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Vats of Vax

August 13, 2026

Welcome to TrustWorks On Call, here with your 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. 

This week, we go Beyond the Whiteboard to describe the rapid growth of concierge medicine, before Dialing In on the disbelief among some health system leaders that Medicaid and Affordable Care Act (ACA) cuts will be allowed to proceed. But first the news, starting with President Trump finding increasingly colorful ways to describe the (non-existent) perils of excessive vaccinations.

Behind the Headlines

Unpacking the forces driving healthcare's biggest stories.

1. Trump orders revised childhood vaccine schedule.

  • President Trump signed an executive order this week to reduce the number of vaccines American children must receive from 17 to 11, while calling for the measles, mumps, rubella (MMR) vaccine to be split into three separate shots.  
  • The executive order resembles the childhood vaccine schedule introduced last January by the Advisory Committee on Immunization Practices (ACIP), which federal courts struck down due to the committee acting in an “arbitrary and capricious” manner that ignored proper procedures for changing vaccine recommendations. 
TrustWorks Take: This executive order has no legs to stand on, lacking the justifications of scientific evidence, legal authority, or even political expedience. That is why President Trump and Health Secretary Kennedy felt the need to exaggerate and make false claims throughout the signing ceremony, with Trump stating that the MMR vaccine can be “lethal” and that kids are receiving “vats of vaccine,” while Kennedy asserted that there are over 70 scheduled childhood vaccines (at most, there are 35 by age 5) and connected vaccines to autism yet again. The split-dose MMR vaccine they are advocating for does not exist, and drugmakers who make MMR vaccines have expressed no interest in creating them. 
 
Only ACIP can change the childhood vaccine schedule, and the administration’s efforts to do so by politicizing the committee have been stopped by the courts, which will not be swayed by another executive order. Therefore, this order will have no material impact beyond sowing further confusion among the American public as to the safety and efficacy of vaccines. It also reverses the administration’s messaging pivot ahead of the midterms, after Kennedy had reportedly been muzzled for his unpopular views on vaccines. Finally, for recently confirmed Centers for Disease Control and Prevention director Erica Schwartz, MD, it presents an immediate headache and test of her loyalties between the science on vaccines and the prerogatives of her bosses.
 

2. Healthcare job growth slows in July.

  • The healthcare sector gained 22K jobs last month, according to the Bureau of Labor Statistics, well below its 36K monthly average over the last year; total non-farm employment was reduced by 23K last month. 
  • Within the healthcare sector, ambulatory services employment grew by 18K jobs, including 4.6K in home health care; nursing and residential facilities added over 4K jobs, and hospitals lost 400 jobs on net.
TrustWorks Take: Healthcare has been the economy’s primary engine of job growth for years, but the sector cannot separate itself entirely from the macroeconomic trends dragging on total employment, such as high oil costs and new trade restrictions. Inflation eats into health systems’ budgets for labor and investment, which helps explain why hospital employment shrunk slightly. Even in a slow month, the jobs report makes clear that the future of healthcare is caring for our aging population in lower-cost outpatient and home-based settings, where job growth remains robust, fueled by the need for lower wage, hands-on caregivers.
 
Corporate AI adoption is central to the jobs story, but as a former Lululemon tech executive observed in a New York Times op-ed, a meaningful share of AI-driven layoffs may have been “AI washing,” in which companies are incentivized to use AI efficiencies to justify every strategic decision, regardless of whether those efficiencies yet exist. Although AI’s responsibility for layoffs to date may have been overstated, its effect on job growth is more visible in the slowdown of new job creation and wage growth. Rather than expanding workforce, employers expect workers use AI to boost productivity. With hiring suppressed, workers have less leverage to negotiate for higher wages, leaving everyone feeling a little bit stuck.
 

3. Health system leaders surveyed on Epic’s AI moat.

  • In anticipation of electronic health records (EHR) company Epic’s 2026 User Group Meeting next week, venture capital firm Redesign Health released a survey that revealed how influential Epic has become on the technology purchasing decisions of health system executives.
  • Among the 112 C-suite and VP-level executives at Epic-based systems, 71 percent described their systems as “Epic-first,” meaning they prioritize Epic modules wherever possible, and 91 percent were confident that Epic will execute on its AI roadmap.
  • The survey also revealed that these systems allocate on average 57 percent of their clinical and administrative technology budgets to Epic. 
TrustWorks Take: This survey almost reads like a press release for Epic, but it was in fact commissioned by a venture fund interested in finding gaps in Epic’s moat. Startups and external vendors have better odds of breaking through with features like imaging and specialty-care AI, which Epic has not emphasized, and discharge planning, which requires coordination across multiple organizations. Epic’s omnipresence and ease of integration make its products the default choice for most health systems. That means external vendors must also design their products with Epic compatibility in mind.
 
Health system execs indicated that Epic products merely need to be “good enough,” or even just on the future roadmap, whereas external products need to demonstrate an outsized return to be worth the bet. This is a tremendous structural and strategic advantage for Epic, which will only increase its dominance of the acute-care EHR market. It also places a target on its back for motivated, Epic-skeptical regulators with an axe to grind, but no basic data-interoperability policies will change the reality that Epic is the starting point for all AI and technology discussions at most health systems.
 

Beyond the Whiteboard

Visualizing key trends from the healthcare industry

Will Concierge Medicine Always Be Niche?
Concierge medicine is a care delivery model, originally focused on primary care but since applied to other specialties, in which practices charge patients an annual fee, ranging from $2K to $100K (but usually below $10K), in exchange for smaller panel sizes, greater access and availability, and more personalized services. Direct primary care (DPC) takes this idea one step further by charging a larger fee and operating entirely outside insurance. Together, they offer an answer to many clinicians’ and patients’ complaints about the underfunded, overburdened status quo of primary care delivery, but only for those who can afford it. 
 
From 2018 to 2023, the number of medical practices offering concierge or DPC services grew 83 percent, and the corresponding clinician count grew 78 percent, but from a very small starting point. In 2023, 7K primary care clinicians (including both physicians and advanced practice providers) worked in concierge or DPC practices. Using a conservative estimate that there are 350K primary care clinicians practicing in the US, approximately two percent of them are in concierge models. This is not to dismiss concierge care as insignificant, as the economics of this model at the practice level can be incredibly impactful, but rather that it can only serve a certain slice of the healthcare market. This slice has been growing thanks to Baby Boomers reaching retirement age, which increases both its demand and supply (concierge works as a great bridge to physician retirement). The recent growth of concierge care instead prompts the question: what is its natural ceiling? How many Americans would pay even more upfront for highly personalized care, and how many practices could that support? 

Dialing In

Sharing insights from our work with clients

No Bailout is Coming
In a prep meeting for an upcoming health system board meeting, the CEO vented his frustration about how unresponsive Congress has been to health systems’ financial stressors. “I was at a fundraiser last month for [a Senator up for reelection this fall], and I got the chance to press him on the trouble we’re in with Medicaid and the ACA. Surely, they could throw us a bone with a one-off package to soften the blow? He just smiled and shook his head! Didn’t even want to give us hope. If our market loses healthcare jobs over this, I hope they understand it’s his fault.” 
 
We may not be regularly rubbing elbows with elected officials, but we can read the tea leaves just the same. Health systems are on the cusp of an unprecedented cut in federal spending on Medicaid and ACA exchange plans, and their federal representatives, no matter how publicly sympathetic, appear to be unable or unwilling to do anything to reverse it. (Some state legislatures have stepped in with spending patches, but their fiscal powers are far more limited.) Still, we have observed a persistent disbelief among some health system leaders, based on the idea that healthcare is too politically important, that these cuts will be allowed to go into full effect over the next few years. Midterm election season tends to produce Congressional gridlock, and predictions of a toss-up election suggest another divided and unproductive Congress next session. Health system leaders should face the music that they must plan as if the cuts will roll forward unchanged, without any Congressional interventions to bail them out.