53 - HCN - SUMMER SOLSTICE SPECIAL 2026
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Speaker 3: welcome back to The Healthcare Nation. It's good to be with you again. As we're recording this, we're approaching the summer solstice, the longest day of the year. I've always liked the symbolism of the solstice, not because it changes the landscape.

It doesn't. The roads are still there. The mountains are still there. The challenges are still there. What changes is the light. For a little longer, you can see farther, and that's where I think healthcare finds itself today. We're halfway through 2026, far enough removed from the pandemic to stop reacting, close enough to the future to begin seeing where the industry is headed, and what we're seeing is a healthcare sector in transition.

Washington is shifting from expansion to accountability. Healthcare leaders are confronting the reality that chronic disease remains the defining challenge of our time. Artificial intelligence is moving from experimentation into operations, and new therapies like GLP-1s are forcing us to rethink what's possible in the treatment of [00:01:00] obesity, cardiovascular disease, and potentially much, much more.

At the same time, patients are asking a very simple question: Is healthcare actually getting better? Not more innovative, not more complicated, not more expensive, but better. Because that's ultimately what matters. Patients don't experience healthcare through legislation or reimbursement models. They experience it through appointments, through bills, wait times, outcomes, and trust.

And if there's one thing I've learned throughout my career, it's that healthcare can survive complexity. It can survive disruption. It can survive change. But what it cannot survive is a loss of trust. So today, Joe and I are going to step back from the headlines. We're gonna talk about the forces shaping healthcare mid-year 2026, what's happening in Washington, why GLP-1s may be one of the most important medical stories of our generation, what artificial intelligence is actually doing inside healthcare organizations, and what healthcare leaders should be watching [00:02:00] as we move into the second half of the year.

Because leadership isn't about understanding where healthcare is. It's about understanding where healthcare is going. I'm Rex Chonada, and this is The Healthcare Nation podcast

Speaker 5: Welcome to the Healthcare Nation podcast. We're committed to bringing you thought leaders in the field to discuss what's new and noteworthy in the healthcare sector. Now your host, Rick Janna.

Speaker 2: joe, great to be back in the studio with you. Yeah, it's good to be back. You know, I tried to do a couple shorts when I was in you know, in Florida- Yeah ... down south. I saw them. They, they, they were great, but it is nothing like two things, number one being in the studio, but- It's fun ... big thing, and I've gotten feedback on this, is having the conversation with you, which is fantastic, so happy to be here, my friend.

Speaker: Yeah, I'm glad you're back. I think a lot has happened, obviously. A lot has happened. So I say we jump right in. Yeah. So we're gonna get into the Washington upcare, or healthcare update that's been going on. So if there's one word that defines healthcare policy in 2026, [00:03:00] what do you think it is?

Speaker 2: Yeah, I'll tell you, and, and you're right, there is a lot to cover, um, midyear, as we said, with this, with this show, and I, I think, you know, I've, I've, I've tried to come up and think about different ways and, and in response to, to your question specifically.

It probably is accountability, and maybe accountability from a few different, um, angles, and let me just start with DC itself. Um, I think there is a thought now m- more about, you know looking for fraud, waste, abuse- Yeah ... and the accountability piece that goes with that, for sure. But I also think that there's a political twist in this where, um, certainly with the current administration, there, there is some agenda-setting, and holding folks accountable to that is an important part of what I think we're seeing as well.

But I don't wanna lose sight of a couple things. One is I think it's, it's no longer how d- how do we cover people, how do we cover citizens? It's moving more towards how do we pay for healthcare [00:04:00] long term, and how does this fit into the administration's agenda? Mm. We're seeing this, obviously, you know, it started out with drug pricing, but not limited to that.

Medicare Advantage, we're gonna talk about that. But, but we're, we're really seeing that right now is with some of the action that's happening right now in Medicaid

Speaker: Yeah. So I think it would be fair to say that, you know, bottom line it for us. What do you think the bottom line is?

Speaker 2: Yeah, I think the, the...

You know, if I was gonna sum it up, if we, coming out of COVID and that whole sense of urgency with that, and I hate to keep bringing up COVID, um, ultimately we won't talk about it anymore, but look, that sense, that kind of gestalt that went with that emergency era, it's done. Now it's gonna be more about accountability, really value return on investment, w- how it fits with a particular political agenda.

And look, we're non-partisan here, so I'm not saying the right or the left. I just think that's gonna be part of- Sure ... the operating program moving forward.

Speaker: Yeah, you, you said before that Medicaid is one of the [00:05:00] biggest healthcare stories of the next several years. Why is that?

Speaker 2: Yeah, and this is important to cover right now at midyear 'cause there's a lot happening, and yeah, yeah, look, we've, we've said this before.

I'm not saying it is the backbone of the healthcare system, but it is clearly part of the backbone that, the, how the system operates and, and i-i-in fact, at a larger scale, let's s- say the sector kinda writ large. There are new federal work requirements coming in to effect in 2027, with CMS guidance requiring any beneficiaries of Medicaid to document 80 hours per work of let's just say community service.

It could be work education, some approved activity. This is going to into effect. Now, we could probably all agree, look, if you're getting Medicaid benefits, and I wanna unpack this a bit, you probably should deserve them because you have some qualifying requirement. Mm. [00:06:00] Chronic disease, some other issue that you're dealing with with respect to your healthcare or some other component that takes into the calculation your financial position as well as your health that, that gives you the eligibility criteria.

What we're seeing right now is that the CMS is requiring a level of diligence at the state level so that they can get the funding from the feds- That we have never seen before. So the, the- And this is gonna be big time investment in technology to really keep let's just say tabs on anyone who is already eligible and receiving benefits, but perhaps more importantly, folks who want to get benefits.

Speaker: And that's probably under, like, the idea of trying to root out fraud? Is that kinda where- That's- ... that's coming from?

Speaker 2: Exactly. If you take a look at, at everything that's happened over, certainly over the last year, let's just say the last 12 months- But

Speaker: that requirement of proving the 80 hours per month, and this isn't going into effect until 2027, like you said, but is that, is the onus of proving that on the person trying to receive [00:07:00] Medicaid, or is that on the state?

Speaker 2: It really is onto the state. Oh, okay. 'Cause the state is going to have to have qualifying requirements that are verifiable and y- hopefully efficient. So if you wanted to go on Medicaid, you'd have to prove, "Look, I can't work for these reasons," or, "I'm not going to school for X." And I b- say you had a cancer diagnosis and, and it impacts you.

You'd have to have a s- you know, a qualifying system that is then reported through the state up to the feds, and that's what we're seeing here. Hmm. So the debate is really shifting from whether work requirements save money, that's, that's one big piece of it, to whether the administrative infrastructure that's gonna be required for the states to, let's just say enforce them, whether that's gonna ultimately erode the potential savings, because there's an incredible amount of investment that's going to have to go in.

Yes- Yeah ... I think the intent here is folks who, who are receiving Medicaid [00:08:00] benefits should be qualified to receive them because of some issue. Verifying that issue is what the states now have to put into place. So every new operating requirement creates an operational cost. We know this whether it's, you know, we, we think about Florida, Georgia, North Carolina, Virginia, every state is being asked to build compliance systems at a time when the, the, their own Medicaid budgets are facing such incredible challenges with workforce, with budget pressures, you name it.

So the policy question, if I could just wrap it up with that, is again, are these savings gonna come from increased employment, meaning, "Hey, you don't deserve to be on it, so go to work or prove that you can work," or simply from folks losing their eligibility because they can't navigate this new structure?

Right. Which is kind of you know, it, it's unfortunate because you hope that the system is much more mature [00:09:00] than that. So- Yeah ... there's a, there's a, you know at the end of the day, it's a trade-off, right? Greater oversight, we want that, but there's gonna be greater administrative burden in this. This, this, again, and I use this term too much, it's a big deal, Joe.

Yeah. It really is at the state level.

Speaker: Or to your earlier point, is it possible in this scenario that there's money saved because some people don't qualify that is then not actually saved because the states have this new administration cost? Yeah,

Speaker 2: the, the short answer is yes, but I think the sad part is what if the person, you know, if there was an individual who actually needed the benefit, but because they, there was some gap in the system-

Speaker: Yeah

Speaker 2: didn't meet the requirements or the reporting time, and they didn't get it. On the other hand, y- you know, they've gotta get this up and going so that, yeah, we root out folks who are probably getting Medicaid and shouldn't, right? Yeah. At the end of the day, we, we wanna be fair across the board.

Speaker: Well, let's shift to Medicare.

Sure. So more than half of Medicare beneficiaries are now enrolled in Medicare Advantage. Do you think this is something that, like, [00:10:00] Washington, D.C. is paying attention to?

Speaker 2: Yeah. Yeah, and I, we've said this on the, on the show before, I think the future of Medicare is Medicare Advantage. I mean, that's certainly been a big part of the GOP's agenda for, going back to Paul Ryan, I mean, this is something, privatizing it, et cetera.

And I'm, I'm being obviously broad with, with, with that comment. But it's no longer in, in my mind, an alternative product. This is definitely part of the infrastructure of Medicare. It's almost, in some ways, and I think this has been proposed, it's the default, it, or it's been proposed that this should be the default.

You go on Medicare, you're gonna go on Medicare Advantage. You'd have to opt out. That's not the case right now. But what we're seeing right now in D.C., I think, is that policymakers are looking more at how MA, specifically Medicare Advantage, is operating and how it is serving the folks that are you know, enrolling in those programs.

Why? Because there's been big issues with pre-authorization, with their [00:11:00] ability to access, you know, surgeries, certain drugs, and at the same time, it's been very expensive. So I think that's why there's more scrutiny from D.C. on this, certainly from the policy side. And I don't mean to attack Medicare Advantage.

Um, this could in some ways be a, a, a natural consequence of l- let's just say growth in general of the program. But I think there's gonna be some scrutiny because, yes, on the patient side, there's been a lot of issues, and at the same time, it's been very costly. All that said, my prediction, Medicare Advantage isn't going away.

It's probably going to be something that will be the... that you'd have to opt out of versus, um, y- you know, having any other choice from the front end in t- in fairly short order.

Speaker: So what about the Affordable Care Act? Where, where's that at?

Speaker 2: We talked a lot about this and the cost of healthcare, and you brought up your premiums as well.

Like, it, it is, first of all, [00:12:00] this has not gone away. I think it's gone more from, you know, coverage, am I covered, am I not, to can I afford what I have? And what we've seen is certainly folks who are in the marketplace, they have experienced significant premium increases. Now, I would say it's not a, it's not a, an, an even playing field- Yeah

because I've actually read through different sources where some folks had a m- let's say a modest increase, if you could call 20% increase a modest increase. Others much more, right? Up to 50, 60 70%. Depends on what you're

Speaker: comparing to. Gas, groceries.

Speaker 2: Absolutely, and that, that's a, that's a really important point.

But because we're seeing that across the board, most folks who are enrolled in these experienced premium increases that were very significant from where they started. That's just the bottom line. And for most people, and you just said it, th- this is competing with housing, food, transportation, childcare.

Yeah. So it's not, can I get coverage? It [00:13:00] really is, can I keep what I have, and can I continue to afford it? And that's why I think affordability, you're seeing this. And I will also add this, as we roll up towards the, the midterms, we're seeing much more of the question of affordability creep into everyone's, you know, narrative who is running for public office.

Speaker: All right, switching topics again, what are people missing about MAHA?

Speaker 2: Yeah. And MAHA is one of your favorite- ... Topics too. I know you're a big MAHA fan or, you know. Look, I, I would say this y- y- you know, for, for, for all the issues, and, and I am supportive of, of many areas of, of, um- Yeah

the MAHA agenda that they're focused on. Look, I think there's certain things, we talked about it before, you know, dyes and colorations in cereals, things like that, microplastics, all of... Yeah, we should have dealt with that a long time ago. Even legacy systems that we've seen [00:14:00] within, um, the FDA, CDC, you know, NIH- Yeah

I think they needed to be looked at at the very least, you know. I think there's a way to do that, and and that's important. One of the areas that, you, you know, to your, to your question that I think folks are missing about MAHA is there is a focus on, on chronic disease, and if you take a look at our healthcare delivery system across the board, it really is created for and executes in an, in an incredible way on acute care.

We know that, right? Heart attack, stroke, you know, surgeries, things that are really acute. Well, that's the... We have an acute care system. It works very well in that way. The management of chronic diseases, we, I think, have a lot of, of growth to go to be able to say we're doing a great job with that.

Yeah. So I really think that the focus on chronic disease that you see come out of the MAHA movement and, and, and the secretary's office, RFK's office, [00:15:00] is good. You know, six in 10 American adults have a chronic disease. Four in 10 have two or more. W- we know obesity, you know, leads to diabetes, leads to metabolic disease.

All of that drives healthcare spending. Yeah. Prevention is a big issue. Their focus on those areas right or wrong with respect to the approach, I think is a good one. Politicizing it is where it gets off the rails, and that's unfortunate. Um- Yeah ... but at the end of the day, and just to give you one answer, is that, look, I think the success of what they're doing is gonna ultimately be measured by the outcomes.

Speaker: Yeah, I'm surprised, 'cause when things get politicized, they, they seem to miss the point a lot, and naming it MAHA, which is like a, a version- Yeah ... of Make America Great Again, which is a part of a very political standpoint, seemed like a branding mistake.

Speaker 2: Yes. Yeah. I think we could say there's no doubt about that one, and even, you know, the politicizing of it, we're seeing that now.

We're... I, I, I, I know you have [00:16:00] a question on, on medical research, but the, we're seeing too much of that, and if you take a look at the breakthroughs that we've had in US healthcare- It's always been from a nonpartisan, you know, m- the merit of the science itself-

Speaker: Sure ...

Speaker 2: that has allowed us to, I think, excel.

Speaker: So follow-up, back to what you were saying before, the idea of, you know, there being a greater focus on chronic disease is directionally correct. Mm-hmm. Like, what's the common thread across all these issues, do you think?

Speaker 2: Yeah, I think, look, we've gotta keep the system going. I'll stop short of saying sustainability, but I think we've got to look at, and this goes back to everything we've talked about so far, you know can we maintain coverage?

Is it going to be affordable? W- w- how are we gonna deal with this chronic disease issue? It's out there across the board. I know GLP-1s are, are, are absolutely putting a dent in it, and we'll talk about that as well, but that's a big piece. Can we maintain the spending level that we're at, the government level of that?

[00:17:00] Population health, are we taking everyone into account equitably? You know, are we looking at everyone across the board? These are all issues that are, that are connected together, and I think what we're looking at, certainly in the health sector, is that leaderships have to, has to recognize that understanding policy is really incentive design.

You know, change incentivizes behavior. Behavior, when it's changed, really does change systems, and that's what we're watching, I think, happen across the healthcare, you know from s- from the patient who has their hand on the lever deciding where they're gonna get care, all the way through to the startups that are thinking, "Hey, I've got the next, you know, good thing that could change the system."

Yeah.

Speaker: All right, switching topics, switching gears. The GLP-1 revolution. Yeah. You know, this has changed so much since the last time I think we talked about- I know, yeah ... GLP-1s. You were talking about what if it's a pill? What if it's covered? Yeah. And it's, like, changed and unchanged three times [00:18:00] since then.

Yeah. So when did you realize that GLP-1s were becoming something much bigger than weight loss drugs?

Speaker 2: Yeah, and two things. N- now it is in a pill form- Right ... and, and it is covered. So it's, it's, e- even with Medicare, those are the new rules that just came out. Listen, I, I... my short answer to that is my perspective on it, I always knew that they were game changing, but when you looked at pounds lost to lives saved, that was a game changer for me-

Speaker: Right

Speaker 2: in this. And the lives saved piece, the data that comes out almost weekly now is r- is absolutely incredible. First it was diabetes. That's how the drug was created, right? When you think about the... Then obesity. Um, now it's moving into addiction, which is incredible. I think there's gonna be new indications coming out for substance abuse.

Obviously, chronic disease, which is w- you know, on the metabolic issues, cardiovascular health, metabolic health, how it crosswalks to kidney health, and the big [00:19:00] news lately is how it's potentially impacting the trajectory of some cancers. Now, there's been some meta-analysis that was done- Right ... it was just done at the ASCO meeting, where there has been benefits that have you know, clearly are apparent with the GLPs with the trajectory of metastatic cancer.

So-

Speaker: I think I read something about that. Is it primarily the discovery, although it's early on discovery, is that it's slowing the progression of

Speaker 2: cancers?

Speaker: Yes.

Speaker 2: I, I think that we could say that in general, and, and it's... again, I wanna qualify this w- with the fact that it's early.

Speaker: Early, yeah.

Speaker 2: But look, it's, it...

the, the indication, the signal, it is all positive in that respect. So if you think about you know, it's, it's, We're not just looking at a drug category. It really is a platform that looks at metabolic disease, and when you think about things like cancer, and cancer, look, I think a lot of folks would say it runs on sugars.

Speaker: Yeah.

Speaker 2: You know, that's the way the energy is produced. That's what GLPs, you know, attack. It makes sense. Yeah. So, um- Hate to bring it back to just- ... real, really [00:20:00] exciting. Really exciting ...

Speaker: hate, hate to bring it back to a branding conversation- Yeah ... but it seems like the drug started as a weight loss thing.

Speaker 2: Right.

Speaker: And some people have issues with that They feel like, "Well, that's not something I should be on medicine for." And it has all these other benefits that aren't just that, and I feel like, once again, the initial branding got it into-

Speaker 2: Yeah, right ... the It, it... I, I hear you with that. You know, it's, it's interesting because h- I think part of what you're saying is would, would we have even understood the potential if it wasn't first accessed as a weight loss drug?

The weight loss drug- Yeah ... is m- you know, may, may be egocentric to, to some folks. Yeah. I, in fact, I saw some data where the biggest use of, of the early GLP-1s, right, the early weight loss drugs, was, like, in the Upper East Side of New York City. They, when they did this analysis of New York. These are folks who probably weren't taking it for, you know health effects.

It was probably primarily to lose the last, you know- Mm-hmm ... 10 to 20 pounds. This is well beyond that, [00:21:00] what we're seeing now, and I think that's the exciting part of what this potential category of drugs is bringing to the table.

Speaker: Yeah, so back to that cardiovascular disease. Yeah. Like, w- why do you think that could be the most important development?

Speaker 2: Yeah. Yeah, and I don't wanna say it's the, the, m- m- the, the most important or the least important or where it fits, but we know this. Look cardiovascular disease, leading cause of death in the United States. If you look at the impact worldwide, when you look at outcomes trials with respect to GLP- with with this class of drugs, demonstrated reductions in most of the major adverse cardiovascular risk.

That is pretty incredible- Mm ... when you think about that. Wow. So the breakthrough isn't just weight loss, it's event reduction in that sense. You're looking at, hey, less heart attacks, less stroke. You know that's incredible. Hospitalizations that are avoided. This is why employers, payers, policy makers are paying attention, because when you have that kind of [00:22:00] reconciliation to great outcomes, you know, it could be one of the most important population health interventions that we've seen in decades.

And I think even the head of Lilly said recently on, on a show that, you know, beside all these positives, this is a drug that folks don't mind taking. You know? It's, which is interesting, you know? It's, it's, it doesn't have the, the type of stigma that others folks, because there's so many positives on this.

Sure. So very, very I think game changing when you think of the indications, and the other side of it is that we, there seems to be, as I said, every week, a new exciting breakthrough. Now, I just wanna caution, look, it's still early on. Sure. Right? Everything looks good, but it's, but it's, but it's early on.

Speaker: So the story isn't... It's fair to say the story isn't just obesity anymore.

Speaker 2: Right. It's not. It's cardiovascular health outcomes, metabolic disease all that coming together. And, you know, again, I think that leadership has [00:23:00] gotta think, "How does this fit into our..." If you're a payer, "How does it, how does it fit into my offering for the, the consumers that are in my health plans?"

Yeah. If you're thinking about this for population health, it just fits.

Speaker: Do you think oncologists are taking a more serious look at GLP-1s?

Speaker 2: Y- we saw this at the recent ASCO meeting, um, because obesity and cancer are so closely linked. Um, and again, we said this earlier, m- so far it does suggest that there's lower rates of certain types of cancer metastases amongst GLP-1 users.

So early on, observational. We don't have proof of cancer prevention. Gotta be thoughtful about this as we move forward, and as you know here, we, we're gonna, we're gonna stay close to the developments on this- Yeah ... because it is so absolutely important. And, you know, the cancer piece is, is part of that.

Speaker: It seems like I've seen a lot about that specific side of it. Why do you think the oncology story is generating so much excitement?

Speaker 2: You know, cancer is probably the [00:24:00] scariest diagnosis anyone can get, and leading cause of death worldwide. And metabolic therapies, yeah, they work, and we've had... By the way, I wanna say this.

We've had incredible breakthroughs in cancer care, in pancreatic cancer and some other ge- geoblastomas. There's incredible drugs that are coming to market right now. This just represents one of yet another, I think, great scientific therapeutic expansions that we've seen in modern medicine. It shows you what can be done particularly when you think about the drug, the pharma companies that are private companies, right?

This is the private sector doing this. So we're getting there. We're not there yet, but we'll keep tabs on it.

Speaker: Yeah. So it's definitely seems like it's, it's one of the most important questions being studied today, like what's its role in cancer? What do you think is, is the biggest unresolved question?

Speaker 2: Yeah, besides the science, I would say, um, the economics, right?

At the end of the day, that's it, right? The science is, is the science and the result is moving faster [00:25:00] than our current healthcare system even understands how we should reimburse or pay for it, and they're very expensive, right? Yeah. So it's no longer like it- the savings outweighing the near term costs, right?

Reducing obesity or diabetes and all this. We, we simply need, I think, to absorb this. And the, the biggest debate here may not be on its clinical efficacy. It might actually be who pays for this who benefits from it, and who gets it.

Speaker: Yeah. So if there's anything, what do you think is, is the one thing that healthcare leaders should remember about GLP-1s?

Speaker 2: Yeah. It's not just about weight loss any- more. That's, that's yesterday's headline. That, that is, that's, that's over. Today it's chronic disease, population health, healthcare economics. Potentially like a game changer, obviously, in cardiovascular health as well as cancer care, so that is incredible.

And I don't wanna forget the, the impact that we're seeing also in substance abuse and addiction. Still under study. [00:26:00] I think indications are coming out for that actually in the, within the next year, and that is, that is really very promising and impactful.

Speaker: Yeah. All right. New segment. Yeah. Markets, AI, and the future of healthcare.

Here we go. We gotta talk about AI.

Speaker 2: Yeah, we gotta ta- And, and the markets- ... and the future. We love... That's a, that's a great three, right? There's no doubt.

Speaker: So let's start with the markets. What are they telling us right now?

Speaker 2: Yeah. Well, as we... Look, today is, June 5th as, as we record this and- Halfway

Speaker: through the year already.

Speaker 2: Yeah. A- and I wouldn't wanna... Looking at the markets today is not good. Let's just hope one day is, is, is, is not a story. But look, I would say what it's telling us with respect to, to healthcare and the health sector, And let me tie this to the AI piece 'cause you asked me markets and AI in the future.

Look, healthcare and the health sector, particularly what we're seeing in the new innovation startups, it is an information data technology business. Yeah. Right? We know that AI absolutely reducing administrative burden, we always said that was gonna be where w- would, would be deployed [00:27:00] first, those low-hanging fruits, right?

The opportunities in workflow, documentation, prior auth, rev cycle. What, what I've seen with respect to the markets and investors is they are funding efficiency right now, not the replacement of the nurse at the bedside or the physician. Right. That's the w- I'm, I'm not seeing that. I think what we're seeing is, is those areas of efficiency that there's a lot of investment and a lot of game-changing.

I think startup's doing that and, and existing players that are there. So for leadership that's out there in, in, in the healthcare, you know, industry world kind of across the board, I think they're seeing benefits with AI in reducing friction for the consumers, patients, and AI is part of that solution and remedy.

In fact, it is a situation now where it's becoming so embedded in healthcare technology that we're not even treating it as a separate, you know, kind of category.

Speaker: Yeah. I'm curious, [00:28:00] have you seen any Any info or any indication about the, the real ongoing cost of AI? I feel like when it came out, it was so new and exciting, and all the plans were free or freemium.

Yeah. And it was kinda like that old analogy of the drug dealer, like the first one is free.

Speaker 2: Yeah, yeah.

Speaker: And now you

Speaker 2: get- Gets you hooked. Yeah ...

Speaker: hooked on it. Now you're like, "Oh, there's a real cost." Yeah. Do you think that there's a real cost in the healthcare sector-

Speaker 2: Yeah.

Speaker: I- ... that hasn't been counted?

Speaker 2: I think, a- and, and I'm not an expert on this, but I think across the board there's a real cost to compute.

Let's just say that. There's a cost, and I don't think that has been really taken into account. Now, I do think over time that the cost of one additional unit is just going to be-

Speaker: Yeah ...

Speaker 2: it'll, it, it'll make it all work out. But right now I think the initial investment and the expectations on the return on investment are a little bit disconnected.

Speaker: Yeah.

Speaker 2: And the expense is probably giving some folks sticker shock.

Speaker: And I think it's fair to say, 'cause I feel like this doesn't get covered, you know, talking about the, the development happening out in Utah that's [00:29:00] supposed to be, like, the size of two Manhattans for the data center.

Speaker 2: Right. Yeah.

Speaker: I feel like the thing that nobody talks about is the, the pr- the natural progression of technology.

Like, I've think I've watched that movie Hidden Figures- Yeah ... with the women working at NASA, and there's a scene in there where IBM installs a supercomputer and it takes up half the thing. Well, my phone has more processing power than that now. That's

Speaker 2: right. That's how quick it happened, right?

Speaker: And so I think that people aren't weighing that into the conversation.

They're like, "Well, the whole n- nation might have to be a data center?" It's like, well, it'll, it will evolve. We just don't know the pace into which- It will- ... degree the efficiency of computing will evolve.

Speaker 2: It will change, there's no doubt. And I, and you know, a- and we can't talk about this and not talk about the world stage too because so much is, is dependent upon chips and chip makers and, and a- Yeah

adoption. And, you know, in our world of healthcare, which is its own economy and constrained by a lot of different issues from regulatory to, you know you know, y- you look at a- Yeah ... how a hospital operates, even the de- deployment of care and the guardrails around that and how we might use AI. So it is going to be an expensive [00:30:00] endeavor.

Speaker: Yeah.

Speaker 2: But again, if I could break it down to the unit level, and I hate to put that, use that in healthcare 'cause folks think I'm equating that with the patient, and I'm not. Just using that as an example. Ultimately, one additional unit is going to be a lot less expensive, and we're gonna see that happen fast.

All you have to do is go back, look at your phone and the-

Speaker: Yeah ...

Speaker 2: you know, I, I, I thought about getting in my car today, and I have a camera, I've got backup camera, I have other cameras in my car. And I think about my father's car. Oh, my gosh. Yeah. You know? I mean, there was- Didn't even have

Speaker: a chip

Speaker 2: in it ... it didn't have a, the chip.

I mean, wow,

Speaker: holy cow.

Speaker 2: Yeah, it had some chips- And- ... but they weren't the kinda chips we were thinking about. And dings and, you know, needed a paint job.

Speaker: Right. But

Speaker 2: yeah.

Speaker: Yeah. It's, it's, So what do you think then is the, the healthcare... What do you think healthcare leaders, what do you think the biggest misconception that they hold right now when it comes to AI?

I

Speaker 2: don't think, Joe, this is much different than what, A lot of individuals think AI will i- initially [00:31:00] impact or ultimately impact, I should say, and that's replacing people. I think folks, you know, are thinking, "Oh, it's gonna replace people." Look into healthcare, I don't think that's the case. I think in, in a in a AI scenario or a large language model being deployed in a clinical setting, it's about helping clinicians spend ultimately more time with patients or figuring out how to, how to fix things with respect to a diagnosis that's challenging.

Every minute returned to a physician or a nurse has absolute value. So that changes. There's no doubt that changes productivity and workflow. I mean, particularly when you think about how adoption of AI is accelerating. So the AI story is about diagnosis, but that's not the thing right now. It's, it's not going to replace a doc from giving a, a, a, a diagnostic opinion and coming up to a conclusion and running a differential.

It's about, I think, initially [00:32:00] giving clinicians time back, and we're gonna-- I think that's gonna be really good, particularly with, with models of care.

Speaker: So what do you think an example of that looks like, an example of AI giving clinicians more time with patients, time back? What does that look like in the real

Speaker 2: world?

Yeah. Let, let's think right now in real time, if you think about ambient AI clinical documentation. So this is where AI is in the background listening to the clinical conversation that, say, your doc might be having with you, and this happens all the time. Your own doc may have done this. Yeah. And it's documenting that.

It's inculcating it, and it's creating a y- you know, in some cases, it'll give a suggested differential diagnosis, but it will certainly organize your plan of care into a note, you know, Right ... that is great for documentation, saves a lot of time, reduces clicks, all of that. Y- a company just recently, I think, got a seven billion dollar valuation and, and you know, a tremendous investment on the street that [00:33:00] specializes in this.

I'm not gonna mention that, but I think those of you who are in the markets probably know who I'm talking about. At, at the end of the day, docs and, and nurses didn't go to school to be data entry specialists. Yeah. And we're seeing the time that is Taken up on doing really important work, which could include s- you know, even being at the bedside with someone who's going through a tough time.

It's, it's taken away because of our current systems, and it leads to burnout and other issues, so every minute returned to clinicians has value. And I would tell you this, economically as well, if you're looking at, um, y- you know, just productivity, and this allows me to maintain, you know, my current, you know full-time equivalent employee count without adding more because n- we're more efficient, that's good too.

Yeah. That's good economics, and I wanna not say that. I

Speaker: think we've heard for a long time, and j- it's almost, like, common knowledge that nurses are overworked. They're being stretched too [00:34:00] thin, that this could be a potential solution to that problem. Absolutely. Like you're saying, it's not necessarily eliminating a nursing position as much as...

It was even a s- a plot line on that Pitch show at the time.

Speaker 2: Yeah. Yeah. Yeah. I didn't, I haven't- Max ... I haven't see- Yeah, I bet it... I'm sure 'cause burnout's right this, this theme in there. Yeah. And you think about... Look, no one went to medical school or nursing school or i- or a- any of the healthcare professions or ancillary areas to spend your time sitting behind a computer inputting data.

Speaker: Charting, yeah. Mm-hmm. All right, so other than AI, back to the markets. Mm-hmm. What's some of the other things that investors are seeing?

Speaker 2: Yeah, I think, look and we've said this so much, healthcare at $5 trillion, one of the largest sectors of the American economy. I mean- Big, huge. If you just took a look at that amount, I think y- probably, you know, 75% of it is spoken for.

There's, there's an opportunity for 25 to 30% worth of innovation that is out there [00:35:00] just because things are moving so fast with respect to technology, which includes artificial intelligence, but not limited to that. The opportunities with new models of care, new structures, I think this is a great area for investors to think about, again, even beyond AI.

And let me get a little bit more specific. We talked about chronic disease. That is an issue that has to be dealt with. GLP-1s are one way with pharma, but not the only way. Um, second thing, workforce shortages. We know there's gonna be a tremendous shortage of physicians and nurses. We're gonna have to change the model of care.

I think that's a great area to look at, how you could augment new models of care, leveraging technology. I think smart investors are gonna look at, you know, how you can deploy these new models of care by leveraging technology, as I said, in new and different ways that will add value. And that's why ultimately I think there's capital continuing to flow into healthcare.

Obviously AI, [00:36:00] again, a big part of that, but not the only piece. We said earlier in the low-hanging fruit with efficiency analytics, but also work flow platforms. The, you know, the investment thesis is fairly straightforward. If you can-- at least right now, if you can help a hospital health system operate more efficiently, you know you're gonna increase, um, the level of value, and that value can be monetized.

So we're seeing that, but it's not stopping there.

Speaker: Yeah. And now on to the category that I think a lot of Americans love to hate until they need it. What about pharma?

Speaker 2: Yeah, and that's a big part of the investment side, right? I mean, you know, this is a, this is a, a massive growth story because right now, and this is my thought and I'm probably a little bullish on this, major pharma companies, yes, they're always challenged with patent expirations that come due and, and some biggies are coming up over the next several years.

So they need new growth engines. And how do they [00:37:00] do that? They look at who's doing what out there and with a new, you know, peptide or or obviously look at GLPs. We've been talking about that. And that drives acquisitions. That drives new licensing deals. That allows for the kind of partnerships or investment in innovation that is very attractive.

We talked about oncology, cancer care absolutely out there, but also rare diseases because now we have a platform, and again, leveraging technology and computational analytics. This is an area though that, you know, I don't wanna say y- y- the money that was probably required to tackle a rare disease, there wouldn't be a logical return if you were looking at it from a shareholder.

I think that's starting to change, and that is really good for, for folks who are- Hmm ... who are, who are suffering from rare diseases. So AI drug discovery going into that big. The science is moving quickly and at the, again, capital is following it [00:38:00] and that is I think a really good thing.

Speaker: What, if anything, do you think that maybe healthcare leaders are underestimating?

Speaker 2: Um, I, and I think folks will disagree with me on this one, but I, but I believe this. Velocity, speed and I, I've said this for years. I, I've taught it as well. It, it used to be the situation where you'd say, "Hey, you wanna know where healthcare's gonna be in 10 years? Look at where business is today on the cover of the Wall Street Journal."

That's changing. I think healthcare is catching up. And why? Because there's so much, I think, investment. There's so much activity in the private sector. That are doing things that are really game-changing that we had not seen before, and that is exciting to me. And technology is a part of it, but all of this coming together, right?

A system that, that has historically moved slower than, than I think many other sectors. But now with the velocity that technology is creating, consumer expectations moving [00:39:00] faster than organizations can even handle, the opportunity for individuals to have agency over their own healthcare with the choices that they make.

I think organizations that are gonna thrive in the next 10 years recognize that, they're adapting to it, and they're going to be very successful. And we're not just talking about big, established organizations. I mean new, you know, non-incumbent disruptors that are gonna be coming out there.

Speaker: Yeah, so if you had to, if you had to give this, this last section where we're talking about the markets and AI and innovation a headline, what do you think it is?

Speaker 2: Yeah, it's the system's transforming. It's transforming fast, right? Again, technology enabled data enabled, consumer aware. Um, w- we're part of the operating model, the new model of care, leveraging technology. The future won't be healthcare or technology. The future will be healthcare and technology.

Speaker: And you didn't even get into wearables and the ability- Mm-hmm ... to collect more information and anything like that. All part of it,

Speaker 2: right? Yeah. I mean, that's it. Yeah, the passive and, and let's say active acquisition of, [00:40:00] of data that's on you that's with you. But also things we wouldn't even think about, like oh my gosh, if you know, um, what my credit score is, and you know what I'm buying, and you know where I buy it, maybe you'll have some insight into what I prioritize- Yeah

with respect to my health. Am I getting my prescriptions filled, and am I, you know making good choices with what I buy? I, I, I wanna stop short of saying Amazon, I think, um, may be exploring that area. But you could see where that would make sense. Why? Because it allows you to look from an actuarial standpoint at risk, and the more I know about you the more I can kinda categorize you.

Mm-hmm. And if I'm going to, you know l- look at this from a, a, a healthcare insurance perspective, that would give me a lot of information to allow me to make a bet on one particular group versus another, or one particular group of behaviors versus another.

Speaker: Yeah. So moving on to the final segment of today's episode, trust, [00:41:00] science, and what comes next.

Speaker 2: Yeah. You got good categories here. I like that.

Speaker: Yeah. Yeah. So why would healthcare leaders care- about Ebola?

Speaker 2: Oh my gosh. Yeah, so look, we didn't... I wanna say I'm glad we're touching on it, 'cause, you know, this is an important thing. I think y- y-

Speaker: Yeah, your, your, your, your stream isn't broken. We are talking about Ebola.

Speaker 2: Yeah, yeah. It's 2026. Why, why, yeah, why should we talk about Ebola? It's kinda crazy when I think about when I first dealt with this, which was back in Chicago, um, like around 2014, 2015, um, when we're looking at receiving hospitals for, for patients who were in, in areas that were stricken with Ebola. Um, why are, or why is this on the radar screen?

Why should we be talking about it? Because I think two things. Number one, we saw What we went through with, with COVID.

Speaker: Yeah.

Speaker 2: And, you know, was it done, was it handled well or not well or whatever? I'll, I'll just park that, but I think we can all recognize that preparedness and informed preparedness matters.

And this [00:42:00] outbreak, and I'm pleased to see it, it, it has the CDC monitoring and screening. We're seeing this with the airports. The numbers I think are not to be dismissed. More than 900 cases, at least with the data that I, that I can recall. Over 200 suspected deaths, probably more because we really can't get a handle on the, you know, some of the actual ways to account for, for those individuals that may have been lost from this.

You know, no confirmed US cases. That to me, that's... Sure, that says a lot. That's good. We've got good systems in place. But don't forget this is a connected world now. Mm-hmm. And that's the scary part. So, um, the lesson isn't necessarily, I think, Joe, with respect to Ebola, the lesson really here is, is readiness, preparedness, infrastructure, public health.

Um, I've said time and time again, you know, healthcare should be considered a part of the public trust, part of the community's trust- Right ... just like public safety and defense and [00:43:00] education, and this is a great example of, of why that matters.

Speaker: Do you worry that we've become a little complacent?

Speaker 2: Um, I do.

I think, um, public health preparedness and, and I think a lot of this had to do with what we went through with, with COVID, but I think, um- We don't

Speaker: seem to care until it's already an emergency.

Speaker 2: Right. It, you only get, only gets attention when there's a real crisis, and, and, and whose definition of a crisis is it?

Yeah. And how do they, you know, how do we do that? And when nothing's happening and, and we have a period of calm, no one wants to do anything. But bugs, pathogens, right, microbes, they don't care about election cycles. They don't care about headlines. They don't care about politics. Um, they care about opportunity, and we really should look at this, I think, just the same way we look at cybersecurity attacks.

Um, you, you, you know they're out there. You know it can happen. You hope you never have to secure yourself against it, but you better have systems in place in case you do suffer some kind of a, a, a breach. And we gotta think the same way, I think, with, with not only [00:44:00] Ebola, but other opportunistic, um- Yeah

diseases.

Speaker: So any signs that we're starting to be prepared? Is anything happening with research funding?

Speaker 2: Um, well let me j- break that down two different ways. One, with respect to the CDC, I think there's been a good initial response, and that's, that's good. With respect to research funding, wow, beyond Ebola, just when we think about research across the board.

Look today's research funding becomes tomorrow's medicine. I think we can, we can agree on that. Um, I'll just say a couple things. What I, what I hate w- and what I see happening right now is there's a partisan component- Mm-hmm ... to research funding. There's been some information that's come out recently on just grant funding, where a political appointee has to be part of any kind of federal grant for research funding now.

Look, I want, I want our audience to, to look into this and do a little bit of investigation on this, but I think I'm better than directionally correct on this. And what concerns me is that when you have, um in this case, a, a [00:45:00] political variable thrown into the merits of science and whether a grant is awarded and, and part of that has to be that the grant comports with the administration's agenda.

That, to me, is really an area that we have to be very watchful for because it takes away from, again, the merits of science, the potential impact, and that's what this country has always been great at. It has been agnostic and objective with respect to if Joe had a great idea for a, a, a science that needed to be advanced, and it maybe represented something that could even lead to a breakthrough, and you were not ever judged whether it was reconciling with the particular party or not.

Sure. You were judged on the science. And when we insert this you know, this other gating condition which has a political and point [00:46:00] appointee part of it, that is concerning. So I think critics and, and, and than me, I worry about political influence in those process because innovation really depends upon research.

And, and look, I'm a big believer in the private markets innovation, but also research that's done at the government level, and I hate to see this because science policy can become patient care, and we don't want that to be delayed.

Speaker: Yeah, I think we, we've talked about this before. There's, there's an almost...

I wouldn't call it new, but it's very apparent right now in our politics that if it wasn't my side's idea, then I might just be ideologically opposed to it from the get-go. Yeah. Kind of what you were saying before. Which I think is an indicator and- That we just don't, we don't trust- Yeah ... based on science exclusively, the merit of an idea.

Yeah. But now there's, like you said, in order for that trust box to get checked in my mind, did somebody on my [00:47:00] side come up with it? Yeah. Is it okay that I'm a fan of this? Yeah. Kind of stuff. So why do you think trust matters so much?

Speaker 2: Yeah. Look, that's a great question, and you know, I would, I would...

Two things along those lines. And don't forget political parties change too. Yeah. So you have to be careful of, you know, you might be in office today or in power today with respect to the, the, the administrative's goals, et cetera, but-

Speaker: I've, I've noticed it- It, it could change ... in the last couple years more than I've ever noticed it in my life so far, which is, like, some of the ideas that used to be right are now left- Yeah

and some of the ideas that used to be left are now right. Yeah. Ideals.

Speaker 2: The, they flip-flop and they change, but, you know, the influence is what we're talking about. But getting back to your question, w- I, I think I could say, why does trust matter? I think, look, healthcare is built on trust. I mean, anyone who's ever had...

I'll just use a, a, a, a pretty obvious example. Anyone who's ever had surgery and had to undergo anesthesia, if someone's putting you to sleep, rendering you unconscious, in a, in a, u- unable and with no ability to have any control over your senses [00:48:00] or responses, et cetera, you better trust the system and the people who are doing that.

Otherwise, you know, I don't know w- h- how if we'd, anyone would ever be having surgery, right? Yeah. That's, that's, that's a good example probably. G- Healthcare can't function without it. The sector is built, if you s- let's just say on the provider side, hospitals, et cetera, being part of it, you have to trust clinicians, you have to trust institutions, including hospitals, but also biotech, pharma, med tech.

I mean, otherwise you wouldn't take a drug. You have to trust science because science is where this comes from. Talking about e- Ebola, we better trust public health systems because patients don't experience healthcare through policy. Yeah. They really experience it through are, am I getting in to see my doc?

Wait times, communication, you know do I trust this person if I have an emergency and I'm going to the emergency department? You want to have that level, I [00:49:00] think, of, you know certainty with the encounter you're gonna have, and that's all built on trust. And it's not a communication strategy.

It's m- it's more than that. I think for me, it, it really is, Let's... I'll break it down business-wise. If you don't have trust in healthcare, you're losing one of the most important competitive advantages you can have over the next person. That doesn't say much because everyone who's delivering care should be doing it in a way that is safe, responsible, and patient-centered.

Otherwise, no one's gonna trust you, and there's good reason for that. So crazy way to answer it.

Speaker: Yeah. Well, in closing then today, final question, what's your final takeaway?

Speaker 2: I would say this, and I'm, and I'm gonna say this optimistically 'cause I, I, I want to be positive on this, and I mean this, too. I think healthcare isn't broken.

It is going through some changes, and, and a lot of them are happening fast, yes, because of technology. Um, we talked about chronic disease. I think there's a big recognition now. It is one of the key central challenges. [00:50:00] Technology, AI is becoming infrastructure. Prevention, and I would- Add to that, longevity is a big move that's becoming, I think, part of the narrative when we talk about healthcare and- Mm-hmm

an individual, again, their agency over their own healthcare. We've always talked about consumers and folks having the ability to make choice of where they get care, who they get it from, how it's delivered. That is absolutely important. We know that technology is changing. As I said, science is expanding, and clearly trust, and I- I'll just say it again, it, it is at the very least a non-negotiable, and economically it's a competitive advantage.

And organizations that a- adapt, who bring this together, who understand that this is all connected, they're gonna adapt the fastest, and they're going to have much more of a hand in, in controlling their own destiny than those who don't.

Speaker: Yeah. Well, we covered a lot of topics [00:51:00] today. Um, I guess just wrapping it up, final thoughts?

Speaker 2: Yeah, look, I, I started the show talking about the summer solstice. Um, it's gonna happen this month. Longest day of the year. The reason, as I said, that, that it matters, it's n- it, it doesn't change the landscape. What it does is it, it gives you longer days, right? More sunlight. You can see much more clearer, right?

There's no fog in that. And I think when I look at healthcare today, we're finally seeing, I think, a lot of the outlines of where we can move forward on, and that's a good thing. And we're seeing this with everything from prevention to, we talked about accountability, the, the consumer side, everything. It's hopefully gonna lead to better health.

And although, um, things are clearing up, it's not over yet, and I think that all that said, for the first time, I think, in several years, we can see further down the road than we have before, [00:52:00] and that's real value. So, um, I'll just leave with this. You know, healthcare isn't necessarily about predicting the future, but it is important to recognize when change is happening and when it's beginning, and I think that change is happening everywhere in the health sector.

So that's my final thought, Joe.

Speaker: Yeah. Well, thanks.

Speaker 2: Great show.

Speaker: Yeah.

Speaker 2: Great to be back in the studio. Good to see you, and looking forward to us doing many more of these, my friend. Yeah. Sounds good. Thank you all for joining us here on the Healthcare Nation podcast. See you next time.