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Like many of you, I’m journeying out to SF later today for JP Morgan 2026. I’m excited to be covering the company presentations this year and sharing my perspectives on what is being discussed in a pop-up newsletter that we’ll send at ~6am PT daily throughout the week.
If you want my takeaways on what’s happening each day, I’d encourage you to sign up below. Some specific topics I’m keeping an eye out for:
AI: Everyone’s favorite buzzy topic. Abridge, Open Evidence, and Open AI are all on the docket, and more. Given all the news from last week, OpenAI will be particularly timely.
VBC: Astrana, Cityblock, Somatus, ThymeCare, and others should provide an interesting update on the state of VBC. I’m especially curious to see how the specialty VBC market is evolving.
Government programs: while the big insurers are absent, Clover and Alignment will provide updates on the MA market, and I’ll be curious to hear what providers have to say about ACA/Medicaid market shifts.
You can check out this page for more details, including the current list of companies Martin and I plan to cover.
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AI
OpenAI’s healthcare PR efforts go warp speed this week
OpenAI was all over the news this week, sharing a number of updates:
First, OpenAI released a rather interesting report called “AI as a Healthcare Ally”. This report in and of itself is worth spending some time musing on as it dives into how people are using AI. Axios had some nice coverage of this report on the 5th, highlighting how 40+ million people globally are using ChatGPT daily for healthcare information. Most interesting to me was the stat that almost 2 million messages a week are sent on ChatGPT about understanding health insurance. You know who I’m sure is thrilled about this report? Consultants pitching work to help both health plans and health systems rethink their front-door strategies. Understandably, there is going to be a lot of conversation about how healthcare brands compete for attention in this new environment. As Martin and I have been discussing in various settings recently, I continue to think that having a more human “front of house” strategy is a winning move here. Anyways, I digress from OpenAI’s week…
On Wednesday, OpenAI announced ChatGPT Health, a consumer-facing PHR-type tool. I’ve lived through too many PHR announcements at this point to get excited about another one, but given the amount of use that OpenAI is citing above, perhaps this time will be different. Brendan Keeler had some really good analysis over here. Healthcare startup b.well seems like a potential big winner in this, as OpenAI is partnering with them for the underlying interoperability infrastructure.
On Thursday, OpenAI announced OpenAI for Healthcare. This includes two separate offerings, ChatGPT for Healthcare and OpenAI API. ChatGPT for Healthcare is an enterprise offering already in use at a number of leading health systems — AdventHealth, Baylor Scott & White Health, HCA, Memorial Sloan Kettering, and others. The offering includes a suite of capabilities, including clinical search, care pathway management, and referral letter generation. This is, in my opinion, the most fascinating development of the week, as it moves OpenAI more directly into competition for the attention of providers with the OpenEvidence/UpToDate/Doximitys of the world via an enterprise-centric approach. And those seem like some meaningful health system names to launch with.
Phew. That wraps my understanding of everything OpenAI shared this week. If any other company made two announcements in two days about how it was launching both a consumer-facing PHR offering and an enterprise-grade AI platform for health systems, I think the central thrust of the conversation would be questioning how much chaos must be occuring that organization and whether it is remotely feasible for a company to execute on these strategies simultaneously. The degree of difficulty in executing all this seems near impossible.
Yet at the same time, when you look at the utilization numbers in the report from early in the week, combined with the health systems already signed up for the enterprise offering, perhaps OpenAI has enough momentum to pull this off? Will be interesting to hear the discussion at JPMorgan, that’s for sure.
AI
Doctronic & Utah launch pilot testing AI for medication refills
In other AI news this week, Doctronic and the state of Utah announced they launched a pilot program last month to test the use of AI to help patients refill medications. Politico’s coverage did a nice job discussing the pilot, which is limited in scope and has a number of guardrails in place as they roll out the approach. Nonetheless, it does seem like a meaningful step forward, both for Doctronic and how AI is being integrated into clinical care more generally. A few hundred patients have signed up for the pilot at this point, and Doctronic expects a few additional states to make a similar move in 2026. Notably, Doctronic secured a medical malpractice policy for this work, underscoring its view of this activity as the practice of medicine.
I had the chance to chat with Doctronic’s Co-Founder, Dr. Adam Oskowitz on Tuesday, which you can watch here if you want to go deeper into the regulatory strategy, how Doctronic is rolling out the pilot, and the implications for ‘Doctronic 2.0’:
It was particularly interesting to hear about how Doctronic is working to drive patients to its prescription refill website, which involves a hands-on approach, going to local pharmacies and talking to them about the benefits, and will expand from there. It’s a good reminder of the human element of all of this, and it seems Doctronic is taking a thoughtful approach to building awareness — and trust — in the local market.
If you want to keep thinking more about this news, I also went deeper in Slack this week on my takeaways from the conversation.
Revisiting the VBC Topic of the Week
Here are the responses to the VBC survey from last week. 41% of the 379 people who responded to the survey are in the camp that VBC isn’t there yet, but is heading in the right direction. Only a few of us think it has been a clear success. Meanwhile, 47 people (12%) responded that it is time to move on from VBC:
Source: HTN 1/4 Newsletter Poll; 379 total responses
In addition to the survey responses, there were a number of really thoughtful comments you all shared about why you selected the answer you did. Rather than try to summarize them all, I’ve put them in a Google Doc that you can peruse here (I removed any identifiable details from responses).
I also had the chance to interview Aledade’s CEO, Farzad Mostashari, this week. In any conversation I have on VBC, Aledade comes up as a leading example of how to implement in a principled, successful way, so I think it’s a great example to consider when answering the question above.
Farzad and I talked about Aledade’s recently announced credit facility and some of the more technical aspects of VBC models; how he thinks about expansion beyond MSSP into MA, commercial, and Medicaid; and how he thinks about broader questions of where VBC is headed — it’s a good case on the more optimistic side of the spectrum, in my opinion:
Other Top Headlines
CMS leaders shared at the Consumer Electronics Show that it is releasing an RFI for a new claims processing platform for Medicare FFS claims, which is now available here. This seems like a big move if CMS indeed replatforms claims processing from its 1970s-era COBOL system to a more modern system. It’s interesting to think about which platform CMS would move to, given that there don’t seem to be many feasible options out there. Some may recall that when Brad Smith wrote his oft-cited NEJM article about CMMI’s progress at 10-years, one of the examples given about the operational challenges that hampered CMMI models was that the Next Generation Accountable Care Organization model saw a $50 million loss because its antiquated systems incorrectly applied the demonstration code to thousands of claims.
Also at the Consumer Electronics Show, the FDA announced it will relax oversight of some AI and wellness products. Not surprisingly, organizations like Whoop (which had previously received a warning letter from the FDA in July 2025 regarding its blood pressure insights feature) applauded the move.
Novo announced that its Wegovy pill is now available for consumers in the US via a number of channels, including CVS and Costco pharmacies, Ro, LifeMD, Weight Watchers, NovoCare Pharmacy, and GoodRx. Ro issued a press release as well about the news, which I imagine will drive solid growth for them in 2026, along with the other brands listed. The GLP-1 market continues to make for a fascinating exercise in branding as various players navigate how to get consumers to their sites to purchase weight-loss meds.
Novo also launched its first “State of Weight and Health Report,” exploring what it calls the Obesity Trap in this country and highlighting the various challenges facing people living with obesity.
Altaris Capital acquired Tegria, a technology services provider to health systems, from Providence. Providence originally launched Tegria back in 2020 as a combination of nine services businesses that collectively had 2,500 employees supporting 350 health care organizations.
Sky News is reporting that TPG is in talks to acquire Optum UK from UHG for £1.2 billion -£1.4 billion ($1.6 - $1.8 billion), with a deal potentially announced in the coming weeks. Optum UK provides EMR software for GPs in England. UHG originally purchased EMIS for $1.5 billion back in a deal announced in June 2022.
Dr Oz sent a letter to Minnesota Governor Tim Walz on Tuesday notifying Walz that CMS is reviewing past quarterly receipts from the state and that it will defer and withhold Medicaid funding moving forward if needed to address fraud. CMS further noted it has identified 14 Medicaid programs in Minnesota at high risk for fraud, finding “extraordinary growth in provider enrollment and payments” while finding the state hasn’t taken action. Collectively, those 14 programs have cost $3.75 billion in state and federal taxpayer dollars, per CMS.
Amazon One Medical is now partnered with Rush University System for Health in Chicago, moving on from its long-time partner in the Chicago market, Advocate Aurora. One Medical and Advocate Aurora originally partnered back in 2019. It’ll be interesting to keep an eye on this trend in other markets, as this now makes two geographies where One Medical has switched partners — it also recently switched to Monefiore in Manhattan, after partnering with Mount Sinai in 2019.
Walmart announced a new offering called Better Care Services, a website that curates virtual care offerings for customers, including LillyDirect.
IntelyCare acquired CareRev, combining two staffing platforms.
Funding Announcements
Pomelo Care, a maternity care model, raised $92 million at a $1.7 billion valuation. Stripes led the round. The press release notes that Pomelo Care, which focuses primarily on Medicaid and employer populations, is now up to 25 million covered lives. It supports 7% of births in the US. It is using the funding to expand beyond maternity to women's and children’s healthcare more broadly.
Apella, an AI platform for ORs, raised $80 million in equity and debt financing. The Series B round was led by HighlandX, with Houston Methodist and others also participating. The press release notes that Houston Methodist, Tampa General Hospital, and MUSC are customers here, with hospital customers averaging a 5% increase in surgical volume.
Protege, a real-world data platform, raised $30 million. a16z led the round.
Canopy, a safety platform for health systems, raised $22 million. 111° West Capital and ACME Capital led the round. Canopy currently works with 300,000+ employees across 60 health systems.
Oasys, an AI operating system for behavioral health clinics, raised $4.6 million. Pathlight Ventures led the round.
Ethicos Health, a new model for specialty pharma prior auths, raised pre-seed funding. Flare Capital and others invested.
What I’m Reading
Making AI work for us: The Defining Health System CEO Leadership Challenge of 2026 by Tom Cassels, Seth Frazier, Tracey Massel, Jared Augenstein
A team at Manatt put out this report this morning, but on a quick skim, it seems to include a number of thoughtful takeaways on how health system leadership should be thinking about the adoption of AI.
Read more
Hospitals Are a Proving Ground for What AI Can Do, and What It Can’t by Te-Ping Chen and Chao Deng
This was a good article in the WSJ about how health systems are adopting AI, noting the recent Menlo Ventures report citing that 27% currently pay for commercial AI licenses. It does a nice job describing both the promise and the challenges in how some systems are implementing AI. Specifically, it discussed how Mount Sinai has seen a $12 million lift from overturning insurance denials, while it had to pause use of an Epic tool that attempted to generate messages from doctors to patients. Apparently, the tool was making mishaps, thankfully in relatively low-stakes situations — like telling a patient who asked for a walker that it couldn’t help them.
Read more
“Bullsh*t” — The New Way Health Giants Hide Billions by Laura Wadsten and Nathaniel Horwitz
A team from Hunterbrook Media published an expose on the GPOs owned by the big three PBM organizations that has been making the rounds, though I don’t think there’s much new here beyond the fact that the PBM GPOs may work remotely. Most of the financial discussion in the article rests on a 2023 Nephron Research report, which I find to be a much more nuanced discussion of PBM financials and how GPOs (and specialty pharma) have been an increasing piece of PBM profits over the past several years. This all seems like a complicated mess I can’t make heads or tails of, and given we’re in a cultural moment where complexity and opacity invite skepticism, it’s easy to see why articles like this gain momentum.
The one thing that always confuses me with the type of narrative in this article: it notes how employers are already moving beyond the Big 3 PBMs to more transparent offerings. So if this GPO stuff is such a blatant way to hide billions of profits from employers, shouldn’t the market work through this problem pretty quickly? Presumably, if employers are tired of this behavior, they now have options and can vote with their feet, no?
Read more
UnitedHealth Group Medicare Advantage Risk Adjustment by FTI Consulting
UHG released the report from FTI Consulting examining UHG’s risk adjustment practices. It’s a pretty nerdy 33-page document that walks through UHG’s risk adjustment policies and finds that appropriate policies and controls are in place internally. It’s interesting to contrast this report with the above discussion — when large organizations explain what’s going on and it’s actually pretty mundane, it seems to get a lot less attention than the earlier finger-pointing. Again, seems reflective of the current cultural moment we’re experiencing.
Read more
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