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Source: https://thehealthcareblog.com/feed/

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<title>This One Weird Trick Can Fix U.S. Healthcare</title>
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<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Thu, 22 May 2025 07:49:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Employer Health Insurance]]></category>
<category><![CDATA[Included Health]]></category>
<category><![CDATA[Owen Tripp]]></category>
<category><![CDATA[shared savings program]]></category>
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<description><![CDATA[By OWEN TRIPP Creating a healthcare experience that builds trust and delivers value to people and purchasers isn’t a quick fix, but it’s the only way to reverse the downward spiral of<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/22/this-one-weird-trick-can-fix-u-s-healthcare/">Continue reading...</a>]]></description>
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By OWEN TRIPP
Creating a healthcare experience that builds trust and delivers value to people and purchasers isn’t a quick fix, but it’s the only way to reverse the downward spiral of high costs and poor outcomes
Entrepreneurs like to say the U.S. healthcare system is “broken,” usually right before they explain how they intend to fix it. I have a slightly different diagnosis.
The U.S. healthcare system is the gold standard. Our institutions and enterprises, ranging from 200-year-old academic medical centers to digital health startups, are the clear world leaders in clinical expertise, research, innovation, and technology. Capabilities-wise, the system is far from broken.
What’s broken is trust in the system, because of the glaring gap between what the system is capable of and what it actually delivers. Every day across the country, people drive past world-class hospitals, but then have to wait months for a primary care appointment. They deduct hundreds for healthcare from each paycheck, only to be told at the pharmacy that their prescription isn’t covered. While waiting for a state-of-the-art scan, they’re handed a clipboard and asked to recap their medical history.
This whipsaw experience isn’t due to incompetence or poor infrastructure. It’s the product of the dysfunction between the two biggest players in healthcare: providers and insurers, two entities that have optimized the hell out of their respective businesses, in opposition to one another, and inadvertently at the expense of people.
Historically, hospitals and health systems — including those 200-year-old AMCs — have dedicated themselves fully to improving and saving lives. I’m not saying they’ve lost sight of this, but until recently, margin took a back seat to mission. With industry consolidation and the persistence of the fee-for-service model, however, providers’ hands have been forced to maximize volume of care at the highest possible unit cost, which in turn has become a <a href="https://academic.oup.com/healthaffairsscholar/article/2/6/qxae078/7687295">main driver</a> of the out-of-control cost trend at large.
This push from providers has prompted an equal-and-opposite reaction from insurers. Though the industry has been villainized (rightly, in some cases) for a heavy-handed approach to utilization management and prior authorization, insurers are merely doing what their primary customers — private employers — have <a href="https://www.healthaffairs.org/content/forefront/affordable-commercial-health-insurance-available-if-we-want">hired them</a> to do: manage cost. Insurers have gotten very good at it, not just by limiting care, but also through<a href="https://www.mckinsey.com/industries/healthcare/our-insights/reimagining-us-employer-health-benefits-with-innovative-plan-designs"> product innovation</a> that has created more tiers and cost-sharing options for plan sponsors.
Meanwhile, healthcare consumers (people!) have been sidelined amid this tug-of-war. Doctors and hospitals say they’re patient-centered, and insurers say they’re member-centric — but the jargon is a dead giveaway. Each side is focused on their half of the pie, and neither is accountable for the whole person: the person receiving care and paying for care, not to mention navigating everything in between.
It should come as no surprise that trust is falling. Only <a href="https://www.forrester.com/surveys/forresters-consumer-buyer-journey-survey-2024/SUS20236">56%</a> of Americans trust their health insurer to act in their best interest. Even trust in doctors — the good guys — has <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821693?">plummeted</a>. In a startling reversal from just four years ago, a whopping 76% of people <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821693?">believe</a> hospitals care more about revenue than patient care.
<figure class="wp-block-table"><table><tbody><tr><td colspan="2">Loss of Trust in Healthcare Providers</td></tr><tr><td> Hospitals in the U.S. are mostly focused on…</td><td rowspan="2"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXe3Vd_i1MlKvSPQgop57w-fi0LMAU8b7LeuG4RBtuAVUAReW-q047_-627XKHP8mhwv3RXel7ZIlOQ93dLRNEjYtY4hg2Lvmtz7gDO8X3Pmgv67XJnf3UyyOoDVVYI5CLQ5oDl8Kw?key=iRlo3g6xYpl71baEr04YSw" width="558.0016792611251" height="210.20556699566853"></td></tr><tr><td><img src="https://s.w.org/images/core/emoji/14.0.0/72x72/23fa.png" alt="⏺" class="wp-smiley" style="height: 1em; max-height: 1em;" />  Caring for patients<img src="https://s.w.org/images/core/emoji/14.0.0/72x72/23fa.png" alt="⏺" class="wp-smiley" style="height: 1em; max-height: 1em;" />  Making money Source: <a href="https://email.chartis.com/hubfs/Jarrard/Jarrard%20Website%20Files/Jarrard%20January%202025%20NCS%20Executive%20Survey.pdf">Jarrard/Chartis</a> (2025)</td></tr></tbody></table></figure>
This trust deficit is the root cause of so many healthcare problems. It’s the reason people disengage, delay and skip care, and end up in the ER or OR for preventable issues. When a good chunk of the population falls into this cycle, as they have, you end up with the status quo: <a href="https://www.aon.com/en/insights/articles/key-trends-in-us-benefits">unrelenting costs</a> and deteriorating outcomes that is dragging down households, businesses, and the industry itself.
There’s no quick fix. Despite what my fellow entrepreneurs might say, no one point solution or technology (no, not even <a href="https://www.fastcompany.com/91316573/aieq-is-transforming-healthcare-not-just-for-doctors">AI</a>) can rebuild trust. The only way to reverse the downward spiral is by serving up a modern experience that is genuinely designed around people’s needs.

Brace yourselves: Building that experience doesn’t require rebuilding the whole system. But it does require step change. It’s time for leaders and innovators across the ecosystem to reimagine and redefine partnerships, people-first care, and payment models to create a new center of gravity in healthcare, one that sits outside the traditional orbit of providers and insurers, yet is also connected to all the capabilities and expertise the system has to offer. That’s the fix, and here’s what I think that looks like:
<h3 class="wp-block-heading">People and purchasers, together</h3>
The group commercial insurance market may very well be healthcare’s new center of gravity. Think about it: collectively, the private employers and public-sector organizations that make up the market represent the nation’s largest purchasers of healthcare, providing health insurance to nearly 160 million Americans. Thanks to their scale and influence, these organizations are uniquely positioned to actually rise above the status quo and create an alternative to the provider-insurer dynamic.
<figure class="wp-block-table"><table><tbody><tr><td colspan="2">Health Insurance Coverage of the U.S. PopulationSource: <a href="https://www.kff.org/other/state-indicator/total-population/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D">KFF</a> (2023)</td></tr><tr><td colspan="2"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXccKBj_13WHKbPUvk6cMmdsa4-lb06ycRdKV3d32Om61Y4HfklLSIUR4BomA12JzcqIT7rDwYU9-1OxjnmnBdGdLlS-oit9yzLJutNqdzT2YZ5yto6fcjXArkDyiJR05_8Hvw9xRA?key=iRlo3g6xYpl71baEr04YSw" width="535.1096534409965" height="172"></td></tr></tbody></table></figure>
Aside from scale, the interests and incentives of these plan sponsors are naturally aligned with those they cover. People (employees) and purchasers (employers) both want the same thing. Employees and their families want more <a href="https://www.fastcompany.com/91116444/a-healthy-workforce-needs-more-connection-not-more-apps">healthy days</a>, with lower premiums and out-of-pocket expenses. Employers want a healthy, happy, and productive workforce, while reducing their astronomical healthcare spend — <a href="https://www.aon.com/en/insights/articles/key-trends-in-us-benefits">projected</a> to be up 9% for private employers this year. In contrast to the zero-sum game between providers and insurers, better health outcomes at lower cost are a win-win for people and purchasers.
Self-funded employers—which represent <a href="https://www.kff.org/report-section/ehbs-2023-section-10-plan-funding/">two-thirds</a> of the group market, and skew larger—are especially important players, due to their purchasing power and their ability to curate benefits and services for their workforce that tap into the best capabilities the system has to offer. Rather than relying on a single carrier, many self-funded employers contract directly with leading brick-and-mortar health systems (as in the <a href="https://hbr.org/2019/03/how-employers-are-fixing-health-care">centers of excellence</a> model), as well as best-in-class service providers across the healthcare ecosystem.
<h3 class="wp-block-heading">End-to-end integration (for real)</h3>
The historical divide between providers and insurers has fractured the healthcare experience, but that’s not the only culprit. In fact, the proliferation of point solutions, digital health apps, and third-party service providers has exacerbated many of the cracks and pain points in the system. “Front doors” that claim to streamline the healthcare experience for employees too often open onto the same fragmented and confusing landscape, if they lead <a href="https://www.linkedin.com/pulse/healthcare-navigation-part-2-where-do-we-go-from-here-owen-tripp-fsjlc/">anywhere at all</a>.
Repairing the experience has to start with integration, and not just clinical integration. Yes, integrated care matters. Connecting primary care with behavioral health and specialty care, blending virtual and in-person experiences, giving care teams shared access to the same data—these are all essential steps. But integration must go much further. Clinical quality and outcomes are inseparable from the administrative, financial, and logistical aspects of healthcare that have long been stranded between providers and insurers.
People intuitively understand the relationship between their mental, physical, and financial health, and they need a trustworthy support system that will address all of these dimensions together, through navigation, financial advocacy, social support, and other historically siloed services
<h3 class="wp-block-heading">A modern take on value-based care</h3>
<a href="https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed">Value-based care</a> has long been viewed as a solution to the misaligned incentives the fee-for-service model has created among providers and insurers. Two decades of experiments led by Medicare, however, have had <a href="https://www.healthaffairs.org/content/forefront/improvement-science-and-value-based-payment-models">mixed</a> (some would say disappointing) results. But those <a href="https://www.statnews.com/2022/07/26/value-based-payment-produced-little-value/">calling for an end</a> to the value-based project are overlooking the untapped potential for alternative payment and care delivery models in the ever-important commercial market.
Healthcare value, as a concept and practice, is <a href="https://www.linkedin.com/pulse/costs-soar-employers-need-double-down-healthcare-value-owen-tripp-0n8zc/">relatively new</a> to the commercial space. Value-based arrangements between health plan sponsors and their healthcare partners have largely been limited to pay-for-performance models and bundled payments for specific clinical services (as with centers of excellence). While some of these targeted solutions do provide savings, measuring ROI has been more of an art than a science. Specifically, the lack of integration described above — integration spanning multiple service providers, as well as clinical and non-clinical services — has made it difficult for plan sponsors to attribute improved outcomes or cost savings to specific solutions.
New value-based partnership models are changing that. Though value-based contracts can take many forms, the leading edge in the commercial market is a <a href="https://www.calpers.ca.gov/newsroom/calpers-news/2024/calpers-announces-new-health-plan-contracts-to-lower-costs-and-improve-quality-and-accountability">shared savings</a> model that incentivizes healthcare service providers and insurers to join forces and drive outcomes that matter to people and purchasers, including experience, clinical quality, and — most important — the total cost of care. It’s not enough to have the right partners and capabilities in place. The model needs to ensure alignment and accountability.
<h3 class="wp-block-heading">Conclusion: From downward spiral to flywheel</h3>
When these pieces come together in a healthcare experience that earns people’s trust, the spiral of high costs and poor outcomes starts to reverse itself. An easier and more integrated people-first experience drives engagement, which improves outcomes. Better experiences and outcomes build trust, which drives further engagement, and so on. Eventually a flywheel effect kicks in: As people get healthier, they need less high-cost care, and they’re more resilient and productive — and that value is passed on to the purchaser.
Healthcare isn’t broken. We don’t need to dismantle or overhaul the system. We just need to get in a better formation so that the very best of the system actually works for people, not against them.
Owen Tripp is the co-founder and CEO of <a href="https://includedhealth.com/">Included Health</a>, a personalized all-in-one healthcare company that partners with employers and public-sector organizations on value-based care.
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<item>
<title>How to Buy and Sell AI in health care? Not Easy.</title>
<link>https://thehealthcareblog.com/blog/2025/05/21/how-to-buy-and-sell-ai-in-health-care-not-easy/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Wed, 21 May 2025 06:30:00 +0000</pubDate>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Matthew Holt]]></category>
<category><![CDATA[Agentic AI]]></category>
<category><![CDATA[AI]]></category>
<category><![CDATA[Bessemer]]></category>
<category><![CDATA[Commure]]></category>
<category><![CDATA[Epic]]></category>
<category><![CDATA[MEDITECH]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109319</guid>
<description><![CDATA[By MATTHEW HOLT It was not so  long ago that you could create one of those maps of health care IT or digital health and be roughly right. I did it myself<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/21/how-to-buy-and-sell-ai-in-health-care-not-easy/">Continue reading...</a>]]></description>
<content:encoded><![CDATA[<div class="wp-block-image">
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By MATTHEW HOLT
It was not so  long ago that you could create one of those maps of health care IT or digital health and be roughly right. I did it myself back in the Health 2.0 days, including the old sub categories of the “Rebel Alliance of New Provider Technologies” and the “Frontier of Patient Empowerment Technologies”
<div class="wp-block-image">
<figure class="alignleft size-full is-resized"><img decoding="async" width="300" height="224" src="https://thehealthcareblog.com/wp-content/uploads/2025/05/map1.jpg" alt="" class="wp-image-109321" style="aspect-ratio:1.3392857142857142;width:390px;height:auto" srcset="https://thehealthcareblog.com/wp-content/uploads/2025/05/map1.jpg 300w, https://thehealthcareblog.com/wp-content/uploads/2025/05/map1-150x112.jpg 150w" sizes="(max-width: 300px) 100vw, 300px" /></figure></div>
But those easy days of matching a SaaS product to the intended user, and differentiating it from others are gone. The map has been upended by the hurricane that is generative AI, and it has thrown the industry into a state of confusion.
For the past several months I have been trying to figure out who is going to do what in AI health tech. I’ve had lots of formal and informal conversations, read a ton and been to three conferences in the past few months all focused dead on this topic. And it’s clear no one has a good answer.
Of course this hasn’t stopped people trying to draw maps like<a href="https://withprotege.substack.com/p/proteges-healthcare-ai-market-map"> this one from Protege</a>. As you can tell there are hundreds of companies building AI first products for every aspect of the health care value (or lack of it!) chain.
But this time it’s different. It’s not at all clear that AI will stop at the border of a user or even have a clearly defined function. It’s not even clear that there will be an “AI for Health Tech” sector.
<div class="wp-block-image">
<figure class="alignright size-full"><img decoding="async" loading="lazy" width="693" height="760" src="https://thehealthcareblog.com/wp-content/uploads/2025/05/proteoge.png" alt="" class="wp-image-109324" srcset="https://thehealthcareblog.com/wp-content/uploads/2025/05/proteoge.png 693w, https://thehealthcareblog.com/wp-content/uploads/2025/05/proteoge-274x300.png 274w, https://thehealthcareblog.com/wp-content/uploads/2025/05/proteoge-137x150.png 137w" sizes="(max-width: 693px) 100vw, 693px" /></figure></div>
This is a multi-dimensional issue.
The main AI LLMs–ChatGPT (OpenAI/Microsoft), Gemini (Google/Alphabet) Claude (Anthropic/Amazon), Grok (X/Twitter), Lama (Meta/Facebook)–are all capable of incredible work inside of health care and of course outside it. They can now write in any language you like, code, create movies, music, images and are all getting better and better. 
And they are fantastic at interpretation and summarization. I literally dumped a pretty incomprehensible <a href="https://public-inspection.federalregister.gov/2025-08701.pdf">26 page dense CMS RFI document</a> into ChatGPT the other day and in a few seconds <a href="https://docs.google.com/document/d/1JfdioeUHyZTPNG3Lzt-scZdB1XzeRezorc8m_BHwE3A/edit?tab=t.0">it told me what they asked for and what they were actually looking for</a> (that unwritten subtext). The CMS official who authored it was very impressed and was a little upset they weren’t allowed to use it. If I had wanted to help CMS, it would have written the response for me too.
The big LLMs are also developing “agentic” capabilities. In other words, they are able to conduct multistep business and human processes.
Right now they are being used directly by health care professionals and patients for summaries, communication and companionship. Increasingly they are being used for diagnostics, coaching and therapy. And of course many health care organizations are using them directly for process redesign.
Meanwhile, the core workhorses of health care are the EMRs used by providers, and the biggest kahuna of them all is Epic. Epic has a relationship with Microsoft which has its own AI play and also has its own strong relationship with OpenAI – or at least as strong as investing $13bn in a non-profit will make your relationship. Epic is now using Microsoft’s AI both in note summaries, patient communications et al, and also using DAX, the ambient AI scribe from Microsoft’s subsidiary Nuance. Epic also has a relationship with DAX rival Abridge
But that’s not necessarily enough and Epic is clearly building its own AI capabilities. In an excellent review over at Health IT Today John Lee <a href="https://www.healthcareittoday.com/2025/05/14/epic-xgm-spotlights-whats-next-for-ai-usability-cosmos-and-much-more/">breaks down Epic’s non-trivial use of AI in its clincal workflow</a>:
<ul>
<li>The platform now offers tools to reorganize text for readability, generate succinct, patient-friendly summaries, hospital course summaries, discharge instructions, and even translating discrete clinical data into narrative instructions.</li>
<li>We will be able to automatically destigmatize language in notes (e.g., changing “narcotic abuser” to “patient has opiate use disorder”),</li>
<li>Even as a physician, I sometimes have a hard time deciphering the shorthand that my colleagues so frequently use. Epic showed how AI can translate obtuse medical shorthand-like “POD 1 sp CABG. HD stable. Amb w asst.”-into plain language: “Post op day 1 status post coronary bypass graft surgery. Hemodynamically stable. Patient is able to ambulate with assist.”</li>
<li>For nurses, ambient documentation and AI-generated shift notes will be available, reducing manual entry and freeing up time for patient care.</li>
</ul>
And of course Epic isn’t the only EHR (honestly!). Its competitors aren’t standing still. Meditech’s COO Helen Waters <a href="https://histalk2.com/2025/04/08/histalk-interviews-helen-waters-coo-meditech-2/">gave a wide-ranging interview to HISTalk</a>. I paid particular attention to her discussion of their work with Google in AI and I am quoting almost all of it: This initial product was built off of the BERT language model. It wasn’t necessarily generative AI, but it was one of their first large language models. The feature in that was called Conditions Explorer, and that functionality was really a leap forward. It was intelligently organizing the patient information directly from within the chart, and as the physician was working in the chart workflow, offering both a longitudinal view of the patient’s health by specific conditions and categorizing that information in a manner that clinicians could quickly access relevant information to particular health issues, correlated information, making it more efficient in informed decision making.  <snip> Beyond that, with the Vertex AI platform and certainly multiple iterations of Gemini, we’ve walked forward to offer additional AI offerings in the category of gen AI, and that includes both a physician hospital course-of-stay narrative at the end of a patient’s time in the hospital to be discharged. We actually generate the course-of-stay, which has been usually beneficial for docs to not have to start to build that on their own. We also do the same for nurses as they switch shifts. We give a nurse shift summary, which basically categorizes the relevant information from the previous shift and saves them quite a bit of time. We are using the Vertex AI platform to do that. And in addition to everyone else under the sun, we have obviously delivered and brought live ambient scribe capabilities with AI platforms from a multitude of vendors, which has been successful for the company as well. The concept of Google and the partnership remains strong. The results are clear with the vision that we had for Expanse Navigator. The progress continues around the LLMs, and what we’re seeing is great promise for the future of these technologies helping with administrative burdens and tasks, but also continued informed capacities to have clinicians feel strong and confident in the decisions they’re making.  The voice capabilities in the concept of agentic AI will clearly go far beyond ambient scribing, which is both exciting and ironic when you think about how the industry started with a pen way back when, we took them to keyboards, and then we took them to mobile devices, where they could tap and swipe with tablets and phones. Now we’re right back to voice, which I think will be pleasing provided it works efficiently and effectively for clinicians. So if you read–not even between the lines but just what they are saying–Epic, which dominates AMCs and big non-profit health systems, and Meditech, the EMR for most big for-profit systems like HCA, are both building AI into their platforms for almost all of the workflow that most clinicians and administrators use.
I raised this issue a number of different ways at a meeting hosted by Commure, the General Catalyst-backed provider-focused AI company. <a href="https://www.commure.com/">Commure</a> has been through a number of iterations in its 8 year life but it is now an AI platform on which it is building several products or capabilities. (For more here’s <a href="https://thehealthcareblog.com/blog/2025/03/24/tanay-tandon-commure/">my interview with CEO Tannay Tandon</a>). These include (so far!) administration, revenue cycle, inventory and staff tracking, ambient listening/scribing, clinical workflow, and clinical summarization. You can bet there’s more to come via development or acquisition. In addition Commure is doing this not only with the deep pocketed backing of General Catalyst but also with partial ownership from HCA–incidentally Meditech’s biggest client. That means HCA has to figure out what Commure is doing compared to Meditech.
Finally there’s also a ton of AI activity using the big LLMs internally within AMCs and in providers, plans and payers generally. Don’t forget that all these players have heavily customized many of the tools (like Epic) which external vendors have sold them. They are also making their AI vendors “forward deploy” engineers to customize their AI tools to the clients’ workflow. But they are also building stuff themselves. For instance Stanford just released a <a href="https://med.stanford.edu/news/all-news/2025/01/ai-test-results.html#:~:text=Stanford%20Medicine%20physicians%20have%20a,physician%20then%20reviews%20and%20approves.">homegrown product that uses AI to communicate lab results to patients</a>. Not bought from a vendor, but developed internally using Anthropic’s Claude LLM. There are dozens and dozens of these homegrown projects happening in every major health care enterprise. All those data scientists have to keep busy somehow!
So what does that say about the role of AI?
First it’s clear that the current platforms of record in health care–the EHRs–are viewing themselves as massive data stores and are expecting that the AI tools that they and their partners develop will take over much of the workflow currently done by their human users.
Second, the law of tech has usually been that water flows downhill. More and more companies and products end up becoming features on other products and platforms. You may recall that there used to be a separate set of software for writing (Wordperfect), presentation (Persuasion), spreadsheets (Lotus123) and now there is MS Office and Google Suite. Last month a company called Brellium raised $16m from presumably very clever VCs <a href="https://brellium.com/resources/blog/brellium-raises-17-million-to-build-healthcares-ai-powered-clinical-payor-compliance-platform">to summarize clinical notes and analyze them for compliance</a>. Now watch them prove me wrong, but doesn’t it seem that everyone and their dog has already built AI to summarize and analyze clinical notes? Can’t one more analysis for compliance be added on easily? It’s a pretty good bet that this functionality will be part of some bigger product very soon.
(By the way, one area that might be distinct is voice conversation, which right now does seem to have a separate set of skills and companies working in it because interpreting human speech and conversing with humans is tricky. Of course that might be a temporary “moat” and these companies or their products may end up back in the main LLM soon enough). 
Meanwhile, Vine Kuraitis, Girish Muralidharan & the late Jody Ranck just wrote a 3 part series on how the EMR is moving anyway towards becoming a <a href="https://thehealthcareblog.com/blog/2025/03/31/platform-shift-from-ehrs-to-udhps-unified-digital-health-platforms-section-1/">bigger unified digital health platform</a> which suggests that the clinical part of the EMR will be integrated with all the other process stuff going on in health systems. Think staffing, supplies, finance, marketing, etc. And of course there’s still the ongoing integration between EMRs and medical devices and sensors across the hospital and eventually the wider health ecosystem.
So this integration of data sets could quickly lead to an AI dominated super system in which lots of decisions are made automatically (e.g. AI tracking care protocols <a href="https://thehealthcareblog.com/blog/2024/11/14/thcb-gang-episode-14-friday-november-14/">as Robbie Pearl suggested on THCB a while back</a>), while some decisions are operationally made by humans (ordering labs or meds, or setting staffing schedules) and finally a few decisions are more strategic. The progress towards deep research and agentic AI being made by the big LLMs has caused many (possibly including Satya Nadella) to suggest <a href="https://www.youtube.com/watch?v=GuqAUv4UKXo">that SaaS is dead</a>. It’s not hard to imagine a new future where everything is scraped by the AI and agents run everything globally in a health system.
This leads to a real problem for every player in the health care ecosystem.
If you are buying an AI system, you don’t know if the application or solution you are buying is going to be cannibalized by your own EHR, or by something that is already being built inside your organization.
If you are selling an AI system, you don’t know if your product is a feature of someone else’s AI, or if the skill is in the prompts your customers want to develop rather than in your tool. And worse, there’s little penalty in your potential clients waiting to see if something better and cheaper comes along. And this is happening in a world in which there are new and better LLM and other AI models every few months.
I think for now the issue is that, until we get a clearer understanding of how all this plays out, there will be lots of false starts, funding rounds that don’t go anywhere, and AI implementations that don’t achieve much. Reports like the one from Sofia Guerra and Steve Kraus at Bessmer may help, <a href="https://www.bvp.com/atlas/the-healthcare-ai-adoption-index">giving 59 “jobs to be done”</a>. I’m just concerned that no one will be too sure what the right tool for the job is.
Of course I await my robot overlords telling me the correct answer.
Matthew Holt is the Publisher of THCB
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<title>Patrick Quigley, Sidecar Health</title>
<link>https://thehealthcareblog.com/blog/2025/05/20/patrick-quigley-sidecar-health/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Tue, 20 May 2025 05:26:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Matthew Holt]]></category>
<category><![CDATA[THCB Spotlights]]></category>
<category><![CDATA[Consumer Pricing]]></category>
<category><![CDATA[Health insurance]]></category>
<category><![CDATA[Patrick Quigley]]></category>
<category><![CDATA[sidecar health]]></category>
<category><![CDATA[Transparency]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109315</guid>
<description><![CDATA[Patrick Quigley is the CEO of Sidecar Health. It’s a start up health insurance company that has a new approach to how employers and employees buy health care. Sidecar is betting on<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/20/patrick-quigley-sidecar-health/">Continue reading...</a>]]></description>
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Patrick Quigley is the CEO of Sidecar Health. It’s a start up health insurance company that has a new approach to how employers and employees buy health care. Sidecar is betting on the radical pricing  transparency idea. Instead of going down the contacting and narrow network route, Sidecar presents average area pricing and individual provider pricing to its members, and rewards them if they go to lower cost providers (who often are cheaper). How does this all work and is it real? Patrick took me through an extensive demo and explained how this all works. There’s a decent amount of complexity behind the scenes but Sidecar is creating something very rare in America, a priced health care market allowing consumers to choose–Matthew Holt
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<title>And Now for Some Fun Future</title>
<link>https://thehealthcareblog.com/blog/2025/05/19/and-now-for-some-fun-future/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Mon, 19 May 2025 05:21:14 +0000</pubDate>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[3D printing]]></category>
<category><![CDATA[drug delivery]]></category>
<category><![CDATA[Kim Bellard]]></category>
<category><![CDATA[Selfies]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109311</guid>
<description><![CDATA[By KIM BELLARD I feel like I’ve been writing a lot about futures I was pretty worried about, so I’m pleased to have a couple developments to talk about that help remind<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/19/and-now-for-some-fun-future/">Continue reading...</a>]]></description>
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<figure class="alignright size-full"><img decoding="async" loading="lazy" width="256" height="256" src="https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ.jpg" alt="" class="wp-image-97379" srcset="https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ.jpg 256w, https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ-150x150.jpg 150w, https://thehealthcareblog.com/wp-content/uploads/2020/01/1_nqqfyFoqgU0fwhWi8cOHbQ-120x120.jpg 120w" sizes="(max-width: 256px) 100vw, 256px" /></figure></div>
By KIM BELLARD
I feel like I’ve been writing a lot about futures I was pretty worried about, so I’m pleased to have a couple developments to talk about that help remind me that technology is cool and that healthcare can surely use more of it.
First up is a new AI algorithm called FaceAge, as<a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(25)00042-1/fulltext"> published last week in The Lancet Digital Health</a> by researchers at Mass General Brigham. What it does is to use photographs to determine biological age – as opposed to chronological age. We all know that different people seem to age at different rates – I mean, honestly, how old is Paul Rudd??? – but until now the link between how people look and their health status was intuitive at best.
Moreover, the algorithm can help determine survival outcomes for various types of cancer.
The researchers trained the algorithm on almost 59,000 photos from public databases, then tested against the photos of 6,200 cancer patients taken prior to the start of radiotherapy. Cancer patients appeared to FaceAge some five years older than their chronological age. “We can use artificial intelligence (AI) to estimate a person’s biological age from face pictures, and our study shows that information can be clinically meaningful,” said co-senior and corresponding author<a href="https://aim.hms.harvard.edu/team/hugo-aerts"> Hugo Aerts, PhD</a>, director of the Artificial Intelligence in Medicine (AIM) program at Mass General Brigham.
Curiously, the algorithm doesn’t seem to care about whether someone is bald or has grey hair, and may be using more subtle clues, such as muscle tone. It is unclear what difference makeup, lighting, or plastic surgery makes. “So this is something that we are actively investigating and researching,” Dr. Aerts<a href="https://www.washingtonpost.com/science/2025/05/12/ai-tool-biological-age-faceage/"> told The Washington Post</a>. “We’re now testing in various datasets [to see] how we can make the algorithm robust against this.”
Moreover, it was trained primarily on white faces, which the researchers acknowledge as a deficiency. “I’d be very worried about whether this tool works equally well for all populations, for example women, older adults, racial and ethnic minorities, those with various disabilities, pregnant women and the like,” Jennifer E. Miller, the co-director of the program for biomedical ethics at Yale University,<a href="https://www.nytimes.com/2025/05/08/well/biological-age-faceage.html"> told The New York Times</a>.
The researchers believe FaceAge can be used to better estimate survival rates for cancer patients. It turns out that when physicians try to gauge them simply by looking, their guess is essentially like tossing a coin. When paired with FaceAge’s insights, the accuracy can go up to about 80%.
Dr. Aerts says: “This work demonstrates that a photo like a simple selfie contains important information that could help to inform clinical decision-making and care plans for patients and clinicians. How old someone looks compared to their chronological age really matters—individuals with FaceAges that are younger than their chronological ages do significantly better after cancer therapy.”
I’m especially thrilled about this because<a href="https://kimbellardblog.blogspot.com/2015/11/my-phone-says-ive-looked-better.html"> ten years ago I speculated</a> about using selfies and facial recognition AI to determine if we had conditions that were prematurely aging us, or even we were just getting sick. It appears the Mass General Brigham researchers agree. “This opens the door to a whole new realm of biomarker discovery from photographs, and its potential goes far beyond cancer care or predicting age,” said co-senior author<a href="https://aim.hms.harvard.edu/team/raymond-mak"> Ray Mak, MD,</a> a faculty member in the AIM program at Mass General Brigham. “As we increasingly think of different chronic diseases as diseases of aging, it becomes even more important to be able to accurately predict an individual’s aging trajectory. I hope we can ultimately use this technology as an early detection system in a variety of applications, within a strong regulatory and ethical framework, to help save lives.”
The researchers acknowledge that much has to be accomplished before it is introduced for commercial purposes, and that strong oversight will be needed to ensure, as Dr. Aerts<a href="https://www.washingtonpost.com/science/2025/05/12/ai-tool-biological-age-faceage/"> told WaPo,</a> “these AI technologies are being used in the right way, really only for the benefit of the patients.” As Daniel Belsky, a Columbia University epidemiologist, told The New York Times: “There’s a long way between where we are today and actually using these tools in a clinical setting.”
The second development is even more out there. Let me break down the CalTech News headline: “3D Printing.” OK, you’ve got my attention. “In Vivo.” Color me highly intrigued. “Using Sound.” Mind. Blown.
That’s right. This team of researchers have “developed a method for 3D printing polymers at specific locations deep within living animals.” 

Apparently, 3D printing has been done in vivo previously, but using infrared light. “But infrared penetration is very limited. It only reaches right below the skin,” says<a href="https://www.eas.caltech.edu/people/weigao"> Wei Gao</a>, professor of medical engineering at Caltech and corresponding author. “Our new technique reaches the deep tissue and can print a variety of materials for a broad range of applications, all while maintaining excellent biocompatibility.”
They call the technique the deep tissue in vivo sound printing (DISP) platform.
“The DISP technology offers a versatile platform for printing a wide range of functional biomaterials, unlocking applications in bioelectronics, drug delivery, tissue engineering, wound sealing, and beyond,” the team stated. “By enabling precise control over material properties and spatial resolution, DISP is ideal for creating functional structures and patterns directly within living tissues.”
The authors concluded: “DISP’s ability to print conductive, drug-loaded, cell-laden, and bioadhesive biomaterials demonstrates its versatility for diverse biomedical applications.”
I’ll spare you the details, which involve, among other things, ultrasound and low temperature sensitive liposomes. The key takeaway is this: “We have already shown in a small animal that we can print drug-loaded hydrogels for tumor treatment,” Dr. Gao says. “Our next stage is to try to print in a larger animal model, and hopefully, in the near future, we can evaluate this in humans…In the future, with the help of AI, we would like to be able to autonomously trigger high-precision printing within a moving organ such as a beating heart.”
Dr. Gao also points out that not only can they add bio-ink where desired, but they could remove it if needed. Minimally invasive surgery seems crude by comparison.
“It’s quite exciting,” <a href="https://shrikezhang.com/"> Yu Shrike Zhang</a>, a biomedical engineer at<a href="https://spectrum.ieee.org/tag/harvard"> Harvard</a> Medical School and Brigham and Women’s Hospital, who was not involved in the research,<a href="https://spectrum.ieee.org/bioprinting-inside-the-body"> told IEEE Spectrum</a>. “This work has really expanded the scope of ultrasound-based printing and shown its translational capacity.”
First author<a href="https://davoodilab.mech.utah.edu/"> Elham Davoodi</a> has high hopes. “It’s quite versatile…It’s a new research direction in the field of bioprinting.”
“Quite exciting” doesn’t do it justice.
In these topsy-turvy days, we must find our solace where we can, and these are the kinds of things that make me hopeful about the future.
Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented <a href="http://tincture.io/">Tincture.io</a>, and now regular THCB contributor
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<title>Health Deserves A Vision More Capacious Than Dashboard Metrics</title>
<link>https://thehealthcareblog.com/blog/2025/05/16/health-deserves-a-vision-more-capacious-than-dashboard-metrics/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Fri, 16 May 2025 06:53:00 +0000</pubDate>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Consumer Wellness]]></category>
<category><![CDATA[Dashboard]]></category>
<category><![CDATA[David Shaywitz]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109284</guid>
<description><![CDATA[By DAVID SHAYWITZ Consumer health and wellness is experiencing a flurry of activity.  The lab testing company Function (motto: “It’s time to own your health”) acquired Ezra, a whole body MRI company<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/16/health-deserves-a-vision-more-capacious-than-dashboard-metrics/">Continue reading...</a>]]></description>
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By DAVID SHAYWITZ
Consumer health and wellness is experiencing a flurry of activity. 
The lab testing company <a href="https://www.functionhealth.com/">Function</a> (motto: “It’s time to own your health”) <a href="https://www.fiercehealthcare.com/health-tech/function-health-acquires-ezra-combine-lab-testing-and-ai-powered-medical-imaging">acquired</a> <a href="https://ezra.com/">Ezra</a>, a whole body MRI company promising “the world’s most advanced longevity scan.”   
<a href="https://ouraring.com/">Oura</a>, maker of the popular smart ring, <a href="https://www.theverge.com/news/661069/oura-dexcom-stelo-meals-glucose-metabolic-health-wearables">recently added</a> an integration for continuous glucose measurement as well as the ability to calculate meal nutrition based on a photo. Oura also <a href="https://thehealthcaretechnologyreport.com/oura-expands-leadership-appoints-ricky-bloomfield-as-chief-medical-officer/">hired</a> Dr. Ricky Bloomfield as its first Chief Medical Officer; Dr. Bloomfield had previously served as Clinical and Health Informatics Lead at Apple, and is known for his expertise in health data interoperability.
Meanwhile, Oura competitor <a href="https://www.whoop.com/us/en/?srsltid=AfmBOoqEkqbpsdNM_w7PgBAqck3uiu6PgkcV6Bs_bOmVmQ_q4OM_34bB">Whoop</a>, maker of a smart band, just <a href="https://www.cnbc.com/2025/05/08/whoop-wearables-whoop-50-mg-price.html">announced</a> the latest versions of its device, with the ability to monitor blood pressure, ECG, and to assess what it describes as a measure of biological age, which it calls “Whoop Age.” Whoop now says it seeks to “unlock human performance and healthspan,” enticing users with the pitch, “Get a complete picture of your health.”
<h4 class="wp-block-heading">Towards a Personal Health Operating System (OS)</h4>
Notice a pattern yet? 
What unites these approaches and <a href="https://erictopol.substack.com/p/the-business-of-promoting-longevity">so many others</a>, as the industry newsletter Fitt Insider (FI) recently <a href="https://insider.fitt.co/issue-no-334-personal-health-os/">observed</a>, is they reflect an attempt to generate a “personal health OS,” intended to “give individuals agency over their well-being,” and more generally, wrest control back from a health system that’s often perceived (especially by young adults) as somewhere between useless and obstructive.
Citing a recent Edelman <a href="https://www.edelman.com/trust/2025/trust-barometer/special-report-health">survey</a>, FI reports,
 …nearly half of young adults believe well-informed people can be as knowledgeable as doctors, two-thirds see lived experience as expertise, and 61% view institutions as barriers to care.
Fed up with <a href="https://insider.fitt.co/issue-no-333-backup-plan/">reactive care</a>, many already collect data across wearables, lifestyle apps, DTC diagnostics, and more, but most are siloed. Rolling up, Function is architecting a unified platform capable of generating clinically relevant insights from raw inputs.
FI points to the proliferation of companies like Bright OS, Gyroscope, and Guava Health focused on “day-to-day data management,” as well as startups like Superpower (“Delivering concierge-level metrics minus the PCP”) and Mito Health (a “pocket-sized AI doctor” that “generates comprehensive digital health profiles by merging labs, medical records, family history, lifestyle info, and more.”)
AI seems poised to play an increasingly central role in many of these companies. 
FI speculates,
A step further, end-to-end LLMs could close the loop, linking cause and effect, turning insights into actions, syncing with PCPs, and laying the foundation for an <a href="https://insider.fitt.co/report/how-ai-can-supercharge-health-and-wellness/">AI-powered medical future</a>.
This is a good time to take a deep breath – as well as a closer, more critical look at this vision of consumer-empowered, data-fortified health.
<h4 class="wp-block-heading">A Powerful Vision</h4>
Unquestionably, there’s a lot to embrace here, including in particular:
<ul>
<li>The opportunity for individuals to gather more and richer health data from a greater variety of sources, including in particular wearables;</li>
<li>The increased possibility of relevant insights (a <a href="https://timmermanreport.com/2021/04/quantified-self-redux/">key deficiency</a> of early “Quantified Self” efforts) from these data.</li>
<li>The explicit centralization of your health data around you (Superpower’s tagline is “Health Data, In One Place”), a long-promised but often frustratingly elusive healthcare goal in practice. Today, still, (still!), so many patients find themselves having to beg and plead for efficient access to their own health information, data that health systems tend to view as a <a href="https://www.forbes.com/sites/davidshaywitz/2015/03/24/data-silos-healthcares-silent-tragedy/">competitive advantage</a> and aren’t eager to let go.</li>
</ul>
A tech-enabled approach to health where you have more abundant data about you, that are explicitly in your control, and which could lead to healthier behaviors represents the sort of progress that deserves to be celebrated.
At the same time, when I look at many of these approaches to health, I see two broad categories of concerns.
<h4 class="wp-block-heading">Concern One: Plural of Fragile Data May Not Be Insight</h4>
The first, perhaps more concrete worry, is that, to paraphrase comedian Dennis Miller, “two of [crap] is [crap],” and simply the collection of a lot of data, much of which may be fragile, isn’t sure to translate into brilliant insight, even if the magical power of AI is fervently invoked.
In an especially incisive “Ground Truths” blog post focused on “The business of promoting longevity and healthspan,” Dr. Eric Topol <a href="https://erictopol.substack.com/p/the-business-of-promoting-longevity">writes</a> that “getting hundreds of biomarker results and imaging tests in an individual greatly increases the likelihood of false-positive results,” a concerning possibility.
I’ve discussed the challenge of false positives <a href="https://timmermanreport.com/2025/03/longevity-is-having-a-moment/">here</a>, and get into some of the details around Bayes Theorem (which informs the assessment) <a href="https://www.wsj.com/arts-culture/books/everything-is-predictable-review-the-secret-of-bayes-a9800cb4">here</a>. The OG reference in this space may be <a href="https://pubmed.ncbi.nlm.nih.gov/16835427/">this</a> 2006 paper by Zak Kohane and colleagues, in which they introduce the term “incidentalome.”
To be fair, at least some of the proponents of extensive testing recognize the challenge of false positives but feel that the opportunity to collect dense data on individuals over time enables important inflections to be observed, a point Dr. Peter Attia explicitly emphasizes in Outlive; I discuss his “risk-management” mindset <a href="https://timmermanreport.com/2025/03/longevity-is-having-a-moment/">here</a>.
Similarly, Nathan Price, a professor at the Buck Institute and the CSO of Thorne, has argued that close inspection (assisted by AI) of rich individual data could identify (for example) opportunities for supplement intervention.  These interventions may not make much of a difference on the population level (hence the paucity of persuasive clinical trial data for supplements, as Dr. Topol notes in his latest book, Super Agers – my WSJ review <a href="https://www.wsj.com/health/wellness/super-agers-review-living-the-good-life-9a38c55c?mod=books_news_article_pos1">here</a>), but could in selected individuals. (I also discuss Price <a href="https://timmermanreport.com/2025/05/our-collective-hope-for-ai-in-health-plus-explanatory-models-and-an-epic-podcast/">here</a>, <a href="https://timmermanreport.com/2025/04/can-you-improve-your-health-without-obsessing-about-it/">here</a>).
Proponents of the “personal health OS” also might emphasize the presence of tailwinds – the likelihood of improved predictions as measurement technologies continue to get better, denser data become available, and the AI tools become ever-more capable.  Perhaps we’re not quite at the point of realizing the future we imagine, advocates might argue, but we’re close enough to start to see what it might look like.

<h4 class="wp-block-heading">Concern Two: A Constricted View of Health</h4>
What’s arguably a deeper concern about the model of health we seem to be moving towards is the degree to which it seems to be informed by a rigidly reductive mindset. In this limited, classically managerial (or consultant) view, health becomes simply metrics on a dashboard, an ever-expanding series of parameters that must constantly be measured, quantified, optimized.
A recent, beautiful <a href="https://www.nytimes.com/2025/05/03/magazine/happiness-history-living-well.html">essay</a> about our evolving understanding of and approach to happiness in the New York Times Magazine by Kwame Anthony Appiah reminds us what we may be missing. 
Around the start of the new Millenium, Appiah writes, we entered
the life-hacking, self-quantifying, habit-stacking era of optimization gurus like Tim Ferriss, whose first book, published in 2007, was “The 4-Hour Workweek” — “a toolkit,” in his words, “for maximizing per-hour output.”
Consequently, Appiah continues, the concept of flourishing was decomposed into “modular upgrades” as we refine our “personal operating system.” 
Yet it’s essential to recognize, Appiah writes, that “happiness is not an optimization problem,” but something deeper and more substantial.
I reached for a similar point in 2018, in a <a href="https://www.aei.org/articles/we-are-not-a-dashboard-contesting-the-tyranny-of-metrics-measurement-and-managerialism/">piece</a> entitled, “We Are Not a Dashboard.” 
Observing that the “dashboard has become a potent symbol of our age,” I wrote that “the ideology of big data has taken on a life of its own, assuming a sense of both inevitability and self-justification.”
I continued, “From measurement in service of people, we increasingly seem to be measuring in service of data, setting up systems and organizations where constant measurement often appears to be an end in itself.”
I’m reminded of a favorite phrase from Kate Crawford’s Atlas of AI (my WSJ review <a href="https://www.wsj.com/tech/ai/big-brains-new-books-on-artificial-intelligence-11621607063">here</a>): “The affordances of the tools become the horizon of truth,” a reminder, in this context, that even if we’re awash in tools enabling the measurement and analysis of health data, we must ensure our understanding of health transcends the limits of these tools.
Of course, the point isn’t to go the other way, and reject metrics completely. 
As Professor Jerry Muller, author of the brilliant book Tyranny of Metrics, <a href="https://www.aei.org/articles/we-are-not-a-dashboard-contesting-the-tyranny-of-metrics-measurement-and-managerialism/">explains</a>, “I can’t see how competent experts could ignore metrics. The question is their ability to evaluate the significance of the metrics, and to recognize the role of the unmeasured.” (emphasis added). 
I also spoke to this need in a 2011 <a href="https://www.aei.org/op-eds/what-silicon-valley-doesnt-understand-about-medicine/">piece</a> entitled “What Silicon Valley Doesn’t Understand About Medicine,” writing, ”a novel technology platform that overlooks the integrated needs of patients or underestimates or fails to account for the complexity and messiness of illness as it actually occurs and is experienced by patients (and those closest to them) will inevitably fall short.”
<h4 class="wp-block-heading">Moving Forward</h4>
To most effectively meet the needs of patients – including the vitally important goal of preventing or preempting disease so people don’t become patients – it’s essential to embrace the power and promise of emerging technologies, including those enabling the conceptualization of “personal health OS,”  while not mistaking this map for the territory (as Alfred Korzybski <a href="https://en.wikipedia.org/wiki/Map%E2%80%93territory_relation">famously instructed</a>). 
It will be essential to establish priorities – in partnership with each patient – and identify a handful of key health parameters on which to focus on; Drs. David Blumenthal and J. Michael McGinnis discuss the topic of “core metrics” thoughtfully in <a href="https://jamanetwork.com/journals/jama/article-abstract/2288464">this</a> 2015 JAMA “Viewpoint.” 
At the same time, we must hold fast to a vision of health and wellness that expands far beyond the confinement of a dashboard and aspires to something beyond the recursive optimization of metrics (as I recently discussed <a href="https://timmermanreport.com/2025/04/can-you-improve-your-health-without-obsessing-about-it/">here</a>). Our approach must be capacious enough to include, authentically value, and meaningfully cultivate other components of a healthy, flourishing life, which might include intellectual captivation, the pursuit of purpose, and social engagement with family, friends, and community.
(Martin Seligman’s PERMA model — positive emotion/joy, engagement/flow, relationships/connection with others, meaning/purpose, and accomplishment — represents a potentially useful framework [see <a href="https://www.aei.org/articles/from-fitness-to-flourish-expanding-the-scope-of-digital-exercise/">here</a>, <a href="https://www.aei.org/articles/corporate-health-and-wellness-has-new-urgency-and-vision/">here</a>] for expanding our thinking.)
Despite the difficulty, if not utter impossibility, of reducing some of the most important and profound components of health to an easily digested number, we must continue to value and pursue them.
Even as we diligently leverage emerging technology to construct and refine health dashboards, let’s resolve to work towards a more expansive, durable, and meaningful vision of health that exists beyond the sterile syntax of rows, columns, and digits.
Dr. Shaywitz, a physician-scientist, is a longtime operator and investor in health tech, the founder of <a href="https://www.astoundinghealthtech.com/">Astounding Healthtech, a lecturer</a> at Harvard Medical School and an adjunct fellow at the American Enterprise Institute. This piece was originally published on the <a href="https://timmermanreport.com/2025/05/health-deserves-a-vision-more-capacious-than-dashboard-metrics/">Timmerman Report</a>
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<title>Tracy DeTomasi, Callisto</title>
<link>https://thehealthcareblog.com/blog/2025/05/15/tracey-detomasi-callisto/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Thu, 15 May 2025 12:42:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Callisto]]></category>
<category><![CDATA[Jess Ladd]]></category>
<category><![CDATA[Rape]]></category>
<category><![CDATA[Sexual Violence]]></category>
<category><![CDATA[Tracey deTomasi]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109295</guid>
<description><![CDATA[Callisto is a non-profit tech company that helps survivors of sexual violence identify repeat offenders. The company was started a few years back by Jess Ladd and Tracy DeTomasi took over as<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/15/tracey-detomasi-callisto/">Continue reading...</a>]]></description>
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Callisto is a non-profit tech company that helps survivors of sexual violence identify repeat offenders. The company was started a few years back by Jess Ladd and Tracy DeTomasi took over as CEO a few years back, It focuses on college campuses where 90% of assaults are perpetrated by repeat offenders, who on average commit 6 offenses. And 90% of assaults are not reported, Callisto is working providing an anonymous solution with Tracey also giving a demo of how it works. This is a  tough conversation about a difficult topic.–Matthew Holt
<figure class="wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio"><div class="wp-block-embed__wrapper">
<iframe loading="lazy" title="Tracy DeTomasi, Callisto" width="639" height="359" src="https://www.youtube.com/embed/pJ1k89aVLYg?feature=oembed" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" referrerpolicy="strict-origin-when-cross-origin" allowfullscreen></iframe>
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<title>Seriously, Aon, you think weight loss drugs save money?</title>
<link>https://thehealthcareblog.com/blog/2025/05/14/seriously-aon-you-think-weight-loss-drugs-save-money/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Wed, 14 May 2025 08:38:00 +0000</pubDate>
<category><![CDATA[Health Tech]]></category>
<category><![CDATA[Accolade]]></category>
<category><![CDATA[Al Lewis]]></category>
<category><![CDATA[Aon]]></category>
<category><![CDATA[GLP1s]]></category>
<category><![CDATA[Lyra Health]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109272</guid>
<description><![CDATA[By AL LEWIS Last month Aon, the major benefits consulting firm, released a “study” claiming: A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/14/seriously-aon-you-think-weight-loss-drugs-save-money/">Continue reading...</a>]]></description>
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<figure class="alignright size-full is-resized"><img decoding="async" loading="lazy" width="160" height="208" src="https://thehealthcareblog.com/wp-content/uploads/2011/06/Al-Lewis.png" alt="" class="wp-image-29363" style="aspect-ratio:0.7692307692307693;width:204px;height:auto"/></figure></div>
By AL LEWIS
Last month Aon, the major benefits consulting firm, <a href="https://aon.mediaroom.com/2025-04-30-Aon-Unveils-First-Workforce-Focused-Analysis-on-GLP-1s-Medications-and-Holistic-Support-Can-Transform-Workforce-Health-and-Bend-the-Cost-Curve">released a “study” claiming</a>:
A significant opportunity to reduce healthcare costs for employers and enhance overall workforce health through a comprehensive obesity management program that includes GLP-1 medications.
This, of course, is the opposite of what most researchers have shown.  And in the immortal words of the great philosophers Dire Straits: “Two men say they’re Jesus, one of them must be wrong.” We’ll shortly see who’s wrong (um, meaning about weight loss drugs) when we dive into the study in a minute. But first, let’s review Aon’s previous analyses. 
A brief history of Aon
Aon claimed that Accolade saved 8%, <a href="https://theysaidwhat.net/2023/07/09/are-accolade-customers-violating-the-consolidated-appropriations-act/">but it looks like they must coincidentally have been absent</a> both on the day that the biostatistics professor explained how control groups work, and also on the day the fifth-grade math teacher explained how averages work. 
Then, they <a href="https://theysaidwhat.net/2024/05/28/aon-channels-britney-spears-in-lyra-report/">claimed that Lyra</a> – which is a mental health company – achieved the following non-mental improvements in the set of patients who had at least one mental health encounter with one of their “220,000 high-quality providers”:
§  A 30% reduction in non-mental health-related ER visits
§  A 30% reduction in generic drug spending
§  A 20% reduction in specialty drug spending
Thanks in part to starting the y-axis at $4000 to improve the optics, Aon also revealed that Lyra achieved a very high “efficiency ratio”:
<figure class="wp-block-image"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXef8WiWClcKSp-E0kfymw8uj37A-COzECy32INTSeMpYP9nId9imxfFuYVmQvuIL6-bVvYN2YVJzvlNAnuUCtsFTxb2B53F5IWzLax52OXsIXxCiwSg8Jk2FEmdGa6AkYpgjAn8zQ?key=cn8O0jtY3Bc6j3xqtKXJMw" alt="A graph of a number of people
AI-generated content may be incorrect."/></figure>
I can’t object to that finding because – despite three decades in this field, about <a href="https://theysaidwhat.net/in-the-news-2/">100 articles/interviews/quotes/citations</a> including <a href="https://www.wsj.com/articles/SB10001424127887323501004578389673547444046">the Wall Street Journal</a>,<a href="https://www.amazon.com/Why-Nobody-Believes-Numbers-Distinguishing/dp/1118313186/ref=sr_1_1?crid=2FH7Y7M02NE1W&dib=eyJ2IjoiMSJ9.QplxDc-0CmTvgTA5DprBuDdcX5FcxWsKTvfUlljfwcc.rcAoTkgG6wtqjcli6tG3Eb-lsuRZPECvYO6O-8xf43U&dib_tag=se&keywords=why+nobody+believes+the+numbers&qid=1743962198&s=books&sprefix=why+nobody+believes+the+numbers%2Cstripbooks%2C122&sr=1-1"> two</a> trade-bestselling <a href="https://www.amazon.com/Cracking-Health-Costs-Companys-Employees/dp/1118636481/ref=sr_1_1?crid=1OS05N5DSUPGZ&dib=eyJ2IjoiMSJ9.pc7zTR0EIOaGy_UlkMxCvA.MdZ3AlbQJnOa8MS7y7rQeX0N_AlAPndRif0gRcwdHTY&dib_tag=se&keywords=Cracking+Health+Costs&qid=1746831394&sprefix=cracking+health+costs%2Caps%2C101&sr=8-1">books</a> and one Harvard Business School <a href="https://www.hbs.edu/faculty/Pages/item.aspx?num=59987">case study</a> – I still don’t know what an “efficiency ratio” is, other than that has nothing to do with comparing participants to non-participants in a mental health study. Apparently an <a href="https://www.google.com/search?q=%22efficiency+ratio%22+in+healthcare&oq=&gs_lcrp=EgZjaHJvbWUqCQgAEEUYOxjCAzIJCAAQRRg7GMIDMgkIARBFGDsYwgMyCQgCEEUYOxjCAzIJCAMQRRg7GMIDMgkIBBBFGDsYwgMyCQgFEEUYOxjCAzIJCAYQRRg7GMIDMgkIBxBFGDsYwgPSAQkxNjQ4ajBqMTWoAgiwAgHxBZjs6P_rQJIG&sourceid=chrome&ie=UTF-8">“efficiency ratio” in healthcare measures how quickly</a> a hospital turns over its inventory. So Aon’s use of the term recalls the immortal words of the great philosopher Bob Uecker: <a href="https://www.google.com/search?q=%22efficiency+ratio%22+in+healthcare&oq=&gs_lcrp=EgZjaHJvbWUqCQgAEEUYOxjCAzIJCAAQRRg7GMIDMgkIARBFGDsYwgMyCQgCEEUYOxjCAzIJCAMQRRg7GMIDMgkIBBBFGDsYwgMyCQgFEEUYOxjCAzIJCAYQRRg7GMIDMgkIBxBFGDsYwgPSAQkxNjQ4ajBqMTWoAgiwAgHxBZjs6P_rQJIG&sourceid=chrome&ie=UTF-8">“Juuussst a bit outside.”</a>
When publicly and privately asked to explain any of these things, Aon clammed up. That was likely wise on their part. 

Nor will they respond here, because they understand the <a href="https://en.wikipedia.org/wiki/Streisand_effect">Streisand Effect</a>. (Barbra sued a photographer for photographing her Malibu mansion from the air as a routine part of documenting erosion along the California coastline at the behest of the state. Six people had downloaded that image before she sued. After she sued, one million people downloaded the image. Also, she lost and had to pay attorney fees as well.)
Most recently, it appears <a href="https://theysaidwhat.net/2025/01/30/aon-finally-shows-their-hand-its-in-the-cookie-jar/">that they may have had their hand</a> in the PBM cookie jar as well.
Aon’s Weight Loss Drug Study
While admitting that costs jump in the first year, Aon found a 7% “bend” in the cost curve in the second year, by participants as compared to a “precisely matched control group.” <a href="https://validationinstitute.com/blog/how-to-tell-if-your-vendors-claims-are-valid-part-two/"> Matched controls, no matter how “precise,” are invalid, period</a>. That is why the FDA doesn’t let pharma companies use them. Most famously, some Very Stable Geniuses in the wellness industry inadvertently proved this when they published this graph. They thought they were showing that participants in wellness programs saved money vs. matched non-participants. Unfortunately for them, a cursory look at the x-axis reveals the “total savings” from the aptly named “treatment” started two years before the treatment started, simply because voluntary participants are motivated.
<figure class="wp-block-image"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXeWw8vZowVFKY8NkSlAotKwamLKL7CfTKF5XI8ByhnqYKQmokJWhBZDHbRkwQsmcxrjs_w6J7G5CcBaCHkjiHEPQFsbZhFZXiJQ4efq-nBujJ5if0WuYoah7qFAsS6uPkKwxCCjZQ?key=cn8O0jtY3Bc6j3xqtKXJMw" alt="A graph showing the cost of a health care program
AI-generated content may be incorrect."/></figure>
The related issue is that over a two-year period – the same duration that Aon studied – most weight loss drug users have dropped out. Yet, there is no accounting for – or mentioning of –   dropouts in this study.
Only people still on the drugs are counted. The others would be “lost to follow-up.” Counting only the ones still in the program at the end is called “survivor bias,” or the “last man standing” fallacy. It’s why any weight loss program shows great results – most people quit most programs because they aren’t succeeding. Ironically, the greater the dropout rate, generally the better the results among the few survivors.
It is also quite literally impossible for costs to “bend” 7% overall by reducing the rate of heart attacks and strokes by 44%. That’s because there simply aren’t enough of these events to do that. The rate of both is about 1 per 1000 in the <65 insured population. And Aon didn’t even claim a 44% reduction in those events. They claimed to reduce the “risk” of these events by 44%. A cynic might observe that obviously if they did reduce actual events by that amount, they would have said so.
No need to take our word for this conclusion. We have made our <a href="https://wldec.quizzify.com/calculator">Weight Loss Drug Economics Calculator</a> free. Enter your own assumptions and decide for yourself.
How they can determine someone’s risk from their claims is anyone’s guess. Suppose twins have parents who died early of heart disease. The first is very concerned about this. He takes statins, metformin, maybe sees a cardiologist, gets a stent etc. The second does nothing to mitigate his genetic risk. The second is at much higher risk than the first, but the “risk score” will say the opposite. <a href="https://www.google.com/search?q=what+%25+of+peopel+with+CAD+get+their+diagnosis+in+the+ER&oq=what+%25+of+peopel+with+CAD+get+their+diagnosis+in+the+ER&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIKCAEQABiiBBiJBTIKCAIQABiABBiiBDIKCAMQABiABBiiBNIBCjExODI4ajBqMTWoAgiwAgHxBfYih0l8B0on&sourceid=chrome&ie=UTF-8">Many people don’t even know</a> they are at risk for coronary artery disease until they have an event. So how can Aon know?
What is Aon up to?
Surely an actuarial consulting firm whose reputation is based on, well, being an actuarial consulting firm wouldn’t risk that reputation by writing articles like these, right?
Well, certainly not for free.
They got paid by Lyra, got paid by Accolade, and (allegedly) got paid by Express Scripts. In this case – for anyone who doesn’t feel like opening the free Weight Loss Drug Calculator above to figure out themselves – Aon will “work with employers in modeling the long-term business impact of GLP-1 adoption.”
And since their model is wrong, “working with” Aon is – once again in the immortal words of Dire Straits – “money for nothing.”
Al Lewis is CEO of <a href="https://www.quizzify.com/">Quizzify</a>, Chairman of the <a href="https://validationinstitute.com/">Validation Institute</a> and bete noir of the wellness industry. He blogs occasionally at <a href="https://theysaidwhat.net/blog/">They Said What?</a>
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<title>When Star Ratings Backfire: How CMS Could Better Support Health In Medicare Advantage</title>
<link>https://thehealthcareblog.com/blog/2025/05/13/when-star-ratings-backfire-how-cms-could-better-support-health-in-medicare-advantage/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Tue, 13 May 2025 06:19:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[The Business of Health Care]]></category>
<category><![CDATA[CMS]]></category>
<category><![CDATA[Elevance]]></category>
<category><![CDATA[Humana]]></category>
<category><![CDATA[MA]]></category>
<category><![CDATA[Medicare Advantage]]></category>
<category><![CDATA[Scan Health Plan]]></category>
<category><![CDATA[Star ratings]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109275</guid>
<description><![CDATA[By EMMANUEL ANIMASHAUN The Centers for Medicare & Medicaid Services (CMS) Star Ratings system represents a cornerstone of quality assessment in Medicare Advantage (MA), designed to empower consumers with transparent information while<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/13/when-star-ratings-backfire-how-cms-could-better-support-health-in-medicare-advantage/">Continue reading...</a>]]></description>
<content:encoded><![CDATA[<div class="wp-block-image">
<figure class="alignright size-large is-resized"><img decoding="async" loading="lazy" width="1011" height="1024" src="https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-1011x1024.jpg" alt="" class="wp-image-109281" style="aspect-ratio:0.9873046875;width:366px;height:auto" srcset="https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-1011x1024.jpg 1011w, https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-296x300.jpg 296w, https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-148x150.jpg 148w, https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-768x778.jpg 768w, https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel-1200x1215.jpg 1200w, https://thehealthcareblog.com/wp-content/uploads/2025/05/Emmanuel.jpg 1498w" sizes="(max-width: 1011px) 100vw, 1011px" /></figure></div>
By EMMANUEL ANIMASHAUN
The<a href="https://www.cms.gov/"> Centers for Medicare & Medicaid Services</a> (CMS) Star Ratings system represents a cornerstone of quality assessment in Medicare Advantage (MA), designed to empower consumers with transparent information while rewarding plans that deliver superior care. Yet recent developments, particularly the<a href="https://www.reuters.com/business/healthcare-pharmaceuticals/humana-says-members-its-highly-rated-medicare-advantage-plans-fell-2025-2024-10-02/#:~:text=The%20sell,5%20last%20year"> seismic downgrading of Humana’s ratings</a> reveal an unintended consequence: a system created to measure and incentivize quality may now be actively undermining it.
The Humana Case: Symptom of a Broader Problem
In 2025, Humana’s Medicare Advantage star ratings collapsed, with only 25% of members remaining in four-star or higher plans, down from 94%. This wasn’t due to declining clinical performance but resulted from CMS’s<a href="https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-star-ratings#:~:text=As%20finalized%20in%20rulemaking%20in,level%20cut%20points"> “Tukey outlier deletion”</a> statistical adjustment implemented with minimal industry consultation. The change raised performance thresholds, causing Humana to lose billions in Quality Bonus Payments and $4 billion in market value.<a href="https://www.healthcarefinancenews.com/news/humana-sues-over-2025-medicare-advantage-star-ratings"> Humana’s legal challenge</a>, arguing that CMS violated the Administrative Procedure Act through non-transparent processes, was denied. Other insurers including UnitedHealthcare and Centene also<a href="https://www.reedsmith.com/en/perspectives/managed-care-outlook-2025/2025/01/medicare-advantage-stars-whats-next-now-litigation-floodgates-have-opened"> share concerns</a> about methodological rigidity and that the rating system may have diverged from its purpose of improving patient care.
Perhaps more striking are the cases of Elevance and SCAN, which further illustrate how rigid metrics can distort assessments of actual care quality. In March 2023, both insurers were<a href="https://fortune.com/well/2024/01/23/medicare-advantage-insurance-elevance-lawsuit-190-million-secret-shopper-phone-call/"> penalized after allegedly missing a single CMS “secret shopper” phone call</a>, a call they claim was never received. The downgrade cost them tens of millions in Quality Bonus Payments and triggered legal challenges. As<a href="https://www.forbes.com/sites/sachinjain/2024/10/24/trick-or-treat-the-fuss-over-medicare-advantage-star-ratings/"> SCAN’s CEO wrote</a>, the sanction came despite strong clinical performance and patient outcomes. A federal judge later ruled in favor of SCAN in June 2024,<a href="https://www.wsj.com/health/healthcare/medicare-will-recalculate-quality-ratings-of-medicare-advantage-plans-eebee409"> prompting CMS to recalculate the Star Ratings</a> across all Medicare Advantage plans. This episode underscores a key concern: when measurement hinges on unverifiable administrative moments, it may end up punishing rather than promoting quality.
How Quality Measurement Can Undermine Actual Quality
<a href="https://www.fticonsulting.com/insights/articles/cracking-code-2025-cms-star-ratings">The Star Ratings system</a> aggregates over 40 metrics across preventive care, medication adherence, member experience, and customer service. However, it disproportionately rewards process compliance and documentation over health outcomes. Plans can excel by optimizing coding, maximizing documentation, or boosting survey participation without delivering better care. This misalignment diverts resources from genuine health innovations.<a href="https://tradeoffs.org/wp-content/uploads/2021/01/w27578.pdf"> Research from an NBER working paper</a> even found that better-rated plans aren’t statistically better at keeping patients alive than lower-rated ones, raising fundamental questions about whether the system measures what truly matters for patient health.
Even more concerning is that MA contracts with higher proportions of dually eligible, disabled, or racially diverse members consistently score lower, not because they provide inferior care, but because the scoring system inadequately adjusts for social risk factors.<a href="https://watermark.silverchair.com/meyers_2021_oi_210012_1623169235.68338.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAzQwggMwBgkqhkiG9w0BBwagggMhMIIDHQIBADCCAxYGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMhhWfcv2Ltii1OBXjAgEQgIIC518T9wEMSVrmd_zLRV4gwQrIFefGB7zWz1JeoaQxBKOpC8nUkF6Z46j1hezgr48wBfKdsuWMYhy7KDD4z5VWn-vkdOP0zxK0BAhGHvpQaP5SCUsG9K0vdN_uZFAChI9n80WeiM3GRBXQNKKgIiyB1SV38HzYJYglemaDgjkpZQ6OZU4xdlmnGp5o-uYPqTVFvd38HCwKvZdjAp13TZq3gSs6nCamGPAIvXhYwsdL1QSrNt9NdOVRAGeBhBOQHZLN_I4wcfvMbGZatPRoABqI634BEakKat9JIkFU-uwA_5S4Afw6hqsrooutyiBsRePJYeBtt68Fp_huo5DaixR1uR1Zmeo4S-UmBRW72Y4R4oOQLXr589gVAS3aptZ8Xv6ildKTyy4g8zY-7sPqxfKAQBN7OfLCT6n4wnhNRk1wGL2vHlfpUFxzttrn0qdn8Z-MB4gBhyRD8-lI2Tq18tM6iLOoHJ8rutqs7jrWXccSkOyCj0RPA-4xw73GbH-K3Y3Lv_r9hcErCghkOH5-EE7rJabQHtL1uYu3gVneoTJFIRV7saVMYnWBQzPXV6gNSdOM3vs8nXw_lBTZklfxAmmrtwyxjnY_UifTkfNUzLrop302TZyEamCi52D1Pi8jEbiScw8Z94s_lUpHzTaGkcRqI3VDSbvKaHdSqMuXaSkse8VNpplvuewSq0tH04l-YVc1OpZXeTLfnd03VCsR3msUrcMlXrt8otxeLe3Hj4Imb4Yms7GW8vzwSuOgz2_ybHsIcaCEWGCJm6InRBHxIc9GOhIbOiK2YRFUgLLQ75tx23q9Pdv_9d33IzqQVnZ1Knc-xMIsb5-UZ8IX2hcS6dXLK4XHR-CcYkUflFvmht4QzwGotNMj4p5WLlB4UCklf-DwBm96ZCkvxkWviOHD--nTKrg1lDvpwPra5g-w1S0q84LQjKGvKvw9p7aEHimdTKCs71Q_4mVRh5KFHFfyj3u49K6EOUw3qW5t"> A JAMA Health Forum</a> study highlighted how plans serving more Black beneficiaries had lower star ratings even when controlling for other factors. This structural bias effectively penalizes plans doing the challenging work of serving populations with complex needs, creating a perverse disincentive to focus on health equity.
The uncertainty from frequent changes in star rating computation could also pose severe implications for strategic planning for companies. When a company like Humana loses billions due to a technical recalibration, it sends a troubling message: long-term investments in quality improvement may not yield returns if measurement methodologies change unpredictably. This volatility makes strategic planning difficult and discourages sustained investment in quality initiatives.
The Real-World Impact on Patients
These methodological shortcomings do not just affect health plans’ bottom lines; they have tangible consequences for Medicare beneficiaries. When plans lose Quality Bonus Payments (QBPs), they often must scale back valuable supplemental benefits like transportation assistance, dental coverage, or in-home support services, or increase plan premiums,<a href="https://advisory.avalerehealth.com/insights/proposed-ma-plan-payment-changes-may-impact-premiums-and-benefits"> as Avalere Health suggests</a>. McKinsey estimates CMS rating changes<a href="https://www.mckinsey.com/industries/healthcare/our-insights/medicare-advantage-star-ratings-may-decline-with-new-methodology"> could cost plans over $800 million in bonuses</a>, reducing resources available for such benefits.

Additionally, rating fluctuations can trigger unnecessary plan switching as members, confused about whether lower stars indicate poorer quality, change plans unnecessarily. These transitions often disrupt established provider relationships and care management programs, potentially harming clinical outcomes.<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC2914034/"> Research shows</a> that disruptions in provider relationships lead to reduced primary care utilization, increased emergency department visits, and higher hospitalization rates, particularly for vulnerable populations with chronic conditions.
Furthermore, plans may hesitate to pilot novel approaches for managing high-cost, high-risk populations if demographic realities mean they could still face rating penalties despite clinical success. This chilling effect on innovation ultimately hurts the beneficiaries who could most benefit from creative care models, reinforcing a system that rewards standardization over meaningful improvements in care delivery for complex populations.
A Framework for Meaningful Reform
To restore the Star Ratings system’s alignment with improving quality care for Medicare beneficiaries, four essential reforms are needed:
1.   Stabilize Methodology and Enhance Transparency: CMS must introduce methodological changes only after robust public notice, meaningful stakeholder engagement, and adequate implementation timelines. Transparency in measure development, weighting, and adjustment is fundamental to maintaining system trust and enabling plans to align their quality strategies accordingly. 
2.   Implement Comprehensive Social Risk Adjustment: The current<a href="https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/Supplement-for-Categorical-Adjustment-Index-.pdf"> Categorical Adjustment Index</a> has<a href="https://www.ajmc.com/view/understanding-the-social-risk-factor-adjustment-s-effect-on-star-ratings"> shown modest impact</a>. A fairer evaluation system must comprehensively account for income disparities, disability status, race, language barriers, and other social factors influencing care delivery and outcomes. This adjustment acknowledges the additional resources required to achieve equivalent outcomes for populations with complex social needs.
3.   Reorient Toward Meaningful Outcomes: Emphasis should shift toward measurable health improvements like reduced hospitalizations and better chronic disease management, rather than focusing heavily on process measures or survey results that may not correlate with actual health benefits. 
4.   Reward Innovation and Health Equity Efforts: CMS should recognize plans making meaningful investments in addressing health disparities and creating innovative care models for underserved communities.
The Humana case, alongside the troubling SCAN and Elevance phone call incident, represents a critical inflection point for Medicare Advantage quality measurement. When a single missed call can trigger devastating financial penalties despite strong clinical performance, and when plans serving millions of beneficiaries can lose billions in value overnight due to methodological changes rather than actual care deficiencies, the system has clearly lost sight of its purpose. 
By implementing the proposed reforms, CMS can transform Star Ratings from a compliance exercise into a genuine catalyst for better patient care. The ultimate measure of success should not be statistical perfection or adherence to rigid administrative protocols but whether the system helps vulnerable seniors live healthier, longer lives while reducing disparities in care quality. Only then will Star Ratings fulfill their intended role: guiding beneficiaries to truly superior plans while rewarding insurers who excel at improving health, not just compliance.
Emmanuel is a physician from Nigeria, and a second-year MPH/MBA candidate at the Johns Hopkins Bloomberg School of Public Health and Carey Business School. His work focuses on health financing, delivery reform, and strategic approaches to health systems transformation.
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<title>Medicaid Budget Cuts: Hospitals will bear the burden, we will pay the price</title>
<link>https://thehealthcareblog.com/blog/2025/05/12/medicaid-budget-cuts-hospital-will-bear-the-burden-we-will-pay-the-price/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Mon, 12 May 2025 18:40:46 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[Getting By]]></category>
<category><![CDATA[Hospitals]]></category>
<category><![CDATA[Linda Riddell]]></category>
<category><![CDATA[Medicaid]]></category>
<category><![CDATA[Poverty]]></category>
<category><![CDATA[Thomas Wilson]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109265</guid>
<description><![CDATA[By LINDA RIDDELL & THOMAS WILSON Recent discussions over Medicaid budget cuts invite us to look more deeply into the house-of-cards that, when it collapses, will hit the states and low-income households<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/12/medicaid-budget-cuts-hospital-will-bear-the-burden-we-will-pay-the-price/">Continue reading...</a>]]></description>
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<figure class="alignright size-full is-resized"><img decoding="async" loading="lazy" width="600" height="538" src="https://thehealthcareblog.com/wp-content/uploads/2025/05/LindaRiddellHeadshot.jpg" alt="" class="wp-image-109268" style="aspect-ratio:1.1152416356877324;width:212px;height:auto" srcset="https://thehealthcareblog.com/wp-content/uploads/2025/05/LindaRiddellHeadshot.jpg 600w, https://thehealthcareblog.com/wp-content/uploads/2025/05/LindaRiddellHeadshot-300x269.jpg 300w, https://thehealthcareblog.com/wp-content/uploads/2025/05/LindaRiddellHeadshot-150x135.jpg 150w" sizes="(max-width: 600px) 100vw, 600px" /></figure></div>
By LINDA RIDDELL & THOMAS WILSON
Recent discussions over Medicaid budget cuts invite us to look more deeply into the house-of-cards that, when it collapses, will hit the states and low-income households hardest. But we will all be harmed.
Some states get 80% of their Medicaid funding from the federal government, as a recent Wall Street Journal article, “<a href="https://www.wsj.com/politics/policy/medicaid-cuts-health-insurance-in-charts-56962433?st=ZyTd2j&reflink=article_email_share">Medicaid Insures Millions of Americans. How the Health Program Works, in Charts</a>” pointed out. Even states relying less on federal funds will be hard pressed to shift their resources to replace the federal share. The ripple effects are clear: states are likely to reduce Medicaid enrollment, forcing low-income people to skip care or find free care, and hospitals will shift resources to cover care they are not paid for. Dollars cut from Medicaid do not vanish; they simply shift to different corners of the healthcare system. Ouch!
A Deep Dive into the Facts
Fact 1. Low-Income Households Already Spend More of Their Income on Health Care: Recent<a href="https://www.bls.gov/cex/tables/calendar-year/aggregate-group-share.htm#cu-income"> Consumer Expenditure Survey</a> data reveals that the lowest 20% of households—roughly corresponding to those enrolled in Medicaid—saw the share of their income spent on healthcare (red in Figure below) rise from 8% in 2005 to 11% in 2023. In contrast, the highest-income 20% devoted only 2% in 2005, rising to about 4% of their income to healthcare in 2023.
<figure class="wp-block-image"><img decoding="async" src="https://lh7-rt.googleusercontent.com/docsz/AD_4nXfaYJ7XhTGTTeiCERaJEm6KLo8pDUQ8VGFsL52dXXlIT-OqSqz729EOcUvwzZdDC92Uhealo50xL5q8WN4Fg3jQ4Z1P7dB0_sE3_D8ZtU4cXzlLbmozKLe1m3DhKJFUpnsePW1WLQ?key=Q5HrvXJsHrYNSZ7IS-Oeeg" alt=""/></figure>
Fact 2. Necessities Consume a Majority of Low-Income Households’ Income: Low-income households spend about 57% of their income on essentials like food and housing (blue in figure). This leaves little to nothing for other expenses. These families have an almost inelastic budget where any additional expense, even one as critical as medical care, forces painful trade-offs. In contrast, high-income households have from 38% to 53% of their income (purple in figure) left over after meeting all basic and other costs.
Fact 3. Affordable Care Act Led to Reduced Uninsured ED Visits: In 2016 — two years after Affordable Care Act provisions took effect —  many states expanded Medicaid, and all introduced health insurance exchanges. These changes brought <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2730788#:~:text=FindingsIn%20this%20cross-sectional%20study%20of%201.4%20billion%20US,to%204%25%2C%20respectively%2C%20after%20the%202014%20ACA%20ins">emergency department visits by uninsured patients down by half</a>—from 16% to 8%.
Fact 4. Uncompromising Obligations at Hospitals: Under the <a href="https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act">U.S. Emergency Medical Treatment and Active Labor Act (EMTALA)</a>, hospitals must treat and stabilize every patient who arrives, regardless of their ability to pay. With <a href="https://www.acepnow.com/article/latest-data-reveal-the-eds-role-as-hospital-admission-gatekeeper/2/">around 70% of all hospital admissions arriving via the ED</a>, a surge in uncompensated care in the ED will directly affect admission rate, the hospital’s core function.
Examining the Key Inferences
Inference 1. Rising Uninsured Populations: Cutting Medicaid budgets is likely to lead to states shrinking enrollment and boosting the number of uninsured individuals.
Inference 2. A Resurgence in Uninsured ED Visits: If Medicaid budget cuts reduce enrollment, the previously achieved reductions in uninsured ED visits could return to the high rates seen before the ACA.
Inference 3. Hospitals Caught in the Crossfire: Budget cuts will force hospitals to provide more uncompensated ED care. The response is likely to be reducing staff, the hospital’s largest cost center  — a move that directly affects the quality and timeliness of both primary and specialty services. <a href="https://www.chiefhealthcareexecutive.com/view/washington-state-hospitals-warn-budget-cuts-could-lead-to-reduced-services">Washington state</a> offers a cautionary tale, where hospital leaders predict longer wait times and lower service levels due to state budget cuts.
Broad Impacts Beyond the Numbers
The health system must pick up the $880 billion slack, not by magically creating money but by shifting resources from other programs.  The healthcare system has its priorities set by the budget scramble–not by the community’s health needs. Health disparities between the rich and poor will widen, and progress made on having more people insured will reverse.
Staff cuts will lengthen wait times and decrease service quality, not to mention they will burn more people out of their health service jobs. The ripple effects of Medicaid cuts will eventually touch all who seek medical care and pay for health insurance.
A Call for Political and Community Action
Now, more than ever, it is time for political stakeholders to recognize that the real cost of Medicaid cuts is borne not just by states but also by communities. Stakeholders, policymakers, community leaders, and the general public must stand up for their own interest in having a sustainable health care funding approach.
Toward a More Equitable Future
The case against Medicaid budget cuts is not merely about dollars and cents—it is about the future of our healthcare system and the health of millions of Americans. Cutting Medicaid benefits may create short-term savings on paper, but it undermines the health infrastructure that serves everyone.
A thoughtful and balanced approach would protect vulnerable populations while ensuring hospitals remain viable centers of care, especially for rural areas. In rural communities, the health sector creates<a href="https://www.ruralhealthinfo.org/topics/hospitals"> 14% of jobs</a>; rural hospitals are generally the largest employer and since they<a href="https://www.aha.org/system/files/2019-02/rural-report-2019.pdf"> serve more Medicaid and Medicare patients</a>, they will be the hardest hit by these budget cuts.
The shift in where healthcare dollars are spent could change every layer of healthcare delivery—from the ED’s ever-growing responsibility to inpatient admissions to primary care’s dwindling resources. It is a call for all of us to rethink how healthcare is funded and to stand in solidarity with those at risk of being left without medical care.
Looking Ahead
Beyond the immediate fiscal challenges, this issue invites a broader discussion on healthcare reform. How can we restructure funding to improve efficiencies? Could community health cooperatives or expanded telehealth services help lessen adverse effects?  These questions deserve robust debate and decisive action.
In these turbulent times, every stakeholder—from local communities to federal policymakers— needs to find solutions that prioritize human health over short-term budget tactics. The stakes are high, and the choices made today will shape healthcare access and quality for decades to come.
Linda Riddell, MS is a population health scientist specializing in poverty and is the founder of <a href="https://gettinby.net/">Gettin’ By</a>, a training tool helping teachers, doctors, case managers, and others work more effectively with students, patients and clients who are experiencing poverty. Thomas Wilson, PhD, DrPH is an epidemiologist focused on real-world issues and board chair of the non-profit Population Health Impact Institute
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<title>A Proud Republican Who Faced Off A Party Leader. . .and Won!</title>
<link>https://thehealthcareblog.com/blog/2025/05/09/a-proud-republican-who-faced-off-a-party-leader-and-won/</link>
<dc:creator><![CDATA[matthew holt]]></dc:creator>
<pubDate>Fri, 09 May 2025 07:32:00 +0000</pubDate>
<category><![CDATA[Health Policy]]></category>
<category><![CDATA[David French]]></category>
<category><![CDATA[Margaret Chase Smith]]></category>
<category><![CDATA[Mike Magee]]></category>
<category><![CDATA[NcCarthyism]]></category>
<category><![CDATA[Trump]]></category>
<guid isPermaLink="false">https://thehealthcareblog.com/?p=109258</guid>
<description><![CDATA[By MIKE MAGEE This past week, Trump’s posting of himself as The Pope surfaced once again David French’s classic Christmas, 2024, New York Times column titled “Why Are So Many Christians So<a class="more-link2" href="https://thehealthcareblog.com/blog/2025/05/09/a-proud-republican-who-faced-off-a-party-leader-and-won/">Continue reading...</a>]]></description>
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<figure class="alignright size-full"><img decoding="async" loading="lazy" width="230" height="273" src="https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee.jpg" alt="" class="wp-image-96080" srcset="https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee.jpg 230w, https://thehealthcareblog.com/wp-content/uploads/2019/03/849660338_medium-dr-mike-magee-126x150.jpg 126w" sizes="(max-width: 230px) 100vw, 230px" /></figure></div>
By MIKE MAGEE
This past week, Trump’s posting of himself as The Pope surfaced once again David French’s classic Christmas, 2024, New York Times column titled “<a href="https://www.nytimes.com/2024/12/22/opinion/christmas-jesus-power-humility.html">Why Are So Many Christians So Cruel?</a>”
As I wrote at the time, “French and his wife and three children have experienced the cruelty first hand since he openly expressed his opposition to Donald Trump during the <a href="https://www.nationalreview.com/2016/10/donald-trump-alt-right-internet-abuse-never-trump-movement/">2016 Presidential campaign</a>. That resulted in threats to his entire family by white supremacists who especially targeted his adopted Ethiopian daughter. Ultimately, he was “<a href="https://religionnews.com/2024/05/15/pca-cancels-anti-polarization-panel-with-david-french-for-being-too-polarizing/">cancelled</a>” by his own denomination, the small (approximately 400,000 members), Calvinist “<a href="https://pcanet.org/">Presbyterian Church of America</a>”.
Over the past week, American politicians of every stripe have debated what exactly was Trump’s motive in debasing the Papacy as Pope Francis was being laid to rest. Three main theories have emerged. 
1.      As a<a href="https://www.ncbi.nlm.nih.gov/books/NBK556001/"> malignant narcissis</a>t, Trump could not bear the fact that Pope Francis was stealing his limelight.
2.      Trump was appealing to conservative Christian Evangelicals who are strongly<a href="https://www.faithtacoma.org/cnsdgrc/the-papacy#:~:text=A%20fractured%20Protestantism%20is%20nothing,time%20it%20has%20been%20so."> opposed to the Papacy</a> on theological grounds.
3.      Trump was appealing to conservative Catholics like New York Post columnist<a href="https://www.washingtonpost.com/world/2025/05/04/trump-pope-social-media-post/"> Charles Gasparino</a> who says, “… we respect Trump more than the socialist Pope.” 
Of course, there likely are elements of truth in each of these. But I prefer to fall back on my New York City high school training and believe that this is the product of a dull witted school yard bully who thought this was funny. 
This is not to say he has the courage to claim ownership. (Obviously this doesn’t get posted without his approval.) No.<a href="https://www.nytimes.com/2025/05/05/us/politics/trump-pope-photo-ai.html"> He lies</a> to your face, saying:
“I had nothing to do with it, Somebody made up a picture of me dressed like the pope, and they put it out on the internet. That’s not me that did it, I have no idea where it came from — maybe it was A.I. But I have no idea where it came from.” 
With his blessing, the image was posted at 10:29 PM on May 02, 2025 on his<a href="https://truthsocial.com/@realDonaldTrump/posts/114441543826801216"> Truth Social account</a>. 

David French likely sees accomplices in the shadows. 
As he explained <a href="https://www.nytimes.com/2024/12/22/opinion/christmas-jesus-power-humility.html">in 2024</a>. “It’s remarkable how often ambition becomes cruelty. In our self-delusion, we persuade ourselves that we’re not just right but that we’re so clearly right that opposition has to be rooted in arrogance and evil. We lash out. We seek to silence and destroy our enemies.” 
He may be right. But when it comes to Trump, I recall another bully, and another heroine. On June 1, 1950, a 53-year old Republican Senator from Maine rose to the Senate floor to confront Senator Joe McCarthy. Four months earlier, in<a href="https://pages.uoregon.edu/eherman/teaching/texts/McCarthy_Wheeling_Speech.pdf"> Wheeling, WV,</a> McCarthy had unleashed a populist attack on what he claimed to be a conspiracy of “205 card-carrying communists in the State Department.” 
What happened next is proudly recalled in the official historical records of the Senate as “<a href="https://www.senate.gov/artandhistory/history/common/generic/Speeches_Smith_Declaration.htm">A Declaration of Conscience</a>.” The tale speaks directly to all those who enable Trump in the current era. It took four years (after this speech) to finally rid America of its menace. It remains to be seen who will emerge as our modern day Margaret Chase Smith, and how much time will pass before we rid ourselves of this modern day tyrant.
Here is<a href="https://www.senate.gov/about/powers-procedures/investigations/mccarthy-hearings/a-declaration-of-conscience.htm"> the official account</a> of Senate Chase’s efforts that day as recorded by the U.S. Senate historians:
‘Mr. President,’ she began, ‘I would like to speak briefly and simply about a serious national condition…. The United States Senate has long enjoyed worldwide respect as the greatest deliberative body…. But recently that deliberative character has…been debased to…a forum of hate and character assassination.’ In her 15-minute address, delivered as McCarthy looked on, Smith endorsed every American’s right to criticize, to protest, and to hold unpopular beliefs. ‘Freedom of speech is not what it used to be in America,’ she complained. ‘It has been so abused by some that it is not exercised by others.’ She asked her fellow Republicans not to ride to political victory on the ‘Four Horsemen of Calumny–Fear, Ignorance, Bigotry, and Smear.’ As she concluded, Smith introduced a statement signed by herself and six other Republican senators–her<a href="https://www.senate.gov/artandhistory/history/common/generic/Speeches_Smith_Declaration.htm"> ‘Declaration of Conscience.’</a>” . . .
“Smith’s Declaration of Conscience did not end McCarthy’s reign of power, but she was one of the first senators to take such a stand. She continued to oppose him, at great personal cost, for the next four years. Finally, in December of 1954, the Senate belatedly concurred with the ‘lady from Maine’ and <a href="https://www.senate.gov/about/powers-procedures/censure/133Joseph_McCarthy.htm">censured McCarthy</a> for conduct ‘contrary to senatorial traditions.’ McCarthy’s career was over. Margaret Chase Smith’s career was just beginning.”
Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of<a href="http://www.codeblue.online/"> CODE BLUE: Inside America’s Medical Industrial Complex</a>. (Grove/2020)
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