PwC Highlights AI-Driven Change In Healthcare
A blockbuster report from management consultant PwC predicts that $1 trillion of national healthcare spending could go to digital-first, personalized medical care. PwC also says healthcare is in the process of a monumental shift to artificial-intelligence-driven, consumer-centric healthcare services, which could mean simplified care models emerge that lower costs and increase quality.
PwC notes that healthcare spending is expected to grow to $8.6 trillion by 2035, hitting 20% of gross domestic product. And this means health plan and provider executives must rethink care delivery.
In terms of payers, PwC notes that medical cost trends are nearing double digits and that payers will be expected to deliver far more with far less. It says AI and other technologies can help build capabilities to deliver medical value and actively manage population risk within the plan and with provider partners. It says payers will increasingly serve as data clearinghouses. Automation will be key to reduce costs as well and free up resources for investment into additional emerging technologies.
#ai #healthplans #providers #technology #quality
Trump To Meet With Democrats As Shutdown Looms
President Trump will meet with Senate Minority Leader Chuck Schumer and House Minority Leader Hakeen Jeffries to discuss government funding ahead of a potential shutdown. Democrats are demanding that healthcare cuts get reversed and premium subsidy enhancements extended as the price of Democratic support for a continuing resolution to keep the government open.
In other news, Axios reports that Republican senators are having early discussions about extending Exchange premium subsidy enhancements.
As well, Wakely has a good white paper explaining how to navigate the potential end of the subsidy enhancements.
And healthcare policy group has a briefer on the impact of the budget reconciliation act delaying two Biden era rules related to Medicaid.
Last, Kaiser Health News recounts how many states have already begun reducing Medicaid spending even though most changes will not be in effect until after the midterms.
Additional articles: https://www.axios.com/2025/09/22/republicans-aca-tax-credit-changes and https://www.wakely.com/wp-content/uploads/2025/09/White-Paper-Navigating-the-Post-Subsidy-Cliff_gch-kr-edits_ajs-formatting.pdf and https://www.kff.org/medicaid/the-impact-of-h-r-1-on-two-medicaid-eligibility-rules/ and https://www.fiercehealthcare.com/providers/states-are-cutting-medicaid-provider-payments-long-trump-cuts-hit
(Some articles may require a subscription.)
#healthcare #governmentshutdown #exchanges #ffy2026
https://thehill.com/homenews/5516320-trump-schumer-jeffries-shutdown-talks
Insulin Pilot Had Benefits
The RAND Corporation says that the Centers for Medicare and Medicaid Services’ Part D Senior Savings Model increased insulin use while reducing out-of-pocket costs for Medicare beneficiaries. The program also decreased costs for the federal government. At the same time, Medicare beneficiaries who do not use insulin experienced increased drug insurance costs as plans had to pay for the program.
The model was tested from 2021 to 2023 in both standalone Part D (PDP) plans and Medicare Advantage (MA). Copays were set at no more than $35 a month.
#medicareadvantage #partd #pdp #cms
CVS’ Omnicare Declares Bankruptcy
CVS Health subsidiary Omnicare, a pharmacy services provider, filed for Chapter 11 bankruptcy reorganization. In part, the filing was tied to a recent $949 million whistleblower lawsuit it lost. The judgment was tied to a case by a pharmacist whistleblower who alleged the company submitted more than 3 million fraudulent claims for prescription drugs. The Justice Department joined the case in 2019. CVS is responsible for $164.8 million in penalties, with the previous owner for the balance.
Additional articles: https://www.modernhealthcare.com/insurance/mh-cvs-omnicare-bankruptcy-reorganization/ and https://www.healthcaredive.com/news/omnicare-bankruptcy-cvs-chapter-11/760783/
(Some articles may require a subscription.)
#cvshealth
— Marc S. Ryan
