MAHA, Steak 'n Shake, and AI Prescriptions | Last Month In Healthcare

This video provides an in-depth exploration of key healthcare news and trends from February 2025, as discussed in the "Last Month In Healthcare" podcast. The hosts, Nathaniel Smith and Spencer Smith, delve into a range of topics, starting with new administrative policies and progressing through market dynamics, pharmaceutical trends, and the rapidly evolving role of artificial intelligence in the healthcare sector. The discussion highlights the interconnectedness of public health initiatives, economic pressures, and technological advancements shaping the industry.

The discussion begins with an analysis of the "Make America Healthy Again" (MAHA) commission's broad mandate, which extends beyond traditional medical interventions to encompass the entire food system, environmental factors, and lifestyle choices as contributing causes to chronic disease. This sets a tone for a holistic view of health. Following this, the hosts examine executive orders aimed at healthcare price transparency, noting the challenges in implementing and enforcing such policies due to the complexity of machine-readable data and the influence of lobbying efforts. The conversation then shifts to market-specific trends, including the growing influence of telehealth companies in direct-to-consumer drug advertising, particularly for GLP-1 medications, and the significant increase in employer-sponsored coverage for these drugs, reflecting a massive shift in consumer demand and benefit design.

A substantial portion of the video is dedicated to the impact of artificial intelligence on healthcare. The hosts explore the dichotomy between the high hopes doctors place on AI to alleviate burnout (e.g., for note-taking, EMR management, symptom checking) and the widespread public distrust stemming from concerns over AI's role in claims denials, algorithmic biases, and broader societal fears. The most forward-looking discussion centers on a proposed bill to classify AI as a licensed practitioner, enabling it to prescribe drugs, potentially leveraging "digital twin" technology for personalized simulations. This segment underscores the regulatory and ethical complexities inherent in integrating advanced AI into clinical decision-making and patient care.

Key Takeaways:

• AI as a Solution for Physician Burnout: A significant majority of doctors (93%) experience burnout, with 80% believing AI can alleviate stress by automating tedious tasks like note-taking, transcribing, and managing electronic medical records, allowing them to focus more on patient care.
• Public Distrust of AI in Healthcare: Despite potential benefits, 65% of American adults distrust AI in healthcare, fueled by concerns over its application in automated claims denials, perceived algorithmic biases, and a general fear of AI's increasing autonomy, potentially influenced by "predictive programming" in media.
• The Future of AI in Prescribing Drugs: A proposed bill aims to classify AI as a licensed practitioner, enabling it to prescribe medications. The concept involves AI ingesting vast amounts of patient data to create a "digital twin" for simulated drug testing, raising significant questions about regulatory oversight, liability, and the human element in care.
• Surging Demand for GLP-1 Medications: One-third of Americans would consider switching jobs for GLP-1 access, and employer-sponsored coverage for these drugs jumped from 30% to 63% in one year, indicating a massive market shift and potential for these drugs to become a leading expenditure category.
• Telehealth's Role in Drug Accessibility: Telehealth companies like Hims & Hers and Ro are significantly boosting ad spending, making drugs more accessible by reducing friction in obtaining prescriptions for conditions ranging from ED to weight loss, and offering a private, direct-to-consumer model.
• Challenges in Healthcare Price Transparency: While executive orders aim to increase price transparency, the current system often involves hospitals providing complex, machine-readable-only files, making effective enforcement and consumer access difficult. True transparency requires robust data processing and clear, actionable information.
• Scrutiny of PBM Practices: The FTC's lawsuit against major PBMs (CVS, Express Scripts, Optum RX) for alleged price fixing through discounts highlights ongoing concerns about drug pricing models, rebates, and the lack of transparency in the pharmaceutical supply chain. A "Cost Plus" model is suggested as a more transparent alternative.
• Holistic Approach to Public Health: The "Make America Healthy Again" commission's mission to fight chronic disease adopts a broad scope, considering factors like diet, toxic material absorption, environmental influences, and corporate practices, signaling a comprehensive view of public health determinants.
• Data Engineering for Healthcare Insights: The discussion on price transparency underscores the critical need for sophisticated software and data engineering capabilities to process, clean, and make actionable the vast amounts of healthcare data, transforming raw information into usable insights for competition and cost reduction.
• Regulatory Compliance in AI Development: The potential for AI to prescribe drugs and its role in claims denials emphasizes the paramount importance of regulatory compliance (e.g., FDA, 21 CFR Part 11) for any AI solution deployed in the healthcare sector, ensuring safety, efficacy, and ethical use.

Key Concepts:

• Digital Twin: A virtual replica of a physical entity (in this case, a patient) that can be used for simulations and testing, particularly for personalized drug prescriptions.
• GLP-1s (Glucagon-Like Peptide-1s): A class of medications primarily used for treating type 2 diabetes and obesity, experiencing massive growth in demand and market impact.
• PBMs (Pharmacy Benefit Managers): Third-party administrators of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, and other government programs.
• Cost Plus Model: A drug pricing model where the cost of the drug is determined by its acquisition cost plus a small, transparent margin, often bypassing traditional insurance and rebate systems.
• Price Transparency: The practice of making healthcare service and drug prices openly available to consumers, intended to foster competition and reduce costs.
• Telehealth: The use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration.

Examples/Case Studies:

• FTC Lawsuit against PBMs: The Federal Trade Commission is suing major PBMs (CVS's Caremark, Cigna's Express Scripts, and UnitedHealth Group's Optum RX) over alleged price-fixing and anti-competitive practices related to drug discounts and rebates.
• Luigi Manon Case: Referenced as an example of AI's application in automated claims denials by insurance companies, contributing to public distrust in healthcare AI.
• Steak 'n Shake Beef Tallow Fries: An example of a food industry company adopting a healthier cooking oil (beef tallow instead of vegetable oil) in response to broader public health discussions, aligning with the "Make America Healthy Again" initiative's focus on food systems.