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Category: Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

Medicaid Should be Abolished. But Not Like This!

By MATTHEW HOLT

A long time ago in a different country, there was a landslide election from a population looking for change. And change they got. Americans had been campaigning for national health care since 1917. There had been failures in 1933 and 1946 and 1961. But in 1965 they got it. Sort of.

But a weird thing happened in the Congress. Out of the political sausage making came a plan that “Cared” for those over 65. While another plan came out that “Aid”ed the poor. (Stole that from the wonderful Adimika Arthur). Weirder still, the Medicare program was and is a Federally-funded program. The Medicaid program was a state-administered program, even though it was at least half funded by the Feds. 

That meant that Medicaid was always vulnerable to the whims of states. Of course many states already had demonstrated dismal records in how they treated their poorer and minority populations in the past (think slavery, Jim Crow, KKK, separate schools, drinking fountains, buses…you get the idea).

So while Medicare became the savior program for anyone who made it to 65, and later for those who were disabled or had kidney disease, Medicaid was a program for poor people that then got treated poorly. (Stole that from Jonathan Cohn). And right now in 2025 it is under severe threat yet again.

Before we get to that threat, it’s worth looking at the program. Medicaid has evolved and now covers most nursing home care (for “poor” seniors), care for the disabled, and even pays Medicare Part B premiums for people too poor to pay their own.  It also covers health insurance for poor people under 65 and in those states that accepted ACA Medicaid expansion, that’s a considerable number. Of course these are people under an imaginary line that makes them too poor to buy on the exchanges set up by the ACA. And usually Medicaid includes the CHIP program, an insurance program that covers poor children set up under Clinton in 1997.

This chart from the venerable KFF shows that while 75% of people on Medicaid are, poor, under 65, and not classified as disabled, 50% of the money goes to those who are not.

This all results in a bizarro world in which there is one Federal government program for people over 65 and the disabled, and then an entirely different state-based one, which spends 1/2 of its money on people who are over 65 and disabled and who are also in the Federal program. This is plain stupid and always has been.

Of course there is more to it than that.

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League Connect Digital Summit is WEDNESDAY

It’s Matthew Holt and I am looking forward to MC-ing the #LeagueConnectDigitalSummit THIS Wednesday May 7.

This one-day virtual event brings together leaders across health care, tech, and consumer experience to explore what it really takes to deliver personalized, digital-first, AI-powered care. I’ll be guiding the day’s key transitions and themes. There’s also strategy & implementation tracks with the likes of Google, Highmark Health, Accenture, Amwell, Deloitte, SCAN, Gainwell Technologies Health, and startups like SimpliFed, Healthily, Linus Health and so many more.

Join me and League for a FREE day of conversations, connection, and actionable insights that move health care forward. 

Oh, yes and Moneyball, The Blind Side and Liar’s Poker author Michael Lewis is the keynote.

Register here

Glen Tullman, Transcarent

A couple of weeks back Transcarent completed its $630m acquisition of Accolade. But CEO Glen Tullman calls it a merger for a reason because Accolade brings people, products and clients that Transcarent didn’t have. Glen got in deep about Transcarent’s new product set in terms of its AI fueled navigation, primary care, weight management, cancer care and partnerships. Where is it going in terms of more with employers (yes!), Medicare (not yet) and aggressive expansion of services? And what can employers and their employees expect in terms of improving customer service from the health care system? Glen and his team have a big vision, big capital backing, and he is definitely intending to move the needle on care access, quality and cost.–Matthew Holt

Roon – the Demo and Interview

I was a little surprised that in the days of limitless content, AI, and all types of medical information being online a company could raise $15m to create a platform where actual doctors could answer specific questions that patients might have. Vikram Bhaskaran, the CEO is ex Pinterest and knows the consumer world well. Rohan Ramakrishna is  a neurosurgeon who is worried about the level of misinformation that he saw showing up in his clinic daily. So Roon is trying to build what might be the impossible, a free personalized (mostly video) guide for health powered by the world’s best experts. They gave me a tour of what they have built so far, and it’s both impressive, ambitious and has a way to go. It’s an interesting demo and it raises some interesting questions about how that knowledge will be shared in the very near future–Matthew Holt

We Need to Nationalize to Prevent Fraud

By MATTHEW HOLT

Two weeks ago I wrote an April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care to save some money. That piece was half-joking but full-serious. 

If you look at what Musk is complaining about there are two major areas of “waste, fraud and abuse” in government spending. 

One is people directly employed by government agencies. Most of the people I’ve ever met in government work damn hard and for much less money than they’d get in the private sector. But you can of course find stories about useless government bureaucrats, who don’t do any work and pad their expense accounts. Those stories are probably about as true as Reagan’s pink Cadillac driving welfare queen in that there is some basis in reality for there being a tiny minority of bad actors, but the politics has far outrun the truth. (BTW that Welfare Queen article by Josh Levin in Slate is remarkable and very long!)

The other major area where Musk claims to be finding fraud is in work contracted out. There are of course lots of types of government work contracted out. If, like me, you’re old enough to remember the Iraq war, you probably are thinking of beltway bandits like Halliburton supplying any number of services to the military. (Remember when the Cheneys were baddies?). Another is the Blue Cross & Blue Shield plans who were the original contractors processing Medicare & Medicaid claims. Funnily enough they couldn’t actually deliver on that so in turn they outsourced it to Ross Perot at EDS and others like ACS, later Conduent. But there’s a ton more across every agency.

Musk & DOGE have been running around in the most ham-fisted way imaginable, axing both actual employees–including 20,000 of the 80,000 working at HHS– and allegedly slashing $150 billion in contracts. Of course on closer examination, many of the “contracts” were already over, or were made up. DOGE has been a pathetic piece of performance art that would be funny if it hadn’t ruined so many careers of people doing great work, or killed so many desperately poor children in poor countries.

The clever people at Brookings, (Elaine Kamarck and Paul Light) in a detailed piece on the topic, came up with an estimate of the ratio between direct employees and contractors.

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Elevare Law launches!

There’s a new health innovation law firm in town! Rebecca Gwilt & Kaitlyn O’Connor have started Elevare Law to help health tech companies. We spent a little time talking about the new firm and who it’s going to work with, and a lot about the different legal and regulatory challenges facing digital health companies. Deep dives into the regs around RPM, RTM & more, and also a lot about what we might expect from the FDA and the rest of the chaos in the new Administration. Plus a little about how AI helps lawyers be more efficient and a lot about how AI may or may not be influenced by health care regulation (TL:DL, it’s going to be slow & state by state) –-Matthew Holt

League Connect Digital Summit on May 7

I’m thrilled to be working with League and I’ll be MC-ing health care’s must-attend virtual CX event, League Connect Digital Summit on May 7. 

An immersive day of inspiration, insights, and incredible speakers is headlined by Moneyball & Big Short Best-Selling Author, Michael Lewis and @HighmarkHealth CEO, @DavidHolmberg, as well as many more.

More than just theory, at the Summit you’ll get actionable strategies and everything you need to drive health care CX forward. – Matthew Holt

Register today to save your spot

The Life365 Demo

Kent Dicks, CEO, and Kendall Paulsen, Telehealth Solutions lead, at Life 365 showed me their comprehensive set of tools and services for remote patient monitoring, or what I call the “continuous clinic”. Kent did this with MedApps, later acquired by Alere. But at Life 365 he’s building a new approach to getting the tools and platforms easy to use for patients, and also getting that collected data ready for AI systems to monitor patients and enable more immediate care. And Kent & Kendall not only talk about it but they show a deep-water demo with both devices and dashboards of both the monitoring and drug adherence devices. A glimpse into where health care ought to be and hopefully is going!–Matthew Holt

Tanay Tandon, Commure

Tanay Tandon is CEO of Commure, which is essentially a startup conglomerate which includes the original Commure, Tanay’s company Athelas, ambient scribe Augmedix, the Strongline staff safety product, Memora Health’s workflows and more. HCA, the big for-profit chain, is one of the biggest customers and an investor in Commure. I grabbed Tanay at HIMSS earlier this month to understand what Commure was building and what he thinks co-pilots/auto-pilots can eventually do in the hospital. Tanay’s aiming for a time when the combo of all the products mean doctors don’t have to touch their keyboard. But what does this have to do with the EMR? And what does their major backer, General Catalyst, intend to do with Commure and its other companies? Hopefully after this things are becoming a little clearer!–Matthew Holt

Sword Health, the Hinge Health S1, and me

By MATTHEW HOLT

The big news in the comeback of digital health is that Hinge Health filed its S1 and is looking to go public soon. I suspect that they’d have preferred to get the IPO done late last year when the AI bubble was expanding rather than deflating, but timing the market is tough! Nonetheless Hinge is almost profitable and at over $350m in revenue at a growth clip of some 75% last year, in terms of a show pony to trot out, it’s about as good as the digital health field has got. The problem is that the last round in 2021 was at a $6bn+ ZIRP-era valuation with Tiger & Coatue paying the idiot price because Teladoc was trading at $15bn market cap then (albeit down from $30bn a year before that!). That is, err, no longer the case. There’s a bunch of weirdness in the IPO structure to pay those guys back, but the main point is that the likely valuation will be in the $1.5-2.5bn range. 

But there’s another problem. And it’s one I have some personal experience with. I must stress that my experience is not with Hinge.

As it happens I did a video interview at Hinge’s booth at HLTH in 2022 when my back collapsed, and I got to try out their Enso device (it helped a bit but not much after the first few minutes using it). I discussed the process with PT Lori Walter and got a quick interview with President Jim Pursely (an old Livongo hand BTW). 

But this past summer I used the services of their main competitor, Sword Health. As far as I can tell the two companies are very similar in their process and services, both with self-service exercises delivered via the smartphone and both moving from remote care from therapists to AI therapists. But I could be wrong. So for this article I am extrapolating from one company to the other to look at the field of MSK digital services overall.

In total, I thought the Sword experience was good as a standalone program. But the problem was that it was standalone.

My problem was with my left knee. I had a lot of knee surgery in 2002-4 as the result of snowboarding into a tree (Hint. If you snowboard, try to make sure you and the board go the same side of the tree). More than 20 years later in 2024 I managed somehow to induce terrible pain in the knee running for a ferry in January, a train in May and an airport shuttle in June. (It seems that travel and my knee disagree). This didn’t stop me strapping up, taking drugs and snowboarding in the 2024 winter season but it certainly slowed me down a whole lot. Around this time there were many reports of people much younger than me getting their knees replaced.

So I thought I should do something about it. My Blue Shield of California plan offers Solera which is an agglomeration marketplace of digital health apps and services. Sword Health is their PT app, so I selected it, enrolled and off I went.

Note that there was zero integration with my PCP, any orthopedic surgeon, any clinical person at the health plan or basically anyone. This was purely patient-driven and managed.

With Sword I had a 15 min intro call on June 6 – then was sent a box containing a generic tablet and six sensors which fit into straps that you attach to your lower and upper legs and arms.

There was a conversation in the app with a PT and then it spat out a selection of exercises for me. The example below is my second exercise session. If you want to check out more, I have put more of the exercise and the chat with the PT here.

Sword suggested, instead of regular 45-60 minute physical PT sessions, that I did four 15 minutes sessions a week. Essentially one every other day.

The end result was that I did eight sessions between June 12 & June 30.

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