Health Care Matters | August 15
Physician Pay Declines Despite Rising Workloads
Recent data from Kaufman Hall reveals a troubling trend in American health care: physicians are working harder but earning less per patient they see. While net revenue per full-time provider increased 5% between Q2 2023 and Q2 2025, revenue per unit of work declined 7% over the same period, meaning doctors are seeing more patients to compensate for decreasing per-visit reimbursements. This productivity squeeze is occurring alongside a 13% decline in support staff relative to physician productivity, forcing doctors to take on more administrative burdens while treating higher patient volumes. Read more here, here, and here
Why It Matters
This data suggests that challenges in health care access and workforce stability are being driven as much by economic pressures as by physician shortages. Increasing administrative requirements—such as complex billing, utilization management, and quality reporting—are adding to per-visit costs and straining practice operations. This can create a cycle in which physicians must see more patients in less time to remain financially sustainable, which in turn may contribute to burnout and practice closures. With medical practice bankruptcies at six-year highs and policy changes that could affect insurance coverage for millions, the independent practice model that has long played a key role in community care faces mounting pressures. While the modest proposed Medicare increases in the 2026 Proposed Physician Fee Schedule may provide some relief, they are unlikely to fully address the underlying administrative demands that consume physician time and resources. Without streamlining these processes, the trend toward consolidation into larger health systems is likely to continue, potentially affecting physician autonomy, costs, and the level of personalized care patients receive.
Insurers Brace for Premium Hikes Amid Cost Pressures
Modern Healthcare and Politico reported that major health insurers posted mixed Q2 2025 earnings, with most facing significant pressure from elevated medical costs as enrollees increasingly seek care. UnitedHealth Group, Elevance Health, Centene, and Molina Healthcare were forced to lower their annual financial guidance, while CVS Health's Aetna and Humana raised projections and Cigna maintained its outlook. Insurers are responding by focusing on maintaining profit margins rather than growing market share, deploying AI for claims oversight, exiting unprofitable markets, and seeking substantial premium increases, with exchange market insurers requesting an average 18% price hike for next year, more than double this year's increases. Read more here and here.
Why It Matters
The industry's posture signals a fundamental shift driven by looming policy changes including the expiration of enhanced Obamacare subsidies, new Medicaid work requirements, and stricter Medicare Advantage oversight. This will likely drive significant premium increases across all segments in 2026 as insurers price in these uncertainties and elevated medical costs. The combination of sicker enrollee populations seeking more care and regulatory pressures suggests consumers will face substantial cost increases, while insurers consolidate operations and become more aggressive in claims denials and provider disputes. This defensive positioning by insurers, described as unprecedented in a decade, signals a prolonged period of higher health care costs for consumers and employers alike.
Look for the Helpers: What $2.5 Billion Can Do: Four Innovations Advancing Women’s Health
The Gates Foundation is making a transformative $2.5 billion commitment through 2030 to develop Over 40 innovative health solutions specifically designed for women in underserved communities worldwide. This groundbreaking initiative addresses a critical gap where less than 2% of health research and development funding goes toward women's health conditions beyond cancer, supporting game-changing innovations like self-administered contraceptive patches, AI-enabled portable ultrasounds, and rapid STI testing devices. By centering women's needs in cutting-edge research, the Foundation is working to unlock $1 trillion in global economic gains by 2040 while ensuring women in low- and middle-income countries have access to life-saving health innovations. Read here.
What We Are Attending
Champions in Care Forum: Driving Caregiver Support in Health Care Delivery
Coral Ally Hope Glassberg joins a panel at the 2nd Annual Champions in Care Forum at 1 PM ET on August 28, 2025, discussing policy opportunities to integrate caregivers and caregiver supports into health care delivery models, with a focus on advancing recognition and support for family caregivers in transplant care. Register here.
Virtual Value-Based Payment Summit
A special edition of the Virtual Value-Based Payment Summit will be held September 3-5, 2025, focusing on preparing for CMS and CMMI value-based care strategic initiatives. The keynote features a fireside chat between Accountable for Health CEO Mara McDermott and CMMI Director Abe Sutton discussing the Innovation Center's strategy and newly announced models like WISeR and ASM. To learn more and register, click here.
What We Are Reading
Family Physicians Fill Critical Gaps in Rural Maternity Care
A new study in Annals of Family Medicine reveals that rural counties where family physicians provide maternity care achieve significantly better birth outcomes, including lower rates of preterm birth, low birth weight, and infant mortality, compared to counties that have hospitals with obstetric services but lack trained maternity care clinicians, highlighting the critical role of family physicians in addressing rural maternal health disparities. Read here.
Venus Williams Exposed All That’s Wrong With Health Insurance
Tennis legend Venus Williams' return to professional tennis after 16 months to maintain health insurance coverage after being placed on COBRA highlights the broader systemic problem of America's employer-based health insurance system, where even millionaires face coverage gaps when work and health benefits are intertwined. Read here.
New Resource: New Analytic Briefs on T-MSIS
CMS and Mathematica have released several new analytic briefs on the DQ Atlas providing essential methodological guidance for researchers working with Transformed Medicaid Statistical Information System (T-MSIS) data, including recent publications on identifying beneficiaries with different benefit types, school-based services analysis, and live-birth delivery data methods. Access the briefs here.
NAMD Timeline Highlights Upcoming Medicaid Policy Shifts
The National Association of Medicaid Directors (NAMD) has released a new timeline summarizing key Medicaid provisions in Public Law 119-21(OBBBA). Highlights include caps on state directed payments in managed care beginning July 2025, restrictions on new or expanded provider taxes, the $50 billion Rural Health Transformation Fund with CMS awards due by December 31, 2025, and new work and community engagement requirements for certain Medicaid expansion adults by the end of 2026. Read the full timeline here.
Job Opportunity
Medical Director- Ambulatory Virtual Care
Ascension is hiring a Medical Director for Ambulatory Virtual Care to lead clinical strategy and innovation for telemedicine, eConsults, and AI-driven care delivery programs across their national health system. To learn more and apply, click here.
Pop Health Podcast
PFS 2026 & ASM: What ACOs and Specialists Need to Know
In this episode, Melissa Cohen is joined by Coral Health Advisors’ Alison Falb and Joy Chen to break down key updates for ACOs in the CY 2026 Medicare Physician Fee Schedule Proposed Rule and explore the new mandatory Ambulatory Specialty Model.