Lyle Berkowitz, MD, FACP, FHIMSS

The road to healthcare reform is paved with unintended consequences. What's not to like about price transparency? Patients shop for care, marketplaces arise, and providers compete on cost and quality. But that's not what happened. In reality, hospitals decided to just pay the penalties or publish indecipherable charge masters. Payers realized they could use the information as a negotiation tactic, pitting one group against another. If you're a small to mid-sized practice in a highly consolidated market, good luck competing. Futhermore, patients don't shop for care the way many (often outsiders) assume. Many still rely on brand, word of mouth, or doctor recommendations. Driven by churn and financial quarter-based incentives, buyers overindex on price. Quality and patient experience, equally important parts of the value equation, are secondary concerns. What seller wants to participate in a race-to-the-bottom marketplace where price transparency works against you? Like many things healthcare, the issue and its solutions are complex. Price transparency alone isn't enough when almost everything else is a black box and a willingness to play by the rules is used against you. Ahilan Sivaganesan, MD Sidney Haitoff Mark Cuban https://lnkd.in/enkNgPCK

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UnitedHealth Group (UNH): A Complex Bet on Simplicity in Healthcare With an MBBS, MPH, and MBA, I’ve spent years navigating the healthcare ecosystem—from patient care to systems design, from clinical outcomes to cost-effectiveness. As a value investor, I’m naturally drawn to complexity—and to companies that simplify it with strategic clarity and operational discipline. UnitedHealth Group embodies that rare integration of payer, provider, and platform. Its ability to harness Optum’s analytics with UnitedHealthcare’s insurance scale gives it a unique edge in a sector moving toward predictive, preventive, and value-based care. I’ve initiated a position at $280—not because I believe I’ve found the bottom, but because I believe I’ve found value. Why UNH? Vertically integrated model aligns cost, care, and data across the value chain Strong free cash flow generation and disciplined capital allocation Resilience in managing healthcare complexity at national scale Long-term tailwinds in chronic care, AI in population health, and Medicare Advantage But a caveat: this is not investment advice. UNH could fall further. Near-term uncertainties remain—regulatory scrutiny, Medicare reimbursements, and operational integration risks are real. Yet for the patient investor, complexity creates opportunity. I often enter “too early,” and that’s a feature, not a flaw, of my process. I invest in companies I’d be proud to work for—and learn from. Would love to hear your thoughts: Are integrated healthcare platforms like UNH overhyped, or misunderstood? #valueinvesting #healthcareeconomics #mbbs #mph #mba #unitedhealthgroup #optum #payerproviderintegration #investinginsystems #publichealthfinance #notinvestmentadvice

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It had to be said! 🎯 Epic's stranglehold on healthcare IT has stifled innovation for too long and the writing is on the wall. The consolidation myth needs to die already. We were promised efficiency and lower costs, but what we got was bloated bureaucracies that prioritize profits over patients. The data doesn't lie: smaller, agile providers consistently outperform these healthcare monopolies on both outcomes and patient satisfaction. Time for a major reset in how we think about healthcare delivery.

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Technology Is the Connector — and Pharmacy Leaders Are Using It to Expand Access Connected Care is no longer just a concept—it’s happening now, powered by technology and led by pharmacy teams. Becker's Healthcare recently highlighted how health systems across the U.S. are leveraging digital tools to bring care closer to patients. From virtual prescribing to automated prior authorizations, from centralized dispensing hubs to mobile infusion units—these innovations are breaking traditional barriers in access. Here’s how technology is driving impact: - Digital platforms like Intermountain’s On-Demand service allow patients to access contraception, naloxone, and more—without a physical visit. - Telepharmacy models are enabling medication therapy management in rural and underserved communities. - EHR integration is optimizing medication safety and coordination, especially for chronic diseases. - Mobile and same-day delivery solutions are transforming the last mile of care, bringing meds directly to doorsteps. - Data-driven workflows are embedding pharmacists into specialty care to fast-track therapy and reduce wait times. What we’re seeing is more than operational change—it’s the evolution of care delivery. When tech tools are built around patient needs and used by empowered clinical teams, we achieve what Connected Care truly stands for: continuity, personalization, and equity. It’s time we stop thinking of pharmacy as a silo—and start recognizing it as a digital front door to better health. Link to article: https://lnkd.in/e5ZDG_se #ConnectedCare #DigitalHealth #PharmacyTech #Telepharmacy #HealthEquity #HealthcareInnovation #BeckersHealthcare

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5 insights on leading the quantum shift in healthcare from Duke Health CEO Craig T. Albanese, MD, MBA: 1. Innovation starts with purpose 2. From problem to progress: easing documentation burden 3. Innovation from the inside out 4. Smart partnerships, shared values 5. Innovation that serves a mission "Start with empathy. Lead with insight. Measure success not in headlines, but in impact." https://lnkd.in/gqZnubjD

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In the future, every request to see a clinician will first undergo an AI-driven assessment that determines urgency and directs patients to the most appropriate care pathway. Few measures can do more to narrow the widening demand-supply gap in healthcare. Oh... and it can be done today (with the Healthily platform). #AITriage #Healthcare #DigitalHealth #ExplainableAI

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I was invited last week to share my perspectives at the CMS and ASTP/ONC Health Technology Ecosystem RFI listening session, on the panel titled “Unleashing the Digital Health Ecosystem.” After a few days of reflection, I have three key takeaways: ➡️ Investing more in #primarycare will accelerate #interoperability. The foundational problem of the current tech ecosystem is not technological – it’s incentive misalignment. Technology, no matter how sophisticated, won't yield meaningful information exchange unless there’s true market demand for interoperability. The most powerful lever CMS controls is payment, so if we want a thriving health data ecosystem, CMS must pay primary care more for what truly matters: keeping people healthy, managing complexity, connecting the dots across the system. ➡️ Outcomes, not checklists, matter most. CMS should reframe certification to prioritize end-to-end utility for clinicians and shift certification from technical minutiae with requirements that would be market-corrected, to clear, outcome-based mandates that focus on real-world, functional data interoperability. ➡️ AI can change the role of data standards. The debate between FHIR and proprietary APIs is quickly losing relevance. While FHIR remains the "minimum viable" standard and proprietary APIs support more complex use cases, AI is reshaping this conversation fast. Soon, AI will serve as a near-costless translator across standards, creating structured, actionable data out of blobs of text. True interoperability will then focus less on rigid adherence to a single standard and more on simply ensuring the frictionless exchange of rich data, with AI handling the interpretation and structuring. Thank you to Amy Gleason, Arda Kara, Kristen Valdes, Brendan Keeler, and Therasa Bell for this conversation in DC. It is exciting to see the Centers for Medicare & Medicaid Services discussing positive progress on important issues, including data standards, incentives, and interoperability.

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Have you seen the CY 2026 Medicare Physician Fee Schedule Proposed Rule? It’s a step in the right direction for all of us building modern, tech-enabled, patient-centered care models in rehab therapy. And touches on all the topics I have been preaching about for the last few years. Here are a few highlights that stood out: 🖥️ #Telehealth #Supervision: Made Permanent ✅ CMS proposes to permanently allow real-time audio-video supervision for incident-to services. A big win for clinics using virtual mentorship, multi-location staffing, and hybrid care delivery. Example: A PT supervising a PTA across town via Zoom during patient education - now allowed. This boosts efficiency and enables broader access to skilled mentorship. 📱 #Remote #Therapeutic #Monitoring (RTM): New Codes Proposed ✅ New codes allow billing for <16 days of monitoring in a 30-day period - finally recognizing the clinical value of short, frequent remote interactions. ✅ Reimbursement will be based on OPPS data (real-world hospital outpatient claims) instead of RUC surveys (self-reported clinician surveys) - a potentially more stable and transparent approach. Example: A therapist tracks a TKA patient’s pain scores and home exercise adherence 3x/week. Even if it’s fewer than 16 days, they can still bill - recognizing the value of real-world engagement and behavior tracking. 📊 #MIPS: Aligning with Whole-Person Rehab & Prevention ✅ A new Musculoskeletal MVP track has been proposed - aligning rehab reporting with functional outcomes, not just checkboxes. ❗️However: The quality threshold is rising (75 points), and reporting complexity is increasing which will be especially challenging for clinics without strong infrastructure and add to administrative burden. Example: A clinic using PROMs and digital outcome dashboards can leverage these MVPs to show the real value of rehab in preventing downstream costs and improving quality of life. These changes are encouraging - but also a clear signal: 👉 The bar is rising. 👉 Administrative demands are growing. 👉 Technology is no longer a “nice to have” - it’s essential. Questions to talk over with your teams: 🔹 Are we positioning ourselves as prevention experts and primary care providers? 🔹Are we set up to deliver hybrid care at scale? 🔹 Can our EMR handle RTM and MIPS without adding to burnout? 🔹 Are we measuring what actually matters for long-term outcomes? Below is a great article written by Cody Lee, PT, DPT with actionable insights on how you should be thinking of this new policy: https://lnkd.in/exPhi8CN? 💬 Let me know if you have any other takeaways from the new ruling and if you agree this is a push in the right direction for quality of care. #ClinicalInnovation #HybridCare #RTM #MIPS #ValueBasedCare #Outcomes #PatientCenteredCare Prompt Health PT Wired, Inc. #Primarycare

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🚨 *TRUMP ADMIN AI ACTION PLAN & IMPACTS ON HEALTHTECH* Just dropped: Trump Admin's America’s AI Action Plan. It’s a full-blown AI doctrine for dominance, with deep ramifications across healthcare, life sciences, and digital health startups. Here’s the TL;DR (with a touch of 🔥): 👉 AI Regulatory Sandboxes in Healthcare: FDA-backed testbeds where startups and researchers can deploy AI tools in real clinical settings. Translation? Faster time-to-evidence, fewer regulatory chokepoints. 👉 National AI Health Standards: NIST will lead domain-specific benchmarks to measure productivity gains from AI in sectors like healthcare. Expect a new baseline for "medically meaningful" AI. 👉 Compute Credits for Startups + Researchers: Think of it as AWS spot markets for compute, but federally backed. Game changer for scrappy AI-first companies building LLMs or multimodal models for health. 👉 Data Liberated: The plan mandates that federally funded research datasets (like from NIH, NSF) be shared for AI training. This opens the floodgates for life science foundation models. 💡 Tailwinds for healthtech builders: • Wave of federal money will go to AI job retraining and CTE. That’s your next customer base: upskilled care workers + AI-native frontline teams. • Government is incentivizing open-weight models, which could shift the competitive balance from cloud giants toward nimble startups with vertical focus. *Bottom line: If you’re in AI x healthcare and not building like it’s the post-Apollo era of American industrial R&D, you’re behind. https://lnkd.in/eh2RtGrJ

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Very timely and wise comments by Nathan H. “$10 billion in digital health investments made healthcare WORSE last year” AI is transforming healthcare, but in 90% they are making problems words. 35 years of experience trumps bad idea with money. Healthcare is the one industry in America that throwing money or technology makes it worse. We have lived it. Silicon Valey loves new ideas and young founders who can’t relate or have practical experience. They fail horribly in time. Great examples below. We can look at example of Amazon, JPM, Berkshire with Haven Health. I was in SFO when they made the announcement January 30. 1988. It was child’s play to predict it would fail.

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How will HIMSS26 advance the conversation around AI in Healthcare? Hear insightful forecasts from 3 expert healthcare journalists: Mike Miliard (Healthcare IT News), Jessica Hagen (Mobi Health News), and Susan Morse (Healthcare Finance News) as they reflect on emerging digital and AI healthcare trends. Discussion themes: 🦋 The evolution of artificial intelligence in healthcare: They discussed the shift from the early AI type toward the more mature and practical applications emerging today. Specifically, they noted that AI vendors and health systems are focusing on more clearly defined use cases that offer measurable ROIs and better workflow integrations. 🦋 The expansion of AI applications: They discussed areas such as revenue cycle management, risk prediction,  readmission prevention, early disease detection, and precision medicine.  Emphasizing the continued importance of “human-in-the-loop”, they discussed the continued need for oversight as reliability gaps (e.g., hallucinations) persist. 🦋 The pending shifts in broader policy and regulatory decisions: They highlighted key topics such as interoperability requirements, data-sharing incentives, federal and state policy shifts, CMS access models, and drug pricing initiatives. Underscoring the inevitability of ongoing regulatory change, they noted that providers, payers, and technology companies must remain agile. Join me as I provide opening remarks for the HIMSS Smart Health Transformation Forum (March 9, 2026, Las Vegas). I am honored to moderate this "forward-thinking event dedicated to advancing healthcare through smarter, connected, and hyper-personalized solutions." Check out the impressive agenda for the SMART Transformation pre-conference track: https://lnkd.in/g-B-z-wT View the full video discussion below: https://lnkd.in/gN_fUPta #HIMSS26 #AIinHealthcare #ArtificialIntelligenceInHealthcare

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Synergistic Benefits of #Predictive and #Generative AI- The combination of Predictive and #Generative AI creates a synergistic effect, enhancing both clinical decision-making and operational workflows. For instance, predictive models can identify patients needing immediate attention, while generative AI can streamline the necessary documentation and communication processes. Successful integration of #AI technologies requires a strategic approach, encompassing data governance, staff training, and ethical considerations. Responsible implementation include but not limited to, maintaining patient privacy and addressing potential biases in #AI algorithms. The attached article emphasizes that the thoughtful pairing of predictive and generative AI holds significant promise for transforming healthcare delivery.

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✨ Cincinnati just took a major step forward in shaping the future of healthcare. The Cincinnati AI in Healthcare Summit brought together 105 leaders across health systems, startups, academia, industry, and policy — and the energy in the room was extraordinary. We heard inspiring perspectives on how AI will transform care delivery, empower clinicians, and accelerate innovation — and we tackled the real-world questions that matter most: 🧠 How will AI reshape the future of medicine and improve patient care? 🛡️ What guardrails and governance systems do we need to ensure safe, responsible deployment? ⚖️ How do we build AI that advances — not threatens — health equity? 💰 How will AI streamline the financial engine and strengthen the sustainability of healthcare organizations? 🌐 How do we activate the incredible AI, research, and clinical assets already in our region to support innovators and founders? The takeaway was clear — AI is not a replacement for human intelligence in healthcare; it is an amplifier. Done right, it will support our clinicians, strengthen our systems, and create more equitable and accessible care for all. Thank you to our incredible speakers, moderators, and partners — and to everyone who contributed ideas, energy, and vision. And a special thanks to The Health Collaborative for investing in this inaugural event and to 1819 Innovation Hub for hosting us. The momentum is real, and this community is just getting started. Here’s to building an AI-enabled, human-centered healthcare future — right here in Cincinnati. #CincyAICatalyst #HealthCollaborative #CincyAIHealthcare #HealthcareAI #CincinnatiInnovation #ResponsibleAI #HealthEquity #CincyAIforHumans

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