Those of us in the industry for a while are also wondering about the all-important question: “How do you shift incentives?” Generally speaking, healthcare moves at the speed of “what’s in it for me?” I’d love to see substantial change based on doing right by the patient, but that doesn’t tend to be how the world works.
That said, I like Amy Gleason’s idea of scanning a QR code at any doctor’s office to pull up medical information, versus having to fill out the same form over and over again.
I am also seeing more focus on Medicare Advantage, and particularly on the issue of upcoding. CMS Administrator Dr. Mehmet Oz spoke about this issue in an interview this week, noting that If Medicare Advantage is costing more than fee-for-service, then it’s “violating the whole premise.” Dr. Oz indicated that there will be more auditing of Medicare Advantage plans.
This administration is also continuing to build inroads with digital health companies, promising such incentives as interoperability, better reimbursement for direct primary care, telehealth and wearables, and fewer restraints on tech, including AI. Many digital health CEOs were invited to D.C., as Trump pushed for a new initiative to make it easier for consumers to access their personal health information. As companies joined the health-tech “pledge,” many in the industry wondered what it would take to bring us from hype to reality.
Out in Silicon Valley, health and AI companies are continuing to get funded. It is truly a “have and have-nots” market with anything related to AI gobbling up VC dollars at sky high valuations, while tech-enabled services is far more challenging. That may be a mistake, as it’s so often the contrarian bets that truly return capital – and there’s so much potential in leveraging AI to make services far more efficient.
With that, let’s talk about this big news this week after a quick note from our sponsor, our friends at Parsley Health.
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News you should see
Humana is boosting annual outlook
What’s been reported: Humana announced an improved 2025 outlook following stronger-than-anticipated Medicare Advantage enrollment and keeping medical costs under control, Modern Healthcare reported this week.
Dig deeper: The major health insurer and Fortune 500 company is expected to exceed $128 billion in annual revenue in 2025, up from the projected $126 billion, the Wall Street Journal reported, undoubtedly outperforming other players.
What the insurer says: "We reduced more benefits, and more significantly than all of our competitors in 2025,” George Renaudin, president of insurance, tells Reuters.
Reading between the lines: There seems to be a corpus of members bouncing back to Humana after picking a different plan. Most health insurers at present seem to be cutting their forecasts, so this will be an interesting one to watch. This is a particularly tough moment for United Healthcare.
EU tariffs poised to raise drug prices
What’s been reported: The U.S. is set to enact a 15% tariff on branded drugs from Europe in a new trade deal that could lead to $19 billion in additional pharmaceutical costs, analysts tell Reuters. What’s more, Europe is a major player in providing the U.S. with a slew of branded drugs.
For consumers: "The big picture is: The cost of imported drugs is about to become more expensive for all Americans," Joe Brusuelas, principal and chief economist for RSM US, told Axios.
Reading between the lines: Specialty drugs are already incredibly expensive for Americans, so further price hikes will only serve to increase inequities. This is also bad news for employers. It’s one of the cost drivers that we’re paying attention to that will create yet more inflation, and potentially lead to a situation that is so untenable that something must be done.
QR codes in the doctor’s office
What’s been reported: QR codes are not just being embraced by restaurants. CMS is toying with promoting the use of SMART health cards, which would allow patients to use QR codes to store their health information. HHS says this will encompass a “national healthcare directory, secure data entry and modernized systems,” according to Mobi Health News.
What HHS is saying: "Imagine scanning a QR code at your doctor's office and instantly sharing your medical history. Imagine having an AI assistant that knows your care plan that helps you manage medications with confidence," said Amy Gleason, strategic advisor to the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services in a YouTube video.
The strategy: This comes as CMS has worked to modernize where patient health care data lives as part of a broader digital health strategy.
Reading between the lines: Amy Gleason is a refreshing pick. She has a strong background in digital health, and has long been a voice of the patient, given her own struggle helping her daughter manage a rare autoimmune disease. Both Amy and her daughter Morgan have been fighting for patient rights for years now - check out this story Chrissy wrote at CNBC highlighting the frequency of medical errors in patient health records.
Sword Health expands
What’s been reported: Sword Health launched “Sword Intelligence” in a play to move beyond direct patient care and embrace AI workflows. The telehealth care provider of over 600,000 patient members claims the new launch has “increased clinician capacity by 14x without sacrificing quality.”
What Sword says: "At Sword Health, we talk about our mission as making world-class care as accessible as running water. And we often say we’re only 5% done. Looking at the opportunity ahead—moving healthcare from a model that relies 100% on human labor to one where AI takes on a central role—that statement has never felt more true," Virgilio Bento, founder and CEO of Sword Health, told Fierce Healthcare.
Reading between the lines: It’ll be intriguing to see how Sword expands its scope of services to compete with Hinge, which is now publicly-traded. Both companies have a strong growth story to tell Wall Street if they can prove they’re more than MSK, and key expansion areas include behavioral health and women’s health. For both companies, AI is also key to their margin expansion story.
White House health tech pledge to ‘kill the clipboard’
What’s reported: During a “Make Health Tech Great Again” event with CMS, The White House announced health tech pledges from a slew of major companies, including Amazon, Apple, Google, OpenAI, Epic, Microsoft, CVS Health, and UnitedHealth Group, STAT reports. This comes amid a national push to improve health care data sharing and champion personalized approaches in medicine.
The pledge: “More than 60 companies pledged to work collaboratively to deliver results for the American people in the first quarter of 2026. Twenty-one networks pledged to meet the CMS Interoperability Framework criteria to become CMS Aligned Networks. Eleven health systems or providers committed to participate and support patient use, and seven EHRs committed to facilitate data exchange and help ‘kill the clipboard,’” according to the CMS press release.
What’s the inside scoop: Health reporter Mario Aguilar says his inbox is “flooded” with organizations sharing that they’ve been selected to the “very exclusive” cohort of 60 health and tech companies, according to his LinkedIn post.
Reading between the lines: The devil is in the details. What does the pledge actually entail? What does this mean in practice? And will there be a carrot, a stick, or both to ensure these goals are met?
Major funding announcements and deals
$243M for Ambience