TrustWorks On Call: A Tale of Two Committees

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. SCOTUS preserves ACA preventive care mandate.

Last Friday, the Supreme Court issued a ruling upholding a provision of Affordable Care Act (ACA) that determines which preventive care services private insurers must cover without cost-sharing.
The case, Kennedy v. Braidwood Management, was decided with a 6-3 vote on the grounds that members of the US Preventive Services Task Force (USPSTF) do not need Senate confirmation as they are “inferior officers” answerable to the Secretary of Health and Human Services (HHS).
Litigation is now expected to continue in lower courts over two other aspects of the original Braidwood case: religious exceptions for employers to not cover pre-exposure prophylaxis (PrEP) drugs, and the constitutionality of two other governmental bodies—the Health Resources and Services Administration, and the Advisory Committee on Immunization Practices—that issue preventive care coverage recommendations.

TrustWorks Take: The “most challenged statute in American history” survives yet another challenge, at least until the religious exception case finds its way before the Supreme Court. Cost-free preventive services are popular and widely used. The Justices did the right thing by affirming the USPSTF’s authority to issue binding coverage recommendations. However (as we’ll detail more in the story below), the feature that saved the USPSTF—its members are subordinate to HHS Secretary Kennedy—has now become our chief source of concern. The makeup of the task force, the recommendations it gives, and the rate at which it reviews and updates these recommendations are all open to change under the direction of the current administration, which is presently applying its political point of view to federal vaccine policy. Preventive care services concerning reproductive and sexual health, already facing legal challenges, could also be undermined from within the administration.

2. Reconstituted ACIP generates controversy with first meeting.

Last Wednesday and Thursday, the Advisory Committee on Immunization Practices (ACIP) met for the first time since HHS Secretary Kennedy fired all 17 members of the panel and replaced them with eight new appointees, including one who has already stepped down, and several who have expressed anti-vaccine sentiments.
In a “chaotic and not transparent” meeting, ACIP recommended against the use of flu shots containing thimerosal, an ingredient present in only 4 percent of flu shots that has been subject to baseless and clinically disproven claims that it causes autism.
ACIP also shared plans to reevaluate the childhood vaccine schedule, which could result in legally binding changes for public and private insurance coverage and school-based vaccination mandates.
In a separate policy decision last week, Secretary Kennedy said the US will end its support for Gavi, a global alliance for childhood vaccines, which had been receiving 13 percent of its budget from the US government.

TrustWorks Take: In response to politicized reorganization of ACIP, physician professional organizations including the American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Academy of Family Physicians (AAFP) have all released statements denouncing these actions and affirming their commitments to fight against vaccine misinformation, with the AAP promising to continue publishing its own vaccination schedule. Despite these efforts, a breakdown of national consensus on the safety and efficacy of vaccines is likely, which will complicate what used to be clear-cut vaccine coverage decisions for payers and state governments. Without the federal backing of routine vaccinations, we can expect to see the acceleration of vaccine hesitancy, a resurgence of vaccine-preventable diseases (both nationally and globally), and a greater burden on health systems and other providers, who operate in a system not designed to handle surges from localized outbreaks and epidemics.

3. Senate passes Big Beautiful Bill with over $1T of healthcare cuts.

Earlier today, the Senate voted 51-50, with Vice President JD Vance breaking the tie, to pass this year’s signature tax and spending bill.
To partially pay for the bill’s tax policies, federal healthcare spending will be subject to over $1T of cuts across the next decade, including $940B in reduced Medicaid spending and over $200B in reduced support for the health insurance exchanges.
The Congressional Budget Office estimates that this bill will cause 11.8M more people to become uninsured in the next decade, and that number rises to about 17M when factoring in other recent or expected policy changes, like the expiration of enhanced marketplace subsidies.
The House is prepared to vote on the Senate’s version of the bill as soon as Wednesday, with July 4th having been named as the target deadline.

TrustWorks Take: Given that the Senate voted on the bill just hours before we send this newsletter, we’ll have to wait until next week—also pending the fate of this bill in the House—before we can fully analyze every provision. However, the broad strokes of the bill have been clear from the start: millions of people will lose health insurance, uncompensated care costs will rise and make healthcare more expensive for everyone, dozens of rural hospitals will close, and trillions of dollars will be added to the federal debt so that we can extend tax cuts that largely benefit higher earners. The marginal tweaks and patches added on last minute to win over hesitant Senators, such as the $50B rural hospital fund, are merely drops in the bucket in light of this bill’s total impact.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

Payer Relations Driving Physician Group Strategy
In an earlier edition of TrustWorks On Call, we shared a graphic detailing the decline of physician independence and the tradeoffs that come with health system or corporate employment. This week, we’re highlighting analysis of the American Medical Association’s Physician Practice Benchmark Survey to provide a new lens on this trend: that payer relations are the problem, and scale—whether through health system or corporate employment, or through practice size aggregation—is increasingly seen as a primary solution. Three of the top five reasons physicians reported for why their private practices were sold in the last decade relate to payers, with sellers seeking higher reimbursement, more capacity to manage administrative burdens, and easier participation in value-based contracts. Affiliating with a health system has the potential to help with all three of these concerns, but so too does joining (or becoming) a larger practice. From 2012 to 2024, the share of physicians in practices of fewer than five people dropped eleven points, while the share in practices of 50 or more increased by six points, nearly equal to the growth of direct hospital employment. The most drastic change in physician employment across the last decade isn’t just the decline of physician independence in general, but rather the near disappearance of small, independent practices. Instead, the ranks of large, multispecialty groups (whether allied with or independent from health systems) are growing because they can boast a scale and market essentiality worthy of payers’ respect at the negotiating table.

Dialing In

Sharing insights from our work with clients

Threading the Needle with Hybrid Concierge Models
We’re sensing a quiet shift underway as we received another request regarding a hybrid concierge model. While continuing to see most patients as before, practices (more than just primary care) are increasingly interested in “reasonable” fees, say $100-200 per member per month, atop traditional insurance in exchange for additional carrier or Medicare benefits—although it must be for services Medicare doesn’t already cover.

The model’s appeal is clear. A predictable revenue stream helps cover the gaps from non-reimbursed or under-reimbursed services, in exchange for better service delivery for the patients you retain. The real success factor comes from making sure the concierge fee translates to a measurably better patient experience: shorter wait times and longer appointment times, workflows that support dual-path operations, and a front desk that feels more like a hospitality relationship management team.

Hybrid models also avoid one of the main tradeoffs of full concierge medicine: having to turn away a portion of your patient panel to support a smaller, more exclusive practice. Truth be told, not all physicians are overly concerned with appeasing patients who won’t pay for enhanced access. However, a hybrid model lets them preserve relationships and revenue without drawing a hard line. It’s far more practical to offer an optional concierge fee to those who value the additional services, rather than impose it across the board.

And it’s not just affluent patients opting in. Medicare Advantage members, commercially insured individuals, and even small employers are showing interest, drawn not by luxury, but by reliability. Especially in competitive labor markets, employers are willing to pay modest fees to secure more responsive care for their teams that support the need to manage care with heightened patient experiences and navigation assistance.

In the end, what’s been most satisfying in our conversations around concierge models is that they quickly move beyond financial diversification toward a reimagining of how care can be accessed and delivered, as well as how patients can be navigated through episodes of care. As more practices test new ways to blend volume with value, hybrid concierge models may quietly set the standard for what modern, patient-centered care looks like.

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A Tale of Two Committees