Health systems are not stepping into artificial intelligence from a place of calm or control. In the United States, spending now exceeds $4.5 trillion, with a significant share tied up in administrative work that adds complexity more than clarity. Clinicians are caring for more patients, navigating more data and making more decisions under pressure than ever before. The system is stretched. Artificial intelligence is entering at a moment when change is no longer a choice.

The discussion drew on the experience of three leaders who are not observing this shift. They are guiding it. Hal Wolf leads HIMSS, influencing digital health policy and implementation across more than 100 countries. Isaac Kohane, MD, PhD, Chair of Biomedical Informatics at Harvard Medical School, has spent four decades defining how data informs clinical care. Ran Balicer, MD, Chief Innovation Officer at Clalit Health Services, operates within one of the world’s most integrated health systems, where data and care are aligned across generations.

These are not just star panelists. They are system-wide architects.  What emerged from the hour-long conversation was not what artificial intelligence can do. It was a recognition that it is already doing more than most systems are prepared to guide and govern.

Dr. Kohane captured the tension immediately. “I think that we have to worry about the fact that we’re going both too slow and too fast.”

That statement reflects a reality many leaders feel but rarely express. Governance takes time because it must. Patient safety, validation and accountability require structure. Practice moves in real time. Clinicians do not have the luxury of waiting for perfect systems.

“They’re so desperate to do right by their patients to use other resources,” Dr. Kohane adds.

That instinct is not a weakness. It reflects a commitment to doing what is right for the patient. When clinicians turn to external AI tools, they are seeking clarity, speed, and confidence in their decisions. Artificial intelligence is already present at the point of care, shaping how physicians assess information, validate thinking, and move forward. The system is not adopting AI. The system is catching up.

This creates a condition that is difficult to measure and even harder to manage. Different clinicians use different ChatGPT platforms. Those tools produce different answers. Different assumptions shape those answers. Over time, consistency erodes. The system begins to operate with multiple definitions of truth (and the risk of varied outcomes).

Dr. Kohane’s warning is not about misuse. It is about misguided permanence. “The worst outcome will be if the worst parts of medicine get concrete poured over it, by AI.”

Artificial intelligence does not fix a system; without leadership, it accelerates the integration of incorrect assumptions. If workflows are inefficient, they become more efficiently inefficient. If bias exists in data, it becomes more precise. If fragmentation defines care, it scales.

This is not a failure of technology. It is a mirror held up to system-wide leadership.

Hal Wolf, among the health sector’s leading policy and operational voices, grounded this moment in proven experience. Health care has seen this pattern before. When internet connectivity entered hospitals, clinicians moved faster than governance. They created access where it was needed. Systems responded later. Risks were discovered after adoption.

Artificial intelligence now follows that same trajectory, though at far greater speed and with far greater consequences. Web connectivity gave quick access to information. Artificial intelligence influences how that information is interpreted and acted upon.

“We have to go faster,” Mr. Wolf said. “But there needs to be structure around it.”

That is the leadership challenge of this moment. Speed without structure creates exposure. Structure without speed creates irrelevance. The tension between the two is not something to resolve. It is something to manage continuously.

The industry has predictably responded to artificial intelligence. It has started where risk is lowest and return is clearest. Documentation, scheduling and revenue cycle optimization have become the entry points. These applications reduce burden and improve efficiency. They are necessary. However, they are not transformational.

The shift occurs when artificial intelligence moves into clinical decision-making. At that point, the question is no longer whether the system works. The question becomes whether it should be trusted.

Who owns a decision informed by an algorithm? How is accuracy validated? What happens when a clinician disagrees with a recommendation? These are not technical questions. They are questions of accountability. Artificial intelligence does not assume responsibility. It does not carry consequence. That remains with leadership.

Dr. Balicer reframed the conversation, shifting how the room thought about artificial intelligence. “There’s no such thing as AI neutrality. Algorithms are just opinions embedded in code.”

That insight is easy to acknowledge and difficult to operationalize. Every model reflects choices. What data is included? What outcomes are prioritized? What trade-offs are accepted? Those decisions are embedded in the system, shaping how it interprets information.

When a health system adopts an AI tool, it is not simply implementing technology. It is adopting a perspective.

At Clalit Health Services, alignment across payer and provider creates a system where priorities are consistent. Even there, external AI models introduce new assumptions. Those assumptions may not align with the system’s goals. If leadership does not define its own values, it inherits someone else’s.

This becomes real in proactive care. Artificial intelligence enables systems to identify patients at risk before they present. It allows for earlier intervention, often improving outcomes.

It also creates a new kind of pressure. “The toughest choice is what not to do,” Dr. Balicer said.

That statement deserves more attention than it receives. Health care has been built around responding to need. Artificial intelligence introduces the ability to anticipate it. When every patient can be flagged, every risk predicted and every intervention suggested, the system is no longer constrained by insight. It is constrained by capacity.

Artificial intelligence expands what can be done. It does not expand who can do it. Leadership becomes the act of choosing who does what based on validated data.

There is a moment that captures this shift. Imagine a primary care physician starting the day not with a schedule of patients who have called for appointments, but with a list generated by AI identifying individuals who are likely to experience clinical complications in the next six months. Some will develop chronic conditions. Some will require hospitalization. Some can be helped now – preventively.

The physician cannot see them all. Artificial intelligence expands what is possible. Leadership decides what is essential and permissible.

The industry often responds to complexity with activity. Organizations pilot, test and explore. They engage broadly without committing deeply. This creates motion. It rarely creates progress. Pilots are nothing more than experiments. At some point, leadership must decide what to scale, what to stop and what defines value.

Hal Wolf grounded the conversation in discipline. Without a defined, shared objective, effort becomes noise. Pilots create learning, though they often avoid decision-making. Leadership requires clarity. What problem are we solving? What outcome defines success? What are we willing to prioritize? Without those answers, artificial intelligence adds another layer of complexity to an already complex system.

Dr. Kohane brought the conversation back to the discipline of leadership. It cannot remain abstract. It must be informed by experience.

“Go and pay a few bucks and use three or four of the models… get a feel for what this does,” Dr. Kohane advised.

That is not a call for technical fluency. It is a call for leadership proximity. Leaders cannot guide what they do not understand. Artificial intelligence does not behave consistently across models. It produces different answers, shaped by different assumptions. Without direct engagement, those differences remain hidden, and leadership becomes removed from the very decisions it is responsible for guiding.

This is where many organizations hesitate. Artificial intelligence feels complex and complexity invites delegation. At this moment, delegation creates distance. Leadership is required to move closer, not further away.

Artificial intelligence is not reducing the role of leadership. It is redefining it.

This is not a gradual transition. It is already underway. Artificial intelligence is embedded in workflows, shaping decisions and influencing behavior in real time. The system is adapting whether leadership is ready or not.

The question is no longer whether artificial intelligence will shape the future of health. It will. The question is whether leadership will shape how it is applied.

Artificial intelligence will not fix health. It will scale whatever we allow it to touch. The question is whether it will scale what is best in health or what we have yet to fix.

The post AI Will Not Fix Health Care – Leadership Might appeared first on Medika Life.

Primary care continuity allows physicians to develop a longitudinal awareness that no episodic encounter or health tech tool can replicate. Over time, physicians learn what is normal for each patient and what represents meaningful clinical change. Subtle physiological shifts, early symptoms or emerging risk factors appear not as isolated data points from a blood exam, but as part of a social narrative unfolding across time. Early recognition allows earlier intervention, often before disease takes its profound toll.

Clinical evidence confirms the protective effect of continuity. It’s not a matter of opinion. A systematic review published in BMJ Open found that patients with sustained continuity of care had significantly lower mortality than those with fragmented care. Continuity did not just improve satisfaction; it altered survival. The physician who knows the patient can detect disease earlier and guide care more effectively.

Listening allows physicians to detect patterns that laboratory values alone cannot explain. Patients share information differently when they believe that their physician understands them and remembers their history. This sustained awareness allows physicians to identify emerging illnesses without relying solely on reactive diagnostics. Continuity transforms listening into clinical intelligence and a deeper care partnership.

In Healing the Sick Care System: Why People Matter, which has become a surprise Amazon bestseller, one insight repeatedly emerges: patients do not seek care only for treatment; they seek reassurance that someone who knows them is guiding their journey. Physicians who listen across time accumulate knowledge that cannot be captured in a chart alone. That memory allows earlier recognition, more accurate interpretation, and wiser intervention. Healing begins in that continuity of understanding.

Transactional Care Solves Symptoms but Sacrifices Understanding

Health has, for some time, been undergoing a structural shift toward transactional encounters. Walk-in clinics, urgent care centers, and virtual platforms provide speed and accessibility that patients value. These models address immediate symptoms efficiently and fill important gaps in care delivery. Accessibility has improved, yet continuity has weakened.

Transactional medicine treats episodes rather than trajectories. Each encounter begins without the benefit of longitudinal understanding. Clinical decisions are made with time-stamp specific knowledge of how symptoms emerged or how physiology has changed over time. Care becomes reactive rather than interpretive.

Research demonstrates the consequences of this fragmentation. Studies published in the Annals of Family Medicine show that sustained primary care continuity reduces hospitalizations and lowers healthcare expenditures. Early recognition prevents complications that require more invasive, costly interventions. Fragmentation delays recognition and increases clinical risk.

In fact, physicians in the vanguard of building relationships encourage their patients to ask questions.  In their co-authored book Let Patients Help! A “Patient Engagement” handbook – how doctors, nurses, patients and caregivers can partner for better care by “e-Patient Dave” deBronkart with Daniel Z. Sands, MD, MPH, the founder of the Society for Participatory Medicine, offer 10 suggestions that clinicians say to encourage patient engagement.

This shift also alters how patients engage with care. Connections that develop over time can be lost quickly when continuity disappears. Patients become consumers navigating isolated services rather than partners guided across time. The clinical relationship weakens, and with it the interpretive depth that makes prevention possible.

Health systems globally recognize the value of continuity. The Organization for Economic Co-operation and Development (OECD), a Paris-based international organization that promotes policies to improve economic and social well-being globally, reports that hospital admissions for chronic diseases, often preventable through effective primary care, account for a substantial share of healthcare utilization. Systems that preserve physician-led primary care continuity achieve better outcomes and greater efficiency. Relationship stabilizes care.

Innovation Requires Connection to Fulfill Its Potential

This shift toward transactional care carries life-threatening implications that extend far beyond the patient experience. It also directly affects whether health innovation fulfills its promise or becomes a compensatory tool addressing fragmentation. Innovation depends on context to generate meaningful insight. Context emerges through continuity. That context can devalue life-saving innovations.

Artificial intelligence, predictive analytics, and remote monitoring technologies are designed to detect patterns across time. These tools require longitudinal clinical awareness to distinguish meaningful change from statistical variation. Physicians who know their patients can interpret innovation correctly and act earlier. Innovation becomes transformative when anchored in relationship.

Fragmented care weakens this interpretive capacity. Data collected across disconnected encounters lacks coherence. Predictive tools lose precision when longitudinal context is absent. Innovation becomes reactive, identifying disease after symptoms emerge rather than predicting disease before it develops.

Technology achieves its highest value when it extends the physician’s ability to listen and observe. Remote monitoring allows earlier recognition of physiological change. Predictive analytics strengthens preventive intervention. Innovation amplifies continuity when guided by sustained physician leadership.

Team-based primary care models reflect this principle. Nurse practitioners and physician assistants expand access while physician leadership preserves interpretive continuity. Research published in Medical Care Research and Review confirms that coordinated team-based care maintains strong clinical outcomes. Physician oversight ensures that innovation remains integrated within longitudinal care. It also improves health professional job satisfaction and reduces burn-out.

Innovation cannot replace the relationship at the center of medicine. Algorithms detect patterns but do not understand meaning, and they do not strengthen physician/patient ties. Devices collect data, but do not know the patient behind the data. Physicians translate information into guidance by integrating technology with human understanding.

The future of health innovation depends on preserving continuity between patient and physician. Technology deployed within sustained relationships strengthens prevention and improves outcomes. Technology deployed within fragmented systems often compensates for structural weakness rather than transforming care. Continuity determines whether innovation fulfills its promise.

Health systems now face a defining moment. Transactional care offers speed and convenience. Relational care offers understanding and prevention. Innovation will achieve its full potential only when it strengthens the continuity that allows physicians to listen, learn, and guide patients across time.

Healing begins with being heard. Health technology succeeds when it helps physicians listen more deeply and act more wisely in the service of the people who entrust them with their care.

The post How Transactional Medicine Threatens the Future of Your Health appeared first on Medika Life.

The country’s trajectory has been building for years. A fast-growing middle-income population, rising chronic disease burden, and expanding health infrastructure have created both demand and urgency. What is changing now is the environment in which innovation can move, driving faster approvals, a culture of collaboration, digital infrastructure and a government signaling policy readiness to engage global partners in shaping the next era of medicine.

The economic momentum is significant. The Indian health ecosystem has expanded from roughly $372 billion in 2023 to $638 billion in 2025, making it one of the fastest-growing major health markets in the world. The broader industry is expected to exceed $610 billion by 2026, fueled by rising insurance coverage, expanding hospital infrastructure, and growing demand for chronic disease management. Health growth in India continues at approximately 10–12 percent annually, well above the growth rates typical of mature markets, reflecting both rising access and structural transformation.

BIOAsia 2026 reflects this inflection point. The global gathering in Hyderabad, themed “TechBio Unleashed: AI, Automation & the Biology Revolution,” highlights the (bio)convergence of biology, data, and intelligent systems reshaping health worldwide. Organizers emphasize that the meeting aims to drive health transformation and reinforce India’s position as a leading global life sciences force. For multinational innovators, the message is increasingly clear: India is not only where innovation is deployed; it is also where it is developed. It is where innovation is increasingly defined. India has become a go-to market for multinational enterprises.

Policy Signals and Market Scale: From Opportunity to Strategic Partnership

India’s regulatory and policy environment is evolving in ways that matter deeply to multinational innovators. One pivotal shift came with the country’s decision to allow certain medicines approved in specified developed markets to launch without local clinical trials, a move designed to accelerate patient access while aligning more closely with global regulatory science. This policy shift reflected confidence in international data, a commitment to innovation, and recognition that faster access must remain central to national health strategy.

The scale of India’s pharmaceutical and life sciences market reinforces this transformation. The pharmaceutical sector reached approximately $68 billion in 2025 and is projected to grow to more than $170 billion during the next decade, driven by expanding middle-income demand and strong domestic manufacturing. India already supplies roughly one-fifth of the world’s generic medicines. It produces the majority of global vaccines by volume, positioning the country as a central player in global health supply chains.

As Aman Gupta of SPAG/FINN wrote in Medika Life, “India’s health sector is undergoing a profound transformation, bolstered by government-led reforms and a favorable FDI regime. The allowance of 100% foreign direct investment through automatic routes in health and related sectors has already attracted global giants.” His observation reinforces a central reality for multinational innovators: India’s policy environment is increasingly designed not only to welcome global participation, but to encourage long-term strategic partnership in building the future of healthcare.

Investment trends tell the same story. Health and pharmaceutical private equity and venture investments have reached multi-billion-dollar levels annually. At the same time, India’s contract drug development and manufacturing sector is projected to exceed $22 billion within the next decade. These dynamics position India as a growth market and as a strategic partner across the innovation lifecycle from discovery and clinical development to manufacturing and global distribution.

Shakthi Nagappan, CEO of Telangana Life Sciences Foundation, captured this moment clearly, noting that BIOAsia arrives at a time when technology and biology are redefining healthcare and creating “unprecedented opportunities for innovation, investment, and impact.” The language reflects partnership rather than transaction, a signal that India is moving from market opportunity to strategic collaboration.

Digital Infrastructure, BIOAsia and the Multinational Innovation Imperative

India’s digital transformation may be its most potent catalyst for long-term health innovation. Unlike many mature systems, the country is building a national-scale digital health infrastructure designed to connect patients, providers, and health systems across a population of more than 1.4 billion people, with a rising middle class of 400 million.

The Global Digital Health Market is projected to grow from USD 288.55 billion in 2024 to USD 2,688 billion by 2035, expanding at a CAGR of 22.55% during 2025–2035. This surge is driven by the rapid adoption of AI-powered diagnostics, telemedicine, wearable devices, and data analytics solutions that are revolutionizing patient care and operational efficiency worldwide.

Hundreds of millions of citizens are already using digital health services, including telemedicine, electronic prescriptions, and remote care. The Ayushman Bharat Digital Mission is creating an interoperable national health ecosystem, enabling secure health records, improved care coordination, and population-scale data infrastructure that supports research, real-world evidence, and precision health.

For multinational companies, this digital backbone creates a uniquely strategic environment, enabling large-scale clinical research, faster pharmacovigilance, AI-supported health insights, and rapid deployment of innovation across diverse populations. India’s digital infrastructure is not simply modernizing health delivery. It is enabling national-scale transformation.

BIOAsia sits at the center of this conversation and convergence. The gathering reflects India’s ambition to lead at the intersection of biology, artificial intelligence, and scalable innovation. Leaders from industry, government, and science convene not only to discuss growth but to shape the next phase of global life sciences, where biology, data, and digital systems converge to influence global health.

One conference panel, among the many high-powered sessions, brings together global leaders in advanced therapeutics to explore how next-generation modalities are moving from discovery to scalable care. Panelists across biopharma, translational science, and hospital systems are examining progress in cell and gene therapies, mRNA, and radiopharmaceuticals, underscoring that innovation now depends as much on manufacturable scale and delivery as on scientific breakthrough. India’s expanding capabilities in clinical research and bioprocessing strengthen its role as a key partner in advancing next-generation therapies.

For multinational innovators, the implications are clear. Engagement in India now extends beyond commercialization. It calls for collaboration in research, investment in digital and scientific ecosystems, alignment with national health priorities and partnership in strengthening health delivery.

India’s Strategic Role in Global Health Innovation

India’s rise in global health innovation reflects the alignment of policy, market growth, digital infrastructure, and scientific capability forces that together are reshaping where and how healthcare innovation occurs.

For multinational companies, India now represents a full-spectrum innovation environment. It is a place to conduct clinical research across diverse populations, scale manufacturing and supply chains, deploy digital health at a national scale, and co-develop solutions addressing both local and global health challenges. Increasingly, India is not simply a recipient of innovation developed elsewhere. It is becoming a co-creator of next-generation health.

This shift changes the strategic equation. Market entry alone is no longer sufficient. Meaningful engagement requires partnership with policymakers, regulators, scientists, health providers, and digital health ecosystems. Organizations that invest in collaboration, align with national health priorities, and contribute to strengthening healthcare systems are most likely to succeed in India’s evolving landscape.

BIOAsia sets the stage for this transformation. It is more than a conference. It is a convergence of global health ambition, scientific capability, and policy momentum. The conversations taking place in Hyderabad mirror a broader reality: the geography of health innovation is expanding, and India is now central to its future.

For global health innovators, the question is no longer whether India matters. The question is how deeply they choose to engage in shaping what comes next.

The post India: The Growing Focal Point for Health Innovation appeared first on Medika Life.

Many private-sector investors are considering health in Africa. Maybe that’s no surprise; the African Development Bank says the Continent could almost double its GDP if health were better. Robert Appelbaum, though, thinks that many are interested in what Africa might export as well as the potential unlocked at home.

Appelbaum has advised multinational pharma companies through the most difficult episodes of the past three decades including the disputes over HIV medicines patents and the transfer of technology to African producers. He also provides legal and business counsel to billionaires who are household names. “Today, investors are looking at the African Continental Trade Agreement (AFCTA) and the commercialisation of African drugs and devices for use across the world,” he told me. “The AFCTA is making Africa into a legitimate manufacturing hub for the full gamut of manufacture from API [active pharmaceutical ingredients] through to fill and finish, whereas in the past we have been in the business of fill and finish,” he added.

The day before we spoke I had been to see the Biomedical Research Institute at Stellenbosch. It houses a network of 26 BSL-3 — highly secure — laboratories to handle infectious diseases samples. There are probably a third as many BSL-3 labs at Stellenbosch alone as there in all of China. The Biobank in the same facility has space for up to seven million samples and provides an exceptionally rapid way of looking back at the evolution of disease outbreaks. It was designed to allow another seven million to be stored when needed. To give an idea of how massive this is, the largest biobank in China can hold 10 million samples and the largest human biobank in Europe can keep 20 million. Maybe the most impressive statistic is that the Stellenbosch institute was completed for about €65 million, a fraction of what it would have cost in Europe.

Cost is not Africa’s only advantage: it has the kind of frugal innovation that hard-pressed European and American health systems need. “There is a huge amount of work taking place — more in devices and technology than in drug discovery. Africans are very innovative at creating for ourselves what does not already exist,” Appelbaum said. These are exactly the areas in which slow first-world innovation is holding back medicine: commissions on antimicrobial resistance assumed point-of-care diagnostics would by now have been able to differentiate between viral and bacterial illnesses and between different kinds of infectious bacteria. They cannot.

Pre-history gives Africa another advantage. As humans spread across the globe from Africa, we lost genetic diversity. It’s said that today there is more genetic diversity within Mozambique than between people in South Asia and people in Europe. In that vast genetic storehouse are hidden undiscovered clues to resisting and treating disease — clues that can be transformed into prevention, diagnosis and treatment by health innovators. As Africans have more access to health services, those genetic assets and liabilities will become more and more evident and accessible. This is a key aspect of the African Human Genome project and of South African agreements with commercial entities such as Illumina and MGI.

To spot the real life implications of these genetic patterns, to find population clusters and to identify possible genetic outliers, a country needs easy, secure access to massive numbers of records. The United Kingdom sees this as a competitive advantage for its four national health services while France’s La poste, the nation’s post office, is bringing together over 40 million patients’ referrals, visit reports and test results. These and other developed world efforts, though, are having to retrofit national analytical frameworks onto multiple old data systems and to pry data loose from academics and care systems with strong proprietorial instincts. African countries are building new national data systems from the bottom up with integration and analysis as part of the original design. Appelbaum thinks that Africa may again leapfrog over Western competitors, just as it did by introducing modern mobile telephony and mobile payment systems while legacy system owners slowed down adoption in Europe and the Americas.

Many think that Oracle has already honed in on the opportunity. It has partnered with the Tony Blair Institute to introduce vaccine tracking systems in Ghana, Rwanda and Sierra Leone and to promote them Continent-wide. Given the vast effort that Oracle continues to put into developing a nationwide repository of health records in the USA and the Gulf states, many see its efforts in Africa as a test run for much broader and more ambitious national health databases. African countries are not waiting. Kenya’s Afya Yangu platform is already operational in a third of the nation’s counties and provides portable individual records including medical history, prescriptions, lab results, and appointments for three million users. South Africa faces some of the same challenges as Europe in unifying or supplanting existing systems but its Health Patient Registration System has registered over 57 million patients across more than 3,000 facilities as a foundation for portable electronic health records. Africa’s health data is a vast opportunity which governments will need to use as the basis for investment.

Private sector health investors are indispensable to Africa, Appelbaum thinks. In the US and Europe, they find far more R&D than governments and foundations combined; that must be the pattern in Africa if the Continent is to not just meet its own health needs but to develop innovations for the world.

The post Why Sophisticated Investors Really Care about Health in Africa appeared first on Medika Life.

I have spent more than 30 years in healthcare with one consistent mission: helping people sustain and improve their lives. That mission has guided my work across large pharmaceutical companies, entrepreneurial startups, and academic institutions. It has shaped how I view innovation—not as a luxury, but as a necessity.

We often speak about healthcare innovation as if it exists in a vacuum. It does not. Innovation only matters if patients can access it, understand it, and afford it. Today’s system too often breaks that chain.

The U.S. healthcare system has evolved to prioritize risk management over prevention, short-term cost containment over long-term health, and utilization controls over patient outcomes. The consequences are real. Breakthrough therapies are delayed or denied. Preventive medicines are underused. Patients are left navigating complexity at the very moment they are most vulnerable.

However, innovation has repeatedly proven it can change the trajectory of disease—and lives—when it reaches patients.

Earlier in my career, I had the opportunity to help build Claritin into a household name. What made Claritin transformational was not just the molecule, but access. Non-sedating allergy relief allowed people to function—to work, learn, drive, and live daily life without compromise. We paired scientific innovation with brand-building, education, and emerging digital tools to enable patients to engage with their care in new ways. That experience taught me something enduring: innovation fails when it remains trapped behind complexity.

As digital channels emerged, I saw how virtual access could democratize care. Early online refill capabilities and digital front doors were not about marketing. They were about meeting patients where they were. Innovation is not only what happens in the lab; it is how solutions are delivered in the real world.

More recently, my work in cardiovascular and preventive medicine has reinforced this belief. Cardiovascular disease remains the leading cause of death globally, yet preventive innovation often struggles most to gain access. When therapies reduce future heart attacks, strokes, and hospitalizations—but do not show immediate cost offsets within narrow budget windows—they face resistance. This is actuarial logic colliding with human biology.

But prevention works. Inflammation matters. Long-term risk reduction matters. Helping people avoid catastrophic events enables them to remain productive, engaged, and present in their lives and with their families. The value of that outcome is difficult to capture on a quarterly balance sheet, but it is undeniable.

Innovation also matters because healthcare is not static. Populations are aging. Chronic disease is rising. Demand for care will only increase. Without continued pharmaceutical innovation—new mechanisms, better tolerability, improved adherence—we risk managing decline rather than enabling vitality.

Critics often frame innovation and affordability as opposing forces. They are not. The real tension lies between short-term system incentives and long-term societal benefit. When access to effective therapies is delayed or denied, costs do not disappear. They shift—reappearing as hospitalizations, disability, lost productivity, and diminished quality of life.

I have worked inside large organizations, small startups, and everything in between. I have seen how difficult it is to bring a medicine from concept to patient—and how fragile that final step of access can be. That is why innovation must be paired with thoughtful policy, modernized reimbursement, and a patient-centered view of value.

Healthcare should not be about simply surviving longer. It should be about living better for longer. Medical innovation, particularly in pharmaceuticals, plays a central role in making that possible. Even in a system burdened by complexity and constraints, innovation remains one of our strongest tools for advancing healthcare.

After three decades, my belief has not changed: when science, access, and mission align, lives improve. That is worth fighting to achieve.

The post Medical Innovation Still Matters—Even When the System Makes It Hard appeared first on Medika Life.

We usually think about outdoor air quality, but sometimes the air in our kitchens is even more dangerous. Did you ever think that home cooking could be dangerous for you? Not in terms of spills or burns, but the air you breathe?

Understanding the Problem

People in the UK spend about 90% of their time indoors, but most air pollution rules only focus on outdoor air. This is a serious problem because many things we do at home, especially cooking, create airborne pollutants that can harm our health.

The INGENIOUS project at the University of York is studying what happens to indoor air quality when we cook. Their research examines homes where many families experience poor air quality both indoors and outdoors.

What’s in the Air When You Cook?

Cooking releases several types of pollutants into your home’s air. The main ones are fine particulate matter (PM2.5), nitrogen dioxide, volatile organic compounds, and formaldehyde. Did you ever think you would be breathing formaldehyde in your home as a result of how you cooked?

PM2.5 is especially concerning. These tiny particles can travel deep into your lungs and even get into your bloodstream. One study found that pan-frying chicken produced PM2.5 levels of 92.9 micrograms per cubic meter. The outdoor air quality standard for PM2.5 is 50 micrograms per cubic meter, so some cooking methods can more than double that amount in your kitchen.

Gas stoves create another issue. They release nitrogen dioxide (NO2), which can irritate your lungs and is linked to asthma and other breathing problems. If you don’t use a range hood, cooking with gas can add 25% to 33% more nitrogen dioxide to your indoor air in summer, and even more in winter. In four out of ten homes studied, gas burners released enough nitrogen dioxide to go over the health standards set for outdoor air.

Who’s Most at Risk?

Young children, older adults, and people with asthma or heart and lung diseases are especially at risk.

The numbers are worrying for children with asthma. A 2006 study found that pollution from gas stoves more than doubles the chances of wheezing and shortness of breath for kids with asthma who live in apartments. Another study showed that children with asthma who are exposed to higher nitrogen dioxide levels use their rescue inhalers 14% more often.

Some communities are affected more than others. In Washington State, Black people are exposed to PM2.5 levels that are over 1.3 times higher than White people, and Asian people face levels 1.5 times higher. American Indian and Alaska Native adults have the highest asthma rates at 18%. And there are cultural factors at work here, as well as the type of cooking you do indoors and the airflow in your home.

The Long-Term Health Impact

Being exposed to PM2.5 for a long time raises the risk of early death for people with heart or lung disease. It is also linked to chronic heart and lung problems, effects on brain health, and pregnancy issues.

Around the world, household air pollution causes 6.7 million early deaths each year. The main health problems are stroke, heart disease, chronic obstructive pulmonary disease (COPD), and lung cancer.

Use Your Range Hood Every Time You Cook

This is the most important step you can take. A range hood that works well and vents air outside can remove 50% to 70% of pollutants if you use it correctly. But studies show that people use their range hoods only 36% of the time in houses and 28% in apartments.

If your range hood only recirculates air back into the kitchen instead of venting it outside, you should open windows or use another exhaust fan.

Cook on Your Back Burners

Range hoods work best when you use the back burners because they are more fully covered by the hood. Cooking on a single back burner with the hood on low speed usually captures 50% to 70% of the pollutants.

Open Windows and Doors

If you do not have a range hood, opening windows or doors can help. One study found that opening both the front and back doors for ventilation creates strong airflow that can remove over 95% of cooking pollutants in just 10 minutes.

Consider Switching to Electric

All cooking creates some pollution, but gas stoves cause extra problems by releasing nitrogen dioxide, carbon monoxide, and benzene. A recent Stanford study found that switching to electric stoves could lower nitrogen dioxide exposure by over 50% across the country. One of the problems, of course, is that electricity or cooking with electricity is more expensive than using gas.

Choose Your Cooking Methods Wisely

Pan-frying and stir-frying at high temperatures make much more pollution than boiling, steaming, or using an air fryer. When you can, choose cooking methods that use lower temperatures.

Why This Matters Now

About half of the people surveyed did not know that cooking creates unhealthy air pollutants. But after learning about the health risks, 64% said they would think about using their ventilation devices more often.

People are spending more time at home. In 2021, Americans spent about 62% of their waking hours at home, up from 50% in 2019. With more people cooking at home, kitchen ventilation is more important.

Newer homes are built to be more energy-efficient, so there is less air exchange with the outdoors. Without good ventilation, pollutants can get trapped inside and build up to harmful levels. In homes with poor ventilation, indoor smoke can have fine particle levels 100 times higher than what is considered safe.

The Bottom Line

Cooking is a normal part of daily life, but it shouldn’t harm your health. By learning what pollutants are released when you cook and taking simple steps to ventilate your kitchen, you can protect yourself and your family.

The research is clear: using a range hood every time you cook, opening windows for airflow, cooking on back burners, and thinking about cleaner cooking technologies can really help. These are not complicated or expensive changes. They are simple habits that can greatly improve the air quality in your home and your health as well.

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The gravitational pull is unmistakable. The Westin St. Francis remains the symbolic center of power, where scale dominates the conversation and capital moves in large increments. However, innovation, from the concept of a molecule or engineering marvel, rarely begins at scale. It starts with a question, a patient-care frustration, a molecular insight and a small group of people willing to compress years of work into minutes of explanation.

That is why the Biotech Showcase matters. It’s why it continues to thrive just off the main stage. Like off-Broadway, this is where blockbusters are discovered.

Seven Minutes to Be Understood

I spent part of the day sitting in one room at the Biotech Showcase, listening to a succession of rapid-fire presentations, each lasting seven minutes per company. The room was only half full, but it was intensely attentive. This was not casual listening. This was evaluative listening.

Companies including OrisDx, IowaiBIO Inc., Endure Biotherapeutics, SIvEC Biotechnologies, Frezent, Sideral Therapeutics, Courative Inc., and others each delivered a tightly constructed narrative of carefully curated slides: the unmet clinical need, the scientific or molecular approach, progress to date and the precise inflection point ahead. Most importantly, resources needed for the next stage of development.

What made these presentations compelling was not polish, it was clarity. There was no time to hide behind jargon or aspiration. Seven minutes forces discipline. It reveals whether a team truly understands its own story. For investors or biopharma partners in the room, it quickly answers the most important question: Is this something I want to continue discussing?

That is the essence of a productive dating game. Not every conversation leads to a match, but the right ones unmistakably spark an attraction.

Why This Room Exists at All

The Biotech Showcase works because it understands timing and intent. Seed and early-stage companies do not come to San Francisco in January to compete with global pharmaceutical announcements. They come because the people who can change their trajectory are already in the city and already thinking about what comes next.

J.P. Morgan Healthcare Week is where the industry takes stock of itself. Large companies outline business plan priorities. Investors recalibrate portfolios. Strategies are stress-tested. In that context, the Biotech Showcase becomes a natural counterbalance: a place where emerging science is introduced not as speculation, but as possibility.

There is also quiet wisdom in the Showcase’s decision to record and share presentations after the event. In a week where schedules overlap and choices are constant, the ability to revisit a story matters. Conversations that begin in a room can continue weeks later, grounded in something concrete and lasting. That continuity is how relationships form—and how trust accumulates.

The City Becomes the Platform

What is easy to overlook from the outside is how completely San Francisco itself becomes part of the infrastructure during this week. Beyond the formal stages, firms across the ecosystem host companies in nearby venues, creating dozens of smaller hubs within walking distance of one another.

At places like the Marines’ Memorial Club, companies are hosted quietly and efficiently, often fifteen or so at a time, by firms such as FINN Partners, alongside others working behind the scenes to support emerging science during the week. During the course of J.P. Morgan Week, these companies may hold more than 200 conversations with analysts, investors, and media representatives. No banners. No spectacle. Just focused, purposeful, personalized dialogue.

This distributed model works because it mirrors how decisions are actually made, not in a single dramatic moment, but through repeated, informed exchanges that foster knowledge and confidence.

When the day winds down, the city shifts again. Evenings during J.P. Morgan Week are reserved for receptions hosted by banks, global companies, industry groups, and even trade commissions from countries such as the UK, including the UK Bioindustry Association. These gatherings are not afterthoughts. They are where formality loosens, where introductions give way to relationships, and where ideas heard earlier in the day are tested in conversation. Science meets context. Strategy meets personality.

When AI Enters the Dating Pool

One of the most notable developments this year is the growing presence of AI companies entering this ecosystem alongside emerging biotech companies—firms such as Briya.Health demonstrates how AI is no longer merely orbiting the life sciences; it is now deeply embedded within them.

Early-stage biotech is data-rich and time-poor. They generate complex, unstructured information long before scale or certainty arrives. AI platforms that can surface insight, reduce friction, and accelerate decision-making change the nature of early collaboration.

When AI innovators and biotech founders encounter one another during this week—often in the same rooms, at the same receptions, and in the same corridors—the conversation accelerates. What might have taken months of coordination elsewhere can happen organically here. That is not a coincidence. It is designed.

Why This Week Still Matters

Events like the Biotech Showcase, alongside complementary forums such as 1BusinessWorld’s Global BioInnovation Forum, emerge because they recognize how innovation actually drives progress. They realize that timing matters: place matters and proximity matters.

These gatherings do not compete with J.P. Morgan Healthcare Week; they complete it. Together, they create a comprehensive view of the health innovation lifecycle, from initial insight to global execution.

What I witnessed in that half-filled room was not hype. It was intent. Seven minutes at a time, company after company made a case—not just for funding, but for belief.

That is why the Biotech Showcase remains exactly what its name promises: a showcase of possibilities. And why, in the great dating game of health innovation, does it remain one of the most honest and productive places to begin?

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Inside the Westin St. Francis, a carefully curated (invite-only) group of life science companies presents to an audience that shapes markets, valuations and strategy for the year ahead. It is the most visible stage in health innovation and remains so for good reason.

However, innovation has never been confined to a single ballroom. It was once clustered along the corridors of New Jersey’s research parks, then radiated west to the Bay Area, before stretching across the Golden Triangle of London, Cambridge, and Oxford, finding parallel intensity in Paris, Rehovot and accelerating across Asia, from China to Singapore and beyond. Discovery has always followed talent, capital, and curiosity – not hotel addresses.

A Tale of Two Meetings in One City

Biotech Showcase reflects that reality. Each January, companies arrive in San Francisco carrying science born far beyond the Bay Area and find a setting designed to recognize promise wherever it originates. The meeting has become a convergence point for a distributed industry, where the next breakthrough is just as likely to come from Beijing or Boston as from Silicon Valley or Singapore, and where sound science and partnership, not proximity, determine what advances.

Parallel to that marquee gathering, another meeting has quietly and persistently grown into an indispensable part of the week’s architecture. Now in its 18^th year, the Biotech Showcase, co-produced by DEMYCOLTON and Informa, has become the gathering place where the broader biotech, pharma, and medical device ecosystems converge to drive the work that ultimately informs trade industry headlines. It is not an alternative to JPM; rather, it is the grassroots connective tissue that enables the rest of the week to function.

It’s Not the Place – It’s the Connections

“This meeting addresses a critical need for emerging biotech companies to be heard. We’re showcasing truly innovative companies, both as presenting companies and in our panel conversations. In fact, during one session, people walked in simply to hear what was new, the information they don’t hear elsewhere,” said  Sara Jane Demy, Founder & CEO of Demy-Colton, one of the gathering’s two convenors.  “We serve as the home for emerging and startup companies – seed-stage through Series A, B, and C, and small-cap. These are the companies developing the breakthrough therapies and technologies that will become the foundation of today’s science, leading to tomorrow’s therapies. We’re the innovation engine for the little guys,” she added.

When Biotech Showcase began almost two decades ago, its purpose was practical rather than aspirational. Many promising companies, mostly venture-backed, science-driven, and globally ambitious, were not on the JPM agenda. They still needed access to investors, strategic partners and business development leaders who were already flying into San Francisco for the “main show.” Biotech Showcase created a professional, disciplined, curated forum for those conversations to happen with intention rather than improvisation.

Dr. MaryAnne Rizk, head of Health AI, AWS, supports Ms. Demy’s words.  “The Biotech Showcase is where the future of medicine is previewed, bringing together an ecosystem of trusted innovators to share the next decade of healthcare.”

As JPM grew in scale and influence from the Hambrecht & Quist Healthcare Conference, it also became more constrained by space, protocol, and precedent. Presentation slots were scarce. Visibility became concentrated. Meanwhile, the number of companies advancing meaningful science expanded exponentially. New modalities emerged. Platform technologies matured. Innovation globalized. The industry needed a setting that could absorb this growth without diluting seriousness or credibility.

Today, the contrast between the two meetings is less about size than about function. JPM remains the industry’s loudest signal, a place where established players outline direction and investors listen for cues and dropped hints.

San Francisco during JPM Healthcare Week has become a global meeting ground for life-science leaders. Eden Ben, CEO of Amorphical, arrived at Biotech Showcase with a clear purpose: “I’m here during JPM Week and Biotech Showcase to present the Amorphical proprietary platform addressing metabolic bone and inflammatory diseases. We’re engaging investors around encouraging clinical results in osteoporosis, Crohn’s disease, and pancreatic cancer, with the goal of securing strategic investment to advance these programs into Phase 2b.”

Biotech Showcase Evolved into A Go-To Setting

Biotech Showcase, by comparison, is quieter but no less consequential. With more than 3,000 attendees, including more than 1,000 investors, and hundreds of presenting companies from around the world, it has become the driving force of the week. There are more than 350 company presentations.  Thousands of one-to-one meetings are scheduled in advance, not left to chance encounters in hotel lobbies. These are not symbolic conversations. They are the early architecture of partnerships, financing, and long-term collaborations.

What is striking is how intentionally this community has formed. A single profile does not define the companies that present at the Biotech Showcase. Some are early-stage and pre-clinical. Others are approaching pivotal trials or preparing for commercial transition. Many are international firms seeking a foothold in the U.S. market. Increasingly, they span disciplines that did not exist when the meeting began: AI-enabled discovery, data-driven trial design, diagnostics that blur the line between software and biology, and climate-adjacent technologies reshaping biomanufacturing and supply chains.

This community has lived through cycles together. It has seen exuberance give way to discipline, easy capital tighten into scrutiny, and promising science tested by unforgiving markets. During the pandemic, when in-person meetings were no longer possible, Biotech Showcase adapted, preserving its core function even as the format changed. When travel resumed after the COVID shutdown, there was a palpable recognition that these structured, face-to-face conversations were no longer a nice-to-have; they were essential.

Some gatherings that once anchored JPM week have shifted their center of gravity elsewhere, following the rise of new conference hubs and festival-style convenings. Biotech Showcase did not. It stayed rooted in San Francisco, aligned with the rhythm of JPM week, and doubled down on what it does best: creating order, access, and momentum for companies still earning their story.

In that sense, it has become the “other mega meeting” of the week, not because it competes for attention, but because it transmits the energy JPM generates and redistributes it across the ecosystem. Investors move fluidly between rooms. Business development leaders extend conversations that began elsewhere. Companies that may never stand at the Westin podium still find themselves in dialogue with mega partners who can change their trajectory.

What makes 2026 feel particularly distinct is the tone of the conversations unfolding inside Biotech Showcase. The industry is recalibrating. After years of volatility, there is a renewed emphasis on scientific rigor, capital efficiency, and partnerships built for durability rather than speed. Artificial intelligence is no longer presented as novelty; it is assumed, embedded, and evaluated for impact. Global health challenges, such as aging populations, the burden of chronic diseases, and climate-driven disruptions, are shaping what investors and innovators consider essential.

Less noise, and More Intent

In that environment, Biotech Showcase feels less like a workaround and more like an integral part of the infrastructure. It is where emerging companies can be evaluated on their merits rather than their market capitalization, allowing investors to see breadth without sacrificing depth. Where the future of health is assembled incrementally, through conversations that may never make headlines but ultimately shape outcomes.

JPM will always be the stage where the industry speaks to itself and the world. Biotech Showcase is where the industry listens, questions, and connects.

“We cover technology and therapeutics from A to Z, focusing on the earliest and most exciting stages of innovation, when the science is bold and the stakes are highest. This is also the most precarious phase, which is why visibility matters. Over the years, we’ve seen many of our companies graduate from this meeting to participate in the J.P. Morgan Healthcare Conference. When they reach that stage, they no longer need us, but there is always a new generation of innovators stepping in to take their place,” reflects Ms. Demy.

Eighteen years in, its importance is no longer anecdotal. It is measurable in attendance, in business development meetings scheduled, in companies that return year after year, either because something meaningful happened the last time they were here or they believe the quality of attendees warrants their attention. It is evident in the way the community shows up not to be seen, but to engage.

That is why Biotech Showcase flourishes, not as a counterpoint to JPM, but as its indispensable counterpart.

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In modern America, “the bread” has changed. It is no longer found in a Parisian bakery but in a community health center, a pharmacy, or a hospital admissions office. It is insulin, chemotherapy, biologics and mental health care. Access to these essentials increasingly depends not only on medical need but also on administrative thresholds, shifting eligibility rules, and delay mechanisms that quietly determine who waits, who deteriorates, and who absorbs financial collapse as collateral damage.

When Illness Becomes Economic Collapse

Medical debt has become the most visible expression of this misalignment. More than 100 million Americans now carry health-related debt, much of it incurred despite having health insurance. For millions of Americans, a single diagnosis can be enough to destabilize their household finances permanently. Medical debt damages credit, constrains housing and determines employment options. It fuels chronic stress that contributes to poorer health outcomes. It punishes people not for recklessness, but for uninvited illness.

The consequences extend well beyond ledgers. Individuals carrying medical debt are significantly more likely to delay or avoid needed care, skip prescriptions or postpone follow-up visits. Families report cutting back on food, utilities or rent to manage medical bills. In this way, illness becomes an economic accelerant, pushing people already close to the edge into deeper instability. Survival may be possible, but recovery, both financially, emotionally, and psychologically, becomes elusive.

For patients with serious illnesses such as cancer, autoimmune disease, or rare conditions, the stakes are far higher. Financial toxicity has been associated with increased mortality among cancer patients, as out-of-pocket costs lead individuals to delay treatment or abandon therapy altogether. This occurs at the same time that medical innovation has never been more promising. Targeted therapies, biologics, and personalized medicine are extending life and improving quality of life. The contradiction is stark: scientific progress accelerates while access narrows.

How Administration Became a Barrier to Care

At the center of this contradiction sits prior authorization. Originally intended as a utilization management tool, it has evolved into a pervasive barrier to timely care. Physicians report that prior authorization routinely delays necessary treatment and consumes hours of clinical time, while patients wait often in pain, sometimes in medical crisis. In oncology, delays can mean missed treatment windows. In neurology, they can mean needless pain or irreversible decline. In mental health, they can mean crisis escalation and hospitalization.

Denial rarely arrives as a clear refusal. More often, whether intentional or not, care is slowed until the patient deteriorates, disengages, or pays out of pocket. The system follows the rule, but the consequence is the weight that the patient carries. What was designed as stewardship increasingly functions as deterrence, too often transferring the burden of cost control to those least equipped to carry it.

Public programs meant to stabilize access have not been immune to this dynamic. Medicaid and Medicare, established as pillars of the American safety net in 1964, now operate amid growing instability. Eligibility thresholds are a moving target. Redetermination processes remove coverage for administrative reasons, rather than due to changes in need. Patients in active treatment lose coverage mid-course, forcing physicians to scramble and patients to panic. Coverage churn disrupts care and erodes trust, encouraging people to delay engagement with a system that is no longer structured to protect them when they are most vulnerable.

Taken together, medical debt, administrative delay, and coverage instability are not isolated policy failures but a systemic pattern. The modern sick-care system excels at episodic intervention but struggles with continuity, predictability, and lived experience. It measures success in transactions rather than trajectories, focusing on efficiency rather than consequences. Innovation thrives, while access to these medicines frays.

Violence is Never Justified

Hugo warned of where this leads. When systems feel unreachable, when appeals are endless and context is stripped away, frustration hardens into despair—the search for bread. Despair does not always erupt visibly. More often, people delay care not because they are indifferent to their health, but because they are afraid of what seeking care will cost them financially and emotionally.

Violence is never justified. The murder of health insurance executive Brian Thompson must be condemned without qualification. It is a human tragedy, not a symbol, and should never be rationalized. At the same time, refusing to examine the conditions that fuel public rage that applaud the killer is a warning sign about how people experience health care as an institution that governs life-and-death decisions while feeling increasingly inaccessible and unaccountable.

In Les Misérables, bread was enough to keep Jean Valjean’s family alive, but it was the weight of rigid systems that nearly broke him. That distinction matters today. When access to health care is treated as something to be rationed through delay, instability, and administrative friction, survival may still be possible, but long-term stability is put at risk. Medical debt, coverage churn, and seemingly weaponized delays do not merely inconvenience patients; they reshape how people relate to illness, the government, and companies, and allocate care.

The path forward does not begin with sanctifying health care, nor with vilifying those who work within it. It starts with recalibration. Administrative tools must serve care rather than obstruct it. Eligibility for public programs must offer predictability, not whiplash. Access must be treated as infrastructure, something that must function under stress, not a privilege rationed through complexity. America’s health-care story is still being written. Its outcome will not be determined solely by innovation or cost control, but by whether systems are designed to work when people are most vuln

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Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family’s health care might soon be upended.

MU Health Care, where most of her family’s doctors work, was mired in a contract dispute with Wingler’s health insurer, Anthem. The existing contract was set to expire.

Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling.

“I know that they go through contract negotiations all the time … but it just seemed like bureaucracy that wasn’t going to affect us. I’d never been pushed out-of-network like that before,” she said.  

The timing was awful.

The query: When a Missouri mom’s health insurance company couldn’t come to an agreement with her hospital, most of her doctors were suddenly out-of-network. She wondered how she would get her kids’ care covered or find new doctors. “For a family of five, … where do we even start?”

— Amber Wingler, 42, in Columbia, Missouri

Wingler’s 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year.

(In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)

Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler delayed her daughter’s appointments for months while she tried to figure out what to do.

Nationwide, contract disputes are common, with more than 650 hospitals having public spats with an insurer since 2021. They could become even more common as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump’s signature legislation signed into law in July.

Patients caught in a contract dispute have few good options. “There’s that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people who are having trouble accessing health care.

If you’re feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:

1. “Out-of-network” means you’ll likely pay more.

Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company’s network.

Most patients prefer to see providers who are “in-network” because their insurance picks up some, most, or even all of the bill, which could be hundreds or thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.

If you decide to stick with your familiar doctors even though they’re out-of-network, consider asking about getting a cash discount and about the hospital’s financial assistance program.

2. Rifts between hospitals and insurers often get repaired.

When Brown University health policy researcher Jason Buxbaum examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18% of them had a public dispute with an insurance company sometime from June 2021 to May 2025.

About half of those hospitals ultimately dropped out of the insurance company’s network, according to Buxbaum’s preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in the network, even after a split.

3. You might qualify for an exception to keep costs lower.

Certain patients with serious or complex conditions might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but the process may prove lengthy. Some hospitals have set up resources to help patients apply for that extension.

Wingler ran that gantlet for her daughter, spending hours on the phone, filling out forms, and sending faxes. But she said she didn’t have the time or energy to do that for everyone in her family.

“My son was going through physical therapy,” she said. “But I’m sorry, dude, like, just do your exercises that you already have. I’m not fighting to get you coverage too, when I’m already fighting for your sister.”

Also worth noting, if you’re dealing with a medical emergency: For most emergency services, hospitals can’t charge patients more than their in-network rates.

4. Switching your insurance carrier may need to wait.

You might be thinking of switching to an insurer that covers your preferred doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your “plan year.”

Certain life events, such as getting married, having a baby, or losing a job, can qualify you to change insurance outside of your annual open enrollment period, but your doctors’ dropping out of an insurance network is not a qualifying life event.

5. Doctor-shopping can be time-consuming.

If the split between your insurance company and hospital looks permanent, you might consider finding a new slate of doctors and other providers who are in-network with your plan. Where to start? Your insurance plan likely has an online tool to search for in-network providers near you. 

But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.

6. It’s worth holding on to your receipts.

Even if your insurance and hospital don’t strike a deal before their contract expires, there’s a decent chance they will still make a new agreement.

Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.

End of an Ordeal

Three months after the contract between Wingler’s insurance company and the hospital lapsed, the sides announced they had reached a new agreement. Wingler joined the throng of patients scheduling appointments they’d delayed during the ordeal.

In a statement, Jim Turner, a spokesperson for Anthem’s parent company, Elevance Health, wrote, “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted.”

Maze from MU Health Care said: “We understand how important timely access to pediatric specialty care is for families, and we’re truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations.”

Wingler was happy her family could see their providers again, but her relief was tempered by a resolve not to be caught in the same position again.

“I think we will be a little more studious when open enrollment comes around,” Wingler said. “We’d never really bothered to look at our out-of-pocket coverage before because we didn’t need it.”

Author: Bram Sable-Smith: brams@kff.org, @besables

Illustrations: Oona Zenda: ozenda@kff.org

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