H L Mencken wisdom that’s as fitting in today’s journals as it was in 1924.

Population Health

Are Preventable Hospitalizations A Flawed Measure?

Preventable hospitalizations are one of healthcare’s most widely adopted quality measures, which is exactly why they ended up in the crosshairs of a new opinion piece in Health Affairs.

Rates of preventable hospital admissions were first developed as an indicator of access to timely ambulatory care over 30 years ago, yet they’re now used to judge the performance of hospitals, health plans, and even individual providers (MSSP is an easy example).

• These measures are typically based on inpatient admissions or ED visits for conditions like hypertension or asthma, where hospitalizations can potentially be avoided if patients have access to effective ambulatory care.

The authors argue that the metamorphosis of preventable hospitalizations from an access measure to a quality indicator was a serious misstep, and incorporate nearly a dozen studies to help make their case.

• One of the most rigorous studies was from the Agency for Healthcare Research and Quality, which found that differences in socioeconomic status explain “a substantial part – perhaps most” of the variation in preventable admissions for many conditions, and recommended against using the metric as a standalone way to assess provider quality.

Those findings prompted the director of the AHRQ to publish an editorial outlining the “persistent challenge of avoidable hospitalizations,” which referenced a VA trial suggesting that high-quality ambulatory care might result in more, not fewer, admissions.

• The VA analyzed 1,400 veterans hospitalized with potentially avoidable admissions for congestive heart failure, diabetes, and COPD. Veterans that received intensive primary care were hospitalized more frequently than those in the usual care group, but were also more satisfied with their care despite the additional hospitalizations.

Other evidence suggests that using preventable hospitalizations as a measure of provider quality can actually decrease care quality by discouraging necessary admissions.

• This study linked reduced readmissions to increased mortality for heart failure patients, unexpected results that might be explained by the fact that “incentives to avoid readmissions may lead to potentially inappropriate management of higher-risk patients… in the outpatient rather than inpatient setting.”

The Takeaway

Whether or not preventable hospitalizations are a flawed quality measure, this article is a solid reminder that “strong beliefs should be loosely held,” and that widely adopted views are often the most important ones to stress-test.

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The Wire

• Verily Introduces Lightpath GLP-1 Support: For the second time in as many years, Alphabet healthcare subsidiary Verily is pivoting its business with the introduction of a new chronic disease management solution named Lightpath. Slated for a debut in 2026, Lightpath is an “evolved” version of Verily’s soon-to-be-phased-out Onduo platform, and will bolster existing programs for diabetes and hypertension with two of the hottest innovations in cardiometabolic care: AI and GLP-1s. More information should be available soon, but it’s hard to imagine that AI and GLP-1s won’t move Verily in the right direction.

• Done CEO Arrested for ADHD Scheme: The CEO and a clinical president of ADHD startup Done were arrested and charged with carrying out a $100M scheme to distribute stimulants without a legitimate medical purpose. The case argues that Done took advantage of relaxed telehealth regulations to target drug seekers with deceptive social media ads and submit fraudulent reimbursement claims. We’ll have to wait for the courts to decide whether the allegations hold merit, but here’s an example of a fun ad in the meantime.

• The Promise and Challenge of VBC: A short-and-sweet viewpoint in JAMA Network Open explored the challenges of designing and implementing value-based care programs. The authors point out that physician-led ACOs often perform better than hospital-led ACOs because savings primarily come from reducing hospitalizations (meaning physicians are incentivized to reduce another organization’s revenue instead of their own), and conclude that policymakers should incorporate that lesson across all VBC models.

• Better Health Bags $14M: Better Health bagged $14M in strategic funding (total raised now $27.5M) to improve access to high-quality treatment for patients managing chronic conditions, especially those who rely on durable medical equipment. The Better Health platform combines peer coaching and education with the home delivery of medical supplies to drive better outcomes across conditions such as ostomy, chronic wounds, and diabetes.

• Brightside Acquires Lionrock: Brightside Health continued its expansion into new patient populations with the acquisition of Lionrock Recovery, which provides virtual intensive outpatient programs for substance use disorder. Since closing its $33M Series B in March, Brightside has pushed deeper into Medicare and Medicaid through new payor partnerships, and Lionrock will now add personalized SUD treatment (individual / group therapy, psychiatry, medication) to its growing list of services.

• Quitting GLP-1s Too Soon: The steady supply of good news for GLP-1s was interrupted by a BCBS study that found 58% of patients discontinue use before reaching a clinically meaningful benefit. The largest-ever study of its kind analyzed data from ~170k GLP-1 patients since the first weight-loss approval in 2014, revealing that 30% discontinued use within the first month. Adherence was especially poor among patients with prescriptions from their PCP as opposed to an endocrinologist or obesity specialist, likely due to the lack of an effective strategy for mitigating gastrointestinal side effects.

• Pager Health Upgrades and Rebrands: Pager Health rolled out new agent-to-agent functionality that allows all care team members to communicate and coordinate amongst themselves or with the patient through a unified conversation. The new capabilities were accompanied by a “major rebrand” from Pager Inc. to Pager Health, with the ambitious name change and website overhaul meant to position the company as a connected health platform as opposed to a communication solution.

• Abridge Partners With Christus: Abridge entered an enterprise-wide partnership with Christus Health, a Texas-based system employing over 15k physicians across 600 care centers. The announcement included a case study pulling data from Abridge and Christus’ two-month pilot, which saw Abridge’s AI clinical documentation solution “reduce clinician cognitive load” by 78% while reducing their after-work documentation time by 60%.

• Fortune 500 Healthcare: Healthcare had a strong showing in this year’s Fortune 500, with 42 major players included in the list of businesses with the most annual revenue across all industries. UnitedHealth Group made the first appearance at rank 5 overall, followed by fourteen pharma companies (starting with Pfizer at rank 38), five health systems (nonprofits were excluded, HCA ranked highest at 66), and six device manufacturers (Abbott ranked 99). Walmart took the top spot with an impressive $648B in revenue, which probably helped ease the pain of losing $230M through its health clinics.

• Plant-Based Ultra-Processed Foods: Ultra-processed foods are bad for your heart, even if they’re plant-based. A new Lancet study analyzed data from 126k UK Biobank participants who completed at least two 24hr dietary recalls between 2009 and 2012, finding that people who reported consumption of plant-based UPFs had a 5% increased risk of cardiovascular disease and 12% higher CVD mortality over 9 years. Meanwhile, every 10 percentage point increase in plant-sourced non-UPF consumption (aka real fruits and veggies) was associated with a 7% lower risk of CVD and a 13% lower risk of CVD mortality.

• New AI Transparency Guidelines: The FDA issued new guidelines on ensuring transparency for companies developing machine learning-enabled medical devices. The agency has been working with Health Canada and UK regulatory authorities on a coordinated approach to medical AI regulation, and transparency – or the ability to understand how and why AI algorithms make their decisions – has been a major point of concern. While the guidelines are a bit vague, they should give AI developers some insight into the FDA’s approach to regulation.

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