Former Department of Justice officials Martin Gaynor and Jonathan Kanter warn that the growing dominance of vertically integrated health care conglomerates—like UnitedHealth Group and CVS Health—threatens competition, raises costs, and limits physician autonomy. In a JAMA opinion piece, they argue that these entities now control everything from insurance and pharmacy benefits to data analytics and physician services, creating “Big Health Care” platforms that mirror Big Tech monopolies.
Author: Abhay Panchal
There are a number of treatment options, and we’ve been fortunate that several have been approved lately for Crohn’s disease. There are the anti-TNF medications, which include medicines like infliximab, adalimumab or certolizumab. Those have been sort of our most longstanding therapies for Crohn’s. We’ve also had vedolizumab for a number of years for Crohn’s disease.
AI has the potential to revolutionize prior authorization by reducing administrative burdens and expediting approvals, but physicians remain wary that it could worsen care delays and increase denials if layered on top of a flawed system. While insurers tout AI’s efficiency, doctors fear it may be used to deny care without proper oversight—especially given past misuse by insurers like Cigna and UnitedHealth. Experts agree that for AI to improve outcomes, prior authorization must first be reformed to be more transparent, clinically grounded, and patient-focused. Otherwise, AI could merely automate inequities at scale.
Dr. Fola May, associate professor at UCLA and associate director of the Center for Health Equity, highlights the importance of patient-centered decision-making in colorectal cancer screening, noting that while colonoscopy remains the most comprehensive option—offering both detection and removal of precancerous polyps—noninvasive alternatives like stool-based FIT and FIT-DNA tests are suitable for those hesitant about colonoscopy.
Oshi Health, a national virtual gastroenterology clinic, has introduced a bold 100% fees-at-risk ROI Guarantee, tying its reimbursement directly to measurable clinical outcomes and cost savings for employers and payers. Unlike typical engagement-based digital health models, Oshi offers high-touch, multidisciplinary care through GI-specialized clinicians who collaborate in real time to drive sustained symptom control, reduce ER visits, and eliminate unnecessary costs.
Marta Wosińska’s analysis in the Brookings Institution spotlights serious concerns surrounding the unregulated compounding of semaglutide, a GLP-1 drug widely used for weight loss. Although the FDA recently declared approved semaglutide no longer in shortage, a booming market for cheaper, compounded versions—often made from bulk powder sourced from largely unregulated Chinese suppliers—continues. The absence of a U.S. Pharmacopeia (USP) quality standard means many manufacturers set their own specifications, increasing risks of impurities and substandard production.
Sap Sinha, MHCI ’22 and COO of Allied Digestive Health (ADH), is transforming gastroenterology care by blending operational excellence with innovation inspired by Penn’s Master of Health Care Innovation program. Under his leadership, ADH’s revenue soared from $70M to $200M, while achieving a perfect CMS MIPS score for quality and cost-efficiency. He digitized patient check-ins, streamlined billing with AI tools, and introduced ambient scribing technology like Suki to reduce clinician burden and enhance face-to-face care. Sinha also founded the NJ and NY Independent Physicians Practice Associations to influence health policy and amplify the voice of independent providers.
The Centers for Medicare & Medicaid Services (CMS) has extended telehealth coverage for Medicare beneficiaries through September 30, 2025, preserving key pandemic-era flexibilities such as payment parity, geographic freedom, and provider expansion. While new CPT codes (98000–98015) for telehealth were introduced, CMS will not adopt them, instead continuing use of existing E/M codes and requiring POS 10 or 02, with Modifier 93 for audio-only services.
Researchers at the University at Buffalo have developed a new AI tool called SCAI (Semantic Clinical Artificial Intelligence) that outperforms most human physicians—and all prior AI models—on the U.S. Medical Licensing Examination (USMLE). By integrating formal medical knowledge from peer-reviewed sources, clinical guidelines, and pharmacological data, SCAI enables AI to reason like a physician. In testing, SCAI-enhanced large language models scored up to 95.1% on Step 3 of the USMLE, surpassing GPT-4 Omni. The study, published in JAMA Network Open, suggests AI like SCAI could support physicians in clinical decision-making—not replace them, but significantly enhance their diagnostic capabilities.
From pay shifts to projected increases in colorectal cancer cases, here are 13 numbers worrying gastroenterologists: 3%. How much gastroenterologist compensation fell in 2024, according to Medscape’s 2025 Physician Compensation Report. 2.83%. The Medicare pay cut that took effect Jan. 1 without Congress intervening and follows a 1.69% Medicare pay cut in 2024 and 2% drop in 2023