On December 10, I had quadruple bypass surgery at Mission Hospital (MH), the HCA Healthcare facility in Asheville NC. It was necessary due to significant blockage (95%) and counsel from my long-time primary care physician at Vanderbilt, Ben Womack.
I chose MH for three reasons:
- In the 15 years I have lived part-time in Asheville, I had consistently heard good things about its heart program from my golfing buddies. I trust them.
- I found a surgeon, Hyde Russell at Asheville Heart, who had exceptional clinical credentials and genuine interpersonal warmth. He justified my confidence.
- Mission Health is under a microscope. It changed ownership from not-for-profit Mission Health to HCA Mission Health in a $1.5 billion deal in 2019. The terms of that transaction—approved by its Board and regulators—were codified in a 146-page Asset Purchase Agreement that specified HCA obligations for 10 years and enabled the creation of the Dogwood Health Trust to invest proceeds in the 18-county area for the benefit of community health. In the period since, Mission nurses unionized, CMS’ issued multiple “Immediate Jeopardy” warnings from CMS and attention has spiked in the community and beyond. Despite its above and beyond assistance in the aftermath of Hurricane Helene in the fall of 2024 that devastated the area, killing 108 and shutting down everything for weeks, criticism of Mission has grown as staffing, safety and quality issues are widely rumored and reported. I chose Mission because I wanted to see firsthand how it operates.
This experience has been enlightening. I kept copious notes and continue to add to that file. My journey spans 3 months, 2 ED visits, a 5-day inpatient stay, an outpatient post-op procedure to clear fluid build-up in my lungs, a follow-up visit with Dr. Russell and the first two weeks of the rehab regimen. Observations to date:
My pre-operative experience was suboptimal. My 26-hour oversight stay in the Mission emergency room (including 12 hours when not a soul opened the curtain to check on me in an ER bed that needed repair) was the initial leg of my journey. That was followed by a cath procedure overseen by a clinician whose bedside manner was toxic and a determination surgery was necessary. After checking with my internist and an unexpected second ED visit, I located Dr. Russell, spent an hour interviewing him and committed to the procedure. In between, there were numerous calls (and ‘please hold’ waits) with Mission Health, Asheville Cardiology and Asheville Heart whose systems are not in integrated and often contradictory. Confused after conflicting recommendations and numerous calls, I made a late-afternoon pre-surgery trip to the hospital to get in-person clarity on pre- and post-op logistics. That worked.
My surgical experience was successful but post-op navigation has been challenging. I was admitted for my procedure at 5 am on December 10. The heart-lung machine was used for only 2 hours during the four-hour procedure and I was discharged 5 days later. Having lost my dad to the same procedure years prior, I was worried. Over the month prior, I had penned my “Endnotes” expecting I might not survive. Now, 5 sessions into my 36-session cardiac rehab regimen, I can confidently say I feel better, and my post-op visit with Hyde confirmed the outcome I had sought. But coordination since surgery across all MH-affiliated entities has been suboptimal: I still lack access to my new medical record repository and my bills are still coming in.
I’ve become a student of MH in the process, having spoken with more than 40 frontline staff in confidence—nurses, techs, therapists, practice administrators and physicians—inquiring about what was working well and their areas of concern, if any. I’ve also read the Asset Purchase Agreement, all 6 of the Independent Monitor reports submitted to the Attorney General, media coverage, attended a Community Meeting hosted by Affiliated Monitor to solicit feedback and reviewed the 2024 case study by Wake Forrest law professor Mark Hall. Based on these, my takeaways are:
HCA operates a profitable business in Western North Carolina. Despite operating through 2016 via a Certificate of Public Advantage monopoly, Mission was marginally profitable. Since coming in, HCA has turned its market dominance into a highly profitable system of 6 hospitals, employed physicians and ancillary programs applying its playbook– aggressive staffing, tight procurement and cautious capital deployment. HCA Healthcare proudly touts its operational discipline to investors and partners, often getting pushback from staff and referring physicians that the cuts are harmful. It is a corporation in which efficiency is hardwired, fads are avoided and leadership is defined by successful financial execution. Strategically, HCA reminds communities it pays taxes, matches or exceeds charity contributions made by competing not-for-profit systems, and negotiates rates with insurers, Medicaid and Medicare that are reasonable. And, in North Carolina, it has successfully defended itself against allegations of staffing and quality neglect noting correctly the Asset Purchase Agreement does not address either with specificity. Criticism is expected; its handling often falls short.
Outcomes are dependent on factors well-beyond the precision of the surgical team and coordination by hospitals and physicians and care teams. In most care settings, patient education is recognized as important but results are disappointing. At Mission, caregivers are too busy to answer questions, education materials are generic and almost useless, online resources (including estimated prices and scheduling) are inaccurate or misleading, physicians are dealing uncomfortable changes and infrastructure to facilitate ‘owning’ my health records is a pipe dream. Were it not for my family, especially Rhonda, Jordan and Erin, my outcome could have been much worse and my outlook on what’s ahead uncertain.
The working relationships between HCA Mission Health, Dogwood Health Trust and the State of North Carolina must be re-focused. The Asset Purchase Agreement upon which HCA Mission Health’s accountability is based is incomplete and inadequate. It predates the pandemic and Helene, and lacks needed specificity on key areas including public health, emergency services and many more. Dogwood’s oversight should be more integrated with MH’ community wellbeing efforts to serve the interests of its 18-county constituency. The state of NC should consider a formal reset for the last 4 years of the APA to assure HCA’s contributions are more directly linked to WNC population health. And, as a result, the expectations for HCA and the Independent Monitor should be revisited to enhance the scope, timeliness, and verifiability of key measures associated with accountability for all. All are needed.
Final thought:
That HCA Mission Health is profitable is no surprise. Ingles Markets, the private 198-unit dominant grocer in WNC saw its profit jump 3 times its prior year despite Helene. Like Ingles, HCA Healthcare did well last year–+ 17.8% but other health systems in the region also reported strong years (Advent Health, Novant, Atrium).
What’s important is recognition that the health system in Western North Carolina needs dramatic improvement to be affordable, transparent and comprehensive. That includes Mission Health and its corporate owner HCA Healthcare. The status quo is not even close.
Paul
P.S. Asheville is the hub of the Western North Carolina economy. The 18-county area is home to 900,000. These page one headlines from last Thursday’s Beacon Tribune are indicative of local coverage (www.thebeacontribune.com):
“Two Deaths, Failure to Isolate Infectious Diseases led to Mission’s Latest Immediate Jeopardy: Systemic staffing failures, unsafe environment chronicled in CMS report, which also includes details of patient’s attack of nurse”
“Ingles sales, profits surged as grocery prices soared following pandemic, financial records show”
Resources
Dogwood Health Trust “Dogwood Health Trust exists to dramatically improve the health and wellbeing of all people and communities in the 18 counties and Qualla Boundary of Western North Carolina… Beyond community investments in the health and well-being of Western North Carolina, one of Dogwood Health Trust’s roles is to ensure that HCA remains in compliance with the terms it agreed to when it purchased the assets of Mission Health System, also called the Asset Purchase Agreement (APA).” www.dogwoodhealthtrust.org
MONITORING REPORT For Sixth Annual Compliance Review Cycle To Assess the Compliance Activities of HCA Healthcare, Inc. operating under the Asset Purchase Agreement for Mission Health System During Calendar Year 2024 Published July 11, 2025https://dogwoodhealthtrust.org/wp-content/uploads/2025/07/IM-Monitoring-Report-Calendar-Year-2024-final.pdf
Staff reductions contributed to Mission’s soaring profits after HCA sale, draft report says April 23, 2026 Asheville Watchdog https://avlwatchdog.org/staff-reductions-contributed-to-missions-soaring-profits-after-hca-sale-draft-report-says/
ASSET PURCHASE AGREEMENT hbgjioklmpbdmemlmbkfckopochbgjpl/https://dogwoodhealthtrust.org/wp-content/uploads/2024/01/Asset-Purchase-Agreement.pdf
HCA’s 15 Commitments May 2025 https://dogwoodhealthtrust.org/wp-content/uploads/2025/07/15-Commitments-Slide-for-web.pdf
HCA, responding to Stein lawsuit, says it never committed to quality care at Mission February 10, 2026 https://avlwatchdog.org/hca-mission-respond-to-stein-lawsuit-denying-they-have-broken-commitments-made-at-time-of-sale .
Draft report says charity care has declined ‘extensively’ at Mission after HCA takeover https://avlwatchdog.org/draft-report-says-charity-care-has-declined-extensively-at-mission-after-hca-takeover
Quotables
HCA Mission Health on staffing, quality accountability: “HCA never promised to provide quality health care, lawyers for the hospital chain argue in asking a court to dismiss North Carolina Attorney General Josh Stein’s lawsuit alleging broken commitments in the purchase of nonprofit Mission Health in 2019.
HCA noted in its response that the Asset Purchase Agreement (APA) — the contract covering the $1.5 billion sale — is “silent as to the quantity or quality of services required” at Mission Hospital.
“The contractual language, as well as the underlying negotiations, demonstrate that Mission’s Hospital Service Commitments are not promises to meet subjective healthcare standards,” the response stated. “HCA promised only to continue to make its facilities, staff, and equipment available to medical staff physicians who want to use those facilities to offer the same services that Mission offered before HCA acquired it..”
HCA, responding to Stein lawsuit, says it never committed to quality care at Mission February 10, 2026 https://avlwatchdog.org/hca-mission-respond-to-stein-lawsuit-denying-they-have-broken-commitments-made-at-time-of-sale .
Pearl on affordability: “For decades, healthcare has consumed an ever-larger share of GDP, while clinicians practiced medicine much as their mentors have for generations.
That era is ending. With costs accelerating and incremental fixes exhausted, healthcare is approaching a breaking point. Act aggressively, now, and the nation can prevent and better control chronic disease, avert hundreds of thousands of heart attacks, strokes and kidney failures, and flatten healthcare inflation.
By contrast, wait another decade and there will be no way to rein in spending or chronic disease. And if workforce adaptation is delayed, as many as 30% of physicians will find themselves trained for a version of medicine that no longer exists.
We still have a choice, but the clock is ticking. “
3 healthcare threats that will soon become a crisis too big to solve Robert Pearl January 26, 2026 https://www.linkedin.com/pulse/3-healthcare-threats-soon-become-crisis-too-big-solve-pearl-m-d–tfuvc/
Bloomberg: Public concerns: “Healthcare costs are weighing on the minds of Americans following the Jan. 1 expiration of Affordable Care Act subsidies, which caused premiums to increase dramatically. New data shows that two-thirds of Americans worry about the price of healthcare more than other expenses, including groceries, utilities, gas and housing, with a majority reporting an increase in medical bills already this year. An estimated 7.3 million Americans will lose ACA coverage in 2026 due to the end of enhanced tax credits, projections show.
Americans Are More Worried About Health Care Costs Than Gas or Groceries – Bloomberg
Spencer Stuart: CEO turnover: “Record CEO turnover at U.S. public companies has put the biggest class of incoming chief executives in years at the helm of massive enterprises—and the newcomers are younger and less experienced than before.
About one CEO in nine was replaced last year across 1,500 of the biggest publicly traded companies… the highest rate since at least 2010, when the U.S. was emerging from the financial crisis.
The result is a grand experiment in leadership as companies grapple with the swift rise of artificial intelligence, the unraveling of long-established trade practices and an unsettled economy and geopolitical order.
Meanwhile, incoming chiefs are younger and less experienced than previous crops of new leaders, Spencer Stuart found. Incoming CEOs averaged 54 years old, compared with nearly 56 for last year’s appointees.
More than 80% of last year’s 168 incoming CEOs were first-timers, with no prior experience running public companies or other major stand-alone enterprises. Two thirds of them have never served on a corporate board before. “
Companies Are Replacing CEOs in Record Numbers—and They’re Getting Younger WSJ February 15, 2026 https://www.wsj.com/business/c-suite/new-ceo-replacements-age-young-5c503b88
Atlantic on Longevity Scam: “Today’s longevity-medicine movement is driven by the same aggressive desire for eternal youth as the mythic stories of old. But whereas in earlier times ideas about wellness could travel only as fast as the people who held them, today just about anyone with an internet connection can use social media and AI-generated graphics to sell medical advice in seconds. Despite a decided shortage of placebo-controlled trials in humans to support that advice, the business of longevity is booming, thanks in large part to sleek direct-to-consumer marketing delivered by health influencers with far more confidence than evidence. By 2030, $8 trillion might be spent annually on longevity-related products…
The irony is that modern medicine has already succeeded at what the modern-day longevity movement claims to offer…A better—and more achievable—goal would be to extend healthy longevity, adding life to years instead of years to life. Scientists and doctors, for the most part, already know how to do this. Daily exercise and maintaining skeletal muscle volume as you age are among the most potent forms of preventive health care.”
The Longevity Scam Atlantic https://www.theatlantic.com/health/2026/02/longevity-medicine-profit-oversold
Dowd on employer tax exclusion: “If policymakers are serious about affordability, this is the place to start. Converting the tax exclusion into a flat, refundable credit to individuals and families would immediately level the playing field across sources of coverage and reduce the incentive to over-insure. Better still, those credits should be tied to health plans that do what today’s system refuses to do: clearly identify which medical practices deliver lower risk-adjusted total cost of care and share the savings with workers who choose them.
If health insurance is unaffordable, it is because healthcare is expensive. Continuing to subsidize arrangements that obscure responsibility for spending only guarantees more of the same. Redirecting those subsidies toward transparency, competition, and shared savings would do far more to restore affordability than another round of premium support ever could
If Healthcare is Unaffordable, Stop Subsidizing It— It’s time to revisit the tax exclusion for employer-sponsored health insurance MedPage Perspectives February 19, 2026 Bryan Dowd, PhD, and Anthony LoSasso, PhD https://www.medpagetoday.com/opinion/
Comers-Hogg on Rural health funding: “Since the passing of the One, Big, Beautiful Bill Act of 2025 (OBBBA) and the announcement of the Rural Health Transformation Program (RHTP), I’ve felt a bit like I’m living through George Orwell’s 1984. In the program announcement, Robert F. Kennedy Jr. noted, “This $50 billion program is about delivering dignity and dependable care to rural communities, making sure every American has access to affordable, high-quality treatment.”
And that’s where I get lost. That sounds great, but “affordable, high-quality treatment” requires funding, and as the kids these days would say, “The math doesn’t math.” Let’s take a look:
Around 20% of Americans live in rural areas and receive care there.
Those in rural areas have worse health outcomes and are at greater risk of dying from car accidents, suicides, and drug overdoses…
The OBBBA cut ~$900 billion to $1 trillion from Medicaid over 10 years.
OBBBA also included a fund for rural health transformation, to the tune of $50 billion over five years.
KFF estimates that Medicaid spending in rural areas will likely decline by $137 billion over 10 years, almost 2.5 times the $50 billion allocated in the RHTP…”
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Economy
CBO Updated Projections:
- The three largest entitlement programs—Social Security, Medicare, and Medicaid—continue to dominate the budget outlook. Over the period 2027 to 2036, 88% of all new non-interest spending (relative to a nominal freeze) is associated with rising expenditures for these programs. CBO expects spending on Social Security, Medicare, Medicaid, CHIP (the children’s health insurance program), and premium assistance under the Affordable Care Act (ACA) to reach 15.5%of GDP, up from 11.9% in 2026.
- Social Security’s retirement trust fund (for Old Age and Survivors Insurance, or OASI) is expected to be depleted of reserves in 2032.
- Over the period 2047 to 2056, Social Security and Medicare spending will exceed the combined value of payroll tax receipts and premiums by an average of 5.2% of GDP, up from 2.7% in 2026.
- CBO builds into its growth forecast a 0.1 percentage point boost in productivity from artificial intelligence (AI) over the period 2026 to 2036. However, with less immigration, total real GDP growth is expected to be just 1.8% per year through 2036. That compares with the administration’s expectation of 3.0% annual growth.”
The Congressional Budget Office’s Updated Projections AEI February 11, 2026 https://www.aei.org/economics/the-congressional-budget-offices-updated-projection
Study: Medicare savings from ACOs: “A study by Ryan and Markovitz found that the program was associated with net losses (after incentive payments) to traditional Medicare of $584 million to $1.42 billion between 2013 and 2021, using estimates of ACO savings in the initial years of MSSP. In this cross-sectional study, we provide updated estimates of MSSP’s budgetary impact between 2012 and 2023 using a more recent longitudinal evaluation of the program’s effects…Results
In models using both primary and conservative savings estimates, ACOs generated net savings to Medicare beginning in the second year of the program. Annual per-beneficiary net savings increased from $20 to $33 in 2014 to $107 to $208 in 2018. Net savings fluctuated between 2019 and 2023, ranging from $0 in 2020 (conservative model) to $202 in 2021 (primary model). Between 2012 and 2023, MSSP ACOs produced an estimated $20.1 billion to $29.2 billion in gross savings, and Medicare made $15.8 billion in bonus payments, resulting in net savings to traditional Medicare of $4.3 billion to $13.4 billion.”
Budgetary Impact of the Medicare Shared Savings Program on Traditional Medicare JAMA Network February 20, 2026 https://jamanetwork.com/journals/jama-health-forum
Pet Care costs: Two in five Gen Z and Millennials (42%) prefer pets to children as they view them as less financially burdensome. Since 2020, pet services costs have increased 34.6% compared to the 25.8% rise in child care prices, according to the Consumer Price Index. The booming growth in pet spending really shows pets have become part of the family, with the overall pet industry reaching ~$157 billion in 2025. Pet care has become one of the fastest-growing service industries, with revenue up 90% over five years — more than double child day care’s growth rate.
Pet care costs are rising faster than child care, climbing 34.6% since 2020 compared with a 25.8% increase for kids’ day care https://www.empower.com/the-currency/money/pet-care-services-costs-news
Hospitals
KFF on hospital price transparency impact: “But amid low compliance and other struggles in implementing the policy since it took effect in 2021, the available price data is sparse and often confusing. And instead of patients shopping for medical services, it’s mostly health systems and insurers using the little data there is, turning it into fodder for negotiations that determine what medical professionals and facilities get paid for what services…
Not all hospitals have fallen in line with the price transparency rules, and many were slow to do so. A study conducted in the policy’s first 10 months found only about a third of facilities had complied with the regulations. The federal Centers for Medicare & Medicaid Services notified 27 hospitals from June 2022 to May 2025 that they would be fined for lack of compliance with the rules.”
Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data February 16, 2026 https://kffhealthnews.org/news/article/price-transparency-trump-hospitals-insurers-health-care-costs/
ProPublica on hospital measles reporting: “With 973 reported cases, South Carolina’s measles outbreak has ballooned into the nation’s largest since the virus was declared eliminated in the U.S. 25 years ago. Yet, since state health officials first confirmed the outbreak on Oct. 2, the state’s hospitals have reported only 20 measles-related admissions, or about 2% of cases. Some infectious disease experts say that the true number is likely much higher…
Across South Carolina, large health care systems have bought up local hospitals and doctors’ practices. With that control, they can exert influence over what those doctors and hospital employees say publicly, especially when it comes to potentially controversial topics like vaccines. At the same time, they face pressure from Republican lawmakers and a growing segment of vaccine-wary patients.
The result is often highly controlled information sharing, or a lack thereof.”
South Carolina Hospitals Aren’t Required to Disclose Measles-Related Admissions. That Leaves Doctors in the Dark February 20, 2026 https://www.propublica.org/article/south-carolina-measles-hospital-admissions
DOJ challenges Ohio Health: Last week, the DOJ filed a complaint against OhioHealth alleging its market power to impose contractual restrictions that impede or completely prevent insurers from offering innovative and money-saving health-insurance plans or plan features. OhioHealth generally forces insurers to include OhioHealth in all of the networks for the commercial insurance products they offer, regardless of how OhioHealth’s prices compare to its competitors, preventing the development of budget-conscious plans in the Columbus area. Without these lower cost and innovative plan options that empower patients to save money by selecting lower-cost providers who still provide high-quality care, patients and employers are faced with fewer health plan choices and higher costs.
OhioHealth owns or manages 16 hospitals and outpatient facilities throughout the State of Ohio.
Justice Department Sues OhioHealth for Anticompetitive Healthcare Contracts That Increase Costs for Ohio Patients Lawsuit Seeks to Reduce Healthcare Costs in Ohio by Allowing Patients, Employers, and Health Insurers to Choose Lower Cost Healthcare Options February 20, 2026 https://www.justice.gov/opa/pr/justice-department-sues-ohiohealth-anticompetitive-healthcare-contracts-increase-costs-ohio
Bloomberg on HCA Founder Frist: “The wealthiest person in U.S. healthcare, as of Feb. 19, is Thomas Frist Jr., MD, co-founder of HCA Healthcare, according to the Bloomberg Billionaires Index, a ranking of the world’s 500 richest people across industries.
- Total net worth: $45.4 billion
- Year-to-date change: +$4.47 billion
- Overall index ranking: 44
Dr. Frist is the major shareholder of Nashville, Tenn.-based HCA Healthcare, a for-profit operator of about 2,400 care sites, including ASCs, freestanding emergency rooms and urgent care centers and physician clinics.
HCA reported $75.6 billion in total revenue from 2025, an increase of $5 billion from 2024. Net income attributable to HCA Healthcare was $6.8 billion in 2025, an increase of more than $1 billion over 2024.
Dr. Frist co-founded the publicly traded health system with his father in the 1960s. He took it public for the third time in 2011 after two management buyouts and owns over 25% of the company with his family. While Dr. Frist doesn’t have an executive position at HCA, his sons, Thomas Frist III and William Frist, are board members.
Forbes gave him a self-made score of seven and a philanthropy score of two.”
Bloomberg Billionaires Index – Thomas Frist
Insurers
United implements primary care gatekeeping policy: “Starting May 1, enrollees in UnitedHealthcare health maintenance organization (HMO) or HMO-point of service Medicare Advantage plans nationwide must get a primary care provider’s referral before seeing a wide array of specialists, which several health advocates say will lead to confusion and care delays for millions of seniors.
UnitedHealthcare, the nation’s largest provider of Medicare Advantage plans, warned that specialty care without a referral wouldn’t be reimbursed and that physicians would be on the hook for absorbing the enrollees’ cost of specialty care.
“Claims denied due to missing referrals will be considered provider liability…The prerequisite has already been the practice in six states: California, Nevada, Texas, Illinois, Missouri, and Nevada. The policy will now apply to the remaining 37 states where UnitedHealthcare offers HMO or HMO-point of service Medicare Advantage plans.
UHG on workforce: “Today’s workforce comprises 4 generations, but 3 of them make up a large majority (75%) of overall membership. Generation X (ages 45–60), millennials (29–44) and Generation Z (13–28) each account for an equal portion of membership, but it’s Generation X that drives the highest spend of any age cohort at 36%. The 3 dominant generations together account for 70% of total spend, slightly below their collective portion of membership. Unsurprisingly, the greatest differential between a generation’s percentage of membership and spend is seen in the oldest generation: baby boomers. This generation (ages 61–79) represents only 10% of total membership yet accounts for 22% of overall spend due to higher rates of chronic conditions, catastrophic care and long-term care. With many baby boomers reaching or surpassing traditional retirement age, younger people now make up a larger portion of overall membership. Younger members’ health is declining… As expected, members become more expensive (on average) as they age. But the faster rate of spend increase among millennials and Gen Z members should serve as a warning sign to employers. Overall, spend is not decreasing as younger employees make up a larger share of the membership — it’s increasing.”
UHG-Health Action Council 2026-hac-white-paper.pdf
Study: Medicare enrollment adverse selection: “Using administrative data from the period 2015–22, we documented that among incumbent MA enrollees, an increasing share of switching to other MA plans or traditional Medicare occurred outside the standard Medicare open enrollment period. Compared with Medicare open enrollment period switchers, alternative enrollment period switchers tended to have higher risk scores and hospitalization rates before switching. In addition, beneficiaries who switched to traditional Medicare or broader-network plans tended to have higher risk scores and hospitalization rates before switching than those who switched to other plans. Our results highlight a trade-off: Flexible enrollment periods may allow some beneficiaries to enroll in plans that better suit their needs but may also allow beneficiaries with higher medical costs to sort into certain MA plans or traditional Medicare, which potentially generates adverse selection if other selection mitigation policies are insufficient
Switching Medicare Plans Outside Open Enrollment Was Increasingly Common, Especially Among Sicker Enrollees, 2015–22 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2025.00915
Physicians
Health Affairs Study: Clinician use of OOP prompts for prescriptions: “Health systems are increasingly integrating real-time benefit tools into their electronic health records (EHRs). These tools are designed to improve the affordability of and adherence to medications by alerting clinicians to out-of-pocket prescription price estimates and lower-price alternatives. Clinicians’ engagement with real-time benefit tools is critical to the tools’ success, yet it has not been comprehensively examined. Using 2019–22 EHR data from 803 ambulatory clinics and 4,894 clinicians in a large health system, we found that clinicians received a median of 19 alerts per 100 orders; of the 87 percent of clinicians who received at least one alert, 91%changed an order in response to an alert at least once. Clinicians made changes in response to 11% of all alerts they received, but they rarely accepted the alternatives originally suggested by the tool. Changes most often involved the pharmacy (60%), followed by quantity (39%), formulation (6%), and medication (4%). Primary care clinicians received the most alerts per month, while medical and surgical subspecialists made changes for a larger share of alerts. For these tools to be successfully implemented, leaders must consider the quality and usability of alerts, time burdens, and alert fatigue
Clinicians Receive Frequent Alerts Yet Rarely Accept the Suggested Changes
Prescription Drugs
McKinsey on obesity market: “GLP-1 therapies are on track to become one of the fastest-growing drug classes in history. Sales are expected to reach $100 billion by 2030. But the real opportunity is bigger than weight loss.
Obesity—once seen as an intractable condition—is now widely recognized as a treatable disease and part of a broader metabolic health crisis shaping healthcare costs, workforce productivity, and consumer demand worldwide.
Metabolic health is a much bigger notion than just obesity. Overall, I see this as a giant economic and health opportunity. It’s going to disrupt and create opportunities across different industries,”
GLP-1s are just the beginning McKinsey February 21, 2026 https://www.mckinsey.com/featured-insights/themes/glp-1s-are-just-the-beginning
Supplement Use: “The global supplement market is now estimated at $100 to $200 billion and is growing rapidly, with the US accounting for about one-fifth of worldwide demand. Once considered to exist only on the fringes of medical care, “stacks” of supplements have now become daily rituals for millions of Americans.
Before the pandemic, around 58% of US adults reported taking some kind of supplement. Today, that number is closer to 75%, according to industry estimates. Online sales are taking over. The Nutrition Business Journal’s 2025 report cited annual growth of over 10% in online supplement sales, even as other pandemic-era e-commerce trends have cooled…
There are many reasons for this shift. A bloated American “sick care” system that no one feels is working well. Growing distrust of one-size-fits-all medical advice. Doctors pressed for time with patients. The rise of direct-to-consumer lab tests that sample blood, spit, urine, and other substances from the body, promising to tell you exactly which pills, potions, and microbiome supplies you need to feel your best…
Quality varies in a lightly regulated market”
The New Medicine Cabinet https://www.businessinsider.com/thorne-supplement-factory-charleston-2026-
