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<ul class="summary-list"><li>While many tech VCs are optimistic about Trump's second term, some healthcare investors feel stuck.</li><li>They're torn between the promise of long-awaited exits and potential threats to healthcare access.</li></ul>Some healthcare-focused VCs are torn about what Donald Trump's presidential win could mean for their portfolios.Six healthcare investors expressed mixed feelings about Trump's win — largely rooted in a tension they feel between the potential for big deals to come back and policies that fear could restrict healthcare access to many patients.Trump could make sweeping changes to healthcare policy in his return to the presidency. He's said he'll let Robert F. Kennedy Jr. "go wild" on health initiatives in the new administration, which could see the former presidential candidate making good on his desires to <a target="_blank" href="https://x.com/RobertKennedyJr/status/1852812012478398923">ban fluoride from public water systems</a>, "<a target="_blank" href="https://x.com/RobertKennedyJr/status/1852872924170010840">get toxins out of our food</a>," and <a target="_blank" href="https://www.forbes.com/sites/conormurray/2024/11/06/heres-what-an-rfk-jr-health-role-in-a-trump-administration-could-look-like-vaccine-skepticism-fluoride-ban/">inject vaccine skepticism into federal decisionmaking</a>, among other initiatives.While Trump is unlikely to <a target="_blank" href="https://www.cnn.com/2024/10/31/politics/aca-trump-repeal-affordable-care-act/index.html">try again</a> to repeal the Affordable Care Act, he may seek to boost Medicare Advantage plans, cut Medicaid spending, and <a target="_blank" href="https://spectrumnews1.com/wi/madison/news/2024/11/07/trump-rfk-fda-cdc-vaccines-fluoride">reorganize federal agencies,</a> from the Food and Drug Administration to the Centers for Disease Control and Prevention, according to an interview Kennedy Jr. gave from Trump's Florida estate shortly after the election.After a <a target="_blank" class="" href="https://www.businessinsider.com/more-healthcare-ipos-coming-what-startups-should-know-barclays-banker-2024-10">three-year IPO desert</a> for digital health startups, healthcare investors are desperate for the exit opportunities that a second Trump presidency could usher in. But some of Trump's proposed health policy moves are making investors nervous about their potential impacts on startups building in care areas like women's health and Medicaid, as well as on doctors and patients.Compared to Trump's first term, "I think you're going to see a more systemic overhaul of the infrastructure that administers our healthcare system, and that could happen relatively quickly," said Michael Greeley, cofounder and managing partner of Flare Capital Partners. "It's the unknown of those moves that makes it really hard to make a long-term investment decision."<div type="image" title="RFK Jr. speaks at a Trump rally as Trump watches." height="683" width="1024" msid="115114971" hostid="261" sizebytes="60192"></div><h2 id="cadda1d2-41e5-4dcc-8fbd-97541af9ac1a">Healthcare exits on the horizon</h2>In the three years since 2021's healthcare funding boom — during which <a target="_blank" class="" href="https://rockhealth.com/insights/2021-year-end-digital-health-funding-seismic-shifts-beneath-the-surface/#:~:text=And%20while%20some%20of%20the,peak%20of%20eight%20in%202020.">21</a> healthcare startups went public — <a target="_blank" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">only four</a> digital health startups have gone public in total, with mixed success.A number of healthtech startups have been waiting on the sidelines for their chance to IPO — and Trump's election should boost their odds, healthcare investors told BI.The lower corporate taxes and deregulation a second Trump term could promise are already amplifying public market optimism. A number of tech and finance giants, from Tesla to JP Morgan Chase, saw their stocks soar Wednesday morning. By midday Friday, the S&amp;P 500 index had risen 3.6% from Tuesday's close.Some startups, including physical therapy startup <a target="_blank" href="https://www.businessinsider.com/hinge-health-s-1-morgan-stanley-ipo-2024-9">Hinge Health </a>and diabetes startup <a target="_blank" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">Omada Health, have already signaled their intentions to IPO when the digital health markets reopen.</a>Several other late-stage startups are moving towards the exits, too. <a target="_blank" href="https://www.businessinsider.com/mavens-cfo-out-as-womens-health-startup-gets-fresh-funding-2024-10">Maven replaced its chief financial officer</a> in October with an executive with public market experience, BI reported. Sword Health has said it's planning to IPO <a target="_blank" href="https://www.axios.com/pro/health-tech-deals/2024/06/04/sword-healths-road-to-ipo">as soon as the second half of 2025</a>.<div type="image" title="Sean Duffy Omada" height="1880" width="2507" msid="115114964" hostid="261" sizebytes="278880"></div>The healthcare M&amp;A market looks ripe for more activity. Big deals could be on the horizon, including the proposed mega-merger of health insurance rivals Cigna and Humana. Bloomberg reported in October that the insurers had <a target="_blank" href="https://www.bloomberg.com/news/articles/2024-10-18/cigna-resumes-merger-discussions-with-humana-after-talks-ended-last-year">resumed talks of combining</a> after previously shelving the deal last December.The Cigna-Humana merger was expected to face significant antitrust scrutiny from the Federal Trade Commission, <a target="_blank" class="" href="https://www.businessinsider.com/openness-in-ai-is-necessary-ftc-lina-khan-2024-7">led by Lina Khan</a> since 2021. She could be removed as the FTC's head early in Trump's second term — and with relaxed M&amp;A regulations, "anything is possible," said What If Ventures founder Stephen Hays.Investors said they also expect to see <a target="_blank" href="https://www.businessinsider.com/big-deals-coming-healthcare-startups-take-privates-private-equity-2024">increased private equity involvement in healthcare</a> through more investments and acquisitions. Healthcare VC has been calling for consolidation in overcrowded areas of healthcare <a target="_blank" href="https://www.businessinsider.com/13-mental-health-startups-ipo-acquisition-merge-buyout-2024-5">like behavioral health</a> for years. Additional interest rate cuts could help facilitate PE-backed mergers, or even rollups of multiple solutions, in the many fragmented areas of digital health and healthcare services, said a Boston-based healthcare investor.<div type="image" title="Cigna insurance" height="2672" width="3563" msid="115114973" hostid="261" sizebytes="1378900"></div><h2 id="8fd35f3b-b1b9-4ac8-ab08-0143afe9541f">Reverberations in women's health and Medicaid</h2>While healthcare investors remain optimistic about what a second Trump term could mean for late-stage startups, VCs said his win could have consequences for key areas of the industry.Reproductive rights remained a top concern throughout the election cycle. Founders of women's health companies and their investors previously expressed concerns to Business Insider about <a target="_blank" href="https://www.businessinsider.com/womens-health-startups-risk-trump-wins-election-2024-10">what a second Trump term could mean for their businesses</a>.While Trump has said he wouldn't sign off on a national abortion ban, experts have <a target="_blank" href="https://www.cnbc.com/2024/11/07/how-trumps-victory-could-change-abortion-rights-in-america.html">raised worries</a> that the president-elect could impose more restrictions on birth control access and abortion pills delivered by mail. Demand for abortion pills, emergency contraception, and related treatments <a target="_blank" href="https://www.theguardian.com/us-news/2024/nov/07/abortion-pills-hormones-trump">exploded on Wednesday</a> as patients rushed to stockpile the drugs in fear of potential restrictions.In the wake of the election, women's health investors are dismayed but hopeful that the sector will largely remain untouched by federal policy changes and that VCs will be able to use their capital to push care forward even in the face of policy threats."In our conversations with others, there is a shared resoluteness to continue to pledge investment and develop innovation in historically underfunded categories (e.g. contraception &amp; abortion access, menstruation &amp; hormonal health, maternal health &amp; fertility, menopause &amp; aging)," said Carli Sapir, the founding partner of Amboy Street Ventures, in an email to Business Insider. "Every dollar and ounce of effort toward these areas now speaks volumes for future impact."<div type="image" title="an abortion rights protest sign reading &quot;stars, stripes and reproductive rights&quot;" height="683" width="911" msid="115114963" hostid="261" sizebytes="45906"></div>Medicaid could also be targeted in Trump's second term. Experts think Trump could <a target="_blank" href="https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146">cut Medicaid funding</a> and enable states to refuse to expand their Medicaid coverage. Those changes could impact dozens of <a target="_blank" href="https://rockhealth.com/insights/unwinding-the-opportunity-medicaids-digital-health-moment/">startups innovating in Medicaid</a>, as well as the millions of patients covered under Medicaid plans, said Jordan Nof, a cofounder and managing partner at Tusk Venture Partners.And if the House of Representatives goes red along with the Senate, experts expect the subsidies that help people pay for health insurance under the Affordable Care Act <a target="_blank" href="https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146">to disappear after they expire at the end of 2025</a>. Without those subsidies, tens of millions of people will see their premiums significantly increase, potentially making coverage prohibitively expensive for many.If fewer patients can afford to be insured, the healthcare system is certain to see <a target="_blank" href="https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/#:~:text=Because%20people%20without%20health%20coverage,declines%20in%20their%20overall%20health.">rising spend</a> associated with increased hospitalizations from otherwise avoidable health problems — a consequence with far-reaching implications across healthcare and the companies building in the sector.<h2 id="f1af4c00-342b-4f1b-b392-ccfc3d9c72fa">A boon for healthcare AI and Medicare Advantage</h2>Trump's victory could have a positive impact on several big areas of healthcare investment.For one, Trump is expected to restrict the government's involvement in AI regulation. That means AI companies, <a target="_blank" href="https://www.businessinsider.com/22-most-promising-healthcare-ai-startups-2024-8">including healthcare AI companies, will keep soaring</a> with fewer guardrails.Without federal AI safety efforts, the healthcare industry will likely move to self-regulate new technologies, especially in more contentious areas like clinical decision support, Flare Capital Partners' Greeley said. Some of those efforts are already underway, including by groups like the <a target="_blank" href="https://www.politico.com/newsletters/future-pulse/2024/10/18/ai-self-regulation-comes-into-view-00184268">Coalition for Health AI</a>, which includes top academic medical centers like Mayo Clinic and Johns Hopkins Speaker alongside tech companies like Microsoft.Still, "there'll be temptations around the margins to more rapidly deploy technologies that aren't yet determined to be safe," Greeley said.<div type="image" title="Dr. Shiv Rao, CEO of Abridge" height="2268" width="3024" msid="115114962" hostid="261" sizebytes="233874"></div>Medicare Advantage plans are also expected to be boosted by a returning Trump administration that's likely to move to further incentivize commercial health insurance. That could be good for the few <a target="_blank" href="https://www.businessinsider.com/alignment-healthcare-devoted-health-startups-medicare-advantage-membership-market-2024-2">young insurers clamoring for market share in Medicare Advantage</a>, like Devoted Health and Alignment Healthcare, and the many startups working to <a target="_blank" href="https://www.businessinsider.com/exclusive-ai-cohere-health-raises-50-million-series-b-extension-2024-1">improve payment processes</a> between insurers and providers. (An increased share of Medicare Advantage plans in the Medicare market might not be good for patients, however, since Medicare Advantage plans <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743">deny claims more frequently</a> than traditional Medicare.)And while Robert F. Kennedy Jr's potential appointment to a key health role in the Trump administration <a target="_blank" href="https://www.pbs.org/newshour/show/health-officials-concerned-about-rfk-jr-s-influence-in-trump-administration">worries some healthcare experts</a>, his focus on "food as medicine" could yield some interesting federal projects and perhaps add momentum to the <a target="_blank" href="https://rockhealth.com/insights/an-apple-a-day-but-keep-the-doctor-in-play-a-primer-on-food-as-medicine-trends-solutions-and-business-models/">nutrition startups gaining traction</a>, said Chrissy Farr, a managing director at Manatt, Phelps and Phillips, and a general partner at Scrub Capital."He's been given carte blanche, apparently, to take this on. Coupled with GLP-1s, I could see America really doing something interesting around food in the next couple of years," Farr said.

Healthcare investors are torn on Trump's second term

New Delhi [India], July 11 (ANI): <keyword id="21467964" type="General" weightage="20" keywordseo="Indegene" source="keywords" meta.keywordsubtype="org" meta.entityname="Indegene" meta.hostid="266" meta.entityid="Indegene">Indegene</keyword> partnered with <keyword id="19895622" type="General" weightage="20" keywordseo="Microsoft" source="keywords" meta.keywordsubtype="org" meta.entityname="Microsoft" meta.hostid="266" meta.entityid="Microsoft">Microsoft</keyword> on Thursday to leverage <keyword id="19896272" type="General" weightage="100" keywordseo="Generative-AI" source="keywords">generative AI</keyword> for the <keyword id="21988347" type="General" weightage="20" keywordseo="medical-industry" source="keywords">medical industry</keyword>, the company informed the exchange in a filing. The partnership aims to help empower global <keyword id="19992819" type="General" weightage="20" keywordseo="life-sciences" source="keywords">life sciences</keyword> companies to scale up the adoption of enterprise-grade Generative <keyword id="6355999" type="General" weightage="20" keywordseo="AI" source="Orion">AI</keyword> (GenAI) services, driving faster innovation. Indegene provides digitally enabled commercialization services for the life sciences sector, emerging biotech, and medical device firms. "GenAI presents a once-in-a-decade opportunity for life sciences companies to modernize business processes and reimagine the effectiveness and efficiency of their operations throughout the value chain. Using GenAI, we're closely working with many of our clients to solve specific business problems, with nearly 50 real-world use cases already in an advanced pilot stage", said Tarun Mathur, CTO, of Indegene. Both companies have committed to developing resources in highly specialized medical and technology tools to co-innovate generative <keyword id="20411515" type="General" weightage="20" keywordseo="AI-services" source="keywords">AI services</keyword> and workflows across commercial, medical, regulatory, and clinical functions. "With a focus on the right use cases, a responsible and compliant approach to scaling up, and shared learnings, we put generative AI to work for our clients", added Tarun. Under the agreement, one of the key initiatives is the Content Super App, which uses Azure OpenAI Service. This modular content value chain simplifies content creation and tagging for life sciences companies, offering a comprehensive view of the content process. It enhances content creation speed, personalizes content, and introduces new conversation formats. Additionally, it streamlines creative and video transformation, effectively engaging healthcare professionals, patients, and payers. Generative AI capabilities are also revolutionizing the medical content value chain. Indegene's solutions accelerate the authoring of key documents like Clinical Study Reports (CSRs) and Protocols by sourcing content from relevant literature. This ensures compliance across clinical and regulatory domains. "Generative AI is profoundly shaping every industry, including life sciences, by offering unprecedented avenues for <keyword id="21146848" type="General" weightage="20" keywordseo="healthcare-technology" source="keywords">healthcare technology</keyword> advancements. According to a Microsoft-commissioned study conducted by IDCi, a staggering 79 per cent of healthcare organizations have now embraced AI. This demonstrates that the tangible business value of this transformation is indisputable" said Alok Lall, Chief Operating Officer, Microsoft India &amp; South Asia. In terms of data management and analytics for clinical trials, Indegene's solutions, using Microsoft Fabric, enhance data ingestion and refinement processes. It also facilitates effortless reporting and ensures governance. The company added that the agreement results in proficient analytics, compliance adherence, and agility in business operations, providing a competitive advantage in the marketplace.

Indegene ties up with Microsoft to leverage generative AI for the Medical Industry, drive faster innovation

<ul class="summary-list"><li>I've lived in Canada for over a decade, and though it's not perfect, I prefer it to the US.</li><li>I've had major surgery and dealt with long COVID for years and haven't paid a cent for healthcare.</li></ul>When my partner was offered a job in <a target="_blank" class="" href="https://www.businessinsider.com/why-toronto-best-city-quick-trip-things-to-do-skip-2024-10">Toronto</a> 13 years ago, we felt like we'd won the lottery.We were living in the Midwest, where people stared at us as if they'd never seen a multiracial couple before and <a target="_blank" href="https://www.businessinsider.com/cosmopolitan-jessica-pels-career-advice-how-to-get-dream-job-2020-4">Cosmopolitan magazine</a> was covered with black plastic in the supermarket because it was too racy.We'd long wanted to live somewhere more diverse and walkable, with less violence. Settling in downtown Toronto — where we could walk or take <a target="_blank" class="" href="https://www.businessinsider.com/canada-via-rail-vs-amtrak-business-class-review-photos-2022-8">public transportation</a> and over half of the population was born outside Canada — was like being in a smaller, cleaner version of New York City.Add on the promise of Canadian healthcare, and we were close to nirvana.After living for more than a decade in Canada, we've come to realize that the <a target="_blank" class="" href="https://www.businessinsider.com/moving-to-canada-from-us-pros-cons-heathcare-home-prices">country is far from perfect</a>. But there are many factors that make it unimaginable for me to live in the US again.<h2 id="a284571f-bca4-4fba-a6f4-d7f8b2efefe7">Canada's healthcare system isn't perfect, but I prefer it to the US's</h2>Canadian healthcare has its downsides.While the majority of care is free, people typically have to pay out of pocket for prescriptions, <a target="_blank" class="" href="https://www.businessinsider.com/why-americans-dont-exercise-mental-health-crisis-depression-anxiety-fitness-2024-6">mental-health</a> care, and dental and vision care, which can make these services inaccessible to many.Despite that, I can't envision living without <a target="_blank" class="" href="https://www.businessinsider.com/dr-adam-kay-americas-been-gaslit-about-socialized-medicine-2019-12">socialized medicine</a> again. I had a complicated pregnancy and an emergency C-section and I developed long COVID four years ago, but I've never paid a cent for healthcare here.When I lived in the US, I worked in public health in California, helping uninsured families access care. I saw firsthand <a target="_blank" class="" href="https://www.businessinsider.com/how-get-medical-bills-reduced-negotiate-challenge-payment-plan-2024-9">how medical debt could ruin people</a>.There was also a brief time when I was in my 20s, before the Affordable Care Act, when I <a target="_blank" class="" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">lived without health insurance</a> in California and was terrified of getting injured and ending up with a huge hospital bill.<h2 id="82b9efcc-e263-4015-b997-fc1d979a471a">Traveling in Canada can be more expensive, but we've found ways to manage</h2><div type="image" title="landscape of Canada's Laurentian Mountains" height="3840" width="5760" msid="115259769" hostid="261" sizebytes="1759662"></div>Because of <a target="_blank" href="https://nationalpost.com/news/canada/airlines-fees-canada">federal regulations</a>, domestic flights in Canada are often more expensive than flights to the US. However, we've found ways to manage by coordinating work trips and visiting friends.<a target="_blank" class="" href="https://www.businessinsider.com/beautiful-natural-wonders-2018-7">Canada's nature</a> is one of our favorite aspects of living here. We've vacationed across the country, but we have a special fondness for Québec's Laurentian Mountains and the forests of Ontario.We also spent months in the Yukon subarctic, where we glimpsed a grizzly bear, lynx, moose, scores of ravens, and wilderness more pristine than I thought possible.<h2 id="001263da-7c4c-4498-aabe-c1e9c7dbf46c">We love the diversity in Toronto, but we have experienced racism</h2>My husband and I found friends through community groups and parent-and-baby classes with other immigrant parents. Our friends are from all over, including Nigeria, Russia, Pakistan, Mexico, China, and Peru.Living in such a global environment is simply second nature for our Canadian-born child, who became trilingual in kindergarten in a public French school.However, immigrants and people of color aren't always treated kindly, despite Canada having had an official <a target="_blank" href="http://pier21.ca/research/immigration-history/canadian-multiculturalism-policy-1971">multiculturalism policy</a> since 1971.My Afro-Latino partner often laments the racism he's experienced in Canada, which has been more directly harmful to him than the racism he experienced in the United States.For example, he sold his bike after nearly being hit by drivers so many times, including one who told him to get off the road before calling him the N-word.When he does porch drop-offs of kids' items I've sold on Marketplace, he gets followed and questioned by people who act like he's a thief.And when we renewed his employer-sponsored work permit at the border a decade ago, an immigration official grilled him and said, "Couldn't they find a Canadian for the job?"In part because of those experiences, my husband has felt compelled to connect even more with different BIPOC communities in Canada.After we moved here, he found out about his Indigenous Caribbean ancestry through genetic testing, and it has become an extremely important part of our experience as a family to educate ourselves about Indigenous people's histories, lives, and teachings. We see it as one of our responsibilities as settlers.<h2 id="859b0674-9e41-4b48-abbc-f3eccee0cca8">I prefer living in Canada to the United States</h2><div type="image" title="Canadian flag with Toronto skyline in the background" height="3744" width="5616" msid="115259767" hostid="261" sizebytes="940328"></div>The longer I live here, the less I feel like I belong when I travel back to the US.My family inhabits multiple marginalized identities — queer, <a target="_blank" href="https://economichardship.org/2023/04/the-disabled-tax-means-i-pay-extra-for-necessities-constantly/">disabled</a>, immigrant, and BIPOC — that are under attack in the US. The ability to live and thrive outside the US, with free healthcare to boot, has long made me feel survivor's guilt for enjoying that stability.There are trade-offs to Canadian life: <a target="_blank" class="" href="https://www.businessinsider.com/canada-housing-crisis-bubble-imploding-real-estate-prices-rent-decline-2023-11">Astronomical housing costs</a> caused by foreign investment and government policy make me worry that when my child is an adult, they won't be able to afford rent, much less buy a home.I'm also disabled and cannot work full time. If I'm ever without my partner's financial support, I wouldn't qualify for or be able to live on my province's <a target="_blank" href="https://www.tvo.org/article/people-cant-live-on-dirt-disabled-ontarians-push-for-odsp-reform">paltry disability benefits</a>.In the end, it's a balancing act.I will forever follow events in American society and politics, even when I someday become a Canadian citizen. But for my family's safety and health, there's no going back.

My husband and I moved from the US to Canada 13 years ago. We love the free healthcare here and the great friends we made.

<ul class="summary-list"><li>The healthcare market looks nearly ready for the next wave of IPOs.</li><li>Barclays' Jon Swope says IPO hopefuls should prepare by increasing the awareness of their companies.</li></ul>It's been a rough few years for healthcare initial public offerings. But the next wave of public healthcare companies looks to be on the horizon.At least two healthcare companies are considering public-market debuts in the not-so-distant future. The diabetes startup <a target="_blank" class="" href="https://www.businessinsider.com/exclusive-omada-health-confidentially-filed-s1-ipo-public-2024-10">Omada Health confidentially filed its S-1 this summer</a>. And the physical-therapy startup <a target="_blank" class="" href="https://www.businessinsider.com/hinge-health-s-1-morgan-stanley-ipo-2024-9">Hinge Health has hired banks including Barclays</a> as it prepares to file its S-1 confidentially.Hinge and Omada likely aren't the only healthcare companies <a target="_blank" class="" href="https://www.businessinsider.com/healthcare-startups-ipo-public-markets-reopens-2024-1">weighing an IPO as market conditions improve</a>.Jon Swope, a managing director in Barclays' healthtech division, told me he expects a pickup in healthcare IPOs in 2025 after a three-year drought.<div type="image" title="A headshot of Jon Swope." height="1200" width="846" msid="114356715" hostid="261" sizebytes="24914"></div>I spoke with him about what the next wave of healthcare IPOs could bring — and which healthcare startups are in the best position to test the public markets.The following has been edited for clarity and length.In the past few years there have been a number of take-privates and near-delistings in healthcare, as well as plenty of healthcare companies that have otherwise struggled in the public markets. What can we learn from those companies' challenges, and how might they impact the next round of healthcare IPOs?The whipsaw of the public markets over the last five years has created a challenging backdrop, even with the overall market improving.From 2019 through 2021, nearly 20 companies went public through IPOs or SPACs in healthtech. At its peak, the total market cap for healthtech and digital health was over $300 billion. Through both take-privates and declines in share prices, that's down to just about $90 billion.Large take-privates like Change Healthcare, Nuance, Cerner, Inovalon, and others are part of the story. The other part is that, on average, the companies that went public or were already public are down by about 80% — names like Teladoc, Accolade, and Health Catalyst.The enthusiasm that supported the last wave, with respect to the positive and innovative business models in healthtech and digital health, is not gone. It's just that these companies haven't been able to achieve growth with profitability. When there's a next set, there's going to be more of a focus on growth and profitability.You see that in the IPOs that happened this year: Waystar and Tempus. Waystar is large-scale, profitable, with growth, and Tempus has the promise of AI, high growth, and emerging profitability. Both have performed since their public debut.In the private sphere, many investors have leaned away from healthcare services and into healthcare AI. What models do you expect the healthcare market to favor in this next round of IPOs?There are three general categories that are investible in healthtech and digital healthcare. One is simply data and then technology and healthcare. Healthcare is arguably two decades behind every other industry in the adoption of technology. Whether it's software, tech-enabled models, or, importantly, the data opportunity and AI opportunity, tech and data infrastructure for healthcare is No. 1.No. 2 is consumer-centric models, such as some B2B2C models, the employer and payer digital-health models, or even direct-to-consumer models. Look at <a target="_blank" class="" href="https://www.businessinsider.com/inside-hims-founders-journey-to-go-public-via-spac-2021-1">the performance of Hims</a>, which has emerged from its post-SPAC purgatory.Consumer-centric healthcare is the future of healthcare, and it's becoming more of our collective reality. The companies with consumer-centric business models that deliver longitudinal engagement and outcomes, financial and clinical, for consumers and the payers of healthcare, both employers and insurance companies, are certainly on the list.No. 3 is value-based care. Much has been made of that as a category, tying together costs and outcomes. And while some of the brick-and-mortar value-based care companies have had their own challenges, support for the adoption of value-based care by providers will continue to be where healthcare is going.Are there models in healthcare that you think are perhaps not the best fit for the public markets right now?The less complex the elevator pitch, the better. While I can't say there's a model that's not a fit, what we heard from investors as things were bending in the wrong direction last boom cycle was: "Wait, what did I just buy? I'm not sure I fully understand this company's business model."Now you have to juxtapose that against the reality of healthcare, which is complex. So it's companies that can articulate a clear and simple story while also navigating the layers of the healthcare ecosystem in executing on their business model.That includes riding the existing rails. In the last five-plus years we've seen companies figuring out how to work with the payers and providers that make up the healthcare ecosystem to bring innovation and disruption to how we experience healthcare.Given the major slowdown in SPAC deals in the past few years and Nuvo's poor performance (<a target="_blank" href="https://www.bloomberg.com/news/articles/2024-08-22/newly-public-pregnancy-care-firm-nuvo-files-for-bankruptcy">and bankruptcy</a>) this year, could we see more SPAC deals for healthcare startups next year?It's a four-letter word for the foreseeable future. I imagine there will be SPACs created, and there are still others that haven't run out of time, but it's unlikely that we see companies using that vehicle that could go public the regular way.For startups that don't go public, will we see M&amp;A pick up in 2025? With large retailers like Walmart pulling away from healthcare, who are the potential buyers?M&amp;A is picking up already, as evidenced by volume this year, and it will continue to, particularly in an easing financing environment and macro backdrop where bid-ask spreads are narrowing.The consolidation activity is in three categories. First, there are the large-cap consolidators including retailers, payers, and Big Tech. There will be deals there, but there are only so many that will be done by that group, which is not much more than a dozen companies.The next is large-cap, and often private-equity-backed, healthtech consolidators. A number of them are private and will continue to be buyers.The third category is just smaller mergers of equals. Especially for enterprise sales, selling into payers or selling to providers, scale matters, and so size matters. We'll see small companies merge with other small companies to get there.Anything else startups should know that might impact this next cycle of IPOs?While these companies that went public in the last cycle may not have fulfilled their promises, they set the stage for an attractive IPO market by going public the right way — executing on the business and growing it, and increasing awareness around the company well in advance of an IPO.At the back end of the last boom wave there was a rush to go public, and SPACs were examples of that. I think that in the 2025, 2026, and 2027 IPO classes, there will be a number of companies that think about it the right way, not rushing to get to the public market.

2025 could bring a wave of healthcare IPOs. Here's what startups should know, according to a top banker.

<ul class="summary-list"><li>George, an American, works in Germany but will move back to the US to retire and collect Medicare.</li><li>He wants to retire in the US because he believes the healthcare options are better for him.</li></ul>After a decade of working abroad, George said he'll return to the US to retire.George, 65, is an American living in <a target="_blank" class="" href="https://www.businessinsider.com/american-living-in-germany-difficult-place-to-live-perks-2024-6">Munich</a>. He plans on working two or three more years before returning to Seattle, where he lived before moving abroad.George is a "<a target="_blank" class="" href="https://www.businessinsider.com/how-retirement-of-peak-boomers-could-affect-economy-social-security-2024-4">peak boomer</a>," meaning he's part of the "largest and final cohort" of baby boomers to turn 65 this year and enter retirement age, according to a <a target="_blank" href="https://www.protectedincome.org/peak65-economic-impact-forum/">report</a> from the Alliance for Lifetime Income's Retirement Income Institute. Many peak boomers are getting strategic about their retirement strategies and when they would <a target="_blank" class="" href="https://www.businessinsider.com/boomer-waiting-collect-social-security-higher-benefit-retirement-no-savings-2024-7">start collecting Social Security benefits</a> in the hopes of getting more bang for their buck. George is one of those individuals: he plans on retiring when he's 67 or 68 to get his <a target="_blank" class="" href="https://www.ssa.gov/benefits/retirement/planner/agereduction.html">full Social Security benefits</a>, which for him, will start when he's 66 and 10 months.Additionally, America's <a target="_blank" class="" href="https://www.businessinsider.com/trump-cutting-medicare-social-security-benefits-2024-3">Medicare benefits</a> and being near family are factors driving his decision to <a target="_blank" class="" href="https://www.businessinsider.com/reverse-culture-shock-moving-back-to-america-asia-singapore-2023-12">retire in the US.</a>"I don't see myself staying here permanently when I have family back home," said George, who asked to use his middle name due to privacy concerns. "Even outside of Medicare, I just feel that healthcare is better," he said.George hasn't given up his American citizenship, and his wife, who lives in Germany with him, is a citizen of the Philippines. He's on a work visa and files with insurance to access Germany's national healthcare services.While he said the healthcare system is great on average, it's becoming more difficult to manage the bureaucracy of insurance filings as an American abroad. That headache could grow even more tedious as he gets older and will likely need more care.George had surgery on one knee in 2015 and is trying to schedule surgery on his other knee for this fall. But, he said he is facing hurdles, such as certain rehabilitation hospitals opting not to treat US citizens for insurance concerns. It makes him even more eager to return to the US."You spend a lot of spare time working things out that are so much easier in the US, especially if you're on Medicare," he said. "You just want to go back home so you don't have to deal with it all."George shared the differences between living in America and Germany, and which aspects he's not ready to give up as he prepares to move back.<h2 id="2676068a-b627-4fa0-a3b6-cf4eccd4301a">The ease of traveling through Europe makes up for the healthcare headaches</h2>George has worked as an engineer at the same company for over 30 years and began taking small work trips overseas in the 2000s. For privacy reasons, he asked not to disclose the company's name.He moved to Saudi Arabia in 2014 to work on overseas projects for a US company. In 2017, he transferred to Munich for a new project, where he's been living ever since.George said many aspects of life in Munich are preferable to the US, including less <a target="_blank" class="" href="https://www.healthdata.org/news-events/insights-blog/acting-data/gun-violence-united-states-outlier">gun violence</a> and the beauty of the Alps in his backyard. He also said the <a target="_blank" class="" href="https://www.businessinsider.com/german-vs-american-work-life-differences-according-to-us-mom-2024-4">quality of life</a> is better for him, particularly because it's a <a target="_blank" class="" href="https://www.timeout.com/news/this-european-city-has-been-named-the-worlds-most-walkable-041224">walkable</a>, cycle-friendly city.He lives in a rented apartment with his wife near the English Garden, a 375-hectare public park packed with architectural sights and a beer garden. He said it's one of the aspects of the city he'll miss the most.Germany's infrastructure is also <a target="_blank" class="" href="https://www.usnews.com/news/best-countries/rankings/well-developed-infrastructure">better</a> compared to the US, George said, including the transportation system. "You can pretty much get anywhere by train or bus within Germany," George said.However, one of his favorite trips is driving south of Germany through the Dolomite Mountains in Italy."There is nothing, in my opinion, like a drive from Germany to Italy," George said. "Those kinds of things I'll miss the most."George said he's enjoyed learning about the cultural quirks of Germany, like Steckerlfisch, a roasted fish often served as a street food. He said he enjoys people-watching and drinking German beer — hefeweizen in warmer and pilsner in cooler seasons.He also enjoys working with people from around the world and appreciates the international atmosphere in the office.<h2 id="80fc0376-1e4a-4898-bc84-a4f6c384325c">Cost of living in Munich</h2>George said German consumers are still managing the effects of <a target="_blank" class="" href="https://www.reuters.com/markets/europe/german-inflation-confirmed-28-may-2024-06-12/">cooling inflation</a>, similar to Americans. Additionally, the main cost of living concern in Munich is <a target="_blank" class="" href="https://www.bloomberg.com/news/articles/2023-07-19/berlin-and-munich-face-rent-surge-as-buying-becomes-costlier">housing</a>.He said utilities are particularly expensive, and he's seen an uptick in electricity and gas <a target="_blank" class="" href="https://www.imf.org/en/Publications/selected-issues-papers/Issues/2023/07/24/Impact-of-High-Energy-Prices-on-Germanys-Potential-Output-536837">prices</a> since the COVID-19 pandemic and Russia's invasion of Ukraine.However, day-to-day food at the grocery store is relatively cheaper than what he'd buy in the US.George said he does miss things about the US, like the quality of red meat he'd buy at the supermarket. He said the US has more variety and more goods imported from countries around the world, particularly when it comes to seasonal produce.One of the best aspects of Munich is the ease of flying internationally, George said."Living here, it's easy to travel to these other places because it's as if you're traveling from New York to Chicago," George said. "I can go for a weekend to Mallorca or Sicily or Dubai."Before he retires to the US, he said he'll try to appreciate all the perks of living abroad."I'm able to travel and enjoy that right now," George said. "I am not ready to give that up yet."Are you an American living or working abroad and considering retiring in the US? Have healthcare concerns influenced your decision to move abroad? This reporter wants to hear from you. Please reach out at <a target="_blank" class="" href="mailto:jtowfighi@businessinsider.com">jtowfighi@businessinsider.com</a>

A 'peak boomer' working in Germany plans to retire in the US because he believes the healthcare is better 

<ul class="summary-list"><li>It can feel like AI chatbots are everywhere, from <a target="_blank" class="" href="https://www.businessinsider.com/ai-dating-chatbots-replika-rizz-how-to-use-2024-4">dating apps</a> to <a target="_blank" class="" href="https://www.businessinsider.com/cvs-pharmacy-use-ai-customer-service-call-centers-tilak-mandadi-2024-6">customer service</a>.</li><li>"Botshit" describes inaccurate or fabricated info produced by chatbots that humans use for tasks.</li></ul>When Jake Moffatt's grandmother died in 2022, he booked a <a target="_blank" href="https://www.businessinsider.com/airline-ordered-to-compensate-passenger-misled-by-chatbot-2024-2">flight</a> to her funeral on Air Canada, hoping to use their bereavement travel discounts.Air Canada's customer service chatbot told Moffatt he could claim the discount after the flight. Yet, the company later denied his discount request because they said it had to be filed prior to the flight.In February, Canada's Civil Resolution Tribunal — an online platform to resolve disputes — ruled that Air Canada's chatbot had misled Moffatt and ordered the airline to compensate him for the discount.The chatbot misleading Moffatt with false information is an example of "botshit," which describes incorrect or fabricated information produced by <a target="_blank" class="" href="https://www.businessinsider.com/how-ai-chatbots-like-chatgpt-work-explainer-2023-7">chatbots</a> that humans use to complete tasks.Researchers Ian P. McCarthy, Timothy R. Hannigan, and André Spicer coined the term in a paper published in January and a July 17 <a target="_blank" class="" href="https://hbr.org/2024/07/the-risks-of-botshit">Harvard Business Review article</a>.Botshit is one example of how the use of AI might worsen companies' customer service. As businesses employ <a target="_blank" class="" href="https://www.businessinsider.com/companies-using-ai-bain-survey-roi-2024-6">generative AI</a>, the researchers said employees must be more critical in managing chatbot-generated responses.<h2 id="4e8446af-2884-470d-8291-77bffb7a99ce">AI is here to stay, but chatbots keep spewing botshit</h2>The use of generative AI in the <a target="_blank" href="https://www.businessinsider.com/chatgpt-gpt-4o-productivity-hacks-for-work-2024-7">workplace</a> has nearly doubled in the past six months, according to a survey of 31,000 global workers conducted between February and March by the research firm Edelman Data and Intelligence. The results were published on May 8 by <a target="_blank" class="" href="https://affiliate.insider.com?h=1276ca41485b68659b6ade9ae14b644ef6e852268612e9f2de3850b3950d0ef2&amp;postID=66994630c79d31931d7b6d84&amp;postSlug=ai-chatbots-bad-customer-service-botshit-inaccurate-information-airlines-accountability-2024-7&amp;site=bi&amp;u=https%3A%2F%2Fwww.microsoft.com%2Fen-us%2Fworklab%2Fwork-trend-index%2Fai-at-work-is-here-now-comes-the-hard-part">Microsoft and LinkedIn</a>.What's more, 79% of business leaders said their companies must adopt AI to remain competitive.According to economist Dan Davies, companies <a target="_blank" class="" href="https://www.businessinsider.com/flight-refunds-customer-service-accountability-sinks-dan-davies-2024-7">employ technology</a> like AI and chatbots to streamline decision-making and optimize efficiency. Over the past decade, <a target="_blank" class="" href="https://www.businessinsider.com/chatbots-are-gaining-traction-2017-5">chatbots have proliferated</a> as a customer service feature for businesses.However, that can also lead to situations where no one employee is accountable for an algorithm going awry.For example, <a target="_blank" href="https://www.businessinsider.com/chatgpt-may-provide-false-answers-to-medical-questions-study-2023-12">researchers</a> in 2023 found that about 75% of ChatGPT responses to drug-related questions were often inaccurate or incomplete. Additionally, when asked, ChatGPT generated fake citations to support some of its inaccurate responses.In January, a UK parcel company <a target="_blank" href="https://www.businessinsider.com/parcel-delivery-firm-pr-nightmare-ai-chatbot-cusses-mocked-company-2024-1">removed</a> its new AI customer service chatbot after it swore at a customer.And when Google <a target="_blank" class="" href="https://www.businessinsider.com/google-gemini-woke-images-ai-chatbot-criticism-controversy-2024-2">rolled out</a> its AI chatbot Gemini earlier this year, it produced historically inaccurate <a target="_blank" class="" href="https://www.businessinsider.com/google-gemini-ai-pause-image-generation-people-woke-complaints-2024-2">images of people of color</a>. The company paused and then relaunched the chatbot's image-generation tool after <a target="_blank" class="" href="https://www.businessinsider.com/google-gemini-woke-images-ai-chatbot-criticism-controversy-2024-2">public backlash.</a>In a February <a target="_blank" class="" href="https://www.businessinsider.com/google-gemini-bias-sundar-pichai-memo-2024-2">memo</a> to employees, Google CEO Sundar Pichai said the chatbot's responses were "unacceptable" and the company had "got it wrong" when trying to use new AI.McCarthy, Hannigan, and Spicer wrote in the July 17 article that businesses that carelessly use AI-generated information jeopardize their customer experience and reputation, going as far as risking legal liability."Managers and organizations are beginning to see an increasing array of new risks based on expectations and professional standards around the accuracy of information," the researchers wrote.Still, they wrote that they believe AI provides opportunities for useful application "as long as the related epistemic risks are also understood and mitigated."<h2 id="d215ff9c-5975-4514-aead-73f48b3a8f30">Black boxing and the risks of using AI</h2>The biggest challenge associated with using AI chatbots for customer service is "black boxing," in which it becomes difficult to discern why an AI technology operates a certain way, according to the researchers.McCarthy, Hannigan, and Spicer wrote that AI customer service chatbots can be improved through more rigorous and specific guidelines, guardrails, and restrictions on the available range of vocabulary and response topics.However, the researchers argued that customer service is the least risky use of AI for businesses.Using AI chatbots for tasks like safety procedures in healthcare, complicated financial budgeting, or legal judgments are cases where it's most essential the AI is accurate, but it's most difficult to verify in real time, according to the researchers.In 2023, a New York law firm <a target="_blank" class="" href="https://www.businessinsider.com/chatgpt-generative-ai-law-firm-fined-fake-cases-citations-legal-2023-6">was fined $5,000</a> after lawyers submitted a court brief containing <a target="_blank" class="" href="https://www.businessinsider.com/lawyer-duped-chatgpt-invented-fake-cases-judge-hearing-court-2023-6">false references</a> produced by ChatGPT.While general AI chatbots like ChatGPT are more susceptible to botshit, practice-specific chatbots that use <a target="_blank" href="https://www.businessinsider.com/retrieval-augmented-generation-making-ai-language-models-better-2024-5">retrieval augmented generation</a>, a technology that enhances AI accuracy, are more promising, according to the researchers.The researchers said that rigorous checking and calibration of the AI's output over time, including expert fact-checking of its responses, can mitigate risks."Chatbots and other tools which draw on generative AI have great potential to significantly improve many work processes," the researchers wrote. "Like any important new technology, they also come with risks. With careful management, however, these risks can be contained while benefits are exploited."

'Botshit' is an example of how AI is making customer service worse 

Inside a prison healthcare company's ownership shell game

<ul><li>41% of all profiles have less than a 5% pay difference between compensation structures for permanent and temporary roles. </li><li>In FY23, salaries grew by a minimum of 3.20% and a maximum of 10.19% across industries.</li><li><keyword id="6354525" type="General" weightage="80" keywordseo="healthcare" source="Orion">Healthcare</keyword> and allied industries experienced a growth rate of 20.46% in average salary in the last 5 years.</li></ul>Average salary growth dipped in FY23 as tougher economic conditions took its toll. But the year also saw the emergence of a host of well-paying ‘hot jobs’ across several industries, as per the Jobs and Salary Primer Report for FY23, by human resource services provider <keyword id="6381892" type="General" weightage="80" keywordseo="teamlease-services" source="Orion">TeamLease Services</keyword>. Salaries grew by an average of 9% in FY23, a tad lower than the 10% seen a year earlier, the report says. Wages grew by a minimum of 3.2% and a maximum of 10.19% across industries in India last fiscal. Interestingly, the report found that 41% of all profiles have less than a 5% pay difference between compensation structures for permanent and temporary roles, indicating the growing parity of temporary employment. The demand for sales and IT roles remained consistently high as organisations persistently prioritise growth and digital transformation. <cmsannotation type="cmsannotation" annotationid="BFSI sees a notable decline in average salaries" comment="subhead" text="BFSI sees a notable decline in average salaries"><keyword id="6356925" type="General" weightage="80" keywordseo="bfsi" source="Orion">BFSI</keyword> sees a notable decline in average salaries</cmsannotation> In terms of average salary growth, Bengaluru stands out with an impressive growth rate of 7.79% compared to the previous year. Conversely, the banking, financial services, and insurance or BFSI sector experienced a notable decline in average salaries this year, following two years of steady growth. Nonetheless, the BFSI industry continues to generate a diverse array of in-demand job roles and is actively implementing strategies to optimise salary structures. Although there has been a decrease in average salaries within the telecom industry, the report emphasises a 10.19% wage increase for the relationship manager role, positioning it as the highest-paying job in the Bengaluru market. Similarly, the game developer role in the media and entertainment sector closely follows with a substantial hike of 9.3%, also in Bengaluru. Says <keyword id="1167128" type="General" weightage="80" keywordseo="kartik-narayan" source="Orion">Kartik Narayan</keyword>, CEO of staffing at TeamLease Services, "Due to socioeconomic factors like global layoffs and funding winter, median salary growth has been slightly lower than last year, yet as the Indian job market continues to evolve, we are seeing an influx of new job roles that have gained momentum from a salary perspective.” Over the past five years, there has been a double-digit growth in the average salary of five out of eight industries in the manufacturing sector and three out of nine in the servicing sector, the report says. Notably, healthcare and allied Industries experienced a growth rate of 20.46%, while education witnessed an impressive growth rate of 51.83%. However, industries such as hospitality, automobile and allied industries, e-commerce and tech startups, and media and entertainment have encountered a decline in average salaries. <cmsannotation type="cmsannotation" annotationid="‘Hot jobs’ on the rise" comment="subhead" text="‘Hot jobs’ on the rise">‘Hot jobs’ on the rise</cmsannotation> The job landscape has seen significant transformations with the emergence of new and exciting roles across industries. A significant number of industries surveyed have reported the emergence of highly sought-after ‘hot jobs’ that come with attractive salaries. Nearly half of these industries are also focusing on creating innovative positions that align with future needs. Out of the 17 industries surveyed, 11 have introduced new "hot jobs," while seven industries have introduced upcoming positions. These profiles include previously unheard-of roles such as Sr. Golang developer in the telecom industry, Sr. biostatistician in healthcare and pharmaceuticals, lead magento developer in e-commerce and tech startups, and robotics instructor in educational services. On the blue-collar side, popular profiles for 2023 include sales executive, electrician, AC technician and forklift operator. Moreover, there are several emerging job roles such as data science consultant in BFSI, media operations executive in <keyword id="34523" type="General" weightage="50" keywordseo="fmcg" source="Orion">FMCG</keyword>, DevOps engineer in IT and knowledge services, content specialist-game in media and entertainment, and <keyword id="5946911" type="General" weightage="50" keywordseo="emobility" source="Orion">eMobility</keyword> charging executive in automobile and allied industries, among others. These evolving job roles reflect the dynamic nature of the job market and the industry's response to technological advancements and changing needs.

Average salary growth dipped in FY23 but new hot jobs are emerging

<ul class="summary-list"><li>Jeffrey Park, 63, has worked in Germany since 2005 and plans to retire there.</li><li>Park is an example of an American who moved abroad as an empty-nester looking for new experiences.</li></ul>Jeffrey Park, 63, hasn't been to the US in 13 years and has no immediate plans to return.Park was born and raised in Baltimore, but his wife Kerstin is from Munich. After starting a family in the US, the duo settled in Germany in 2005. And Park said he's planning on retiring abroad.Park is an example of an <a target="_blank" class="" href="https://www.businessinsider.com/move-from-us-to-france-without-visiting-first-worth-it-2024-1">American who moved</a> abroad <a target="_blank" class="" href="https://www.businessinsider.com/empty-nester-traveled-alone-first-time-2023-8">as an empty-nester</a> looking for new experiences and job opportunities. While <a target="_blank" class="" href="https://www.businessinsider.com/baby-boomer-retire-medicare-benefits-living-abroad-germany-healthcare-2024-7">some Americans</a> are <a target="_blank" class="" href="https://www.businessinsider.com/boomer-military-veteran-raised-kids-germany-retired-texas-social-security-2024-8">returning to the US</a> for retirement, Park said he's certain he's retiring in Germany. He said the free public healthcare and quality of life are better than in the US.<h2 id="5414171f-4f3f-42f0-91f7-2585ddb42227">A stint in Germany sets the stage for later life</h2>As an undergraduate at the University of Pennsylvania in the early 1980s, Park met Kerstin, who is German and was visiting the US on vacation.Park took a break from college and lived with Kerstin in Munich in 1982 and 1983 before returning to the US to finish his studies. The two married in Baltimore in 1983.Park transferred to Johns Hopkins University and graduated with bachelor's degrees in English and German in 1986.At that time, Park and Kerstin had their first daughter. Park worked as a movie theater manager for a few years and then landed a job at Giant Food, a grocery store in the Baltimore area, where he worked for 13 years.In 2002, Park earned his Master's in education from Towson University in Maryland and taught English at a middle school for three years.In 2005, when Park and Kerstin's youngest daughter graduated from high school, they moved to Germany. Kerstin's family had lived in Munich, and their newly established empty nest made it easier to go abroad.<h2 id="4134d731-43d1-4c6c-bad9-28d6c8badcb7">Homeownership and renting in Germany</h2>Park and his wife moved abroad without job offers, but he said they found employment soon after arrival. Park found work as an English language coach, and Kerstin — who studied biology — found a job at the Gene Center Munich.They lived in Munich for nearly a decade, renting an apartment for the first five years. He said rent was about $720 (€650) a month. In 2010, they bought an apartment in Munich for about $243,850 (€220,000).Homeownership in German cities is rare compared to the countryside, Park said, and Munich is one of the <a target="_blank" class="" href="https://www.jll.de/en/trends-and-insights/research/housing-market-overview#:~:text=Munich%20remains%20the%20most%20expensive,cities%20are%20much%20more%20moderate.">pricier housing markets</a>.In 2014, Kerstin received a job opportunity at the Max Planck Institute in Göttingen, which is located in central Germany. They moved to Göttingen but still own and rent out their apartment in Munich. Today, Park works as an English lecturer at the University of Göttingen.<h2 id="6be99e2d-9786-49db-9e4b-f70e9ebd2f18">Life in a bucolic village near Göttingen</h2>After renting in Göttingen for four years, Park and his wife moved to Ebergötzen, a small village south of the city with a population of less than 2,000 people.Park said it's a beautiful, bucolic village, and he enjoys the outdoorsy lifestyle. When they moved to Ebergötzen in 2018, they bought a house for about $498,780 (€450,000).The property has a barn, pear trees, apple trees, and a walnut tree. The village has a great bakery and butcher shop, and things feel more calm than in the US, Park said."Everything's just a little bit more personal, or smaller, or a little bit old-fashioned, compared to American life," Park said.Park takes the bus to work daily, which he said runs every 30 minutes and is efficient — he said he hasn't driven a car in about 15 years.Attracted to Park's ease of life in Germany, his two daughters both moved to the country in the past decade. In fact, one daughter, her husband, and their three children live with Park and Kerstin in their house in Ebergötzen, along with three dogs, four guinea pigs, and chickens.<h2 id="adfb0d2e-e50e-4888-8d0e-d915da6f129a">Retiring in Germany for healthcare and quality of life</h2>In Germany, the mandatory retirement age for civil service workers depends on the year they were born. As a university teacher, Park's mandatory retirement will be in August 2027, when he will be 66 years old.He said his wife makes more than he does working in biology, and the couple feels financially stable. He said they hope to be able to pay off their mortgage on the Munich apartment and Ebergötzen house by the time he retires.As a US citizen with a permanent residence visa working at a public university, Park said the healthcare system is efficient and easy for him.He has a public healthcare insurance card and said he doesn't pay anything for care. While in Germany, Park broke his collarbone, had a cataract operation, and had a detached retina that required emergency surgery."In all three cases, there was not a single insurance form I had to fill out and zero out-of-pocket charges," he said. "As far as I can tell, the quality of care was just as good as I would have gotten in the US."Park also said he thinks Germany is better for raising a family than the US. He enjoys watching his grandchildren grow up bilingual, and he said Germany feels much safer than the US, particularly because there isn't the same level of fear around gun violence and <a target="_blank" class="" href="https://worldpopulationreview.com/country-rankings/school-shootings-by-country">school shootings</a>.Park retained his US citizenship and residency, so he's eligible for Social Security. Americans can claim Social Security at 62, but the extent of their benefits varies until they reach their full retirement age, which depends on a person's birth year. For Park, that will be 67. He said he is waiting to collect his benefits to earn the maximum amount.Park said he hasn't been to the US in over a decade because he's conscious of the carbon footprint of flying back and forth across the Atlantic and has plenty of travel options in Europe.His father, who is 97, lives in Baltimore and visits Park in Germany once a year.Park said that while he's lived abroad for nearly two decades, he certainly feels American. In fact, he enjoys sharing American culture with his students and neighbors in Germany.Are you an American who moved abroad? This reporter wants to hear your story. Please reach out at <a target="_blank" class="" href="mailto:jtowfighi@businessinsider.com">jtowfighi@businessinsider.com</a>

A baby boomer from Baltimore moved to Germany 19 years ago and plans to retire there. He says free healthcare and quality of life are better than in the US.

<keyword id="21692" type="General" weightage="100" keywordseo="Joint-pain" source="Orion">Joint pain</keyword> can be debilitating, affecting mobility, comfort, and overall quality of life. While medication and physical therapy are common treatments, your diet can also play a significant role in <keyword id="20951268" type="General" weightage="20" keywordseo="managing-joint-pain" source="Orion">managing joint pain</keyword>. Certain foods can either exacerbate inflammation or alleviate it, making dietary changes an essential aspect of <keyword id="20951267" type="General" weightage="20" keywordseo="joint-pain-management" source="Orion">joint pain management</keyword>. By adopting healthier food habits, you can potentially reduce inflammation, strengthen joints, and mitigate discomfort. Here's a guide on the dietary changes you should consider to tackle joint pain effectively. Reduce Inflammatory Foods Foods high in refined sugars, trans fats, and processed ingredients can promote inflammation in the body, worsening joint pain. Cut back on sugary snacks, processed foods, and fried items. Limit your intake of red meat and high-fat dairy products, which can contain inflammatory compounds that contribute to joint inflammation. Embrace Anti-Inflammatory Foods Incorporate more fruits and vegetables into your diet, especially those rich in antioxidants and phytonutrients. Berries, leafy greens, and cruciferous vegetables like broccoli and Brussels sprouts can help combat inflammation. Include omega-3 fatty acids found in fatty fish like salmon, walnuts, and flaxseeds. These healthy fats have been shown to reduce inflammation and alleviate joint pain. Choose Whole Grains Opt for whole grains over refined grains to increase your fiber intake and reduce inflammation. Whole grains like brown rice, quinoa, and oats provide essential nutrients and promote digestive health, which can indirectly influence <keyword id="3812178" type="General" weightage="20" keywordseo="joint-health" source="Orion">joint health</keyword>. Avoid processed grains and white flour products, which lack nutritional value and can contribute to inflammation. Increase Intake of Lean Proteins Incorporate lean protein sources such as poultry, fish, tofu, and legumes into your meals. Protein is crucial for muscle repair and maintenance, supporting joint health and function. Minimize consumption of processed meats and high-fat cuts of meat, as they can contain pro-inflammatory compounds that may <keyword id="20951269" type="General" weightage="20" keywordseo="aggravate-joint-pain" source="Orion">aggravate joint pain</keyword>. Stay Hydrated Proper hydration is essential for joint health, as it helps maintain the lubrication and cushioning of your joints. Drink plenty of water throughout the day to keep your joints well-hydrated and functioning optimally. Limit consumption of sugary beverages and alcohol, as they can contribute to inflammation and dehydration, exacerbating joint pain. Monitor Food Sensitivities Pay attention to how your body reacts to certain foods and ingredients. Some individuals may have sensitivities or allergies to specific foods that can worsen joint pain. Consider keeping a food diary to track your symptoms and identify any patterns between your diet and joint pain flare-ups. Consult with a healthcare professional or registered dietitian to explore potential food sensitivities and develop a suitable dietary plan. Making thoughtful changes to your food habits can have a significant impact on managing joint pain and improving overall joint health. By prioritizing anti-inflammatory foods, whole grains, lean proteins, and adequate hydration, you can help reduce inflammation, alleviate discomfort, and support optimal joint function. Remember to listen to your body, stay mindful of food sensitivities, and consult with healthcare professionals for personalized dietary recommendations tailored to your individual needs. With the right approach to nutrition, you can take proactive steps towards alleviating joint pain and enhancing your overall well-being. Note: The article is based on content generated by AI models like Bard and Chatgpt.

Nourishing joints: dietary solutions for joint pain relief and enhancing joint health

<ul class="summary-list"><li>Big businesses such as hospital systems, insurers, and PE firms are gobbling up medical clinics.</li><li>Some doctors and industry experts fear corporate owners could prioritize profits ahead of patients.</li></ul>Independent doctors are almost a thing of the past.UnitedHealth Group struck a deal in March to buy the nine-state doctor group of the struggling hospital system Steward Health Care. The same month, the powerful healthcare conglomerate, which owns the nation's largest <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">health insurer</a>, got the green light to take over a decades-old independent Oregon <a target="_blank" href="https://www.oregonlive.com/business/2024/03/oregon-health-officials-give-emergency-ok-to-corvallis-clinics-acquisition-by-insurance-giant-unitedhealth-group.html">medical practice</a>, adding another 100 healthcare providers to its roster. It picked up a 400-doctor <a target="_blank" href="https://www.fiercehealthcare.com/payers/unitedhealth-quietly-scoops-new-york-physician-group-crystal-run">group</a> in New York about a year before.These are just the purchases we know about; there could be many more. Physician practice deals often go unannounced and get little attention from regulators, but they add up. Near the end of 2023, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth's Optum</a>, the business unit housing its clinics and surgery centers, said it employed or was affiliated with 90,000 doctors. That's a whopping 10% of all doctors in the US.Though it's the hungriest, <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">UnitedHealth</a> is just one buyer in the market for physicians. Little by little, big businesses have taken over healthcare in the US. Hospitals have been scooping up medical practices for decades to create giant health systems. Insurance companies fought back with their own clinic purchases. Private equity firms increasingly staked claims to nursing homes and groups of specialists such as emergency physicians and dermatologists.And in the last few years, tech companies and retailers like Amazon, CVS Health, and Walgreens added thousands of doctors to their payrolls when they bought <a target="_blank" href="https://www.businessinsider.com/cvs-walgreens-amazon-primary-care-acquisition-strategy-2024-3">primary-care chains</a>.Nearly 78% of US doctors are employed by hospitals or other corporate entities, such as insurers and PE firms, according to <a target="_blank" href="https://www.physiciansadvocacyinstitute.org/PAI-Research/PAI-Avalere-Study-on-Physician-Employment-Practice-Ownership-Trends-2019-2023">research</a> from consultancy Avalere and the Physicians Advocacy Institute. For the first time, more medical practices were owned by corporate entities (30%) than hospitals (28%) as of January 2024, the research found.There's mounting evidence that this trend toward corporatization could harm patients. Research has found that prices go up when hospitals and private-equity firms buy medical groups. Sometimes, care gets <a target="_blank" href="https://www.nber.org/papers/w30928">worse</a>, but there's still much unknown about how corporate ownership affects medical care, especially when it's a giant like UnitedHealth or CVS doing the buying.Some doctors and experts in the industry fear corporate owners could prioritize their investors and profits ahead of patients, and doctors could lose the ability to make their own decisions about what's best for a patient."The big guys aren't cheaper. They don't deliver better customer service, they aren't more timely, none of that. They're just able to negotiate higher prices," said Farzad Mostashari, the CEO of Aledade, a company that aims to help primary care practices stay independent.The federal government is starting to pay attention. In March, it <a target="_blank" href="https://www.ftc.gov/news-events/news/press-releases/2024/03/federal-trade-commission-department-justice-department-health-human-services-launch-cross-government">launched</a> an inquiry into PE firms and other corporate owners' "increasing control over healthcare" and how this might threaten patients' access to affordable and quality care.The feds also zeroed in on UnitedHealth, <a target="_blank" href="https://www.wsj.com/health/healthcare/u-s-launches-antitrust-investigation-of-healthcare-giant-unitedhealth-ff5a00d2">reportedly</a> facing an antitrust investigation by the US Justice Department into how its medical group acquisitions affect consumers and competitors. News of the probe surfaced before a <a target="_blank" href="https://www.businessinsider.com/change-healthcare-cyberattack-small-mental-health-practices-payments-money-2024-3">cyberattack on UnitedHealth's</a> technology business, Change Healthcare, caused hospitals and clinics nationwide to forgo billions in payments — raising more questions about UnitedHealth's chokehold on the healthcare industry.<h2>Doctors are hot commodities</h2>It's tough to lump the many buyers of medical practices together, as they're pursuing different strategies. But, in essence, they're all hiring doctors for their relationships with patients, who bring opportunities for more profits. <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">US healthcare spending</a> reached $4.5 trillion in 2022, representing almost a fifth of the national GDP.Hospitals rely on doctors — especially those who provide primary care — to refer patients for lucrative procedures or surgeries. <a target="_blank" href="https://www.businessinsider.com/unitedhealth-stock-exec-medical-costs-rising-2023-6">Insurers like UnitedHealthcare</a> and CVS' Aetna are required by federal law to spend most of the money they collect in premiums on medical care. Still, they can pocket more of those premiums by sending patients to clinics they own.Pharmacies hope that buying medical practices will give more prescriptions to fill and get more customers to buy over-the-counter products at the front of the store."They all realize that patients will follow what their doctors tell them to do or where their doctors tell them to go," said Chas Roades, a longtime healthcare consultant. "So it allows them to both drive traffic to a downstream profit model that they're interested in growing, and I think it also is a way to get consumers to trust them."Meanwhile, independent doctors have a tough time going it alone. Reimbursement is shrinking, and small practices don't have the ability to <a target="_blank" href="https://www.ama-assn.org/system/files/2022-prp-practice-arrangement.pdf">negotiate higher rates</a> as big hospital systems do. Plus, running a modern medical practice is expensive, requiring investments in staffing, technology, and electronic health records. <a target="_blank" href="https://www.businessinsider.com/ai-chatbots-tech-doctors-medicine-healthcare-system-empathy-quality-email-2023-6">The pandemic</a> made things even more challenging, spurring many doctors to sell their private practices.<h2>The quiet takeover of physician practices</h2>Much of the takeover of physician practices has slid under the radar. That's because acquisitions valued below <a target="_blank" href="https://www.ftc.gov/enforcement/competition-matters/2024/02/new-hsr-thresholds-filing-fees-2024">$119.5 million</a> don't have to be reported to federal regulators, and many practice purchases don't meet that threshold. Publicly traded UnitedHealth, for instance, rarely announces its purchases of medical groups and surgery centers."We're really flying blind here with respect to understanding how many acquisitions by which entities and what geographies and what specialties," said Yashaswini Singh, an assistant professor at Brown University who studies healthcare consolidation.This lack of disclosure has made consolidating doctor practices difficult to study. Research into private equity's effects on healthcare is just emerging, and there's little to no academic, peer-reviewed research on how other corporate owners' acquisitions affect healthcare prices and quality, Singh said.Studies, including Singh's <a target="_blank" href="https://jamanetwork.com/journals/jama-health-forum/fullarticle/2795946">research</a>, have shown, however, that PE ownership leads to steeper prices and more utilization, meaning patients may have more frequent doctor's appointments. Together, that drives healthcare costs higher. Research also suggests that PE ownership of nursing homes and hospitals <a target="_blank" href="https://jamanetwork.com/journals/jama/article-abstract/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355&amp;utm_source=For_The_Media&amp;utm_medium=referral&amp;utm_campaign=ftm_links&amp;utm_content=tfl&amp;utm_term=122623">worsens the quality</a> of care. One <a target="_blank" href="https://www.nber.org/system/files/working_papers/w28474/w28474.pdf">paper</a> found that patients who went to nursing homes owned by private equity firms had a 10% greater chance of dying.And yet, private equity companies are rapidly expanding their presence in healthcare. A 2023 <a target="_blank" href="https://www.antitrustinstitute.org/wp-content/uploads/2023/07/AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf">study</a> found that one private equity firm owned 30% of the market share for physician practices in over a quarter of metropolitan areas across the US. A single PE firm owned over half the market share in some areas.<h2>'An unsatisfying way of practicing medicine'</h2>Acquisitions by other corporate giants might not produce the same outcomes as PE firms, said Zirui Song, an associate professor of healthcare policy and medicine at Harvard Medical School who studies private equity in healthcare. PE firms are unique in holding on to their acquisitions for only a few years and saddling their acquired companies with debt and fees. Owners who hang on to their medical groups might be more motivated to improve services, he said.Anecdotally, though, many doctors don't like working for corporate overlords, Roades said. Older physicians who own equity in their medical practice get a nice payday when they sell, but the younger ones left behind are closely managed and measured in terms of cost and productivity, he added.It's "an unsatisfying way of practicing medicine. We're seeing a growing number of disgruntled early and mid-career physicians in these groups who find themselves suddenly working for large corporations, and this is not what they wanted to do with their lives," he said.After a few years working at Optum-owned Oregon Medical Group, Dr. Nick Jones opened a <a target="_blank" href="https://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3">direct primary care practice</a>, a type of clinic that charges a monthly fee instead of billing insurance. He said there's a sense of powerlessness for primary-care doctors in the traditional healthcare system — whether they're employed by Optum, a large hospital system, a private-equity firm, or a nonprofit clinic.With thousands of patients to treat, they face a mountain of administrative paperwork and have no control over their schedules. These problems stem from the fact that primary-care doctors are <a target="_blank" href="https://kffhealthnews.org/news/article/compensation-pay-primary-care-shortage-solution/">underpaid</a> in the traditional "<a target="_blank" href="https://www.commonwealthfund.org/publications/newsletter-article/moving-health-care-system-away-fee-service">fee-for-service</a>" healthcare system, in which doctors are paid for every visit, he said.While he felt supported at his previous Optum-owned clinic because of his office manager, "the financial underpinnings and the economics of medicine" made it unsustainable and stressful, Jones said. "There was a three or four month wait for patients to see me. There was still too much on our plate to do, and [during the pandemic] there weren't enough medical assistants or case managers or nutritionists or other support to make 20 patients a day feel like the right thing to do."<h2>Doctors worry corporate giants put profits over patients</h2>The insurers and retailers say care is better and cheaper when integrated under one roof, connected to the health plan, pharmacy, or other provider organizations.For its part, Optum says it wants to improve the health and well-being of people and lower the cost of care with integrated care teams and better technology. It says it's helping clinics transition to providing <a target="_blank" href="https://www.businessinsider.com/optumhealth-ceo-plans-to-make-clinics-a-100-billion-business-2021-4">"value-based"</a> or "accountable" care, which means that its doctors get paid fixed fees upfront that, in theory, encourages them to keep patients healthy and order fewer unnecessary tests.Optum said in a statement it continues "to focus on supporting physicians, advance practice clinicians, and nurses in closing gaps in care and helping the health system perform better for everyone."A spokesperson pointed to a <a target="_blank" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799376">study</a> by Optum published in JAMA Network Open in December 2022 that found seniors in value-based care arrangements were less likely than seniors in traditional payment models to visit the emergency room, or be admitted at the hospital for COPD, asthma, stroke, or heart attack.But there are potential dangers. Patients may end up with fewer choices as bigger companies edge out competitors.California health system Emanate Health sued Optum in 2023 for anticompetitive behavior. It alleged that Optum canceled its contracts with Emanate hospitals and steered patients away after Emanate refused to agree to certain terms. Among the terms: Emanate primary-care doctors would serve only Optum patients, and Optum would get first dibs if Emanate decided to sell its primary-care practices.Care might also feel less personal. Some <a target="_blank" href="https://www.businessinsider.com/one-medical-patients-affected-unitedhealthcare-mount-sinai-dispute-2024-3">One Medical patients</a> complained that since the chain folded into Amazon, their appointments were shortened, and certain features for seniors, like having health coaches available during patient visits, went away, according to a report from <a target="_blank" href="https://www.washingtonpost.com/technology/2024/02/28/amazon-health-one-medical/">The Washington Post</a>.<h2>Patients could end up spending less time with doctors and face higher costs</h2>Dr. Mitch Li, an emergency physician who started Take Medicine Back, a group that opposes corporate owners pushing into healthcare, said patients will spend less time with their doctors and potentially face higher costs from predatory billing practices."The corporate practice of medicine is the reason why <a target="_blank" href="https://www.businessinsider.com/gen-z-millennials-giving-up-medical-care-cant-afford-costs-2024-2">healthcare costs</a> are out of control," Li said.Above all, some doctors fear having to make decisions that benefit the owner's bottom line, even though they may not be the best option for a patient.Dr. Michelle Cooke, a primary-care physician, previously practiced at an Atlanta clinic owned by a hospital system. Though the system was not-for-profit, it didn't operate like that, and over time, the job became unbearable, she said.She had more than 3,000 patients assigned to her care — <a target="_blank" href="https://www.jabfm.org/content/jabfp/29/4/496.full.pdf">far more</a> than typical — and appointments were too short, especially for the chronically ill, she said. The hospital system would prioritize lucrative physicals for <a target="_blank" href="https://www.businessinsider.com/cigna-selling-medicare-advantage-business-insurers-higher-costs-slower-growth-2024-2">Medicare patients</a> rather than seeing patients with an urgent need."It really got to the point where I feel like I was working to feed the corporation," Cooke said. "It really wasn't incentivizing what the patients needed."Cooke has since opened a direct primary care practice, where she sees just a few hundred patients and can spend more time with them. She said she's found that she prescribes less medication now because she has time to educate patients on lifestyle habits and nutrition.<h2>The federal government and states are dialing up the scrutiny</h2>The Federal Trade Commission, the US Department of Justice, and the Department of Health and Human Services are <a target="_blank" href="https://www.wsj.com/articles/federal-agencies-probe-private-equity-profiteering-in-healthcare-2ba4c23a">stepping up scrutiny</a> of healthcare deals, particularly those backed by private-equity firms. The agencies also signaled that they want to look at smaller deals that typically wouldn't trigger an antitrust review.Several states have also increased their oversight of local healthcare consolidation. Some state lawmakers are also trying to strengthen <a target="_blank" href="https://www.nejm.org/doi/full/10.1056/NEJMp2306904#f1">laws prohibiting</a> corporations from practicing medicine. Most states have these bans on the books, but companies have found various ways around them.It's unclear if any of these efforts will meaningfully slow the corporatization of healthcare. And, to be sure, some physician practices may not have survived without an infusion of capital from a corporate buyer.A bill introduced by Oregon State Rep. Ben Bowman would have closed certain <a target="_blank" href="https://www.opb.org/article/2024/02/22/oregon-lawmakers-could-limit-corporate-ownership-of-medical-practices/">loopholes</a> and put more distance between corporate entities and their medical practices. Bowman told Business Insider he wanted to prevent big businesses from eroding doctors' autonomy."A physician who went to medical school who took an oath — their highest ethical duty is to care for their patients. Whether it's a private equity firm or a large corporation, their highest ethical duty is to generate a return on investment for their shareholders. Those two incentives are fundamentally at odds," Bowman said.The bill, opposed by Amazon and CVS, died in March, but Bowman said he plans to reintroduce it in 2025.Around the same time the bill died, UnitedHealth's Optum and The Corvallis Clinic — the small Oregon medical practice that Optum struck a deal to buy — requested that their tie-up receive an emergency exemption from state review because of the Oregon clinic's deteriorating finances.The proposed acquisition, first announced in December, had received plenty of pushback from state residents. The request also came as hospitals and clinics nationwide faced cash shortfalls because of the cyberattack on UnitedHealth's Change Healthcare.A week later, Oregon's health authority approved the request.

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