Kevin and Martin open on a busy first week of healthcare earnings, where a January snowstorm and collapsing respiratory volumes turned out to be a bigger driver of HCA's quarter than ACA expiration or state directed payments combined. They cover Elevance's nearly billion-dollar accrual on the flash drive saga, Molina's marketplace MLR optics, and the rising patient-pay dynamic Cedar flagged on LinkedIn. They also revisit Zeke Emanuel's Bulwark piece on healthcare cost-cutting and reframe the question around whether 18% of GDP on healthcare is really the problem worth solving.
Alli Oakes, Chief Research Officer at Trilliant Health, breaks down their new behavioral health report — why $500B in untreated mental health costs dwarfs the $200B we spend treating it, where the supply-side gaps are most acute, and why D2C behavioral health is on average more expensive than traditional in-network care.
Neil Batlivala, CEO of Pair Team, walks through how Pair Team scaled to a thousand-person medical group serving high-needs Medicaid populations, the watershed moment with Flora, their AI care advocate, and the company's approach to the CMMI ACCESS Model — including why CMMI's rates are built bottoms-up from cost-to-deliver rather than value-delivered, and what that means for CAC and device cost economics.
Amanda Rees, CEO of Bold, makes the case for a device-agnostic, AI-first lifestyle change platform inside ACCESS, and why Bold's existing Medicare Advantage playbook on falls prevention and behavior change positions them differently than the MSK players that opted out.
Patrick Keavy and Rebecca Springer of Bailey and Company join to discuss the state of the Medicare Advantage brokerage market post-Medicarians — how 606 accounting reshaped the space from 2019 to 2021, why this AEP came in 20-30% south of expectations for many brokers, and why churn in the carrier base may actually be making high-quality brokers more valuable, not less.
Kevin and Martin close with the New York Times piece on Dr. Norman Rowe and the $440K breast reduction, the IDR arbitrator cottage industry now lobbying to entrench itself, the Doctronic-Utah Medical Board standoff on AI prescribing, the Washington state senator picking up the WISeR criticism, and Epic's growing role in AI adoption — and what it means when a B Epic product priced at $100K beats an A-minus startup product at $1M.
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