Dec 1, 2025 Current Resources

Monday Morning Update 12/1/25

November 30, 2025 News 2 Comments

Top News

Best Buy’s CFO says in the company’s Q3 earnings call that it record a $192 million asset impairment charge for exiting Best Buy Health, which it says was caused by pressure in Medicaid and Medicare Advantage.

Best Buy paid $400 million for the Scotland-based hospital-at-home technology vendor Current Health in October 2021. It sold the business back to its co-founder Christopher McGee in June 2025 for an unstated price.

HIStalk Announcements and Requests

Poll respondents mostly blame Done for its Adderall mess, but plenty join me in faulting the clinicians who eagerly stepped into the company’s marionette strings seeking patient cash rather than patient care.

New poll to your right or here, for providers, as requested by a reader: Which research-only firm do you use most often when buying IT products and services?

I spent dozens of weekend hours watching “Cunk on Earth” and related episodes on Netflix and YouTube. I will proclaim it as the second-funniest series I’ve ever seen, trailing only “Arrested Development” for the number of laughs out loud. I can’t get enough, especially of the truly baffled expressions of the high-profile British academics who ponder Philomena Cunk’s interview questions such as, “When the human body dies, what hole do ghosts come out of, north or south?” Or in her narration, “With its cowboys, guns, and steam train rides, America became known as the land of the free, which must have come as a surprise to all the slaves.” Any of her musings that begin with “My mate Paul” are guaranteed gold.

A Reader’s Notes from the EHealth Exchange and Sequoia Project + Carequality Annual Meetings in Nashville

EHealth Exchange

Statistics

25 billion exchange transactions in 2025, supporting 300+ million patients.
Vast majority of transactions are for treatment purposes. A key goal for the future is to encourage more non-treatment exchange.
132.5 million electronic case reporting transactions to APHL AIMS (this number is the total done on behalf of eHealth Exchange, TEFCA, and Carequality, since all of those eCR transactions go through eHealth Exchange)
1.7 billion patient histories retrieved by VA and DoD. 149 million shared back with community providers.
2026 roadmap: heavy focus on FHIR, the CMS Health Tech Ecosystem, and TEFCA

Kim Brandt, CMS Deputy Administrator and COO

Key focus area is rooting out fraud, waste, and abuse.
Medicare spending on skin substitutes went from $256 million in 2019 to $10 billion in 2024. Unclear how much of this was a volume increase in skin substitutes versus an increase in prices.
$17.2 billion in estimated overpayments to Medicare Advantage plans for 2022. Stepping up oversight of risk adjustment process.
$1.9 billion in estimated improper payments for durable medical equipment in fiscal year 2024.
1.8 million Medicare beneficiaries enrolled in hospice care, which is a 12% increase from 2020. Brandt says this is “inconsistent with demographics.”
CMS conducted Enhanced Site Visits for hospices and DME suppliers; 60% of the ESVs Nov 24 – Jul 25 resulted in revocations of Medicare enrollment.

Breakout Session on FHIR

eHealth Exchange has been investing in FHIR infrastructure. Most of their FHIR-based exchange (which is not much) is for public health purposes.
They have a SMART on FHIR app that serves a proxy for other SMART on FHIR apps, basically a container app that allows other apps to run inside of it. Unclear why providers would want to allow this app in their environments, given that the true consumer of the data would be obfuscated.

Panel on Health Data Utilities

Craig Behm, President and CEO of CRISP. Numerous state borders in their coverage area means patients are crossing borders often for healthcare. This makes governance the greater challenge, rather than technology. They have to account for all the variation in state laws around privacy, AI, and more.
Erica Galvez, CEO of Manifest MedEx. Manifest MedEx powers the infrastructure for electronic lab reporting and electronic case reporting for the entire state of California. Not seeing demand for data through TEFCA. They are participating in TEFCA through the eHealth Exchange QHIN and yet they have practically zero TEFCA exchange.
Amy Gleason, Acting DOGE Administrator. She was disappointed to find that rules she helped craft during the first Trump administration won’t come into effect until 2027 (I believe she was alluding to CMS 0057 that introduces API requirements for prior auth and payer-to-payer exchange). Goals of the CMS Health Tech Ecosystem are to promote innovation, build partnerships among participants, experiment, and move faster than government can. Her daughter was diagnosed at age 12 with an autoimmune disease, after 15 months of numerous concerning symptoms, doctor visits, and misdiagnoses. Gleason shared that the final diagnosis was a bit lucky: a provider wanted to do light therapy and the payer said they needed to get a biopsy first, which led to the ultimate diagnosis. “Only time prior authorization ever helped us.” Over the course of her life, her daughter has acquired 47 patient portal accounts. Some are from one-and-done sites of care, like an urgent care, but some are for providers she regularly sees. Gleason is bullish on the potential of AI. She says her daughter was rejected for a clinical trial, so her daughter uploaded her medical records to ChatGPT and asked for any trials she is eligible for. ChatGPT found that she actually was eligible for the original trial. Also cited an instance where her daughter was having side effects and her doctor recommended going to the ED. Daughter consulted ChatGPT and it pointed out she forgot to taper down from steroids, leading her to develop a taper-down plan and avoid an ED visit. A sandbox/proof-of-concept for the proposed national provider directory has been developed and testing is starting. Sounds like initial testing is happening in Oklahoma.

Sequoia Project/Carequality

Amy Gleason and Tom Keane, Assistant Secretary for Technology Policy

Gleason gave the same presentation from the eHealth Exchange meeting, so nothing new.
ASTP priorities: patient control of their data, data liquidity, and deregulation.
ASTP is revisiting all EHR certification criteria, with the goal of eliminating some of them, and is planning to revise/reduce info blocking exceptions.
No specifics provided, however the currently regulatory agenda hints that ASTP will codify several enforcement discretions previously announced.

Dr. Keane said HIPAA (or the interpretation of it) is creating info blocking; they are looking at how to address that.
To increase enforcement of info blocking, ASTP is consulting with states for anti-competitive law enforcement and with the FTC.
A priority for TEFCA is building out support for research-based exchange.
Oracle becomes the 11th designated QHIN under TEFCA

Other Tidbits

Clinical Architecture and NCQA are working on a rubric for assessing the quality of FHIR payloads, with the goal of reducing the burden of Data Aggregator Validation/Primary Source Verification.
CMS is working on a proposed rule (CMS 0062) to streamline prior authorization of drugs. CMS 0057 covered prior auth interoperability for procedures/services only, not drugs.
Sequoia Project and Carequality have worked on aligning and refining definitions and practices to encourage greater transparency. Principals (entities who have signed the framework agreement) must identify all of their authorized delegates in the directory, and delegates must identify the Principal they are requesting data on behalf of.

Reader’s Takeaways

Plenty of confusion on how the CMS Health Tech Ecosystem is different from TEFCA. Those who have pledged to the HTE seem convinced they are complementary; those on the outside are less clear/more skeptical.
There was at times a level of frustration that bubbled up among attendees. Folks seem to recognize that a lot of spaghetti has been thrown at the wall, and some has stuck, but interoperability is still a struggle and outcomes still aren’t good.
HIPAA is becoming a dirty word, viewed as an outdated law that doesn’t fit with the technologies and landscape we have in 2025 and that is misused as an obstacle to data exchange.
Payer-provider exchange through the national networks seems unlikely. Not enough trust between the parties, and providers want to get paid for the data they’re sharing.
Note that the HTE specifies that payers should be able to query for data related to recent claims and quality measures. Also, currently under the TEFCA SOP for Operations, TEFAC participants must respond to queries for data related to HEDIS, quality measures, and care coordination starting 2/16/26. Whether these actually come to fruition is TBD.

Acquisitions, Funding, Business, and Stock

Brown University Health psychiatry fellow Bhargav Patel, MD, MBA sues health AI company Sully.AI and several of its executives for firing him as chief medical officer. His lawsuit says that the company didn’t pay him, classified him as an independent contractor, and fired him for raising concerns about its lack of compliance with HIPAA and FDA requirements. The lawsuit claims:

Plaintiff joined a call with Defendant Nasser and a prospective hospital customer to whom Defendants were attempting to sell an AI radiologist. Patel was told that the product was basically a ChatGPT wrapper, but on the call, Defendant Nasser claimed Defendants were utilizing an FDA approved AI model. When the hospital’s representative responded that their own research failed to discover the existence of an FDA approved AI radiologist model, Defendant Nasser became upset and abruptly ended the call … Patel also expressed the same concerns to co-founder Henry Duong (“Duong”), stating, “I think we should be a little more careful with those things. Don’t want to expose ourselves to legal liability when it comes to compliance/FDA approval type things.”

I’m enjoying the latest HealthVC newsletter from European fund partner Martyn Eeles, who explains to startups how to keep pilot projects from becoming a slow death sentence:

Buyers will commit only to those metrics that they already track, not to ones invented by their vendors.
Harmless-looking discounts become psychological anchors that block a clean path to commercial pricing.
The most valuable part of a pilot is the evidence, which lives in operational data that buyers control unless founders negotiate data rights upfront.
Strong pilots often fail to expand because missing renewal language forces the entire negotiation process to restart.
Founders expect product performance to speak for itself, which it never does. Enterprise relationships are built on cadence, visibility, and trust, not performance alone.

Announcements and Implementations

An auditor’s report finds that New South Wales left key costs out of its $650 million USD Epic-powered Single Digital Patient Record project, such as integration work.

Government and Politics

Three big insurers ask the federal government to limit their liability for potentially catastrophic claims that involve AI.

Digital health executive Tarun Kapoor, MD, MBA says that health tech conferences are failing – and he skips the presentations anyway – because panels can’t touch podcasts that dive deeper while costing zero in time and money. He adds that health system leaders who participate in the panels upend the conference “ladies drink free” business model by dodging vendors to head home at first opportunity.

image[10]

Chillicothe VA Medical Center (OH) introduces EHRnie the Eagle, who accompanies its Change Leadership Team to talk with staff and veterans about the VA’s EHR deployment.

Other

Advocate Health paid its CEO $26 million in 2024, up 49% from the previous year.

image[6]

NEJM AI describes a fast track manuscript review process that combines AI and human reviews to accelerate acceptance within seven days of submission, conditional on making requested revisions.