capital ~$127.7B/yr revenue (non-profit; reserves mission-locked)

opt

constrained — non-profit; Risant roll-up

grav

GROSS — 13.1M members, 40 hospitals, 25,505 physicians …

New 09-02 (events of 09-01): the AI fight jumped bargaining units, and the new one is ten times larger. California Nurses …

capital ~$448B/yr revenue + ~$89B float

opt

constrained (MLR) but Optum is a free lever (M&A)

grav

~$380B+/yr GROSS routed + 50M members; Optum touches …

Standing picture below holds unchanged since 07-28. No new development since 07-28 — no digest mentions across 08-10→08-14 and no update to …

capital ~$400B/yr revenue

opt

constrained + debt-laden (Aetna / Oak St)

grav

~$340B+/yr GROSS — Caremark 75M, ~9,100 pharmacies (~1/5 of …

New 08-15: the one open thread item from last week's Q2 print resolved this week — Aetna's reimbursement cuts to Alma-contracted …

capital ~$275B/yr revenue

opt

constrained core / free Evernorth (Express Scripts)

grav

GROSS — 185M+ relationships + 1.7M providers (widest …

New 09-25 (event 09-23): OPENAI PARTNERSHIP. Cigna said on 09-23 it is working with OpenAI to build AI tools for patients with complex …

capital ~$199B/yr revenue + >=$6B/yr operating cash flow

opt

constrained + 11-state Blue license fence

grav

GROSS — ~46.8M members

Standing read holds unchanged: Carelon re-led (new co-chiefs over 90M consumers, 03-31), ABA/SUD cost targeting, and the BH 'ghost network' …

capital ~$130B/yr revenue

opt

most constrained — ~85% govt MA/Medicaid, CMS-set rates

grav

GROSS — #2 Medicare Advantage insurer (~5-6M MA members, …

Standing read holds unchanged: the thinnest actor in the wave, dedicated crawl still recommended.

capital ~$75.6B/yr revenue

opt

free capital allocation (buybacks) / rate-constrained …

grav

GROSS — 186 hospitals + ~2,000 sites across 21 states + UK …

No new HCA-specific development since the 08-04 crawl. Standing read holds unchanged: six AI initiatives live at 130+ hospitals (Timpani …