andrew
Recent articles
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Epic Presses On After Leadership Exits
Epic is at a massive strategic juncture, launching tools for health systems to build their own AI agents and a generative AI model trained on data from over 320M patients,…
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Physician Independence Drops Below 20 Percent
Since 2018, over 80K physician practices have changed ownership structure from independent (“physician-owned”) to ownership by an integrated delivery network (“hospital-owned”) or a corporate entity, like a health insurer, private…
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Another Worrying Medical Debt Survey
A new study from the Commonwealth Fund produced one of the most concerning statistics yet about the US medical debt crisis: about one in three working-age (19-64), privately insured adults are…
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Winners and Losers of Rural Health Fund Year One
The Rural Health Transformation Program, created by the One Big Beautiful Bill Act as a $50B offset to Medicaid cuts for rural healthcare, has doled out this year’s…
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What We Talk About When We Talk About Cost
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Dispute Resolution Process in Dispute
Researchers at the Georgetown University Center on Health Insurance Reforms published their analysis of the costs incurred by the No Surprises Act (NSA) independent dispute resolution (IDR) process, putting the…
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The Un-Elimination of Measles
Two residents of Pennsylvania recently became the first US measles deaths this year. Both were unvaccinated, and one was an infant. In Lancaster County, where they lived, the share of…
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Trump’s Health Policy Runs Through HHS, Not Congress
With midterm election season upon us and divided government likely waiting for us next year, any meaningful piece of healthcare legislation could be years away. This Congress left its mark on…
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Will Concierge Medicine Always Be Niche?
Concierge medicine is a care delivery model, originally focused on primary care but since applied to other specialties, in which practices charge patients an annual fee, ranging from $2K to $100K (but…
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There is More to Strategy than Merging
After regulatory and economic uncertainties slowed hospital transactions at the start of the Trump administration, deals began to pick up as 2025 wound down. The first six months…
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Why Prior Authorizations May Be Here to Stay
Prior authorizations may be the single least-popular aspect of our healthcare system, generating such consistent criticism from consumers and regulators that the nation’s health insurance companies voluntarily signed a…
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340B Program Hits $100B Milestone
Purchases made through the 340B drug discount program reached $100B last year, more than double their total in 2021. Disproportionate Share Hospitals (DSHs), which qualify for 340B by serving a…
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UHG Reversing Out of a Ditch
UnitedHealth Group (UHG) has experienced a few difficult years, to say the least. The Change Healthcare hack, the murder of Brian Thompson, and federal investigations and lawsuits drained the company’s morale and…
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Employers Searching for Answers to Cost Growth
As strong as NHE growth has been, employers’ healthcare expenses have been growing even faster. Employers’ group health plan costs are expected to jump 9 percent in 2027, the largest…
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Meet the COO of Federal Healthcare Policy
For over a year now, we have been hearing from our Beltway insider friends that Chris Klomp, a political outsider originally placed in charge of Medicare, was someone…
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All Talk, No Action on Healthcare
This week, Congress passed its annual budget reconciliation package that boosts immigration enforcement by another $70B, after using that legislative vehicle cut Medicaid spending by $1T over a decade…
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Payers and Providers Growing Further Apart
The No Surprises Act IDR portal is not the only avenue of dispute between payers and providers. Looking at the state of contract negotiations, payer-provider relations may have…
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Early Impact of the ACA Subsidy Expiration
In response to preliminary data showing that ACA enrollment declined drastically in 2026, the Trump administration and state governments are reportedly fighting over whether better policing of fraud or…
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Modeling Medicaid Cuts
Nebraska became the first state to implement the Medicaid work requirements mandated by last summer’s One Big Beautiful Bill Act, marking the start of an estimated $1T of Medicaid cuts over the…
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The Future Value of Hospital Mergers
Hospital merger activity hit a 15-year low in 2025, as an uncertain policy environment following the inauguration of President Trump caused many health systems to delay major strategic decisions. However,…
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What Scale Gets You
A unique aspect of the healthcare delivery is its inseverable ties to local settings and physical infrastructure. Health systems’ services are limited to the regional markets they serve,…
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The Mixed Effects of AI on Revenue and Employment
An NBER working paper published earlier this year uses the framework of “AI exposure” versus “AI adaptivity” to show the different ways AI could impact healthcare productivity and employment. A job…
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Physician Partnerships as Maturing Relationships
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Rumors of the Demise of MA Profitability Greatly Exaggerated
When CMS proposed to keep Medicare Advantage (MA) payment rates essentially flat for 2027, it raised the possibility that the Trump administration was finally getting serious about its rhetoric of reining in…
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The MDI Effect: Putting the Mouth Back in the Body
Starting with medical school and extending through nearly every aspect of the practice of medicine, from care delivery to insurance billing, the teeth are treated as if they…
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Uninsured Rate About to Rise Sharply
Last month, the Congressional Budget Office (CBO) updated its baseline projections of health insurance coverage by source for the first time since June 2024. In the intervening time, Congress reduced…
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Payers and PBMs are One in the Same
For years, much of the consternation around the vertical integration strategies of payers has focused on their moves in the provider space: CVS Health buying Oak Street Health, Humana buying Kindred…
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Medicare’s Value Problem
As part of its 2021 Innovation Center Strategy Refresh, the Centers for Medicare and Medicaid Services (CMS) set a goal of having 100 percent of traditional Medicare (TM) beneficiaries…
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Millennials May Finally Save an Industry
Millennials, the generation of people born between 1981 and 1996, have been accused of “killing” every industry from restaurants to gyms, as cover for these industries failing to adapt to…
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Ten Years of Site-Shifting Care Delivery
As gold-medal-game winning USA Olympic-team hockey players Jack Hughes and Megan Keller could tell you, a good strategy requires skating to where the puck is going, not where it has been.…