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In the News
What happened in healthcare recently—and what we think about it.
- UnitedHealth’s difficulties show no sign of letup. UnitedHealth Group’s troubled times persist as the healthcare conglomerate’s stock continued its sharp decline this week. The company reported lower-than-expected profits in its second quarter earnings report and lowered its full-year outlook, blaming surging care costs and a spike in utilization. Compounding the troubles, UnitedHealth confirmed it is the subject of civil and criminal investigations by the Department of Justice into its Medicare Advantage billing practices, an inquiry it had not previously disclosed. Adding to the turbulence, the company announced plans to exit multiple Medicare Advantage (MA) markets as it looks to rationalize its footprint.
- The Gist: It seems like just yesterday that UnitedHealth Group was the envy of U.S. healthcare. Those days appear to be over. UnitedHealth has been the model of a vertically integrated giant: as the largest health insurer by membership, its sheer scale in the U.S. healthcare marketplace is unmatched. But growing public scrutiny, poor earnings and a difficult regulatory environment present challenges UnitedHealth has not previously faced. Heightened DOJ scrutiny of MA billing could trigger audits, compliance reviews and even clawbacks that might ripple through provider contracts; while persistent underestimation of utilization and care costs suggests payers may tighten fees or shift risk to providers. Meanwhile, premium increases in MA lines signal a tougher reimbursement climate in 2026. Leadership and operational upheaval at a major payer can slow decision-making and contract renegotiations, so disruption could be on the horizon for health systems.
- More docs say goodbye to traditional Medicare. Physicians continue to exit traditional Medicare, a trend that accelerated during the pandemic and has not slowed since, a new study revealed. Published last week in JAMA Health Forum, the study finds that burdensome documentation, stagnant reimbursement, growing demands for administrative communication and a shift toward larger, consolidated practice settings are key drivers. Primary care doctors are leading the way, followed by hospital-based and surgical specialists. The trend has raised alarm about long-term access and continuity of care for Medicare beneficiaries.
- The Gist: This shift is more than a workforce issue. It’s a signal that the traditional Medicare model may be losing its toehold on a critical segment of the physician workforce. As clinicians move into larger systems, opt out entirely or shift toward models like direct primary care, the safety net for seniors begins to fray. The exodus occurs just as the silver tsunami hits, with roughly 1 in 5 U.S. residents slated to be of retirement age by 2030. Fewer independent doctors may mean less geographic access and fewer choices for patients, especially in rural and other underserved areas. These exits point to the possibility of a looming crisis in access as they portend a potential early warning of structural instability in the Medicare physician pipeline.
- Report: Hospitals still fail to capture some harm events. Hospitals failed to capture more than half of patient harm events during inpatient stays, even when those events were clearly documented in medical records, a new report found. The report, published Tuesday by the Department of Health and Human Services’ Office of Inspector General (OIG), found that existing surveillance systems, including internal reporting processes, missed many adverse events ranging from minor complications to serious harm. The report defines captured events as those that hospital staff identified and reported using incident reporting systems, medical review process or another system to monitor harm events and quality of care; and defines harm as any undesirable clinical outcome—not caused by underlying disease—that was the result of medical care or that occurred in a healthcare setting, including the failure to provide needed care. For many of the uncaptured events, staff did not make a recording because they either did not consider the event to be harm or because it wasn’t standard practice at the hospital to capture them. OIG concluded that these gaps limit hospitals’ ability to learn from mistakes and improve patient safety.
- The Gist: This report lands like an echo from 1999, when the Institute of Medicine’s landmark To Err Is Human report estimated that tens of thousands of deaths each year were due to preventable medical error. That report kicked off the modern patient safety movement, but 25 years later, it appears that the field is still undercounting errors. Despite decades of awareness, technology and quality initiatives, hospitals still struggle to reliably detect harm in real time. Underreporting means hospitals can’t fix what they can’t see. For health systems, the findings reinforce the need to revisit how patient safety is operationalized, measured and incentivized. If safety events remain invisible, so will the solutions.
Plus—what we’ve been reading.
- Allergic immunity, raised in a barn. Published in July in The Washington Post, this article describes the science behind why children living in Amish communities in Indiana show some of the lowest allergy rates recorded in the United States. Just 7% tested positive for common allergens compared with more than 45% in non-Amish children living in farm communities and more than 50% of U.S. children raised in non-farm settings. Studies comparing communities of Amish and Hutterites, another U.S. farming community with a similar genetic ancestry and lifestyle, suggest early, daily exposure to farm animals and barn dust can help shape immune responses in infancy. Researchers have traced this “farm effect” to microbial proteins and beneficial bacteria, which appear to dampen inflammation and allergic reactivity and are found in barn environments. Researchers now are trying to isolate these agents and develop scalable interventions (such as probiotics) that might reproduce the effect in urban settings.
- The Gist: Research into microbiomes began in the mid-1800s, yet understanding of the human biome remains incomplete. The hygiene hypothesis originating in the late 1980s foretold advancements in early allergy treatments and immunotherapies. Now, environmental mimicry has emerged as a frontier in allergy prevention, focusing on early microbial exposure as a potential tool in allergy prevention. Translating the farm effect into clinical tools may be a promising solution for rising asthma and allergy rates. If microbial exposures can be standardized and delivered safely, allergy risk profiles could shift. For health systems managing a rise in immune-related conditions, replicating the immune training found in Amish farm life could transform care for allergic diseases. The delivery vehicle might be clinical, but the blueprint appears to be agrarian.
Graphic of the Week
A key insight illustrated in infographic form.
The role of immigrants on hospitals’ staffs
This week’s graphic features data from a KFF analysis of how prevalent immigrants are in the hospital workforce. The data, from the U.S. Census Bureau’s 2023 American Community Survey, show that about 1 in 6 hospital workers overall are immigrants. In some states, fewer than 5% of hospital workers are immigrants; but in several, particularly those with high immigrant populations in general, immigrants comprise a significant proportion of hospital staff. The proportion of immigrants working in U.S. hospitals is highest among physicians and surgeons and building cleaning and maintenance workers. Among all clinical workers, 13% are naturalized citizens, while 4% are noncitizens. According to the KFF analysis, most immigrant hospital workers overall (including clinical and nonclinical workers) are citizens, but about a quarter are noncitizen immigrants. The share of hospital workers who are immigrants has stayed constant since 2018.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
Cost pressures are expected to continue across the healthcare supply chain in 2026, with pharmacy spending expected to rise by 3.84% and non-pharmacy supply costs increasing about 2.3% in the year starting July 1, 2025.
These projections are detailed in Vizient’s Summer Spend Management Outlook, which offers a comprehensive forecast of pricing trends across pharmaceuticals, medical-surgical supplies, capital equipment and services in both acute and ambulatory settings. One key finding: a major driver of pharmacy inflation is the rising cost of specialty and complex medications—particularly GLP-1 therapies and biologics—with ambulatory pharmacy costs outpacing those in acute care.
On Our Podcast
The Gist Healthcare Podcast—all the headlines in healthcare policy, business and more, in 10 minutes or less every other weekday morning.
Last Monday, we heard the conclusion of host J. Carlisle Larsen’s conversation with BayCare Health System’s Chief Nurse Executive Trish Shucoski and Rocky Hauch, an advanced nursing educator for the system, about the successful nurse wellbeing pilot being rolled out to all 16 BayCare hospitals.
This Monday, JC speaks with Coalition for Health AI CEO Brian Anderson, M.D., about his organization’s recent partnership with the Joint Commission to develop best practices and guidance for healthcare systems’ use of artificial intelligence tools in healthcare settings.
To stay up to date, be sure to tune in every Monday, Wednesday and Friday morning. Subscribe on Apple, Spotify, Google or wherever podcasts are available.
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 review past editions. We also have all of our recent Graphics of the Week available here.
Best regards,
The Gist Weekly team at Kaufman Hall
