TrustWorks On Call: Thawing Out

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. DHS shooting risks government funding deal.

On Saturday afternoon, US Border Patrol officers in Minneapolis shot and killed Alex Pretti, a 37-year-old intensive care unit (ICU) nurse at a Veterans Affairs (VA) hospital, about one mile away from where an Immigration and Customs Enforcement (ICE) agent killed Renee Good, earlier this month.
Responding to mounting outrage over these deaths, Senate Democrats announced that they would oppose the current funding bill for the Department of Homeland Security (DHS), which is packaged with the other funding bills, including for healthcare; the Senate needs to pass these bills before Saturday in order to avoid a partial government shutdown.
The agencies at risk of going unfunded after Friday include: Health and Human Services (HHS), Defense, Labor, Housing and Urban Development, and Homeland Security (although ICE itself would be largely unaffected, due to its $75B supplemental funding package from last year’s budget reconciliation law).

TrustWorks Take: This is a newsletter about healthcare business and policy, so it should not have to feature a story about agents of the US government harming law-abiding citizens in the name of immigration enforcement. However, the healthcare angle of this story is unavoidable. Federal agents shot and killed an ICU nurse; as a likely result, the federal government will shut down, its healthcare agencies will operate at limited capacity, and Medicare’s telehealth flexibilities and Hospital-at-Home waivers will again expire. At every level and in every sense, this is no way to run a country.

If a shutdown occurs, Congress will probably come to an agreement that reopens the government within a few days, if not weeks. The worst healthcare consequence may be that Hospital-at-Home programs could briefly shutter again. The impact of Alex Pretti’s death will last much longer and be felt more deeply—first by his family, friends, coworkers, and patients, but also as something for the whole country to process. For the healthcare industry, his death should be considered in the context of this administration targeting undocumented immigrants in emergency rooms, preventing lawfully present immigrants from enrolling in health coverage, and restricting the supply of foreign-trained physicians. We hope that the death of an ICU nurse, as noble a profession as any, can serve as a galvanizing moment for the healthcare community.

2. Congress summons insurance execs to grind axes.

Last Thursday, the CEOs of UnitedHealth Group, CVS Health, Elevance Health, Cigna, and Ascendium (a California Blues-plan parent company) answered ten hours of Congressional questioning, sitting before both the House Energy and Commerce’s Health Subcommittee and the House Ways and Means Committee.
Lawmakers of both parties criticized insurance companies for their failures to limit healthcare cost growth, overuse of prior authorizations, vertical integration strategies, and high executive pay packages; Republicans also used the hearings to denounce the Affordable Care Act (ACA), whereas Democrats brought up Republicans cutting Medicaid funding and allowing the ACA subsidies to expire.

TrustWorks Take: The word of the day was “blame,” and there’s more than enough of it to go around in healthcare. At the hearings, insurers received blame both for their sky-high premiums and for their efforts to limit medical spending through prior authorization. These contradictory messages suggest that Congress is more interested in using insurers as a scapegoat for rising healthcare costs than in finding a solution.

Providers may be tempted to celebrate that insurance companies are the ones eating the most blame these days, but it’s a cycle that, without a solution, will keep on switching according to the whims of political discourse. Only a few years ago, large health systems faced public scrutiny for their debt-collection practices. Now it’s insurers and their prior authorizations. The next time around, it might be hospitals’ turn again, getting threatened with a loss of not-for-profit status if they don’t rein in their prices. In a system defined by misaligned incentives and administrative waste, there's no one “bad actor” in need of reform. Systemic change will require multiple sectors evolving together, either on a slow and deliberative path or through strong and abrupt policymaking.

3. US exits World Health Organization.

Last Thursday, the US completed its withdrawal from the World Health Organization (WHO), a process that began one year ago with an executive order signed by President Trump.
US officials cited the WHO “mishandling” the COVID pandemic, and failing to reform in its aftermath, as justification for US withdrawal.
The US recalled its staff and contractors from all WHO offices, suspended all engagements with the WHO, and stopped paying its dues, including about $280M in arrears that the US reportedly does not plan to pay.

TrustWorks Take: The Trump administration is spinning this decision to stand up to China while scolding the world for our collective failures in COVID response, However, an underlying driver of this decision is that they do not believe in the WHO’s mission of funding and coordinating global public health. The dismantled US Agency for International Development (USAID) was the first casualty of this logic, which approaches every problem with the question, “What’s in it for us?” The US reaps many good things from its global health programs, both charitable and strategic, so only a myopic view of the dollars returned can make them look like a bad deal. Even with all the travel restrictions in place during the pandemic, we saw clearly how diseases do not stop at borders.

Instead, the Trump administration’s global health policy will look more like this controversial study, in which thousands of babies in the West African country of Guinnea-Bissau were to delay receiving the hepatitis B vaccine until six weeks after birth, violating the globally accepted standard of care. The US-funded study was paused after receiving heavy criticism from the public health community, who saw it as unethical and exploitative. But for Health Secretary Kennedy and the Trump administration, they only saw it as a chance to confirm their priors on vaccines without risking Americans’ lives.

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

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 levels. Opioids, in particular synthetics like fentanyl, remain present in a majority of overdose deaths, highlighting that increased access to opioid addiction treatment and decreased access to opioids are the two primary factors driving the declining death rates. Treatment options have improved, thanks to a concerted effort to make available naloxone, an overdose-reversing drug, and new policies allowing the use of methadone at home. Billions of dollars of opioid settlement funds flowing into all kinds of treatment systems and educational efforts have helped as well. On the drug supply side, causal theories are a little looser. China may have helped tamp down on a fentanyl precursor; the population of people who use drugs in the first place is thought to be declining; and the pandemic-specific effects that created a “perfect storm” for drug abuse have subsided with time. Realizing these declines provides a source of hope in drug addiction treatment circles, who want to keep the momentum going and reverse not just a few years, but a few decades of drug overdose trends.

Dialing In

Sharing insights from our work with clients

Avoiding a “Fairy Dust” Approach to AI
Health systems’ approach to artificial intelligence (AI) has evolved quickly over the past two years. Coming out of COVID, providers were trying to get their heads around what AI is, while managing an onslaught of start-ups promising vague returns from partnership or investment. Now, many have started to see some early wins. Automating non-clinical functions like prior authorization or revenue cycle tasks has sped up cycle times. And physicians have seen real value in ambient dictation systems, reducing the time they spend documenting in the EMR during and after visits.

As systems got more comfortable with AI, they started to see a wide range of applications, and adoption now feels like it has hit a fever pitch. As one CIO told us, “Healthcare was late to the game on AI. We’re trying to make up ground and pilot as many applications as possible." The challenge of a “fairy dust’ approach to AI, where you sprinkle a little bit of AI on everything hoping something blossoms, is it will delay seeing value from AI investments. Artificial intelligence is a tool that can solve many kinds of problems and make lots of processes more efficient, but not something that needs a strategy unto itself. Rather, systems should shape their strategy around where AI can make an impact. But attaining real ROI also requires follow-through. As one COO noted, “It’s a lot easier to automate a process on paper than to reduce the number of staff that we have doing the work now. But that’s where you get the savings.”

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