Few patients knew its name, yet Change Healthcare handled a huge share of American medical bills. When a doctor sent a claim to an insurer, it often passed through Change's network on the way. The Nashville company was formed in 2017 when McKesson merged its health IT business with Change Healthcare, a company backed by Blackstone. It filed to go public in 2019, carrying heavy debt and a promise that software and data could take cost out of health care.

A Clearinghouse for Claims

Change Healthcare traced its roots to Emdeon, a claims business that once sat inside WebMD. Its core job was dull and vital. It checked insurance claims, sent them on, and moved payments back. On top of that network it sold software and analytics to hospitals and insurers. The 2017 deal with McKesson made it larger. The bet was that a company sitting between every party in the system could sell them tools to waste less money.

Bought, Then Breached

Change cut its IPO price to $13 a share on June 26, 2019, below its target range, and used the money to pay down debt. The stock rose about 15 percent on Nasdaq the next day. In 2021 UnitedHealth Group agreed to buy it for about $13 billion, including debt. The Justice Department sued to block the deal and lost. The purchase closed in October 2022. In February 2024 a ransomware attack shut down Change's systems and exposed data on about 190 million people.

Cover: "Any Thing for Me, If You Please?"—Post-Office of the Brooklyn Fair in Aid of the Sanitary Commission, Winslow Homer. Art Institute of Chicago, public domain. Chosen for a crowded post office window (a clearinghouse for messages).