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Which Platform of Platforms (UDHP) is Right for your Health System? A Market Analysis

Neil Jennings
Vince Kuraitis

By NEIL JENNINGS & VINCE KURAITIS

This entry is part 5 of 5 in the series Platforming Healthcare — The Long View

In previous posts in this series, we have covered the definitions of Unified Digital Health platforms and whether “EHRs can become UDHPs.” In this follow-on post, we’ll talk through the requirements for success for a UDHP and which types of healthcare organizations are best suited for which types of UDHPs. This post will build on findings from the previous posts.

The Market Needs UDHPs: Key Takeaways from Previous Posts

UDHP Framework

Key Takeaway 1: The healthcare industry needs UDHPs to create a centralized, common architecture for healthcare organizations

Key Takeaway 2: The healthcare organizations leveraging UDHPs will achieve a myriad of benefits, from competitive advantages to clinical, financial, and operational gains

Key Takeaway 3: UDHPs are not all-or-nothing or mutually exclusive from EHRs. As we explored in our last post, EHRs could expand into UDHPs. These EHRs as UDHPs (or the relative platform of platforms) may be the optimal choice for some market segments. EHRs may also be accommodated into cloud-first UHDPs.

Key Takeaway 4 / Guiding Criterion: This post will focus on US regional and local health systems and outpatient groups of all sizes.

The Approach: Market -> Segments -> Options -> Fit

  • For this post, we will start from the top-down market perspective, analyzing the overall market landscape.
  • Once we have described the landscape, we will call out the key segments (organization types, sizes, and profiles) that we will be evaluating.
  • At this point, we will approximate IT budgets and IT team sizes by organization type to determine capabilities of building as opposed to depending on partners and vendors.
  • Then, we’ll review the constraints for implementation and ownership, outlining the drivers of UDHP fit.
  • Next, we’ll break down the different ways UDHPs can be developed and maintained.
    • Leveraging an EHR as UDHP
    • License from UDHP vendor
    • “Home grown” cloud-first solution
  • Finally, we’ll crosswalk the segments and the optimal option for each segment, based on their specific needs and estimated IT and budgetary resources.

The Healthcare Market & Major Health System Segments

Starting with a compelling graphic from the Kaiser Family Foundation, we see a 2023 breakdown of the total US healthcare medical expenditure, totaling ~$4.9 trillion.

While the total healthcare spend that occurred in hospitals is an astounding ~$ 1.5 trillion, accounting for 31% of total healthcare spend, this leaves much of care outside the four walls of hospitals. This amount of care occurring outside of hospitals aligns with efforts to push patients into less acute care settings, emphasizing preventative, proactive medicine instead of acute, reactive medicine. As the need for UDHPs applies to more than inpatient hospitals, we will also review the other segments highlighted in the pie chart, including: outpatient clinics and practice groups, and “other health” containing services delivered at other contexts like PACs and SNFs, and Ambulatory surgical centers.

Continue reading…

When is Preventative Care not Preventative? Let’s get Labcorp to join in! (with UPDATE)

By MATTHEW HOLT

To join in the fun I am having with Blue Shield of California & Brown & Toland Physicians IPA being unable to tell me why I have a $34.94 bill for lab work (see image) that should either be covered as preventable under the ACA, or have co-pay of $50 (see image of the BS of CA screenshot for the $50), I called Labcorp.

After 6 minutes I got a very confused person. BTW there is NO way to communicate with Labcorp on the website, and if you put your invoice number into their IVR system there is NO way to get a human. The only way to do that is to hang up and start again, NOT put in your invoice number and hit 0. Then wait on hold with muzak to get a human. They then ask your DOB and phone number. The call center is in the Philippines BTW.

I explained that I wanted information on which test was not covered under the ACA. Brown and Toland/Blue Shield’s EOB says I have a $0 co-pay (see image).

The Labcorp rep told me that of the 5 tests done (with CPT code and price), 3 were not covered. The Lipid (85027 $107.10), the A1C (80061 – $81.90) Uric Acid (84550 $43.05). 2 of those 3 clearly are covered under the ACA. The Uric Acid one may not be according to my reading of the CMS site. Labcorp submitted that bill to Blue Shield. The rep consistently told me the claim was sent to Blue Cross Blue Shield of CA, which doesn’t exist.



At that point — 15 minutes in — the call dropped. I don’t know if they just hung up but they had asked for my phone number. They didn’t call me back.

But I am a pain in the ass, and I called them back. After roughly 4 mins on hold, I got another rep. She told me ALL of the CPT codes/lab tests were subject to copay. She told me that Blue Shield (NOT Brown & Toland Physicians) has bundled all of these codes and there is a co pay for all of them. Which is what the bill says.

So the only thing I can do is to send an email with the screenshot of the EOB, which is from the IPA not Blue Shield. So I did that and may get a response in 3-5 business days.

I know you are on tenterhooks. Let’s see what happens next but the complete absence of anything resembling consumer transparency or access to the relevant information makes a mockery of everything Paul Markovich says on stage.

UPDATE. Labcorp both emailed me back AND asked me to contact them on Linkedin. See what they asked for! Yes even though they have sent me a bill and I sent them the invoice number, they want every detail possible about the claim they ALREADY have!

Full email below just for giggles

Matthew Holt is the founder and publisher of THCB

Après AI, le Déluge

By KIM BELLARD

I have to admit, I’ve steered away from writing about AI lately. There’s just so much going on, so fast, that I can’t keep up. Don’t ask me how GPT-5 differs from GPT-4, or what Gemini does versus Genie 3. I know Microsoft really, really wants me to use Copilot, but so far I’m not biting. DeepMind versus DeepSeek?  Is Anthropic the French AI, or is that Mistral?  I’m just glad there are younger, smarter people paying closer attention to all this.

Still, I’m very much concerned about where the AI revolution is taking us, and whether we’re driving it or just along for the ride. In Fast Company, Sebastion Buck, co-founder of the “future design company” Enso, posits a great attitude about the AI revolution:

The scary news is: We have to redesign everything.

The exciting news is: We get to redesign everything.

He goes on to explain:

Technical revolutions create windows of time when new social norms are created, and where institutions and infrastructure is rethought. This window of time will influence daily life in myriad ways, from how people find dates, to whether kids write essays, to which jobs require applications, to how people move through cities and get health diagnoses.

Each of these are design decisions, not natural outcomes. Who gets to make these decisions? Every company, organization, and community that is considering if—and how—to adopt AI. Which almost certainly includes you. Congratulations, you’re now part of designing a revolution.

I want to pick out one area in particular where I hope we redesign everything intentionally, rather than in our normal short-sighted, laissez-faire manner: jobs and wealth.

It has become widely accepted that offshoring led to the demise of U.S. manufacturing and its solidly middle class blue collar jobs over the last 30 years. There’s some truth to that, but automation was arguably more of a factor – and that was before AI and today’s more versatile robots. More to the point, today’s AI and robots aren’t coming just to manufacturing but pretty much to every sector.

Former Transportation Secretary Pete Buttigieg warned:

The economic implications are the ones that I think could be the most disruptive, the most quickly. We’re talking about whole categories of jobs, where — not in 30 or 40 years, but in three or four — half of the entry-level jobs might not be there. It will be a bit like what I lived through as a kid in the industrial Midwest when trade in automation sucked away a lot of the auto jobs in the nineties — but ten times, maybe a hundred times more disruptive.

Mr. Buttigieg is no AI expert, but Erik Brynjolfsson, senior fellow at Stanford’s Institute for Human-Centered Artificial Intelligence and director of the Stanford Digital Economy Lab, is. When asked about those comments, he told Morning Edition: “Yeah, he’s spot on. We are seeing enormous advances in core technology and very little attention is being paid to how we can adapt our economy and be ready for those changes.”

You could look, for example, at the big layoffs in the tech sector lately. Natasha Singer, writing in The New York Times, reports on how computer science graduates have gone from expecting mid-six figure starting salaries to working at Chipotle (and wait till Chipotle automates all those jobs). The Federal Reserve Bank of New York says unemployment for computer science & computer engineering majors is better than anthropology majors, but, astonishingly, worse than pretty much all other majors.

And don’t just feel sorry for tech workers. Neil Irwin of Axios warns: “In the next job market downturn — whether it’s already starting or years away — there just might be a bloodbath for millions of workers whose jobs can be supplanted by artificial intelligence.” He quotes Federal Reserve governor Lisa Cook: “AI is poised to reshape our labor market, which in turn could affect our notion of maximum employment or our estimate of the natural rate of unemployment.”

In other words, you ain’t seen nothing yet.

While manufacturing was taking a beating in the U.S. over the last thirty years, tech boomed. Most of the world’s largest and most profitable companies are tech companies, and most of the world’s richest people got their wealth from tech. Those are, by and large, the ones investing most heavily in AI — most likely to benefit from it.

Professor Brynjolfsson worries about how we’ll handle the transition to an AI economy:

The ideal thing is that you find ways of compensating people and managing a transition. Sad to say, with trade, we didn’t do a very good job of that. A lot of people got left behind. It would be a catastrophe if we made the similar mistake with technology, [which] that also is going to create enormous amounts of wealth, but it’s not going to affect everyone evenly. And we have to make sure that people manage that transition. 

“Catastrophe” indeed. And I fear it is coming.

Continue reading…

How exactly is my lab test co-pay $34.94?

By MATTHEW HOLT

I moved over something I wrote on linkedin, so that it doesn’t vanish. I do this type of thing so you don’t have to & to make Brett Jansen happy I am writing in one line paragraphs.

My question, is how do LabCorp, Brown & Toland and Blue Shield Of California come up with this stuff?

1. I go for my free annual checkup

2. I get blood/lab tests which AFAICT are included in the ACA free checkup.

3. My pre-diabetes is still “pre”. My cholesterol is good!

4. Blue Shield of California puts the claim on its website. The EOB representation says
–total billed $322.28
–In network savings $271.37
(note difference is $50.91)
–Patient responsibility $0

5. Then it has 5 sub-charges for different tests (which I assume total to the $322.28). All have a different price. All say “in network savings” of the same amount. All say Patient Responsibility $0

6. Labcorp sends me a bill. for $322.28. “Adjustments” $287.34. Difference $34.94.

7. I call Blue Shield of California customer service. Its annoying as hell automated system reads me the claim EOB that I can see on the website.

8. After a few minutes of that I hit 0 and get a human eventually. After a loooong time she goes to call Brown and Toland, the IPA that is somehow involved in the lab billing. They tell her that I do indeed owe $35. (26 mins on the call)

9. I ask her why, given they are allegedly free under the ACA, I am being charged for these lab tests. She says that the medical group has sent her the CPT codes and she can tell me which of the 5 lab tests I owe for.

10. (On the Labcorp bill the charges are split up by test (no codes provided), but the “adjustment” is to the total, so there’s no way to tell what the adjustment per test is. Reminder that on the BS site, they all adjust to $0.)

11. But that information is not in whatever documentation the IPA gave her. She goes back to call them AGAIN. Because, yes I am difficult and I did ask her to. Minute 37 at this stage

12. Minute 45. The person from the IPA comes on line. She keeps asking if I want a service or a diagnosis code. But tells me they will review the claim. My guess is that one of these codes doesn’t count as preventative. Eventually she gave me the 5 CPT codes for the tests.

13. The BS rep is still on the call. She chimes in and the IPA rep (who I think is in India judging by accent and bad phone connection) agrees that my lab copay is $50. (BTW the BS rep is clearly American but her phone connection is dreadful too!)

14. After a lot of clarification (OK, me leading the witnesses) they both agree that if the co-pay is $50 but my bill is $34.94, then something is off, and maybe one of the codes has been classified as non-preventative, therefore not free under the ACA.

15 The IPA (Brown & Toland Physicians) rep is going to resubmit this to the claims team. I should get a new EOB. From whom I have no idea. I thank them both for their time and we hang up. 1 hour 4 minutes

I know that wasted more than $34.94 of my time, and certainly way more than that of Blue Shield of California & Brown & Toland Physicians money. But it’s just an indication of how screwed up internal billing and customer service is at these antique orgs!

Matthew Holt is the founder, author and publisher of THCB

Ami Parekh & Ankoor Shah, Included Health

Ami Parekh is the Chief Health Officer & Ankoor Shah, is VP, Clinical Excellence at Included Health. I had a long conversation with them about the philosophy of how we are doing population health and how we fix the system that we have today. I’m arguing for more primary care, but Ami restated it and says, you need somone you trust who is an expert who can help you make decisions. And this might not be a human! How do we change the system, and how does telehealth work now and how will it change? Defining health from the person perspective, not the way the health system wants to define it! Matthew Holt

Are the MA(HT)GA crowd going to be proud of themselves?

By MATTHEW HOLT

I have been trying hard to suppress this line of thought but when I woke up in the middle of the night with this piece basically fully formed in my head I couldn’t not write it. Yes I might lose some friends, but someone in health tech has to say this.

Last week a bunch of health tech companies, providers, plans and others went to the White House to an event remarkably called “Make American Health Technology Great Again”. The main organizer Amy Gleason is someone I consider an industry friend. No one can doubt her credentials in wanting to help patients, especially given her daughter Morgan’s medical condition and her awful experience in the health system. The initiatives spelled out–while they are voluntary and based on actions and regulations that are already on the books–will be net net good for American health care, and good for patients. 

Now, almost everything proposed is happening anyway. Anyone in health tech knows that it’s much easier to get health data and to run AI on it than it was in 2020, and it was way easier to get health data in 2020 than it was in 2016. Yes, of course it should be better and easier than it currently is. Yes, it should have happened quicker. Yes, the big provider systems and their main EMR Epic have not exactly bent over backwards to make data access more convenient for patients and innovators. Yes, of course there are too many demands to “send us a fax”. I personally had great fun with a UCSF-affiliated hospital last week, speaking to 5 different people and ending up both emailing and faxing them a referral to get an appointment. I’m pretty sure I’ll be doing the same thing in 2028. 

You can read tons more about the plans, the event and the voluntary agreement from luminaries like Lisa Bari and new dad Brendan Keeler.

But none of that is what is troubling me. What is deeply disturbing is the normalization of the people allegedly in charge of the nation’s health and health tech and the nonchalance and even knee-bending of those who went to the event last week.

Now I wasn’t there, even if several industry friends and clients were. I was at several similar events back in the Obama administration, but what we have seen from this Trump administration is a radical and toxic departure from America’s leadership in health and democracy, and it is not acceptable.

This is encapsulated by the people on the dias, and the actions they have taken.

Trump and his administration have committed so many egregious authoritarian acts that there’s no way to list them all. Just because people voted for him and the Congress and Judiciary is neutered does not obviate the fact that he was – deep breath – convicted of rape and separately found to be lying about mortgages in a civil court; convicted of 34 felonies for essentially tampering with the 2016 election; and impeached twice–once for politicizing America’s foreign policy and once for starting a violent coup. Don’t forget that at the time of the 2024 election he was being–another deep breath–prosecuted for stealing (and presumably selling) state secrets; being prosecuted for vote tampering in Georgia; and being prosecuted for planning the coup on Jan 6. It’s worth pointing out that two countries that have recent experience of dictatorships (Korea and Brazil) have both prosecuted and banned from office the leaders who attempted similar crimes there. (Incidentally I highly recommend you watch I’m Still Here, the Oscar-winning story of one family whose father was “disappeared” under Brazil’s military dictatorship in the 1970s).

Since his return to office, Trump has overseen the greatest direct political corruption ever in this country – you can bribe him directly via his memecoin. He has also overseen the transformation of ICE into an American-style Gestapo. Masked unidentified ICE agents are now snatching people, including both citizens and legal immigrants, off the streets and burying them in concentration camps here and abroad. Don’t forget that many immigrants or first generation immigrants are heading up those health tech companies at the meeting last week, not to mention how many poor, and perhaps undocumented, immigrants are working in our health care system. 

I haven’t even mentioned the impending cuts to Medicaid, the program for the poorest Americans, which will be the result of Trump’s “One Big Beautiful Bill Act”. That is sure to have a terrible effect on patients and on much of the health system, including many health tech companies trying to support Medicaid patients.

I didn’t even mention Epstein! And this is the guy America’s health care community wants to go and politely applaud just because he reads a speech about interoperability?

And it doesn’t stop there.

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Emily & Me–Money Remaking Medicine

The super connector and super intelligent Emily Peters, (who has quite her own patient adventure story–tl:dr GO GIVE BLOOD) and has written several books including Artists Remaking Medicine, is working on another one called Money Remaking Medicine. She invited me on a show called the Positive Deviants Detectives which is kind of a book club called the Health Care Reinvention Collaborative all hosted by the very wise Dawn Ellison. We talked and the audience joined in about the history of money, HMOs and more in health care and whether we can re-fangle it to make the money do the right things. Matthew Holt

Steve Brown, CureWise — AI for patients

Steve Brown is a genuine digital health OG. Starting with video games for kids with diabetes he eventually turned Health Hero into one of the first disease management companies. It was used in the VA to manage patients at home with CHF, diabetes and more and eventually sold to Bosch. Steve left health care for 15 years, but then at the start of this year had his own health issue. Which turned out to be cancer. He turned to AI and has built an amazing early stage patient facing AI doctor, called CureWise. It essentially has turned LLMs into multiple doctors. He gave me a full and fascinating demo. This is clearly the future but it’s also the present for Steve who is patient zero and the first user as well as the CEO. Amazing stuff. — Matthew Holt

Have Some Water – While You Can

By KIM BELLARD

We live on a water world (despite its name being “Earth”). We, like all life on earth, are water creatures, basically just sacks of water. We drink it, in its various forms (plain, sparking, carbonated, sweetened, flavored, even transformed by a mammal into milk). We use it to grow our crops, to flush our toilets, to water our lawns, to frack our oil, to name a few uses. Yet 97% of Earth’s water is salt water, which we can’t drink without expensive desalination efforts, and most of the 3% that is freshwater is locked up – in icebergs, glaciers, the ground and the atmosphere, etc. Our civilization survives on that sliver of freshwater that remains available to us.

Unfortunately, we’re rapidly diminishing even that sliver. And that has even worse implications than you probably realize.

A new study, published in Science Advances, utilizes satellite images (NASA GRACE/GRACE-FO) to map what’s been happening to the freshwater in the “terrestrial water storage” or TWS we blithely use. Their critical finding: “the continents have undergone unprecedented TWS loss since 2002.”

Indeed: “Areas experiencing drying increased by twice the size of California annually, creating “mega-drying” regions across the Northern Hemisphere…75% of the population lives in 101 countries that have been losing freshwater water.” The dry parts of the world are getting drier faster than the wet parts are getting wetter.

“It is striking how much nonrenewable water we are losing,” said Hrishikesh A. Chandanpurkar, lead author of the study and a research scientist for Arizona State University. “Glaciers and deep groundwater are sort of ancient trust funds. Instead of using them only in times of need, such as a prolonged drought, we are taking them for granted. Also, we are not trying to replenish the groundwater systems during wet years and thus edging towards an imminent freshwater bankruptcy.”

As much as we worry about shrinking glaciers, the study found that 68% of the loss of TWS came from groundwater, and – this is the part you probably didn’t realize – this loss contributes more to rising sea levels than the melting of glaciers and ice caps.

This is not a blip. This is not a fluke. This is a long-term, accelerating trend. The paper concludes: “Combined, they [the findings] send perhaps the direst message on the impact of climate change to date. The continents are drying, freshwater availability is shrinking, and sea level rise is accelerating.”

Yikes.

“These findings send perhaps the most alarming message yet about the impact of climate change on our water resources,” said Jay Famiglietti, the study’s principal investigator and a professor with the ASU School of Sustainability. 

We’ve known for a long time that we were depleting our aquifers, and either ignored the problem or waved off the problem to future generations. The researchers have grim news: “In many places where groundwater is being depleted, it will not be replenished on human timescales.” Once they’re gone, we won’t see them replenished in our lifetimes, our children’s lifetimes, or our grandchildren’s lifetimes.

Professor Famiglietti is frank: “The consequences of continued groundwater overuse could undermine food and water security for billions of people around the world. This is an ‘all-hands-on-deck’ moment — we need immediate action on global water security.”

If all this still seems abstract to you, I’ll point out that much of Iran is facing severe water shortages, and may be forced to relocate its capital. Kabul is in similar straits. Mexico City almost ran out of water a year ago and remains in crisis. Water scarcity is a problem for as much as a third of the EU, such as in Spain and Greece. And the ongoing drought in America’s Southwest isn’t going any anytime soon.

Continue reading…

V Bento, Sword Health

I got to interview V Bento the CEO of Sword Health. We had been in a little back and forth on Linkedin but this was the first time we actually had talked. Almost all of their business is in the US in MSK but they have recently added mental health and V is not shy in talking about the other areas they are heading into. They have had some controversial moments. They just raised money at an amount ($4 Bn) higher than larger rival MSK health outfit Hinge Health is trading at on the public market. Then I used it a year ago via Blue Shield of CA, and found it effective but expensive. Finally, there’s a lawsuit from the folks at Aging 2.0 who claim that they are owed equity from an accelerator Sword was part of in the 2010s.

V talked about all of these, specifically about how they are now charging their clients, and why he thinks they are worth their valuation–which apparently has no special terms for general Catalyst which invested at that valuation. He wouldn’t talk about the lawsuit other than to say he was happy with his position. But we had a good discussion and got to hear about their new tech, including their use of AI, and why V is so bullish on the company moving beyond MSK. Matthew Holt