The Grand Roundup: Mass General Brigham's AI PCP backlash, Hinge Health pushback on CMMI ACCESS, No Surprises Act increasing costs, US drug access & TAMs, AI market signals, and more

The billing problem is actually an affordability problem | Seth Cohen (Cedar)

Seth Cohen runs Cedar, which sits inside the bill-pay workflow for health systems across the country, meaning he sees the patient collections reality that most hospitals are still processing. Most providers still sort patients into commercial, government, and self-pay, a taxonomy that made sense 15 years ago and doesn't anymore. ACA premium churn is quietly flipping commercial AR to self-pay retroactively, Medicaid redeterminations hit January 1st, and the average hospital is already collecting about 40 cents on every patient dollar owed. For a $5B system, that's $250M in net income lost annually. Seth argues that the billing problem has quietly become an affordability problem, and that the fix isn't better statements or more outreach—it's meeting people where they actually are. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas [http://luma.com/htn-ursa-atlas] Links referenced Seth’s LinkedIn post on ACA premiums: https://www.linkedin.com/feed/update/urn:li:activity:7453134273911455744/ [https://www.linkedin.com/feed/update/urn:li:activity:7453134273911455744/] How to contact Seth: seth@cedar.com [seth@cedar.com] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Why U.S. healthcare doesn't need more money—it needs a different system | Ezekiel Emanuel

Ezekiel Emanuel helped write the ACA, and now he's thinking about what comes next. To those saying America needs to spend more on healthcare, he points to countries like Germany, Switzerland, Norway—all have universal coverage, their systems provide comparable care quality to the U.S., yet they spend considerably less. The issue isn't money—it's how the system is organized. On the reform timeline, he expects policy change to happen in the 2032 election cycle, when the Medicare trust fund starts coming into view. As for AI, he believes it will be a fully integrated piece of the clinical landscape by 2030, but should be part of value-based payment, not fee-for-service. He also shares his thoughts on the longevity craze... and mentions a standing bet with Bryan Johnson. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas [http://luma.com/htn-ursa-atlas] Links referenced Zeke’s article in The Bulwark: https://www.thebulwark.com/p/democrats-must-fix-medicaid-not-just-undo-trump-bbb-damage-universal-coverage-seven-principles-reform-health-care [https://www.thebulwark.com/p/democrats-must-fix-medicaid-not-just-undo-trump-bbb-damage-universal-coverage-seven-principles-reform-health-care] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

The Grand Roundup: Finding the optimal amount of healthcare fraud, ACA premium churn, wealthy New Yorkers are buying "med-à-terres", Zeke Emanuel on where healthcare policy reform is headed, and more

Kevin and Martin open with an unusual question: how much fraud should we actually tolerate in healthcare? News from Minnesota prompted the question, where the state just disenrolled 3,400 Medicaid providers, most not for fraud, but for incomplete paperwork. Kevin's argument is that zero-tolerance consolidates the market around whoever's best at compliance, not care. Martin mentions that we're underfunding the people who catch sophisticated fraudsters, and prior auth does actually work. They also discuss the ABA therapy workforce explosion (5X growth in behavioral techs since 2019), which the Wall Street Journal frames as a fraud story and Martin pushes back on. Then they pivot to a very different kind of story: wealthy New Yorkers are buying $5M apartments to be used as "med-à-terres" for just a few specialist visits a year, and some luxury condos now feature Atria longevity clinics. Ezekiel Emanuel—ACA architect, UPenn Vice Provost, author of Eat Your Ice Cream—comes on to talk about whether a real healthcare policy reform moment is coming. He shares the basics of the proposal he is working on drafting, and discusses about when he thinks it will be the right time for this transformative reform. He also talks about how much of U.S. GDP should go toward healthcare costs, and how the industry should use (and bill for) AI in a way that makes sense. Seth Cohen, president of Cedar, closes with a view on provider finance. Hospitals still sort patients into commercial, government, and self-pay, a taxonomy that made sense 15 years ago. Driven by that, plus numerous additional challenges, the system is not working for patients. Seth argues that the billing problem has become an affordability problem, and the fix isn't better statements—it's meeting people where they are. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas [http://luma.com/htn-ursa-atlas] Links referenced WSJ on ABA fraud: https://www.wsj.com/health/healthcare/autism-therapy-insurance-bills-880b9dba?mod=mhp&_bhlid=14a8b4ad00b8b90f14f4e33aeb944007aa658e91 [https://www.wsj.com/health/healthcare/autism-therapy-insurance-bills-880b9dba?mod=mhp&_bhlid=14a8b4ad00b8b90f14f4e33aeb944007aa658e91] WSJ on “med-à-terres”: https://www.wsj.com/real-estate/luxury-homes/wealthy-retirees-are-buying-med-a-terres-to-be-near-their-new-york-doctors-f411c9db?mod=series_housingmarket [https://www.wsj.com/real-estate/luxury-homes/wealthy-retirees-are-buying-med-a-terres-to-be-near-their-new-york-doctors-f411c9db?mod=series_housingmarket] WSJ on longevity as an amenity: https://www.wsj.com/real-estate/luxury-homes/the-new-amenity-in-luxury-living-longevity-services-91369ca8?mod=WTRN_pos1 [https://www.wsj.com/real-estate/luxury-homes/the-new-amenity-in-luxury-living-longevity-services-91369ca8?mod=WTRN_pos1] Zeke’s article in The Bulwark: https://www.thebulwark.com/p/democrats-must-fix-medicaid-not-just-undo-trump-bbb-damage-universal-coverage-seven-principles-reform-health-care [https://www.thebulwark.com/p/democrats-must-fix-medicaid-not-just-undo-trump-bbb-damage-universal-coverage-seven-principles-reform-health-care] Seth’s LinkedIn post on ACA premiums: https://www.linkedin.com/feed/update/urn:li:activity:7453134273911455744/ [https://www.linkedin.com/feed/update/urn:li:activity:7453134273911455744/] How to contact Seth: seth@cedar.com [seth@cedar.com]

Before, during, and after GLP-1s: the role of nutrition in metabolic care | Amit Shah (Virta Health)

Prior to the wave of GLP-1s, Amit Shah has spent a decade working on reversing metabolic disease through nutrition. As a leader at Virta Health, he's experienced the impact that changing what people eat can have on type 2 diabetes, cardiovascular events, and outcomes across a surprising range of conditions. In this episode, he talks about the reality that 93% of American adults have some form of metabolic dysfunction, addresses patient preferences for medication or lifestyle changes through diet, and shares how Virta is showing that a nutrition-first approach, paired thoughtfully with GLP-1s, delivers better outcomes and lower costs for the employers and health plans. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by: Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas Abridge: Join Abridge's first-ever Keynote on June 11, where CEO Dr. Shiv Rao will share their biggest step yet toward saving time, money, and lives. NYC and streaming globally. Register: events.abridge.com/keynote

Why foster-connected youth fall through healthcare's cracks—and how to fix it | Michelle Turner (Here Now Health)

Michelle Turner spent years as a foster parent watching the healthcare system fail the kids in her home because the existing system wasn't built for them. She founded Here Now Health to fix that, creating a virtual mental health platform purpose-built for foster-connected youth, controlling for the many barriers they face in seeking care. She walks through the little-known world of foster specialty Medicaid plans, why this high-acuity population has attracted almost no innovation, and how Here Now Health is proving that early, consistent care is both better for kids and far cheaper than the crisis cycle states are currently funding. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by: Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas Abridge: Join Abridge's first-ever Keynote on June 11, where CEO Dr. Shiv Rao will share their biggest step yet toward saving time, money, and lives. NYC and streaming globally. Register: events.abridge.com/keynote Referenced: Here Now Health: herenow.health / michelle@herenow.health