I randomly found this interview I had completely forgotten about on Youtube from 2011. I was younger and thinner then, even though I didn’t have much hair. And I was very optimistic that tech was going to change health care in 10 years……and that it was going to take a long time. Guess we are still waiting!
Above the Fold
Kevin Wang, Suki
Suki is one of the original Ambient scribing, now Ambient intelligence, companies. They’re selling both to providers and to other partners using their tech in their tools and services (think telehealth, other EHR providers like Athena, and more). Kevin Wang is the Chief Medical Officer, and he told me about the evolution of ambient documentation, how it makes doctors happy, and how it’s now moving into improving coding (and billing) but will soon be moving into improving clinical decision support. We haggled a little about the ROI from Ambient and where that comes from (remembering codes), and discussed how the EMR v Ambient plays out. And we talked a little about what the impact of ambient and AI will be on medicine…–Matthew Holt
Healthcare’s Quiet Dependence on the “Possimpible”
By GANESH ASAITHAMBI
In an episode of the sitcom How I Met Your Mother (HIMYM), Barney Stinson introduces a fictional word: possimpible. The possimpible combines “possible” and “impossible” and describes the extraordinary achievements by people who refuse to accept conventional limits. In modern healthcare, the possimpible is no longer a joke; it has quietly become an expectation.
Clinicians are expected to provide care that is safer, faster, and more compassionate despite rising administrative burdens, workforce shortages, and an increasingly complex patient population. These expectations often extend beyond what existing systems were designed to accommodate. The distance between what the system can provide and what patients need is increasingly filled by clinicians.
Picture this example at the end of a clinician’s day. A physician takes a seat to call a patient’s family. The phone conversation takes longer than expected with questions about their loved one’s prognosis and hesitancy about what to do next with fear about what is to come. The physician provides reassurance and guidance. The physician hangs up, only to find that note dictations are not complete and messages are still unread. None of this shows up as productivity, but it is needed to provide quality care. There are thousands of scenarios like this that take place every day in American health care.
These moments appear routine. However, they reflect something more consequential: healthcare has become quietly dependent on clinicians to stretch beyond the boundaries of the systems they work within.
Continue reading…Adventures in health care billing. My $51.96 zit co-insurance
By MATTHEW HOLT
I know my many fans love me delving into the world of why we get seemingly incorrect trivial bills in health care, and what they all mean. The long telenovella of the $39.94 bill from Labcorp is as yet stalled with One Medical apparently resubmitting the original claim with the new preventative codes on it. But even though I am continuing and expanding my role as a difficult patient this year, there are still some blasts from the past that won’t quite leave.
This particular one concerns some rather unpleasant dermatology issues. For many years I had an nasty small sore/lesion on my leg that never quite healed. Then I started getting a few more that started as zits and never quite left. My wise PCP Andrew Diamond at One Medical told me to use some antibiotic wash and referred me to a dermatologist. Unfortunately the one I was referred to was out of network for the Blue Shield HMO I was in, but one request back to One Medical and I was both sent to a dermatologist in my network and got a pre-auth in the mail from Blue Shield to go see him!
Dr Cristian Gonzalez took a quick look at my leg, decided what the problem was, and proceeded to inject, freeze and attack my various lesions. He then prescribed a cheap topical steroid for me to use, and basically after 4 visits over the summer and Fall, my legs went back to resembling a baby’s bottom–well more or less.
For each specialty visit Blue Shield had a co-pay of $85 per visit, which I handed over using my HSA card. One time the front desk said I had a balance, but when I asked them what it was for they told me it was a mistake. Until this week.
Some 4 months after my last visit I got a bill in the mail for $51.96
Given that I had made a co-pay of $85 each time, this seemed a little odd. So I took a look at my Blue Shield EOBs. (BTW they are back online, you may recall they vanished when Blue Shield cancelled and then changed my plan but the Internet never forgets….)
There a curious anomaly began to play out. Each visit generated three identical claims and three more or less identical EOBs.
Continue reading…Calling BS
By KIM BELLARD
We are living, you’d have to say, in the age of bullshit. Our politicians can’t answer the simplest of questions without spouting word salad answers aimed at running out the clock until the next question. Our corporations spew endless platitudes about their lofty goals in an attempt to distract us from their mendacious profit-seeking. And now we have AI producing endless volumes of words, an unpredictable amount of which aren’t remotely true.
For better or worse (and, trust me, it has often been for worse), I’ve always been one to ask “why,” to probe vagueness — whether it was a teacher, a boss, or a politician. Call me cynical, call me skeptical, call me inquisitive, but I have a low tolerance for bullshit, in its many forms. So I was thrilled to see that a new study suggests that employees who don’t fall for corporate bullshit may be better employees.
The study is from Shane Littrell, a postdoctoral researcher and cognitive psychologist at Cornell University, whose research “focuses primarily on how people evaluate and share knowledge, particularly the ways that misleading information (e.g., bullshit, conspiracy theories, corporate messaging) influence people’s beliefs, attitudes, and decisions.”
One wonders what he was like as a child.
His new research introduces a new tool called the Corporate Bullshit Receptivity Scale (CBSR), which was “designed to measure susceptibility to impressive-but-empty organizational rhetoric.”
His paper defines “bullshit” as “a type of semantically, logically, or epistemically dubious information that is misleadingly impressive, important, informative, or otherwise engaging,” and distinguishes it from other types of speech (such as jargon) in that “it is both functionally misleading and epistemically irresponsible.”
Continue reading…Ian Shakil, Commure
Ian Shakil is the Chief Strategy Officer of Commure, the AI platform being used by HCA, Tenet and others. He came to Commure via its acquisition of Ambient AI vendor Augmedix, and there are a lot other other new acquisitions within Commure (Athelas, PatientKeeper, Memora Health, Rx Health etc). We dived in not only about what Commure does but the big question of how does a client like HCA or Tenet decide what Commure does, vs what Meditech does, vs what Google does vs what they do internally. We also (sorta) looked into the various criticisms (basically all from Sergei Polevikov!) of what Commure and its main funder General Catalyst are up to and what is happening at Summa Health the hospital in Ohio that GC bought. He also says the good experience from AI will come to help patients this year, and I’ll be holding him to that!–Matthew Holt
Function Health has a 23andMe problem
By DEEKSHA HEGDE
I had an itch to draw parallels between the two. The structural facts kept lining up in ways I couldn’t dismiss, and by the end, I stopped trying.
Function’s product is an app: you pay $365 a year, go to a Quest Diagnostics location, get 160+ biomarkers tested twice a year, and receive clinician-written notes interpreting your results. The lab testing is fully outsourced. Function is the layer on top: panel design, member experience, clinician note generation, longitudinal tracking.
Function Health raised $298 million at a $2.5 billion valuation in November 2025. At 25x revenue, the market clearly isn’t buying a lab reseller. It’s buying the data flywheel: longitudinal biomarker histories that compound in clinical value over time, aggregated across hundreds of thousands of members into a dataset that health plans, pharma companies, and AI developers can’t build any other way. A member with four years of data can’t switch to a cheaper competitor without losing the trend. The unit economics work if the interpretation layer scales without proportionally scaling headcount, which is what the Medical Intelligence Lab, their generative AI model launched in November 2025, is built to do. Function is also building toward a B2B enterprise channel, positioning the product as a way to keep employees “healthy, focused, and ready to perform.”
It satisfies a burning need for specific personas: the worried well, the health optimizers, the people who saw their loved ones get diagnosed a little too late, the people who aren’t waiting for a diagnosis before they start paying attention. These are people the rest of the industry has mostly left alone. I wrote earlier this year, in a piece on Hinge Health, about the prevention paradox: the employer ROI model is structurally blind to the member who benefits most from early intervention. Function skips the employer ROI story entirely, charges the member directly, and doesn’t try to prove a CFO case it can’t make. Yet.
Continue reading…Jason Prestinario, Particle Health
Jason Prestinario is CEO of Particle Health. The company is best known for its current lawsuit against Epic, but behind that there is a real company delivering a set of products as on ramp for clients wanting to access health data. Particle was cut off from access to Carequality & Epic a couple of years back but is now both delivering services to its customers and separately suing Epic for being an abusive monopoly regarding its payer platform. I had written about this a couple of years ago but I used this chance to catch up with Jason, to see what the sate of play was. He explained that Carequality said that Particle was right in the original dispute, and why they were right and Epic was wrong. The court case continues. But it’s interesting to hear from someone in the middle of the new disputes about data. — Matthew Holt
Assault on Scientific Integrity Is “Fundamentally Problematic.”
By MIKE MAGEE
This past week, U.S. District Court Judge Judge Brian E. Murphy, dealt Trump and RFK Jr. a severe blow. Not mincing word, he voided HHS vaccine schedule changes and labeled the action an assault on scientific integrity that was “fundamentally problematic.”
In early December, 2025, President Trump directed HHS Secretary Robert Kennedy to review the standing childhood immunization schedule. That schedule has historically guided the state school-entry requirements for vaccines as well as mandating no out-of-pocket costs to parents from vaccine insurers.
The order had followed Kennedy’s summary dismissal of all members of the CDC’s Advisory Committee on Immunization Practices replacing them with a suspect group of vaccine skeptics without any peer review.
Professional organizations, including the American Academy of Pediatrics and the American Medical Association quickly challenged the action in court.
Judge Murphy suspended the appointment of 13 of the 15 new vaccine panel members, and stated that only 6 of the 125 “even under the most generous reading, have any meaningful experience in vaccines.” The swift rebuke followed the evaluation of the new RFK Jr. appointed group’s work output by an independent coalition of scientific researchers which documented 60 misleading or false segments and vaccine claims in their inaugural December meeting.
AAP President Andrew Racine M.D. was quick to applaud the court’s decision, stating ““This decision effectively means that a science-based process for developing immunization recommendations is not to be trifled with and represents a critical step to restoring scientific decision-making to federal vaccine policy that has kept children healthy for years.”
The action couldn’t come soon enough according to state Public Health officials across the country who have been struggling to turn around a Measles epidemic tied to lax vaccination rates.
Continue reading…Mario Danek, QNovia
Mario Danek is CEO of QNovia, a behavior change platform focusing on smoking cessation product. Essentially the problem with smoking cessation nicotine products is that they don’t deliver the “hit” of a cigarette as quickly as a cigarette or a vape. Mario’s new vape-like product delivers a nicotine replacement therapy (think like Nicorette gum) just as quickly as the form factor it’s replacing. He is hoping that the device/drug/and forthcoming mental health support will be the engine to reduce the current smoking rate from the stubborn level it’s got stuck at. He told me about its likely time to commercialization–Matthew Holt
