UCSF Chair of Medicine Dr. Bob Wachter

We’re kicking off the spookiest week of the year with a serendipitous study that sprinkled some nice data on the recent AI alignment conversation.

In separate and completely unrelated news, the LA Rams are so back. Maybe. Sorta. Knock on wood.

– Jason Barry, Managing Editor

Artificial Intelligence

LLMs Recommend More Care Than Doctors 

Sometimes a serendipitous study in NEJM AI is just what the AI doctor ordered to round out a great debate with some empirical evidence.

AI alignment is a hot topic. Before the ink was done drying on our top story from last week, we were blessed with a peer-reviewed study comparing the cost of LLM-recommended care to actual care from treating physicians.

• The headline stat: LLM-recommended care is about 3.2x as expensive as physician care.

Here’s how they found it. Researchers compared the diagnostic and referral plans of 24 leading LLMs (20 general-purpose, 4 medical-specific) with those actually made by physicians across 200 outpatient and ED visits. Every order was priced at 2026 Medicare rates.

• AI care averaged $314 per visit, versus $97 for the physicians.
• The gap was split almost evenly between extra tests ($105) and specialist referrals ($111).  

LLMs hate sitting still. While physicians ordered no diagnostics in two-thirds of encounters, AI felt the need to order something in every one of those cases – usually standard tests like metabolic panels, hemoglobin A1c, and lipids.

• Further prompting helped but didn’t fix it. Telling the models to be “cost-aware” cut the gap to 2.5x, and a “parsimonious” prompt trimmed it to 1.4x.
• The extra tests were judged guideline-concordant in about 20% of the cases where AI ordered more. The rest was just more.

Dr. Wachter called it. The UCSF Chair of Medicine had barely finished his essay on the AI alignment problem before this study arrived with “some empirical meat to put on its bones.”

• He agrees with the study authors that the latest findings don’t argue against clinical AI, but rather that its value depends on how it’s deployed.
• He also agrees that the next advance should be systems that recognize “what is enough while balancing patient safety with parsimony.”
• The biggest difference lies in how we get there. Wachter believes “what is enough” isn’t something AI will discover on its own, it’s a value judgment that health systems, payers, regulators, and AI developers “will have to encode deliberately.”

The Takeaway

It probably isn’t great news for already-skyhigh spending that AI is recommending care that’s 3x more expensive than physicians. That said, practicing differently isn’t necessarily practicing worse, and this study left the question open whether AI is tilting toward wastefulness or thoroughness.

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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.

The Wire

• Risant Goes to Oklahoma: Risant Health agreed to acquire INTEGRIS Health, Oklahoma’s largest nonprofit system and the third acquisition of Kaiser Permanente’s effort to “raise the bar for value-based care” after Geisinger and Cone. INTEGRIS is keeping its name and gaining some capital it says it couldn’t raise alone after two years of losses (and Medicare cuts looming). Risant mentioned that it drove a 1% margin improvement at Geisinger and said nothing about Cone, but more acquisitions could be arriving sooner-rather-than later if it sticks to the 4 to 5 health system roadmap it laid out in 2023.
• Ghost Networks Are Real: A secret shopper study in JAMA Health Forum suggests that ghost networks are haunting mental health access. Researchers out of The Ohio State University placed 5,800+ calls to mental health clinicians in major commercial payer directories across five states and booked an appointment less than a quarter of the time. About 60% of calls went unanswered, 56% of those that connected turned up directory errors, and one in five reached providers with no availability. The No Surprises Act already requires accurate directories, which says plenty about the current state of enforcement.
• Notable Launches Flow Compass: Notable introduced Flow Compass, a new layer of its Notable Platform that gives healthcare operators more control over their AI workforce. Flow Compassus lets operators ask in plain language what their automations are doing, where they’re failing, and what to build next. It also generates pre-launch test cases, traces failed runs to root cause, and builds ROI dashboards. Notable says its agents already return 3.2M hours a year, and running that agent workforce is now the job.
• Baba Banks $40M: Baba raised $40M of Series A funding to become the AI-powered care partner for Medicare and Medicaid patients. Every Baba patient has a dedicated care team, including care coordinators and licensed therapists, to ensure that everything is connected from specialist visits and hospital discharges to behavioral health and in-home support. The startup was picked for CMS’s ACCESS Model in June, and just published BabaBench, a benchmark for whether AI agents can finish long-haul tasks like insurer calls and billing fights. 
• Premiums Hit $28k: KFF’s annual employer survey put the average family premium at $28k for 2026 (up 5% year-over-year), while individual plans rose the same amount to $9,804. Workers’ share jumped 9% to $7,471 for family coverage as 44% of large firms shifted more premium onto employees, and 2027 forecasts are approaching double digits. Premiums outran wages (3.7%) and inflation (2.7%) yet again. The other big story was that GLP-1 coverage for weight loss stalled at 18% of large employers, and 79% of the holdouts said they’re not likely to add it.
• Rural Hospitals on the Brink: The AHA says 300+ rural hospitals are at risk of closure or service reductions due to Medicaid cuts in HR 1, which are estimated to reduce federal spending in rural areas by nearly $140B. Medicaid covers 16M rural Americans and nearly half of rural births while paying under 58 cents on the dollar, 40%+ of 1,800 rural hospitals already run negative margins, and 150 have closed or converted since 2010. Expiring ACA credits ($1.6B) only make the math uglier.
• Redesign + ARC + AVIA: Redesign Health is merging with ARC Global, Sheba Medical Center’s innovation arm, and the combined company is acquiring AVIA to form an innovation network for over 100 health systems across five continents. The model embeds technologists inside partner systems to turn frontline ideas into products and companies the institutions share in. ARC brings 31 health systems, 130+ startups, and $6.7B in portfolio value, while AVIA brings 90k users vetting 7,000 solutions. Founding health systems get named in the coming months.
• K Health + Wix: K Health is partnering with Wix to integrate its PatientGPT clinical AI into adaptive web experiences. By combining PatientGPT’s clinical AI that’s grounded in medical records with Wix’s ability to build dynamic experiences, the result will reportedly be “one brain that navigates patients through their health system and knows who they are and what they need with pages that rebuild themselves around each patient in real time.” Should be exciting to see in action.

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.

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.

Privia Accelerates VBC Success With Navina

How do you give physicians new AI tools to accelerate VBC without slowing them down? Privia Health found its answer with Navina. They co-designed an under-one-hour training program that onboarded 800+ clinicians in the first year, driving 87% weekly active usage while providing clearer visibility into their patient panels. Read the full case study to see what it takes to make adoption stick and outcomes follow.

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.

• State of Payor 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. Head over to the full report to get insights tailored to your role and org type.

• AI That Cares: Healthcare isn’t one-size-fits-all. Your AI shouldn’t be either. Tucuvi works with health systems to deliver personalized care to their unique populations, from routine administrative tasks to the most complex clinical workflows. See why leading healthcare organizations trust Tucuvi to support their care teams.

The Industry Wire

1. Quest Diagnostics confirms cyberattack compromised patient data.
2. Big Tech backs CMS effort to expand electronic prior authorization.
3. Trump administration proposes new curbs on China biotech deals.
4. AvaSure names 2026 AvaPrize honorees for virtual care innovation.
5. Mark Cuban sets sights on rare disease treatment.
6. Bedside nurse turnover hits 18%.
7. Startup claims to use A.I.-created viruses to treat a patient.
8. A top MAHA adviser is leaving the White House.
9. Flu hospitalization rate hits highest October level since 2010.
10. Beth Israel Lahey Health founds new center to test AI safety.