August passed with a flurry of events that produced emotional whip-lash in the public’s psyche: highs sparked by the engagement of pro-football all-star Travis Kelce to iconic superstar Taylor Swift and the return of college football to a low headlined by another mass casualty incident. This time, a mentally-ill lone gunman murdered two innocent kids and sent 17 wounded to Minneapolis hospitals for care.
In August, main street corporations announced strategy changes: Cracker Barrel relented to shareholder pressure to restore its “Old Timer” branding and Sycamore Partners completed its restructure of beleaguered Walgreens. Two global companies gained notoriety: supercomputer maker Nvidia became the most valuable publicly-owned company market-cap hitting $4.28 trillion market-cap Friday and the Department of Justice announced a new investigation into UnitedHealth Group’s PBM operations Optum Rx as other investigations of UHG by the FTC and DOJ continue. And Epic convened its User Group in Verona WI announcing its big play in AI.
Summer is over. September is here. It’s the month when presumably normalcy returns in most communities and households. Schools start. Pro football starts. Routines are set. It’s the last month of fiscal year 2025 for the federal government and in Michigan and Alabama (46 states began FY26 July 1, NY started April 1 and Texas September 1). It’s when Congress returns from its August recess to wrap up unfinished business for FY25 and organize for FY26 initiatives. It’s when incumbent members of the House and Senate decide whether to run again or not, and when Supreme Court justices and clerks prep for their loaded 2025-2026 docket that features arguments about conversion therapy, the Chevron doctrine and more.
For healthcare organizations, September 2025 will not be normalcy. Business plans and strategies extending through 2027 will be impacted by actions and events that occur in the next 30 days. Key September events/activities to monitor are:
Focus: Congressional Debate: Several pieces of legislation from the GOP controlled 119th Congress will be debated in key committees this month:
- Health Care Affordability Act of 2025 (H.R. 247) which addresses potential mechanisms to restore enhanced subsidies to insurance coverage eliminated in the Big Beautiful Bill Act
- Bipartisan Health Care Act (S. 891) which addresses expansion of telehealth utilization, extends Acute Hospital at Home program through 2029 and more.
- Older Americans Act Reauthorization (S. 8914) which covers programs for seniors and disabled populations.
- FY26 Budget Cuts to HHS: Congress will further define particulars of its “waste, fraud and abuse” actions in the Big Beautiful Bill Act (July 4, 2025) focused primarily on fraud in the Medicaid program eligibility and administrative streamlining in HHS.
- 340B Drug Pricing Reforms: Drug companies and the administration support replacement of the current 340B payment model with a rebate system; hospitals are strongly opposed believing it will add to their administrative costs. Drug makers counter the program is abused by providers but 340B savings were not included in the BBBA so the debate will be contentious.
- Expanded Hospital Price Transparency Executive Order: The Administrative doubled down on hospital price transparency mandates (and non-compliance penalties) vis a vis its latest EO. Efforts to extend price transparency to insurers and prescription drugs enjoy strong support in Congress despite industry pushback. Historic pushback against price transparency by AHA and other hospital associations is not forgotten by the Trump administration which authored the first Hospital Price Transparency Executive Order in 2019.
Focus: Monetary Policy: The Federal Reserve Board meets virtually September 15-17 where it is expected to lower its borrowing rate amidst White House pressure to influence its decisions, Wall Street desire for economic stability and Main Street fear of price hikes and inflation. The availability and costs of capital (debt/equity) to operators and investors is significantly impacted by fed decisions: the healthcare industry is 18% of the GDP and the country’s biggest private sector employer but it’s annual growth (5.6% CAGR) is well above overall economic growth (GDP) and therefore problematic to the rest of the economy and its money supply. Since healthcare represents almost 15% of private equity bets, the unintended consequence of private equity investing in healthcare will grab headlines in September. For example, NH Senator Hassan’s new proposed legislation limiting PE ownership in privately-operated opioid treatment facilities “opens a can of worms”.
Focus: MAHA (Make America Healthy Again) and Public Health: The August dismissals of key CDC officials came weeks after HHS Secretary Kennedy dismissed CDC’s Vaccine Advisory Committee with White House’ approval. These actions assure mounting tension between traditional advocates of evidence-based public health policies and what some consider fringe views on health and wellbeing being championed by RFKJ. Political appointments and policy directives coming from CDC, FDA and CMS will accelerate MAHA ‘anti-healthcare status quo’ federal initiatives (like vaccinations, food safety, et al) and expand access to alternative health interventions that many in healthcare believe harmful. September appointments to key oversight committees will signal the directional change. And growing concern about the dismantling of the nation’s public health apparatus among Republican members of Congress is certain to draw attention.
Focus: Medicare Advantage Business Practices Oversight: The growth in Medicare Advantage enrollment has sparked intensified scrutiny of MA sponsor business practices, especially the big names like United Health and Humana. Industry studies have chronicled wide variance in Part C offerings and costs, and government studies have shown payments to plans by Medicare may have been in error. The business practices of MA plans have drawn sharp criticism from hospitals and physicians for under-payment, restrictive prior authorization, closed panels and investigation by the DOJ and FTC alleging fraud. September marks a key period for insurers: it’s when negotiations with providers are sharpened, plan offerings for 2026 are finalized and state approvals for premium increased reviewed. Tension between MA plan sponsors and providers is already high. It will reach a boiling point this month.
Beyond these four, there’s much more, especially in states where legislators will determine how they’ll respond to Medicaid cuts, how legislators’ slow hospital and drug price increases and how they’ll oversee insurer’ rates and compliance. Each state will pursue these differently, especially since all are required by law to balance their books annually (unlike Federal Government).
My take:
Most healthcare organizations—payers, hospitals, medical groups, life science companies, advisors– operate with a high level of confidence in their internal capabilities and a low level of confidence in lawmakers to enable their success. They share a general lack of trust and confidence in Congress but recognize regulation at local, state and federal levels is necessary.
Most healthcare organization boards believe the long-term destination of the entire U.S. health system is an unknown. There’s too much uncertainty. They depend on the organization’s CEO to read the tea leaves for them.
Most create annual environmental assessments. A few of these are appropriately comprehensive, accurately constructed or used effectively.
Most healthcare organizations are focused on short-term results that enable survival and sustainability. A few do more.
Most are paying attention to their products, supply chains and competition; some are making changes.
And all are worried about how things will change as Congress resumes its work this week. That’s why September 2025 for healthcare will be far from normal.
Paul
15 Quotables from Last Week: Happy Labor Day!!!
Meyer on CDC status: “For anyone who missed it, it’s been a whirlwind week at the CDC. Here’s the recap. After 6 months of “death by a thousand cuts” — including layoffs, rescinded grant funding, and content censorship — the CDC descended into chaos on Wednesday. First, CDC Director Susan Monarez, PhD, was fired after refusing to resign. Soon after, three longstanding CDC leaders announced their resignations , citing political interference and pressure to sign off on unscientific vaccine recommendations. A few other high-level departures were also reported earlier this week.
While it’s tempting to label this just one more upheaval in an upheaval-prone administration, the impact of these departures on our nation’s leading public health institution will be far-reaching…The grim reality is that the effects of this mass exodus are likely to reverberate in every corner of our nation’s public health infrastructure and across every specialty in medicine.
The evisceration of the CDC is a disaster for all of us. Nationally, the dysfunction at CDC could easily undermine its programs and trigger a rise in the nation’s overall burden of disease…”
The Evisceration of CDC Is a Disaster for All of Us | MedPage Today
340B program expansion vs. reduced hospitalization: “… in the absence of Congressional action, the 340B Program is poised for continued growth, particularly as an increasingly sicker U.S. population will drive increased demand for high-cost specialty medications, such as oncology drugs.
More importantly, specialty (e.g., Humira®) and high-cost (e.g., GLP-1s) drugs are increasingly serving as effective substitutes for surgical interventions. As such, the 340B Program could be a modern-day Trojan Horse, with the current revenue generation from the program masking the looming wholesale replacement of hospital-based interventions in favor of specialty pharmacy prescriptions. Health economy stakeholders should consider the ramifications of such a scenario, ranging from the cost implications of one-time surgical interventions versus the duration of the substitute pharmaceutical interventions to the risks associated with powerful, but novel, therapies without long-term outcome histories.”
Minnesota’s 340B Program was associated with $630M in net revenue in 2023 for all covered entities
Corporatization in healthcare: “The health care industry is exceptional in the United States: it relies on private businesses operating in markets to fulfill a fundamental human need. Because of health care’s essential nature, many observers have viewed the growing influence of large companies in the industry, known as “corporatization,” as odious, akin to privatization of fire and police departments. The corporatization of health care often evokes images of rapacious companies that prioritize profits over patients, since corporations operate according to the logic of business, emphasizing efficiency and financial returns, whereas medical institutions have traditionally operated as professional or charitable enterprises.
Although some critics yearn for a return to a purely professional ethos in health care, such a reversal is impractical and potentially irresponsible. Corporatization tends to arise in circumstances in which patients demand cheaper or higher-quality care and large organizations can support those aims by taking advantage of economies of scale (in which the cost of each additional unit — such as a hospitalization or dose of medicine — is lower than the cost of the previous one). Evaluating corporatization requires understanding why it occurs, when it can succeed, and why it can go wrong…
Ultimately, the exceptional nature of health care means that any market incentives will be imperfect. Corporatization will always involve trade-offs because there is no simple or universal “fix” to align profits with value for patients. In each area of medicine, regulators will need to decide whether the deal inherent to corporatization is a worthwhile one — and whether the alternatives are any better.”
CMS Report on 2024 ACO Results: Tuesday, the Centers for Medicare and Medicaid Services announced results for ACO Performance for 2024: “For Performance Year (PY) 2024, ACOs in the Shared Savings Program achieved the highest rates of shared savings since the inception of the program. Out of 476 ACOs, 75% of ACOs, representing 80% of the 10.3 million assigned beneficiaries, are earning performance payments totaling $4.1 billion, and Medicare saved $2.4 billion relative to benchmarks. PY 2024 had the highest share of ACOs receiving performance payments and the highest amount of savings for ACOs and Medicare since the inception of the Shared Savings Program.
Low revenue ACOs continue to outperform high revenue ACOs, generating $316 vs $175 net per capita savings. Low revenue ACOs are typically physician-led ACOs or are comprised of FQHC/RHCs, while high revenue ACOs are typically hospital-led. ACOs composed predominantly of primary care clinicians performed better compared to ACOs with fewer primary care clinicians, with $401 vs $219 in net per capita savings.”
CMS https://www.cms.gov/files/document/fact-sheet-ssp-py24-financial-and-quality-results.pdf
Corporate Board Member survey findings:
- With only 31%of directors expecting economic improvement over the next year, the environment remains perched between slowdown and stagnation—both equally threatening.
- 64% of directors cited AI adoption as their top strategic opportunity in the current environment.
- 65% expect revenue growth and 56 %anticipate profitability gains, but just 42% plan to raise capital expenditures.
Boardroom Confidence Erodes Amid Washington ‘Chaos August 29, 2025
Bain on Healthcare Private Equity in 2025: “In the first half of 2025, global healthcare buyout deal value fell slightly below 2024 on an annualized basis. The second quarter in particular saw a drop in value, which was most pronounced in medical technology and biopharma. Still, deal value was higher compared with the first half of 2024.” Key 1st half metrics 2025 vs. 2024:
- Healthcare PE Deal Value: $62B vs. $44B
- Healthcare PE Deal Count: 173 vs. 182
Deal Markets Recalibrate: Healthcare Private Equity 2025 Midyear Update | Bain & Company
HHS demands states remove references to gender ideology: “The U.S. Department of Health and Human Services (HHS) through its Administration for Children and Families (ACF) demanded that 46 states and territories remove all references to gender ideology in their federally-funded Personal Responsibility Education Program (PREP) educational materials within 60 days. This action reflects the Trump Administration’s ongoing commitment to protecting children from attempts to indoctrinate them with delusional ideology. “
Trump Administration Puts 46 States and Territories on Notice to Remove Gender Ideology Content from Sex Ed Materials August 26, 2025 HHS.gov
Rosenbaum on Medicaid Work Requirement: “Despite a mountain of evidence showing its deleterious effects, a Medicaid work requirement is now law. The mandate, considered by its supporters to be a centerpiece of the One Big Beautiful Bill Act (OBBBA), is the product of a desperate search to find ways to help offset over $3 trillion in tax losses, coupled with the enduring desire among Affordable Care Act (ACA) opponents to repeal the Medicaid expansion for working-age adults. To accomplish their goal, work requirement advocates coupled a claim that removing millions of people from Medicaid somehow makes the program more efficient with grossly misleading “research” characterizing Medicaid beneficiaries as healthy adults living off their benefits, with free time on their hands.
This portrayal enabled lawmakers to deny the obvious—that, by indirect means, they were repealing the ACA Medicaid expansion. With a “lazy adult” script in hand (the same one used to impose work requirements as a condition of cash assistance and food benefits), lawmakers turned a blind eye to CBO impact estimates and extensive research showing that work requirements “succeed” in culling the rolls by creating hurdles too impossible to navigate. The efficiency trope is equally outrageous given the enormous implementation burden states now confront.”
Bloomberg UHG probe widens: “The US Justice Department’s criminal division is digging into UnitedHealth Group Inc.’s prescription management services as well as how it reimburses its own doctors under an ongoing probe into the firm’s operations…
The previously unreported areas of the probe show the scrutiny is broader than was known and goes beyond an inquiry into possible Medicare fraud. Investigators are looking into business practices at the company’s pharmacy benefit manager Optum Rx, in addition to the physician payments, said the people, who asked not to be identified discussing a confidential matter.
The health care conglomerate has also been under investigation by the department over potential civil antitrust issues, while the US Federal Trade Commission has filed a lawsuit accusing the company and two rival pharmacy benefits managers of driving up insulin prices. The companies have disputed the FTC’s allegations and Optum Rx called the suit “baseless.”
UnitedHealth Ongoing Criminal Probe Is Broader Than Medicare – Bloomberg
AHCA nursing home survey: “Medicare Advantage plans deny post-acute care on a daily or weekly basis for members in a majority of nursing homes — often against the advice of medical professionals, according to a new survey from the American Health Care Association.
The AHCA…surveyed more than 360 nursing home providers in May and found that 37% said post-acute care is delayed or denied at least once a week. Another 29% said such decisions come as frequently as every day.
The findings build on other research suggesting MA plans aggressively restrict care, which critics argue is done to increase their profits. UnitedHealth, the parent company of the largest MA insurer in the U.S., is currently being investigated by lawmakers for potentially impeding care for residents of nursing homes.”
Study: Effectiveness of large language model chatbots (LLMs)—ChatGPT, Claude, and Gemini—to suicide-related queries:
“ChatGPT and Claude provided direct responses to very-low-risk queries 100% of the time, and all three chatbots did not provide direct responses to any very-high-risk query. LLM-based chatbots did not meaningfully distinguish intermediate risk levels. Compared with very-low-risk queries, the odds of a direct response were not statistically different for low-risk, medium-risk, or high-risk queries. Across models, Claude was more likely (adjusted odds ratio [AOR]=2.01, 95% CI=1.71–2.37, p<0.001) and Gemini less likely (AOR=0.09, 95% CI=0.08–0.11, p<0.001) than ChatGPT to provide direct responses.
LLM-based chatbots’ responses to queries aligned with experts’ judgment about whether to respond to queries at the extremes of suicide risk (very low and very high), but the chatbots showed inconsistency in addressing intermediate-risk queries, underscoring the need to further refine LLMs.”
Study: Think-tank performance: “Large-language models (LLMs) increasingly inform policy research. We asked 5 flagship LLMs from leading AI companies in 2025 (OpenAI, Google, Anthropic, xAI, and DeepSeek) to rate 26 prominent U.S. think tanks on 12 criteria spanning research integrity, institutional character, and public engagement. Their explanations and ratings expose a clear ideological tilt. Key findings:
- Consistent ranking. Center-left tanks top the table (3.9 of 5), left and center-right tie (3.4 and 3.4), and right trails (2.8); this order persists through multiple models, measures, and setting changes.
- Overall: Across twelve evaluation criteria, center-left think tanks outscore right-leaning ones by 1.1 points (3.9 vs. 2.8).
- Core measures. On the three headline criteria of Moral Integrity, Objectivity, and Research Quality, center-left think tanks outscore right-leaning ones by 1.6 points on Objectivity (3.4 vs. 1.8), 1.4 points on Research Quality (4.4 vs. 3), and 1 point on Moral Integrity (3.8 vs. 2.8)
- Language mirrors numbers. Sentiment analysis finds more positive wording in responses for left-of-center think tanks than for right-leaning peers.
- Shared hierarchy. High rating correlations across providers indicate the bias originates in underlying model behavior, not individual companies, user data, or web retrieval.
JPK on household data: “Household income data is cut a variety of ways- by household tenure, type, age, origin, sex, obviously physical size etc…And those iterations go on and on and on. Per capita measures on their own are not going to adequately isolate for incomes associated with growth in households of smaller size…
Traditionally, the real estate market has leaned heavily on Median Household Income (MHI) as a benchmark for affordability, demand, and investment decisions. But times are changing. With the rapid rise of single-person households, it’s no longer enough to rely solely on household-level data. That’s where Per Capita Income (PCI) becomes increasingly important. Unlike household income, PCI gives us a clearer picture of individual purchasing power, especially in urban markets where single professionals, renters by choice, and younger demographics dominate demand.”
(59) Jordan Keckley, CPA | LinkedIn
AI role in think tank influence: “Left‑leaning bias in artificial intelligence (AI) is widely documented: today’s most‑used services tend to favor people, ideas, and institutions on the left of the spectrum. Because large‑language models (LLMs) now largely define how journalists, analysts, and citizens consume policy research, any tilt can quietly steer attention and approval toward or away from particular organizations…
The body of work covering political bias in AI-generated content is newer and growing (Wan et. al, 2023; Abid, Farooki, & Zou, 2021; An et al, 2024). So far, the results from this research have been consistent, with researchers finding significant evidence of a left-leaning ideological bias in LLM responses (Motoki, Neto, & Rodrigues, 2023; Rozado, 2024; Motoki, Neto, & Rodrigues, 2025; (Westwood, Grinner, & Hall, 2025). Given the well-documented trust that users place in this technology, and its left-leaning ideological tilt, this evidence has implications for how research and policy institutes (“think tanks”) and their ideas are consumed by the public…
As LLM-generated think tank reputations circulate, they quietly decide who is noticed, invited, quoted, and funded…A think tank deemed principled, dispassionate, and rigorous is far more likely to testify before committees, shape policy, or land in major stories; any doubt on one dimension can relegate a think tank to the margins. By centering on this triad, our study pinpoints the currency that buys access in Washington and the national press.”
KLAS Research Report: Oracle Health performance: Per the firm’s analysis released last Thursday:
- Oracle Health has lost customers and client satisfaction hasn’t improved in the three years since the technology giant acquired electronic health record vendor Cerner, in a $28 billion deal.
- Oracle Health has lost 57 unique acute care customers in the past three years, 12 of which are larger health systems with more than 1,000 beds, according to the health IT research firm.
- Problems with OH’ EHR rollout in the implementation of Department of Veterans Affairs have negatively impacted the company’s market acceptance. Note: per Klas, in 2024, Epic controlled more than 42% of acute care hospitals, while Oracle held 23%.
KLAS Research www.klasresearch.com
