA identified four factors that got the EHRM off the dime. FTR: 

• Fixing hundreds of problems related to the initial rollout of the EHR system at the six original VA sites. Some of these related to efforts by local VA facilities to customize the system, which only complicated the process.
• Eliminating the bureaucracy that was holding the project back. VA replaced that unwieldy system with a single council that answers to top VA leaders, increasing accountability and making it easier to find and implement common sense decisions.
• Getting local facilities more involved. As VA’s lead official on the EHR rollout, VA Deputy Secretary Paul Lawrence has visited all 13 deployment sites this year and has engaged directly with facility leaders at each location to answer questions and make sure these sites are ready to go.
• Hiring more people to ensure the rollout goes smoothly. VA has already hired dozens of staff to help with the rollout in Michigan and other locations and is in the process of hiring a total of 400 people.

Last year, VA terminated contracts for at least six independent contractors supporting the EHRM as part of a mass cleanup of department contracts. FNN

Federal News Network, Healthcare Dive

There is nothing in the release, of course, about Oracle Health’s manpower cuts, rumored to be 30%, nor the persistent talk that the EHR unit will be sold or spun off. Or the effects that the recent indictment of a former EHRM head will have in Congress. In this Editor’s view, Oracle’s corporate redirection to and big bet on AI datacenters strongly suggests that Oracle will not be engaged with this deployment by the time 2031 rolls around.

OpenAI, founded as a non-profit with integrity at its core to “prioritize the safety of humanity over the company’s success, or even its survival”, recapitalized last year as a for-profit corporation with 26% of the shares owned by the OpenAI Foundation. It is now a trillion-dollar company that had no trouble raising a paltry $122 billion last week [TTA 2 April] though arguments are made that at least some of that money are IOUs or contingent. ChatGPT has become almost generic for AI, like Kleenex has become for tissues. The battles over control and direction of the company are now totally controlled by Sam Altman, whom former colleagues are not shy about pointing out his difficulty with the truth and a pattern of deceit, for instance to his board, to employees, and Microsoft. Yet everyone continues to do business with him. The FOMO Factor is very strong.

Mr. Altman makes extremely broad statements on the future of work (most traditional managerial, healthcare, and IT jobs will be taken over by AI, thus most of us will be unemployed), has easy access to President Donald Trump, as well as other world executives, and may, as the headline barks, control our future. Thus, he is a person of consequence.

My read so far of this is that within OpenAI, there is no one to counterbalance Mr. Altman’s immense ambition, his desire to dominate and win, not only with AI but also over all business and everyday life. These are character issues that also show up in aspects of his personal life, detailed in the article. If past results are predictive of the future, this flaw usually curdles into the desire to control countries and a complete disrespect for the rest of us leading our lives. 

Sam Altman May Control Our Future–Can He Be Trusted?, 

I will offer two LinkedIn comment posts on this article from an AI person I respect, the head of Curiouser.ai, Stephen Klein. Many of his posts on LinkedIn deal with what AI can and cannot do in business. He writes that he is “committed to designing technology that augments people, creates jobs, and elevates humanity. It’s time we all got back to thinking for ourselves.” 7 April, 8 April 

Our second Must Read is from Sergei Polevikov’s AI Health Uncut, a long analysis on the failure of Carbon Health and what it tells us in “this business we have chosen”. “What The Hell Went Wrong?” and its implications need answers–because it’s being repeated again and again. Today’s article (9 April) is Part 1 of 2, sets the stage about the mistakes made (insiders talk) and, with full credit, springboards off Stuart Miller’s (Haverin Consulting) original analysis made at the time of the Chapter 11 reorg. What we called the ‘Ominous Parallels’ was a Must Read here on 12 February.  TTA (as Telecare Aware, our original name) and this article are also mentioned twice (thanks!).

Those who have yet to subscribe for Mr. Polevikov’s analytic, erudite, and revealing (Emperor’s New Clothes!) POVs can read part of this article for free–but seriously, if you’re in this business, the subscription is worth your money. He also podcasts (links are on his Substack, link at lower right sidebar).

An early and scandalous publisher (before he utterly lost it), Matt Drudge, used to say that he ‘went where the stink is’. Mr. Polevikov does the same. The stink is of our broken primary care reimbursement system, the Covid steroids that pumped up the company, flailing management running through money like drugs, and good ideas for patient care buried under incompetence. 

TTA has an open invitation to industry leaders to contribute to our Perspectives non-promotional opinion and thought leadership area. Today’s topic is on how the most recent two-year extension of Medicare telehealth flexibilities necessitate a more robust healthcare infrastructure to better utilize the additional data generated by remote patient monitoring. The author, Jiang Li, Ph.D., is founder and CEO of Vivalink, Inc., a Silicon Valley company developing digital health technology solutions for remote patient monitoring in healthcare and clinical research.

Ensuring equal healthcare access to Americans across the country is an ongoing effort. The latest funding bill from Congress looks to improve access by expanding where and how people receive care through a two-year extension of Medicare telehealth flexibilities. The bill adds to the five-year extension to the CMS Acute Hospital Care at Home (AHCAH) waiver, which allows hospitals to deliver acute inpatient care in patients’ homes with full Medicare reimbursement. Since its launch in 2020, the program has continued to receive extensions in the continued effort to ensure Americans living in rural or remote areas receive the healthcare they need.

Under the current Medicare extensions, telehealth provides real-time medical and mental health appointments over secure video from a patient’s location, along with a wide range of Part B services such as specialist consults, rehab, and psychotherapy. This latest extension allows beneficiaries to continue receiving this care from an expanded list of healthcare providers. While the original waiver was authorized in response to COVID-19, research shows that around 17% of healthcare visits were conducted via telehealth modalities post-2020, with over 116 million global users listed in 2024.

Telehealth helps address a gap in healthcare access felt by many Americans living in rural locations. While the extension provides flexibility for those patients to continue receiving remote care, it isn’t enough to close the gaps in American healthcare on its own. What will define its success is a deliberate investment in infrastructure from health systems, policymakers, and technology developers alike.

Exploring the Access Problem

Nearly 80% of rural America is classified as medically underserved, facing barriers such as provider shortages, high poverty rates, and a rapidly aging population. For Medicare-eligible patients in these communities, the obstacles to consistent care, including transportation limitations to caregiver responsibilities, can often prove to be insurmountable, blocking them from necessary medical care.

We see the direct result of these consequences in the data. One significant example is cardiac rehabilitation — more than one million Americans become eligible each year, yet fewer than 20% participate. Even among those referred, less than 34% enroll, largely because the model still demands repeated clinic visits that many patients simply cannot manage. This has been a slow but sure systemic struggle, embedded in how care has historically been designed and delivered.

We can see these consequences further compounded by issues with traditional monitoring. Episodic, in-clinic measurements offer only brief snapshots of a patient’s health, often missing transient but dangerous events occurring between visits. A study at Brigham and Women’s Hospital found that 27% of cardiac surgery patients experienced new atrial fibrillation episodes after discharge that traditional follow-up would have missed entirely. This post-discharge period, long treated as a clinical blind spot, illustrates the value of supporting remote care.

Making Changes for a Stronger Infrastructure

The outcomes of the AHCAH waiver have been significant: an analysis of over 5,800 patients treated under the waiver at Mass General Brigham found in-care mortality below 1%, compared to a national inpatient average of approximately 2%, with only 7% requiring return hospitalization. The cost savings are notable as well, with one review finding that hospital-at-home (HaH) patients cost approximately 20% less than traditional inpatients, allowing Medicare to spend $1,000 to $3,300 less per case across common conditions like pneumonia, heart failure, and sepsis in the 30 days post-discharge.

To ensure similar outcomes and savings at scale, a stronger infrastructure is needed. We’re already seeing movement in the replacement of traditional, episodic data by medical-grade wearable sensors capable of continuous ECG monitoring, temperature tracking, and real-time data transmission. We’re already seeing solutions for issues such as interrupted data capture during connectivity gaps, simply by expanding the storage capabilities of devices that support rural Medicare populations.

Interoperability is equally important. Biometric data from wearables should flow directly into electronic health records and centralized clinical dashboards, delivering real-time alerts without burdening staff with manual data entry. For regional and mid-sized hospitals that serve the most underserved populations, this means access to modular platforms rather than expensive third-party bundles that absorb reimbursements before they reach patient care.

Supporting a Stronger Future

The decision to extend Medicare telehealth flexibilities is a market signal for health systems. Regulatory uncertainty has been one of the greatest barriers to the advancement of remote patient monitoring platforms, wearable infrastructure, and other programs. When reimbursement timelines are measured in months, it is difficult to justify multi-year infrastructure investments. As the CMS update extends reimbursement by two years, at-home care now has the opportunity to become an evolving standard of Medicare delivery worth investing in.

The opportunity extends well beyond Medicare. The same remote patient monitoring infrastructure enabling home-based acute care is powering decentralized clinical trials, expanding access for older and rural patients historically excluded from research. These opportunities for growth and inclusivity, supported by CMS, signal that at-home care is becoming a permanent feature of how Medicare is delivered.

The WHOOP wearable definitely whooped it up with a $575 million Series G (for Giant) funding. It’s a fitness and health watch that is reasonably trim and presentable sans a screen. It tracks sleep, activity, heart health and menstrual cycles (if applicable) through measurement of heart rate variability (HRV), resting heart rate (RHR), respiratory rate, and blood oxygen levels, and appeals to the very athletic with metrics around recovery and strain. The Boston-based company claims 2.5 million members internationally; in 2025 it marked 2025 growth of 103% and exited at the infamous ‘run rate’ metric of $1.1 billion. Their AI twist is around biometric data and how it is used to guide tracking and performance. It is heavily pitched to elite sports with famous athlete endorsers/investors such as soccer star Cristiano Rinaldo, basketball’s LeBron James, and golfer Rory McElroy.

The round was led by Collaborative Fund and includes global participation from a gang of investors including 2PointZero Group, Qatar Investment Authority (QIA), Mubadala Investment Company, Abbott, Mayo Clinic, Macquarie Capital (entities administered by Macquarie Capital), Glade Brook, B-Flexion, IVP, Foundry, Accomplice, Affinity Partners, Promus Ventures, and Bullhound Capital alongside a group of prominent global athletes and individual investors. The additional funds will be used for growth in the US plus international expansion across Europe, the GCC, Latin America, and Asia. The wonderfully subjective (by investors) metric of valuation stands at $10.1 billion. Total funding since 2012 is over $900 million.

WHOOP received the infamous Warning Letter from FDA’s Center for Devices and Radiological Health (CDRH) in July 2025 regarding marketing claims for Blood Pressure Insights (BPI) on the basis that the company did not have an approved application for premarket approval (PMA) or 510(k) approval of that feature. The founder/CEO is contesting FDA as he believes that the feature is for general wellness purposes and is covered under the 21st Century Cures Act.  Mobihealthnews, WHOOP release

(In all honesty, this Editor had only vaguely heard of it, but her idea of a expensive watch usually has the name Elgin or Hamilton on the face and is usually antique (Omega too, sigh). In fitness watches, she thinks of Apple, Samsung, and the low-profile Withings (which makes traditionally styled smartwatches) but none of them have persuaded her to part with several hundred dollars.)

Anthropic buys a tiny bio research software developer for a stunning $400 million in stock. Coefficient Bio was founded only eight months ago and reportedly had only nine employees. It was so stealthy that it never got past the placeholder website. The amount was reported by its 50% owner, venture capital firm Dimension, which realized a hefty 38,513% IRR on the investment. Coefficient was working on AI models and software for biological research.  Apparently founder Samuel Stanton and his team will join Anthropic’s Health Care Life Sciences area. It’s interesting that Anthropic is building up their healthcare footprint after making their customized AI available to both consumers and clinicians, quite a contrast to OpenAI’s purchase of TPTN, a small podcaster of tech news and personalities (CNBC). HISTalk 4/6/26, Silicon Angle, Newcomer

Early stage companies also nabbed some decent fundings

Behavioral health therapy assistant Jimini Health raised $17 million in seed funding from M13, Town Hall Ventures, LionBird, Zetta Venture Partners, and OneMind, bringing total funding to more than $25 million. Their AI-forward (of course) Sage platform fills the niche left by fully remote telementalhealth companies in supporting large behavioral health provider organizations. NYC-based Jimini  promotes a clinician-supervised and controlled patient-facing, reimbursement-ready and compliant infrastructure with licensed clinicians maintaining oversight of every patient interaction. According to the release, the funding will be used to build partnerships with “several of the largest behavioral health provider organizations in the country and expand Sage’s clinical capabilities across comorbidities, care settings, and patient engagement modalities”. Release, Behavioral Health Business, Mobihealthnews

Insight Health’s $11 million Series A will be used to scale its agentic AI platform. The round was led by Standard Capital, with participation from Kindred Ventures, Pear VC, Eudemian, 43 and ElevenLabs. Insight Health uses AI to automate routine clinical and non-clinical tasks such as phone and front-desk coordination, referral and fax processing, pre-clinical intake, and clinical documentation. For instance their agents engage with patients directly via voice or text. Current customer base is in clinics. Their Aura AI Scribe and Virtual Care Assistant are available in athenahealth’s Marketplace. Their total funding is about $16 million. Release, Mobihealthnews

Short takes:

Noom buys 503A licensed pharmacy Tailor Made Compounding (TMC). The buy, according to Noom, will enable them to expand beyond weight loss GLP-1s further into the healthy aging segment, with longevity peptides, hormone replacement, and cosmetics. Noom has weathered several pivots, starting in 2008 with fitness apps, then added behavioral change with a weight-loss coaching app in 2017. It has pretty much settled into the lucrative e-prescribing and wellness ‘preventative care’ area targeting health plans and employers. TMC’s client base includes 400 clinics and multiple telehealth partners, which presumably Noom will let them maintain. Acquisition cost and staff transitions were not disclosed beyond integration ‘later this summer’.  Release, Mobihealthnews

‘IT’ clinical information search engine/AI chatbot OpenEvidence inks deal with NY’s Mount Sinai Health System. It is Mount Sinai’s first enterprise-wide AI deployment and integration across clinical roles, according to the health system’s announcement last week. It will be integrated into their Epic EHR. OpenEvidence, with a eyeblinking valuation of $12 billion [TTA 13 Feb], claims a daily average usage by 40% of US doctors in 10,000 hospitals and medical centers of their free search engine trained on journals and clinical medical data only. It fills a gap that competitors Doximity, Epocrates, and Medscape aren’t doing. It has added clinical trial matching to its capabilities filtering trials by study design, enrollment status, and geographic proximity. This adds on to Sutter Health’s integration into doctors’ Epic workflows announced earlier this year. Healthcare IT News

Hey, startup founder–why aren’t YOU building a $1.8 billion revenue company with AI and just you (and your brother)? In 14 months? On $20,000?

It’s a simple marketing model selling e-prescriptions for GLP-1 weight loss, peptides and other longevity meds, others for specialized men’s and women’s health such as hormone balance and hair health, and prepackaged meals to go. Medvi runs the website, the checkout, and the customer relationship including service. All the sticky stuff, such as licensed physicians to prescribe, prescription processing, pharmacy fulfillment, shipping logistics, and regulatory compliance, are outsourced to OpenLoop Health (telehealth) and CareValidate (virtual care management and med fulfillment (plus presumably a meal supplier). AI tools wrote the website code and copy, the ever-popular ElevenLabs for customer facing voice tools, chatbots for customer inquiries, AI agents to connect all the systems…a veritable proof positive of the vision of Sam Altman of OpenAI on what he believes will be the Future of Business Without Workers, Only Customers. Winning Altman’s bet of the first billion dollar AI-built company, in fact.

AI handling most of the work, designed by founder/CEO Matthew Gallagher, who had to bring in his brother because it took off so fast. Outsourcing to known telehealth/telemedicine suppliers. All he did was the marketing and selling. A veritable genius in pulling this all together–then getting an article in the NYT that any PR person or marketing director would ‘kill’ for? What could be wrong? 

Other media dug into the pretty picture, doing the work the NYT wouldn’t do. The chatbots initially hallucinated pricing and products for customers. It sent links to customers confirming intake forms that with a minor digit change in the sequential integer at the end, accessed other people’s records–a significant breach of HIPAA that was solved between the discoverer and an assistant at Medvi–but apparently never reported to HHS’ Office of Civil Rights as required. Medvi received one of those charming warning letters from the FDA in February about their website depicting GLP-1 injectables with their name on the syringe (still there) as well as featuring compounded weight loss and other meds as ‘FDA-approved’–yes, those compounded GLP-1’s no longer permitted for well over a year, and in any case, not approved. [TTA 12 Mar]. There is no record on the FDA website of a response (required within 15 working days) to the FDA letter. OpenLoop itself had a January data breach affecting 1.6 million patient records and is facing a class action lawsuit on compounded oral tirzepatide manufactured by Triad Rx–and sold by Medvi. Oh yes, there are faked up before-and-after pictures on the website of customers.

Even more blatant is its use of extensive affiliate marketing featuring deepfaked doctor pictures and personas talking up Medvi–5,000 ad campaigns reported by Meta in their library last week, according to Business Insider/MSN. The doctors quoted either did not exist or linked to stores in Angola. They used AI-generated video testimonials and recycled identical scripts across multiple fabricated doctors. Mr. Gallagher told the online outlet in an email that “maybe 30%” of its advertising was through affiliates”. 

AI slop. And the Times fell for it!

This Editor predicts that based on the multiple articles read on background for this article, that the laundry list of problems goes on much longer than this. Medvi will either hire a cleanup crew, go forth and sin no more, or shut the doors in a hail of litigation. Each one of them has its own spin worth reading: Forbes (surprisingly), Drug Discovery & Trends,  Techdirt (!–particularly tart), Futurism, Moneywise, LinkedIn. Mr. Gallagher better hold on the Lamborghini and start putting a significant part of that gusher of cash aside for a compliance expert and some good attorneys.

According to the Department of Justice (DOJ), the charges carry a statutory maximum sentence of 20 years in prison, with false statements adding another five years maximum per charge and possible financial penalties. The three counts involve violations of United States Code (USC) Title 18, Sections 1001 and 1519.

As executive director for the OEHRM, Mr. Windom was responsible for leading the long-term vision, strategic management, technical direction, acquisition, and deployment of the Cerner EHR in the VA that was announced in June 2017 and awarded in May 2028. He is being charged with accepting and soliciting gifts and cash from a group of VA contractors and subcontractors he termed the “Power Group”, then failing to disclose them according to law. This group included eight persons in seven independent minority-owned contractor companies in IT and health IT services and technology, management consulting, diversity and inclusion work, project management, business development, and general support services. Two companies were prime contractors directly on the VA EHRM project and overseen by Mr. Windom. 

He is accused of flagrantly accepting and demanding cash and gifts from the contractors, including meals, drinks, entertainment, casino chips from the MGM National Harbor and Aria Las Vegas, and gift cards for Louis Vuitton luggage totalling over $15,600. His demands from individuals and interactions with them are extensively detailed in the indictment. Mr. Windom also failed to report gifts on standard VA forms, and denied the gifts to Federal law enforcement officials interviewing him twice in 2021. In 2024, when interviewed again, Mr. Windom admitted accepting chips. The gift acceptances from vendors with clear conflicts of interest and failures to report, including on his required annual public financial disclosure form, were violations of established Federal ethics laws and regulations restricting gifts. 

According to the indictment, he also pressured the vendors to make business decisions unrelated to the EHRM that advanced certain personal diversity objectives and then demanded to be rewarded. He also threatened this Power Group with economic and reputational harm, particularly but not only related to his diversity networking expectations (General Allegations, point 14).

John Windom, aged 64, has an interesting background. He joined the VA in September 2017 after retiring from service as a Navy Captain. While in the Navy, he had direct experience of the Cerner EHR implementation at the Department of Defense (DoD) as a program manager for their Defense Healthcare Management System Modernization Program. His 2017 appointment as executive director of the OEHRM replaced Genevieve Morris, interim chief health information officer, who had moved from ONC in July but resigned almost immediately in August citing a change in direction (MedCityNews). He became a three-year Limited Term Senior Executive Service (SES) member, a prestigious status in the Federal Government. As OEHRM ED, he reported to the Deputy Secretary of the VA and shifted after the May 2018 selection to onboarding the Cerner EHR. He became a career SES in July 2020. His Federal biography for Congress from this time is here. Mr. Windom was reassigned from OEHRM in April 2022, moving to deputy director of the Federal Electronic Health Management Office, a joint DoD-VA initiative to support the delivery of a single, integrated EHR.  It is not clear where or if he is currently employed. 

US Attorney for the District of Columbia Jeanine Pirro said in the DOJ release “As alleged, the defendant exploited his senior position for personal gain and concealed gifts and financial relationships that created serious conflicts of interest in the health care of our nation’s veterans. Such conduct is not only a betrayal of the public trust—it undermines confidence in the institutions dedicated to serving those who have sacrificed for this country.” The case is being investigated by the US Attorney’s Office for the District of Columbia, the FBI Washington Field Office, and the Veterans Affairs Office of the Inspector General (OIG). It is being prosecuted by Assistant US Attorney Emily Miller. No timeline for the start of the trial was announced.

None of this seems to have directly involved Cerner, now Oracle Health, per the indictment. But in this Editor’s opinion, because of Mr. Windom’s role in the selection of the Cerner EHR and the disastrous implementation of VA Mann-Grandstaff (VISN 20) in October 2020 and four more in 2022, all terminated in 2023, Oracle would be unwise to not prepare for a few questions about Cerner’s relationship with Mr. Windom. 

Both Senate and House VA committee chairs are highly concerned about this indictment. Apparently, it will not delay (and reasonably should not) the scheduled rollout of the 13 VA locations starting this month [TTA 8 Feb].

News sources include Federal News Network, Healthcare IT News, and Military Times.

Languishing Teladoc faces activist shareholder as Q1 reporting nears.

While Pineal positioned Teladoc’s current situation as the global leader in virtual healthcare with a 100 million member base, it blamed the company’s “distressed-level valuation” — trading at 4.18 times enterprise value to EBITDA — on multiple management mistakes. These began with the 2020 acquisition of Livongo (a near-fatal self-inflicted error) and now extend to capital spent on bolt-on acquisitions proven to be not accretive to revenue at present, no presentation to shareholders of a multi-year business plan by management to increase share price (down 90% from pre-COVID highs), and share dilution through too many shares outstanding–177 million at present from 90 million in 2020. 

Pineal’s remedy list is not unexpected and cuts straight to the chase:

• Increasing cost efficiencies, primarily additional cost cutting. 
• A share buyback up to $200 million to reduce dilution. 
• Exploring a break-up of the two core businesses – Integrated Care and BetterHelp – into separate entities, via a sale or spin-off transaction.

It believes that Teladoc has plenty of upside due to expanding reimbursement for virtual healthcare, lower out of pocket costs (including permanent first-dollar coverage in high-deductible health care plans and two rural health support programs), their launch of their new 24/7 Virtual Care Platform, a shift for BetterHelp’s behavioral telehealth to an insurance-based payer model boosting conversion and lifetime value–expected to grow to a $100 million run rate in 2026, and international expansion, the real boost for BetterHelp. (This Editor notes that the ‘bolt-on’ acquisition of UpLift was a part of BetterHelp’s conversion to a payer model–see below.)

BetterHelp is Pineal’s primary focus in the letter as the ‘crown jewel’ versus the older Integrated Care platform. Pineal notes the recent $835 million acquisition by UHS of Talkspace, another telementalhealth provider with a checkered track record, as an argument for a BetterHelp  spinoff or sale. 

The ‘or else’, always a part of these activist challenges, is concern “that continued inaction risks a private-market bid at a level well below true intrinsic value”, poison to major shareholders.

Pineal owns TDOC shares through its Pineal Capital Fund 1. The number of shares was not disclosed nor is known through filings in Ireland or the open letter.

What this all means. Or could mean.

Teladoc’s 2025 was flat versus the prior year–retrospectively an improvement versus the bloodlettings of prior years. But their 2026 projection was also flat. In 2025, BetterHelp, their behavioral telehealth unit, fell 9% year over year to $950.4 million in revenue. In reporting 2025 results, Teladoc announced that the Integrated Care business would move from subscription models to visit-based revenue to compensate for enrollment reductions at some client health plans in government programs and reductions in ACA subsidies.

It’s a mystery why Pineal sees BetterHelp as a ‘crown jewel’ when for 2026, Teladoc is projecting a 7% revenue reduction. This Editor has not forgotten that BetterHelp was also seen by former CEO Jason Gorevic (exited 2024) as the future of the company. In May 2025, Teladoc added insurance coverage to primarily DTC BetterHelp by acquiring UpLift for $30 million.

There have been some gains in the share price (about 6%) but it closed today slightly down at $5.28. Stock analyst Zachs isn’t exactly bullish on Q1 results to be reported on 29 April. Revenue projections are down 2.71% to $612.3 million versus Q1 2025, with EPS down $0.3, a 58% drop versus Q1 2025. The year looks equally down with revenue of $2.51 billion, essentially flat to down -0.81%. Yahoo Finance

But…there’s more, just like the direct response commercials.

A further analysis in Bitget shows that total institutional holdings in Teladoc declined by 29.4%. CEO Chuck Divita sold 27,731 shares on 11 March, reducing his direct stake by 7% to roughly $2 million. Yet for some reason, investor Ray Dalio through his firm Bridgewater Associates has been buying on dips, notably increasing its Teladoc stake by 151,000 shares or 31.2% in Q4 2025. However, this can be attributed to speculation to salvage a small (.01%) but underwater position. 

It is clear that Pineal is pushing for a greater valuation of Teladoc shares, as well as a buyback that would bolster their fund’s cash position. It’s an educated guess, but they are not going to be alone among the battered shareholders, either. Watch for another shoe drop around the Q1 earnings report on 29 April.

Coverage from Reuters, Investing.com, 

Your Editor is feeling a little whipsawed this usually quiet pre-Easter and Passover week.

OpenAI had no problem raising $122 billion as it moves to conquer the AI World (and maybe the Universe) via ChatGPT. Considering their claim that they are generating $2 billion in revenue per month, just replace the millions raised in the earlier digital age with billions. There’s a laundry list of investors including institutions, individual investors via banks, plus exchange-traded funds managed by ARK Invest. The anchor investors are strategic partners Amazon, NVIDIA, and SoftBank, with continued participation from Microsoft. SoftBank co-led the round alongside a16z, D. E. Shaw Ventures, MGX, TPG, and accounts advised by T. Rowe Price Associates. The release notes leadership in consumer AI and growth in enterprise AI; as noted here, in January OpenAI debuted ChatGPT for Healthcare (enterprise) and put into test ChatGPT for Health (consumer).

At a ‘virtual VC conference’ earlier this week, one investor panelist estimated that 14% of venture capital funding in 2025 went to exactly two companies, OpenAI and Anthropic (Claude). That disproportion rings alarm bells to this Editor, who well remembers the ludicrous dot-com boom/bust, and even earlier the insane financing that went into (mostly failed) airlines during deregulation–including the airline she worked for.

Another healthcare segment that hasn’t had much problem raising funds is e-prescribing of GLP-1 drugs. Miami-based eMed raised $200 million in its Series A, bringing its valuation to over $2 billion. Fronted by NFL quarterback legend Tom Brady, recently named founding chief wellness officer who is also an investor, the round was led by earlier investor AON Consulting with the addition of a starry roster of individual investors noted in their brief release. eMed’s eRx is marketed both to individuals and employers; the fresh funding will support further development of its agentic AI platform plus a new capitated model “designed to help employers bend the healthcare cost curve”. This Editor notes the lede in most articles about eMed is Brady and the $2 billion valuation; as our Readers know, the latter is a subjective and oft-inflated estimate of market value especially at this early stage. TTA dug into eMed and some of the company’s interesting history, crossing over into Ali Parsa and Babylon Health, here.  Reuters, FierceHealthcare, Mobihealthnews

Moving back into reality, Avo, a NYC-based clinical AI information platform, raised a $10 million Series A. Avo’s calling card is bringing together EHR, revenue cycle including payer, patient data, and knowledge bases to streamline use at the point of care. Funders were led by Noro-Moseley Partners, with participation from existing investors AlleyCorp, Las Olas Venture Capital, MedMountain Ventures, Epsilon Health, and new investor Scrub Capital. Avo has a solid roster of customers that include Geisinger, Mass General Brigham, and local providers such as Englewood (NJ) Health. They also have an intriguing feature: an ambient listening copilot that references patient data and generates documentation that improves revenue cycle. Release

Stedi’s Series C is typical in this hard-raise market in both level and number of investors, with a bit of a twist. The $50 million raised brings their total to $142 million, and will be used to expand its product presence and scale infrastructure. Denver-based Stedi’s calling card is an API-first and cloud-native financial clearinghouse that in revenue cycle management sits between healthcare providers and payers (insurers) to process essential transactions like eligibility checks, claims, and electronic payments. The funding was led by by Addition, with participation from Stripe, Ribbit Capital, USV, First Round, BoxGroup, and Bloomberg Beta. There was also a group of angel investors who jumped in, including Tobi Lütke (CEO of Shopify), Guillermo Rauch (CEO of Vercel), and Karim Atiyeh (CTO of Ramp). Finsmes

Since we opened with Oracle, we’ll close with them. Five days before 30,000 employees globally were declared unnecessary, Oracle announced that they leased additional space in Nashville, specifically 116,000 square feet within The Neuhoff District at 1320 Adams Street. Oracle now has 2,000 “seats” across three Nashville locations. The release touts “teams focused on a wide variety of roles, including sales and marketing, cloud engineering, software development, and product management. The company is actively recruiting ambitious thinkers and leaders eager to shape the next generation of cloud infrastructure and AI innovation. ” Perhaps some of those hundreds of folks in KC and other locations can be rehired in Nashville (sic).

A bad wake up this morning for too many people.

It is the largest layoff in the company’s history, by a company not shy about rolling layoffs. It was rumored to be this extensive at the top of this month with the departure of five key executives and a TD Cowen analysis [TTA 6 Mar]. As is typical, Oracle stock on the NYSE rose close to 4% as of 1pm ET today.

What we know:

There were no HR calls, no videos, no manager calls, no advance warning, which is the current cold and human-free style one now expects. Many surviving managers up to senior levels weren’t told in advance of team layoffs, based on Reddit postings.

As anticipated, Oracle Health, as part of the RHS area, was hard hit with 30% layoffs, based on press reports and Reddit/The Layoff.

Early reports (to be updated) out of primarily India, where Oracle employs many thousands in IT and development, indicated the layoffs hit hardest in these areas–FTA RollingOut via Times of India:

• RHS (Revenue and Health Sciences) — employees described a reduction in force of at least 30%, with 16 or more engineers from individual business units cut in a single action. (Editor’s Note: this includes the Oracle Health EHR team which was the former Cerner) 
• SVOS (SaaS and Virtual Operations Services) — similarly reported a 30% or greater reduction, with manager-level roles included in the sweep.
• NetSuite’s India Development Centre (IDC) — cuts spanned project management, individual contributor, and manager roles across multiple seniority levels.

The terse email informs employees that “we have made the decision to eliminate your role as part of a broader organizational change. As a result, today is your last working day.” Employees are also instructed to provide their personal email in order to receive FAQs and separation documents to sign off via DocuSign, as their Oracle emails will be deactivated “soon”. They are also warned against downloading any Oracle “confidential information”. Reports indicated that Mac laptops have new tracking software to determine violators, and that access to systems was already disconnected for those released. Full email text is available on Business Insider.

Some employees noted April 3 as their formal last working day, with a one-month “garden leave” period to follow. Based on TheLayoff postings, some in the US have later dates such as June 1. 

Details for India employees indicate that the normal “N+2” severance package of salary paid in months=years of service was offered. Unvested stock (e.g. RSUs) was lost. Those with vested stock still had access via Fidelity.

Many of those laid off in the US are in Kansas City Missouri (the former Cerner HQ), and have 10-20 years with the company. Most dates are before vesting of unvested RSUs. Slack counts indicate at least 10,000 gone, and likely more. Layoffs also took place in Canada and Europe, according to reports.

US labor laws about layoffs are at two levels, Federal and state; the latter varies. To this Editor’s knowledge, no Federally required WARN (Worker Adjustment and Retraining Notification) notices nor information under OWBPA (Older Workers Benefit Protection Act, which applies when employees over 40 years old are laid off) have been filed. Federal WARN starts with 50 or more employees 60 days before a plant closing or mass layoff. Many states have their own WARN laws and triggers.

What does this mean?

Oracle has taken on a massive debt load that has halved the stock from last year’s highs. For starters, Oracle took on $58 billion in new debt in just two months. Without exception in these reports, the need for layoffs and restructuring are being laid at the feet of the debt required for an extraordinary and costly change in company direction–from a provider of rapidly eroding SaaS to cloud computing services and AI datacenter contracts. This is  despite a strong Q3 and year projections [TTA 11 Mar] which had some but not enough positive effect. It is not just the debt load dragging down Oracle though–it is the time that these datacenters take to build out, get online, and generate cash flow.

TD Cowen’s report, covered in our 5 February article, nailed this quandary to the max. Oracle has entered into multiple contracts with OpenAI, Meta, and Nvidia. Lenders have doubled their interest rates on these Oracle projects to near non-investment grade levels, Oracle’s credit default swap (CDS) spreads have tripled, and private datacenters for lease are scarce because of limited market financing. Oracle can transfer some of these buildout costs to clients, but takes on risk for the bulk of it. In this Editor’s view, Oracle trapped itself into a classic squeeze. FTA: If the company doesn’t build the datacenters, it risks falling behind its massive strategy to dominate the AI datacenter business. Yet the price of this is to abandon its massive investment in healthcare, a linchpin strategy, and the customers there.

Oracle is in a tight spot without a lot of options other than more unattractive debt that further depresses the stock price. Their buildouts of datacenters, such as Stargate in Abilene, Texas, have been fraught with conflicts–the long ‘taffy pull’ of buildouts versus the annual development of ever more powerful chips that AI clients want before cash flow gets going. The difference in timelines is the killer [TTA 10 Mar]. And I suspect that Nvidia doesn’t take exchanges on their chips, once purchased.

Their largest shareholder with 40% of voting stock, executive chairman/CTO/founder Larry Ellison, still took his dividend. Unlike other founders in the past, he hasn’t mortgaged a yacht, an island, or sold a share to help stake the company in this transformation [TTA 6 Mar]. Instead, he seems to be focused on supporting his son’s Skyhorse media endeavors, the latest being the besting of Netflix in buying Warner Bros. He is also 81. These are factors to investors. Our Readers will recall that in 2022, Michael Neidorff, 25-year CEO of Centene, was forced out at age 79 by an activist shareholder group (Politan Capital, later famous for upending Masimo) that referred to both his age and tenure.

One does wonder how many of the laid off employees had specific skills that would have been useful in changing over to cloud/AI. It’s doubtful that Oracle had any process to evaluate individual competencies or capabilities for future fit. Having gone through a mass layoff when Centene absorbed WellCare Health Plans, this Editor knows first hand that companies do not evaluate individuals–they cut based on category, place, title, compensation, and other factors. Survivors either are in the right place, category, or sprint through internal contacts to another berth. This post on LinkedIn by a company that has created a ‘verification infrastructure’ to do this evaluation, instead of layoffs “based on broad assumptions about job categories rather than verified assessments of individual capability” makes you wonder whether an IT giant like Oracle even considered this approach before spending easily half a billion dollars on ‘restructuring’. 

What are the consequences of fewer people at Oracle Health? This month (April), the massive 13 facility EHRM rollout with the VA begins. And Congress, by this late spring and summer, which is budget time, will be turning the full force of scrutiny on Oracle if it doesn’t go as smooth as 30 momme silk satin. And what will it mean to health system clients and prospects? Where is their reassurance that when an IT person emails or picks up the phone with a problem, that there will be someone at Oracle Health who even knows them? Based on Reddit posts, some employees were doing their onsite support jobs when they got their termination notices and had to leave. “Is anybody there? Does anybody care?” may be the cry of hospital IT managers. That’s not good for sales or account teams…if anyone at Oracle cares about new sales and retentions.

Is Health, once the focus of Oracle’s Big Transformation, now just a used and broken toy? What’s the future of Oracle Health if the strategy is AI 24/7 and EHRs and healthcare system SaaS just do not fit the picture anymore?

Updated 31 March PM: Oracle is not admitting the cuts or the volume of them publicly. CNBC’s sources are stating only that the cuts are ‘in the thousands’. This corresponds to the early reports in Business Insider (link above). This Editor wonders if they ever will beyond a filing with the SEC. Also Wall Street Journal.  One wonders how long they can keep mum to customers and shareholders.

In addition, if WARN notices aren’t filed at locations with 50+ employees and layoffs aren’t delayed for 60 days, expect blowback at the US and state department of labor levels plus class action lawsuits. Oracle may actually sneak under this particular wire with dispersed locations and remote workers. Updated 2 April: A WARN notice was filed in Missouri, home to most of Oracle Health’s employees at the Kansas City campus. 539 employees have been laid off effective 26 May-1 June, which fulfills the 60 day notice requirement. Reportedly they are on payroll but not working. As of now, Oracle will keep the campus open. We previously noted that KC gave Cerner and later Oracle considerable incentives to build that campus. Fox 4 Kansas City