Tag: health insurance

This Month (or so) In Digital Health: AI, Data, GLP-1s, and Money (Lots and Lots of Money)

~ iambeastwood ~ Leave a comment

Welcome to the eighth edition of This Month in Digital Health, where you get to read my very own thoughts on the news and trends that caught my attention over the last few weeks. We’re a bit tardy this month – Sandwich Generation Caregiving for the win, am I right? – which means there’s been extra time to gather hot takes on AI, data, healthcare costs, and GLP-1s. Have at it, folks.

AI likes it easy. Healthcare isn’t. Therein lies the rub. Yet another paper has shown that LLMs can outperform physicians when making rote decisions (even general-purpose LLMs) that don’t have to account for the stuff that happens in real life – whether it’s delays in prior authorization or claims denials powered by AI or, like, patients’ unaddressed social needs or the stress of the hospital. Nor does it help that providers fear overreliance on AI will diminish clinicians’ critical thinking capabilities.

Who can access data? What is data? What is access? Rock Health found that 57% of Americans own at least one wearable, and many are tracking health metrics. That’s good! The bad news: Wellness apps interpreting device data aren’t really regulated, and physicians have no idea how they conclude a patient is at risk of, say, depression. Plugging data into an LLM isn’t much better, as general-purpose LLMs aren’t HIPAA covered entities (though the healthcare-specific ones are).

GLP-1s are taking over healthcare, and not in the best ways. Speaking of wearables, Mass General and Samsung Health are partnering to see whether a smartwatch can track muscle loss in adults on a GLP-1. That’s good, because it’s a common concern for patients who lose weight. Other concerns are emerging, too, including GLP-1 prescriptions from telehealth providers who don’t talk about the risks or the importance of healthy habits, and the efficacy of GLP-1 pills, which has self-employed insurers thinking twice about insurance coverage.

Great googily moogily, healthcare is expensive. On top of everything else, GLP-1s are making healthcare even more expensive – to the tune of 9% increases in commercial costs in 2027, per PwC. Only 7 nonprofit Blues plans had positive operating margins in 2025, and many provider-sponsored health plans are giving up amid rising costs and general industry instability. Speaking of which, more than 75% of executives think healthcare’s financial instability will reach an existential tipping point before the end of the decade. Good times.

Meanwhile, in other stories of interest:

  • Given the odd juxtaposition of primary care (with low costs and generally stable utilization) and health insurance (which is meant to cover expensive, unpredictable events), a JAMA paper proposed the notion of primary care as a public utility through which states create a common fund that pays practices directly. Insurers could still compete on other lines of business. I’ve heard worse.
  • The ACCESS Model for Medicare goes into effect on July 5. With 150+ participants already lined up, Second Opinion posed a reasonable question: What about ACCESS for Medicaid? Makes sense to me, especially since states have embraced managed care.
  • When it comes to rural health transformation, the numbers don’t add up. As $50 billion in federal aid doesn’t equal nearly $1 trillion in losses, states are focusing on cost-cutting strategies, not innovation. Good job, everyone.

Happy summer, Northern Hemisphere. If you know me, you know this is my least favorite time of the year. (And if you don’t, well, now you do.) If you need me, I’ll be under an oscillating fan, within a foot of an AC, and waiting until the humidity breaks to do anything that will cause me to begin to sweat.

This Month (or So) in Digital Health: AI’s Growing Pains, Federal Health’s Shrinking Pains

~ iambeastwood ~ Leave a comment

Welcome to This Month in Digital Health, where I summarize news articles that recently caught my attention and attempt to try to put the trends in broader context. Stop me if you’ve heard this before, but one of the main themes this month is AI, which healthcare finally seems to be putting under the microscope. Also of note is how the Iran war will impact health systems and how federal health may be gutted yet again.

The honeymoon’s over for clinical AI. One study found clinicians save less than 30 minutes a day using AI scribes and don’t decrease their after-hours EHR use. Another one determined Epic’s algorithms don’t perform well in the real world, which matters because AI vendors struggle to compete with EHR incumbents even if their products work better. So, it comes as no surprise that healthcare’s struggling to calculate AI’s ROI and getting impatient when ROI is slow to arrive. On top of everything else, experts say AI oversight and governance need to catch up. Good times.

Consumers understand AI’s limitations. About one-third of American adults turn to AI with health-related questions. Don’t run around screaming that the robot doctors are taking over, though. Education and research make up more than half of healthcare AI queries, compared to 8% for care questions, and people readily admit they use AI because it’s convenient, not because it’s accurate. Seems like there’s most definitely some log-hanging fruit for all those consumer AI health tools (nearly diagramed by Rock Health).

Federal health funding? What federal health funding? The White House is proposing a 12% cut to HHS in 2027, though it’s worth noting Congress ignored a similar request last year. Even with funding restored, HHS is in disarray after massive job cuts (as are other federal agencies), as detailed in excellent long reads from Healthcare Dive. Also, 400-plus hospitals are at risk of closing due to Medicaid cuts that are projected to reach $1 trillion over the next decade.

Healthcare may feel the pinch of the Iran war. Disrupted shipping in the Strait of Hormuz may not impact medical supply chains immediately, and the uncertainty of what may come means stocking up is a bad idea. Cybersecurity is a more immediate threat, as “cyber conflict increasingly mirrors geopolitical tensions,” one expert told Healthcare Brew.

Prior authorization: Now with slightly less time wasted! The insurance industry patted itself on the back by eliminating 11% of prior authorizations, according to an AHIP statement. Meanwhile, Health Affairs found 90% of prior authorizations are approved the first time, which essentially means the $30 cost per transaction is paying for a rubber stamp.

In other relatively interesting news:

Thanks for playing along. See you next time.

The Beastwood Files: February(ish) 2026

~ iambeastwood ~ Leave a comment

The person in charge of maintaining my work schedule (me) gave me too many longform assignments in late February and early March, while the person in charge of maintaining my running schedule (also me) insisted I remain on track for my marathon on Memorial Day weekend, so (in what is beginning to be a recurring pattern) this post is appearing during the second week of the month.

Stuff I Wrote

Things I Did

  • Succeeded in getting my mother’s taxes done at the Senior Center in town (thanks, AARP volunteers!)
  • Went out of my way to participate in a social event (the annual party for the running club I recently joined)
  • Made Snow Mountain in the front yard amid two significant storms with “help” from my young assistant
  • Introduced my son to the concept of false spring during a 75-degree day in early March

Adventures in Fatherhood

  • A recent obsession with couch-cushion forts evolved into destroying said forts. It was determined that the dinosaurs living in the neighborhood should be made aware of the demolition schedule and potential for loud noises. “Be a news reporter,” my son said to me, not realizing just how prepared I would be for the moment. (Lest you think I’m a trombone player in my spare time, I’ve probably worn that fedora a half dozen times since buying it on our honeymoon in 2019 after failing to pack a hat for part of our trip.)
  • We all went cross country skiing for the first time (at Great Brook in Carlisle). My son took off on us as soon as he was strapped into his skis – which was great, except that neither of us were quite ready to chase him. (Not a bad problem to have, mind you.) We only went once this winter, but I’m pretty sure we’ll want to go again.
  • We spent quite a bit of time watching the Olympics, in part because it was 15 degrees out the first weekend of the Games. Our favorite sports were biathlon, bobsled, and ski mountaineering. I did not subject my family to watching the 50-kilometer cross country ski races in their entirety. We also really, really got into the ads.

Happy early Pi Day, which is one of the most important days of the year in the Beastwood household (because of pie, not math).

This Month (and Last Month, Too) in Digital Health: It’s Been a Long Time, So Here Are Some Long Reads

~ iambeastwood ~ Leave a comment

Welcome to This Month in Digital Health, which looks at trends that got my attention and attempts to unpack why I think they’re important. We’re actually looking at almost two months’ worth of stuff here, as life caught up with me in January. As a result, there’s less focus on hard news – besides, you already read about all those AI releases – and more on analysis and commentary that looked interesting to me.

Will Oracle have to sell the EHR formerly known as Cerner? Oracle has committed $500-plus billion to AI data centers – enough that the company may need to lay off 30,000 people and sell off Cerner, which it bought for more than $28 billion less than 4 years ago. One report suggested Amazon, Google, and Microsoft are probably the only companies with enough cash to buy Cerner – and even then, would they want it? (Or will Epic decide now’s as good a time as any to make its very first acquisition?)

Prior authorization is better, but still not the best. As of Jan. 1, the timeline for prior authorization responses is half as long as it used to be. But providers say 72 hours for urgent care decisions is still too long – I’m not a doctor, nor do I play one on TV, but I think they have a point – and add that “delays and hassles” persist. Payers have pledged to step up real-time decisions, but providers argue promises don’t equal actions.

Providers, payers are also at odds over bill disputes. The independent dispute resolution process kicked off years ago in response to the No Surprises Act. Payers accuse providers of attempting to inflate reimbursements, while providers argue the nuance of regulation favors insurers. Meanwhile, both wait for regulatory clarity, especially on what people can actually dispute.

Medicaid is in trouble. You already know that. The nation’s largest publicly operated health plan is L.A. Care, which serves 2.2 million Medicaid beneficiaries in Los Angeles County. The plan projects 30% of enrollees dropping off the rolls by 2028 – and straining the insurer’s finances – thanks to One Big Beautiful Act cuts. Process automation and other efficiency improvements can only do so much, I’m afraid.

A Medicare Advantage shell game in Arcadia. In parts of Oregon, Optum removed a bunch of doctors from Humana’s Medicare Advantage network just in time for open enrollment. Guess who was the only other MA insurer in those areas? If you guessed UnitedHealthcare – owned by the same company – then you win, um, well, no one really wins anything here. Not even the insurance giant, which expects revenue to decline in 2026 as it makes less money off Medicare Advantage.

New York bucks the patient data access trend. Various states have been extending protections for personal health information, what with HIPAA being 30 years old and all. Legislation in New York would have done the same – but Gov. Kathy Hochul vetoed the bill at the end of last year, citing a broad scope coupled with stringent frameworks “which may discourage innovation.” Critics said the veto is a win for Big Tech; others described the bill as onerous.  

Seniors are quitting weight-loss drugs in droves. Roughly half of Americans over 65 who were prescribed GLP-1s stopped taking them within a year. There are plenty of possible reasons, from bad side effects to muscle loss (a particular concern for older patients) to loss of insurance coverage. Weight-loss pills could help, particularly for patients who don’t like injections, but daily doses present their own challenges.

Inpatient surgery won’t be a cash cow much longer. CMS is signaling it aims to phase out the list of inpatient-only surgical procedures, meaning more will move to outpatient facilities. That could save money for patients (and payers) but cut revenue for hospitals already strapped for cash. One option for bucking the trend: Optimize operating room capacity, largely through standardized processes.

Is it time for digital therapeutics to shine? In December, the FDA launched TEMPO, a pilot program for digital therapeutics tied to chronic condition management. The program could breathe some life into a struggling market segment; participating medical professionals can prescribe therapeutics before they’ve received FDA clearance, and real-world data from users would in turn inform clearance decisions.

For PCPs, fewer patients doesn’t mean less EHR time. Providers that make a concerted effort to reduce visit volume don’t spend equally less time plonking about in their EHRs. Researchers found PCPs who cut visit volume by nearly one-third only spent 21% less time in the EHR – and dreaded “pajama time” actually increased. There’s a straightforward explanation: After reducing visit volume, the patients that PCPs had left were in fact more complex.

Enjoy the rest of February, everyone.

This Month in Digital Health: Confirming Things We Already Knew

~ iambeastwood ~ 1 Comment

Welcome to This Month in Digital Health. Here, I highlight news articles and trends that recently caught my attention and attempt to explain why they matter. The main theme for the last few weeks has been reports and stories confirming things we already knew – which is still important, because it always helps to hammer home the message.

AI is complicated. AI was a big talking point at HLTH, what with the AMA announcing its Center for Digital Health and AI (to develop policy and training resources, among other things) and the Cleveland Clinic CEO saying AI is necessary for solving big problems like access to affordable care. Easier said than done, though, as 49% of orgs are seeing AI innovation delayed, while AI’s many ethical issues resemble a can repeatedly kicked down the road and healthcare’s slow sales cycles leave AI vendors waiting for the check to come in the mail.

Insurers aren’t popular. Forrester found only 54% of consumers view health insurers are trustworthy, and only 53% understand claims decisions. Insurers are trying to curry favor by streamlining prior authorization, though most consumers said they’ll believe it when they see it. It certainly doesn’t help that 60% of consumers blame insurers for medical debt and 70% say healthcare is unaffordable – a problem that will get worse before it gets better.

Everyone wants ROI. Not everyone gets it. Half of digital health purchasers use performance-based contracts; the Peterson Health Technology Institute expects that number to rise as health plans, hospitals, and employers scrutinize contracts to ensure they deliver value. When it comes to virtual care, fewer than 30% of providers earn significant ROI, as Healthcare Dive put it, citing Sage Growth Partners. That might explain why Amwell is mulling the sale of legacy assets that aren’t part of its virtual care platform.

Private equity likes money. Two fairly damning reports from Health Affairs illustrate what private equity’s doing to healthcare. One found hospice facilities owned by PE had higher profits and lower per-patient spending compared to other ownership models, and another found specialists affiliated with PE negotiated higher prices than independent physicians. Mind you, other for-profit entities exist in healthcare, and non-profits don’t always hold up their end of the bargain; it’s still not a good look.

Other things we already knew or saw coming from miles away:

That’s all for now. Tune in next month to see if the trends are more of the same.

This Month in Digital Health: Everything Is Not Awesome

~ iambeastwood ~ Leave a comment

Welcome to This Month in Digital Health, where I highlight news articles and trends that recently caught my attention and attempt to explain why they matter. The key theme for the month? Everything’s a mess.

Telehealth is in trouble. Medicare’s telehealth flexibilities expired at the end of September. With the federal government shut down and not authoring an extension, vendors and providers face a cliff, with some keeping services available and others opting not to. The hospital at home program faces a similar fate, as it too needs an extension from Congress to stay alive. Basically, care is now less accessible – just in time for flu season!

Rural health needs help. Applications are open for the Rural Health Transformation Fund – and just in time, what with multiple federal rural connectivity programs facing funding cuts. Amid the well documented rough road ahead, some rural providers are forming clinically integrated networks, though their aim is more about survival than about the traditional CIM focus on value-based care. Really, though – I feel like rural providers can and should do whatever it takes.

AI use isn’t equitable. HHS data released before the shutdown found an unsurprising digital divide in predictive AI use, with small, rural, independent, and critical-access providers all lagging. Groups such as the Coalition for Health AI fear safety net providers will only fall further behind unless they’re able to recruit the IT staff required to get AI efforts up and running. This is broadly consistent with pretty much every single type of healthcare IT, and sadly I don’t see it changing any time soon.

Insurance costs are going through the roof. No matter how you’re insured, you’re paying a lot more in 2026. Employers’ healthcare costs are poised to rise 9%, while Affordable Care Act premiums will increase close to 20% – and some will more than double is tax credits expire. The culprits? Drug costs (especially GLP-1s), the cost of care, and the impact of the One Big Beautiful Bill Act. Luckily, nothing else has seen significant price increases in the last year, right? Right?

Medicare Advantage is in trouble. Most MA insurers are scaling back their plan offerings in 2026, and annual premiums for the general MA population are expected to increase 22%. Many insurers are also trimming supplemental benefits from MA plans, too, as they say it’s getting too expensive to offer coverage. On a related note, non-profit MA plans didn’t fare terribly well in recent Stars ratings announcements. This all makes me wonder if the MA bubble is bursting: Though 54% of eligible beneficiaries are in MA plans, the pace of growth is slowing. (Remember the second derivative from AP Calculus?)

Also of note:

That’s it for now. Leave a comment if I missed something interesting. We’ll see you next month. Hopefully things will be less depressing.