👋 Welcome to my Sunday recap of healthcare news, as we enter month 3 of the singularity 2026. This edition features another busy week in healthcare innovation land, as Q4 earnings season wrapped up for a number of VBC / MA companies, along with healthcare’s favorite malcontent. There were some notably different reactions to the 2027 Advance Notice than earlier in earnings season. I think it’s worth checking out my convo with Alignment’s CEO, which featured some interesting insight into its clinical model and how that is driving consistent performance in MA. Last, but not least, I found it hard to ignore all the AI prediction pieces these days, so I thought I’d share my favorite piece of AI thought leadership from a certain Dunkin’ Donuts spokesperson. Enjoy!

- Kevin

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MUSING

Ben Affleck, the AI abundance / apocalypse, and healthcare

The broader market conversation around AI disruption felt like it reached a fever pitch this week, with Cintrini Research’s dispatch from 2028 spooking the market early in the week and then Jack Dorsey proactively laying off almost half the staff at his company, Block, due to expected AI productivity gains. Or perhaps mismanagement. FOBO (Fear Of Being Obsolete) is apparently now a thing. But also, it has been growing for years now.

Cintrini does an effective job of sketching a scenario two years from now in which we’re essentially the humans in a less-pleasant version of Wall-E. White-collar jobs are replaced by an abundance of AI agents, which quickly eliminate the need for jobs and trigger an economic collapse because nobody can afford their mortgages anymore. Adding insult to injury, the cute robot cleaning our garbage doesn’t seem to exist in Cintrini’s world, which is a bummer.

To me, the Cintrini scenario seems more likely to make for a good sci-fi thriller than reflect reality in 2028. Back here in the real world, Dunkin’ Donuts brand ambassador Ben Affleck recently expressed one of the most interesting perspectives I’ve heard on AI, on The Joe Rogan Show of all places. Affleck argued that while AI will certainly change a lot, ultimately it will be a productivity-enhancing tool for industries like Hollywood. Citadel Securities piled on here and also penned an excellent rebuttal of Cintrini, making a similar argument to Affleck, just backed with the kind of data you’d expect from an economist. It concludes that AI may be just enough to offset the headwinds facing our economy and keep it growing at around 2% GDP.

The conversation feels similar to the Financial Times chart from a few months ago that has been making the rounds, highlighting the bizarrely wide range of potential outcomes being discussed here (the FT chart is a stylized version of a chart from the Dallas Fed in June 2025).

What I’ve found most interesting in conversation this week is applying the Cintrini-style thinking to healthcare, specifically how the industry's labor inputs might change by 2028.

It's not hard to envision the scenario where a massive amount of job loss could occur as healthcare companies go through Block-style restructuring exercises and lean in on becoming “AI native” organizations. Virtually all of the back office roles that exist to help manage the friction that has been created in US healthcare over the past fifty years seem ripe for automation, right? That’s what, hundreds of thousands of jobs? Millions? This is before we even touch the third rail conversation about care delivery and the clinical workforce. What are all those people going to do? How will safety net programs function? The doomer scenario seems very tangible here.

Yet at the same time, I was just writing in this newsletter a few weeks ago about the most recent jobs report, where healthcare jobs are the one area of the economy consistently growing. This occurred while one of the top healthcare topics in 2025 was the rapid adoption of AI by health systems for RCM use cases, which was driving financial outperformance (and underperformance for payers). Shouldn’t we already be seeing evidence of job loss given that? Or how about the infamous example of radiologists, a profession that has done a remarkable 180-degree turn in Silicon Valley narratives. In a decade, Silicon Valley seems to have gone from viewing radiologists as the profession most likely to be obsolete to the leading example of Jevons Paradox, as radiologists appear to be doing better than ever. Although perhaps that isn’t evidence of Jevons Paradox.

It’s all a very confusing mess that makes my head hurt. If one thing is clear, it is that we are in a period of dislocation as we grapple with what the world will look like moving forward.

I am curious what you all think about what the healthcare jobs picture will look like in 2028 — if you’re looking at a Department of Labor jobs report in mid-2028, do you think there will be more or fewer people working in healthcare? I’ve broken it down by overall and white-collar versus blue-collar jobs, as I think it’s worth thinking through all those shifts.

My personal hunch: the overall number of healthcare jobs will increase, with some declines in white-collar jobs more than offset by increases in blue-collar jobs. Said differently… I tend to think the 2% GDP growth scenario will play out, but underneath that, we’ll continue to grapple with hard questions about growing inequality in a hyper-capitalist society.

Public Markets Updates

Lots of big stock swings in the VBC / Medicare Advantage market this week following earnings calls. Will run through some of the key earnings calls takeaways below:

  • Hims reported on Monday, with its stock falling another 7% on the week. Hims side-stepped much of the GLP-1-centric drama over the past few weeks, instead going out of its way to repeatedly note how little of its business is compounded GLP-1s today and how unconcerned it seems with the GLP-1 mess it is in. International growth is becoming a central piece of the Hims story, as they shared plans to rapidly expand in the top 10 international markets on the heels of recent acquisitions, before focusing on profitability in those markets later. If you trust the management team's narrative, there is still a compelling one here, as they expect to grow the business to $6.5 billion in annual revenue and $1.3 billion in Adj EBITDA by 2030, up from $2.3 billion and $318 million today, respectively. As I shared in Slack this week, if you took away all identifying details and told me a company generating $2.3 billion of revenue, growing 59% YoY, with an Adjusted EBITDA margin of 14%, is only trading at an enterprise value around $3.8 billion, I’d tell you that seems like a great investment. Yet when you tell me that the company is Hims, and their management team neglected to mention on the earnings call that they’re under SEC investigation, after all the recent shenanigans, I very much see why investors are skeptical here.

  • Evolent traded up 25% for the week after reporting strong growth, specifically in oncology. The oncology business is expected to be 65% of Evolent’s revenue in 2026, up from only 36% in 2025. Evolent is seeing a ton of new business, with its 2026 cohort generating $900 million of revenue, up from its previous estimate of $550 million. The call featured some interesting nuggets about how Evolent’s approach is proving particularly effective in oncology, where a single tumor type can have up to 200 different care pathways today. The ACA business is a notable drag on Evolent’s 2026 results, as its two largest exchange customers decreased their membership by 60% and 40%. If you’re interested in VBC, especially specialty VBC, I’d encourage you to listen in here.

  • agilon stock is up 31% after it charted a path to Adj EBITDA breakeven in 2026, a vast improvement from a loss of almost $300 million in 2025. It has been on a significant recontracting effort in 2025, noting in part that it shed ~50k MA lives that didn’t align with its approach of prioritizing profitability. agilon’s three largest customers are Aetna, Humana, and UHC, so it’s interesting to consider who will take back that bad risk in 2026.

  • Alignment Health reported on Thursday, and despite exceeding the high end of guidance on all metrics, its stock fell ~6% this week. Alignment continues to execute well despite the challenging broader MA market dynamics, driven by its underlying approach to care management as a health plan. Given the consistent performance, the question for Alignment is really how quickly it can grow and whether its model will continue to perform. 2027 is setting up to be a fascinating year for Alignment as the market expects it to demonstrate its ability to grow both quickly and profitably, particularly outside California. I had the chance to chat with Alignment CEO John Kao on Friday afternoon (see below for the interview), and he articulated his view that the lack of IPAs outside of California should actually make performance easier in those markets, which appears to be supported by Alignment’s early results in those markets. Will be worth keeping an eye on that 2027 growth conversation here.

  • Clover’s stock didn’t move much this week as it achieved Adjusted EBITDA profitability for 2025 and expects to achieve positive net income in 2026. As Clover moves past its hype-filled SPAC-y era, it increasingly looks like a smaller version of the Alignment narrative on the opposite coast. It is finding success as an MA plan in New Jersey, built on its history as a provider-sponsored plan in that market. But it has struggled to build on that momentum outside of the New Jersey market. While it grew 53% to 153k members in 2026, New Jersey accounts for ~127k of Clover’s membership. Georgia is the only other state where it has any notable membership, which grew from ~10k to ~22k members. Clover’s tech platform, Counterpart Health, remains part of the narrative, but when analysts ask questions like “will it contribute to 2026 guidance?” and the answer is “no,” it’s hard to get too excited about the opportunity there, as we sit here almost two years after the Counterpart model was publicly announced.

  • Privia Health continued its streak of solid performance and saw its stock increase ~10% this week. Privia’s earnings call was relatively uneventful, with questions largely focusing on how Privia continues to grow from here. There were some interesting conversations in Q&A around how Privia is positioned to use AI, the growth opportunity from the Evolent Care Partners acquisition, and in other markets, and Privia’s approach to shared risk in MA.

We also wrote some updates on Option Care Health, Universal Health Services, Fresenius, and Acadia Healthcare on Slack this week.

HTN Radio: An interview with Alignment’s John Kao

On the heels of Alignment’s earnings on Thursday afternoon, I had the chance to chat with John Kao on Friday. The conversation focused on Alignment’s clinical model — how it works with its network of providers and provides in-home wrap-around services via its Care Anywhere model. It’s a fascinating framing of a Medicare Advantage plan that feels culturally more like a care delivery organization than anything else. It’s easy to see the appeal of this approach, and I’ll be curious to watch if more of the industry moves in this general direction.

Links:

Other episodes this week:

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Other Top Headlines

Funding Announcements

Quote of the Week

One of the more interesting elements from earnings calls this week was the shift in tone I heard from agilon, Alignment, and Clover towards the recent 2027 Advance Notice. Each indicated that while it’d be nice if the trend number were higher, they feel they’re in a good position for 2027 performance, even if the 2027 Final Notice doesn’t increase much from the Advance Notice.

Here’s how Clover’s CEO Andrew Toy articulated it in the analyst Q&A:

…on the Advance Notice. I think based upon the trend, as I said in the commentary, we actually think it is a somewhat reasonable trend. I know that the industry was looking for a higher-level trend coming in there, and CMS did a number of things, taking the waste and abuse out and looking at more recent data. Now I think that there is an opportunity, and potentially the rate might move upwards a little bit, but we are certainly not relying upon that.

So I think at the high-level benchmark rate, while perhaps others were looking for an even higher rate, we see that as being pretty straightforward and reasonable.

Source: Clover’s CEO Andrew Toy on Clover’s Q4 2025 earnings call

The game theory implicit in these statements is fascinating to me, both for CMS and the various Medicare Advantage plans. A few weeks ago, the large players uniformly expressed their disappointment with the Advance Notice rates. Now the “insurgent” class of smaller startup-y players in the Medicare Advantage ecosystem essentially says they’re going to be ok even with those rates because their models insulate them from the rate reductions. This diverges from the talk track of the larger players, which seemed to indicate that they wouldn’t see any outsized impact from the changes.

Given that CMS leadership has publicly discussed in other settings (i.e. ACCESS) the idea of supporting “insurgent” models to drive more competition in markets, it is interesting to see a group of “insurgents” come out less critical of the CMS changes during earnings season.

Now, if you’re a smaller public company reliant on succeeding in Medicare Advantage as your sole narrative to investors, you’re going to need to express confidence that you can do so. But if you’re CMS leadership, I’d imagine you’re snipping the quotes from those earnings calls, saying, what’s everyone so upset about? Another fascinating data point as we gear up for Final Notice in a few weeks.

What I’m Reading

ChatGPT Health performance in a structured test of triage recommendations. By Ashwin Ramaswamy et al
An article in Nature Medicine by a group of researchers at Mount Sinai identified concerns about how ChatGPT Health responded to a set of clinical vignettes, with some clinicians worrying it could “feasibly lead to unnecessary harm and death.” I’m sure that risk is there, and I'll keep it in mind when I still ask ChatGPT Health if my kid has the flu.
Read more

AI, Equity, and the Workforce That Makes Whole-Person Care Possible by Janine Kundsen and Soshanah Brown
This guest perspective in HTN highlights workforce considerations to take into account when considering the adoption of AI in safety-net settings. A good addition to the conversation, building on Toyin Ajayi and Andy Slavitt’s piece a few weeks ago.
Read more

One Step Forward And One Step Back For US Health by Darshak Sanghavi, Jake Segal, and Caroline Whistler
An interesting read in Health Affairs on ARPA-H’s HEROS program. It’s yet another example of an interesting outcomes-based model cut off by the changing tides of federal funding. I’m not sure what the answer is here, but the stops and starts with interesting programs like this seem like a real challenge. Read more

Accountable Health Communities Model - Final Evaluation Report by RTI International
CMMI released the Final Evaluation Report for the Accountable Health Communities model. The Executive Summary provides a nice overview of the findings, suggesting that focusing on “upstream drivers of health” can lead to cost savings while also reducing inpatient and ED utilization.
Read more

Issue 33: Evidence of Administrative Complexity: Health Insurance Claim Denials in Massachusetts by the Massachusetts Health Policy Commission
A look at fully-insured commercial health plan data in Massachusetts finds that, on average, insurers denied 20.4% of commercial claims in 2024.
Read more

Infinite Healthcare: What’s It Worth? by Jay Rughani, Jane Rhee, and Julie Yoo
The a16z team penned an abundance perspective on the future of clinical AI, suggesting that an increase in proactive care will reduce reactive care and result in an improved health system that delivers “more health per dollar than anything we’ve built before.” I agree with some of the piece, although I’d argue with the chart suggesting that healthcare spending as a % of GDP will fall as we go through this transition. I’d place a friendly wager that the opposite will happen. But to the overall point, as long as we’re getting more health per dollar spent in the process, that may still actually be a good thing. That caveat strikes me as one of the bigger contention points for the industry in the years ahead — how much of this proactive care wave is actually resulting in better health per dollar?
Read more

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