AHIP CEO: “We are laser-focused on affordability”

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AHIP CEO: "We Are Laser-Focused on Affordability"

The skinny
Affordability is top of mind for executives at AHIP as Americans battle skyrocketing healthcare costs, said President and CEO Mike Tuffin during a press briefing on Tuesday at the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum.

The drivers of cost
Tuffin pointed the finger at hospital consolidation, as well as actions by drug manufacturers like patent thickets (in which there is a dense web of multiple patents around one medication).

AHIP's priorities
Tuffin said AHIP is focused on improving affordability across four zones: more competition, site of service reforms, administrative burden and aligning incentives around outcomes.

Soundbite
"We are laser-focused on affordability at AHIP," Tuffin said. "That's, of course, the issue at every kitchen table. … We see the cost of hospital care, certainly the cost of brand prescription drugs, specialty care, imaging, down the line, just continuing to rise faster than wages, faster than inflation. That's driving up premiums across all markets. Premiums directly reflect the underlying cost of medical care."

— By Marissa Plescia

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Gilead's Second Billion-Dollar Acquisition in a Month

The deal
Gilead Sciences agreed to pay $1.67 billion up front to acquire Ouro Medicines, a startup developing T cell engagers for autoimmune disorders. Depending on the progress of the Ouro drug, Gilead could shell out up to $500 million more in milestone payments. Gilead is also working on a deal to share the financing of the upfront and milestone payments with Galapagos, its longtime partner in immunology and inflammation drug R&D. It's Gilead's second big M&A deal in the past month, following the $7.8 billion acquisition agreement for cancer cell therapy developer Arcellx.

The drug
T cell engagers (TCE), a type of bispecific antibody designed to bind to a target on a T cell and a target on a disease-driving cell, first reached patients as cancer treatments. Ouro is part of a new group of companies bringing this therapeutic modality to autoimmune disorders. The startup's drug, gamgertamig, is currently in early clinical development for two rare immunological disorders, autoimmune hemolytic anemia and immune thrombocytopenia.

Why this matters
Current treatments for many autoimmune disorders include chronically taken drugs that suppress the immune system. This approach introduces complication risks, such as higher susceptibility to infections. A TCE therapy depletes disease driving immune cells. It's hoped that the immune cells that replace them don't attack healthy tissue, resulting in a reset of the immune system. If this benefit proves lasting, a TCE could be a one-time treatment without the need for immunosuppressive therapies.

Soundbite
"We want to pursue new scientific targets that can really evolve the field of inflammatory diseases in a variety of indications," Gilead CEO Daniel O'Day said. "And you're going to see more of that playing out."

—By Frank Vinluan

How A Rural Hospital Is Using AI to Catch Heart Disease Sooner

High-tech stethoscopes
At Wayne General Hospital in rural Mississippi, clinicians say AI-powered stethoscope usage is helping them detect heart problems earlier in patients who often have limited access to specialists.

The hospital's clinicians began using Eko Health's digital stethoscope last year — initially simply for higher quality listening, but they later began using its AI features to detect heart conditions more quickly. The platform combines stethoscope data with real-time electrocardiogram data to flag serious cardiac conditions like atrial fibrillation, low ejection fraction and valvular heart disease. Its AI engine interprets the data in real time, helping identify abnormalities that might be missed during a standard exam.

CPT code? Secured
Wayne General began billing for the AI-enabled exams in December, with early analysis showing average reimbursements of around $120 per exam, said Jason Rogers, an emergency nurse practitioner and vice president of clinical operations at Wayne General Hospital.

CMS established a payment rate for Eko's diagnostic AI system last July. Since Eko's tool has CPT code for reimbursement, Wayne General can offset costs while also expanding access to advanced cardiac detection in their rural community, Rogers stated.

Helping close diagnostic gaps
Wayne General is the sole hospital serving Wayne County, Mississippi. Patients in rural communities typically have to deal with long travel times, delayed care and having little to no access to specialists — so deploying AI-powered diagnostics on-site can help bridge crucial gaps in access, Rogers noted.

Since activating the AI analysis, he said clinicians frequently find previously undiagnosed cardiac issues — mainly abnormal rhythms, murmurs and low ejection fraction. On a per-shift basis, Rogers said he uses the system about 10 times, and it usually flags two to four undiagnosed cases of a heart condition.

— By Katie Adams

Virtual Specialty Care Has Time. Will We Use It Wisely?

Worsening wait times
In high-demand specialties like gastroenterology and urology, patients are already waiting weeks or months for care in many parts of the country. A recent report from the HRSA projects a shortage of over 140,000 physicians by 2038, with 30 out of 35 specialties facing deficits. The numbers are staggering, and they're not distant. In many areas, especially rural communities, the future shortage is already today's reality. As backlogs grow, symptoms worsen, disease progresses, and care becomes harder to deliver.

Virtual care can help
A virtual-first approach changes when and where specialty care begins. When patients move quickly from symptom to evaluation, unnecessary escalation can sometimes be avoided. Earlier intervention lowers downstream costs. Faster access can improve procedural throughput. Most importantly, patients get answers when symptoms begin, not after they worsen.

What's required
With Medicare telehealth coverage extended through 2027, healthcare has a defined window to build thoughtfully. That means integrating virtual pathways into existing workflows rather than creating parallel systems. It means deploying trained APPs with clear supervision structures. It means measuring access, clinical outcomes, and operational performance in tandem.

Payment policy is evolving. Patient expectations are evolving faster. Organizations that take this period to redesign access intentionally may expand capacity without major capital investment. Those that delay may find the competitive landscape shifting around them.

— By MedCity Influencer Sheri Rudberg

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AHIP CEO: “We are laser-focused on affordability”