Check out my exclusive with Dr. Charles "Chuck" Saunders on the day he was named the new chief clinical transformation officer and president of Value-Based Care Enablement at @Lumeris. Chuck will run the company’s VBC enablement business and lead clinical development and adoption of Tom, Lumeris’ AI-powered primary care as a service platform.

A new coalition, the Association for Direct Care, has launched with a mix of health systems, physician advocacy, and employer-purchaser muscle behind it. The mission is to get more employers and clinicians dealing directly with each other, cut out the administrative bloat, and bring some transparency to how care gets purchased. Alyssa Simpson Rochwerger, co-founder and CEO of Grounded Health @getgroundedhlth, which joined the coalition, explained, “Every other dollar a company spends is visible. Finance can see software spend, travel spend, payroll — down to the transaction. Healthcare is the one place where an employer pays the bill and never sees the receipt.” Direct contracting is being pitched as the fix: real access to claims and pricing data, less middleman, more accountability. What they're actually asking for: • Expanding direct contracting across commercial markets and federal health programs • Better access to healthcare data • Fewer regulatory/administrative barriers standing between patients, employers, and providers I have to wonder how much traction this gets with Congress in the near term, but the timing tracks. Indiana's already built laws specifically enabling direct-to-employer arrangements, and groups like this tend to be a signal that a policy push is coming, not just a press release. Worth keeping an eye on who else joins in the coming months. Press release: Learn more:

What I'm hearing from health system finance leaders: AI is supposed to fix margins. What I'm seeing: denials are climbing, coding is more complicated than ever, and out-of-pocket costs are up. Something doesn't add up. So I’m hosting an off-the-record retreat for CFOs and RCM execs to problem solve. The Hospitalogy AI Retreat Nov. 2-3 in Phoenix

Leaner plan benefits, higher rates, and a lot of confusion for consumers. I spoke with @GydeInc co-founder and CEO, @Will_Johnson, about how Gyde gives brokers the tools to meet this moment and guide consumers through it. Watch the full episode in this post. Listen on Apple: Listen on Spotify:

You guys know I have been interested in the rural health transformation efforts and whether things will be truly transformational. Well, CMS just dropped its first obligated funds report for the Rural Health Transformation Program, showing how each state has obligated RHTP funds (as reported by the states themselves) between December 29, 2025 through July 31, 2026. Year One officially closes on October 30 so there's more reporting to come. CMS plans to refresh the numbers once states submit their November 30 quarterly reports, then quarterly after that. Here's how I broke down the first report card in Tuesday's issue of Hospitalogy (for a look at some notable spending examples, check out the full article here: 1. How much has been obligated So far, states have obligated roughly $4B of the almost $10B awarded across all 50 states for Year One. 2. Pace varies widely by state 10 states had obligated at least 75% of their award by July 31; Georgia, Hawaii, and New Hampshire had committed 100%; and 15 states had obligated less than 10%, including New York and West Virginia at exactly $0. Texas, which received the largest Year One award ($281.3M), had obligated just 18.9% ($53.3M), a reminder that award size and obligation pace move independently. Six of the slowest states — Alabama, Arkansas, Florida, Idaho, New Mexico, and Wyoming — reported that every obligated dollar so far went to program operations (staffing, administration, grant management) rather than to any of their actual initiatives. 3. Where the money is going Technology-related categories (IT Advances, Consumer Tech Solutions, and the technology-relevant share of Innovative Care) account for roughly 22% of obligated dollars (about $876M), making technology the single largest theme in Year One spending so far, just ahead of workforce (about $651M, 16%). Within the technology bucket, three sub-areas stand out: • Telehealth and virtual care, approx. $143M obligated, with 20 states reporting activity • EHR/EMR modernization, approx. $154M obligated, with 15 states reporting activity • HIE and interoperability, approx. $141M obligated, with 18 states reporting activity Chronic disease prevention and management (about $481M, 12%) and capital expenditures/infrastructure (about $280M, 7%) round out the largest named categories. Meaningful obligated dollars also sit under categories like Appropriate Care Availability, Behavioral Health, and Program Administration. More than half of obligated dollars sit in line items that describe a use rather than naming a recipient type (state agency, contractor, hospital, etc.). Hospitals show up in some states' line items (38%), but very few name specific hospitals. 4. What's next Up to $40 billion more is scheduled to flow over the next 4 years of this 5-year, up-to-$50B program. But, per a companion GAO review of CMS's implementation, each state's share depends on demonstrating 'satisfactory progress' toward its approved initiatives, and CMS may withhold, reduce, or recover funding for noncompliance. States have limited ability to appeal those decisions under the program's authorizing legislation. CMS report PDF:

I’ve set the agenda for the Hospitalogy AI Retreat, 11/2-11/3 in Phoenix...an opportunity for health system senior leaders to navigate healthcare’s hardest problems with their peers. The agenda: • Reorganize or Explain: Healthcare’s AI Fork in the Road. Dr. Jonathan Slotkin of Geisinger on what’s real, what’s vaporware, and the governance frameworks Geisinger runs on. • Who Has to Say Yes: AI Governance and Physician Alignment. I’m moderating Dr. Neil Gheewala (US Heart and Vascular), Michael Batt (Hall Render) and Dr. Nadia Smati (Faculty at Houston Methodist and Partner at Ainsley Health) on the gap between the C-suite that bought the tool and the clinicians who will (probably) use it. • Hardwiring Trust and Social Capital in a Time of Turmoil. Dr. Tom Lee of Press Ganey on why trust is the rate-determining step in AI adoption. • Hospitalogy Hot Seat. No slides. Attendee participation. This is going to be a lot of fun. Content runs two hours a day. The rest is roundtables, 1:1s, workshops and probably some golf. Travel and hotel are covered for approved attendees. Apply here: @GeisingerHealth @HallRender @MethodistHosp @PressGaney @Hospitalogy_HC

Which model won after Jefferson Health and Lehigh Valley Health Network merged? Dr. Baligh Yehia says that’s not the question Jefferson asks. In this week's Claims Denied episode, I sat down with Dr. Yehia, President of Jefferson Health, to talk about running a 33-hospital system that wants to be an operating company, not a collection of hospitals. He breaks down how Jefferson Health is integrating LVHN, why the team lets AI-era rebuilds replace the usual model bake-off, and what it takes to align incentives when a payvider only covers part of your patients. Listen on Apple: Listen on Spotify: In this episode: • Why “standard as possible, different as necessary” is the default Jefferson is building around, and why quality came before back office in the LVHN integration • Why payviders are one of the few models that can truly align incentives, even with no commercial book (Medicaid, Medicare Advantage, and ACA only), and how Jefferson still removes friction, like skipping prior auth for plan members moving to the next site of care • The goal of handing 10 million hours back to clinicians in 3 years • “Nursing out loud”: ambient for nurses is in 3 pilots, and the early wins are nurses eating lunch and clocking out on time • Why AI won’t fix misaligned payment models, and will just run automated denials and automated appeals at machine speed @TJUHospital @LVHN @Hospitalogy_HC

A new report from Prosper AI estimates specialty practices are missing up to $125K per physician every year across 4 areas: missed calls, lapsed patients, avoidable denials, and unpaid patient balances. The report suggests these aren’t separate problems; they’re 4 connected levers practices can pull to capture this missing revenue with AI voice agents. The first lever: preventing missed calls. 18% of calls to practices go unanswered during the day, and 81% after hours. One plastic surgery and dermatology group that uses Prosper AI to handle its calls saw appointments booked rise 17% in August 2026 vs. the year before (an additional 3,315 appointments across 37 providers), and peak wait times fell from 7 minutes to zero. Using an industry benchmark of $392 per dermatology visit, Prosper AI estimates those extra appointments are worth about $1.3M for that month. The report lays out the path for how each lever feeds the next. Using AI to avoid manual administrative errors and to verify benefits ahead of a patient visit help prevent denials. Ensuring patients know their costs upfront makes them more likely to show up, and more likely to pay. A practice that's easy to book and clear on cost stands out, which brings in new patients and starts the cycle again. Macroeconomics are out of practice leaders' hands. These levers are not. And Prosper AI's new report covers the strategies to pull them. Get the full report here: In collaboration with @ProsperAI_HQ

"Shift as much left as you can." That's one way Melissa Hannan, VP of Product, says R1 (@R1RCM) is helping hospitals and health systems reimagine the revenue cycle workflow and avoid costly mistakes.   Melissa sat down with me recently to discuss Phare Utilization Management, the newest extension to Phare, R1's revenue cycle management operating system (Phare OS). Phare UM is AI-driven case review across 100% of encounters, continuous chart analysis, and payor-specific denial likelihood, all built to catch risk upstream, before it becomes a denial. We discussed how clinical judgment and payor intelligence come together, and why the physician advisor's expertise stays central while the mundane stuff gets stripped out. Check out the clip of our video together below, where Melissa describes how Phare UM changes how risk gets caught, not just reviewed. You can view the full video here: (In partnership with R1) @Hospitalogy_HC

Claims Denied is back for a new season! Thrilled to kick it off with @Will_Johnson, co-founder and CEO of AI startup @GydeInc ( I drove down from Dallas to Austin to sit in-studio with Will, who was 17 months post-incorporation at the time, with a decade at @OscarHealth behind him. Will brought a thesis I hadn't heard anyone articulate this cleanly: Healthcare's real front door isn't the carrier or the PCP. It's the broker, and there are fewer of them every year while the job gets harder every year. We get into why Will thinks commission rates stay flat while ACA premiums rip 14%, why an AI founder calls himself "a huge software bear," why roll-up is a banned word inside his own M&A shop, and the Capstone deal he thought was dead until a February coffee in Austin. Healthcare keeps trying to go around the broker. This episode makes the case for going through them. Check out this highlight video and get the full conversation at the links below: Listen to the full episode on Apple: Listen to the full episode on Spotify: Watch on YouTube:

You probably missed a lot of healthcare news, analysis, and resources in September. Don't worry! Catch up with Hospitalogy's September recap issue here: I talk about this and more: • @BCBSAssociation report on what they characterize as AI-enabled RCM upcoding • @OrtetAI launches as Frontier AI Lab for Health with $500M commitment from Thoreau • @Cigna investor day highlights • M&As announced this month • Notable investment news and funding @Hospitalogy_HC

Every health system's roadmap for the last 3 years: point AI at the back office. Ambient docs. Coding. Denials. All correct. All now table stakes. My newest deep dive on Tom from brand partner @Lumeris explores: • Why the next battleground for AI is access • What changes when labor stops being the constraint • Why the EHR can't be your source of differentiation • How AI is helping healthcare leaders rethink primary care Check it out:

Thomas Lee, MD has been an incredible thought leader in this industry for decades and we get to learn from him live at the Hospitalogy AI Retreat! Dr. Lee is CMO at Press Ganey and Editor-in-Chief of NEJM Catalyst. Practicing internist and cardiologist at Brigham and Women's Hospital. Harvard Medical School faculty. Former Network President of Partners Healthcare Group. He's written 9 books and 500+ articles in NEJM, Harvard Business Review, the Times, and the Journal. The man has been thinking about what makes a health system trustworthy longer than most of us have been in the industry. And he's speaking at the Hospitalogy AI Retreat this November. If you're interested in meeting Tom and hearing his off-the-record take on patient trust as AI moves into the exam room, apply to join us at the Hospitalogy AI Retreat. It's happening this fall (November 2-3) in Phoenix. We're covering your travel. @ThomasHLeeMD @Hospitalogy_HC @PressGaney @nejmcatalyst @harvardmed @BrighamWomens @HarvardBiz

Most health systems don't have a UM system. They have four disconnected teams doing four different reviews — utilization review, physician second-level review, payor peer-to-peer, and clinical appeals — with zero shared feedback loop. R1 fixes that with Phare Utilization Management, the latest expansion to Phare, healthcare’s first revenue operating system (Phare OS). Check out my deep dive to see how Phare UM is delivering early results like first-level reviews in under four minutes, half resolved without a human touching them: Written in collaboration with R1 but, as always, 100% my take.

Without the right VBC playbook for 2027... Miss the documentation, fail the audit. Miss the care gap, lose the quality score. Miss both, and you're losing money on the contract. On 9/30, I'm talking with Dana Brandenstein, VP of Provider Enablement at @PriviaHealth, and Dana McCalley, VP of Value-Based Care at @Navina_ai, about what separates the teams that are ready for 2027 from the teams that aren't. We'll discuss: • Why retrospective workflows and delayed follow-up put revenue and audit readiness at risk. • What audit-ready documentation looks like under V28 • How leading organizations stop work from getting lost between teams and tools • Where AI can give your team back time for patients, not paperwork We'll also run through a self-assessment so you can see where your org lands. Join us live or RSVP for the recording.

2026 really is the year of the health consumer, starting with all aspects of primary care. Off the top of my head, look at what has happened in the first 9 months of 2026 alone: Anyone can order advanced lab testing from their phone. Apple announced it at a $119 price point, alongside more accurate heart monitoring and bifurcated HRV. They also cloned most of WHOOP's feature interface in the process, which leaves form factor as one of the last real differences between the two. Whoop is still very much a core player here, and just raised dang near $600M at a $10B valuation. Fitbit (now part of Google) Air is coming at the category from underneath with Google behind it and no subscription attached to the hardware. ŌURA is going public at a reported $17B+ valuation on over a billy in revenue, with material moves into traditional healthcare settings. DTC telehealth isn't slowing down one bit, between the grifters and the pill mills now selling peptides and compounded GLP-1s next to the labs and the ED meds. Amazon's One Medical announced a slew of AI-enabled offerings, and remains a major pharmacy and primary care provider. And we'll keep seeing new entrants blending direct primary care, longevity (Function Health), and concierge care — all AI-enabled, all offering countless peptides, tests, and technology alongside actual physicians. Which begs the question of which DTC and general consumer players have staying power versus which ones churn out once the novelty (and the funding) wears off. What I'm wondering is...what is the evolving role of primary care when you can order labs through your iPhone, Whoop, or Oura app and then self-assess through AI before anyone in a white coat ever sees the results? I'd welcome thoughts around where you guys see the space evolving, particularly traditional primary care in the midst of all this chaos. It's a brave new world. @Apple @ouraring @onemedical @Google @function @WHOOP

Jonathan Slotkin is speaking at the Hospitalogy AI Retreat this November. He's CMO for Strategy and Growth at @GeisingerHealth. Practicing neurosurgeon. Co-founder and GP at Scrub Capital. Co-founder of Contigo Health. His take on self-driving car safety made it into the Congressional Record. His writing regularly appears in Harvard Business Review, STAT, and Noema Magazine. He has authored more than 70 peer-reviewed scientific publications. The man is a legend. If you're interested in meeting Jonathan and hearing his off-the-record take on healthcare's adoption of autonomous systems, apply to join us at the Hospitalogy AI Retreat. It's happening this fall (November 2-3) in Phoenix. We're covering your travel. @Hospitalogy_HC

Where is employer-sponsored insurance heading? We're talking about in this episode of Claims Denied. I recently sat down with @AhmedMarmoush, CEO and co-founder of Handl Health, fresh off their Series A. Ahmed's path is unlike any guest I've had: clinical pharmacist in New Zealand's single-payor system, to a consultant alongside the country's former Director General of Health, to an $800 bill for a routine physical in LA that turned into a company. (They offered him 50% off if he paid within a few days. He compared it to haggling in an Egyptian street market. He's not wrong.) We get into why cost shifting is dead, how variable copay plans really work, what's inside Handl's value index, and why he's betting on being the enablement layer between brokers and carriers instead of building yet another health plan. If you touch benefits strategy, brokerage, or health plan ops, this one's worth the commute. Full episode in this post. TIMESTAMPS (01:35) From pill counter in Auckland to founder in LA: what a single-payor upbringing teaches you about US healthcare (and why healthcare repeats itself every 10 years) (13:30) The $800 "free" physical, the 50% phone discount, and haggling with hospitals like it's a Cairo street market ("Welcome to US healthcare") (17:12) Price transparency files were a goldmine nobody could read: how Handl went from data vendor to plan orchestrator for 800+ brokers (23:52) Cost shifting is dead: variable copays, shopping by episode instead of CPT code, and the end of point-solution sprawl (28:13) Inside the value index — cost, quality, appropriateness — and why "tier and steer" is the whole ballgame (36:13) Selling outcomes instead of software: AI turns a high-touch services business into a product (47:22) Why Handl is building the enablement layer between brokers and carriers, not another health plan @Hospitalogy_HC

NEW POD DROP: I sat down with Dr. Ramon Lizardo, ER doc turned 3-time operator turned investor, and former CEO of @Tele911_. Ramon shares his impressive journey: Getting into medical school on a single borrowed application he found in his backpack a month later. He left a $300K+ clinical job for $40K base and a $25K bonus, with debt. Then he built a company that turned Baltimore, Fort Worth, and San Francisco into cities where calling 911 puts a physician on your screen in 37 seconds. When the Key Bridge collapsed, the city called him at 3 a.m. and asked him to go live early. We talk about the physician hierarchy, why nobody teaches doctors how money works, and the digital health profitability problem. Ramon also told me, on the record and before anyone else, where he's going next. Ramon even suggested a working title for the episode: "Health Tech Physician-founder Can't Control His Children" (His 5-year-old and 8-year-old were negotiating a treaty in the next room the whole time.) This is the best kind of episode. Genuine, honest, and one not to miss! Full episode in post. TIMESTAMPS (00:01:47) Know your reports' kids' names (00:05:08) One borrowed application, one doctor (00:13:34) Nobody teaches doctors finance (deliberately) (00:26:56) $300K clinical to $40K base (00:36:16) Own the pipes, control the market (00:37:45) He invented the rate card (seriously) (00:53:22) A psychiatry skeptic changes his mind