Listen to the episode on a streaming platform by clicking one of the links below:

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• Humana closed its acquisition of the Florida-based primary care chain MaxHealth, one of the largest such deals since CVS’s purchase of Oak Street Health in 2023.

  • With MA reimbursement falling behind utilization trends, payviders like Humana and UnitedHealth are leaning further into owned provider assets that might steer downstream volumes away from health systems in competitive markets.

  • If health systems don’t acquire the care delivery assets that private equity firms are looking to unload, payers might swoop in instead.

• The Trump administration is appealing a federal court ruling that struck down a Biden-era regulation expanding what merging companies need to disclose to the FTC.

  • The appeal signals that the more aggressive antitrust posture that began under the previous administration still retains some bipartisan support.

  • If the new merger rules are rolled back, a more permissive legal environment for M&A could give growing health systems and financially distressed hospitals more strategic options.

  • Larger health systems tend to attract more media and antitrust scrutiny, but they also have cheaper access to capital for strategic transformation.

• In a 6-3 ruling, the Supreme Court struck down President Trump’s sweeping emergency tariff rates. This week’s featured graphic breaks down the alternative legal authorities that the administration is drawing on to replace them with new tariffs.

• CMS unveiled surprisingly low rates for its new ACCESS model, a voluntary alternative payment model for chronic conditions like high blood pressure, diabetes, and depression.

  • Third-party analysts say the ACCESS rates are significantly lower than the equivalent fee-for-service rates under traditional Medicare, spurring speculation that the new model will only be feasible for startups that replace human clinicians with AI-guided care.

• CVS launched a new GLP-1 drug access service that lets employers decide how much they want to subsidize out-of-pocket costs for their employees.

  • High prescription drug costs remain a top employer concern, and health systems with provider-sponsored commercial plans should consider matching similar features.

  • Health system-sponsored weight management programs might not be able to compete on cost with virtual-only alternatives pushed by payers.

Listen to the episode on a streaming platform by clicking one of the links below:

• Listen on Spotify

• Listen on Apple Podcasts

• The Trump administration is scrapping its proposed 340B rebate pilot just weeks after a federal court issued a temporary block on procedural grounds.

  • If the administration revives the pilot, it has agreed to go through a new rulemaking process with advance notice and public comment.

• This edition’s Key Market Dive looks at the latest quarterly and full-year earnings reports across the healthcare sector.

  • HCA’s strong results showcase not only its ability to leverage scale to control costs, but also its disciplined approach to capital spending and systemness.

  • Payers with exposure to MA like UnitedHealth and Elevance continue to face a mismatch between utilization and reimbursement trends, while commercially focused payers with value-based capabilities like Cigna are thriving.

  • Amazon’s plan to spend nearly $200B of its capital on AI-related investments is spooking investors, but the company might be able to find further synergies with its healthcare segment.

• Payer stocks plummeted more than 20% after CMS gave notice that next year’s MA rate increase will be essentially flat.

  • The agency is also moving to exclude chart reviews without follow-up care from their risk adjustment model. For-profit plans that effectively gamed the system will face a larger hit to their revenues.

  • Health systems might prefer to work with the regional nonprofits and BCBS plans that are now taking market share from the national for-profits. But the changes could also shutter provider-sponsored plans that can’t absorb a margin hit in the current environment.

• ChenMed is no longer widely prescribing GLP-1 medications to its members for weight loss, citing unintended side effects like muscle loss and increased falls.

  • ChenMed’s focus on a single patient type—seniors on MA—allows them to tailor their approach and make a more compelling value-based pitch to payers.

  • Health system-sponsored weight management programs might consider similar moves, but a shift away from GLP-1s might disappoint younger consumers who specifically join these programs to obtain prescriptions.

• MSK disruptor Sword Health is acquiring rival Kaia Health in a $285M deal that will consolidate their customer bases.

  • In addition to greater scale, the acquisition might help Sword care for patients with a wider range of conditions, making their app-enabled service more attractive to employers.

• This week’s featured graphic takes a comprehensive look at contract disputes between payers and providers that spill out into public view.

  • Unsustainable economics and eroding negotiating leverage are making private compromises harder to reach, leaving patients in limbo for weeks, months, or even years.