Ruth here. On Monday, I sat down with the CEO of a health tech company and two health system executives to talk about how they’re using artificial intelligence to improve patient care. The conversation was off the record, so I can’t name names. But, I thought the insights from the conversation were useful enough to repeat here. 

Both health systems are using LLMs to allow patients to query their medical record. They’ve set up an AI interface that lets patients log-on, ask questions, relay symptoms, and even get help with the droll task of managing their own day-to-day health like developing meal plans and menus. These health systems also pair this capability with 24-7 online urgent care. 

They say this is increasing their ability to provide more access to care for patients, even though it’s not necessarily generating more paid-for appointments. 

Where primary care once served as the main entrance to care, AI is increasingly becoming that front door. One in three adults have asked a chatbot about their physical or mental health in the last year, according to KFF data. But these systems aren’t the most reliable and are known to undertriage. It makes sense that health systems would want to build their own version and try to steer patients to use that instead of Chat. 

What this does is create more connection between patients and their health system and potentially offers patients more value, they say. Through this chat interface, these two health systems are trying to make it easier for patients to get an immediate online appointment if they feel they need it. The hope is that this kind of interface will lower emergency room visits and increase patient participation in their own health, whether that means exercise, following a particular diet, or taking their pills as prescribed.

If this works, it might mean fewer visits or certainly, fewer big-ticket visits. That ultimately could eat into already thinning health system margins.  

The health systems I talked to see it differently. If patients engage in their health more, it will mean less stress on the ER and potentially more inbound for obesity clinics, menopause practitioners, and behavioral health, among other specialists, they say. 

“If they want bariatric surgery, we have that,” said one of the executives, meaning, they can do it all, from AI advice to weight management to something more invasive if necessary. 

Essentially, they see AI as creating not only the connective tissue that can keep the health system connected to patients between visits, but also a way to funnel them to more (expensive) care. That has implications for health spending (specialty care is a driver of health spend) and value based care models for specialty care, but I’ll leave that for another day.

Now, onto the news of the week with Annalisa Merelli. 

The White House announced an executive order to accelerate research in innovative treatments for serious mental illnesses, with particular emphasis on psychedelic research. The order also provides $50 million in funding for states developing psychedelic treatment programs, and the promise that any effective treatment would be fast-tracked for approval. 

“The president’s lenient tack on some mind-altering drugs ushers in a new world of right-wing drug policy. While the administration has emphasized hardline, militaristic tactics when it comes to fentanyl, its recent actions on “softer” drugs could represent a new era not just for Republican politics but also for American drug policy writ large,” writes addiction reporter Lev Facher at STAT.

The FDA is convening panels later this year as it considers lifting restrictions on injectable peptides, which are mostly unapproved, illegal drugs that have become popular after trending on social media. Recently, RFK Jr. admitted to using them with success, and is keen on getting restrictions on the substances lifted.

Peptides seem to be popular, including among people otherwise resistant to taking medication. “It’s so difficult to convince some of these patients to take statins which have so many studies backing them, and yet they are open to going and injecting themselves with peptides,” Dr. Shaila Pai-Verma, an internal medicine doctor at a concierge practice in Chicago, told the WSJ’s Sumathi Reddy. 

A new study from Mass General tested 21 different large language models, finding that they performed poorly at diagnosing, failing to come up with a list of testable lists of potential diagnoses. Once they were provided more information about the case, they arrived at the correct diagnosis 90% of the time, but were unable to perform well in the earlier stages of reasoning through a potential condition. 

OpenAI rival Anthropic has surged in value in recent weeks as buyers seek out dwindling shares of the company’s stock, according to Business Insider. Meanwhile, demand for OpenAI shares is hitting a slump, the report says. The company is currently valued at $880 billion.

The Utah Medical Licensing Board is up in arms about the state’s AI prescription renewal program, which launched earlier this year, the board said in a letter to the state board of commerce. “Overseeing prescription refills is a task reserved for properly licensed medical practitioners,” they write, and as the body that oversees those licenses, they felt they should be involved in this program. However, the Medical Licensing Board says they weren’t made aware of it until after it was already live. As a result, they say, it should be “immediately suspended.”

1) A super interesting move today into the migraine space with a drug-free approach that leverages your Enso neuromodulation device. Can you walk us through the process of how you uncovered the opportunity here? And as the team surveyed the landscape, what gave you conviction?

For years, members using Hinge Health’s neck program have been reporting fewer migraine attacks and less medication use. We started digging in - and learned that roughly 3 in 4 people with migraine also have musculoskeletal (MSK) pain. Indeed, neck pain can cause migraine attacks and vice versa. I also learned how quietly prevalent migraine is – as many as 1 in 6 Americans, with women twice as likely to be afflicted than men. As we continued digging in, we also saw that access to headache specialists is incredibly limited, with fewer than 800 certified across the entire country! So it’s no wonder people with migraines or headaches struggle to see a provider. 

While new drugs are available, they can be expensive with meaningful side effects. We saw an opportunity to enhance the care experience for people: using a neuromodulation device and neck exercises to reduce their pain, advanced trigger tracking to adjust their lifestyle influences, and a care team to coordinate it all. We felt if we could do all of that, we’d have an exceptionally differentiated and comprehensive care program. 

In good news, the FDA recently cleared our Enso device to be used for Migraine, and so the rest fell into place… 

2) From an employer and health plan POV, are migraines ranking high as a major cost driver? Is it showing up in the claims, or will it require market education?

The costs employers are incurring today are more than you might think! Migraines are one of the leading causes of disability in working-age people. At the national level, it’s estimated that migraine costs US businesses $78 billion every year. But we can’t forget about the individual costs, both to the person living with the condition and to the employer or health plan that is covering those costs. 

Our internal analysis found that people with migraine drive more than $16,000 in annual medical and pharmaceutical spend. Between medications, injections, emergency visits, and other intervention costs, the total is more than twice as much as those without migraine, so it’s a significant uptick. That dynamic has played out in our conversations with our clients, and it’s a key reason underpinning the insatiable demand we’re seeing. 

3) How do you plan to roll this out to customers? Will the strategy primarily target both health plans and employers? Will it be available to consumers who would be willing to pay out of pocket? 

We’ve already had over 125 clients covering more than 2 million lives adopt the program, with hundreds more clients in the wings - the interest has been overwhelming. 

Given how large the demand has been, we’re rolling it out to a first wave of clients next month, and it will become more widely available to other clients and partners in July. We’re getting inbound from both employers and health plans about our Migraine Care Program. Many of them shared their own firsthand experience with migraine, and that they’ve been noticing increasing pharmaceutical costs. 

When you layer in the lack of access to migraine specialists in the US – only 1 for every 65K migraine sufferers – it’s clear why the appetite for this program has been as strong as it has. That degree of scarcity means we’re really competing against non-consumption, and a baseline experience that is inaccessible for many. 

Going direct to consumers is an interesting idea, and it’s one that we’ve considered generally, but for now, we’re focused on our current model of providing access via health insurance and employers – with 99.9% of our members paying $0 out of pocket for our care.

4) In the broader digital health space, we see significant expansion into conditions that involve comorbidities. Migraine makes a lot of sense for Hinge Health, given the focus on MSK. Can you speak to that trend? And where do you see the limits? 

We are always looking at ways we can address MSK-adjacent conditions that impact our members – our women’s pelvic health, menopause and migraine programs are examples of that work. 

But our ambition is much broader than that. Our vision is to transform outcomes, experiences, and costs by using technology to scale and automate the delivery of care. We believe the technology infrastructure and distribution channels we’ve built within MSK can extend into multiple conditions. Migraine is our next step, but it won't be the last.