‘This Is Crazy’: Health Experts Call for Changes to the No Surprises Act
The No Surprises Act, enacted in 2020 to shield patients from unexpected medical bills, relies on an Independent Dispute Resolution (IDR) process when insurers and providers cannot agree on payment. Health‑care leaders now warn that the IDR system is being gamed: 3.4 million disputes have been filed from 2022‑June 2025—far above the 55,000 CMS forecast—most initiated by providers who win at roughly 4.5 times the in‑network rate. The surge has generated about $5 billion in costs and produced outlier awards such as a $255 million judgment on a $7,000 claim. Stakeholders are calling for regulatory and congressional reforms to curb the abuse and restore balance.
Frozen Does Not Mean Stable: Rethinking Cryopreservation in Cell and Gene Therapy Manufacturing
Cryopreservation remains a linchpin for cell and gene therapy (CGT) manufacturing, yet frozen material is not inherently stable. Real‑world operations introduce transient warming events (TWEs) when products are moved, accessed, or shipped, silently degrading viability and potency. Traditional reliance on...
DPC Is Scaling — The Financing Architecture Isn’t Ready
Direct primary care (DPC) practices have exploded, growing 83 percent since 2018 to over 2,700 sites serving roughly 250,000 patients, and the global market is projected to reach $93 billion by 2034. While DPC delivers longer visits and lower utilization, the migration...
Personalized Rehab Solution: Supporting Patients With Work Responsibilities
Personalized rehabilitation programs are emerging to accommodate clients who cannot abandon work responsibilities. Facilities like Tranquil Shores offer flexible scheduling, remote therapy, and tailored treatment plans that align with individual career demands. By integrating technology and confidential care, these programs...
A New Opportunity to Reduce Resident Burnout: Young Doctors Are AI Natives
Resident physicians are experiencing burnout at rates higher than any other U.S. worker, driven by demanding schedules, financial pressures, and limited control over time. Traditional mental‑health services often fail to accommodate their irregular hours, prompting many to turn to AI‑based...
Key Amenity Categories in Luxury Rehabs, According to The Sanctuary at Sedona
The Sanctuary at Sedona outlines a comprehensive luxury rehab checklist that blends high‑end amenities with rigorous clinical care. It highlights seven amenity categories—privacy, clinical depth, personalization, integrative wellness, advanced tech, environment, and hospitality—each designed to improve retention and therapeutic engagement....
How A Small Rural Hospital Is Using AI to Catch Heart Disease Sooner
Wayne General Hospital in rural Mississippi has adopted Eko Health’s AI‑powered digital stethoscope, allowing clinicians to detect cardiac conditions such as atrial fibrillation, low ejection fraction and valvular disease in real time. The AI engine combines auscultation with ECG data...
AHIP CEO: “We Are Laser-Focused on Affordability”
AHIP President and CEO Mike Tuffin told a Washington briefing that affordability is the organization’s top priority as hospital, drug and specialty care costs outpace wages and inflation. He blamed hospital consolidation and drug‑maker patent thickets for rising premiums and...
Why Pure DTC Doesn’t Work in Healthcare, Per Muse Capital
Muse Capital partner Rachel Springate argues that pure direct‑to‑consumer (DTC) models rarely succeed in healthcare because they ignore insurance and system constraints. She highlights a hybrid approach where startups first attract consumers, prove outcomes, then integrate with payers and health...
12 Senate Democrats Unveil Plan to Cut Costs, Expand Coverage
Twelve Senate Finance Committee Democrats unveiled a health‑care plan aimed at reversing recent premium spikes, simplifying enrollment, and curbing insurer profiteering. They cite the expiration of ACA‑enhanced premium tax credits, which caused average premiums to double, as a key driver...
Imaging Interoperability Offers a Lifeline to Rural Hospitals and the Patients Depending on Them
Rural hospitals, already strained by shrinking Medicaid enrollment and decades of closures, now face an acute threat: 315 facilities are at immediate risk of shutting down and another 450 are in serious jeopardy. A core driver of this crisis is...
Why GI Providers Should Care About That “Health Hack”
Patient dissatisfaction is driving a surge in DIY health hacks, especially in gastroenterology where one‑third of patients report avoiding care after negative experiences. Influencers promote trends like "fibermaxxing," urging excessive fiber intake that can aggravate conditions such as small intestinal...
The Saga of Utah’s Rx Refill Bot: A Bold Bet on AI & Researchers Who Cried Foul
Utah became the first state to allow an AI system to autonomously handle routine prescription refills for patients with chronic conditions. The pilot, run with New York‑based startup Doctronic, seeks to reduce delays and improve medication adherence. A London‑based security firm,...
NYU Stern Report Urges Regulation of Private Equity in Healthcare
A new NYU Stern Center for Business and Human Rights report warns that private‑equity ownership of healthcare facilities has driven higher complication rates, staffing cuts, and a tenfold increase in bankruptcy risk, prompting calls for regulation. The study finds PE...
A Once in a Generation Opportunity to Reimagine Rural Health
Rural America faces chronic workforce and infrastructure challenges, but the CMS Rural Health Transformation Program (RHTP) offers a multi‑year funding initiative to modernize care delivery. The program encourages a shift toward community‑centered, data‑driven population health models that integrate clinical services...
How to Boost Trust in Tech? 4 Perspectives From SXSW
At SXSW, industry leaders tackled the widening trust gap in technology and healthcare, highlighting four distinct approaches. Merck introduced its “Red Chair” campaign to keep patient perspectives front‑and‑center in drug development. City of Hope showcased Hope LLM, a generative‑AI tool...
Inside One VC’s Litmus Test for Investable Healthcare AI Startups
Katie Jacobs Stanton, former Yahoo, Google and Twitter executive, transitioned into healthcare investing after a stint as CMO at Color Genomics. In 2019 she founded Moxxie Ventures, focusing on early‑stage AI‑driven health companies such as Dandelion Health, Pharos Health, Luminai...
How PreSeed Is Tackling the Sperm Donor Shortage
PreSeed Fertility launched a recruitment and matching platform to address the stark gap between the over 100,000 U.S. families searching for sperm donors and the roughly 1,500 donors currently registered. The service pairs families with a concierge specialist and provides...
Behavior Changes Happen Outside the Exam Room, But Validation of Lifestyle Medicine Programs Cannot
Providers struggle to verify lifestyle‑medicine outcomes because behavior changes occur outside the exam room. The article argues that remote patient monitoring (RPM) can supply objective, real‑time data to validate nutrition, exercise, and stress‑management programs. CMS’s MAHA ELEVATE model and new RPM...
The “Third Way” For Digital Health Engagement
Kris Narayan argues that today’s health‑tech landscape is split between EMR giants that protect clinical data within the office and consumer‑focused AI tools that demand medical expertise to use. Both approaches fail to engage patients during the daily "micro‑moments" after...
Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis commissioned Datos Insights to survey over 2,200 health‑plan executives, employer‑benefits leaders and insured consumers, revealing mounting financial pressure across the healthcare ecosystem. The study shows that 63% of employers view price transparency as a key cost‑management tool, while 68%...
Which FDA Division Has the Most Stability As AI Tools Get Adopted Across the Agency?
The FDA has shed roughly 20% of its workforce after the DOGE cuts, prompting a rapid rollout of artificial intelligence tools to offset the expertise gap. Among its centers, CDER is beginning to stabilize, CDRH remains relatively insulated, while CBER...
Employer Groups Applaud Bill that Aims to Spur Competition in Healthcare
Employer advocacy groups praised the Healthy Competition for Better Care Act, a bipartisan bill targeting anticompetitive contracts in the U.S. health‑care market. The legislation would ban all‑or‑nothing network clauses, anti‑steering, anti‑tiering, most‑favored‑nation, and gag provisions that limit price transparency. Introduced...
At SXSW, Cuban and eMed CEO Draw Contrast Between Them and Other “Marketing” Companies
At SXSW, Mark Cuban and eMed CEO Linda Yaccarino announced a partnership that will route employer‑sponsored GLP‑1 weight‑loss prescriptions through Cuban’s Cost Plus Drugs. Yaccarino highlighted eMed’s 90 % one‑year retention rate, contrasting it with the 50‑60 % churn seen at direct‑to‑consumer players...
Isaac Health Introduces New Virtual Program to Reduce Dementia Risk
Isaac Health, a virtual memory clinic, unveiled an eight‑week, neurology‑led lifestyle medicine program aimed at reducing dementia risk. The weekly virtual group sessions address sleep, nutrition, physical activity, cognitive engagement, vascular health and stress management, and are offered in individual,...
The Lethal Cost of Regulatory Perfection in Rare Disease
During a congressional hearing, neurologists warned that rare disease patients are dying while therapies linger in FDA review. The FDA recently rejected the SCA drug troriluzole, demanding more statistical certainty despite trial data showing over 50% fall‑risk reduction. Congress has...
When Recalls Fail — The Gap Between Notification and Action
A 2018 FDA Class II recall of the LINX Reflux Management System failed to remove the device from hospital inventories, leading to implants months after the notice. Lawsuits filed in 2026 allege that recalled implants remained in stock and were used...
Rethinking Where Patient Recruitment Begins
Clinical trials have long relied on site‑based recruitment, leaving under‑ and misdiagnosed patients underrepresented. Recent studies show digital outreach can identify symptomatic individuals who never enter traditional healthcare pathways, dramatically expanding the eligible pool. Digital campaigns have cut cost per...
Report: Virtual GI Solutions Save Money, Improve Patient Symptoms
The Peterson Health Technology Institute report finds that virtual gastrointestinal programs can both improve patient outcomes and lower costs. Wraparound solutions that add nutrition and behavioral support cut annual spending for IBS patients by $1,889, while clinician‑led multidisciplinary platforms save...
The Aging Crisis Is Here, and Technology Is No Longer Optional
By 2034, roughly one‑fifth of Americans will be over 65, creating the first senior‑majority population and an old‑age dependency ratio above 0.35. The surge strains healthcare staffing, with projected physician shortages exceeding 90,000, and inflates caregiver demand beyond the 50 million...
Debunked Episode 24: PBM Reform Brainstorm, Elevance Faces CMS Penalty Risk, Hims & Hers’ Eucalyptus Deal Takeaways
The Debunked Podcast explored reforms for pharmacy benefit managers, highlighting a bipartisan bill from Senators Warren and Hawley aimed at limiting healthcare consolidation. Co‑hosts also warned that Elevance Health’s seven‑year failure to submit risk‑adjustment data electronically could trigger a CMS...
Startup Vima Adds Parkinson’s to Movement Disorder Scope, Expanding Series A Round to $100M
Vima Therapeutics announced an additional $40 million raise, taking its Series A funding to $100 million. The capital will support parallel Phase 2 trials of its lead candidate VIM0423 in isolated dystonia and Parkinson’s disease, expanding the startup’s focus beyond the rare movement disorder....
Carrum, Virta Join Forces on Employer Weight Management Solution
Carrum Health and Virta Health announced a partnership delivering a full‑spectrum weight‑management solution for self‑insured employers. The collaboration links Carrum’s value‑based surgical care with Virta’s virtual nutrition coaching, medication management and GLP‑1 prescribing. It creates a seamless pathway from conservative...
Why Staff Safety Is the Foundation of Clinical Excellence
Healthcare organizations must prioritize staff safety to achieve clinical excellence. Research shows physical and psychological safety are top predictors of patient safety grades, and a 10% rise in staff turnover intent correlates with a 14% increase in inpatient mortality. Burnout...
Chronic Overmedication: The Polypharmacy Waste and Safety Problem
Polypharmacy affects nearly 42 % of adults 65 + taking five or more drugs, with 12 % on ten or more, driving higher pharmacy spend and safety risks. Medicare patients alone incurred about $3 billion in excess drug costs from early refills and oversupply,...
In the Absence of Objective Measures for ALS, Caregivers Are the Only Witnesses. We Shouldn’t Have To Be.
The ALS Functional Rating Scale‑Revised (ALSFRS‑R) remains the primary tool for tracking disease progression, but its limited granularity misses daily fluctuations and subtle improvements. Caregivers, like the author, become the sole recorders of these nuanced changes, highlighting a critical data...
Valuing Early-Stage Life Sciences Companies: The Why, the How, and the Impact
Early‑stage life sciences firms face unique valuation challenges due to regulatory, market and scientific uncertainties. Traditional discounted cash flow models are unsuitable, so practitioners rely on risk‑adjusted NPV, market comparables, and venture‑capital exit methods. These valuations influence capital raising, stock‑based...
Dialysis Isn’t Optional. Transportation Can’t Be Either
Non‑emergency medical transportation (NEMT) is essential for dialysis patients, whose weekly treatments depend on reliable rides. Missed appointments can trigger fluid overload, electrolyte imbalance, and even cardiac arrest, turning a simple no‑show into a medical emergency. NEMT providers act as...
Eyes on the Future: How Retinal Imaging Is Reframing Preventive Medicine
Retinal imaging is transitioning from a niche eye‑disease tool to a non‑invasive platform for systemic health assessment. Recent studies show that microvascular patterns in the retina can predict cardiovascular events, diabetes, kidney disease, and even early cognitive decline. AI‑driven analysis...
Why This Rural Health System Is Scaling AI for Point-of-Care Decision Making
Presbyterian Healthcare Services in New Mexico is expanding its use of GW RhythmX’s AI‑powered precision‑care platform, now deployed with 200 primary‑care clinicians across its nine‑hospital system. The tool, embedded in the Epic EHR, surfaces clinical insights and evidence‑based recommendations at...
Virtual-First Care Shouldn’t Spark an “A-Ha” Moment Anymore
Michael Dalton argues that virtual‑first care has moved beyond a novelty, yet many health‑system leaders still react with surprise when they see fully integrated models. He highlights that true virtual‑first requires deep EHR integration, clinical governance, and seamless handoffs, not...
Privacy Expectations in Consumer AI Tools: How Patient Use of ChatGPT Health and Claude Differs From HIPAA-Regulated Care
OpenAI and Anthropic are rolling out both enterprise‑grade AI suites for hospitals and consumer‑focused health assistants like ChatGPT Health and Claude Pro. Enterprise tools operate under HIPAA, allowing covered entities to negotiate Business Associate Agreements that impose strict data safeguards....
AI Startups Are Tying Fees to Completed Tasks. Will Hospitals Buy In?
Healthcare AI startups are moving from traditional SaaS subscriptions to transaction‑based pricing, charging per successfully completed task such as scheduling or intake workflows. Companies like Prosper AI, MedCalls.ai and Intelliclinic tie fees to usage, promising alignment with customer ROI. Investors...
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How to Build Effective Referral Networks and Improve Patient Navigation [Video]
Arbiter’s chief product officer Anjali Jameson highlighted systemic misalignment between hospitals and payers, emphasizing how fragmentation undermines referral efficiency. She outlined core components for building effective referral networks, including data standardization and shared accountability. Meanwhile, Clever Care Health Plan’s CIO...
The Kaiser Settlement Should End the Guesswork in Medicare Advantage Oversight
The U.S. Department of Justice secured a $556 million settlement with Kaiser Permanente for allegedly submitting unsupported diagnosis codes to boost risk‑adjusted Medicare Advantage payments. The case, covering nearly a decade of overcoding, underscores the systemic pressure on clinicians to add...
Using Real World Data From the Patient Experience to Improve Drug Development
Randomized trials for non‑small cell lung cancer often miss real‑world nuances that affect patients' quality of life. Real‑world data (RWD) and social determinants of health (SDOH) expose hidden barriers such as transportation gaps and limited molecular testing access. Pharma can...
AI, VR, and the Training Gap: Why New Healthcare Tech Fails Without Workforce Readiness
Artificial intelligence and virtual reality are poised to transform healthcare education, yet adoption rates remain sluggish. The article argues that the primary barrier is workforce readiness, especially among nurse educators who control training decisions. Without intentional change management, leadership support,...
Grow Therapy Raises $150M to Expand Employer, Health System Partnerships
Grow Therapy announced a $150 million Series D round, bringing its total financing to $328 million. The round, led by TCV and Goldman Sachs Alternatives, will fund expansion into employer‑sponsored mental‑health benefits, deeper health‑system partnerships, and advanced AI tools for providers and patients....
How New Medicare Rules Will Reshape Cardiac Monitoring and Remote Patient Care
Medicare’s 2026 Physician Fee Schedule introduces outcome‑based payments for cardiac care, rewarding providers who prevent ER visits, readmissions, or accelerate recovery. The rule also replaces the in‑person supervision requirement for the technical component of remote cardiac monitoring with virtual oversight,...
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Balancing the Role of Physicians and AI [Video]
At the ViVE conference, Smarter Technologies’ chief medical officer Ruben Amarasingham highlighted the firm’s AI strategy aimed at improving data accuracy while easing physicians’ documentation load. He cited positive customer feedback that the platform reduces administrative burden and delivers clear...
