Maneesh Goyal, Chief Operating Officer at the Mayo Clinic Platform

Welcome to the last Digital Health Wire of the year, as we’ll be taking a break next week for the holidays! Thank you to all of our readers and sponsors who make this newsletter possible, and keep an eye out for our next issue on January 3rd.

Digital Health

Oracle Acquires Cerner for $28.3B

Sometimes when there’s smoke, there’s fire, and that was definitely the case with last week’s rumor that Oracle was in talks to acquire Cerner in one of the largest healthcare M&A moves of the year.

Database and cloud infrastructure provider Oracle is acquiring Cerner for $28.3B in a transaction expected to close in early 2022. Upon closing, Cerner will be organized as its own dedicated business unit, serving as Oracle’s “anchor asset” to expand deeper into the healthcare sector.

What does Oracle gain from the merger?

Cerner marks Oracle’s largest acquisition ever, with several key benefits justifying the move.

• Oracle and Cerner share a large overlap in end users. Cerner has access to an existing customer base in a giant market, potentially expediting Oracle’s pivot toward the cloud by leveraging these established relationships.
• Cerner is expected to be a source of durable revenue growth, with Oracle anticipating a positive earnings impact in the first year that is likely to accelerate as it expands Cerner’s services into new regions.
• As Oracle looks to push into healthcare, access to patient data will be a deciding factor of success, and Cerner’s EHR data helps eliminate its reliance on third party data providers.

What does Cerner gain from the merger?

Cerner was valued at close to $23B heading into the merger (vs. Oracle’s $280B valuation), and it will be looking to pursue ways to use its newfound scale to help it move past the EHR business that’s been slowly losing ground to competitors like Epic.

• Oracle’s resources, infrastructure, and cloud capabilities will accelerate Cerner’s pace of technology development, while its global footprint could also allow Cerner to reach new geographies faster than if it was a standalone company.
• Oracle’s hands-free Voice Digital Assistant will become the primary interface for Cerner’s clinical systems, reducing time spent typing and creating more time to care for patients.
• Cerner will move to Oracle’s Gen2 cloud with the goal of achieving “zero unplanned downtime in the medical environment,” a migration that should happen quickly because of previous integrations between the two companies. 

Industry Impact

If this strategy sounds familiar, it’s right from Microsoft’s playbook, with the tech giant acquiring Nuance for nearly $20B to add more clinical speech recognition tools while gaining a foothold in healthcare.

Cerner has been in the process of shifting its focus beyond its core EHR business, under the helm of David Feinberg, who left Google to become the company’s chief executive in October. 

Feinberg has stated that improving usability and data analytics would be a critical component of Cerner’s strategy going forward, and the combination of Oracle’s Voice Digital Assistant and cloud computing capabilities could go a long way toward making this strategy a reality.

Nuance’s Patient Engagement Must-Haves

Consumer demands are shifting, and they’re looking to get more out of their digital health technology. Nuance outlines the 5 must-haves for your patient engagement strategy here.

The Wire

• Healthcare Hits the $4T Mark: In 2020, the US healthcare market crossed the $4T threshold for the first time, growing 9.7% to reach $4.1T. Last year represented a sharp acceleration from the 4.3% increase seen in 2019, largely driven by the federal government’s active approach to supporting public health in response to the pandemic. While overall healthcare utilization declined during 2020, healthcare’s share of the US economy spiked to 19.7%, due to a combination of federal involvement and a 2.2% decline in total gross domestic product.

• Found Funding: Just two months after emerging from stealth, weight care management startup Found closed $100M in Series B funding at a $600M valuation. Found provides a platform that combines personalized coaching, community, and medication management to help patients with weight loss. The company’s valuation and 6x year-over-year revenue growth are a testament to its huge total addressable market, with US obesity prevalence recently surpassing 42%.

• Shared Decision Making: A study published in Mayo Clinic Proceedings found that a growing number of primary care physicians are recommending stool sampling for colorectal cancer screenings (24%), especially among patients who are adverse to invasive procedures. Although nearly all physicians acknowledged that colonoscopies are their preferred screening method, they also reported that sharing all options to support shared decision-making often leads to better outcomes, since the best screening option is the one that the patient will actually access.

• Carrot Fertility Test: Carrot Fertility announced the launch of its at-home Female Fertility and Wellness Test, which offers a customized panel of biomarkers to provide a comprehensive view of fertility health. To use the test, patients mail a small blood sample (finger-prick) to Carrot for testing, then set up a telemedicine visit with a clinician to discuss how factors such as cholesterol, blood sugar, and vitamin D levels might impact pregnancy outcomes.

• Staffing Ratios: A new study of 87 Illinois hospitals published in BMJ Open found that for every one-patient increase in nurse workloads, hospitals see a 16% increase in mortalities and a 5% increase in the odds of a patient extending their stay by an extra day. Although the patient-to-nurse staffing ratios ranged from 4.2 to 7.6 (mean=5.4), the researchers concluded that more than 1,595 deaths and $117M could have been saved had the hospitals maintained a 4:1 patient-to-nurse staffing ratio during the one year study period.

• Well Series B: Well, a member engagement solution for employers, raised a $70M Series B round ($186M total funding) to help scale its operations and help its AI-enabled platform reach more members. The company is aiming to create “a unique category of digital health intervention” by facilitating continuous engagement through personalized incentives, rather than episodic services after problems arise.

• Amazon’s New Head of Health: Amazon has tapped it’s former Prime chief, Neil Lindsay, to helm its health initiatives, which include online pharmacy, telehealth, and diagnostics units. According to reporting by CNBC, Lindsay will continue to oversee Amazon’s global branding and promotional efforts, while bringing his marketing skill set to the health division as the Amazon Care service begins its nationwide expansion.

• AI Survey: Optum’s annual AI survey of over 500 senior healthcare executives found that respondents are excited about AI’s potential to improve outcomes in multiple areas, including virtual patient care (41%), diagnosis (40%), and medical image interpretation (36%). The survey results indicate that AI will continue to be a significant focus moving forward, given that 85% of healthcare leaders have an AI strategy, while only 48% have implemented it.

• Happify for Migraines: Happify Health recently announced plans to develop a digital therapeutic for migraine treatment following a successful pilot study of 5k migraine sufferers. Nearly 18% of migraine sufferers who completed at least two of Happify’s migraine assessments reported an improvement in migraine frequency and stress reduction, which should be welcome news for the 1 in 6 US adults that Happify claims suffer from frequent migraines.

• Mightier Games: Video game therapeutic creator Mightier closed a $17M Series B round ($29M total funding) to further the development of its video games that pair with a wearable heart-rate monitor to help children practice calming down when upset. Adding wearables to video game treatment sets Mightier apart from other companies in this space, such as Akili Interactive, which recently raised $110M after receiving FDA De Novo clearance for its EndeavorRx digital therapeutic.