Health Care Matters | October 31
Halloween Hot Takes
We know the world is feeling generally full of tricks and very little treats this Halloween, so we're bringing some much-needed levity with hot takes on very important things like candy corn, full-size candy bars, and whether Twizzlers deserve rights. We asked Coral staff and allies to weigh in on fall's most pressing debates. Consider this your brief respite from the policy trenches to a place where the stakes are lower, but the feelings run just as high.
“It is no longer considered best practice to scare the little kids at the door.” – Two Canoes CEO Katherine Schneider
“Candy pumpkins are better than candy corn……mic drop.” -- Milliman Principal and Consulting Actuary Noah Champagne
“Trick-or-treating is fine, but have you ever created a color-coded Excel dashboard to analyze your candy haul’s year-over-year trends? That’s the real treat.” -- Milliman Principal and Healthcare Consultant Pamela Pelizzari
"Carving a pumpkin is a sloppy mess and an invitation for every squirrel in the neighborhood. A nicely painted one is both cleaner and prettier." -- Milliman Principal and Consulting Actuary Cory Gusland
"There’s no point in Halloween candy unless it’s chocolate — everything else is just filler." -- Decipher Health Strategies President Hope Glassberg
"Apple cider donuts are overrated, and yes, I've tried them warm.” -- Coral Co-founder Meg Koepke
“I don't like the Halloween Themed Peeps, I only enjoy them in chick form. Stay in your lane.” -- Coral Co-Founder Melissa Cohen
“Gummy bears and licorice are the only candy worth eating.” -- Coral Director Trevor Abeyta
“Twizzlers are the best! But only red for me.” -- Coral Consultant Sarah Kolk
"After 15 years of dairy-free exile, Reese's Pieces are back in my life and I'm making up for lost time. I brought a bag to my desk and let's just say self-control? I don’t know her.” -- Coral Director Kate Freeman.
“I would rather have no candy than eat Reese’s pieces.” -- Coral Consultant Emily Patterson
"Peanut butter M&Ms have the correct ratio of chocolate to peanut butter, but Reese's Pieces have the superior peanut butter flavor.” -- Coral Sr. Consultant, Andrew Petee
“Peanut butter M&Ms are the #1 M&M and are a superior version of Reese’s pieces but I still like both.” -- Coral Partner Maria Alexander
HHS Recalls Staff to Process Rural Health Transformation Applications
HHS is bringing back furloughed employees during the government shutdown to process applications for a $50 billion Rural Health Transformation Program created by Congress this summer. Both CMS and HRSA staff are being recalled specifically to review state applications due next week, with funding announcements expected by December 31st. This follows CMS's recent recall of all furloughed employees to handle Medicare and ACA enrollment tasks. Read here.
Why It Matters
The decision to recall furloughed workers specifically for this task reveals the administration's expectations about the shutdown's duration. With applications due November 6th, officials are clearly planning for the impasse to extend at least another week. It also underscores which health care priorities the Trump administration considers essential during a funding lapse: rural health funding designed to cushion Medicaid cuts gets staff coverage, while other programs remain frozen. States are now finalizing their applications ahead of the deadline, and the December 31st announcement date suggests this rural health initiative will proceed on schedule regardless of the broader budget negotiations.
Morgan Health Survey Reveals Gaps Between Interest and Use of Midwifery Care
Morgan Health published results from a 2025 survey of approximately 2,500 individuals with employer-sponsored insurance (ESI) and Medicaid who gave birth in the prior two years, revealing significant gaps between interest and use of midwifery care. While fewer than 1 in 5 ESI-covered individuals had a midwife as part of their care team, 66% of those not currently using midwives expressed interest in doing so for future pregnancies. The research demonstrates that midwifery care leads to better outcomes, including lower cesarean section rates and improved postpartum mental health support compared to traditional obstetrician-led care. Key barriers preventing broader adoption include lack of clarity about insurance coverage, limited awareness of midwifery services, and difficulties navigating the health care system to access midwife providers. Read here.
Why It Matters
This research validates the foundational premises of CMMI's Transforming Maternal Health (TMaH) Model by demonstrating that midwifery care already achieves the model's core objectives: lower cesarean rates and better postpartum mental health outcomes compared to traditional care. Critically, the findings expose why payment reform is necessary. Despite proven benefits and strong patient interest, fewer than 1 in 5 ESI members currently access midwives due to coverage ambiguity, poor care navigation, and system barriers. As TMaH launches and establishes reimbursement structures that reward coordinated, midwife-inclusive care, we expect participating health systems to proactively expand midwifery access, while employers and commercial payers increasingly align their benefit designs with the model's approach. For non-participating states, this research presents a compelling case for implementing similar reforms independently through state Medicaid innovations, employer-led initiatives, or commercial payer pilots to capture the demonstrated value of expanded midwifery care.
Look for the Helpers: Saving Lives by Meeting People Where They Are: Boston's Harm Reduction Shelters
The Boston Public Health Commission has transformed shelter operations by implementing harm reduction strategies that prioritize safety and dignity for people experiencing homelessness and substance use. Through innovations like low-threshold beds with 24-hour access, overdose prevention monitoring, on-site medical care, and staff training in naloxone administration, they've created welcoming spaces where 33.5% of residents have successfully transitioned to permanent housing. Their work demonstrates that meeting people where they are with compassion rather than prohibition, saves lives and opens pathways to stability and recovery. Read here.
What We're Writing
Reading Between the Lines: What Paragon’s Reform Agenda Signals for the Innovation Center
Our latest blog post explores a new report from the Paragon Institute, "How to Reform the CMS Innovation Center with a Choice and Competition Approach," offers a view into how the Trump administration may be thinking about the Center for Medicare & Medicaid Innovation (CMMI). Beyond its critique of the past decade of spending and model design, the report reads like a framework for where CMMI may be headed and, in many ways, aligns with what we're already seeing emerge from the Innovation Center. Read here.
What We Are Reading
The Continued Evolution of CMS’s Mandatory Models: The Ambulatory Specialty Model (ASM)
Milliman published a white paper analyzing CMS's proposed Ambulatory Specialty Model (ASM), a mandatory five-year risk-based payment program starting in 2027 that will hold specialists accountable for managing congestive heart failure and low back pain patients, emphasizing that success will require not just quality care but also strong provider collaboration and data analytics capabilities. Read here.
Medicare Beneficiaries Embrace Digital Health, But Income Gaps and AI Trust Issues Persist
A KFF survey found that 8 in 10 Medicare beneficiaries now use digital health tools, defying the stereotype of tech-resistant seniors, but reveals significant disparities, with only 51% of lower-income seniors using these apps compared to 91% of higher-income beneficiaries, and notes that low trust in AI (just 31%) remains a major barrier to widespread adoption. Read here.
Promises and Pitfalls of AI in Health Care
A new article in AJMC explores how AI is transforming health care through improved diagnostics and efficiency while highlighting critical challenges around algorithmic bias, transparency, and the essential need for human oversight in clinical decision-making. Read here.
Reducing Spending And Enhancing Value In US Health Care: Reflections On The GAO Report
A Health Affairs Forefront article examines the GAO's 2024 report on reducing US health care spending, emphasizing the urgent need to strengthen primary care investment, reform payment models away from fee-for-service, and address anticompetitive practices, though implementation faces significant headwinds from recent policy shifts that have slashed funding for critical programs like Medicaid and Medicare. Read here.
All the CMS Cooks are Back in the Kitchen: What’s on the Regulatory Menu?
A McDermott+ blog post reports that CMS has recalled all staff amid the shutdown to stay on track with key deadlines like the Rural Health Transformation Program applications and open enrollment, though some HHS divisions remain furloughed. Read here.
What We're Listening To
Faisel and Friends: Raising the Bar in Value Based Primary Care Payment w/ Purva Rawal, PhD
Former CMS Innovation Center Chief Strategy Officer Purva Rawal joins the Faisel and Friends podcast to discuss advancing value-based primary care payment models, highlighting the critical need to move beyond fee-for-service defaults and leverage community relationships to transform health care delivery. Listen here.
Pop Health Podcast
Rural Health Transformation: How States Can Align Stakeholders for Lasting Change
The Rural Health Transformation Program represents a $50 billion investment in the future of rural health care. In this episode, we sit down with Caitlin Westerson, Senior Director for State Policy and Advocacy at United States of Care, to explore what this program means for states, providers, and communities. Together, we unpack the opportunities and challenges in applying for funding, the role of value-based care in building sustainable models, and how states can align stakeholders to create lasting change in rural health systems.