Cost Plus Drugs Founder Mark Cuban on Medicare for All.

I was celebrating the birthday of one of the smartest people on the planet this weekend (hey mom!) and she said she loved last week’s virtual-first care webinar with Ovatient. If you missed it, fear not – the full conversation is now available on-demand for your viewing pleasure.

– Jason Barry, Managing Editor

Artificial Intelligence

Integrating Consumer AI Into Healthcare Pathways

If AI recommends the right care and nobody is around to get it, did it really recommend the right care? A new perspective piece from Topol and friends in Nature Health doesn’t think so.

Four authors, four models. Eric Topol, Yilan Wu, Alvin Liu, and Pearse Keane

sort health AI into quadrants of integration (interface, data, orchestration, workflow) and compare four products by how deep they go:

• ChatGPT Health – 230M health queries a week and optional record connections, but no orchestration
• Claude for Healthcare – a consumer arm that connects records and an enterprise arm working the back office (prior auth, claims appeals, coding)
• Amazon Health AI – links triage to One Medical visits and Amazon Pharmacy fulfillment
• Ant Group’s Afu – the deepest integration, with booking, physician routing, pharmacy, and insurance payment inside Alipay (140M users, 60% from lower-tier cities)

Models are more than their output. Once a system routes care and moves money, accuracy stops being the only question that matters.

• Does the patient reach the right care?
• Does the prescription get filled?
• What do they pay out of pocket, and where do people drop out?

Those questions need answers. The authors propose that those pathway outcomes (completion, abandonment, cost burden) should become the minimum evidence standard, and each should be reported on individually.

The evidence isn’t keeping up with deployment. None of the four companies has published product-specific performance numbers, and the only independent evaluation the authors could find showed ChatGPT Health under-triaging 52% of gold-standard emergencies.

• That’s the “infrastructural turn” in a nutshell: systems become hard to bypass before anyone has verified they work.

Epic is the cautionary tale. It became default infrastructure before governance caught up, hospitals adopted its models because they were already integrated, and its sepsis model needed 109 alerts to find one true case.

• Consumer AI got there in months instead of decades, with no hospital committee standing between the algorithm and the patient.

Closed loops are the sharpest risk. When one company interprets the symptom, routes the referral, fills the prescription, and collects the payment, every step that should be an independent check lives inside the same P&L.

• Afu is the clearest example, and the authors want routing transparency and conflict-of-interest disclosure treated as infrastructure requirements, not nice-to-haves.

The Takeaway

AI is more than model quality and benchmarks, and it’s great to see more research focusing on the human patient aspects of human patient-facing AI systems.

A New Path for ACCESS Model Participants

Building your CMS ACCESS program? Withings was accepted into the inaugural cohort as both a participant and a device partner via the ACCESS Tools Directory. Bring the same FDA-cleared, cellular-enabled devices into your program, including BPM Pro 2, capturing clinical measurements and patient-reported outcomes at the point of reading, purpose-built for value-based cardio-kidney-metabolic care.

Unlock Better Care With LOLA 

Whether you’re looking to augment your team’s capacity or capabilities, Tucuvi’s clinically validated LOLA voice agent is purpose-built to make it happen – and has the success stories to prove it. Hear first-hand from Tucuvi’s customers how LOLA is empowering clinical teams to care for patients while maximizing ROI.

The Wire

• EliseAI Bags Nine Figures: EliseAI just closed another massive round – $350M at a $4B valuation – to continue automating the two H’s driving 40% of spending for the average American: housing and healthcare. The startup’s agents support medical practices with patient scheduling, intake, and front-desk operations, while also helping property managers handle leasing, maintenance, and resident engagement. Hey if your AI can tackle the clunkiest industry, why not have it tackle the second clunkiest?

• The Rise of Big Mental Health: Here’s a beautiful chart from the founder of Single Aim that illustrates the meteoric rise of Big Mental Health. Nearly a third of mental health clinicians on payer panels are now affiliated with just six companies, a trend that was virtually nonexistent 10 years ago. Headway, Grow Therapy, Alma, Rula, LifeStance, and Talkspace have all been booming as clinicians are drawn to the convenience of having a company handle all the credentialing and billing that makes accepting insurance easier. On the other hand, some are worried about another middleman taking a share of the revenue. 

• Included Health Plan: Included Health took the lid off its new primary care-centered Included Health Plan following close of its recent Firefly Health acquisition. Included Health Plan combines nationwide care delivery, personalized support and clinical guidance, and a plan design that incentivizes high-value care. The release sums it up by saying the move was made “to help employers overhaul the economics of healthcare instead of passing cost increases on to employees.”

• All Hale Early Prevention: Hale joined the growing crop of startups looking to make earlier heart-disease prevention more accessible. The platform coordinates CAC CT scans, blood testing, and physician-reviewed results through independent clinical partners. That allows Hale to pair calcium results with advanced markers like Lp(a) and ApoB, to help facilitate next steps and monitoring, a model that follows the new AHA guidelines for personalized heart risk assessment. Services range from $129 to $399 so that more consumers can get their hands on them.

• Hospital Performance Dips: Hospital margins slid to 1.4% in July per Kaufman Hall’s latest National Flash Report. Operating margins and observation days both dropped month-over-month, while discharges increased amid persistent payer mix pressures. With more care shifting to outpatient settings, Kaufman Hall expects hospitals to see a greater performance impact from outpatient volume fluctuations, including seasonality of elective surgeries.

• AI Restructures Patient Research: While experts have raised red flags about consulting AI for clinical advice, a recent survey revealed that patients are using chatbots to support existing research sources rather than replace them. Internet data from 1.5k adults’ and survey responses from over 500 patients showed about 80% use AI alongside sources like health information sites and forums to understand their health quickly. Nearly half of patients also use AI to understand their doctor’s messages in plain-language, but they were more likely to use vetted sites when it came to treatment decisions.

• Site-Neutral Savings: New research from the Employee Benefit Research Institute found that reimbursements for outpatient departments were 102% greater than for physician’s offices doling out the same prescriptions. That gap amounts to $12.7B in extra healthcare spending for employee-sponsored health plans. As lawmakers size up site-neutrality plans that would eliminate the gap, hospitals are unsurprisingly standing behind their numbers, citing their provision of broader care services.

• Telehealth Alleviates Anxiety: For many patients admitted to the emergency room for chest pain, the cause may be anxiety rather than a cardiac issue – but that doesn’t mean treatment isn’t important. A study in JAMA Internal Medicine collected data from 375 patients with low-risk chest pain and anxiety who either received primary-care referrals, peer-supported online CBT, or virtual therapist-delivered CBT. As measured by the 21-point GAD-7 system, peer-supported groups had the greatest average benefit (-5.54 points), with primary care coming in last (-4.32 points).

• Cardiac Rehab at Home: People with heart conditions prefer cardiac rehab at home – shocker. A Vivalink survey of more than 150 U.S. adults with cardiac conditions found that 79% of patients would participate in cardiac rehab, and 68% preferred a primarily home-based or hybrid approach. However, like much of American healthcare, health coverage ranked as the top concern (58%), with 60% unwilling to pay out of pocket. 

Telehealth Has a Ceiling. Here’s How MetroHealth Broke It

For too many patients, traditional telehealth visits often lead to a dead end. To reach its full potential, virtual care needs a reboot. The MetroHealth System partnered with Ovatient to do just that with a new virtual-first care model built on the EHR and connected to patients’ ongoing care journeys. A study of 50k patient encounters shows the results: 100% of patients were able to have a new appointment within 3 days, 35% of virtual primary care patients were net new or re-engaged, and virtual urgent care achieved 17% lower 72-hour ED use than in-person visits. Read the report to learn more about MetroHealth’s approach.

Making Healthcare Feel More Human

Abridge has always believed that the best healthcare technology should make healthcare feel more human. That means focusing on the most human signal we have: the conversation. Head over to CEO Shiv Rao’s latest blog to see Abridge’s vision for bringing the broader healthcare ecosystem into the picture, so clinicians can focus more on the practice of medicine and less on the process of medicine.

State of Payer Enrollment and Credentialing

Over half of provider orgs are losing revenue due to credentialing delays – with many missing out on over $1M annually. Medallion’s new report unpacks the forces quietly undermining operational and financial performance, and how leaders across the industry are addressing them. Check out the full report to get insights tailored to your role and org type.

The Resource Wire

• Turning Ideas Into Action: Healthcare has never been short on great ideas. What is new is the ability to turn them into reality at the pace patients need. Discover how Bunkerhill Health is closing the distance between knowing and doing, so providers can get back the two things they never have enough of: the time and the clarity to care for people.

• The AI Hardware Built for Clinical Work: Phones were never meant to be propped on a desk for a 12-hour clinical day. Heidi Remote transcribes patient sessions offline, stores them securely on-device, and syncs to Heidi whenever you’re in range. Just clip on and get to work with the Heidi Remote.

• 8 Keys to Gain an AI Edge in VBC: As value-based care models evolve and competition intensifies, healthcare leaders are seeking practical strategies to improve performance across risk, quality, and financial outcomes. Head over to Navina’s roundup of eight key insights from VBC leaders to learn how aligning AI-powered tools with organizational priorities and clinician needs can help secure a measurable competitive edge in value-based care.

The Industry Wire

1. New Gemini model finds critical flaw in widely used hospital software.
2. CDC plan to cut disability questions from health survey draws pushback.
3. Grindr pushes deeper into healthcare with PurposeMed acquisition.
4. Women now account for majority of DO primary care physicians.
5. CMS projects lower Medicare Advantage premiums in 2027.
6. Judy Faulkner drives Epic deeper into the hospital C-suite.
7. Governors ask HHS for more time on Medicaid work requirements.
8. Pennsylvania reports fifth measles death.
9. First multi-cancer blood test nears FDA approval.
10. Cleveland Clinic, Inova build ‘second, invisible clinic’ in primary care.