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Gary Jessee is senior vice president, national Medicaid consulting practice, at Sellers Dorsey.

Medicaid, which offers coverage to nearly 80 million Americans, has evolved far beyond basic care toward whole-person care. The program could use more entrepreneurs.

Why Medicaid is the most innovative payer in healthcare | Viewpoint 

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

 - After the ViVE conference in the Music City, it’s looking like AI won’t be a one-hit wonder for the healthcare industry.

The conversations about AI dominated the digital health conference, which probably isn’t a surprise. But it still can’t be ignored.

Here are five quick takeaways, and they’re not all about AI.

(Here’s a video roundup of ViVE. The story continues below.)

Thousands came to ViVE in Nashville for discussions on AI, cybersecurity and more

ViVE: Highlights from the digital health conference

It’s not just that people are talking about AI in healthcare, but why they’re so enthusiastic.

Hospital and healthcare executives are seeing more evidence that AI-powered technologies are capable of helping their organizations.

Healthcare leaders say they’re especially encouraged about ambient listening tools that record and summarize clinician conversations with patients, saving doctors and nurses time in documentation and reducing stress.

Marty Bonick, president and CEO of Ardent Health, said the system is seeing promising results in using AI documentation technology.

“I do think we are at the point where technology is going to start working for our caregivers and our patients, versus the other way around,” he told Chief Healthcare Executive® in 

, president of the Mayo Clinic Platform, said Mayo is using ambient documentation in Arizona and Florida, so nurses don’t need to touch a keyboard to summarize notes. And AI algorithms at Mayo are showing high degrees of accuracy, he said.

In a conversation on one of the main stages at ViVE, Halamka said, “We really are at the point in 2025, the data is good enough, the technology is getting good enough, the compute is getting available enough, and the use cases are getting clearer. So next year, we talk about what's real.”

One other note: healthcare executives are showing that they’re not just going to buy an AI tool to get the latest gadget or tech. They’re looking at AI tools that solve their problems, but aren’t inclined to try a solution and hope they can find a problem for it.

Doctors seem to be very enthusiastic about using AI documentation tools to reduce the number of hours they spend on documentation, including the dreaded “pajama time,” healthcare leaders and physicians say at ViVE.

However, doctors have some concerns about the increased efficiency AI could provide. Doctors welcome using AI to reduce their documentation demands and have more time to spend with their patients (and with their families). But doctors are worried that the added efficiency means they’ll be asked to see more patients, and spend less time with patients.

chief clinical innovation officer of Medrina, said he hears from AI vendors telling him that they’re solutions will enable him to see more patients.

“I'm like, I don't know if I want to see more patients. I want to provide better care,” Tariq said.

Nurses also say they welcome using AI tools

 and other technology, but they need solutions designed with them in mind.

Jing Wang, dean and professor of the Florida State University College of Nursing, said, “There are a lot of nurses who are very pro-AI.”

But nurses also want to be sure the tools mesh with their workflows, and protect patient safety. Hospital leaders need to consult nurses before deploying tools, and talk with nurses who have concerns about new solutions.

ViVE featured a series of discussions on cybersecurity, and it’s clear that remains a pressing concern among hospital and healthcare leaders.

John Riggi, national advisor for cybersecurity and risk with the American Hospital Association, 

outlined the growing threats of cyberattacks

, noting 259 million people in the U.S. were affected by breaches of health data.

Riggi stressed that hospitals and health systems must work to deter attacks and be prepared for disruptions when breaches happen. He also stressed that many hospitals are being affected by breaches of their business partners and vendors. “The bad guys have figured out often our third parties and business associates are less secure than we are,” Riggi said.

There seems to be growing frustration among hospitals about being blamed for breaches of their partners.

He also said that most healthcare cybeattacks are launched from ransomware groups outside the U.S., and the government needs to do more to disable those organizations.

Anika Gardenhire, chief digital and information officer of Ardent Health, outlined 

her system’s recovery from a cyberattack

. She stressed the importance of preparing for attacks. As she said, “It’s really not a matter of if. It’s just a matter of when.”

John Couris, president and CEO of Tampa General Hospital, 

 and urged hospitals and health systems to prepare for weather emergencies. His system regularly confronts risks of hurricanes, but he said all health systems need to prepare for more intense storms, wildfires, and flooding.

 with Chief Healthcare Executive®, Couris said the key for health systems is, “You need to be constantly planning.

“This can't be sort of like, well, we focus on it four months out of the year, because that's when we're most vulnerable for natural disasters,” he said. “Wherever you are in the country, you need to be constantly doing it.”

Couris acknowledged those efforts can be costly.

““This stuff's expensive,” he said. “But you know what's even more expensive? Not doing something.”

Leaders at ViVE acknowledged that too many patients aren’t getting the care they need. Too many can’t afford care, or they don’t have easy access to doctors.

the conflicts between hospitals and insurers over claim denials

, several healthcare leaders noted that it’s the patients that are suffering when they can’t get approval for treatments, or their care plans are delayed.

““Who falls through the gap? It’s the patient,” said Rick Gundling, senior vice president of healthcare financial practice at the Healthcare Financial Management Association.

Dr. Soumi Saha, senior vice president of government affairs at Premier, Inc., said that many patients don’t have the energy to keep fighting for care.

“We know that patients that have to go through this process, many of them abandon care,” Saha said.

AI consumed conversations as expected, but conversations are getting more nuanced. The annual event also revealed more anxiety about pressing problems.



Topic

Five from ViVE: Takeaways from the digital health conference

 – Hospitals and physicians have grown increasingly frustrated about insurers denying claims, saying it costs them time and money while hurting patient care.

At the ViVE digital health conference, a panel of healthcare leaders expressed optimism that technology and artificial intelligence can offer some relief, but they also said that the solution won’t be solved simply by technology.

Dr. Soumi Saha, senior vice president of government affairs at Premier, Inc., says AI isn’t a panacea.

“The process itself is broken,” Saha said. “So you can't just simply put tech or AI on top of this broken process and hope that miraculously it solves all the issues that we're facing day on day out.”

“And so you have to go back to step one, in many ways,” she said. “Fix the process first, and then let's think about, as we're fixing that process, what is the role of technology and AI as part of a new process?”

ViVE brings healthcare voices to Nashville

Premier examined claims from 2022 and found that 15% of all claims are initially denied, including some that had pre-approval from insurers. Providers and hospitals are spending $20 billion annually into fighting administrative claims, Saha said. On average, hospitals are spending about $44 per claim to adjudicate back and forth.

Saha said Premier is going to release new data on the costs of denials within the next few weeks, but she did offer a preview of the upcoming findings.

“Here’s the spoiler alert: nothing has changed,” Saha said.

Premier found similar rates of denials of claims. But she said one key change is the rising costs of fighting those claims, which is now almost $10 per claim higher “because of just simply how much labor costs in health care right now.”

Ash Shehata, KPMG’s U.S. sector lead for healthcare, moderated the discussion. "I think the pressure seems to be mounting a little bit on change," Shehata said.

Tensions between hospitals and insurers are growing, said Rick Gundling, senior vice president of healthcare financial practice at the Healthcare Financial Management Association. His group has surveyed insurance executives and hospital leaders about the increased conflict.

“From our standpoint, it's really become much more contentious between the two,” Gundling said.

Both payers and hospital systems have been using more AI tools to automate the process of filing claims, Gundling said. Healthcare leaders have said that using those tools should streamline claims and help ensure that all the requirements are met, thus improving the process and removing friction. But it hasn’t exactly worked out that way.

As more claims are denied, Gundling said, “It’s turned providers, hospitals, into collection agencies.”

Azlan Tariq, chief clinical innovation officer of Medrina, said AI has the potential to streamline the claims process. But he also pointed out that electronic health records were billed as a tool that would reduce headaches on clinicians, and many doctors cite the time they spend on documentation as a leading cause of burnout.

“We're spending more time in front of the computer now and less time in front of the patient,” Tariq said.

Providers and hospitals aren’t the only ones suffering, Gundling added. 

Most doctors say delays and denials of claims hurt patient care

, according to surveys by the American Medical Association.

“Who falls through the gap? It’s the patient. It’s the consumer,” Gundling said.

Some of the most problematic areas of denials involve providers aiming to move patients into post-acute care, which is a common source of tension between hospitals and payers.

‘It's really challenging, and it's a significant opportunity there to make things faster and better,” Tariq said.

For patients who have encountered denials, especially after an insurer gave pre-approval, the delays can be maddening.

“That is devastating to a patient who thought that they went through the process correctly in order to ensure that their bill was going to be something that they could tackle at the end of the day," Saha said. "So, the patient implications are huge."

"Also, just in general, we know that patients that have to go through this process, many of them abandon care, because they just don't have the time or effort to get on the phone," she added. "They don't understand the process. And so, you see a lot of care not being provided."

If patients are struggling or stressed with denials or delays in treatment, hospitals can pay a price as well, Saha said.

“There is a link between denials and patient satisfaction,” Saha said.

“And when patients consistently say that they're not satisfied with their care because of denials, that then impacts a hospital’s or health system’s grading, which then impacts their ability to borrow capital,” she added. “So there's a lot of financial implications here that occur because of the patient perspective, that it's the provider that is inhibiting their care, not really understanding the why or how.”

Gundling suggests more cooperation from providers and payers could make a difference, such as developing score cards of drugs both can agree on for treatment. He also suggested building certain standards of patient and member satisfaction within contracts between payers and providers.

“I find that payers and providers, they want to work together on the patient’s side,” Gundling said. “I think we just sometimes have to shake ourselves out of it to build trust and to move forward with a better experience.”

Healthcare leaders talked about the frustration hospitals and doctors are facing when insurers reject claims, the impact on patients, and the need for a better process. 

Broken claims process won’t be fixed by AI alone | ViVE 2025

By many measures, this year’s flu season is emerging as the worst in years.

Hospitals report packed emergency departments with patients with the flu, and federal data indicate the most severe flu season in 15 years.

The Centers for Disease Control & Prevention

 reported that 31% of flu tests were positive last week. Nearly 8% of patients visiting doctors offices and outpatient facilities were for respiratory illnesses, and flu-like symptoms, the highest level since 2009.

The CDC estimates that there have been at least 310,000 hospitalizations due to the flu, with 13,000 deaths. More than 48,000 Americans were admitted to hospitals over the past week. 

 for patients with influenza are “very high,” the CDC says.

At least 24 million Americans have become ill with the flu, the CDC reports. Nationwide, 

 have “high” or “very high” levels of flu activity, according to the CDC.

Ericka Hayes, MD, senior medical director of infection prevention at Children's Hospital of Philadelphia, says positive tests for the flu are the highest in the last 10 years of flu seasons. She says 57% of those tested last week were positive.

Some of those being admitted to the hospital include patients who were vaccinated.

“The influenza vaccine match was not the best,” Hayes tells Chief Healthcare Executive®. “I will also say the uptake of influenza vaccine in the first place this year was lower than in years past as well. So we are seeing patients who get sick enough to be hospitalized despite having an influenza vaccination, which is unusual.”

Still, Hayes says the vaccines offer some protection against developing more severe illness, and she says there’s value in getting vaccinated, even later in the flu season.

“I still think there is protection offered again, for having potentially less severe disease with vaccination. So I think that's important to remember,” Hayes says.

Ohio reported a 90% increase in flu cases over the last week, the Ohio Hospital Association reports.

Cincinnati Children’s says the number of positive flu cases more than doubled since last week, rising from 402 to 896. Doctors at Cincinnati Children’s warn of long waits in emergency departments for issues that aren’t life threatening, and are urging parents to take children to primary care doctors if their kids have the flu or flu-like symptoms.

Children’s Hospital Los Angeles reported the positive rate for children tested for influenza is 17.5%, compared to 2.6% the same time last year.

Flu cases are also higher than usual at Seattle Children’s.

“Seattle Children’s is currently seeing high levels of influenza and levels are higher than that seen last year,” a spokesperson for the pediatric system said in an email.

Also in Washington state, MultiCare’s hospitals in the Puget Sound are at or over capacity, 

In Michigan, Corewell Health is seeing high volume due to patients with the flu, COVID-19, and respiratory syncytial virus (RSV), the 

 reports. "That's wreaking a lot of havoc," Dr. Charles Gibson, chief medical officer of Corewell Health West, told the Free Press.

The flu season is peaking later than usual, but Hayes says it may be some time before there’s a drop in numbers.

“There are some years where the flu is really tapering down by February,” she says. “I've got to say, this year, we're not, we're not coming down. I can't say that we're headed downward yet. And again, I suspect, given how robustly it's come up, it's not like it's going to drop quickly. So I suspect we may still have, you know, several weeks of significant influenza activity.”

In addition to getting the vaccine for those who haven’t already, Hayes stresses the importance of thorough hand washing as a prevention step. She also suggests considering masks when in closed quarters, including public transportation, as another step.

Some areas are also seeing an uptick in patients with norovirus, which is highly contagious. Hayes issued a warning for those with norovirus to stay home, given how easily it spreads.

She also issued a special warning for healthcare workers who may have norovirus to be especially mindful to stay home and not bring it into their facilities.

“Healthcare workers with GI symptoms, it's absolutely critical that they stay home, because it can rip through units so quickly, affecting both staff and patients,” Hayes says.

Federal and state health officials report more positive tests and hospitalizations than in previous years, and some facilities are packed with patients.

Hospitals wrestling with worst flu season in years

President Donald Trump is returning to the White House, and that is likely to have a big impact on hospitals and health systems.

Hospitals are pressing Trump to preserve key funding for Medicare and other important priorities. But perhaps the biggest source of anxiety lies over the Medicaid program, which enables Americans with lower incomes to access healthcare.

Medicaid also provides important funds to hospitals, particularly those with a higher percentage of patients with lower incomes.

Moody's Ratings issued a report last week on trends to watch in 2025, and projected that hospitals should brace for cuts in Medicaid.

“The Trump administration offers the potential for material shifts in healthcare policy that would negatively affect not-for-profit and for-profit hospitals, particularly concerning Medicaid spending and subsidies for the insurance exchange marketplace,” the report stated.

“Hospitals could suffer from significant federal funding cuts and regulatory changes affecting Medicaid and state directed payments (SDP), which are administered by state Medicaid agencies but approved by the federal government,” Moody’s said. “A reduction in Medicaid or SDP funding would disproportionately impact hospitals in states that expanded Medicaid under the Affordable Care Act.”

What hospitals are seeking from Donald Trump and the new Congress

he doesn’t plan to try to abolish the Affordable Care Act

, as he did in his first term. He has said he’d look to improve it, although he hasn’t revealed specifics.

Noting that Trump is looking for places to reduce spending to finance tax cuts, it’s possible that Trump will look at cuts to Medicaid and the Affordable Care Act, Larry Levitt, executive vice president for health policy at KFF, wrote in a 

“Trump has said that Social Security and Medicare cuts are off the table, and defense reductions are unlikely as well,” Levitt wrote. “That means almost half of federal spending would be protected from cuts, leaving Medicaid, which is the next largest source of federal spending, and the ACA as prime targets for spending cuts. The math is inescapable.”

While Trump may not get rid of the Affordable Care Act, enhanced subsidies put in place by President Biden are slated to expire at the end of 2025. Republicans, who control both the House and Senate, could let that additional aid fade away.

Affordable Care Act enrollment rose to more than 21 million people in 2024, a record, and nearly double the 11 million people in 2020, 

But enrollment would almost certainly drop significantly without the additional aid from subsidies put in place by Biden in 2021, Levitt projected.

Nonprofit hospitals in particular could take a hit if the subsidies vanish, or are significantly diminished, Moody’s projected.

“Changes reducing or eliminating subsidies that help purchase insurance on the exchanges would likely lead to a rise in the uninsured or self-pay patients,” the Moody’s report said. “The increase would disproportionately impact not-for-profit hospitals that serve a large number of low-income and vulnerable populations.”

Lisa Kidder Hrobsky, senior vice president of federal relations, advocacy and political affairs for the American Hospital Association, says hospitals will push Congress to preserve the subsidies.

“We really are concerned and want to make certain that these subsidies to get insurance on the marketplaces continue,” Kidder Hrobsky says.

worried about the prospect of cuts for Medicaid

. Georges C. Benjamin, MD, executive director of the American Public Health Association, told Chief Healthcare Executive® in November that he’s concerned about Medicaid cuts.

“We know that there's been at least some verbalization on the campaign about reducing support for Medicaid, because their perspective of the Medicaid program is very different than my perspective of the Medicaid program, which is a comprehensive insurance program for people,” Benjamin said. “They see it as a program that needs to be limited in this cost. It actually saves taxpayers money.”

If hospitals see more patients without any healthcare coverage, then that’s going to affect their bottom line as they provide more uncompensated care.

“A higher uninsured rate stands to increase uncompensated care, curbing margins and straining resources, which could limit hospital investments in community health programs and facilities,” Moody’s said in its report.

Trump has also said he plans to expand the use of tariffs on some imported goods, which could affect hospitals and health systems. President Biden also imposed tariffs on certain medical supplies from China.

If the Trump administration imposes tariffs, it could add to cost pressures for hospitals, Moody’s Ratings said in its report.

“Increased tariffs on imported medical supplies, pharmaceuticals and equipment could lead to higher procurement costs. Hospitals, which operate on tight budgets, may struggle to absorb these additional expenses,” the Moody’s report stated.

Kevin Holloran, senior director of Fitch Ratings and head of the U.S. healthcare sector, said the imposition of more tariffs will add to financial pressures to hospitals. The tariffs by themselves aren’t damaging but they add to the other headwinds hospitals are facing.

“This will, at least over the near term, most likely result in higher prices for equipment and supplies for healthcare providers,” Holloran told Chief Healthcare Executive®.

Hospitals poised for better year in 2025, but system remains fragile

The second Trump administration promises to bring changes that will affect America’s hospitals, with concerns about Medicaid funding, ACA subsidies, and potential higher costs with tariffs. 

How Donald Trump’s return affects hospitals: Medicaid, the Affordable Care Act and tariffs

With the resurgence of powerful labor unions, 2024 saw two significant strikes: the Amazon workers' and the dockworkers' strikes. Both worried retailers that supply chains could experience delays, and prices could rise in 2025.

For retailers, this meant stocking up on the latest electronics so the shelves wouldn't be depleted during the vital holiday shopping season. That's preparation in the same way that if your restaurant specialized in Kobe beef, you would have a backup generator for refrigeration when the power went out. Or if you and your family were taking a long car trip, you'd want to ensure your AAA membership is still valid.

Organizations know supply chains can’t run without IT security software protecting mission-critical data. Hence, a priority is ensuring that procedures to mitigate risks are in place to protect critical operations and resources from attacks that could cause significant interruptions and the loss of vital information. That's also preparation.

Now, apply all this preparation thinking to the healthcare system. The words "critical" and "vital" truly live up to their meaning during a strike, when healthcare operations are strained and patient care is impacted.

All this wise preparedness—retailers stocking up on goods, restaurant generators, car service for road breakdowns, security software—is the same foresighted wisdom that healthcare providers must apply to their strategic thinking for a work stoppage.

The staffing agency becomes the operational safety net if a healthcare organization faces imminent threats to its function due to strikes or increased demand. In these cases, the staffing agency is not just a backup but more of a critical player whose purpose is to maintain operational readiness. 

In a crisis, when healthcare organizations face shortages or even stoppages, staffing agencies play an important role. 

Gary Jessee

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