The Projection — a symmetric watercolor butterfly

The Projection

The surface is never the system.

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pocket

Health

Payers + providers — the care economy.

The metrics — aggregated from members; click for the breakdown

Posture
consolidating — 2 of 7 (consolidating 2 · retrenching 2 · at-war 1 · hedging 1 · expanding 1) 7 members →
Capital · available
across 7 members — open each for the figure + sources 7 members →
Capital · operating
across 7 members — open each for the figure + sources 7 members →
Capital · deployed
across 7 members — open each for the figure + sources 7 members →
Capital · in
across 7 members — open each for the figure + sources 7 members →
Capital · out
across 7 members — open each for the figure + sources 7 members →
Optionality
across 7 members — open each for the figure + sources 7 members →
Gravity
across 7 members — open each for the figure + sources 7 members →

What's new this week

Members 7

us 1 thread

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

opt
constrained — non-profit; Risant roll-up
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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 …

us 1 thread

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

opt
constrained (MLR) but Optum is a free lever (M&A)
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~$380B+/yr GROSS routed + 50M members; Optum touches …

New 08-16: no further movement all week (08-10→08-16) — an explicit-zero Sunday for the mental-health lens (trade press doesn't publish …

us 1 thread

capital ~$400B/yr revenue

opt
constrained + debt-laden (Aetna / Oak St)
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~$340B+/yr GROSS — Caremark 75M, ~9,100 pharmacies (~1/5 of …

New 08-16: no further movement — an explicit-zero Sunday for the mental-health lens (trade press doesn't publish weekends). One housekeeping …

us 1 thread

capital ~$275B/yr revenue

opt
constrained core / free Evernorth (Express Scripts)
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GROSS — 185M+ relationships + 1.7M providers (widest …

New 08-16: no further movement all week (08-10→08-16) — an explicit-zero Sunday for the mental-health lens, and the shared …

us 1 thread

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

opt
constrained + 11-state Blue license fence
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GROSS — ~46.8M members

New 08-16: no further movement all week (08-10→08-16) — an explicit-zero Sunday for the mental-health lens, and no new Elevance-specific …

us 1 thread

capital ~$130B/yr revenue

opt
most constrained — ~85% govt MA/Medicaid, CMS-set rates
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GROSS — #2 Medicare Advantage insurer (~5-6M MA members, …

New 08-16: no further movement all week (08-10→08-16) — an explicit-zero Sunday for the mental-health lens, and still nothing …

us 1 thread

capital ~$75.6B/yr revenue

opt
free capital allocation (buybacks) / rate-constrained …
grav
GROSS — 186 hospitals + ~2,000 sites across 21 states + UK …

New 08-16: still quiet — no HCA-specific development; the `hca-healthcare` thread remains last_seen 08-04, now 12 days stale. HCA carries no …

Vocabulary