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In the News
What happened in healthcare recently—and what we think about it.
- Trump administration continues transparency push. The Centers for Medicare & Medicaid Services (CMS) has begun implementing revised hospital price transparency requirements. In new guidance published last week, CMS updated its price transparency rules, now requiring hospitals to list “actual prices of items and services, not estimates,” following a February executive order to bolster oversight of requirements enacted in 2021. President Trump has said that regulators have given too much leeway to hospitals and insurers. The administration has also asked for public input on how to boost compliance with existing transparency rules. “Transparency in health care is essential, not optional,” CMS Chief of Staff and Deputy Administrator Stephanie Carlton said.
- The Gist: President Trump has made price transparency a priority since his first term in office, when he introduced regulations in 2019 that required hospitals to publicly disclose prices reflecting what patients and insurers “actually pay” for services. More than half of hospitals already meet the technical requirements of the rule, but CMS has issued 10 penalties so far this year for noncompliance, compared with 3 for all of last year. The 2021 rule requires hospitals to post pricing information in a consumer-friendly display for their most common procedures, including standard charges. But it is unclear to what extent this information will be useful or usable for patients, much less a technical burden for health systems. The CMS guidance comes as the departments of Labor, Health and Human Services and the Treasury jointly issued a Request for Information seeking public input on how to improve prescription drug price transparency, demonstrating that the Trump administration remains serious about transparency.
- Hinge Health’s splashy IPO: an indicator for digital health companies? Hinge Health, a digital physical therapy company founded in 2014, debuted last week on the New York Stock Exchange with an initial public offering (IPO) that raised $473.3 million. The company, which had previously raised hundreds of millions of dollars in venture capital funding, opened trading at $32 a share; on its first day, its stock rose 23% to $39.25 per share. Hinge Health offers virtual musculoskeletal care and physical therapy including through an artificial intelligence-backed movement sensor and a wearable device that provides electrical nerve stimulation. It reported a net income of $17.1 million in the first quarter of 2025.
- The Gist: Digital health IPOs hit the brakes after a number of companies went public in 2021. This marks the first major digital health IPO since then. More IPOs could be coming, especially because Hinge Health’s was considered successful. The profitability helps, as investors were unhappy with the performance of other digital health companies in the aftermath of their IPOs. But good news for Hinge Health might be a mixed bag for hospitals and skilled nursing facilities that provide physical therapy as part of their orthopedic service lines. The digital nature of Hinge Health’s product may provide therapy to those who might otherwise have trouble accessing it, but could cut into providers’ lines of business or require them to beef up their own digital offerings.
- CMS to scour Medicare Advantage for fraud. CMS last week unveiled an aggressive new strategy to tackle Medicare Advantage (MA) fraud. The strategy consists of a review of all eligible MA contracts each payment year in newly initiated audits, and will deploy more coders to do so. The agency will also speed audits from payment years 2018 to 2024, with the goal of completing these older reviews by 2026. The agency plans to use “enhanced technology” to quickly review medical records to work through the backlog. An MA industry lobbying group called the move the “right approach” to ensure payment accuracy.
- The Gist: MA has proven popular with seniors, with more than half of Medicare beneficiaries enrolling in the program. MA plans tend to offer more benefits and better care coordination for patients, but they cost the federal government more than traditional Medicare—to the tune of $84 billion in 2025. The prevalence of overpayment or fraud in the industry has not been firmly established. The announcement could spell trouble for the largest carriers because clawbacks could be sizable. Lawmakers from both parties appear eager to chip away at perceived fraud, with the perception that the program is too expensive because it exaggerates the sickness of its members for increased reimbursement. The program will likely be the subject of ongoing scrutiny as Congress and President Trump look for ways to save money without cutting too many benefits.
Plus—what we’ve been reading.
- Lessons learned from the last measles outbreak. Published in May in The Wall Street Journal, this article is the personal account of a Bronx pediatrician who recalls his experience fighting a measles outbreak in the 1990s. The author, working in a community health center at the time, traces the circumstances that led to the outbreak and compares it to the current one. Guidelines from the Centers for Disease Control and Prevention (CDC) led to a sharp decline in measles in the early 1980s, but the disease resurged later in the decade and early 1990s due to a lack of access to adequate healthcare. Congressional action that followed, including creation of the Vaccines for Children Program and the Children’s Health Insurance Program, ultimately led to the CDC’s declaration of the elimination of measles in the United States in 2000. The author explores the critical function of federal support in achieving public health success and expresses concern over the “fraying safety net programs for children,” preventable pediatric deaths and international vaccination program cuts.
- The Gist: The current measles outbreak has ballooned to more than 900 cases in 29 states since February, with 121 hospitalizations and 3 deaths. Considered eliminated 20 years ago, measles has resurged in part due to vaccine hesitancy, misinformation and mixed messaging. The recent defunding of USAID international vaccination programs and potential cuts to Medicaid could further impede vaccine access, repeating the circumstances that led to the 1990s measles. Maintaining access to essential preventive care and safeguarding provider trust remains critical to ensuring a measles vaccination rate of 95%, which is considered the standard to achieve herd immunity given the disease’s high transmissibility.
Graphic of the Week
A key insight illustrated in infographic form.
Troubled times for a major payer
This week’s graphic highlights UnitedHealth Group’s recent financial difficulties—which the large healthcare conglomerate did not fully anticipate. Compared with the first quarter of a year ago, UHG’s operating margins at the start of 2025 are up across the board, led by health data and analytics unit Optum Insight; and, like other major commercial payers, its consolidated revenues also are higher than they were at the start of 2024. Nevertheless, UHG shook financial markets in late April when it reported lower-than-expected first-quarter earnings, plunging its stock price more than 20% in one day. High utilization in its Medicare Advantage business and unforeseen changes in its Optum Health unit hurt the company. The losses caught Wall Street, and the healthcare field, by surprise because UHG is nation’s most vertically integrated payer. The fallout continued this month as CEO Michael Witty abruptly resigned in mid-May, citing “personal reasons,” and suspended its 2025 guidance. It appears that UHG is re-learning an old lesson: it’s difficult, quarter after quarter, to derive profit from healthcare. Payers and pharmacy benefit managers are facing increased federal and public scrutiny; but while UHG failed to project its medical cost headwinds accurately compared with other payers, the company still has significant assets to leverage should the waters remain choppy.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
For many health systems, utilization management (UM) has long been a functional necessity, but rarely a strategic priority. As a result, traditional UM functions today are frequently fragmented, inconsistent and outpaced by competing financial, operational and regulatory demands.
In a new article, Kaufman Hall’s Barbara Vandegrift and Brooke Balster are joined by Andrea Ortman, Vice President, Hospital Services for Geisinger Health System, in discussing the need for elevated UM performance. The article includes a case study of Geisinger’s UM transformation, which led to significant improvements in both observation rates and revenue.
On Our Podcast
The Gist Healthcare Podcast—all the headlines in healthcare policy, business, and more, in ten minutes or less every other weekday morning.
Moderna announced last week that the Department of Health and Human Services cancelled its multimillion-dollar award to develop an avian flu mRNA vaccine. We get that story and more healthcare business and policy news on Monday.
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Thanks for reading! We’ll see you next Friday with a new edition. In the meantime, check out our Gist Weekly archive if you’d like to peruse past editions. We also have all of our recent “Graphics of the Week” available here.
Best regards,
The Gist Weekly team at Kaufman Hall
