What we're reading: April 2026 edition
- Eric Fontana
- 6 days ago
- 12 min read
This week we zoom around the virtual halls of Union Healthcare Insight to find out what our researchers are thumbing through and reacting to as they filter signals on where healthcare is heading.
But first, don't forget to register for our upcoming Board Briefing, "Key industry players: What's happening with health tech." We'll take a close look at the health tech landscape—the only sector in the healthcare industry that seems to be thriving amid difficult macro conditions—including an in-depth analysis of the health tech landscape, key trends, and significant headwinds and tailwinds in 2026.
Register at the link here or click the image below.
What we're reading this week
Now let's get into what we're reading this week at Union.
Amanda Berra, EVP, Head of Education and Custom Research
Why I think this article was worthy of highlighting:
It’s a rubber-meets-the-road proof point, from an atypical source, about a new and highly consequential change in healthcare cost growth rates. It really brings to life the fact that we are seeing a switch from “unsustainable” (for decades, somehow) to “actually unsustainable”, as in “a whole bunch of cities and towns in Massachusetts, doing nothing different in how they pay for healthcare for their employees and families, are all of a sudden THIS YEAR being driven into the red by medical cost increases.” This is a signal worth sitting up and paying attention to.
Again: “Unsustainable” has been THE dominant pattern of healthcare cost/spend growth rates, not just in the U.S., but everywhere across the globe, for as long as I can remember. So, it takes a big red blinking light to get people’s attention that something has changed enough to make cost growth rates somehow MORE or even ACTUALLY unsustainable—and that’s what the readers of South Shore (MA) News have got in this article.
We at Union have been doing our part to draw attention to these trends. It’s a fundamental piece of our current State of Healthcare, in which we explain how national insurers’ core economics are being destabilized by rising MLRs, driven primarily by higher-than-forecasted utilization of clinical services (lots more thoughts on that). Employer groups are also forecasting medical cost growth trends a couple of percentage points higher from the post-ACA norm. Post OBBBA, without subsidies for ACA premiums, those premiums are going sharply up. We write and present a ton about all the moving pieces here so, if you’d like a keynote along these lines, explore our research membership.
But it’s always attention-grabbing when healthcare policy news comes not from that type of source—not us or KFF or MedPAC or Pacific Business Group on Health—but instead from a hyper-local media source. Here we have a reporter who might otherwise be writing about crime rates or infrastructure proposals breaking the story that real cities and towns in Massachusetts, all of which are a short(ish) drive from where I reside, are in deep trouble on healthcare costs right now. The data points are stark. The consequences are impressively real: “Because municipalities cannot easily raise taxes to absorb these health care shocks, they are being forced to gut municipal services, leave vacant positions unfilled, lay off teachers and librarians, or push for controversial property tax overrides.”
Anyway, it’s worth reading for all the above reasons. AND ALSO, because it’s a very well-written, well-researched, impressively complete and constructive summary of the factors at play and potential levers towns can turn to. Local media for the win!!!!
What I'm watching for next:
At the city/town level, I expect we will see new ways of organizing and paying for benefits. Same as is happening among large, self-insured employers. For example, while not mentioned in this particular article, I would think they are going to start thinking along the lines of ICHRAS. At the national/international level, well, that’s a longer conversation for another time....
Eric Fontana SVP research
Article: CEO of America’s largest public hospital system says he’s ready to replace radiologists with AI
Why I think this article was worthy of highlighting:
Here we go again with the latest iteration of the "AI will replace radiologists" saga. Ten years after Geoffrey Hinton’s prediction that medical schools should just stop training radiologists (and one year after a (paraphrasing) “Whoopsie I might’ve got that wrong” retraction) we now have a major health system CEO making similar assertions in a public forum. What’s perhaps more interesting than the prognostication itself are the potential motivations underpinning such a sentiment being expressed. Consider this for a moment: Public hospitals everywhere—including in New York—are presumably looking at the books in a post OBBBA-world that has seen Medicaid negatively impacted due to mechanics of federal matching. This might not be the "AI replaces clinicians" headline it's initially made out to be. Instead, we're possibly observing a quasi-AI-washed shot across the bow at physicians (and possibly nursing unions more broadly) that “you are replaceable." The broad-ranging attention given to this statement by clinicians, including many public responses from practicing radiologists, indicates they’re challenging the fallacy of the argument at face value, which has the perverse effect of validating the narrative, rather than calling it out for what it might be: a subtle negotiation ploy being played out in the open. Such responses from the clinical community also completely miss an important signal for how health system leadership may get creative in their future attempts to manufacture opportunities as they claw at potential opportunities for significant cost relief.
If we entertain the narrative at face value for a moment, it’s worth noting that the American College of Radiology reports that imaging demand is outpacing professional supply. Hardly the hallmark of an AI takeover. Further, the consensus remains among actual experts (evidenced here, here, here, and here among numerous potential other exhibits) that not only is AI unable to supplant the cross-disciplinary skills of radiologists, but early innovation may have made workflows increasingly complex in some cases. The short of it: From where we stand today, suggestions of an AI-radiology takeover are much further from being real than some would have you believe.
What I’m watching for next:
Near-term it's a good bet we'll see more examples where cost-challenged entities start speculating openly about replacement as negotiation gamesmanship. What I'm also curious about, when these instances arise, is why nobody seems to call out a health system leader's willingness to boil down key organizational roles to a singular oversimplified “thing”—in this case, radiologists reading an image. This begs such questions as: “Do our leaders really understand what our key people do?” and “What is the motivation behind saying these things, at this time?”
The likely signals on “AI will replace x profession” probably won't be found in lay-media headlines. The clinical world is in many ways still coming to grips with how Gen-AI performs across the full, messy breadth of what clinicians like radiologists actually do: incidental findings, clinical correlation, cross-specialty consultation, and ambiguous presentations. Now, if FDA clearances start expanding meaningfully into those domains, or if coding, billing and reimbursement start being restructured in ways that disadvantage human reading studies—those are signals worth paying attention to. And not to mention rigorous, peer-reviewed, real-world performance data that assesses outcomes. Absent that: “Fuhgeddaboudit”. At least for now.
Jordan Peterson, Research Consultant
Why I think this article was worthy of highlighting:
We at Union have been talking about the limits of vertical consolidation for a while now. The national insurers are facing escalating structural pressures—and we see those challenges clearly reflected in their financial performances. Long story short, the argument for vertical consolidation used to be that it created efficiency. But now we’re increasingly seeing critics call out the structure for contributing to higher costs, weaker transparency, and more regulatory risk.
What I find more interesting about the scrutiny on vertical consolidation (and the article calls this out): this is one of the few bipartisan areas of agreement in healthcare. We see both sides of the aisle proposing political and regulatory crackdowns, especially so for PBM practices. It seems that the broader affordability crisis and the fact that “Big Insurance” is increasingly framed as the villain in that story makes it politically easier for both parties to train their fire on insurers.
What I'm watching for next:
Moving forward, I’ll certainly be watching to see if the growing public and regulatory scrutiny turns into any concrete action. The answer is probably a “no” (at least not to the extent that the national insurers are truly broken up), given the complexity of achieving that aim. That said, we could start to see some smaller steps toward this aim (like the recent Arkansas law that prohibits PBMs from owning pharmacies—which is currently blocked by a federal judge). At the same time, I’ll also be watching to see how insurers respond to the growing backlash/scrutiny of their vertical consolidation and how they try to defend vertical integration as a way to manage costs and improve care coordination.
Marina Renton, Research Consultant
Why I think this article was worthy of highlighting:
Maybe it’s because I live in the Bay Area, the epicenter of the tech bro “biohacking” referenced in the headline, but I’m not entirely surprised to find that a (somewhat) accessible version of the concept—the diet, supplement, and self-monitoring elements—is edging toward the mainstream. It fits with the cultural moment, as the author points out: The influence of direct-to-consumer health (an emerging area of research for Union) enabling individuals to order glucose monitors or at-home diagnostic services, and the MAHA proponents touting lifestyle modification to address chronic illness and expressing skepticism for the medical establishment. Plus, healthcare costs are high and rising, and it’s not always easy to get in to see a doctor when health worries strike, so it stands to reason that certain individuals find a sense of empowerment in collecting data about their own bodies. That said, it seems also to speak to an underlying health anxiety and skepticism about mainstream medicine.
What I'm watching for next:
What are the implications of this cultural moment for the healthcare industry as a whole? Are these “biohacking” approaches truly “complementary medicine,” or are they being used as substitutes for consultation with physicians (or therapists, for “longevity” could really be a cover for existential dread)? What will this do to providers’ patient mix? I could see it going multiple ways—one being patients presenting at the doctor’s office more frequently and with more data (that they may or may not have already accurately interpreted), and another one where this DIY ethos breeds more mistrust. Plus, I expect there will be stories emerging about supplementation getting out of hand—bad interactions between products being one possibility, and another being finding that some products on the market are just snake oil being peddled by charlatans. At that point, does the government step in? Does trust in mainstream medicine shift again?
Brandon Aylward, Research Consultant
Why I think this article was worthy of highlighting:
The MedCity News article on hospital margins stands out because it captures a critical inflection point in healthcare: the slow, uneven financial recovery of hospitals after years of pandemic-driven disruption. What makes it particularly worth highlighting is how it goes beyond headline margin improvements to unpack the underlying volatility: labor costs, payer mix shifts, and persistent operational inefficiencies that continue to pressure systems. It reinforces that “recovery” is not uniform and, in many cases, still fragile. For innovators, operators, and investors alike, this is a reminder that financial performance in healthcare is increasingly tied to adaptability, whether through workforce redesign, digital transformation, or new care delivery models.
What I'm watching for next:
Looking ahead, I’m watching how hospitals translate these incremental margin gains into more sustainable strategies. Will systems double down on cost containment, or pivot more aggressively toward revenue diversification and "value-based care?" I’m also paying close attention to how technology, particularly AI and automation, moves from pilot to scale as a lever for both efficiency and clinical impact. Finally, the role of payers and policy changes will be critical: reimbursement dynamics and regulatory shifts could either stabilize or further strain margins. The next phase isn’t just about recovery, it’s about whether health systems can fundamentally reshape their operating models for long-term resilience.
Steve Rowe, Managing Director of Research
Why I think this article was worthy of highlighting:
The focus of the article highlights the growth a MEDVi, a DTC online retailer selling compounded GLP-1s. Though healthcare isn’t the focus of the article: The article was celebrating the founder to build a >$1B company entirely using AI (along with the help of his brother and a few contractors). The broader healthcare reaction on various social media platforms was swift: Friend of Union, Brendan Keeler (who Union recently interviewed) wrote a comprehensive take-down, while various healthcare insiders and VCs also piled-on for a few reasons.
First, it illustrates the inherent tension in the “pharm to table” trend and how quickly a lack of oversight can lead to fraud. On one hand, increased access is often good. Telemedicine companies (Ro, Hims, etc.) can make it more convenient to connect to a doctor and secure a prescription, while avoiding embarrassment that comes with a face-to-face meeting.
Yet clearly without sufficient oversight, and when demand so far outstrips supply, it’s too easy for the excesses of the MEDVi case to emerge: aggressive affiliate marketing, fraudulent marketing claims about compounded alternatives to FDA approved drugs, and online sign-ups that seem to all but guarantee the legally required physician prescription is a rubber stamp.
Second, it represents what could be coming in healthcare as the barriers to hyper-personalized care fall. You’ve already seen this trend with companies like Midi that cater to a particular demographic at a particular moment in their life. I expect we’ll see much more of this. As Marina wrote above, we’ve seen a wave of companies targeting “biohacking” men and a couple years ago we saw this for ADHD medication.
Third, it raises the possibility of an increasingly fragmented care journey for many patients. Rather than having a single PCP with a complete picture of a patients’ health (and a tempering nature that avoids prescribing aggressively), patients may have multiple medications from different pharmacy services, different apps to manage various chronic conditions, etc.
And yet, for all of these concerns, there is clearly a market for these services. And that speaks to the fourth notable trend the MEDVi discussion brings up: how traditional medicine, with increasing physician and nurse shortages, isn’t adapting to meet consumers’ demand—opening up a lane for new companies to fill it.
What I'm watching for next:
Lots of pieces to this: First, how aggressively the FDA under this administration scrutinizes this wave of DTC compounding pharmacies. Second, how will traditional healthcare players establish a “safe” route that meets consumer demand? Both Lily and Novo have launched DTC platforms that avoid the worst excesses of MEDVi; will we similarly see more traditional healthcare players open specialty clinics catering to the needs of health optimizers? Finally, I have an eye on data portability and how patients will assemble a comprehensive view of their care even as they turn to different platforms for services.
Chris Loumeau, Research Consultant
Why I think this article was worthy of highlighting:
This is one of those pieces that subtly, but importantly, reframes what a true clinical “breakthrough” actually looks like. CAR-T therapy has mostly been framed as a complex, high-cost cancer therapy. What’s interesting here is the shift in how people are starting to think about it. Instead of managing chronic disease indefinitely with drugs and RPM, what emerges is the possibility of a one-time clinical intervention that materially changes the trajectory of the disease. The initial data is admittedly small, but it’s notable that patients with severe autoimmune conditions who haven’t responded to other clinical interventions are going into sustained remission after a single CAR-T treatment.
There's also a broader pattern here that shows up in a lot of places right now. Some of the most important shifts in healthcare aren’t coming from entirely new technologies per se, but from existing ones applied differently. CAR-T has been on Union’s radar in that context, as part of the next wave of clinical therapies that could fundamentally reshape how we think about chronic disease management, and this is a tangible example of that taking shape. Similar dynamics are showing up elsewhere, playing out across AI deployment, advanced clinical diagnostics, and precision medicine. Of course, early days, but interesting to watch.
At the same time, there are some constraints. Costs remain high, limiting access, especially in the U.S. where most use is tied to clinical trials. And researchers don’t fully understand the long-term durability of outcomes. But if even a subset of autoimmune diseases becomes “resettable,” that has profound implications for national pharma spend, care delivery, and how we define chronic disease more broadly in this country.
What I'm watching for next:
Whether CAR-T remains a last-line option (due to cost/access barriers) or starts moving earlier into treatment pathways. That will come down to a few practical questions: whether it works consistently, the durability of the response, cost, and efficacy across a broader range of diseases.
There’s also a business model question underneath this. A one-time therapy (even at low adoption) starts to disrupt models built around ongoing treatment. On the provider side, this concentrates care in a handful of specialized centers that have the right clinical capabilities and operational infrastructure for delivery, reinforcing a more centralized delivery model at a time when much of the system is trying to push care out into lower-cost, better distributed care settings.
Big picture: The biggest question about CAR-T is whether or not this is more of an edge-case clinical breakthrough or an early sign of a fundamentally different way to treating chronic diseases altogether.