andrew
Recent articles
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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.…
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Only Healthcare is Hiring
According to the Bureau of Labor Statistics January jobs report posted last week, of the 130k net jobs the US economy added January, an astounding 124K of those jobs came…
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When Trust Stops Working
Last September, Robert F. Kennedy Jr. wrote in an op-ed that “restoring public trust in the Centers for Disease Control and Prevention” (CDC) was one of his primary objectives as…
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Healthcare Returns as Top Kitchen Table Issue
Headlines this week captured consumer confidence reaching a 12-year low this month, and while our preferred consumer sentiment index was slightly more optimistic, there is no debating that Americans hold a…
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A Bright Spot from an Unlikely Subject
After 25 years of persistent rise, drug overdose deaths in the US fell by record amounts in 2024 and 2025. Down 38 percent from 2023, overdose deaths have now reached pre-pandemic…
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Healthcare Growing Faster than Rest of Economy
In 2024, the US economy spent $5.3T on healthcare, an all-time high according to recently released data from CMS. Occupying 18 percent of the US economy, healthcare’s share of GDP…
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Rural Health Program Lacks Funds for Transformation
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“Nice” Reasons for Hope in Healthcare
Although nothing compares to the operational challenges of 2020 as COVID swept the nation, 2025 was as difficult a year for healthcare strategy as any in recent memory.…
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More Dollars than Results for the Healthcare Lobby
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Commercial Insurance Premium Increases Feel Unsustainable
Every fall, KFF publishes perhaps the authoritative account of commercial group-coverage price growth with its Employer Health Benefits Survey. Its lookback on 2025 found that family premiums grew by…
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Hospital at Home Programs on Pause
Despite consistent bipartisan support, Congress allowed the Acute Hospital Care At Home waiver program to expire after four years and three extensions when it failed to avert a government shutdown.…
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Providers and Payers Deploying AI Against Each Other
According a recently released Bain and KLAS report, both providers and payers are focusing on the AI investments “most likely to improve profit margins.” Profit generation is only one…
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The Decline of Your Local (Chain) Drugstore
As we discussed last week, the news of Rite Aid’s final closure comes in context of the broader struggles faced by retail pharmacy chains. This week’s graphic quantifies those…
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The Inevitability of Site Neutrality
The 2026 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule picks up where the first Trump administration left off, proposing to eliminate over three years Medicare’s Inpatient Only (IPO)…
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Consumers About to be Caught in Health Plan Crunch
During the upcoming open enrollment season for Medicare Advantage (MA), a record 28 percent of MA members are expected to switch plans, driven by payers cancelling unprofitable plans and paring back benefits.…
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A Positive Vision for Health Systems
Against the backdrop of unprecedented threats to the health system business model, we’d like to offer an organizing principle for health system strategy: health systems should strive to…
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Medicare’s Ever-Growing Physician Pay Gap
Every year, we see the same song and dance play out: the proposed Medicare physician fee schedule (PFS) includes an unacceptable cut, lobbying groups work frantically to either…