TrustWorks On Call: Shot, Shot, Chaser

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. Chaos surrounds RFK Jr. at HHS.

Last Thursday, Secretary of Health and Human Services (HHS) Robert F. Kennedy Jr. clashed with both Democrats and Republicans on the Senate Finance Committee over his vaccine policies and the recent firing of Centers for Disease Control and Prevention (CDC) Director Dr. Susan Monarez.
Dr. Monarez, who became the first CDC director to be confirmed by the Senate in July, claimed she was fired because she stood up to Kennedy on vaccines by refusing to pre-approve recommendations without solid evidence from a reconstituted Advisory Committee on Immunization Practices (ACIP).
Four senior CDC officials quit in protest amid Kennedy’s feud with Dr. Monarez, and over 1,000 current and former federal HHS workers have since called for Kennedy to resign for “endanger[ing] the nation’s health.”

TrustWorks Take: Secretary Kennedy appears to have few (if any) friends left in the Senate. Before the session, Senate Majority Leader John Thune (R-SD) took umbrage at the dismissal of Dr. Monarez so soon after the Senate confirmed her, and prominent Senators and physicians Bill Cassidy (R-LA) and John Barrasso (R-WY) used the session to express their concerns over Kennedy’s moves to restrict vaccine access, in violation of his confirmation hearing promises. Throughout this saga, Kennedy has retained a long leash of support from President Trump, who tepidly praised both Kennedy as having “a lot of good ideas” and some vaccines for being “so incredible,” which likely renders the growing tension between GOP Senators and Secretary Kennedy moot. Kennedy and Cassidy agree, for example, that President Trump deserves a Nobel Prize for overseeing Operation Warp Speed, even if Kennedy opposes the vaccines it produced. Without meaningful Congressional oversight of the Executive Branch, these hearings are merely theater covering the very real destruction of our public health institutions. Kennedy claims he wants to restore public trust in government health agencies, but the political pressure he’s placing on scientific advisory boards has only made it more difficult for healthcare professionals and the public to find, trust, and act on evidence-based medical guidance.

2. States advance their own vaccine policies.

Last week, California Governor Gavin Newsom, Oregon Governor Tina Kotek, and Washington Governor Bob Ferguson announced the West Coast Health Alliance to provide unified recommendations on immunization practices in response to the “politicization” of agencies like the CDC; Hawaii joined the alliance within 24 hours.
New York Governor Kathy Hochul declared a "statewide disaster emergency” to ensure all New Yorkers can get a COVID vaccine without a prescription or specific Food and Drug Administration approval, and Massachusetts Governor Maura Healey ordered that insurers have to pay for vaccines recommended by the state instead of solely relying on CDC recommendations.
Florida Surgeon General Dr. Joseph Ladapo announced that Florida would be ending all school vaccine mandates, although the state health department has since narrowed the policy to only lifting the mandates for hepatitis B, chickenpox, Hib influenza, and pneumococcal diseases.

TrustWorks Take: In the leadership vacuum created by the chaos at the federal level, Democrat-led states are responding by attempting to fill the void, whereas Florida, with perhaps other Republican-led states to follow, is accelerating the destruction of basic public health practices. Evidence-based healthcare shouldn’t vary by state, but vaccines are poised to follow reproductive care as a highly politicized field of medicine that produces significantly different outcomes depending solely on one’s state elected officials (i.e., less on science and more on politics). However, states’ efforts to shore up vaccine protections, while commendable, are inherently limited. States cannot compel self-insured employers, who are responsible for over half of private-sector enrollees, to cover vaccines. And while the West Coast Health Alliance could replace the expertise of ACIP, insurers and employers won’t be bound to follow its recommendations in the same way. The net effect of these competing policies will be more confusion for individuals, businesses, and insurers, and less access to vaccines everywhere.

3. Prostate cancer diagnoses on the rise.

According to a recent study by the American Cancer Society, prostate cancer incidence has increased by 3 percent per year from 2014 to 2021, after declining 6.4 percent per year from 2007 to 2014.
Prostate-specific antigen (PSA) testing has declined for most age groups since 2008, due in part to the test’s oversensitivity; however, the decline in PSA testing has coincided with a rise in advanced-stage prostate cancer.

TrustWorks Take: This study illustrates why population health guidelines like cancer screenings need to evolve with the times. Prostate cancer is tricky to manage at a population level, as it has high incidence, strong survival rates, and a screening test that can detect it years before the cancer becomes symptomatic. We backed off the PSA test because it was catching too many cases that were unlikely to metastasize or cause death, which invited overtreatment. Now, we’re detecting more advanced-stage cases because of this decline in early screening, although changing environmental factors may also be driving up incidence. These results call for another adjustment to screening standards, like resetting a barometer, while we continue to research better screening methods than the PSA. This is yet another area where it is crucial to have responsive policymakers at the federal level who are capable of making nimble, evidence-based recommendations that reflect new realities.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

The Future of the US Economy in Two Charts
Healthcare job growth is showing signs of weakness in 2025, but it’s one of the only sectors of the economy with any job growth at all. The healthcare and social assistance sector has been responsible for 93 percent of the net employment gains this year, after making up almost half the net employment gains in the two years prior. Despite this, or more likely because of it, healthcare companies have struggled to be profitable amid high labor costs, and the largest publicly traded healthcare companies have provided poor returns for investors. In contrast, big tech stocks have been market darlings for years, and the likes of Google, Microsoft, and Meta are pouring billions into AI infrastructure to maintain this advantage.

These two trends are more connected than they appear. AI’s great promise is to improve productivity, in large part by replacing human labor. AI innovations will surely transform the healthcare system, including its relationship to labor. Compared to other industries, however, healthcare will remain relatively dependent on human labor, especially for jobs at the bedside that face relatively low risk of disruption by AI. This divergence between healthcare and tech illustrates a structural risk for the U.S. economy: labor growth concentrated in a sector with limited productivity upside, and capital growth concentrated in a sector that generates profits but few jobs. Without intentional policies that bridge these two poles and investments that plug AI innovation into healthcare operations and workforce models, the country risks entrenching an economy where healthcare functions as the nation’s jobs program, while tech captures the value. That’s neither sustainable nor equitable.

Dialing In

Sharing insights from our work with clients

Call Coverage as a Canary in the Coal Mine
A hospital CMO called last week looking for strategies to secure coverage across orthopedics and urology. A few of the older doctors who had been active participants on the medical staff had stopped taking call as they moved toward retirement, and the younger physicians were asking for steep hourly rates, if they opted to participate at all. “Even if we tossed a ton of money at it, I’m not sure we could get people to take it,” he shared.

Getting calls like this nearly every week from executives with the same problem has us feeling like it’s 2005 all over again. Back then, call coverage was high on the CEO’s agenda when surgical specialists started to shift their focus to growing outpatient volume as minimally invasive procedures took over. Now, the outpatient shift is still the primary factor, but there’s often a new catalyst. As private equity and other investors take over specialist practices, they may question why doctors would “waste their time” with call. As one surgeon shared, their investor partners noted that most of the patients seen on call were Medicaid or Medicare beneficiaries, “not the lucrative commercially insured patients these guys want taking up the spots in our surgery centers.”

Gaps in call coverage are a sign of a larger issue of doctors moving further away from the hospital. What used to be a partnership to deliver comprehensive care has devolved into a largely economic transaction, where alignment is further challenged by the growth of private equity firms and their focus on near-term returns. While it makes sense that doctors want to be compensated for their time, health systems would be wise to focus on the larger strategic issues, beyond the call question, that ensure continuous and stable hospital-based care. Given the importance of specialty care to the system, what type of intentional strategies can we craft that go beyond transactional call pay to create durable partnerships that align hospitals, physicians, and investors around common goals to mutual benefit?

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Shot, Shot, Chaser