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Happy Thursday, Hospitalogists! I'm back after absolutely losing my mind in Austin from my week of conference travel as the season picks up and wanted to share some thoughts from the week! If you've replied to me recently, bear with me as I work through my inbox and I hope you find this write-up of Sessions useful! Before I get into it, just a quick note: VBC audits are about to get a lot less forgiving. Join me and two VBC leaders on 9/30 to see where you stand. Was this email forwarded to you? Subscribe Here
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Sussing out the Scene at Sessions
Nashville Healthcare Sessions is always a must-attend for me. I enjoy Nashville, the folks are down to earth and kind and hospitable, and the mix of people in attendance is always top notch given Nashville’s reputation as a formidable healthcare hub. This year did not disappoint and while I was only there for a bit over 24 hours, I did want to share my learnings and catch you guys up to speed on what seems to be top of mind for folks to date late in 2026! If you attended Sessions, I would love to trade notes. Reply with some thoughts! Here’s a quick rundown: Current consensus views voiced during panels
Affordability is the bottleneck and continues to dominate conversations. $5.3T industry growing ~6% a year, Medicare hospital insurance trust fund insolvent in 4 years (noted as the breaking point / catalyst for the Balanced Budget Act of 1997 that included major Medicare cuts), employers eating 9-11% increases into next year, $900B to $1T of Medicaid cuts over a decade, 25-30% of every dollar going to admin. Nobody on any stage suggested new money is coming. As one exec has characterized it to me, “our $100M a year problem is now a $150M problem.” Fewer partners, deeper, with shared downside. A typical system carries ~500 IT vendors and sends exactly 2 decisions to the board. 4-year contracts with CPI-plus escalators got named as an automatic no in today’s healthcare economy, and I found it fascinating that multiple speakers argued partners should carry outcomes accountability the same way providers do. AKA, pony up some of the capital to make the partnership happen, go at risk, or get lost. Data foundation first, AI second. Get the ontology and the process clarity right. Foundational stuff here to future proof your health system. Near-term AI value is administrative. I can’t tell you how many times RCM, scheduling, prior auth, documentation were brought up. Admin is easy. Admin is less risky. Admin, admin, admin. Ambient was the one deployment everybody described as a clean win for physicians and patients both. Adoption takes longer and has more to do with people and processes than tech itself. EMRs took 20+ years, ~60% of Medicare provider payments were still paper checks in 2000, and the original telehealth statute sat untouched from 1997 until Covid struck. Site of care is the proven play, and the incentives still fight it. ~$40B of ASC volume growing ~6% a year with roughly ~$110B more sitting at HOPDs and high-cost inpatient settings that could move, at 40-60% savings. Copay parity and Medicaid funding design blunt most of it. Patients are already inside the LLM. Seniors asking AI assistants what their care should be, and provider orgs optimizing for how they surface in LLMs (GEO) rather than search rank. The new norm. Prep your Zocdoc account. Systemness. Grouping like assets, building repeatable playbooks, designing regionally, killing unwarranted clinical variation. As standard as possible, as different as necessary. Diverging perspectives during sessions
Platform standardization vs. open ecosystem. One argument for enterprise consistency on a single stack, one argument for best-of-breed optionality on a secure open platform, both made within about 90 minutes of each other. My question is…can both win? Pace. I found - and continue to find - the friction between rate of technological change versus healthcare conservatism fascinating.
One thread: there's no period of repose anymore, nothing gets absorbed before the next thing hits. Another thread: nothing in healthcare ever moves fast, so stop bracing for the overnight rewrite. Value-based care. Called a dirty word in a post-V28 down cycle by one panelist and framed as VBC 2.0 (enabled by better data and decision support) by another. Build vs. buy. One operator builds crown-jewel IP and incubates companies around it. Another said pretty bluntly they'll never build AI systems and expect partners to deliver the value and share the savings. Divergence on Pilots. "Skip the pilot, pick the right partner, pilot only to learn the rollout" vs. a partnership built explicitly on pilot, learn, then scale. Who takes the policy hit. Hospitals described as more in the crosshairs than in past cycles, MA possibly first, versus the other viewpoint that when it lands it lands on everybody. Payer data reciprocity. Some plans will negotiate off shared comparative data. Most reportedly won't. Notable Quotes from the Floor
"We have an edifice complex. We love building buildings." "The absolute lowest cost place for a patient population who can least afford to pay for care is the only place they don't use." "You can save $15,000 on a procedure or an imaging test. Why not pay an extra $1,000 to get the physician to go to the right place?" "When we digitized the healthcare system, we digitized all these paper processes." "Why wouldn't we hold vendors accountable for outcomes as well?" "Don't be a line item on the P&L that can be changed out." "I need fewer partners on the technology front and the services front, and go deeper with them." "We've become really good operators at workarounds." "Instead of doing pilots, let's just pick the right partner." "AI accelerates incredible progress, but it can also generate a higher volume of what you don't want." "It's a myth that seniors don't know how to use technology." "Doctors are over. They're gone." — a venture investor quoted in the NYT, read aloud from stage and immediately rejected. "How did you go bankrupt? Gradually, then suddenly." — on how AI showed up in healthcare. "Wall Street is littered with people who thought healthcare was easy." "Who knew healthcare was so easy?" — an investor out of hospitality who took a value-based care company public during COVID. He did not do well. Neither did his shareholders. "I'm still shocked when I ask a healthcare CEO who their member of Congress is and they don't know. That's table stakes." "We still have a guild problem." "If all you do is recite your vanilla value proposition, you've lost sight of the fact that there's another person on the end of that conversation." That's it - let me know what your impressions were from the conference or if you have any other thoughts about consensus/diverging views. I'll also be at HLTH and around the Vizient Connections Summit if you want to connect at either of those events. And, of course, don't forget about my Hospitalogy AI Retreat.
Event: Building the VBC Playbook for 2027 and Beyond2027 brings prospective risk adjustment, V28 fluency, and audit-ready documentation as table stakes for VBC. Join me, Dana Brandenstein, VP of Provider Enablement at Privia Health, and Dana McCalley, VP of Value-Based Care at Navina, to see how top-performing teams are preparing — and where AI actually fits. Thanks to Navina for partnering with us on this one. Register here.
MISCELLANEOUS MADDENINGS
I missed getting this in my Tuesday send because of travel but had to share my recap of the Ohio State game with you guys! I was up in the upper deck for this one and was pretty disappointed to be next to a bunch of Ohio State fans. You gotta be kidding me right? Our lousy alumni selling their tickets to the enemy. Terrible. Anyway, the folks next to my wife and me were very kind and I enjoyed chatting with them about the game. But there were some obnoxious fans in the row behind us who at one point were doing the 'Boomer, Sooner' chant (which was incredibly weird when you also consider Ou lost to Michigan that day). Plus, I just have to mention this. There's always one. Every. Time. I. Go. To. A. Texas. Game. I see someone in the stadium wearing full on Aggy gear. This woman comes sauntering up the bleachers decked out in aggy attire. Why is this fanbase like this? Anyway, during halftime, my wife and I were pissed and questioning why we had gotten childcare, paid for a hotel, and driven all this way to show up when our team hadn't. It started with some major flukes (the interception, the fumble) and simply couldn't find an offensive rhythm from there. We continued to hold this belief until halfway through the 3rd quarter when Sark said "Let's ride" and started going for it on 4th on our half of the field. What you won't get from the papers or the box score, though, is the real thing that turned the tides of the game. The 4th quarter drone show.
If you haven't been to a UT (the real one) game or if your stadium doesn't do a drone show, it is awe inspiring. You look up and see a huge Longhorn staring down at you with the lights completely out, or the UT Tower, or the logo...and it simply changes your perspective in that moment. Austin, Texas is the best place in the world, and, despite my team being down 20 points entering the 4th, the only place I wanted to be in the world at that moment. The rest is history. Hook 'em. (PS my prediction is still holding strong)
Thanks for the read! Let me know what you thought by replying back to this email. — Blake |
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