There is no doubt Robert F. Kennedy, Jr. is sincere about wanting to make the world a better place. The Hudson River cleanup, which he helped lead, is one of the most successful environmental achievements in the United States. It had bipartisan support, set global standards, and earned the highest compliment: imitation.
It was quite reasonable to believe Mr. Kennedy could use those same skills and passion to lead Health and Human Services (HHS). He has a proven track record with complex systems, scientific evidence, and protecting public welfare. Even skeptics of his appointment want him to succeed.
But skill sets in one domain do not always translate to another domain—no matter how strong that skillset is. And it can be very difficult to realize this until the effects of the Law of
Unintended Consequences start to complicate things—as is now happening with Mr. Kennedy’s approach to public health. I know the feeling — because I had made the very same mistake.
Lessons from Databases
I had over fifteen years of experience with databases in auto parts, newspapers, manufacturing, and insurance before I started working with healthcare databases. Each domain had its own complex logic but I could adapt from one domain to another relatively easily.
When I started at the University of Iowa’s Department of Anesthesia, I was confident I could make a smooth transition to a new domain as I always had.
My first assignment was simple: create a report of the active prescription medications listed for a patient at a given appointment. It didn’t take very long to figure out how to find patient data, appointment data, and prescription data. My expertise in databases was transferring to a new domain quite smoothly!
All I had to do was use a chart I had and see how to make the connections.
I can read…how hard could that be?
Not only was it harder than I expected it to be, but I also didn’t immediately recognize why.
Parallel Paths
Mr. Kennedy took a similar path with vaccines and autism. He could see patient data. He could see vaccine data. He could see autism data. The connections seemed clear.
In my case, a researcher at Iowa had a theory that the length of a clinical appointment could be predicted by the number of prescriptions a patient was taking. My job was to combine all of the relevant data. He would then use that for his calculations.
I built a dataset. Everything looked right. But I was so new I didn’t realize there were hidden flags that identified appointment types. And flags for prescriptions that were active on the date of the visit. I didn’t even know there was a database flag that identified them. Flag is an oversimplification; it was far more complex than that.
Kennedy thought he had confirmation of his theory in 1998, when Andrew Wakefield and colleagues published a study in The Lancet suggesting a link between the MMR vaccine and autism. It looked right. It seemed obvious. A lot of people believed it. But like my report, it was flawed — a small sample size, uncontrolled design, and speculative conclusions. My initial dataset had “false” data because I missed some flags. My mistake was caught long before the data ever got close to any kind of study. Not only did the Wakefield study include falsified data, it made it to the publication stage.
My researcher kindly showed me my errors and I was fortunate it was early on in the process. Meanwhile, epidemiologists and clinicians have repeatedly shown Mr. Kennedy where his conclusions don’t stand up. Yet, like a friend of mine who once argued astronomy with Dr. James Van Allen — yes, the Van Allen Belts Van Allen — some convictions are hard to let go of, no matter how authoritative the counterevidence.
Three Questions for Transferring Expertise
I have learned to ask myself three questions whenever I enter a new domain — and I think they apply to all of us…including Mr. Kennedy.
So some of the more outspoken employees have written a letter. That should do the trick.
The letter, which they call the FEMA Katrina Declaration, was signed by almost two hundred current and past employees (although only three dozen allowed their names to be public). They charge:
Since January 2025, FEMA has been under the leadership of individuals lacking legal qualifications, Senate approval, and the demonstrated background required of a FEMA Administrator. Decisions made by FEMA’s Senior Official Performing the Duties of the Administrator (SOPDA) David Richardson, Former SOPDA Cameron Hamilton, and Secretary of Homeland Security Kristi Noem erode the capacity of FEMA and our State, Local, Tribal, and Territorial (SLTT) partners, hinder the swift execution of our mission, and dismiss experienced staff whose institutional knowledge and relationships are vital to ensure effective emergency management.
The letter goes on to list “Six Statements of Opposition,” calling to reverse various actions the Administration has taken that they believe impairs FEMA’s ability to fulfill its mission. Each seems perfectly reasonable, and none seems likely to result in action, at least unless/until disasters strike enough red states to force action.
FEMA spokesperson Daniel Llargues was not impressed, responding: “It is not surprising that some of the same bureaucrats who presided over decades of inefficiency are now objecting to reform. Change is always hard. It is especially for those invested in the status quo. But our obligation is to survivors, not to protecting broken systems.”
I probably wouldn’t have paid much attention to the letter, except it comes two months after some 90 NIH scientists issued their “Bethesda Declaration” to protest what has been happening to the NIH so far in the Trump Administration. Addressed to Director Jay Bhattacharya, it declared:
For staff across the National Institutes of Health (NIH), we dissent to Administration policies that undermine the NIH mission, waste public resources, and harm the health of Americans and people across the globe. Keeping NIH at the forefront of biomedical research requires our stalwart commitment to continuous improvement. But the life-and-death nature of our work demands that changes be thoughtful and vetted. We are compelled to speak up when our leadership prioritizes political momentum over human safety and faithful stewardship of public resources.
The Declaration lists five categories of cuts the Administration has taken, about which they warn: “Combined, these actions have resulted in an unprecedented reduction in NIH spending that does not reflect efficiency but rather a dramatic reduction in life-saving research.”
Amen to that.
Director Bhattacharya was somewhat more respectful than Mr. Llargues in his response, claiming: “The Bethesda Declaration has some fundamental misconceptions about the policy directions the NIH has taken in recent months, including the continuing support of the NIH for international collaboration. Nevertheless, respectful dissent in science is productive. We all want the NIH to succeed.”
I don’t believe him. This Administration does not recognize any dissent as “respectful.”
This is Part 2 of Jason and Gigasheets’ investigation into the Capital Women’s Care vs UnitedHealthcare contract dispute in which (partially at my request) he expanded the investigation to look at other providers in the same market. Revealing stuff!–Matthew Holt
While Capital Women’s Care (CWC) battles UnitedHealthcare over contract terms, a deeper look at Maryland’s OBGYN market reveals a complex competitive landscape where negotiated rates vary dramatically across providers and procedures. By analyzing price transparency data from both UnitedHealthcare and CareFirst BlueCross BlueShield, we can see exactly what each insurer pays CWC’s competitors. The results are eye-opening.
The Players in Maryland’s OBGYN Market
Our analysis focuses on four OBGYN providers in Maryland that have contracts with both UnitedHealthcare and CareFirst. These four practices were selected as a representation of the broader market because they have published rate data with both insurers, allowing for direct comparisons. However, Maryland’s OBGYN landscape includes dozens of additional providers, from solo practitioners to hospital-based practices, each with their own negotiated rates that may follow different patterns.
The four providers in our analysis include:
Capital Women’s Care – The large practice at the center of the UHC dispute, with multiple locations across the region
St Paul Place Specialists (Mercy Medical Center) – Baltimore-based OBGYN practice with established market presence
Maryland Physicians Edge – Women’s health group with OBGYN services, now part of Advantia
Simmonds, Martin & Helmbrecht – Established OBGYN practice, also under the Advantia umbrella
The four-provider sample provides valuable insights into competitive dynamics among major market players and helps contextualize the CWC-UHC dispute within broader industry patterns.
Following our analysis in Part 1, we examined negotiated rates for three common gynecologic procedures:
Code 56515: Destruction of cervical lesion (treatment following abnormal Pap smears)
Code 57288: Sling operation for stress incontinence (surgical procedure)
Code 58558: Hysteroscopy with sampling (diagnostic procedure for abnormal bleeding)
The Rate Comparison: UHC vs CareFirst
Rate variations in the price transparency data reveals a complex competitive landscape where UHC pays 200-500% more than CareFirst for hysteroscopy procedures across all providers in our sample, while Capital Women’s Care shows mixed positioning. Sometimes Capital Women’s Care commands premium rates from UHC (codes 56515, 57288), other times they’re receiving comparable rates to smaller competitors (code 58558). The data suggests both sides in the CWC-UHC dispute have legitimate arguments: CWC already receives competitive or premium compensation, while rate inconsistencies across procedures indicate room for negotiation.
Extreme rate variations (up to 519%) between UHC and CareFirst reveal market complexity, with Capital Women’s Care showing mixed competitive positioning that supports both sides’ arguments in their contract dispute.
Key Findings: A Tale of Two Insurance Strategies
UHC Generally Pays More Than CareFirst
Across 12 provider-procedure combinations, UnitedHealthcare pays higher rates than CareFirst 75% of the time. This suggests CareFirst has been more aggressive in negotiating lower rates across the Maryland market.
Hysteroscopy Shows the Most Dramatic Differences
For Code 58558 (hysteroscopy with sampling), the rate differences are staggering:
UHC pays 203-519% more than CareFirst across all providers
Average UHC rate: ~$2,200 vs CareFirst rate: ~$510
This represents the largest systematic difference across procedures
Capital Women’s Care Commands Premium Rates
CWC’s rates relative to competitors reveal why UHC may be resistant to further increases:
Code 58558: CWC’s UHC rate ($2,384) is already comparable to competitors, despite CWC’s larger scale
Code 56515: CWC gets slightly better terms from UHC ($581) vs competitors ($352-411)
Code 57288: CWC receives significantly higher rates from UHC ($1,685) vs most competitors ($1,008-1,258)
Wide Rate Variations
The most extreme example: Simmonds Martin & Helmbrecht receives 519% more from UHC than CareFirst for hysteroscopy procedures (a difference of nearly $1,700 per procedure). These patterns suggest that while some procedures have established market rates, others (particularly diagnostic procedures like hysteroscopy) lack standardized pricing, contributing to the complexity of provider-insurer negotiations like the CWC-UHC dispute.
Rate variations reveal dramatic pricing inconsistencies across Maryland’s OBGYN market, with hysteroscopy procedures showing the most extreme disparities difference between the highest and lowest negotiated rates for identical services.
What This Means for the CWC-UHC Dispute
CWC Already Commands Premium Rates
The data reveals a key insight: Capital Women’s Care isn’t necessarily getting unfair treatment from UHC. In fact, CWC often receives higher rates than competitors from both insurers:
For hysteroscopy (58558), CWC gets comparable UHC rates despite being a larger practice that should theoretically have less negotiating leverage
For cervical procedures (56515), CWC receives 40-65% higher rates from UHC than smaller competitors
For sling operations (57288), CWC’s UHC rate ($1,685) significantly exceeds most competitors
This pattern suggests UHC’s resistance to further rate increases may be economically rational rather than punitive.
Industry-Wide Rate Fragmentation
The massive variations between UHC and CareFirst rates across all providers highlight fundamental pricing inefficiencies in healthcare. However, within each insurer’s network, CWC consistently commands premium rates, suggesting their market position is already strong.
Scale vs. Negotiating Power
Conventional wisdom suggests larger practices should receive lower per-unit rates due to volume efficiencies. The data shows the opposite: CWC often receives higher rates than smaller competitors, indicating they’ve successfully leveraged their size for premium pricing rather than volume discounts.
The Broader Market Dynamics
CareFirst’s Market Power
CareFirst BlueCross BlueShield appears to have leveraged its position as Maryland’s dominant insurer to negotiate significantly lower rates across the board. With roughly 50% market share in Maryland, CareFirst can drive harder bargains with providers who can’t afford to lose access to half their potential patient base.
UHC’s Perspective Becomes Clearer
UnitedHealthcare’s position in the dispute gains context when viewed against competitor rates. UHC is already paying CWC premium rates compared to other Maryland OBGYN providers. From UHC’s perspective, further rate increases would create an even larger gap between what they pay CWC versus smaller practices.
The Economics of Provider Consolidation
The data illustrates a key tension in healthcare consolidation: large practices argue their size justifies higher rates due to quality and convenience, while insurers worry about paying premium prices for what should be commodity services. CWC appears to have successfully established premium pricing, making UHC’s resistance to further increases economically understandable.
Looking Forward: What This Means for Healthcare Costs
The Price Transparency Revolution
This analysis is only possible because of federal price transparency requirements that took effect in 2021. For the first time, we can see exactly what insurance companies pay different providers for the same services, revealing the massive hidden variations in our healthcare system.
Market Efficiency Questions
The data raises fundamental questions about market efficiency:
Why does the same procedure vary by 500% between insurers at the same provider?
Are patients getting better care when insurers pay more, or are some insurers simply paying inflated rates?
How can patients make informed decisions when rate variations are this extreme?
Regulatory Implications
These findings may attract regulatory attention, particularly around:
Whether rate variations this extreme serve any legitimate purpose
How to ensure patients aren’t penalized for insurance-provider rate disputes
Whether price transparency alone is sufficient to drive market efficiency
Conclusions: Both Sides Have Valid Arguments
The Capital Women’s Care vs UnitedHealthcare contract dispute becomes more nuanced when viewed through competitive rate data. Our analysis reveals that both sides can point to legitimate evidence supporting their positions:
Capital Women’s Care’s Case:
Rate Inconsistencies: For some procedures like hysteroscopy (58558), CWC receives similar UHC rates to much smaller competitors, despite CWC’s larger scale and presumably higher overhead costs.
CareFirst Comparison: CWC’s significantly higher rates from CareFirst for certain procedures (like sling operations at $2,245 vs UHC’s $1,685) suggest room exists for UHC rate increases.
Market Position Justification: As Maryland’s largest OBGYN practice, CWC can argue their scale, convenience, and comprehensive services warrant premium compensation.
UnitedHealthcare’s Case:
Already Premium Rates: Across multiple procedures, CWC receives higher rates from UHC than smaller competitors (40-65% higher for cervical procedures), indicating UHC already recognizes CWC’s value.
Economic Reasonableness: Further rate increases would create an even larger premium gap between CWC and other providers, potentially making UHC’s network economics unsustainable.
Mixed Performance: The inconsistent pattern across procedures suggests CWC’s premium positioning isn’t uniformly justified across all services.
The Complexity of Healthcare Negotiations:
Rather than a clear case of unfair treatment, the data reveals the inherent complexity of healthcare rate negotiations. Both parties can legitimately point to specific procedures and comparisons that support their position, while the overall picture remains genuinely mixed.
This analysis suggests the dispute reflects broader challenges in healthcare pricing: How do you fairly compensate scale and market position while maintaining reasonable cost structures? The competitive data shows there’s no obvious “right” answer; just different ways to interpret the same complex market dynamics.
The real insight isn’t that one side is clearly right, but that healthcare rate negotiations involve legitimate competing interests where reasonable people can look at the same data and reach different conclusions about fair compensation.
Jason Hines is CEO of Gigasheet which delivers AI-powered price transparency market intelligence.. This was first posted on their corporate blog
Note: This analysis is based on a sample of price transparency data filed by UnitedHealthcare and CareFirst BlueCross BlueShield, as mandated by federal regulations. The rate calculations are aggregations of data from multiple contracts and locations within each provider organization. To expand our rate analysis from Part 1, we resolved EINs to organization names using public data sources.
(I copied this here from Linked in where it 65+ comments just so I can find it when the story continues) Too painful to write up fully but I am on my 4th transfer in one phone call to MarinHealth trying to get an echocardiogram (EDIT-not an EKG as I originally wrote). They have lost the referral from One Medical twice. I had to download the referral and email it to them (Lucky it’s on the One Medical system). Every person has asked for my DOB and phone number. The guy who got the email, read the referral and transferred me. The latest guy appears very puzzled & wants me to fax him the referral. Eventually he gets me to his supervisor who says that radiology & cardiology are separate and they can’t receive an email because it’s a HIPAA violation. (I claimed to be Lucia Savage & laughed at him). Now I have to figure out how to fax it to them and the supervisor promised to call me back. He had to ask for my phone number….
Oh and I can’t book a echocardiogram on MyChart, but I can book a mammogram.
I’ll follow up in the comments. BTW that phone call was 19 minutes
UPDATE: OK, so I faxed them via a dodgy efax company whose “free trial” I need to remember to cancel. The supervisor did call me back, but for some reason my phone didn’t ring! He left a message and booked an appointment for me. But not in their Marin facility. In the next county over! (And Sonoma is very lovely). A 45 min drive rather than a 10 min drive from my house. I can SEE the appointment in the UCSF MyChart, and I can cancel it. but I cannot request a change or see when I could book one closer to me (presumably at a later date). So I guess I will call back on Monday….
UPDATE: So I called back today and got the appointment changed to the closer location. I had to wait one more day… I know you are all on tenterhooks so I will tell you if my heart works in 2 weeks!
UPDATE to the Update. A human called me and cancelled my appointment. Apparently the tech was out sick. Still no word on whether I have a heart or just a black pit inside my chest
UPDATE: I finally got in and had the Echocardiogram. Marin Health had an iPad based fast check in (well done). I didn’t recognize whose software it was. The echocardiogram took 45 minutes and was a bit like having somone stick their finger in your chest the whole time. Yes I do have a heart! More to come
My friend Rosemarie Day joins me to talk about the Healthcare Leaders for Democracy session coming up on September 4 (Thursday) at 8pm ET 5pm PT. It’s a one hour session with Atul Gawande as the keynote speaker, joined by Don Berwick and John McDonough. It’ll be a fascinating discussion and it’s a fundraiser for Movement Voter Project, but it’s free to sign up.
Rosemarie and I talked about how we work on getting grassroots mobilization for the mid-terms and beyond, and we hope people will come and join.
On August 1, 2025, Capital Women’s Care (CWC), one of the largest OB/GYN practices in the Mid-Atlantic region went out-of-network with UnitedHealthcare, affecting tens of thousands of women across Maryland, Virginia, Pennsylvania, and Washington D.C. The contract dispute between Capital Women’s Care (CWC) and UnitedHealthcare offers a fascinating case study in how price transparency data can illuminate the real dynamics behind these high-stakes negotiations.
The Public Battle
Capital Women’s Care, with more than 250 physicians and healthcare professionals, confirmed that its agreement with UnitedHealthcare would lapse despite ongoing negotiations. The practice urged patients to contact UHC to voice their concerns about losing access to their providers.
UnitedHealthcare fired back with detailed public claims on their website, alleging that CWC “refused to move off its demands for double-digit price hikes” and is “significantly higher cost today compared to peer providers throughout Maryland and Virginia”. UHC provided specific examples, claiming that a vaginal delivery from CWC would cost “more than 120% higher – or over $2,600 more – than the average cost of other OB/GYN providers”.
But what does the actual price transparency data reveal about these competing claims?
What the Transparency Data Shows
Using Capital Women’s Care’s negotiated rates from UnitedHealthcare’s own machine-readable files, we analyzed a sample of common OB/GYN procedures from Maryland rate data. While this represents only a subset of all procedures and focuses specifically on Maryland rates, it provides valuable insights into the real payment dynamics between these organizations. The data paints a more nuanced picture than either party’s public statements suggest.
Data Methodology Note: Our analysis examined negotiated rates for Capital Women’s Care from publicly available machine-readable files, focusing on Maryland providers and filtering out statistical outliers (rates below 50% or above 500% of Medicare). We analyzed rates for both UnitedHealthcare and CareFirst across three common OB/GYN procedures where both payers had sufficient data.
CWC’s Rate Position vs Other Payers
Our analysis of three common OB/GYN procedures in Maryland reveals that CWC’s rates with UnitedHealthcare were actually quite competitive compared to other major payers:
Negotiated rates for three common OB/GYN procedures show UHC was paying competitive rates compared to CareFirst
For the three procedures where both UHC and CareFirst have negotiated rates with CWC:
This sample data suggests UnitedHealthcare was already getting favorable rates from CWC compared to other major payers, calling into question UHC’s claims about CWC being “significantly higher cost.”
The Medicare Benchmark Reality
Both UHC and CareFirst were paying CWC rates well above Medicare in our sample:
UnitedHealthcare: 143-175% of Medicare rates
CareFirst: 166-220% of Medicare rates
While CareFirst paid higher rates, UnitedHealthcare’s rates were still substantial premiums over government reimbursement, suggesting the “double-digit increases” CWC requested may have been attempts to align with market rates other payers were willing to pay.
The U.S. has a healthcare cost problem that everyone knows about but no one talks about openly. For decades, the same medical treatment has cost very different amounts. Hospitals down the street from each other might charge five times more or less for the exact same thing. Patients couldn’t find out the real costs ahead of time. Even many insurance companies didn’t know the actual rates. Two recent laws tried to fix this problem. The Hospital Price Transparency Rule came into effect in 2021. The No Surprises Act came into effect in 2022. These laws have two main goals. First, they need healthcare providers to share their real prices. Second, they aim to stop some unfair billing practices.
On paper, these measures should have transformed the market. Patients would “shop” for cheaper care. Providers would compete, driving down prices. Insurers would negotiate with real market benchmarks. But three years in, the impact is scattered and superficial. Compliance is inconsistent. Prices remain incomprehensible to ordinary consumers. In some markets, transparency has even led to higher prices. The main problem is that the laws don’t have strong enough punishments.
A November 2024 study found that 46% of hospitals did not follow all the rules. The patterns are the same everywhere. Hospitals share incomplete data. They create machine-readable files that are hard to use. They hide “shoppable service” lists in website folders. Search engines cannot find these folders. The No Surprises Act was meant to stop surprise bills for some out-of-network care. But it hasn’t worked much better. The law has stopped millions of surprise bills. But the dispute process (the IDR) has more cases than it can manage.
Ingrid is one of the OGs of customer service in health plans, PBMs and as she insists startups. She and her co-founder Marin Nelson have built Sobrynth–a company that is taking a whole new approach to helping with (primarily) alcohol addiction in the workplace. Despite the rise of mental health solutions, EAP, the focus on substance abuse and a lot of DTC plays in alcohol use disorder (starting with AA and going on from there), there’s not much specifically for employers. Ingrid showed me the app, the process and we had a great chat about the problem and how Sobrynth can help–Matthew Holt
Over the weekend Labcorp sent me a final due notice on my bill…. the one that they couldn’t tell me about without asking for all the information they already had.
I call Labcorp customer service in the Philipinnes. The friendly rep says that they have had a message saying that “the insurance company requires that Labcorp provides documentation from the ordering physician”. What documentation, I ask? A letter that tells them what the updated codes are. Given that the Brown & Toland Physicians rep told me those codes and they must have been sent them by Labcorp when Labcorp sent in the claim, that seems to make no sense. I’m not yet prepared to ask my doctor’s office to get involved in this! (Better look out though, Andrew Diamond!). So I’ll let that go for a moment.
However, Labcorp says that they received an EOB from Blue Shield of California PPO–it had my correct member number even though I am an HMO not PPO member. No the EOB did not come from the IPA Brown & Toland Physicians, and yes I asked very precisely. The EOB says the co-pay is $34.94. Labcorp can’t ascribe it to any one of the 5 individual lab tests (which all look preventative under the ACA to me but maybe one isn’t). So the $34.94 is the copay from the EOB that Blue Shield of California sent to Labcorp.
They asked me for my copy of the EOB. I sent one 5 days ago, but sent it again just to be sure.
Next up, asking Blue Shield of California what precisely they sent to Labcorp saying my co-pay is $34.94 when the one they sent me (well have on their website) says $0. Oh and by the way, the standard copay for labs on my plan is $50, not $34.94!
On my Blue Shield of California member portal there’s a message with a letter. Apparently they opened a customer grievance for me! I called the customer grievance number in the letter. According the answering IVR message there is a chat option for providers with grievances, but not one for consumers. My hold time is estimated at 20 minutes. A nice rep called Susie comes on in only 15 mins.
After verifying that she knows who I am she says there are 2 different grievances! One is an appeal for the lab test & one is a complaint about the process, both opened August 12. I suspect they were initiated by the nice man from the Executive office who called me on that day. Rep Susie is limited to telling me that appeal status. But she tells me that an appeal coordinator is looking into the complaint and will be back in touch within 30 days. AND she gives me an email to reach said coordinator at! So I sent that person an email….lets see what happens!
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
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.
