In the News
What happened in healthcare recently—and what we think about it.
- CMS indefinitely suspends part of GLP-1 pilot. The Trump administration announced Tuesday that it will pause a portion of its five-year pilot project to expand coverage of GLP-1 medications, reportedly after receiving pushback from insurers because of the financial strain they might incur. Under the pilot, known as the BALANCE Model, the Centers for Medicare & Medicaid Services (CMS) would have negotiated drug pricing and coverage terms with GLP-1 manufacturers on behalf of state Medicaid agencies and Medicare Part D plan sponsors. Medicare will still cover GLP-1s through a transitional program beginning in July and running through the end of 2027 outside of the Medicare Part D benefit. The Medicaid portion of the pilot will continue, and states can apply through July 31 to participate.
- The Gist: GLP-1 medications have triggered sharp, sustained demand, and that isn’t changing anytime soon. The BALANCE Model was meant to extend access to the drugs for Medicaid and Medicare patients; the pause casts further uncertainty for some patients as they try to sort out access and cost issues related to these blockbuster drugs. The suspension of the BALANCE Model comes as major retailers enter the fast-growing GLP-1 market with their own programs. Last Tuesday, Amazon’s One Medical launched its own nationwide program that embeds GLP-1-driven weight loss services as part of primary care rather than a standalone service, while Walmart announced earlier this month that it would expand its GLP-1 services. As demand for GLP-1s grows without a stable coverage framework, more patients may be pushed into retail-based programs, with providers left to manage affordability and clinical oversight without clear reimbursement pathways.
- HHS issues call for nominations for U.S. Preventive Services Task Force. A call for nominations to the U.S. Preventive Services Task Force was issued Tuesday, days after Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. expressed frustration about the panel at a Congressional hearing. The Task Force makes recommendations for preventive care, and insurers typically follow its recommendations to guide coverage decisions for preventive care services. The Task Force has not convened since March of last year, and appointments to replace panelists whose terms expired last year have not been made. New panelists would begin their terms in July.
- The Gist: The Task Force plays an integral role in guiding prevention care and reimbursement; under the Affordable Care Act, insurers must fully cover certain Task Force-recommended services. But the panel, which is composed of volunteer experts and administered by an agency within HHS, has been under criticism from several corners, including Secretary Kennedy, for some time. Given the central nature of the Task Force’s recommendations for how preventive care is delivered and reimbursed, it bears watching who will be nominated to the panel. The perspectives of the Task Force members and their recommendations may dramatically impact care pathways and ultimately health outcomes.
- UnitedHealth beat quarterly estimates. UnitedHealth Group posted strong first-quarter earnings this week, with performance beating earlier estimates. The healthcare conglomerate also improved its profit outlook, declaring that it expects higher adjusted earnings while maintaining its revenue guidance of more than $439 billion. After a tumultuous year last year, United is pursuing a turnaround strategy that includes sizable AI investments, a push for greater transparency, and some divestures and cutbacks. In a host of changes, UnitedHealth announced a deal to buy a health technology platform, sold its Optum UK business, and saw a decline in its Medicaid, Medicare Advantage, and value-based care membership.
- The Gist: UnitedHealth Group, owner of the nation’s largest commercial health insurer, seems to be recovering after a year of difficulty. The announcement signals a turning of the tide for UnitedHealth after an earnings shortfall and a challenging 2025 overall. The recently finalized 2027 Medicare Advantage rate update from CMS—which set a 2.48% payment increase, reversing an earlier proposal of just 0.09%—may have also contributed to a boost in investor confidence for insurers, including UnitedHealth, that have Medicare Advantage business. For hospitals, UnitedHealth’s profitability shifts increase uncertainty. Falling membership across its insurance products could lead to bad debt and uncompensated care as more patients seek care without coverage. And as UnitedHealth sharpens its focus on profitability, it is likely to approach negotiations with greater discipline and selectivity. This shift will make contract discussions even more challenging.
And — what we’re following.
- President Trump last week nominated Erica Schwartz, M.D., M.P.H., a former deputy surgeon general during President Trump’s first term, to be the next director of the Centers for Disease Control and Prevention.
- Physician burnout rates are falling, according to a report from American Medical Association released last week.
Plus—what we’ve been reading.
- Community health workers bridge care gaps. Published last week in The New York Times, this article describes the role of community health workers (CHWs)—trusted local aides who help people navigate care and address social needs. It describes how CHWs are increasingly seen as a cost-effective way to improve outcomes, but they remain underfunded and inconsistently integrated into healthcare. CHWs have been part of the healthcare landscape since the 1960s, operating under many titles (such as health promoters, outreach workers, and community health educators), but do not have a standardized educational pathway. Certification and licensing requirements vary widely by state, and in some cases, don’t exist at all. CHWs provide in-person support and address nonclinical barriers to care such as transportation, housing instability, food access, and social isolation. Studies demonstrate that CHWs have an outsized impact and reduce avoidable care for patients with serious illness and cancer. CHW programs cost about $1,500 per patient, far less than hospital care, but have not spread widely because payment is fragmented and inconsistent. Medicare began covering some services in 2024, but gaps remain.
- The Gist: CHWs are a low-cost, low-tech intervention with high dividends and significant cost benefits, particularly as health systems navigate a shift from volume-driven care to value-based models. Their importance highlights just how much care delivery extends beyond the four walls of the hospital. It’s a model with clear promise, but uneven adoption and fragile funding leave a structural gap. Hospitals that treat CHWs as a nice-to-have rather than a need-to-have may fall behind and, worse, do their communities a disservice. The model depends on sustained investment and reimbursement mechanisms that are still evolving; without those, CHW programs tend to remain small, grant-funded, or pilot-based. The patchwork nature of training and licensure is an added hurdle for multi-state systems. But, if health systems do not take a deliberate role in scaling this workforce, large segments of vulnerable populations are at risk of falling through the cracks. The upside is significant: lower length of stay, better outcomes, and greater patient trust.
Graphic of the Week
A key insight illustrated in infographic form.
Hospital performance off to a tenuous start in 2026
Kaufman Hall’s latest National Hospital Flash Report underscores persistent cost pressures that continue to strain hospital and health system finances. Calendar year-to-date margins adjusted for corporate allocations declined at the start of the year. Operational shifts—fewer inpatient days, greater reliance on outpatient revenue, and softer, uneven volumes—reflect an ongoing transition in where and how care is delivered.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
Health systems once built ambulatory strategies with a hyper focus on growth. As reimbursement tightens and payers steer care to lower-cost settings, providers must balance ambulatory volume with efficiency.
A new article explores how leading systems are redesigning their ambulatory networks to optimize where care is delivered—and keep pace amid rapid change.
On Our Podcast
The Gist Healthcare Podcast—all the headlines in healthcare policy, business and more, in 10 minutes or less every other weekday morning.
Earlier this month, JC spoke with Robert Wachter, MD, Chair of the Department of Medicine at the University of California, San Francisco and author of A Giant Leap, about what feels different in this current wave of AI in healthcare and where it’s already starting to take hold in practice.
This Monday, the conversation turns to what happens as these tools are used more widely and how their limitations show up in real-world settings, from questions about reliability to how they’re used by clinicians and patients.
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The Gist Weekly team at Kaufman Hall
