Weekly Health Tech Reads 10/26/25

Regular newsletter readers will know the conversation around prior auths this year has caught my attention. When CMMI’s WISeR model was announced earlier this year, it seemed like a pretty straight-forward effort to me — here were a few areas of spend, like skin substitutes, that clearly seemed to have something odd going on, and this program is intended to help limit that. Particularly for CMMI, which has come under fire in DC for not reducing costs, this seemed like a no brainer. So I’ve been surprised at the amount of backlash in DC and calls from members of Congress to halt the program. Even this week, former CMMI Director Elizabeth Fowler penned an op/ed encouraging a “watchful waiting” posture towards the model, acknowledging the concerns and skepticism, while also acknowledging the real underlying problems it seeks to address.

It goes without saying at this point that prior auths have become a topic that more broadly is seen as the worst of managed care in this county. What is less discussed, though, are the similarities between the conversation we are collectively having today and the public backlash against managed care in the 1990s. To wit, I was fascinated to learn that in 1999, UnitedHealthcare made a decision to remove all prior auths from its plans. I recently had a chance to chat with Archelle Georgiou, who was UHC’s Chief Medical Officer at that point in time, to discuss that decision. You can check it out here.

The decision generated national fanfare at that time, although we discussed in the conversation how it wasn’t as well received by some state regulators and employers. Archelle also shared that this move was made by UHC as an effort to reduce medical spending at the time, a concept that was rather counterintuitive to me, given I generally think of prior auths as a key cost containment tool for payers. It was fascinating to hear her discuss how eliminating them, and replacing with some form of prior notification + care management, could actually generate meaningful savings for a health plan. When I think about the market today, I think about an MA plan like Alignment that seems to be doing quite well compared to the rest of the industry by emphasizing a similar narrative around care management. It’s not hard to see the appeal of such an approach.

So as we think about the broader healthcare crises today in this country, and more specifically the role of prior auths, this conversation was a good reminder to me that we’re dealing with new versions of the same things that we were dealing with 25 years ago. If you’re a policy maker, entrepreneur, or executive thinking about how to navigate all of this change, I think it’s worth listening to Archelle’s experience as you think about navigating the path forward.

It’s a common thought at this point that health systems are significantly ahead of payers in adopting AI tools, which is a key part of what is causing the differential financial performance between health systems and payers the past few quarters.

This Menlo Ventures survey of 700+ executives provided a fascinating visual supporting that point — healthcare has seen a massive uptick in AI adoption over the past twelve months. It has surging from <9% a year ago to 22% today, dramatically outpacing the US economy, which has grown to 9%. But look at the data for health systems versus payers: health systems are at 27%, while payers are only at 14%. It’s generally confusing to me why payers have been caught so flat-footed by this shift, but nonetheless this data seems to support that notion.

This quote below in particular stood out to me. While I know there’s a lot of momentum here, seeing quotes like this in the article give me some pause. I’m not sure that I view it as a positive proof point for the market that an organization like SimonMed is piloting 50+ AI vendors.

Provider consolidation and its malcontents: an interview Olivia Kosloff by Olivia Kosloff and Martin Cech
I thought this was a good back-and-forth between this week about the drawbacks of consolidation and how to better support independent practices. It’s interesting to read about the point Kosloff makes regarding value-based care heading the wrong direction, when so much of the theory of VBC (at least as I think about it) is about supporting independent clinicians in doing right by patients. For VBC proponents, I think it highlights the magnitude of the challenge in driving VBC adoption ahead. Read more

The Concierge Cure? by Lisa Rosenbaum
Speaking of provider independence, there seems to be a renewed interest in concierge care lately as a alternative path forward for a broken primary care infrastructure. This opinion in NEJM is an interesting read on the merits, and drawbacks, of the model. Read more

Scaling Remote Patient Care: The Mechanics of a Paradigm Shift in Chronic Disease Management by multiple authors
An interesting read in NEJM Catalyst about a remote monitoring program that Providence co-developed with Cadence. Across 2,500 patients and nine markets in four states, it has seen some solid results across patients with hypertension, heart failure, and diabetes. It notes that 37% of patients were from rural / underserved areas, which seems notable particularly given the upcoming Rural Health Transformation program and health systems’ interest in helping to manage the $50 billion in funding that will be doled out to support rural markets. Read more