The goal of the new non profit Ten Ten Ten founded by TJ Tedesco & Bhargav Raman is to take America from being the most expensive health system in the world with the 48th best outcomes to the top Ten in outcomes, at 10% of GDP in Ten years. Are they crazy? Is there any hope of doing this? I spent a long time in conversation with them suggesting that they probably are, but it was a great conversation to hear why they are doing this and how they think we might do this–Matthew Holt
2026: A Year for Reimagining Healthcare’s Safety Net
By JEFF BRANDES
To say healthcare’s safety net experienced tectonic shifts in 2025 would be an understatement. The rapid introduction of multiple and massive policy shifts left many healthcare leaders reeling with more questions than answers.
As the industry turns the corner into 2026 and the dust begins to settle, it’s time for stakeholders to respond by leveraging all resources and tools available. Current industry shifts will necessitate structural and process changes that ensure the best health outcomes for all communities.
Foundational to any strategy is a recognition that AI and automation have found their place in countering administrative burden in healthcare, and mainstream use of these tools will help speed the industry’s race to greater value. Care teams that previously spent hours reviewing documentation, identifying risk-adjustment opportunities and organizing population-level insights can now claw back the time needed to get ahead of care gaps.
In 2026, healthcare leaders must acknowledge that new realities are here to stay and will require reimagining how the industry delivers optimal care for vulnerable populations. Safety net organizations that have not invested in automation for managing routine tasks will get left behind in the new world of managing population health. By leaning into the following three strategies, stakeholders can realize the promise of value-based collaboration.
Keeping Medicaid Patients Connected to Care
Sweeping changes to Medicaid eligibility, financing, and administrative requirements will have far-reaching impacts on coverage. Current workflows that address these challenges are complex and overwhelming for many resource-strapped safety net providers—not to mention patients and families.
On the Medicaid front, infrastructures that lean into unified data and integrated workflows can help providers become more proactive in identifying those at risk of losing coverage. Specifically, tools that pair eligibility data with clinical and social risk insights can guide outreach prioritization and patient assistance. In addition, providers can use automation to build multilingual renewal campaigns that personalize patient interactions such that vulnerable populations understand their healthcare options.
Safety net providers are already seeing success with the right strategy. For example, the California Primary Care Association (CPCA) leveraged automation and analytics to mobilize outreach and support Medi-Cal renewals and new enrollments across 38 counites. From January 2024 to June 2025, the initiative reached more than 1.3 million people, achieving more than 159,000 Medi-Cal enrollments and re-enrollments.
Continue reading…Trust No One
By KIM BELLARD
You know, it’s gotten to the point when I just try to tune out the things Robert F. Kennedy Jr. says. “Schizophrenia can be cured with a keto diet”? Sure, whatever. “The war on protein is over”? Who even knew there was such a war? The carnivore diet is a great way to lose weight and gain “mental clarity”? It sure doesn’t show.
His most dangerous statements, though, are probably those related to vaccines. He was known as a vaccine skeptic – no, make that critic – long before he was named as HHS Secretary, but being Secretary put him in position to put his anti-vaccine views into action. He has revamped the committee that make vaccine recommendations, putting people on them that share his skepticism.
The committee has already made significant changes to childhood immunization schedules, and they’re not done yet. The head of the vaccine advisory committee isn’t just skeptical of measles vaccines, he’s not keen on mandating the polio vaccine either. His committee is expected to go after COVID vaccines next.
One particularly outspoken committee member, Dr. Robert Malone said: “I’m not deaf to the calls that we need to get the Covid vaccine mRNA products off the market. All I can say is, stay tuned and wait for the upcoming A.C.I.P. meeting. If the F.D.A. won’t act, there are other entities that will.” He told The New York Times that scientists or regulators who claimed COVID vaccines were safe are “either being disingenuous, or they are not considering the context or are ignorant.”
Meanwhile, RFK Jr.’s nominee for Surgeon General is, shall we say, big in the MAHA movement but not so much in medical professional circles, having placed her medical license in “inactive” status. Her own website brags that she “is considered controversial because her work challenges the economic and cultural foundations of U.S. healthcare, agriculture, and food systems.”
The impacts of these attitudes are neither academic nor far in the future: we’re already in the midst of an unprecedented measles outbreak that many attribute to the vaccine skepticism that RFK Jr. and his ilk have spawned and encouraged.
What caused me to write about this is a new poll out from KFF: Trust in the CDC and Views of Federal Childhood Vaccine Schedule Changes. Top-line finding: “the public’s trust in the CDC remains at its lowest point since the COVID-19 pandemic.” Well, you can’t be surprised by that.
“Six years ago, 85% of Americans, and 90% of Republicans, trusted the CDC. Now less than half trust the CDC on vaccines,” KFF President and CEO Drew Altman said. “The wars over COVID, science, and vaccines have left the country without a trusted national voice on vaccines, and that trust will take time to restore.”
What I found particularly interesting is that, as Dr. Altman said, pre-COVID trust in the CDC was both high and across party lines. Republicans, though, lost trust during the pandemic and basically have never recovered. It took the Trump Administration to get Democrats to lose their trust – but, in fact, their trust still remains higher (55% versus 43%). Independents hover slightly above Republicans, but well below Democrats.
Specifically, about trust in childhood vaccine recommendations only about 44% have some or a lot of faith in federal agencies such as the CDC and FDA, and that doesn’t vary much by either party ID or support for MAHA. E.g., 47% for MAHA supporters versus 43% for Not MAHA Supporters. What does it say about MAHA that believers don’t have faith what the creator of MAHA is doing?
Continue reading…Will HHS Enhance or Stall the Promise of Artificial Intelligence for Healthcare?
By STEVEN ZECOLA
In its Strategy for Artificial Intelligence (V.3), the Department of Health and Human Services (“HHS”) acknowledges that: “For too long, our Department has been bogged down by bureaucracy and busy work.” HHS promises that it will accelerate artificial intelligence (“AI”) innovation, including “accelerating drug and biologic approvals at the FDA.”
History shows that well-intended but cumulative regulatory intervention – more so than scientific complexity – is the primary deterrent to rapid technological progress. If AI is subject to the typical pattern of regulatory creep, its potential to accelerate drug discovery and development will be significantly reduced. To avoid this outcome, HHS should develop a plan that is premised on a zero-based regulatory approach. That is, each new technology such as AI should start with a clean slate and only the minimum requirements deemed necessary to show effectiveness and safety should be applied in the approval process for that technology.
The Pace of Innovation
Medical innovation has lagged the pace in the other sectors of the economy. As Dr. Scott Podolsky of Harvard Medical School observed: “Medicine in 2020 is much closer to medicine in 1970 than medicine in 1970 was to medicine in 1920.” Podolsky points to breakthroughs such as antibiotics, antihypertensives, antidepressants, antipsychotics, and steroids that have not been met with same impact as innovations in the later 50 years.
Two explanations have been offered for this phenomenon: 1) the inherent complexity of biological processes; and 2) the regulatory approval process.
As a benchmark for comparison to the following case studies, the development of 4G communications spanned less than a decade, with discussions starting around 2001, technical specifications being released in 2004, and the first commercial networks launching in 2009.
Regulatory Intervention in New Technologies
- The Human Genome (Great Science Leads to Regulatory Paralysis)
The Human Genome Project (HGP) ran from 1990 to 2003, and has been lauded as one of the world’s greatest scientific achievements. The project identified the specific location of genes and DNA, creating a “roadmap” of the human genetic code and facilitating the identification of disease-related genes.
The HGP focused on balancing rapid scientific progress with ethical safeguards. Oversight was primarily managed through internal ethical programs and international data-sharing agreements rather than a single overarching legislative or regulatory body.
Under this structure, the HGP beat its target date by two years. That is to say that the complexity of the problem did not cause any delays, and progress was not impeded by the standard drug-approval bottleneck.
However, once the genetic roadmap was handed off for drug discovery and development, progress slowed dramatically.
Continue reading…Arnold Ventures Part II “Structuring Information Felicitously”
By JEFF GOLDSMITH
In the first part of our look at Arnold Ventures, we explored its business model and generous support of elite University health policy experts to further an ambitious health policy agenda. In this second part, we will explore some of the questions raised by Arnold’s aggressive approach.
Zack Cooper is an Associate Professor of Economics and Health Policy at Yale University*. He is the academic investigator at the heart of the so-called the 1% Solution, an Arnold Ventures funded project which encompasses most of its health policy agenda. The core idea of the “1% solution” is that while comprehensive health reform (e.g. “Medicare for All”) may not be achievable, pursuit of a bevy of policy goals with smaller price tags could generate savings that could be reinvested in policy improvements.
Cooper was the object of unwanted press scrutiny for receiving extensive sub rosa funding from United Healthcare for research work and writing instrumental in the enactment of the No Surprises Act in 2021, which was aimed at controlling out-of-network health insurance billing. United was expected to be the largest single beneficiary of this legislation. (The biggest “surprise” emerging from the No Surprises Act was that providers are winning 80% or more of the independent mediations of these disputes, suggesting that it was health insurers, not providers, who were gouging the public).
According to Arnold’s 990s, Cooper and his Yale policy shop, the Tobin Center for Economic Policy, received over $5 million from 2018 to 2024. Of this amount, $700 thousand funded the 1% Project itself, including more than a dozen papers by academic colleagues on topics ranging from surprise billing to PBM reforms to site neutral outpatient payment to hospital market concentration.
As part of this project, Cooper and a University of Chicago colleague, Zarek Brot-Goldberg, published a paper in early 2024 of the economic impact of hospital mergers: “Is There Too little Anti-trust Enforcement in the Hospital Sector?” which found that 20% of hospital mergers had an adverse economic impact on their communities. The alternative off-message headline, “80% of hospital mergers had no adverse economic on their communities” never surfaced.
However, a follow on piece got wide circulation thanks to a June, 2024 Wall Street Journal article, which exposed it to millions of readers without any reference to Arnold Ventures funding. The paper, which featured an astonishingly complex multivariate econometric model, was originally published by the National Bureau of Economic Research (NBER is also funded by Arnold Ventures). This paper linked hospital mergers to widespread layoffs in the communities where the mergers took place and a subsequent wave of suicides and drug overdoses (!).
Continue reading…Primary care, Concierge Care & AI – How to fix health care
At last week’s HITLAB January 2026 Symposium, Matthew Holt gave a talk about what’s wrong with primary care, how concierge care for all can fix it, and how the most advanced primary care telehealth groups are using AI now.
John Arnold: The Most Powerful Man in Healthcare Nobody has Ever Heard Of (Pt I)
By JEFF GOLDSMITH
It has happened at least a dozen times. I mention John Arnold and am greeted by knowledgeable healthcare colleagues with a blank stare. Houston billionaire John Arnold is the most powerful man in US healthcare that nobody has ever heard of. An investing savant, Arnold made $50k in high school trading collectors’ hockey cards over the Internet. He became the star natural gas trader at Enron in his early twenties. Arnold, who played no role whatever in Enron’s storied collapse, left the company in 2001 with an $8 million bonus. In 2002, at age 28, Arnold founded a hedge fund, Centaurus Advisors, focusing on energy investing, and reeled off a decade of 100% annual returns.
Bored with investing and by then a multi-billionaire, Arnold shut down Centaurus in 2012, and decided to change the world. With his Yale trained attorney wife Laura, John created a family foundation. and funded it with a large share of their personal wealth. For reasons we will explore more fully below, in 2019, Arnold converted their foundation to a ”for-profit charity” known as Arnold Ventures. At nearly $4.7 billion in assets in 2024, Arnold Ventures was about a third of the size of the lions in foundation world, Robert Wood Johnson ($14.7 billion in 2023) and Ford ($13.7 billion in 2024). Arnold Ventures 501c3 grantmaking subsidiary gave away a cool $194 million in 2024 to a bewildering array of grantees from American Enterprise Institute to Families USA.
But Arnold’s business model is fundamentally different than these legacy charitable foundations.
Continue reading…Shifting Sands Part 3
By GEORGE BEAUREGARD
Fifteen months ago, I wrote in The Health Care Blog about the “incoming tide” of early-onset cancer.
At that time, the global rise in the incidence of early-onset cancer in younger people that had occurred over three decades had been noticed and was being monitored by researchers, scientists, and other healthcare professionals. Articles on research discoveries in this topic sporadically appeared in top medical journals such as Nature, The New England Journal of Medicine, and The Lancet.
From 2005 to 2011, some early warning articles surfaced in generalist publications in mainstream media outlets like The Wall Street Journal and The New York Times. Those stories were framed as tragic “one-offs” or medical mysteries. Following a landmark study published by the American Cancer Society (ACS) in 2017 (1), the narrative shifted from “anecdotal” to “epidemic”. In 2020, the death of actor Chadwick Boseman, who was diagnosed with colorectal cancer at the age of 43 catalyzed mainstream media reporting on the situation. Chadwick died one month before my son, Patrick, who was 32 years old. Patrick was featured in a WSJ article in January 2024.
Since then, other reputable national publications like Time magazine and The Economist, and major media news outlets have featured stories about the growing situation. Stories about it have even appeared in some popular supermarket tabloids.
Over the past year, articles about the potential causative roles of diets high in ultra-processed foods, obesity, environmental factors, sedentary lifestyle, and a gut bacterium’s genotoxin remnant mutagraph, so-called Colibactin, have appeared.
The recently released ACS report Cancer Statistics, 2026, presents a jarring “good news, bad news” dichotomy and has garnered wide attention. The good news: overall, five-year survival rates for people with cancer have increased from 50 percent to 70 percent since the mid-70s. A 40 percent increase. Certainly a cause for celebration. (Mary Lasker would be smiling.)
But a dark reality persists.
Continue reading…Indiana – It is the best of times, and the worst of times
By MIKE MAGEE
“Hoosiers receive heroes’ welcome in return to Bloomington” screamed last week’s ESPN headline, as IU claimed top spot in college football nationwide. It’s been awhile since sports elevated that state’s mood.
In his classic review of the famous movie, “The Hoosiers,” Roger Ebert writes, “This is a movie about a tiny Indiana high school that sends a team all the way to the state basketball finals in the days when schools of all sizes played in the same tournaments and a David could slay a Goliath. That’s still the case in Indiana.”
That final sentence came to mind last month, as the Midwestern state with a population of around 7 million (17th in the nation) punched above its political weight and landed headlines like this one on December 11, 2025 in The Hill – “Indiana Senate rejects new House map, defying Trump.”
Some facts were clear: Twenty-one Indiana state senators had joined all 10 Democratic state senators to defeat a proposed redistricting map that would have assured a gain of 2 additional House of Representative seats for Republicans in the 2026 mid-term elections. But most political pundits misread why they did it, and ignored a crucial economic report from 10 months earlier that informed their actions. More on that in a moment.
First a bit of history. A century ago, Eli Lilly Jr. (grandson of the founder of the famous pharmaceutical giant Lilly & Co.) cut a deal with the University of Toronto to be the sole supplier of their life-saving drug – insulin. Headquartered in Indianapolis, Indiana, they were ideally positioned because the state’s three economic pillars were manufacturing, agriculture, and health sciences.
To secure adequate supply of insulin was both a scientific and logistic challenge of historic proportions. Eli Jr.’s focus on line manufacturing helped. Raw material demands required the design of a refrigerated railway support system dead ending at Lilly manufacturing sites. This was made necessary since purifying 8 ounces of insulin required two and a half tons of beef or pork pancreas readily available from state farms. Sourcing the raw materials locally was not a problem. At the time, 86% of the state’s lands were controlled by 195,786 farming families committed to farming (including livestock management and slaughter houses).
Fast forward a century and the state remains heavily dependent on its tripartite pillars – manufacturing, agriculture and health sciences. That was the message broadcast with great political effect on April 15, 2025 in a first ever economic forecast update from Muncie, Indiana, the home of Ball State University and its’ well-respected Center for Business and Economic Research led by Michael J. Hicks, PhD. For over 50 years CBER has published “data-rich, nonpartisan research relevant to communities and businesses throughout Indiana.” Their reputation is built on one word – trust.
Continue reading…A $2,000 Voucher and 600 Patients: The Math Behind Fixing Care
When I was at HLTH last October Bradley Bostic invited me on his BoomBostic Health podcast. I was in the mood for ranting about the health care system and promoting my desire for getting everyone concierge level primary care. Bradley was very generous in giving me a mike and a lot of rope. I am embedding the youtube version and if you want just audio it’s here. (I was also losing my voice so there’s a cleaned up transcript below)–Matthew Holt
Bradley:
Well, hello and welcome back to another episode of Boombostic Health in the Wild here at HLTH 2025 in Las Vegas. I’m thrilled to have Matthew Holt with me, who is the leader at The Health Care blog, a blog I follow, and I appreciate you being here, Matthew.
Matthew
Bradley, thank you very much. I count my readers, you know, on about two hands, so I want to keep you in good health. I have a little joke. We used to have a podcast that actually wasn’t that well-followed called the THCB gang and one of my colleagues on THCB gang was at a conference and a guy in the row behind him said “oh I recognize your voice, my father used to listen to the podcast but then he died.” When my colleague told me the story I said, we don’t have enough listeners and subscribers to lose them like that – we’ve got to keep them alive in order to keep the podcast going!
Bradley
Well, Boombostic Health was really born out of my pension for building companies in the health tech world and investing in companies. When we first started this. I wasn’t sure if anybody would listen to it. My mom passed away from cancer 25 years ago. So, I knew she wouldn’t be listening to it unfortunately. But that was a big thing that inspired me to get into healthcare. And lo and behold, there is a really interested audience out there that wants to know how innovation is transforming our broken health care system. And clearly with your background with Health 2.0 and The Health Care Blog, this is an area that you’re focused on. And I think you said you have two easy steps. Oh no, two steps, not necessarily easy to fix healthcare.
Matthew
So the preamble to this is I’ve been doing this for a long time. I came to America in 1989.
Continue reading…
