Tag: digital health

2026 State of Digital Health Purchasing

Posted on by Virginia Hunt

Peterson Health Technology Institute’s 2026 State of Digital Health Purchasing offered insider access to the minds of executives that are actively spending on digital health solutions.

PHTI surveyed 321 people with buying power across health plans, employers, and health systems to shine light on everything from purchasing approaches to contracting strategies.

Respondents revealed that AI use is wide. That doesn’t mean deployment is deep. 

  • Health systems and health plans have both homed in on solutions for clinical documentation, with 93% and 86% of decisionmakers reporting some use.
  • That said, only 41% of systems and 26% of plans reported enterprise-level deployment of the technology.

Same budgets, different targets. A third of purchasers said their digital health budgets have been consistent over the past two years, but they’ve started honing those budgets on solutions with better returns.

  • Patient outcomes surprisingly ranked as the top priority. 97% of purchasers prioritize technology that improves access and clinical performance.
  • It was nice to see patients edge out revenue, even by a slim margin. 96% of respondents looked for solutions that improve the financial performance of their org.
  • That was especially true within crowded markets surrounding the top three care priorities: diabetes, primary care, and mental health.

The focus is coming by necessity. Many vendors apparently aren’t meeting expectations. 

  • Cost-savings expectations weren’t met for 31% of health plans, 28% of employers, and 22% of health systems.
  • Engagement has also become increasingly important, yet 47% of purchasers report enrolling <25% of eligible members. 
  • Poor engagement and costs also ranked in each purchasing group’s top three reasons for switching vendors — and the main reasons they’d be willing to spend more.

Those numbers are affecting contracts. Purchasers are incentivizing vendors to hold up their end of the bargain by hanging their payments on outcomes.

  • More than two-thirds of employers use performance-based contracts, and 85% of contracts hold a quarter (or more) of fees contingent to performance.
  • Vendors also have less time to prove their worth, as 70% of contracts only last one to two years.

The Takeaway

Purse strings aren’t getting any looser, and more vendors are competing for the same purchers. PHTI expects capital to start flowing toward those with numbers that back their worth… quickly.

App-Based Interventions Can’t Do It All

Posted on by Jack Troy

Anxiety, obesity, diabetes — there’s apps for all that and more. But which risk factors and outcomes actually respond to smartphone-based interventions? A new paper in The Lancet Digital Health separates helpful software from homescreen clutter. 

Mountains of data went into this study. The umbrella review and meta-analysis covered 78 systematic reviews, 496 primary studies, and over 177k participants. 

Apps came out looking pretty good. They made a dent in 21 of 31 outcomes. 

  • Users got moving, adding to their step counts and exercise time. 
  • BMI, weight, and waist size (but somehow not body fat percentage) fell.
  • On the mental health front, anxiety, mindfulness, and stress saw the most positive movement, with depression and wellbeing just behind.
  • Glucose levels improved — more than any other metric, at that. 

But the study was a heartbreaker for cardiovascular disease apps (and a grab bag of other categories). 

  • Blood pressure was the only CV outcome that responded to apps.
  • Cholesterol, triglycerides, and CV disease mortality didn’t budge.
  • Fruit and veggie intake, smoking, and hospitalization were also unchanged. 

Here’s where the lessons on better building and deploying apps come in. Researchers, clinicians, developers, and policymakers, take note.

  • Tracking and monitoring were most useful when it came to physical activity, glucose management, nutrition, and medication adherence. 
  • Educational content went a long way for mental health. 
  • Support from healthcare professionals or a community was broadly helpful. 
  • Goal-setting and behavioral planning were generally underused. 

Some outcomes might just be harder to achieve, though. 

  • The researchers theorize that apps are good at short-term behavioral changes, but struggle with conditions that require intensive, multifaceted care.

The Takeaway

App-based interventions are cheap, non-invasive, and low commitment, but this study shows they’re not useful for all conditions. Take that how you will, either as a sign to ditch smartphones for some types of care or double down with better features. 

Epic Dominates, But Don’t Discount Competitors

Posted on by Jack Troy

Epic’s empire has reached, well, epic proportions. The software goliath’s grip on health systems gets tighter by the day, but a new report from startup studio Redesign Health doesn’t count out David just yet. Pencils up, founders. 

Redesign Health talked to the big wigs. Here’s a quick look at the survey group. 

  • A total of 112 execs at U.S. health systems served by Epic gave their thoughts. 
  • Two-thirds get final say on clinical and administrative purchasing, and the rest hold at least some official sway in these decisions. 

Most seemed pretty content with Epic. The platform has a quality edge to some, though its sheer size looks to be influencing things. Blink twice and we’ll call Oracle.

  • A huge majority (71%) described their system as “Epic-first.”
  • 80% expect prioritization of Epic going forward vs. 6% for external solutions. 
  • Epic is winning because of easy integration (50%), superior capabilities (48%), being “good enough” vs. alternatives (48%), and cost effectiveness (47%).

There’s room for competition. Execs placed the likelihood of another vendor matching Epic in various arenas on a one-to-five scale, and were generally open to outsiders. 

  • The greatest opportunities lie in imaging (3.52), quality tracking (3.51), and discharge and transfers (3.51).
  • Epic is most entrenched when it comes to patient flow (3.16), interoperability and integration (3.21), and non-imaging clinical decision support (3.22). 

But if you come at the king, you best make sure your product rocks. To ditch Epic, decision-makers must be confident they’ll get major results, and fast. 

  • Nearly half (49%) said external vendors must show significantly higher ROI and/or better outcomes, while just 18% grade Epic and its competitors on the same scale. 
  • It tracks that 63% ranked easy integration as important, with faster time to value close behind at 59%.

The Takeaway

Redesign Health’s report on Epic could serve as a roadmap for other companies to score some victories in the battle for market share. Those looking for one simple trick that Epic doesn’t want you to know will be disappointed, though. The broad strokes lesson is to make a product so good it’s irresistible. 

2026 Healthcare Forecast Cloudy, But AI Rays Could Poke Through

Posted on by Jack Troy

Venrock’s 10th annual survey of healthcare insiders reveals they’re a pessimistic bunch lately, harboring cynicism about recent policy developments and the future of health tech IPOs, though views on AI were more of a mixed bag. Let’s break down the results. 

But first, a bit about the survey. More than 200 leaders from all corners of healthcare shared their thoughts with Venrock. Some areas were better represented than others.

  • Respondents skewed toward the private sector (28%), investing (20%), life sciences or pharma (16%), professional services (8%), and academia (7%). 

Venrock loaded up the questionnaire with AI inquiries. Big picture: Insiders are becoming more comfortable with the tech, but remain mindful of its downsides. 

  • Trust in AI grew for 73% and fell for 2% (unclear who hurt them). 
  • Just 9% view AI as the most overrated trend in healthcare.
  • HIPAA breaches (24%), harmful hallucinations (19%), and overspending on healthcare-specific platforms (28%) ranked highest among possible AI pitfalls. 
  • Most expect AI to create an costly arms race between payers and providers (63%) as each side rolls out bots specifically designed to argue with other bots.

Here’s another fun one: M&A targets. There’s no consensus on who will get snapped up next, but the industry seems confident it will be a big name in AI-powered services. 

  • OpenEvidence (21%), Komodo Health (18%), Abridge (14%), and Sword Health (11%) were the top answers out of 10 companies, but only after none of the above (46%).

So the hottest firms are going public? Nope — that’s one thing people can agree on. 

  • Only 3% think health tech IPOs will be back in style this year, with the rest split roughly down the middle between 2027 and 2028 or beyond. 
  • For those keeping score, 42% of last year’s respondents predicted a health tech firm would go public in the first half of 2026. Tumbleweeds…

In fairness, it’s hard to predict the future, especially with $1.15T in Medicaid cuts looming over everyone’s heads. 

  • Will they harm rural hospitals? Empty state coffers? Ruin MCOs? Strain blue-state safety net hospitals? Most checked all of the above (65%). 

The Takeaway

Some of the smartest folks in healthcare think we’re heading toward a world of payer-provider bot wars, sluggish health tech IPOs, and brutal fallout from Medicaid cuts. Here’s to hoping Venrock’s survey missed the mark. 

The Case for Primary Care as a Public Utility

Posted on by Jason Barry

What happens if primary care gets treated like a public utility – something that everyone can access as easily as running water?

A new article in JAMA paints a beautiful picture of what that might look like, and even colors it in with a roadmap for how to get there.

Primary care is a critical component of healthcare. It’s also far from universal.

  • More than a third of U.S. adults lack access to primary care, an eye-popping number that unfortunately makes more sense knowing primary care only sees 5 cents of every federal dollar spent on healthcare.

The authors frame up the issue perfectly. 

  • “Primary care has long fit awkwardly as an insurable risk in the marketplace. Insurance is designed to protect against large, unpredictable expenses. Yet primary care is largely predictable, similar to food, housing, and other common necessities.”

The proposed solution? A primary care common fund, which pools primary care spending from public and private purchasers and pays practices directly. Here’s the basic outline:

  • The common fund would comprise current primary care spending from payors, and include the additional spending that states invest into primary care in the future.
  • A state authority – much like a public utility – would administer the funds and pay practices directly.
  • The “pluralistic financing” of primary care would remain intact. Employers and individuals would continue to pay premiums for commercial plans, and Medicaid would continue to be financed by federal and state funds. On the back end, the state would redirect the primary care portion of payor premiums (their contribution) to the common fund.
  • A key point is that the common fund starts with no “new money.” Baseline contributions equal what purchasers are already spending on primary care (ex. Oregon has a primary care spending target of 12%, and would assess 12% of plan premiums). 
  • Payors would no longer need to compete on prices and benefits for primary care, but they’d still compete on their specialty and other lines of business.
  • People remain enrolled in coverage for non-primary care services, but the common fund “assumes responsibility for coverage and payment of primary care and accountability for its spending.”

The Takeaway

If the U.S. wants everyone to have access to the benefits of primary care, a good start might be making sure everyone has access to primary care. This paper charts a path to get there straight down the middle of single-payor and free-market approaches, and a “Medicare Advantage for Primary Care” feels more doable than ripping and replacing the entire system.

Nourish Cooks Up $100M of Series C Funding

Posted on by Jason Barry

Nearly 200M Americans are hungry for help managing a nutrition-related chronic condition, so Nourish just raised $100M of Series C funding to fill their plates with AI-native metabolic care.

Nourish is a proactive substitute for a reactive recipe. Its entire virtual metabolic clinic is purpose-built to tackle chronic conditions before problems start to escalate.

  • The care model revolves around nutrition-first interventions, but it’s the fully coordinated wraparound support that transforms access into better long-term outcomes.
  • The secret ingredient? Dietitians… plus AI, obviously.

Over the last four years, Nourish has grown into the country’s largest dietitian-led metabolic health clinic, with a roster of over 10,000 Registered Dietitians.

  • Every Nourish patient works with an RD to work through a comprehensive care plan – with lab testing, GLP-1 prescribing, and medication management all baked in if needed.
  • Patients also receive a personal AI agent to support behavior change and coordinate with other providers. These reportedly have “hundreds of thousands of MAUs and world-class engagement metrics.”
  • The RDs are equipped with their own AI agents to help surface insights, automate administrative work, and improve quality of care.

The outcomes are the main course. Nourish patients see an average of: 

  • 8% weight loss
  • 1.3-point A1C reduction
  • 31-point LDL reduction
  • 23-point systolic BP reduction

GLP-1s are the dessert people can’t get enough of. Despite demand for metabolic care exploding alongside the rise of GLP-1s, medication alone is rarely enough – only 46% of patients stay on GLP-1s at six months, and most who quit regain the weight.

  • Nourish’s care model shines here too. Over two-thirds of Nourish patients remain on GLP-1s at six months, and they lose 33% more weight on their way there.

The Takeaway

Nutrition support has been covered by insurance for over a decade, yet only a tiny fraction of those who could benefit ever actually use it. GLP-1s changed that demand equation, and Nourish just loaded its plate with $100M to give people the access they’re suddenly craving.

Medicare’s None the WISeR

Posted on by Jason Barry

Washington state just delivered an unfortunate crash course on U.S. health policy after the model aimed at “Wasteful and Inappropriate Service Reduction” led straight to higher costs and fewer treatments for seniors.

Does Medicare need prior authorizations? CMS designed WISeR to find an answer by testing whether bringing AI-driven prior auths (which are already widespread among private payors in Medicare Advantage) to traditional Medicare could cut down on wasteful spending.

  • The six-year pilot kicked off in six states on January 1st (AZ, NJ, OK, OH, TX, WA), targeting a list of 13 “low value” services with a high potential for fraud or waste – most notably orthopedic pain management procedures and skin substitutes.

Washington is already tapping out. Less than five months in, Senator Maria Cantwell (D-Wash.) had enough data to publish her new report on the “clear risks of AI in Medicare.”

  • Drawing on a Washington State Hospital Association survey of 16 hospitals, the report found that procedures previously approved within days are now taking 4 to 8 weeks. 
  • CMS’ own WISeR standards call for responses to providers within 1 day for urgent care and 3 days for routine care, both of which are now clocking in at 15 to 20 days.

You get what you pay for. WISeR compensates third-party administrators for each claim they deny, under the assumption that these denials account for the reduction in wasteful spending.

  • That obviously creates some adverse incentives, which the report eloquently framed up by saying the model “incentivizes WISeR contractors to weaponize AI-driven medical determinations not for the sake of efficiency… but to maximize profitability.”
  • As a result, Washington hospitals have had to add staff and increase hours to manage the surge in prior auths – not a great formula for lowering the cost of care.

The report went straight to the top. At a Senate hearing last week, Senator Cantwell made her case directly to HHS Secretary RFK Jr., who said “that kind of delay is unacceptable.”

  • He went on to say that prior auths are there to prevent the government from being “ripped off” by unethical providers and only applies to 5% of services in Medicare.
  • That might be accurate, but it doesn’t mean they aren’t high-volume services. A separate KFF analysis found that 86% of the 1.1M Medicare beneficiaries that used at least one of the services on WISeR’s list in 2024 received a pain management service.

The Takeaway

Reducing waste in Medicare is a worthy goal, but so far it looks like the best way to make it happen probably isn’t by adding prior auths to the program that many seniors specifically chose to avoid them.

The Rise of the Generalist-Specialist

Posted on by Jason Barry

Healthcare’s tidy hierarchy of specialties was formed by cognitive necessity. The corpus of medical knowledge is too massive for a single person to master and the clinical workforce was organized around it, but a new article in Health Affairs says it might be time for a redesign if AI removes that constraint.

AI is scaling specialist-level knowledge. Leading models are coasting through Board exams and polishing their clinical capabilities, which the authors argue will quickly scale specialist-level knowledge to the point where most specialty care can be delivered by PCPs.

  • They coined the term “generalist-specialists” for a new category of doctors that transcends narrow specialty definitions.

Clinical expertise is increasingly democratized. The authors see a future where AI-augmented clinicians can manage the full constellation of patients’ chronic conditions within disease-based domains rather than organ-specific specialties. They give a few examples:

  • Cardiometabolic Diseases – combines cardiology, endocrinology, and nephrology
  • Infectious & Inflammatory – rheumatology, infectious disease, & gastroenterology
  • Primary Care: spans OB/GYN, internal medicine, and pediatrics.

That could have some major benefits. Instead of shuffling a diabetic patient between an endocrinologist, cardiologist, and nephrologist, a generalist-specialist could manage the full cardiometabolic picture.

  • That means fewer handoffs, faster diagnoses, and lower co-pays. It would also unlock a ton of specialty capacity for the patients that need it most.
  • Consolidating care under fewer clinicians would also be a tailwind for value-based care, although it would likely increase utilization in a fee-for-service world by converting deferred, fragmented, or incomplete care into a cohesive billable treatment.

AI isn’t the only barrier to making that happen. Everything from med schools and malpractice standards to credentialing and referral systems would need to be completely overhauled.

  • The generalist-specialist vision also assumes that specialists will be on board with either becoming quasi-PCPs or upskilling to ultra-complex care. Definitely not a given.
  • Patient safety concerns also go without saying, but the AI will probably be pretty decent by the time we have cardio-endocrin-nephrologists putting together the care plans.

The Takeaway

AI could easily bring specialist knowledge to generalist fingertips, but if overworked PCPs are going to start also being OB/GYNs it will take more than a fancy LLM to get there.

Why AI Vendors Struggle to Compete With EHRs

Posted on by Jason Barry

Anyone who has ever tried selling AI into health systems will tell you that it’s tough to compete with EHRs, but a new article in JAMA makes the case that it’s actually gotten too tough – and it might be time for regulators to step in.

Most markets reward the best products. The healthcare industry has a funny way of preventing that from happening, and EHR vendor dominance is a textbook example.

  • EHRs hold advantages across infrastructure, workflow integration, procurement, and pricing that make it difficult for third-party tools to gain a foothold.
  • A 2025 Health Affairs study backed that up by showing that 79% of U.S. hospitals use AI models from their EHR vendor, compared to just 59% that use AI from third-party developers.
  • A Bain report drove the point home. Two-thirds of Epic customers said they’d pick a “good enough” Epic option over a better competing product.

These EHR advantages are a natural feature of the market. That said, it’s up to regulators to decide whether the status quo is serving patients and the overall healthcare system. The JAMA authors argue that it doesn’t, and offer three areas where targeted policy could level the playing field.

Infrastructure – Integrating AI tools into clinical workflows requires real-time data access and the ability to survive EHR upgrades intact, both of which are dramatically easier for EHR vendors – particularly as data fields get added or removed.

  • Potential Policy – Mandate broader API adoption so third parties can access EHR data on equal footing, and use existing EHR certification and interoperability frameworks to do it.

Workflow and Usability – The authors specifically flag EHR vendors’ edge in understanding the trade-offs of allocating limited screen real estate to new AI tools, something that’s harder for third parties to gauge from the outside looking in.

  • Potential Policy – Require EHR vendors to offer more robust developer sandboxes – similar to Apple’s iOS developer environment – so third parties can build and test without operating at a structural disadvantage.

Procurement and Pricing – Long-standing health system relationships give EHR vendors a streamlined path through procurement, as well as the leverage to “use pricing structures that incentivize adoption.”

  • Potential Policy – Although this is the hardest area for a policy fix, the authors suggest that improving transparency around AI performance could at least help health systems make more informed decisions regardless of where a tool comes from.

The Takeaway

EHRs are in a powerful position, and companies in powerful positions have a long track record of making life harder for their competition. Healthcare is too important of an industry to not have the best products rise to the top, and this article offers some sound strategies to make sure that stays possible.

Inside the World’s First One-Man AI Unicorn

Posted on by Jason Barry

We officially have our first one-man, billion-dollar AI startup, and it’s in healthcare… for better or worse.

It was hard to be online last week without stumbling across the New York Times profile on “How A.I. Helped One Man (and His Brother) Build a $1.8 Billion Company.”

The article tells a shimmering tale of AI entrepreneurship. The 41-year old founder took just two months, $20k, and a dozen AI tools to get his startup Medvi off the ground.

  • Medvi plays at the intersection of two trends that seem almost engineered to mint new billionaires: agentic AI and GLP-1s.
  • The online telehealth provider offers GLP-1s for weight loss, with an army of AI agents handling everything from website copy and design to ad images and customer service.
  • It had 300 customers in its first month, generated $401M in its first full year (2025), and revenue is now on track to hit $1.8B after the founder doubled the headcount by hiring his brother.

Medvi is basically dropshipping healthcare. They’re in the business of acquiring customers, not delivering care. The entire clinical infrastructure runs through turnkey partners.

  • CareValidate manages the physician licensing and prescriptions.
  • OpenLoop handles the pharmacy fulfillment and shipping.

Here’s what NYT forgot to mention. The article notes that Medvi’s founder was “nervous to talk publicly” about the company and hasn’t exactly been waving his momentum around.

Some solid sleuthing from digital health’s finest offers a few hints as to why that might be:

  • Medvi (or partners with a conveniently long leash) spun up 800+ fake doctor Facebook accounts to aggressively advertise their meds. Not great.
  • They’re named in a lawsuit alleging a nationwide scheme to manufacture and promote a fraudulent, unapproved oral tirzepatide pill. Also not great, allegedly.
  • Their onboarding accepted a user with a February 31st birthday, then told them they had a 94% chance of hitting their goal weight of 200lbs starting from 7’11” and 350lbs. Yikes.

Sam Altman called it. The OpenAI CEO was spot on with his prediction that AI would quickly let solo founders generate billions by eliminating the inefficiency seen at larger orgs. Unfortunately in healthcare, much of that “inefficiency” is in place to protect patients.

The Takeaway

Is it impressive that one founder and a little grayhat marketing can now do billions in revenue? Yes. Should we be dropshipping healthcare through predatory ad funnels? Probably not. 

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