Back to Insights
TrustWorks On Call Newsletter Header

New Website, Same TrustWorks

May 13, 2025

Hello and welcome back to TrustWorks On Call—here’s our healthcare business and strategy 411 for the week. If you enjoy our work, please consider forwarding it along to a friend and encouraging them to subscribe! 

Before we get into today’s news, we have an exciting announcement to make: our website (https://trustworksco.com) has undergone a complete redesign! We invite our readers to peruse, admire, and provide precious feedback on the new look. While you're there, don’t miss the new Insights page, featuring the entire TrustWorks On Call archive.

Back to this edition, our Beyond the Whiteboard section delves into how consumerism in healthcare is evolving, plus we’re Dialing In on strip mall healthcare clinics. But first, here’s the news:

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. UnitedHealth Group CEO Andrew Witty steps down.

  • UnitedHealth Group (UHG) announced Tuesday that, effective immediately, CEO Andrew Witty will be stepping down for “personal reasons,” after four years in the role.
  • Stephen Hemsley, former UHG CEO from 2006-2017 and current Chairman of the Board of Directors, will be taking over as CEO, while Witty will serve as senior advisor to Hemsley.
  • The company also pulled its 2025 financial outlook, after cutting its annual guidance in April, as accelerating care costs continue to hurt margins, especially in its Medicare Advantage (MA) business, more than anticipated.
  • Prior to this news, UHG shareholders filed suit against UHG, claiming the company issued misleading guidance by reaffirming its 2025 outlook in the wake of the murder of UnitedHealthcare CEO Brian Thompson.
TrustWorks Take: While we won’t speculate on the personal reasons involved in Witty’s decision—he’s had arguably the most stressful job in America since the Change Healthcare hack last year—UHG needed a shakeup at the top, and Hemsley as a former CEO should offer a steadying hand. However, UHG’s problems go deeper than leadership. Its internal culture and external reputation were rocked by the Change hack and Brian Thompson’s murder, leading to its AI-powered prior authorization tactics and vertical integration strategy receiving heightened regulatory scrutiny. Meanwhile, in the long run, aging MA populations and the natural limits of acquisition-based growth—it can only buy so many more physician groups before antitrust enforcement steps in—will make it extremely difficult for UHG to maintain its “long-term growth objective of 13% to 16%.” The throughline of these problems is that UHG’s vertically integrated scale, which has been the engine of its success and the model other payers have emulated, has exposed the company to more risks than it can apparently handle. In order for UHG to deliver on its promise to “return to growth in 2026,” it should spend the rest of 2025 focused on fully integrating its myriad assets (including cybersecurity protocols), determining (as other payers have) where its portfolio may be overextended, and figuring out why it missed the mark on MA utilization trends (when other payers didn’t). UHG is showing that it’s not too big to fail, or at the very least struggle, due to a shaky foundation that discounted transparency, the patient experience, and provider trust as critical components of success.

2. House GOP unveils budget bill with deep Medicaid cuts.

  • The House Energy and Commerce Committee introduced a bill Sunday night that seeks to reduce federal healthcare spending, mostly on Medicaid, by over $700B annually to help pay for extending tax cuts from the first Trump administration.
  • To reduce federal Medicaid spending, the bill would require states to impose work requirements on able-bodied adults without dependents, introduce cost-sharing for expansion enrollees earning 100-133 percent of the poverty line, freeze state provider taxes at current levels (limiting a funding channel for state-directed payments), and allow for stricter and more frequent eligibility reviews.
  • Healthcare measures not related to Medicaid include delaying a $8B cut to disproportionate share hospitals until 2029, reducing the Medicare physician pay cut, and reining in certain pharmacy benefit manager business practices, like spread pricing.
TrustWorks Take: The House GOP’s budget proposal could have been worse—there aren’t per-capita caps on federal Medicaid payments to states—and it still could get better—there’s lots of negotiating left to do, including with the Senate—but the initial outlook from this bill is quite dire. Preliminary analysis from the Congressional Budget Office estimates that this bill would cause 8.6M Medicaid enrollees, over 10 percent of current enrollment, to become uninsured. Factoring in another 5M adults losing coverage with the scheduled expiration of the enhanced Affordable Care Act (ACA) marketplace subsidies, the number of uninsured Americans would rise from about 27M to over 40M by 2034. As deleterious as this would be for the newly uninsured, the loss of public funding and rise in uncompensated care would hit providers equally hard, especially in rural areas, leading to hospital closures and service cutbacks that would impact all patients. Responding to the House bill’s release, Sen. Josh Hawley, a Missouri Republican, penned a New York Times op-ed to call these cuts “morally wrong and politically suicidal,” further stoking the flames of what’s expected to be contentious intra-party negotiations to reach a final bill.

3. Trump withdraws surgeon general pick, nominates Dr. Casey Means.

  • Last Wednesday, President Trump withdrew his nomination of Dr. Janette Nesheiwat for surgeon general and replaced her with Dr. Casey Means.
  • Dr. Nesheiwat, a family medicine physician at CityMD and Fox News contributor, was revealed to have allegedly embellished her medical education and emergency medicine board certification, leading her nomination to be pulled.
  • Dr. Casey Means, a self-described “former surgeon turned metabolic health evangelist,” recently rose to prominence, along with her brother Calley Means, who advises Robert F. Kennedy, Jr., while promoting their cowritten book about metabolic health on high-profile podcasts.
  • Dr. Means practiced functional medicine in Oregon, but her medical license has expired, which may trouble her confirmation process as the surgeon general has traditionally been required to have an active license.
TrustWorks Take: Ideologically, Dr. Means appears to be aligned with RFK Jr.’s beliefs—expressing concerns about the quality of our food supply, our overreliance on pharmaceuticals, and childhood vaccine schedules—making her a relatively mainstream member of the “Make America Healthy Again” movement. To the extent that she advocates for healthier diets and the importance of exercise, she’ll do more good than harm, and she’s expressed less antivax sentiment than many in the MAHA coalition. However, we’ve now gone from a surgeon general nominee who allegedly lied about her board certifications to one that not only has no board certifications but doesn’t even have an active medical license, reportedly thanks to the concerns of a far-right activist who opposes both nominees for being insufficiently antivax. Confirming Dr. Means despite her lapsed licensure and lack of qualifications would be disrespectful to the Office of the Surgeon General and contribute to the erosion of public trust in federal healthcare communication.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

With Great Prices Come Great Expectations
Following up on last week’s graphic covering the public’s declining view of US healthcare quality, this week’s graphic illustrates recent trends and changes to the consumer healthcare shopping experience. Under a standard consumer choice model, prospective patients weigh the available financial and quality information about their provider options against their own preferences and cost constraints. In theory, cost-exposed consumers will shop for higher-value care, inducing competition from providers to offer the highest-quality or most-affordable services. Based on this theory, and to minimize their own liability for healthcare expense growth, employers have shifted increasing shares of their covered workers to high-deductible health plans—60 percent of covered workers faced single-coverage deductibles of at least $1K in 2024, up from 22 percent in 2009. The unfortunate flaw in this model is that healthcare consumers lack full information about the price and quality of healthcare services. Even with improvements to price transparency, fewer than one in five adults are aware of their healthcare costs before they receive care.

As for quality, consumers care about a provider’s licensure, years of experience, and reputation, but these are only proxy measures for the quality of a given care experience. Instead, patients often rely on other factors like convenience and access to select their providers, which are important aspects of quality shopping experience more so than a quality healthcare experience. And while quality information about providers remains underutilized, patients have embraced the tracking of their personal healthcare data through wearables and other health tech, which has further altered the patient-provider relationship. More than ever before, patients are coming to healthcare services with opinions and data about their own health, while paying for more of their care themselves. In this sense, they’re becoming not just consumers of care but customers—who are (supposedly) always right.

Dialing In

Sharing insights from our work with clients

The Urgent Care Strip Mall and the Future of Physician Enterprise
Sometimes the best insights come on the way to a client. Somewhere off I-95, wedged between a vape shop and a fitness franchise, I spotted not one but two urgent care centers, a primary care clinic, and a “walk-in dermatology” storefront, all in the same strip mall complex. And sure enough, a free-standing ED not a half mile down the road. This clustering is a symptom of care fragmentation, with retail logic being applied to clinical ecosystems. Care is becoming a product of proximity and speed, not continuity or connection. The great growth in fragmented care sites is an attempt to respond to consumer desires, but it needs to be more thoughtful and integrated.

Provider groups should modernize how, where, and through what channels they deliver care without just defaulting to full on retail model. In strip malls, healthcare clinics are more like sushi restaurants than fast food chains—their quality seems questionable unless you’ve been pushed to go there by a friend or an app, and one bad experience means you’ll never go back. Rather than hoping for random foot traffic to walk through their physical front door, these clinics are best suited to capture volumes first generated by a digital front door. That’s not a portal buried three clicks deep, but a unified, user-friendly platform where patients can schedule, message, check in, and follow up seamlessly in furtherance of a continually relevant relationship. Longitudinal relationships, team-based models, and shared data still deliver the best results in value-based environments. Strip malls clinics should be an accessibility feature of a broader integration mission, one that starts with a digital front door and strategically moves the patient into the right convenient physical location, or as part of a partnership to fill a specific gap in care delivery.