David Chou

2026 Is an Execution Year for Government Programs & Innovation Healthcare providers enter 2026 with something we haven’t had in a while: short‑term stability. Labor pressures have eased. Volumes have recovered. Margins while remaining thin have stopped eroding. But for organizations with significant Medicaid and Medicare Advantage exposure, this moment isn’t about relief. It’s about using predictability to fundamentally redesign how care is delivered and financed. Reimbursement headwinds are clearly forming: Medicaid cuts will phase in over the coming years Enhanced ACA subsidies are expiring Rate adequacy and risk adjustment scrutiny continue to intensify This gives leaders a narrow window to act. For government programs, innovation can’t be optional or incremental. The systems best positioned for 2027 and beyond are already: ✅ Reassessing program and market participation ✅ Investing in scalable, value‑based operating models ✅ Using data, analytics, and partnerships to manage risk not just volume ✅ Designing workforce and care models that work at public‑payer margins In an environment where 3–5% operating margins define success; execution matters more than ambition. Boards and regulators alike are asking tougher questions: Are we structurally prepared for lower reimbursement or waiting for policy relief? Innovation in 2026 isn’t about pilots. It’s about institutionalizing what works in Medicaid and Medicare Advantage today, before the financial pressure deepens. The runway is short but it’s real. How health systems respond at this moment in time will shape their options and access for communities for years to come.

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⚠️⚠️⚠️AI tools falling a little flat in enterprise healthcare tech content? That’s a strategy issue…and one you don’t need a high-commitment agency relationship to address. Focus on the fundamentals to get more out of that AI investment. This blog will get you started “Students who focused on the basics were winning matches and seeing progress. Those who couldn't shake the distraction of trending moves fell behind, lost competitions (because they weren’t able to apply high-context techniques against fundamentally-competent opponents), or dropped out altogether out of frustration.”

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We've been talking about the "digital front door" in healthcare for years. Years. In practice, that mostly meant call deflection, keeping the patient away from the humans but, patients deserve better than that. I'm proud to share what we've been building at Hippocratic AI: AI Front Door. It replaces the tangle of call centers, IVRs, and portal logins with a single AI agent that can schedule appointments, answer billing questions, explain lab results, arrange transportation, and follow up after visits, across phone, text, and chat. The key difference? It's omnitopic. A patient can start by scheduling an appointment, then seamlessly ask about lab results, address a billing issue, coordinate a referral, and arrange a ride home, all in the same conversation. All clinically safe. No transfers. No "let me connect you to another department." No starting over. And every interaction builds on the last. Full awareness of patient history and past conversations. That's the line we drew. Not deflection. Help. #HealthcareAI #PatientAccess #HippocraticAI #Transformation #AI

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In a recent CVS Health article, we share how we're using technology to better understand and serve patients and members across CVS Health, including Health Care Delivery. Tools like generative agent simulations help teams model real-world behaviors, test ideas earlier, and design care experiences with greater confidence. By pressure-testing journeys, messaging, and service design before they reach patients and members, we can bring the consumer’s voice into decisions sooner. This reinforces a simple but important idea: when we design around how people live, behave, and seek care, we’re better positioned to deliver experiences that are more intuitive, equitable, and impactful. Learn more in the article and white paper: https://lnkd.in/epZW-pEr

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Great spotlight on how Florida Medical Center is transforming efficiency and provider satisfaction by partnering with ScribeEMR for virtual scribing. Real results. More facetime with patients, less time on charts. Proud to be part of a company helping practices do what they do best, deliver exceptional care. Read the full story: https://lnkd.in/eTmGsPJh

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Exciting news from CMS and AMA on advancing interoperability in healthcare! The new CMS Interoperability Framework is a critical step toward a more connected, patient-centered system—one where patients control their data, clinicians receive complete information at the point of care, and digital tools support real-time, personalized decisions. This matters because true interoperability isn’t just about data exchange—it’s about enabling better care, fewer delays, and stronger outcomes. Key to success: • Privacy and security must be prioritized • Innovation must be evidence-based • Payment models must support outcomes and experience • Technology should strengthen, not replace, human connection Looking forward to supporting this vision and a future where digital health works for all. #Interoperability #DigitalHealth #PatientCenteredCare #CMS #AMA #ValueBasedCare #HealthTech #FutureOfHealthcare

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🎯 Selecting a telehealth vendor shouldn't be an IT procurement project — it's a clinical operations transformation. With \$50B flowing into rural health through CMS's Rural Health Transformation Program, healthcare organizations have a once-in-a-generation opportunity to anchor telehealth into their care delivery systems. But here's the problem: most organizations skip the most critical phase — defining what they actually need. This #TelehealthTuesday article breaks down the systematic approach to telehealth vendor selection: ✅ Build a multidisciplinary team (not just IT)  ✅ Document current challenges AND future vision  ✅ Define your specific telehealth services  ✅ Design the user experience before selecting technology Because the right vendor isn't the one with the most features — it's the one that fits your organization's needs, workflows, and vision. 📖 Start with defining your needs and requirements: https://lnkd.in/gAHidvmc Are you working on telehealth vendor selection under your state’s #RuralHealthTransformation program? I'd love to learn about your approach — comment below! #TelehealthTuesday #RHTP #RuralHealth #Telehealth #HealthcareStrategy

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On Wednesday, over 60 health tech companies signed a pledge orchestrated by the Centers for Medicare and Medicaid Services to make health data-sharing easier and to build apps for patients to access and act on their health data. CMS Administrator Mehmet Oz said in a press release that the agreement signals a coming “paradigm shift in the U.S. healthcare system.” Some of the biggest names in health care and technology agreed to the pledge, including Amazon, Apple, Google, OpenAI, Epic, Microsoft, CVS Health, and UnitedHealth Group

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The AI competition is intensifying in healthcare among EHR vendors, with Epic and Cerner enhancing their systems to include advanced voice and document intelligence features. Can Oracle's AI roadmap strengthen its position against Epic?

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See how AI agents in healthcare are automating prior auth, clinical documentation, RCM & more. Real use cases with measurable results in 2026.

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Louisiana stands at a critical juncture in healthcare transformation, with Artificial Intelligence poised to drive equitable, safe, and scalable advancements in health delivery. Rigorous analysis of federal and state policy shifts, such as CMS's Medicaid redesign efforts and Louisiana's ongoing Digital Infrastructure Improvement Initiative, reveals both opportunities and challenges unique to our region. First, Louisiana’s Medicaid population disproportionately benefits from AI-enhanced predictive analytics that can tailor care management pathways—supporting preventive interventions aligned with health equity goals. Data from the Louisiana Department of Health confirms a 15% improvement in early chronic disease detection when AI tools are integrated into community clinics serving underserved populations. Second, workforce readiness remains a pivotal factor. Recent state workforce development reports highlight that augmenting clinician AI literacy and embedding AI competencies in nursing and allied health training programs are crucial for sustainable adoption, ensuring technology complements frontline care rather than complicates it. Given these insights, how might Louisiana’s health systems, technology innovators, and policymakers collaboratively establish a governance model that balances AI-driven innovation with ethical oversight—advancing public trust without stifling progress? We invite thought leaders across health, policy, and technology sectors to engage in this dialogue—building a unified framework that anchors AI in Louisiana’s distinctive socio-economic and regulatory landscape. #HealthcareLeadership #HealthcareAI #DigitalHealth #LouisianaHealth #GovTech

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SNP Care Management Update: CMS Targets HRA Measures in the MA Star Ratings Program CMS’s FY2026 Proposed Rule signals a major shift in how Special Needs Plans (SNPs) are measured in Star Ratings, specifically, the removal of the SNP Care Management measure that tracks Health Risk Assessments (HRAs). What SNP Care Management Requires Today 1. Health Risk Assessments (HRAs): SNPs must conduct comprehensive HRAs for each enrollee to identify chronic conditions, functional limitations, social needs, and risk factors. 2. Individualized Care Plans: Based on HRAs, plans create personalized care plans to guide interventions, preventive services, and follow-up. 3. Monitoring & Documentation: Plans track and update care plans regularly and submit documentation to CMS to show compliance. Why CMS Is Proposing Removal According to the proposed rule: 1. Process vs. Outcomes: The measure is administrative, tracking completion of tasks rather than actual health improvements. 2. Limited Differentiation: Most plans perform well on this measure, so it doesn’t meaningfully distinguish high- vs. low-performing plans. 3. Strategic Shift: CMS wants Star Ratings to focus on clinical outcomes and patient experience, rather than operational compliance. What CMS Is Not Doing Here is the key clarification: · Although CMS proposes to remove the SNP Care Management (HRA completion) measure from Star Ratings, this change does not eliminate the underlying requirement for SNPs to complete HRAs. · The proposal affects quality measurement, not the regulatory responsibility. SNPs are still required to perform HRAs, develop care plans, and deliver care management. HRAs continue to be central to compliance, audits, and resident care. Bottom line: HRAs remain important for care delivery, but the spotlight in Star Ratings is shifting from checking boxes to improving resident outcomes. If MA plans and organizations feel that this is an important MA star rating, they must respond to the CY2027 Policy and Technical Changes to Medicare Advantage by January 26, 2026. #MedicareAdvantage #SNP #ISNP #NursingHomes #StarRatings #HRAs #PopulationHealth #ResidentCare #LongTermCare #ClinicalQuality

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Good point Mike, the gap isn’t vision, it’s execution discipline. Healthcare doesn’t need more AI pilots. It needs governed operating models where AI is embedded into high-volume workflows, measured, and scaled. AI becomes strategic the moment it moves cash, reduces friction, and holds up under audit. #HealthcareAI #RevenueCycle #CycleIQHealth

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This week, the White House announced the Health Tech Ecosystem initiative and the CMS Interoperability and Patient Access Framework. These are significant steps towards liberating our clinical data from its traditional silos. To build a national health tech ecosystem, we will need to achieve widespread adoption of a FHIR-based API infrastructure. Additionally, we must focus on acquiring, optimizing, and delivering high-quality data that is secure, suitable for its intended use, and ready for artificial intelligence applications. This effort should include comprehensive, longitudinal patient histories, standardized data that meets national standards, and the contextualization and harmonization of both structured and unstructured data. #HealthTech #Interoperability #FHIR #CMS #ClinicalData #ValueBasedCare #DigitalHealth #Availity #AIinHealthcare #DataOptimization #HealthcareInnovation https://lnkd.in/eFnGSP8f

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The new CMS TEAM model is a speed test for value-based care. With shorter episodes, rolling baselines and real downside risk, success depends on how quickly hospitals can turn information into intelligent action. Hospitals that act now can transform data into foresight, assess risk, coordinate care and improve outcomes in real-time. Those who wait will pay the price of guesswork. Discover why insight, not data, will define TEAM’s top performers. https://bit.ly/3LYoCK4 #WeAreBambooHealth Healthcare IT Today

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It’s great to hear firsthand how MMC Members are using Contract Genie to simplify their workflows and gain insights about their contracts quickly and easily.

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Billions of healthcare dollars are spent every year not on patients, but on fighting over who controls the patients’ money. Health insurers often claim financial strain. The numbers tell a very different story. In 2023 and 2024, the largest U.S. health insurers reported tens of billions of dollars in profits. UnitedHealth Group alone generated more than $20 billion in net income. Those profits are not driven by better care. They are driven by control. Through vertical integration, insurers now own physician practices, pharmacy benefit managers, specialty pharmacies, data companies, and post-acute services. The same organization can decide what care is approved, who delivers it, which drugs are covered, and how everyone gets paid. That is no longer insurance. It is the practice of medicine by a financial entity. The hidden cost is staggering. Billions of dollars are consumed by billing, prior authorizations, utilization review, denial management, and endless appeals. Hospitals and practices build entire infrastructures just to argue for payment after care is delivered. That money comes from only two places. Patients directly, or the government, which means taxpayers. Either way, it is still patient money. None of this spending improves outcomes. It exists solely to battle over control of healthcare dollars. At the same time, physicians are increasingly employed by the very systems that deny care. Their allegiance shifts from the patient in front of them to the organization that signs their paycheck. Clinical judgment is replaced by protocols. Advocacy is replaced by compliance. This is the core problem. The doctor-patient relationship is being dismantled and replaced with a service-provider model. Patients are no longer the center of the system. They are the revenue stream moving through it. We are told denials are about appropriate care. We are told consolidation improves efficiency. Yet we have created one of the most administratively expensive healthcare systems in the world, while trust, autonomy, and relationships erode. The real question is no longer whether this model generates profits. It is whether a system designed this way can still claim that patients come first. I’m interested in hearing from clinicians, policy leaders, and economists. When does integration cross the line into domination? #ucsdhealth #mhcm #healthmatters UC San Diego Health

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Thank you Sarah Moors from Digital Health Insights for taking a deeper dive into the patient privacy ramifications of CMS's new "Make Health Tech Great Again" initiative. Healthcare organizations must still protect data privacy. The HIPAA rules are still in place. I love these specific take aways from your article. 😳Many consumer health apps fall outside HIPAA protections, meaning sensitive patient data could end up sold to advertisers or used in ways patients never intended.  😳This is a test of responsibility. Access to richer patient data could enable more personalized AI tools and remote monitoring, but companies that cut corners on privacy could face regulatory backlash and consumer rejection.  😳Can the administration balance innovation with protection for vulnerable populations? Read Sarah's entire article here. #patientprivacy #dataprivacy #interoperability #makehealthtechgreatagain Stephanie Kindlick Anthony Murray Hassan F. Abdallah JD, CHC, FACHDM Jillian Schmitt Moliehi Weitnauer Angela Rose, MHA, RHIA, CHPS, FAHIMA https://lnkd.in/gvhrRzat

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