Health Care Matters | August 22
Leaked MAHA Report
A leaked draft of the Make America Healthy Again (MAHA) Commission's second report reveals a research-focused approach that emphasizes education over regulation, though the document remains preliminary and could undergo changes before its official release. The draft, which the White House has been circulating to industry representatives, calls for investigations into food ingredients, chemical exposures, and FDA regulatory pathway reforms while taking a relatively moderate stance on industry oversight. Key pharmaceutical provisions include increased oversight of direct-to-consumer drug advertising, formation of a mental health prescription working group to evaluate SSRI and stimulant use in children, and plans for vaccine injury investigations alongside a new NIH research program. The draft directs NIH and FDA to strengthen efforts to repurpose existing generic drugs for new chronic disease treatments and NIH and OSTP to develop AI‑driven cancer and chronic disease research to reshape clinical trial design. The report does not focus on CMS but includes possibilities like collaborating with NIH on autism research using real‑world data, updating hospital food standards with CDC, joining a prescribing oversight working group, and working with states on Medicaid and CHIP quality metrics aimed at prevention and reduced overuse of medications. Read more here, here, and here.
Why It Matters
This draft signals the Trump administration's effort to balance RFK Jr.'s health reform agenda with maintaining support from key industry stakeholders, though the preliminary nature of the document means final policies could shift considerably. Two provisions we’re following closely: the report proposes a joint NIH-FDA initiative to streamline how existing drugs are repurposed for new chronic disease treatments, along with an AI-driven research effort on pediatric cancer that could become a model for other conditions. The generic drug repurposing initiative could significantly impact pharmaceutical markets and treatment options by streamlining approval pathways for repurposing existing drugs to treat chronic disease, though implementation details remain unclear. Meanwhile, the AI research component for pediatric cancer and chronic disease management represents a major federal investment in health care technology that could reshape clinical trial design and treatment protocols. While less visible, CMS is positioned to play a role in autism research, prescribing oversight, and Medicaid/CHIP quality metrics, which hints at a shift toward outcomes-based accountability. Together, these provisions highlight priorities that could reshape standards of care.
GoodRx Announces Collaboration with Novo Nordisk to Expand Access to Ozempic and Wegovy
GoodRx and Novo Nordisk announced a new program making Ozempic and Wegovy available to eligible self-paying patients for $499 per month at more than 70,000 pharmacies nationwide. The price applies only to patients with a prescription who are paying out of pocket, typically because their insurance does not cover GLP-1 drugs for weight loss. GoodRx reported that 17 million people searched its platform for GLP-1 savings in the past year, up 22 percent from 2023.Read 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: Community Health Paramedics Transform Health Care
Harris County Emergency Corps (Houston, TX) launched an innovative Community Health Paramedic Program that goes beyond traditional emergency response, featuring specially trained Paramedic-RN teams who provide patient navigation, health education, and mobile integrated health care through home visits and ongoing support. These teams help patients navigate the complex health care system while empowering them with knowledge about their conditions, with one program leader noting that "patients leave the program with more knowledge, greater independence, and a sense of health empowerment." This compassionate approach represents a growing movement where paramedics extend their lifesaving mission beyond emergency calls to build healthier, more resilient communities through preventive care and patient advocacy. Read more here and here.
What We Are Attending
FDA in Flux: Leadership, Policy, and the Road Ahead
Coral Health Advisors Partner Alison Falb will join experts from Milliman for an upcoming webinar on September 4 at 12 pm ET. The conversation will cover congressional oversight and budgetary constraints, policy function mergers, anticipated reforms in drug review and approval, the integration of artificial intelligence, and the future of diversity in clinical trials along with enhanced patient data use. Register here.
Is MA Risk Adjustment Ready for a Revolution?
The Alliance of Community Health Plans is convening an expert panel on August 21 at 12 PM ET to explore the future of Medicare Advantage risk adjustment following the V28 release, featuring industry visionaries and policy experts discussing current program insights, potential reforms, and innovations that could shape a more effective MA system. Register here.
What We Are Reading
CMMI’s New Strategic Direction: Three Priorities For Success
Health Affairs Forefront published an analysis of the Center for Medicare and Medicaid Innovation's new strategy, recommending three key priorities for successful implementation: using behavioral science principles beyond financial incentives to increase patient engagement, creating reimbursement systems that encourage technology adoption, and addressing inefficiencies across the entire Medicare program rather than just within individual payment models. Read here.
The Starfield Signal: A Shared Vision and Roadmap for AI in Primary Care
The American Academy of Family Physicians and Rock Health released "The Starfield Signal," a comprehensive roadmap calling for AI to strengthen primary care's core attributes but only if primary care stakeholders are involved throughout the innovation lifecycle, proper training and support are provided, and key system barriers around payment, infrastructure, and trust are proactively addressed. Read here.
Call for Nominations
HHS and CMS are seeking nominations for a new 15-member Healthcare Advisory Committee that will advise on improving federally administered health care programs, with a focus on chronic disease prevention, reducing regulatory burdens, advancing real-time data systems, improving Medicaid quality, and modernizing Medicare Advantage. Nominations are due 30 days after publication (around September 21, 2025) and should be submitted to HAC@cms.hhs.gov with complete application packages including qualifications, supporting documentation, and references. Read 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.