February 24, 2023

The Weekly Gist: The ChatGPT with Extra Dad Jokes Edition

by Chas Roades and Lisa Bielamowicz MD

Suddenly it seems like everyone is talking about ChatGPT, the AI-driven large language model that looks poised to disrupt Google, upend journalism, and (perhaps blessedly) eliminate the five-paragraph homework assignment altogether. Honestly, our eyes glaze over whenever someone starts yammering about ChatGPT, much as they did during last year’s crypto craze. But hey, maybe that’s how AI will beat us, not with a bang but with a thousand think pieces from worried pundits. Anyway, we decided to take a closer look, and fired up the bot with the following prompt, just as an experiment: “Write the opening paragraph to a newsletter in the style of the Weekly Gist. Make it humorous and include at least one ‘dad joke.’” So here it is, courtesy of our new robot overlords:

Greetings and salutations, my dear readers! It’s time for another edition of the Weekly Gist, the only newsletter that’s as informative as it is dad-joke-tastic. We’re coming to you this week with all the latest news and trends from the world of healthcare, but don’t worry, we promise to keep it light-hearted and pun-derful. So sit back, relax, and let’s dive into the latest and greatest in the world of health…care (see what we did there?).

Call us if you need us. We’ll be at the beach.


What happened in healthcare this week—and what we think about it.

  1. UnitedHealth Group (UHG) closes its $5.4B acquisition of LHC Group. The deal, first announced in March 2022, will bring LHC’s home health locations, hospice sites, and long-term acute care hospitals across 37 states into UHG’s Optum division. LHC also has over 400 joint-venture arrangements with hospitals. The acquisition received heightened scrutiny from antitrust regulators, but was ultimately allowed to proceed.

The Gist: LHC’s postacute footprint expands UHG’s Medicare Advantage value play, guaranteeing postacute capacity and providing a platform to funnel care into lower-cost settings. UHG’s strategy is right in line with its peers: Humana fully owns home health provider Kindred at Home (now branded CenterWell Home Health), and CVS Health plans to acquire Signify Health, which provides home care services with an emphasis on risk scoring. But achieving lower cost of care will require integration of postacute referrals and care management across rapidly expanding physician networks.

  1. Humana to exit employer-sponsored insurance market. On Thursday, Louisville, KY-based Humana announced it will wind down its Employer Group Commercial Medical Products business over the next two years. The company said its exit from all fully insured, self-funded, and federal employee medical plans—a book of business that shrunk to under 1M lives in 2022—will allow the company to focus more on its Medicare Advantage (MA) offerings, which covered over 5M lives in 2022. Humana is currently the second largest MA payer behind UnitedHealthcare.

The Gist: In a move signaled earlier this month, Humana has chosen to double down on its more profitable MA business, rather than continuing to compete with other major payers in the shrinking employer-sponsored commercial market. Humana already offers MA plans in 89 percent of US counties, more than UnitedHealthcare, but its 2022 MA growth was only a third of United’s (250K new lives enrolled, versus 750K). This move allows Humana to devote more resources to fielding competitive MA plan offerings and integrating its growing portfolio of physician and postacute care assets.

  1. Biden Administration withdraws permissive hospital antitrust guidance. Earlier this month, the Department of Justice (DOJ) and the Federal Trade Commission (FTC) quietly released joint revisions to three healthcare antitrust policy statements which it now considers “overly permissive”. While two of the policies date back to the 1990s and relate to information sharing, the most significant, published in 2011, stated that certain ACOs were “highly unlikely to raise significant competitive concerns”. Instead, the FTC and DOJ say their policy will be to review these arrangements on a case-by-case basis.

The Gist: While unlikely to alter the ACO landscape significantly, this new guidance signals a departure from Obama-era policies that gave outsized priority to ACO development in cost-reduction efforts. Until now, ACOs were passed over for scrutiny, while regulators focused on more traditional hospital mergers in an attempt to prevent outsized market leverage. Moving forward, the Biden administration must strike a delicate balance between policies that encourage greater coordination amongst independent healthcare entities working together to improve patient care and lower costs, and the market leverage that such coordination can generate

Pluswhat we’ve been reading.

  1. Should we be prescribing ketamine via telehealth? A revealing article published in the New York Times this week explores the potential for both relief and abuse unlocked by the ability for physicians to prescribe ketamine virtually. Ketamine was originally approved decades ago as a sedative for surgery but has found two new lives: one as an emerging treatment for severe depression (though there is a lack of rigorous research on long-term outcomes), and the other as a psychedelic party drug. Due to concerns over its addictive properties and side effects, access to the medicine was tightly restricted by the Drug Enforcement Agency (DEA), until a provision tied to the COVID public health emergency (PHE) allowed providers to prescribe controlled substances like ketamine without in-person evaluation. This has caused a “ketamine boom” in which patients, aided by investor-funded startups offering the drug, can gain access to ketamine with little to no supervision, with some experiencing significant negative side effects including neurological symptoms and loss of bladder control.

The Gist: The growth in ketamine prescriptions—and the number of online-only startups providing access to the drug—is a prime example of the “Wild West” landscape of telemedicine industry. These purveyors often address conditions in isolation with minimal coordination on a patient’s other health needs. They also lack the infrastructure for close, ongoing monitoring, which can easily result in patient harm with a drug like ketamine, given its side effect profile. The DEA is currently exploring regulations to govern the remote prescribing of all controlled substances after the end of the PHE. We hope they can find a middle ground that maintains access while limiting abuse and prioritizing patient safety.


A key insight or teaching point from our work with clients, illustrated in infographic form.

A battle of (growing) titans in healthcare  

We’ve updated our annual comparison of the relative size of the largest healthcare companies, with the graphic below comparing 2022 revenues to 2019 for a sense of how different companies and industry sectors weathered the pandemic. The annual revenues of the five largest health systems in 2022 pale in comparison to the industry’s true giants—and the gap only widened over the pandemic. The largest health systems averaged just 5 percent annual growth since 2019, while the largest companies in each other healthcare subsector have grown revenues by over 10 percent annually. Unsurprisingly, the pandemic drove Pfizer’s revenue to a record $100B in 2022—over half of that was driven by the company’s COVID vaccine and antiviral treatment, Paxlovid. Amazon’s 2022 revenue was nearly double its pre-COVID level. While very little of that growth came from healthcare, it enabled the company to fund investments like its all-cash $3.9B purchase of One Medical, which closed this week. Even the nation’s largest health systems cannot compete with that kind of firepower, and looking beyond revenue paints an even more difficult picture. According to Kaufman Hallalthough the median hospital has grown its revenue by 15 percent, it has seen expenses climb 20 percent, and lost 26 percent of margin since 2019.


A recommendation from our weekly diet of music, movies, TV, and other good stuff.

Land of Sleeper by Pigs Pigs Pigs Pigs Pigs Pigs Pigs—Fourth and best (so far) album from this Newcastle stoner/doom metal outfit (also known as Pigs x7) that knows better than to take themselves too seriously. Forty minutes of heavy metal music in the best tradition of Black Sabbath, with a cheeky twist of psychedelia. Kerrrrang!!!


What we learned this week from our work in the real world.

A resurgent interest in outsourcing

Unsurprisingly, given the mounting economic pressures many health systems are facing, we’re beginning to hear more discussions among executives about outsourcing non-core services as a way of containing costs. Whether it’s contracting with an outside company for things like laundry and dietary services, or more extensive outsourcing to vendors for revenue cycle and IT services (such as the much-ballyhooed partnerships with Optum that have grabbed headlines recently), we’ve seen a resurgence of interest in finding ways to offload key areas of non-clinical operations. In some ways it makes sense: we’ll stick to our knitting, and let someone else handle areas that they’re probably better at. But a recent comment from one system CEO captured our concern about the outsourcing trend. “For us, outsourcing is like Lucy and the football…we’ve been here before. What we’ve learned is the complexity of managing the vendor relationship often outweighs any potential cost savings. And in the end, we never seem to garner enough savings to make it worth the effort.” As to the broader “partnerships” around revenue cycle, IT, and population health, she added, “We’d never give up control of those aspects of the business—they’re too important. Plus, I’m not sure how you’d ever unwind it once you’d let your own staff become employed by a vendor. We’ll be keeping a close eye on these outsourcing deals as the year goes on, and we’d love to hear your experience with the strategy as well.


All the headlines in healthcare policy, business, and more, in ten minutes or less every weekday morning.

Last Monday, JC spoke with David Jarrard, Executive Chairman of strategic healthcare communications consulting firm Jarrard Inc., about the results of his company’s latest national consumer survey on public perception of hospitals and healthcare in the United States.

And coming up this Monday, JC will talk with attorney Stuart Vogelsmeier, EVP and Chair of the Healthcare and Business practices at St. Louis-based law firm Lashly & Baer, about how the Federal Trade Commission’s proposed ban on noncompete agreements could impact the healthcare industry.

[Subscribe on Apple, Spotify, Google, or wherever fine podcasts are available.]

That’s all for this week. We promise that actual human beings wrote this entire edition, without the assistance of artificial intelligence (~beep boop~ as far as you know). Let us hear from you—we’d love to get your feedback, and we’d be so grateful if you’d share the Weekly Gist with friends and colleagues, and encourage them to subscribe, and to listen to our daily podcast.

Of course, please do let us know if we can be of assistance in your work. You’re making healthcare better—we want to help!

Best regards,

Chas Roades
Co-President and Managing Director

Lisa Bielamowicz, MD
Co-President and Managing Director