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Newsweek
4 hours ago
- Business
- Newsweek
Health Care Data CEO Gets Real About Wearables
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox. Good morning. Moody's released its quarterly health care report on Tuesday. Let's take a look at the highlights. Moody's quarterly paints a sobering picture for hospitals and health systems. The biggest headline, unsurprisingly, is that Medicaid cuts are coming—and they're steep. The newly enacted federal budget reconciliation law is projected to slash Medicaid spending by $1.1 trillion through 2034, compared to previous projections from the Congressional Budget Office. This could leave hospitals with more uninsured patients and fewer reimbursement dollars, especially safety-net and rural providers. Congress' next moves will determine the exact conditions of this new normal. If lawmakers do not extend expanded premium tax credits for the Affordable Care Act by the end of the year, the CBO estimates that the number of uninsured Americans would increase by at least 4.2 million. Republicans are not keen on this measure, but it's still possible that they could compromise with Democrats to get other key GOP health care policies passed. One of those key policies is pharmacy benefit manager (PBM) reform, something that, historically, has garnered bipartisan support. They've been criticized by lawmakers on both sides of the aisle for overcharging for medications. Cigna, CVS Health and UnitedHealth—which together own 80 percent of the PBM market—face a credit risk if the government does crack down, according to Moody's. For more on the Congressional health care standoff, read on to the next section. Insurers' finances are also in a precarious position. On the bright side, CMS' Medicare Advantage reimbursement rate is rising to 5.1 percent in 2026. This is likely to float the industry to more typical earnings and margins after a period of weak performance, Moody's projects. But its analysts aren't sure how long it will take to regulate. For now, they gave health insurers a "negative" outlook due to higher-than-expected spending, particularly on weight-loss drugs and behavioral health care. I'll end on a positive note. Moody's analyzed CMS data, which suggests that the independent dispute resolution (IDR) process is becoming more efficient. The No Surprises Act (NSA) has been a headache for many providers since it was enacted in 2022, but the process is finally hitting its stride, per the numbers. New IDR claims continued to increase throughout 2024, but the number of resolved claims began to surpass new claims starting in the third quarter. "This, along with a consistently high provider win rate in disputes, suggests a decline in NSA-related accounts receivable and an easing of liquidity stress," Moody's analysts said in the report. How are you feeling about your organization's financial situation as we head into the latter half of 2025? Let me know at In Other News Major health care headlines from the week Congressional Republicans are hoping to pass a bipartisan health care package by year's end, with proposals to rein in pharmacy benefit managers (PBMs), expand Medicare coverage for weight-loss drugs and boost cancer screenings. But Democrats—frustrated by deep Medicaid cuts in the recent GOP megabill—are demanding Affordable Care Act tax credit extensions as a condition for talks, according to Politico. But Democrats—frustrated by deep Medicaid cuts in the recent GOP megabill—are demanding Affordable Care Act tax credit extensions as a condition for talks, according to Politico. The standoff highlights deep partisan tensions over health care, with both sides weighing how much they're willing to trade to secure their policy wins. Bankrupt hospital operator Steward Health Care has filed a lawsuit against its former CEO Ralph de la Torre and three other executives, alleging they harmed the company "through their greed and bad faith misconduct." and three other executives, alleging they harmed the company "through their greed and bad faith misconduct." A spokesperson for de la Torre told the Telegram & Gazette that he denies the allegations. Massachusetts-based Steward filed for bankruptcy in May 2024, subsequently closing two hospitals and selling others. De la Torre has previously been criticized for buying a megayacht while the system was in financial and legal turmoil. Hims & Hers is facing a lawsuit from a group of its shareholders , alleging the telehealth platform's senior executives and board gave misleading statements to investors. , alleging the telehealth platform's senior executives and board gave misleading statements to investors. The plaintiffs claim that Hims & Hers misrepresented its short-lived partnership with Novo Nordisk , which was announced in April and terminated by the pharmaceutical company in late June. Hims & Hers allegedly told investors that it could offer both Novo Nordisk's Wegovy and compounded semaglitude under the agreement—which Novo Nordisk has denied, calling the sale "deceptive" and claiming it "put patient safety at risk." , which was announced in April and terminated by the pharmaceutical company in late June. Hims & Hers allegedly told investors that it could offer both Novo Nordisk's Wegovy and compounded semaglitude under the agreement—which Novo Nordisk has denied, calling the sale "deceptive" and claiming it "put patient safety at risk." The investors' lawsuit also claims that Hims & Hers falsely represented the legality of compounded semaglutide sales, and told them it was compliant with FDA regulations. The Alice L. Walton School of Medicine has officially opened in Bentonville, Arkansas, TIME reported. Walton—Walmart heiress and the world's richest woman—will cover tuition for the first five graduating classes. Pulse Check Executive perspectives on key industry issues Jannine Versi is the CEO and co-founder of Elektra Health. Jannine Versi is the CEO and co-founder of Elektra Health. Elektra Health We're gearing up for our Women's Global Impact event on August 5 in New York City, and a number of health care leaders will be in attendance from companies like MUSC, the American Heart Association, Northwell Health and Virtua Health. During our health care spotlight panel, we'll discuss the leadership gender gap in the industry and explore how women executives are working to bring more attention to female health issues. For this week's Pulse Check, I'm bringing you a sneak peek from my interview with Jannine Versi, co-founder and CEO of Elektra Health. The company aims to "smash the menopause taboo" via its telehealth clinic, educational materials and private community for women. Here's what Versi told me about her journey and priorities: Has being a woman shaped your leadership style or the way that you think about your work in the health care industry? Absolutely. I know what it feels to be dismissed or minimized or told by a provider "that's just PMS" "or you need to manage your stress" in an offhanded way when something feels wrong. In terms of my team, we are female-founded and predominantly identify as women, but I actually don't think that changes how I try to lead — with urgency and empathy and also, with a high bar because our patients deserve the best. Women make up 70 percent of the global health care workforce, but hold just 25 percent of the industry's leadership positions. What do you make of this gender gap? How might we begin to close it? This gap is a moral issue and a missed opportunity. Women are the engine of the health care system, yet their perspectives are often missing from the rooms where decisions get made. That disconnect affects everything from research agendas to benefit design. We need more women at the helm of health systems, on investment committees and leading companies. But we also need systems that are built to retain and promote them. That means flexible leadership paths, accountability on gender metrics and real investment in women-led innovation. Put differently, I believe in the power of diversity, equity and inclusion. I also want to call out a couple partner organizations – like the University of Pittsburgh Medical Center (UPMC) and Emblem Health — both led by women — which aren't just talking about women's health. They're investing in it meaningfully because it's smart and strategic for their business and the right thing to do in serving patients and members. Meanwhile, I have heard for a long time from various payers and systems that they are "still figuring out" their women's health strategy. I suspect some will regret not moving more swiftly because women are increasingly and rightly expecting better from their providers and insurers. That kind of leadership sets a new standard—and hopefully, it's just the beginning. Register here to see Versi speak live at Newsweek's Women's Global Impact Summit in New York City on August 5. C-Suite Shuffles Where health care leaders are coming and going Bill Gassen has been chair-elect of the American Hospital Association. The Sanford Health CEO will assume the seat in 2027, making him the AHA's top elected official. has been named The Sanford Health CEO will assume the seat in 2027, making him the AHA's top elected official. Click here to snag a ticket! Gassen will be speaking at Newsweek's Digital Health Care Forum on September 16 in New York City. I'll be moderating the conversation, discussing the business case for technology and innovation. Howard University Hospital Corporation in Washington, D.C., has selected Kerry Watson as its interim CEO, effective August 1. This won't be his first time at the safety-net health system; he worked there as an administrator from 1982 to 1992. Watson has held numerous executive roles at health systems across the U.S., including service as interim CEO of UF Health St. Johns, CEO of Maui Health System and president of Wellstar Atlanta Medical Center (which shuttered in 2022). UC Davis Health has has announced three changes to its leadership team, selecting an interim CEO, interim vice chancellor of human health sciences and permanent dean of the School of Medicine. Dr. David Lubarsky, former CEO and vice chancellor of human health sciences, retired in February to become president and CEO of Westchester Medical Center Health Network in his home state of New York. to become president and CEO of Westchester Medical Center Health Network in his home state of New York. The California health system has divided his former positions amongst Michael Condrin (interim CEO) and Dr. Bruce Lee Hall (interim vice chancellor of human health sciences). Condrin most recently served as UC Davis Medical Center's chief operating officer, while Hall was the enterprise's chief clinical officer. (interim CEO) and (interim vice chancellor of human health sciences). Condrin most recently served as UC Davis Medical Center's chief operating officer, while Hall was the enterprise's chief clinical officer. Dr. Susan Murin assumed the top role at the School of Medicine in January, reporting to Hall. She has been with UC Davis Health for 29 years, previously as vice dean for clinical affairs and executive director of its medical group. Executive Edge How health care execs are managing their own health Dr. Mitesh Rao is the founder and CEO of OMNY Health. Dr. Mitesh Rao is the founder and CEO of OMNY Health. OMNY Health For this week's Executive Edge, I connected with Dr. Mitesh Rao, founder and CEO of the health care data platform OMNY Health. I've featured him before for his insights on wearable technology and how he uses it to monitor his health while balancing a busy work and travel schedule. In late June, at a House Energy Committee hearing, HHS Secretary Robert F. Kennedy Jr., told lawmakers that wearables will be "key" to his "Make America Healthy Again" (or "MAHA") agenda. He hopes that every American will be wearing one of these devices in the next four years—a goal that sparked significant debate about wearables' data security and efficacy. I followed up with Rao to get his latest take on wearable tech in health care. Here's what he told me: "Wearables have become a hot topic in health care, especially after RFK Jr. touted plans to get every American wearing one, then quickly backed off. I wear an Oura ring daily and have tried a variety of different wearables, including a Fitbit and a Google Watch, which I found more distracting than helpful." "What keeps me coming back to wearables isn't the reminders to stand up or go for a walk--it's the data. I enjoy seeing how my sleep quality changes after a long week of work travel, or how my body responds to things like a late dinner or a skipped workout. These are helpful personal reminders and insights, but it doesn't necessarily mean I will eat dinner earlier tomorrow or skip my next work trip." These are helpful personal reminders and insights, but it doesn't necessarily mean I will eat dinner earlier tomorrow or skip my next work trip." "That said, I do see value in wearable data in the clinical setting, and research shows 94 percent of people who use one are open to sharing their data with their doctor . However, as someone who has devoted their career to democratizing access to health care data, I believe we need to address some major privacy concerns before rushing to use these insights for research." . However, as someone who has devoted their career to democratizing access to health care data, I believe we need to address some major privacy concerns before rushing to use these insights for research." " Think about 23andMe . A few years ago, everyone was quick to take the saliva test, but when they filed for bankruptcy, people immediately realized 'Wait, my DNA could be sold in a fire sale?'" . A few years ago, everyone was quick to take the saliva test, but when they filed for bankruptcy, people immediately realized 'Wait, my DNA could be sold in a fire sale?'" "If wearable data is going to be used responsibly, we must always make sure it benefits people more than it benefits platforms. This begins with transparency. Every time I've set up a new wearable device for myself, I've chosen not to allow it to share my data for 'research' because I've no insight into how or what is being done with that data, or how it will be secured and protected. Until this is made clear for users, we're not ready to apply it meaningfully in health care." Before you go, check out Dr. Lawrence Rosenberg's reflection on what "excellence" actually means in health care. He is the president and CEO of the Integrated Health & Social Services University Network for West-Central Montreal, and a member of Newsweek's CEO Circle. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox.
Newsweek
17-07-2025
- Health
- Newsweek
City of Hope CEO on the Challenge "Greater Than Any One Entity Can Tackle"
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox. Every day, I see a new example of inefficiency in the American health care system. Lagging medical research. Siloed data with unclear applications. A tedious revenue cycle. Too few providers despite climbing demand. If you're reading this newsletter, I'm sure you can relate—you likely have your own library of personal and professional moments that made you ask, "Surely this isn't the best we can do?" We usually groan about the daily slowdowns, but it can be tough to translate anecdotes into action. That's why this study, published July 15 in The Lancet Global Health, was so intriguing to me. It actually puts a number on our inefficient health care system and gives us something to measure ourselves against. Researchers from the Institute for Health Metrics and Evaluation (IHME), based at the University of Washington in Seattle, measured health spending inefficiency for 201 countries from 1995 to 2022. They compared each country's health adjusted-life expectancy to its level of health care spending, and estimated the cost of one additional year of healthy life to determine inefficiency scores. "When we talk about inefficiency in this work, what we're describing is a gap between the best possible outcome and then the actual observed outcome," Dr. Amy Lastuka, lead research scientist at the IHME, told me. Previous research has established that the U.S. has the highest per capita health care spending of its peers, but the IHME determined that we have an inefficiency gap of 6.2 healthy years in our life expectancies. In other words, Americans could—and should—be getting 6.2 more years of bang for our bucks. Even after accounting for high levels of behavioral and metabolic risks in our population, we fell short of the best possible health outcomes for the amount that we spend. China, on the other hand, appears to have cracked the spending code. They achieved zero inefficiency in 2022. The good news is that there is a better way; the bad news is that our way is not meeting that gold standard, while our international competitors are. I asked Lastuka why we're lagging—and although the IHME didn't investigate specific drivers of U.S. health outcomes, she did share some global patterns they observed. Higher vaccination rates and higher use of prenatal care were associated with more efficient systems, as were higher investments in preventative care. A higher percentage of government health care spending, as opposed to private insurance or out-of-pocket payments, was also linked to more favorable outcomes. And governance structures are "really important" to health systems' success, Lastuka said. Government corruption was associated with less efficient health care spending. "It does seem to be the case that there are countries that are getting more healthy life years for less money," Lastuka said. "We certainly don't have all the answers in this paper, but I would hope that policy makers and [health care] stakeholders look at who is really performing the best according to this analysis, and try to dig deeper into what they're doing in those locations so we can learn from them." What's the biggest bog to the U.S. health care system right now? Let me know your thoughts at Essential Reading City of Hope recently launched its own generative AI model: HopeLLM. The tool can assist with patient onboarding, summarizing vast medical records in seconds. It also works to match patients with clinical trials and pull relevant data for research. HopeLLM has been a hit with providers and has also attracted interest from the pharmaceutical industry, according to Simon Nazarian, City of Hope's chief digital and technology officer. Read more deployment insights from our exclusive interview here. And read on to the Pulse Check section for a slice of my recent conversation with CEO Robert Stone. HHS proceeded with thousands of layoffs after receiving a green light from the Supreme Court, The New York Times reported on Tuesday. Employees who dealt with communications, public records, medical research contracts and travel coordination for overseas drug inspection were included in the terminations. Health Secretary Robert F. Kennedy Jr. also laid off his chief of staff and deputy chief of staff for policy this week. Kennedy "lost confidence" in these individuals after only a few months on the job, a source told CNN, which broke the news. But it remains unclear what particular event (if any) sparked the firings. Large employers are preparing to scale back health care benefits next year amid rising costs from weight loss and specialty drugs, per a Wednesday report from the consulting firm Mercer, shared with Newsweek. Of the surveyed companies, 51 percent shared plans to increase cost-sharing in 2026—a 45 percent increase from the same survey in 2025. More than three-quarters of employers told Mercer that the rising cost of GLP-1 weight loss drugs was a top issue. This has the potential to make a bad situation worse for employees. KFF released new poll results this week, revealing that 1 in 5 American adults have not filled a prescription because of cost. Plus, patients with employer-sponsored insurance continue to rate their insurance more negatively than those with Medicare or Medicaid, reporting a negative view of their monthly premiums, out-of-pocket costs and prescription co-pays. The Hospital of the University of Pennsylvania is set to pay $207.6 million in a record-breaking medical malpractice verdict for the state. This week, an appellate court upheld a lower court's finding that the hospital delayed a cesarean section—causing the child to be born with severe brain injuries including cerebral palsy. Courts ruled that the 2018 procedure deviated from standards of care. The mother had an infection in her uterus, and the C-section was delayed by 45 minutes. The hospital tried to appeal the case, arguing that it relied on an unlawful "team liability theory," asking jurors to find the collective care team responsible without naming a specific individual. Their appeal was ultimately rejected, but the hospital intends to continue its challenge of the "legally flawed verdict," according to recent statements. Pulse Check Robert Stone is the CEO of City of Hope. Robert Stone is the CEO of City of Hope. City of Hope For this week's Pulse Check, I connected with Robert Stone, CEO of City of Hope, one of the nation's largest cancer research and treatment organizations. Its hospitals are pillars in some of the largest American cities, including Los Angeles, Chicago, Phoenix and Atlanta. But the health system aims to reach beyond the hubs, bringing top-notch cancer care to all corners of the country. Whether through novel AI developments, groundbreaking genomic research or brick-and-mortar expansion, access is a major priority, Stone told me. It's only fitting that I share his thoughts in this aptly named newsletter—find a portion of our interview below. Improving access to cancer care is a major focus for your organization. How, specifically, do you envision large cancer centers like City of Hope bridging those gaps? There is a gap between the innovation taking place at academic cancer centers and the people who can actually access these breakthroughs. That's why we're bringing optimal cancer care closer to where people live and work. We've grown tremendously over the last 10 years, and that includes becoming this national system. We opened and acquired hospitals across the country so that now 86 million people live within a short driving distance of one of our hospitals. There is an aspect of having facilities in the communities where people live, putting your own experts and treatments in those communities. Beyond our long-time campus in Los Angeles, we have just opened a new cancer center and will open a new hospital at the end of the year in Irvine, California, [and we have facilities] just outside of Phoenix, Chicago and Atlanta. Part of the answer though is, really, if you're going to put patients first, if they can stay in their communities to be treated, that's the best answer for them. Their support system is there. Their lives are there. They're most comfortable. And so we've taken a lot of effort to partner with health providers in different communities. We have a subsidiary that we formed five or six years ago called Access Hope, and the purpose of Access Hope was to partner with the treating physician of cancer patients and get our expertise to them, rather than find a way to drive that those patients to one of our facilities. We invited a number of other leading cancer centers to join us in that effort, because if you're putting patients first, it's not about any one center. So Dana Farber, Northwestern, Emory, Fred Hutchinson, UT Southwestern, Johns Hopkins are all partners in servicing and making sure patients across the country get the right diagnosis and the right treatment plan, even without us providing that care. That's part of the solution. Continuing to use technology in new ways to partner with others is also part of the solution. I think the bottom line is cancer represents hundreds of diseases and there's no one-size-fits-all approach. The common denominator is putting patients at the center and figuring out how you're going to get the latest discoveries to them as fast as possible. What's one innovation in the oncology space that you believe will have a significant impact on public health beyond cancer care? A lot of the genomic work that we've seen and that we've applied to cancer has applicability to other rare diseases and rare childhood diseases. Thanks to genetics, we now know that cancer is not one disease but hundreds—unique variants that can be targeted for treatment. Unlocking the human genome has provided an unimaginable amount of information on the human body. If you typed out a sequence in 12-point font at 60 words per minute and for eight hours a day, it would take 50 years to type just one human genome. And that stack of papers would be as tall as the Statue of Liberty. Today, the relative low cost and quick turnaround time has exponentially expanded the use of genomic data to fuel our incredible progress. Things like accurate genomic testing, where we can ensure the correct diagnosis, or precision medicine, with tailored treatment plans designed around specific variants of cancer to greatly improve outcomes and the patient experience. With precision medicine, I think you're going to see patient populations get smaller and smaller over time, because we'll understand that targeted therapies--whether you're talking about cancer, or other therapies or other diseases--you'll have smaller patient populations to apply it to. And I think that that's really important. I'll give you an example in oncology. If we were in a room with 200 people and we all had lung cancer, maybe three of us would have the same type of lung cancer. And so the innovation that allows you to focus on smaller and smaller patient population sets, that approach is going to happen throughout medicine in general. What about the health system status quo needs to change in order for genomics research and innovation to reach its full potential? I think health systems need to embrace change, right? Technology and innovation are going to lead to a changing environment. I tell people that the days of 10-plus-year strategic plans, to me, are over. We have to accomplish 10 years' worth of work in five years because the environment changes so, so quickly. I think the key is focusing on what's good for the patient. If you approach it through that lens, you realize speed is of the essence and that cancer is a challenge greater than any one entity can tackle. It represents a team sport, which makes partnerships and collaborations so important. Historically, thinking has been siloed. Your collaboration tends not to happen at the same level as it should, and you've got to think of cancer care as a team sport. You've got to be able to operate with speed, mobility, agility. You have to be flat and fast. You've got to see change as an opportunity and then create value through differentiation. Those are things that I think health care is waking up to. C-Suite Shuffles Dr. Phillip Chang is the new system SVP and chief medical and quality officer for CommonSpirit Health, tasked with overseeing clinician, quality and safety leaders across more than 2,200 care sites in 24 states. is the new system for tasked with overseeing clinician, quality and safety leaders across more than 2,200 care sites in 24 states. UnitedHealth Group named Mike Cotton its CEO for Medicaid , a role that has been vacant since May. The Medicaid division was previously led by Bobby Hunter, who will now oversee both the Medicare and Medicaid divisions in a streamlined role. named its , a role that has been vacant since May. in a streamlined role. Aledade, the nation's largest network of independent primary care providers, tapped Dr. Lalith Vadlamannati to serve as its chief technology officer. He most recently held the same title at the digital joint and muscle clinic Hinge Health, and previously worked as VP of engineering at Amazon, leading international expansion for its eCommerce business. Executive Edge Dr. Stacey Rosen is the volunteer president of the American Heart Association and executive director of Northwell Health's Katz Institute for Women's Health. Dr. Stacey Rosen is the volunteer president of the American Heart Association and executive director of Northwell Health's Katz Institute for Women's Health. Northwell Health Last week, I sat down with Dr. Stacey Rosen, who was recently named volunteer president of the American Heart Association. She's also the executive director of Northwell Health's Katz Institute for Women's Health in New York—and will be speaking at Newsweek's upcoming Women's Global Impact Summit. We discussed her upbringing and the "mythical" qualities of the heart that compelled her to study it. And, in preparation for the Summit on August 5, we discussed the long history of neglect for women's health in medical research and cardiology: a wrong that Rosen has dedicated her career to righting. I asked her to give her best advice for women health care leaders, but I think parts of her answer will resonate regardless of sex: "Decide what's important to you. Identify your vision, priorities, integrity, mission, and make that always your North Star. Stick to your true values, work hard and keep at it. Stick to your true values, work hard and keep at it. "There have been a lot of times in my career that [I've gotten] frustrated. Things don't go as you want. Your grant doesn't get supported, or 'women's health' becomes a term you're not supposed to use. If it's important to use, you've gotta stick with it. "My advice to women is to decide what's important to you when it comes to how you are perceived at the workplace. Don't make assumptions about things, but also, don't sit quietly in the corner of the room. There are times that it's hard, and times that you have to decide when you ignore a comment and when you don't ignore a comment...I tell women who are often frustrated as the only, or one of few [women in the room] to decide what's important and to keep working at it." Register here to see Rosen speak live at Newsweek's Women's Global Impact Summit in New York City on August 5. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox.
Newsweek
10-07-2025
- Health
- Newsweek
Meeting Redesign + Tuition Comp: How Execs Are Tackling Workforce Woes
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox. I've been preparing for our inaugural Digital Health Care Forum here at Newsweek, so naturally, I've had digital transformation on the brain. "Digital transformation" is one of those buzz phrases that I constantly hear in conversations with health care executives—and I understand why. Although the terms are loosely defined, they evoke consistent, polished images that health systems want to be associated with: cutting-edge technology, efficient systems, the elimination of whirring fax machines and messy handwriting. A digitally transformed hospital will be quieter, smoother, more effective. But there's a reason that hospital officials tend to say, "We're in the midst of a digital transformation," and not, "We've completed our digital transformation." Modernization isn't a box that can be checked. It's a moving target. Lately, the federal government has announced multiple initiatives that aim at a techier health care system. Updates to the prior authorization process will require health plans to standardize electronic submissions. The DOJ, FBI and HHS intend to collaborate on a "health care data fusion center" to better identify and prosecute fraudsters. And in MedPAC's June report to Congress, the commission recommended better data collection to improve the accuracy of Medicare payment rates. These are all positive steps in theory, but in practice, there's likely going to be a learning curve. This week, the assistant secretary for technology policy's office released a data brief reflecting on the CDC's Public Health Data Strategy. Beginning in 2022, certain hospitals were required to submit data related to various public health care metrics, including immunization registries and syndromic surveillance. The data suggests that it hasn't been an easy process for health care providers. In 2024, more than 8 in 10 hospitals reported at least one challenge with electronic public health reporting. The most common complaint—filed by 55 percent of hospitals—was the technical complexity of interfaces, transmission or submission processes. That's why many health care leaders are taking digital transformation slow. Technology promises speed, but if platforms aren't easy to use and tailored to specific needs, they can have paradoxical effects. Kristin Myers, Northwell Health's inaugural chief digital officer, articulated this well during our conversation about AI governance this week. "AI has so much potential, and we're really in the beginning years of being able to see that potential," she said. "We want to be able to elevate the patient, clinician and workforce experience, and just drive a more connected health care ecosystem. The key to it all is being able to scale AI across a health system, but to do that, you really need AI governance and structure and an intent process." I'm excited to gather more than 100 health care executives in our New York City office for the Digital Health Care Forum on September 16, when we'll dedicate a whole day to those intent processes, the "hows" behind the "whys." We're gathering some of the industry's top voices on AI, tech and innovation, including Dr. Daniel Yang, Kaiser Permanente's head of AI, and Aneesh Chopra, the first chief technology officer of the United States. View our agenda and register to join us here. You don't have to wait until September to let me know how your organization is approaching digital transformation. Email me at I'd love to hear from you! Essential Reading Teladoc Health is offering free non-emergency care to Texans affected by severe floods, CW33 reported. The telehealth provider can diagnose and treat general medical conditions like colds, flu symptoms and sinus infections, and it can prescribe medications and issue refills. Texans can access the service at no cost by calling Teladoc Health's Natural Disaster Hotline at 855-225-5032. On Tuesday, HHS Secretary Kennedy declared a Public Health Emergency in the state of Texas. Read more about the record-breaking flooding of the Guadalupe River here. The DOJ recently delivered the results of Operation Gold Rush, the largest health care fraud bust in national history led by HHS' Office of the Inspector General. Mark Lee Greenblatt, former inspector general for the U.S. Department of the Interior, breaks down the scheme in this op-ed for Newsweek. led by HHS' Office of the Inspector General. in this op-ed for Newsweek. Yale New Haven Health is offering voluntary retirement packages to long-serving employees, according to documents obtained by the Connecticut Insider. The packages contain continued salary payments equal to two weeks of pay per completed year of service, up to 28 weeks. They also include subsidies to health care benefits and higher payouts for unused PTO. The decision was motivated by "significant financial and operational challenges," health system officials said. according to documents obtained by the Connecticut Insider. The packages contain continued salary payments equal to two weeks of pay per completed year of service, up to 28 weeks. They also include subsidies to health care benefits and higher payouts for unused PTO. health system officials said. The NIH is implementing caps on allowable publication costs for scientific research, per a news release shared with Newsweek. Beginning in FY 2026, the agency will limit "unreasonably high article processing charges that [have] placed undue financial pressure on researchers and funders," NIH Director Dr. Jay Bhattacharya said. Read more about the challenges facing disease researchers here. Pulse Check Steve Beard is the chairman and CEO of Adtalem Global Education. Steve Beard is the chairman and CEO of Adtalem Global Education. Adtalem Global Education Yesterday, St. Louis-based SSM Health announced a collaboration with Chamberlain University (one of the nation's largest nursing schools, with 23 campuses across 17 states), designed to address clinical workforce shortages. Its new Aspiring Nurse Program offers tuition support with clinical experience at SSM Health's facilities across Oklahoma. In exchange, students commit to join SSM Health after graduation. The program is expected to add 400 new nurses to the health system's ranks each year. Eventually, additional cohorts will be launched in St. Louis and Kansas City, Missouri, as well as in Illinois and Wisconsin. For this week's Pulse Check, I spoke with Steve Beard, chairman and CEO of Adtalem Global Education, Chamberlain University's parent company, and a leading provider of health care education. Here's what he told me about the new partnership with SSM, and what it means for the future of health care workforce education. Editor's Note: Some responses have been lightly edited for length and clarity. Steve, one of the benefits of this program is the ability to "tailor" nursing students' education to the unique needs of SSM Health. Tell us more about that. One of our hopes is that when our students do the clinical portions of their academic journey, they're doing it in SSM facilities and getting to know the standard operating procedures of those SSM facilities. Over time, we expect to have SSM clinicians serve as adjunct faculty in our programs, where they're able to help shape the academic experience of our students. We also have a long history of developing specialty tracks at Chamberlain tied to specific disciplines, whether it's oncology or home health care. Over time, as we come to better understand the priorities for SSM and the communities they serve, we can certainly think about tailoring our curriculum itself to better reflect the needs of SSM such that our students show up ready on day one. They're familiar with the organization they're going to work with. They've spent time in that environment. They understand the needs of the patient population of that community, which I think gives them a great affinity for SSM as a prospective employer and vice versa. Why is it so valuable for a health system to have nurses that are loyal to their organization and have trained specifically within its boundaries, as opposed to travel nurses and other forms of contract/temporary labor? One of the things we all learned during the pandemic is that the spot market for clinical talent—whether that's contract or travel nursing—has a high degree of variability, both cost variability and outcome variability. Obviously, that's a pain point for providers. In addition, we've seen that there's the risk of a high degree of turnover, particularly in the early years of employees' experience with the system. Anything a provider can do to create a stickier relationship makes the system more successful, [for both] the employee and the employer. That reduces turnover and lowers the acquisition cost associated with identifying that employee which all [contributes] to the economic benefit of the system. But we also think it improves the performance and safety of the system, as you're getting folks who know your system, know your hospital, know your clinicians and have a relationship with you. Our proposition is, here's a way to get involved with a future employee early in their academic career in a way that makes them easier to obtain, likely to perform better in your environment, and, in ways, that allow you to acquire them at a much less expensive proposition than you would in the spot market for talent. And we think across those three dimensions, this represents a whole new way of thinking about talent acquisition. How does the tuition reimbursement model work to effectively generate that ROI for the health system? We've experimented with this model for a long time. The way it works is, students come into nursing school in the way they would in [an] ordinary course, and most students are either borrowing to finance their education, or they're doing a combination of loans plus self-pay and other resources. What SSM does is in exchange for service commitment from that student, they actually begin to retire some of the indebtedness that the student has incurred as part of their academic journey. They're basically exchanging that commitment to the system for that tuition reimbursement, and so they're not delivering that value to the student until that student is delivering that value to them. And as it turns out, supplementing or offsetting the cost of attendance for nursing school is far less than the cost associated with current rates of turnover amongst those nursing workforces today. It's actually a higher return to invest in a service commitment than it is to try to sustain the cost of consistent high turnover amongst your nursing population. C-Suite Shuffles John R. Nickens IV will be the next president and CEO of Pheonix Children's, taking the reins from Robert L. Meyer upon his retirement, no later than October. Nickens joins the Arizona health system from New Orleans, where he currently works as corporate president of hospitals for LCMC Health and CEO of its University Medical Center. Wellstar Health System has named Ketul Patel its next president and CEO, succeeding Candice Saunders, who announced her retirement in January. Patel currently serves as CEO of Virginia Mason Franciscan Health in Tacoma, Washington, and as president of CommonSpirit Health's Pacific Northwest Region. He will join Marietta, Georgia-based Wellstar in late October. Sally Susman is departing her role as executive vice president and chief corporate affairs officer at Pfizer after 18 years with the organization. The company decided to integrate her job function into other areas of the business, according to a LinkedIn post from Pfizer CEO Albert Bourla. Susman will remain on the board of The Pfizer Foundation and will also explore personal passions like mentoring and writing her next book, she said in her own LinkedIn update. after 18 years with the organization. The company decided to integrate her job function into other areas of the business, according to a LinkedIn post from Pfizer CEO Albert Bourla. and will also explore personal passions like mentoring and writing her next book, she said in her own LinkedIn update. Executive Edge Dr. Heather Farley is the chief wellbeing officer at MUSC Health. Dr. Heather Farley is the chief wellbeing officer at MUSC Health. MUSC Health Dr. Heather Farley is the chief wellbeing officer at MUSC Health in Charleston, South Carolina. She's a pioneer in the staff and care provider wellbeing space, having previously served as the chief wellness officer at ChristianaCare in the Northeast. One of Farley's main priorities is burnout reduction, she told me in a recent interview. She believes that to create real change, health systems should focus on reforming systems and workflows—not just teaching individual coping skills. "You can't take the canary out of the coal mine, teach it to be more resilient, shove it back in the same coal mine and expect it to survive," Farley said. "You actually have to change the coal mine." Here's what Farley told me about her work to "change the coal mine," drive work efficiency and promote personal well-being at MUSC Health: "One of the projects that we focused on in this past fiscal year was stress first aid. The stress first aid concept was initially born in the military. It was created to address a very high stakes, high-pressure environment, and to be able to assess where people are mentally and emotionally, and how they can provide that first aid for themselves and for one another. [Stress first aid] has now been adapted into health care, so we rolled out training for our teams. "The idea behind stress first aid is not to make anybody a counselor or a therapist if they're not already, but it's really to give people the skills that they need to recognize when someone on their team is struggling, to respond effectively and then to get them connected with resources if they need that. It's one of our system wide goals to get 30 percent of our leaders across the enterprise trained in stress first aid within the next year and ratchet it up from there. "I'd also highlight [our] "getting rid of stupid stuff" programs. This one is borrowed from the [American Medical Association], and again, it's that idea of getting rid of the non-value-added work and the pebbles in peoples' shoes. We just hired a "getting rid of stupid stuff" manager, and we're working together to create an infrastructure in our system to identify and remove those pebbles. "One of the initial projects within that [initiative] was a meeting design package. There are a couple of components to it, but one is just creating that culture around efficient and effective meetings, where people are engaged and we're not just [undergoing] death by meetings: removing the unnecessary meetings, shortening them to what you really need, making sure that only the people who really need to be there are there. We set the defaults of our meetings to 25 and 50 minutes rather than 30 and 60, so that you're not on back-to-back-to-back Teams meetings without a break. This creates that opportunity for micro-breaks, which are so important for us to be able to function optimally and for our wellbeing." Register here to see Farley speak live at Newsweek's Women's Global Impact Summit in New York City on August 5. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox.
Newsweek
03-07-2025
- Health
- Newsweek
Health Insurance CEO Pulls Back Curtain on Prior Auth Reform
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox. To commemorate the Fourth of July weekend, I have an American story for you. It's got all the Stars and Stripes: entrepreneurial spirits, bootstraps mentalities and the familiar drag of bureaucracy. For the past several months, I've been working on this feature story about how patient advocacy groups are changing the pace of health care, working to find and fund cures for their loved ones' rare diseases (and, in some cases, their own). What I found was a community of ordinary people doing extraordinary things—not because they had the time, training or resources, but because they had no other choice. Parents, spouses and patients have taken on roles once reserved for pharmaceutical executives and lab directors, plunging headfirst into grant writing, data sharing and even drug development. These patient advocates are becoming increasingly important to the field of rare disease research, Dr. Dominique Pichard, director of the NIH's National Center for Advancing Translational Sciences' (NCATS) division of rare disease research and innovation, told me. Less than 5 percent of known rare diseases have an FDA-approved treatment available. Research efforts tend to focus on impacting the most lives with the fewest resources, as grant funding is competitive and hard to come by. But this means that many rare diseases are left untouched. Conditions that impact fewer than 200,000 Americans are difficult to lobby for—and those that do garner attention still face challenges when looking to establish expert advisory panels or fill a clinical trial. That's where patient advocacy groups come in, compiling data, educating providers and serving as connectors between small populations and large research institutions. In some cases, their efforts have helped fast-track clinical trials. In others, they've secured the first-ever FDA-approved treatment for a rare disease. But while their success stories are remarkable, they also raise bigger questions: Should patients be expected to do this much? Should finding a cure for a devastating condition depend on how many calls a parent is willing to make or whether they can raise $5 million? "[This work] is really important, but it has also created a pressure on families," Pichard said. "They feel like selling their assets, quitting their jobs and learning science is the only way [their] child can get a cure." This piece explores that bittersweet tension between the promises and pressures of patient-led progress. I hope you'll give it a read this holiday weekend, and maybe share it with someone who, like the advocates featured, refuses to take "no" or "slow" for an answer. Essential Reading The FBI has uncovered $14.6 billion worth of fraudulent claims submitted to Medicare, Medicaid and other government health care programs , the agency said on Monday in conjunction with the Department of Justice (DOJ). The investigation resulted in 324 defendants being charged, including 96 medical professionals. , the agency said on Monday in conjunction with the Department of Justice (DOJ). The investigation resulted in 324 defendants being charged, including 96 medical professionals. Now, the DOJ, FBI and HHS say they are collaborating to create a health care data fusion center that will help them identify, investigate and prosecute health care fraud. that will help them identify, investigate and prosecute health care fraud. And yesterday, the entities announced a DOJ-HHS False Claims Act Working Group, in which HHS will refer potential False Claims Act violations to the DOJ. Read more about the working group, its members and its goals here. Microsoft AI unveiled new research demonstrating AI's abilities in sequential diagnostics. The company's new model-agnostic MAI Diagnostic Orchestrator (MAI-DxO) achieved 85.5 percent diagnostic accuracy—outperforming generalist physicians, who reached the correct diagnosis 20 percent of the time, on average. The company's new model-agnostic MAI Diagnostic Orchestrator (MAI-DxO) achieved 85.5 percent diagnostic accuracy—outperforming generalist physicians, who reached the correct diagnosis 20 percent of the time, on average. The study has its limitations. Microsoft's panel of 21 U.S. and U.K. doctors had a median of 12 years of experience but were not allowed to use search engines, language models or other sources of medical information when interacting with SDBench. These tools are common in physicians' practices, with about 1 in 5 using generative AI and about 7 in 10 using search engines on a regular basis, according to recent research—so the human participants may have achieved higher diagnostic accuracy if allowed to access their typical suite of online resources. The report received mixed reviews, generating significant hype in the digital health care space but receiving pushback from skeptical physicians. I spoke with Microsoft AI CEO Mustafa Suleyman and Health Vice President Dr. Dominic King about the research ahead of its release. Get the exclusive scoop here. The Joint Commission has launched "Accreditation 360," a project it says will set a "new standard" for health care accreditation —using data analytics to fine-tune its focus on benchmarking and outcomes. The reforms include an updated accreditation manual, a new certification program, and moves to improve transparency and streamline processes. The organization has removed 714 requirements from the hospital accreditation program. Read all about The Joint Commission's dive into the digital era here, featuring exclusive insights from President and CEO Dr. Jonathan Perlin. —using data analytics to fine-tune its focus on benchmarking and outcomes. The reforms include an updated accreditation manual, a new certification program, and moves to improve transparency and streamline processes. The organization has removed 714 requirements from the hospital accreditation program. Read all about The Joint Commission's dive into the digital era here, featuring exclusive insights from President and CEO Dr. Jonathan Perlin. Read all about The Joint Commission's dive into the digital era here, featuring exclusive insights from President and CEO Dr. Jonathan Perlin. The Senate voted to advance President Donald Trump's One Big Beautiful Bill (H.R. 1) on Tuesday, approving nearly $1 trillion in proposed Medicaid cuts that would revoke health care coverage from at least 11.8 million Americans over the next decade. (H.R. 1) on Tuesday, approving nearly $1 trillion in proposed Medicaid cuts that would revoke health care coverage from at least 11.8 million Americans over the next decade. The House Rules Committee advanced the Senate's proposed changes, andat the time of writing on Wednesday afternoon, House Republicans were gunning to approve the final version by July 4. In an opinion piece for The New York Times, Larry Levitt, executive vice president for health policy at KFF, wrote: "This Republican policy bill is effectively a partial repeal of the Affordable Care Act to help pay for tax cuts, and should it reach President Trump's desk, it would represent the biggest rollback in federal support for health coverage ever." Pulse Check Paul Markovich is the president and CEO of Ascendiun. Paul Markovich is the president and CEO of Ascendiun. BCBS Paul Markovich is the president and CEO of Ascendiun, the nonprofit, ultimate parent company of Blue Shield of California, Blue Shield Promise Health Plan, Altais and Stellarus. He previously served as CEO of Blue Shield of California from 2013 to the end of 2024 and currently sits on the boards of the Blue Cross Blue Shield (BCBS) Association and America's Health Insurance Plans (AHIP). On Tuesday, I connected with Markovich to discuss last week's prior authorization reforms, born from a roundtable with health insurance companies and backed by HHS and CMS. Editor's Note: Some responses have been lightly edited for length and clarity. AHIP and BCBS were involved in these reforms, and you sit on the boards of both. From your perspective, when did these conversations about changing the prior authorization process really begin? They've been going on for probably the better part of a year behind the scenes with both trade groups. The plan was to develop these criteria and then go out and publicly announce them, but we [decided] we would love to get some positive feedback and support from the federal government. In particular, the Centers for Medicare and Medicaid Services is a pretty big customer and client on this one. So we went to them and said, "Look, this is what we've come up with. This is what we're planning on doing. A, How do you feel about it? And B, Would you be willing to say you feel good about it in public?" And they said, "You know what? We really like this, and before you go public, let's talk about this in more detail, and go out effectively together and talk about these changes." That ultimately led to the announcement, but it was very much conceived and driven by the trade associations for the health plans. The prior authorization process has been debated by physicians, hospitals, health plans and even the government for a number of years. What about this particular moment made it time to act and lean into reform? It was really clear this was our top pain point with patients, with the physician community and hospitals as well. This was the thing that was causing the most frustration and friction in the system. There was the sense that the status quo was problematic, and that at some point there would probably be a solution, or solutions that were developed. Then the question would be, who was going to develop them, and where was [reform] going to come from? Was it going to come from the federal government, state governments? All of those were possibilities. And I think we all just recognized we can do a whole lot better than this, and we need to do a whole lot better than this—and we can either construct something that we feel would be impactful without being detrimental, or we can wait for someone else to develop a solution which might be impactful but could also be detrimental, depending on how it's crafted. There have been various events along the way, various ups and downs in the political process, but eventually, this was too painful of a point to be left alone. One of the reforms laid out in the pledge is the standardization of electronic prior authorization submissions. What has been holding up the digitization process, and what will be the greatest challenge going forward? One of the biggest barriers to getting there—and it is going to be our biggest challenge going forward—is establishing and adopting standards for the real-time digital exchange of the information. And I know this from personal experience, because I've been a champion of creating a comprehensive digital health record for every American for many years. We managed to get a law passed in California that requires the sharing of data from physicians and hospitals to health plans: so we have actually created for our members a comprehensive, real time digital record in California, but it's in part thanks to that law and the requirement to share the data. But what ends up happening most of the time in prior authorizations is the health plan will say, there are certain best practices in health care that have been researched, that clinicians agree upon. There's a consensus about what the model of care should be in this situation, and what [the provider is] proposing to do is not consistent with that. But typically what happens is you [as a health plan] don't have all the information on the member. It's there in the medical record somewhere, but it hasn't been sent to the plan in a format that they need to say, "Yes, I can match this up. This patient has this diagnosis. Yes, their test results would indicate that they need this procedure or this drug. It's consistent with medical protocols." So typically, we're missing information, and then a series of time (days, sometimes ) that goes by where we're faxing requests for information. That's been the biggest challenge in the pre-authorization process. When we announced as a plan back in the fall of last year (before these industry announcements) that we were going to a real-time digital solution for prior authorization, we did a little spoof video with me bashing the fax machine to smithereens, which you may find entertaining. To me, that's the biggest thing, Alexis. It's getting standards and protocols down, getting that data available. How is it that the health plan can access that information on the patient, from the physician and hospital, and more broadly, from all of the care that they've had in their history of care? If we have access to all of that, there's absolutely no reason why these prior authorization decisions can't happen as quickly as your prior authorization decisions do on your credit card, and that's what we're shooting for. But what needs to happen is that digitization of the data and that real time sharing of it—and there's been challenges with that, historically. C-Suite Shuffles Oregon Health & Science University tapped Dr. Shereef Elnahal to serve as its sixth president after a lengthy national search. Previously, Elnahal was appointed by President Joe Biden as undersecretary for health at the VA. tapped to serve as its sixth after a lengthy national search. Previously, Elnahal was appointed by President Joe Biden as undersecretary for health at the VA. Debra Jaeger is the first chief revenue officer at Mount Sinai , based in New York City. In the role, she'll be responsible for integrating revenue cycle operations across the health system, reducing variation in processes and eliminating silos. is the first at , based in New York City. In the role, she'll be responsible for integrating revenue cycle operations across the health system, reducing variation in processes and eliminating silos. Rich Liekweg is retiring from his role as CEO of BJC Health System on October 1. Liekweg joined the St. Louis-based health system in 2009 and assumed the top role in 2018. He was instrumental to the health system's growth and oversaw its 2024 merger with Saint Luke's Health System in Kansas City. Nick Barto, current president of BJC, will succeed Liekweg. Executive Edge Dr. Jeffrey Giullian is the chief medical officer of DaVita Kidney Care. Dr. Jeffrey Giullian is the chief medical officer of DaVita Kidney Care. DaVita Dr. Jeffrey Giullian is the chief medical officer of DaVita Kidney Care, which provides kidney care and dialysis services across the nation and works to transform the experience of the more than 35 million people in the U.S. that live with chronic kidney disease (CKD). Giullian has been busy at DaVita, which is growing its value-based care arrangements and expanding access to kidney transplantation. (Last year, more than 8,200 DaVita patients received a kidney transplant, the company's highest number of annual transplants to date.) He also lives a full life outside of work, serving in an advisory capacity at the University of Colorado and the Denver Business School, and preparing to be an empty-nester when his daughter begins college at UCLA this fall. For this week's Executive Edge, I connected with Giullian to learn how he juggles it all: "Prioritizing health and wellness is something I take seriously—not just because of the demands of my role, but because I believe it's foundational to showing up as my best self, both professionally and personally. One of the ways I stay grounded is through running . It's a consistent part of my routine that gives me space to reflect, recharge, and maintain physical and mental clarity. . It's a consistent part of my routine that gives me space to reflect, recharge, and maintain physical and mental clarity. "I also try to be intentional about how I spend my time outside of work. With my daughter preparing for college, my wife and I are focused on making the most of this chapter as a family. That means carving out time for meaningful experiences, even amid a full calendar. I've found that when I align my personal time with what matters most—family, movement and purpose-driven work—it becomes easier to maintain energy and perspective. "Wellness, to me, isn't just about physical health. It's also about staying connected to a sense of purpose. When I feel aligned with the work I'm doing and the values I hold, I'm more energized, more present and more resilient in the face of challenges. That sense of purpose acts as a compass. It helps me make decisions about where to invest my time and energy, and it keeps me grounded when things get busy. Whether I'm contributing to meaningful change in health care or showing up for the people who matter most in my life, I've found that fulfillment comes from knowing that my actions are part of something larger." This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox.
Newsweek
26-06-2025
- Health
- Newsweek
Joint Commission CEO Breaks Down New AI Certification
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox. I've settled on my word of the week: transparency. Over the last seven days, my schedule has looked like a patchwork quilt, spanning several distinct sectors of the health care industry. But from the government's roundtable on prior authorization reform to my conversation with Joint Commission CEO Dr. Jonathan Perlin (read on for more on both of those), transparency has emerged as a common thread. Health systems and insurance companies must be transparent with one another; health systems and insurance companies must be transparent with patients. And, of course, health care companies must be transparent with their employees and customers—especially when deploying AI. Monday through Wednesday, many of my colleagues were in sunny Sonoma, California, for Newsweek's cross-industry AI Impact Summit. Senior Reporters Lauren Giella and Katherine Fung kept eyes on the health care side of the agenda, which included speakers from Kaiser Permanente, Hospital for Special Surgery, AdventHealth and UMass Medical. "Transparency was a big theme for AI adoption in health care—not only when dealing with medical records and personal data, but also for why and how organizations are implementing automation tools," Giella wrote. Dr. Allen Chang, ACMIO at UMass Medical, warned the audience not to neglect employees' concerns about losing jobs to AI, nodding to last year's strike by the California Nurses Association. "A lot of us say that we're not going to be replaced by AI, we want to believe that, but in medicine, we can't just invoke this and expect that to address the underlying drivers as to why people are asking about this," Chang said on Tuesday's health care panel. What could those underlying drivers be? I found some clues in Wolters Kluwer Health's new generative AI readiness report, released at the start of the month. Their survey of health care stakeholders found that 76 percent cite "reducing clinician burnout" as a major priority, and 85 percent say "recruiting/retaining nursing staff" is top of mind. But only 45 percent of nurses responded "yes" when asked if generative AI can reduce clinician burnout. I asked Dr. Peter Bonis, chief medical officer at Wolters Kluwer Health, to help me make sense of that gap—or "disconnect," as he called it. "Our survey is indicating that there's an opportunity to work with allied health professionals and clinicians to deeply understand their needs and where some of these technologies can help; to have them on participatory boards as they themselves get educated on what these tools can do; and to select these tools so that they are optimizing their workflows, and they have agency in this process," he said. I've been reporting on a lot of AI-related "disconnects" lately, both within health systems' AI deployment efforts and in external communications with vendors. I asked Bonis: Do these lapses indicate that we're taking the wrong approach to AI deployment in the health care industry? He told me that this isn't exclusive to the health care industry, and that every business is wrestling with the same sort of issues. (Phew.) But, he acknowledged, health care is a high-stakes game, and it's important to deploy AI safely (and transparently) for the benefit of employees, patient care and overall health equity. He believes health systems will succeed if they focus on patient care and bolster that foundation with sound operations and a successful business model. "The fusion of those two directives is what creates a future-ready health care system that understands how to use these advanced technologies to advance their operations—to do that thoughtfully—and then to have a coherent pathway to start to use these tools to advance that higher stakes domain," Bonis said, "and that's the journey that we're on." I also spoke with Dr. Perlin, head of the Joint Commission, about that journey to a "coherent" AI pathway. Read on to the Pulse Check section to see what he said. Essential Reading Aiming to improve the prior authorization process, HHS Secretary Robert F. Kennedy, Jr., and CMS Administrator Dr. Mehmet Oz hosted a roundtable of health insurance executives and stakeholders on Monday. on Monday. Attendees agreed to six reforms: (1) standardizing electronic prior auth submissions, (2) reducing the volume of services that require prior auth, (3) honoring existing approvals during insurance transitions, (4) improving transparency and communication around decisions, (5) implementing real-time approvals for most requests by 2027 and (6) ensuring medical professionals review all denials. (1) standardizing electronic prior auth submissions, (2) reducing the volume of services that require prior auth, (3) honoring existing approvals during insurance transitions, (4) improving transparency and communication around decisions, (5) implementing real-time approvals for most requests by 2027 and (6) ensuring medical professionals review all denials. These companies were included in the discussion: Aetna, AHIP, Blue Cross Blue Shield Association, CareFirst BlueCross BlueShield, Centene Corporation, The Cigna Group, Elevance Health, GuideWell, Highmark Health, Humana, Kaiser Permanente and UnitedHealthcare. Together, they represent about 75 percent of Americans with commercial or Medicare Advantage plans. The Lown Institute has released its highly anticipated index of America's Most Socially Responsible Hospitals. This year's honor roll comes at a critical time, as hospitals work to maintain equitable care amid potential Medicaid cuts, rising costs and ongoing workforce challenges. Duke Regional Hospital topped this year's acute care ranking, marking its fifth year on the list. Eli Lilly's once-weekly insulin efsitora displayed promising results in Phase 3 clinical trials, reducing A1C and meeting safety standards for adults with Type 2 diabetes, according to detailed datapublished by the company this week. The new drug hopes to simplify diabetes management by reducing the frequency of insulin injections. Diabetes is becoming more prevalent in the United States , affecting nearly 15 percent of adults. By the end of 2025, Eli Lilly plans to submit the drug to global regulatory agencies for the treatment of Type 2 diabetes. reducing A1C and meeting safety standards for adults with Type 2 diabetes, according to detailed datapublished by the company this week. The new drug hopes to simplify diabetes management by reducing the frequency of insulin injections. Artisight, the NVIDIA-backed health tech company specializing in AI-powered "smart hospital" infrastructure, announced a $40 million investment from a dozen health systems. It's an unprecedented level of support from some of the nation's largest, most forefront integrated systems and academic medical centers. (The list of names was reviewed by Newsweek but is not being released to the public at this time.) Pulse Check Dr. Jonathan Perlin is president and CEO of the Joint Commission. Dr. Jonathan Perlin is president and CEO of the Joint Commission. Joint Commission If you've been paying attention to the news lately, you may have had the same question that I did: What on earth is going on at the Joint Commission?The independent health care accreditation and certification organization has launched a couple high-profile, high-tech partnerships in recent weeks. First, it announced a long-term relationship with Palantir, intending to use the company's AI platform to streamline accreditation/certification processes. Then, it joined forces with the Coalition for Health AI to establish a "suite" of AI best practices playbooks and a new certification for hospitals. Now, if you work at a hospital, you likely live by the Joint Commission's standards. That's why I called Dr. Jonathan Perlin, president and CEO of The Joint Commission, last Friday. There was a bit of "geeking out about AI," as Perlin put it. But mostly, we discussed the recent CHAI partnership—and what it could mean for quality/safety standards and hospital certifications. Editor's Note: Responses are lightly edited for length and clarity. AI is so different from other components used to assess quality. Each health system uses it in a unique way, and applications vary between hospitals, departments and even patient populations. "Good AI" can be tough to quantify. How do you plan to create a standard with this new certification program? CHAI's lane is really the technology itself, and ours is the organization's governance process for the responsible use of that. You may have seen our Responsible Use of Health Data Certification that has six attributes, and this is really an extension of that. What we anticipate—and this is a work in progress—is that building from the Responsible Use of Health Data [Certification], there'd be requirements for de-identification or privacy that could be data controls for security. There should be some mechanism for transparency with patients. Most importantly, there would be like an oversight or governance structure that addresses the algorithm's or the AI's performance. The notion is that an organization can look to CHAI and to the market to identify an AI tool, but it has to have an active and ongoing governance process to look at the performance of that tool in their environment. To give an example, I think there are three essential components. One is technical: Is [the tool] valid and reliable in a sort of mathematical sense? Second, is it valid and reliable clinically? Does it present the right clinical information? And third, is it valid and reliable in a demographic sense, that you're not applying an AI trained specifically for detection of sepsis in adults to children. To make that clear, if CHAI's lane is really the external performance of the algorithm and the assurance aspects outside of health care, the way we do this [new certification] is not specifically directed at the certification of the AI tool, but the certification of process for the organization's own governance and oversight of the use responsible use of that AI tool. Will this certification assess tools that health systems developed internally, vendor tools that they deploy, or a combination of both? What else will you be looking at within each hospital's AI ecosystem? We anticipate that the certification, which would be given to health care organizations, would be based on the governance structure and the oversight structure I described [above]. We expect it would be applied both to homegrown and off-the-shelf technologies. Our focus is on continuous governance. Let me give an example that's literally closer to home. We just finished a renovation [at my house], and we had an electrical inspection after the work was completed. The wiring of the house is not going to change over time, but the wiring of AI, if it's retrained, if it drifts, etc., may change over time—so the organization needs to have a mechanism for periodic review of the performance of its "electrical system," to use the analogy, not just at inception, but periodically, or frankly, for the life of the use of that technology. Any advice for health systems that are currently building up their AI governance structures, to ensure they're on the right path ahead of the Joint Commission and CHAI's certification? Take a look at our Responsible Use of Health Data Certification , because it really provides insight into the concepts of governance as the regulatory frameworks are emerging. Despite the fact that device drug approvals are static, they are viewing the use of device (good outcomes or bad) as the responsibility of the clinicians and health care organizations that use those. Having come from operations and large systems myself, it's really important to have a set of externally validated standards that demonstrate what "good" looks like for responsible governance and oversight. I think organizations like ours are hugely excited about the potential, but we want to set up common standards to assure that we realize that potential responsibly. If you liked this sneak peek, remember to check out next week's edition, which will include more of my interview with Perlin. C-Suite Shuffles Joseph Impicciche is retiring as CEO of Ascension, after six years at the helm of the St. Louis-based system. Eduardo Conrado, the health system's current president, will become its new CEO on January 1, 2026. Conrado was named to Ascension's executive team in 2018, after five years on its board of directors. Throughout his tenure, he has also served as the system's chief digital officer and chief strategy and innovation officer. The Medical University of South Carolina (MUSC) has selected Dr. John Marymont as its next provost and executive vice president for academic affairs. Currently, he serves as vice president for medical affairs and dean of the medical college at the University of South Alabama. Lovelace Health System is undergoing its fourth CEO change since 2022, the Albuquerque Journal reported. President and CEO Troy Greer resigned last week after two years in the role. The health system—one of the largest in New Mexico—declined to comment on his exit. Executive Edge Dr. Leigh Vinocur is a thought leader on stress management amongst health care professionals. Dr. Leigh Vinocur is a thought leader on stress management amongst health care professionals. Dr. Leigh Vinocur Dr. Leigh Vinocur tells me that she considers herself a "lifelong learner." She's spent her career learning different elements of medicine, starting as a urology resident, becoming a board-certified emergency physician and serving as chief medical director for a major health system, overseeing more than 100 providers in the mid-Atlantic region. Now, she is the medical director of a men's health clinic and works part-time in clinical trials at a nutraceutical company. But throughout her working life, Vinocur has also learned a great deal about stress. After leaving her big-box health care role, she dealt with a "corporate medicine hangover." On July 12, she's releasing a book about her journey: Never Let Them See You Sweat: How Science Can Help Us Harness Stress for Success. This week, I connected with Vinocur to learn what her research—and personal experiences—taught her about stress in the health care setting. Here's what she told me: Editor's Note: Responses are lightly edited for length and clarity. "Today, in this political climate, we're seeing changes to health care, erosion of public health. It's making it even more difficult [to work in health care leadership]. There were always issues as a physician, fighting with insurance companies—but as physician executives, it's that kind of double bind that they're in, because they're caregivers, but they're administrators. They have rules they're enforcing, fiscal and institutional constraints, but they have to put their patients first, too. And it's stressful. "Not all stress is always horrible and bad. It gets you to your tiptop performance, you know. Stress was an evolutionary development and advantage to keep us safe. If you were out there being chased by a predator, all those reactions from the hypothalamus, the pituitary, the adrenal release the cascade of hormones for that fight or flight. Whether you're a runner in the Olympics standing in the blocks, or whether you're an ER doctor waiting in the resuscitation room for those accident victims to come in, that little boost of stress gets you at your top performance. It's just this continued stress that is so challenging. "I tell executive leaders that they need some buffer in between meetings. You need to create little micro-breaks during the day that are just for you to calm down. Whether that's meditation (there are apps on our watches and our phones), deep breathing (like box breathing, where you inhale through your nose for four seconds, hold it for four seconds and exhale for four seconds through your mouth), or leadership mentoring (where you have open dialogue and create a safe space to talk about some of the ethical dilemmas you may be facing). Whether that's meditation (there are apps on our watches and our phones), deep breathing (like box breathing, where you inhale through your nose for four seconds, hold it for four seconds and exhale for four seconds through your mouth), or leadership mentoring (where you have open dialogue and create a safe space to talk about some of the ethical dilemmas you may be facing). "All throughout the book, there are discussions on things you can do in nature, like 'forest bathing.' Study after study says that if you can get to a green space, like a park, that can lower your blood pressure. Just being out in nature, getting outside—you don't even have to exercise—can be a great relief." This is a preview of Access Health—Tap here to get this newsletter delivered straight to your inbox.
