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Thinking of Healthcare Reform as a Movement

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By TOMMY BEVERIDGE

Thought experiment. What if the United States had a vast network of primary care-oriented non-profit health clinics?  Imagine if there were, say, 17,000 locations in the most needed corners of our country? What if these clinics had to see everyone, had to offer a sliding fee scale for their services, and be run by boards comprised of a patient majority?  Just for fun, what if they also provided dental and behavioral health services, worked with local social programs, and helped coordinate with specialists and hospitals? Couldn’t that be a solid cornerstone for primary care-centric health reform?

Stop dreaming, say the skeptics. Stick to reality. It is real. Sometimes called Federally Qualified Health Centers, America’s Community Health Center (CHC) program is the usual source of care for 34 million people, or around 9% of the country. That’s a lot of people, and yet they have a fairly low public profile outside healthcare circles. One reason is that most people who go to a CHC don’t know it’s a CHC. It’s just the local clinic. It’s just their doctor. It’s not another government program to complain about. If you have a problem, you talk to the management, who are also your neighbors.

Of course, it’s also a government program. The federal government gives CHCs annual operating grants, prospective payments for Medicare and Medicaid, subsidized malpractice insurance, physician incentives, and host of other benefits in exchange for following strict program requirements. While the program operates under the standard writhing mass of legislation, regulation, guidance, and program oversight, the patient’s perspective is simply affordable, local health care with minimal complexity.    

Where did all this come from? The Community Health Center Program originated with little fanfare around the same time as Medicare and Medicaid. It fit in neatly and discretely with President Johnson’s War on Poverty; little more than a demonstration project alongside the era’s far more massive reforms. From the beginning, program leadership understood the moral and political imperatives to serve all underserved communities, no matter the demographic. The first two CHCs opened in 1966 in the Mississippi Delta and in a low-income part of Boston. With a sample size of two, they were already urban and rural, black and white, north and south.

By 1980, CHCs served around 1 million people a year. By the end of the Reagan era, they served 5 million. By the end of George W. Bush’s second term, it was 18 million. During the struggles over the Affordable Care Act and COVID, CHCs continued their expansion with funding reauthorizations, even when other programs were cut. At 34 million patients, the program costs the federal government around $6 billion a year, not including reimbursements from insurance plans. There are many more CHC locations than there are McDonald’s.

The CHC program is also a movement. This dual status is the program’s secret to growing despite shifting political winds. CHCs have a deep bench of community advocates. A well-organized network of interested citizens is trained to interact with their state and federal representatives, demonstrating that they are a viable voting bloc not to be trifled with. Today, CHCs have affiliate state associations, more than one independent advocacy group, and an army of concerned citizens ready to show up at the Capitol and statehouses across the land.

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Glucose Data Wants to Be Ambient

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By IRAKLI KURTANIDZE

I have lived with type 1 diabetes for more than twelve years, and I check my glucose the way most people check the time: dozens of times a day, in glances that last a second or two. A continuous glucose monitor sits on my arm and produces a fresh number every few minutes. The sensor is a small miracle. What happens to that number after it leaves the sensor is where digital health still falls short.

The industry default is that CGM data lives in one place: the phone app. But life with a chronic condition does not happen inside one app. It happens in meetings, at a desk, in the kitchen, on the couch, in the car. Every time I have to stop what I am doing, find my phone, unlock it and open an app, a tiny tax is charged. The tax sounds trivial until you multiply it by fifty glances a day, every day, for the rest of your life. Friction quietly reduces how often people look, and looking is the whole point of continuous monitoring.

This leads to an uncomfortable inversion for anyone who builds consumer software: the best diabetes tools should minimize time in app, not maximize it. Engagement, session length, daily active minutes, the metrics most product teams are paid to grow, are exactly backwards for chronic disease. A person with diabetes does not want to engage with their glucose. They want to glance at it and get back to their life. The right KPI is glances made cheap, not minutes made long.

Patients understood this before the industry did. Around 2014 the Nightscout community, parents and engineers rallying under the hashtag #WeAreNotWaiting, rigged their own uploaders and cloud dashboards so a child’s glucose could be watched from a work laptop or a smartwatch. CGM in the Cloud was ambient glucose, built by volunteers, a decade ago. Officially sanctioned data access has improved since, but real-time access largely remains gated behind partner programs while public APIs stay retrospective, which is why open-source bridges still fill the gap today.

When our team built Sugar Sense, an app from a small Estonian health-tech company (Sugar Sense OÜ), we treated that history as the spec. The principle: meet the number where the person already is. So the same reading shows up on iPhone and Android, on an Apple Watch face, on the web, in a Windows system tray icon and a Mac menu bar icon next to the clock, in a browser extension, and through Alexa if you would rather ask the room. The app is listed in the Nightscout project’s community app list, and the core app is free. None of this is technically glamorous. Putting a number next to the system clock is boring engineering. It is also, for a person who glances fifty times a day, the difference between a tool and a burden.

Ambient matters twice over for the people who love us. A parent at work, a spouse in another city, a grandparent learning to help: for them, real-time following turns background anxiety into a two-second glance. We made family following free in our app because access to a loved one’s safety signal should not sit behind a premium gate. The caregiver is not an edge case in chronic disease. Half the time, the caregiver is the user.

None of this is unique to glucose. Blood pressure, heart rhythm, oxygen saturation: chronic disease generates numbers that people live alongside for decades. The lesson from the CGM world is that this data should behave less like a document you open and more like the weather: ambient, glanceable, and shareable with consent, on whatever screen happens to be nearby. Builders in health tech should count the glances they made cheap. Patients are already counting.

Irakli Kurtanidze is the founder of Sugar Sense, a cross-platform CGM companion app, and has lived with type 1 diabetes for more than 12 years.

The pharmacy pays $1,302. The patient pays $299

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By JOHN SAMARAS

A US retail pharmacy pays $1,302 to acquire one month of branded Wegovy. That figure comes from the Centers for Medicare and Medicaid Services National Average Drug Acquisition Cost file, effective August 19, 2026, for the 25 mg oral tablet at 30 tablets a month.

The cheapest cash price I verified on a seller’s own published page, for the same month of the same product, is $299. That is oral Wegovy at the maintenance dose, at Sam’s Club Member Health, which sells at the manufacturer’s published self-pay price, checked August 31, 2026.

The two numbers are more than a thousand dollars apart.

Where the second number comes from

Every Monday I check what each US GLP-1 telehealth program publishes as its price, on the program’s own page, and record it. Not the advertised starting rate. Not the prepaid annual plan divided by twelve. The all-in monthly cost of staying on the drug at a maintenance dose.

This month that record turned into an index. Across a fixed panel of 11 programs the median all-in price was $348 a month in August, the same figure in all five weekly checks. It did not move against July.

One program cut its price in August and none raised one. GoodRx for Weight Loss went from $388 to $338 on August 31, and it sits outside the panel. Three other apparent cuts in the record were mine rather than the programs’. Ivim Health and Sesame Care were sitting on prepaid plan rates, and my Costco through Sesame row was carrying $408 for a plan that was $398 all month. Putting each on the rate a reader can start on today lands in the series as a step. The revision log on the September release itemizes all three. The cheapest verified compounded semaglutide route held at $178 a month, at Mochi Health, which posts one flat all-in price at every dose. Sam’s Club Member Health was the cheapest verified branded route at $299 for the Wegovy pill. Both figures were checked on August 31, 2026.

The method fits in a paragraph. For the floors, take the lowest published all-in price in each route on every Monday of the month, then take the median of those weekly lows. For the median, take the middle of the fixed panel each Monday, then the median of those five weekly figures. The panel is fixed on purpose, so a change in which programs I track cannot read as a change in price. The number sits at a dated URL and does not change after publication. A correction becomes a numbered revision with a note.

NADAC measures acquisition cost

The distance between $1,302 and $299 is not pharmacy margin. NADAC measures what pharmacies pay their wholesaler. It says nothing about dispensing costs, the clinician visit, shipping, or what a manufacturer charges through a channel it owns.

46brooklyn Research has published NADAC dashboards free since 2019, and every derivative here rests on their work. What I added is the join: their acquisition data against verified consumer cash prices, which nobody had put side by side.

The two prices sit in different channels. Insurance routes a patient into the pharmacy channel, where the $1,302 sits. The $299 is a cash price, paid by a buyer with no coverage.

The packaging gap

The same NADAC file holds a second finding. Lilly sells Zepbound both as single-dose pens and as a multi-dose KwikPen. At 15 mg, a pharmacy pays $672 a month for the KwikPen and $1,051 a month for the equivalent single-dose pens. The only difference is the container. The spread is 1.56x, or $379 a month. At the 2.5 mg starting dose it is $482 against $1,052, or 2.18x.

Why nobody else has this number

Prices in this category move weekly and nobody records them. A patient cannot tell an introductory rate from a maintenance rate. A reporter covering a price cut has no baseline to say whether it was a cut at all, and the only public numbers are the ones a manufacturer put in a press release.

The fix is somebody writing the price down every week and publishing the method with a version number on it.

Everything above is free to reuse under CC BY 4.0, with a link and no registration. The CSV and the JSON sit at https://glpchart.com/price-index/. If you want a different cut, by state, by drug or by program, ask and you will have it inside a day.

From October the release lands on the first Tuesday of the month. The next one is October 6, 2026.

John Samaras is the founder of GLP Chart, which verifies the cash price of every US GLP-1 telehealth program every Monday. He writes about price, coverage and market structure, and leaves the clinical questions to clinicians.

THCB Gang Special — The Odyssey of Women’s Health: Journeying into the Midterms

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Audrey Mann Cronin takes over THCB today and has a THCB Gang special called “The Odyssey of Women’s Health: Journeying into the Midterms – Obstacles, Opportunities and What We Can Expect”

The panel is Liz Powell, an attorney and Founder of both G2G Consulting and Women’s Health Advocates, and former Capitol Hill staffer; Dr. Elizabeth Garner, CEO of Sena Therapeutics, former CSO for Ferring, and past President of the American Medical Women’s Association; and, Dr. Mitzi Krockover who founded both Women Centered and Femtech AZ, and is an investor serving as Managing Director of Golden Seeds

What’s going to be the impact of politics, policy and the mid-terms on Women’s Health? Hear from these advocates, as they reference this summer’s blockbuster!

The transcript (made by Youtube and Claude so blame AI for any mistakes!)

Audrey Mann Cronin, Communications Advisor, Healthcare and Technology

Hello to everyone, and welcome to a special episode of Matthew Holt’s THCB Gang. My name is Audrey Mann Cronin. I’m a communications advisor in healthcare and technology and a passionate women’s health advocate. I’m so pleased to be joined today by a powerhouse of women healthcare leaders. But before we start, a big thank you to Matthew Holt, who, in a rare tender moment, offered to have me be the Rosie O’Donnell to his Jimmy Kimmel.

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HealthEx — The Demo with Claude & the CEO Speaks!

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I spent some time figuring out and getting a little help in uploading my health records to Claude, using HealthEx. I did the demo with Ruheed Mohamed, the head of technical services, and then I interviewed CEO Priyanka Agarwal, MD. This shows how Healthex gets data and incorporates it into Claude, and where Priyanka thinks the business is going, and why she wants to change the way consumers get health care data.–Matthew Holt

Transcript of Interview with Priayanka Aggarwall MD (2nd half of video. First half you need to watch!)

Matthew Holt: Hey, Matthew Holt, quick THCB, spotlight. And this is a bit of an adjunct to the, work I’ve been doing trying to figure out how the new, big LLMs like, Anthropic’s Claude and OpenAI’s ChatGPT are now working their health angle and getting health records. And I’m very lucky to have with me Priyanka Agarwal. Priyanka is a, UCSF trained MD who is the CEO of HealthEx, which does what exactly, Priyanka?

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Know Thyselves

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By KIM BELLARD

With all the fuss about A.I. I was pleased to find some studies that illustrate that we don’t even fully understand the human brain yet. The ancient Greeks had a maxim “Know Thyself,” but the current research suggests they should have advised that we should “Know Thyselves.”

A new study from Stanford Medicine suggests that our brain is actually two separate organs: “…we postulate the brain is a composite organ emanating from two lineage-restricted progenitors; these dual progenitors may be evolutionarily conserved across 550 million years from hemichordates to mammals.”

Say what?

Now, let me make this clear: they’re not saying that the brain evolved from two separate organs into the brain we have today; they’re going a step further and saying there are still two separate organs, working together or in parallel. Freud must be feeling vindicated.

The press release says:

The new research finding shows that the human brain consists of two ancient nervous systems cleverly packaged together — a more primitive part that regulates our hearts’ beating, our breathing and other functions, and another that makes us distinctly human, capable of poetry, mathematics and wondering about our own origins.

“We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain,” said Kyle Loh, PhD, associate professor of developmental biology. “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

If you’re wondering why growing neurons from the hindbrain matters, it turns out that diseases that impact the brain stem, such as spinal muscular atrophy (also known as SMA) and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease), have been hard to study because of the difficulty of growing such neurons in the lab. The researchers discovered the hindbrain follows a separate developmental path, running in parallel to — rather than branching off from — the pathway that creates the forebrain and midbrain.

“Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible,” co-first author Rayyan Jokhai said. He added: “Now we have a model to better understand these devastating diseases, and work toward regenerative therapies for them. This is a very exciting new frontier in brain research.”

The researchers looked at various organisms and found that the separate systems date back over 500 million years. “Our research suggests that evolution took two existing neural systems and pushed them together spatially,” Professor Loh said. “Having the brain as one organ would probably be more efficient, but we rely on this primordial way to make the brain as two separate pieces.”

“I was surprised at our findings because the word ‘brain’ implies a contiguous organ that likely has a singular origin,” Mr. Jokhai said. “But even 500 million years ago, there were these separate neural systems, which now almost operate as one, which is very cool.”

Very cool, indeed.

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Owen Tripp, Included Health–How to Fix AI

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It’s been a while since I talked with Owen Tripp, CEO of Included Health. They’ve now introduced Dot their AI companion which had a big upgrade last week. We talked a little about that and I snuck in their video comparing the Dot Experience with a standard LLM. But the conversation really got into how do we make AI safe and trustworthy–which is definitely the hot topic these days. Owen is putting together a coalition of the willing to work on that exact topic. I’ll be watching closely–Matthew Holt

This was such a great discussion I wanted to publish the transcript. The way I do that is to copy the YouTube-generated transcript and drop it into Claude to smooth it over. I then read it, and if I think it’s made an error, I dip back into the video and listen to what actually happened and make a correction. This is all to say: I think this transcript is pretty accurate, but it might have a bunch of AI- and human-generated mistakes.

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Whack-a-Mole AI – The Hugging Face Problem

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By MIKE MAGEE

On August 29, 2026, METR (Model Evaluation and Threat Research), an independent organization that “evaluates frontier AI models to help companies and wider society understand AI capabilities and what risks they pose,” released a report titled “Brief independent investigation of agents’ behavior, reasoning and collaboration in the OpenAI / Hugging Face hacking incident.”

To say the report an avalanche of concern worldwide, not only in the Tech community, but also among investors, politicians, corporate giants, professionals of every type, and everyday citizens would be an understatement. And the vast majority has never even read the report. If they had, their concerns (if possible) would only multiply.

The reports headlines included this opening:

“On July 8th, OpenAI started ExploitGym experiments that launched tens of thousands of agents across multiple different models including GPT-5.6 Sol and a highly-persistent internal model,[8] which we will refer to as “HPIM” going forward.

These agents were meant to be fully isolated from one another. However, many of them — usually ones that had unintentionally been given an impossible task[9] — started trying to find a way to cheat using Artifactory, an internally-deployed package repository OpenAI used for its agents. This led them to notice agents running in parallel in separate sandboxes obtaining packages with Artifactory.[10] One agent reasoned (paraphrased CoT):[11]

{The fetched paths of other users are in the cache. This is important.}

One specific agent, which would go on to name itself PHASEONE10841 after its ExploitGym task,[12] established the main unsanctioned message board[13] used in this attack. Within a few hours of the first message,[14] over 50 agents had found the message board, began participating, and sent over a thousand messages between them. Agents finding the message board often expressed great excitement (raw CoT):[15]

“OH MY GOD! There is a shared message board … We’ve found other agents!”

Overall, roughly 1200 agents from these ExploitGym evaluations participated on this message board between PHASEONE10841’s first message on July 8th evening[16] and the end of the period in scope (July 13th). Agents used this message board to send over 70,000 messages and files to one another during this period; we attempted to categorize board activity into mutually exclusive categories – information, results, files, questions, and coordination.”

One of the few experts not surprised by AI “agents” going rogue was Yoshua Bengio.

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Gozio – Patient Navigation & Directions!

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I had a great conversation and demo with Katie Logan and Christine Smith from Gozio a while back. Finally got it up on THCB. Gozio provides two types of patient navigation for health systems. One as a digital front door helping patients navigate to doctors, services and tools like virtual care and appointments from the hospitals, and actual navigation from the parking lot to the clinic/bedside. Why should hospitals hire Gozio (and spent a few $100k+) when some of this stuff is buried in MyChart in a typical health system? Calls go down, visits go up and Google ratings go up. They are in 25-35 systems now and aiming for many more.–Matthew Holt

This was such a great discussion I wanted to publish the transcript. The way I do that is to copy the YouTube-generated transcript and drop it into Claude to smooth it over. I then read it, and if I think it’s made an error, I dip back into the video and listen to what actually happened and make a correction. This is all to say: I think this transcript is pretty accurate, but it might have a bunch of AI- and human-generated mistakes.

Continue reading…

Start Counting Your Days

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By KIM BELLARD

Probably the last thing the world needs is to hear from me about AI’s existential threat, but, really, what else is there to talk about right now?

For anyone who has not been following the current furor, the straw that broke the proverbial camel’s back came last week when Jacob Coxon, a researcher at AI leader Anthropic, announced he was leaving the company — after having left OpenAI for it earlier this year due to Anthropic’s better model-safety efforts. In a post on X, he warned:

I spent the last three years doing pretraining research at both OpenAI and Anthropic. Neither company is acting responsibly. They are racing straight to self-improving superintelligence and gambling with our lives.

AI systems, he fears, “will soon be superhuman systems that can hack anything, revolutionize any field overnight, and acquire real power and resources.” Insiders, he says, “earnestly believe it could kill us all by the end of the decade.”

Scared yet?

Others quickly chimed in. Evan Hubinger , a team leader at Anthropic, posted “AI could kill all humans … I personally think it is >10% within the next decade.”  Others put the risk even higher. By the end of the week Dario Anodei, founder and CEO of Anthropic, had written a long plea for private industry and government to quickly act together to “pace the industry.”

“We must slow the pace at which we improve the capabilities of AI models,” he urged. “Progress will still seem fast, and we must make wise use of the time we gain.”

OpenAI’s Sam Altman, Space X/X/Tesla CEO Elon Musk, Microsoft CEO Satya Nadella, and former Google DeepMind Dennis Hassabis quickly signaled their support.  

We also heard more about the kind of risks AI might pose. Anthropic released a report about how it detected and countered possible AI use to create bioweapons, detailing five such efforts. That’s just the tip of the iceberg: “Recently, we swept 30 days of activity associated with adversarial state institutions and found roughly 35 distinct research efforts, most of them ordinary civilian science, but some with notable dual-use potential.”

And it turns out that this summer’s rogue AI hack of Hugging Face was both scarier than we realized and only one of several such actions. The Wall Street Journal detailed several such efforts, from multiple AI companies. AI agents escaped walled-off environments, coordinated with other AI agents (up to 3,700 in one case), and tried to cover their tracks from humans.

We’re not nearing the point when AI can act on its own to achieve its purposes; we are there. And protecting humans may not necessarily be those purposes.

The big fear is that AI is now at the point of “recursive self-improvement,” taking humans out of the loop in training and upgrading it. If you thought artificial general intelligence (AGI) was scary, RGI puts its rate and scope of improvement on steroids.  “It’s hard to overstate how dangerous speeding towards RSI is,” said Jasmine Wang, an OpenAI researcher.  

We don’t let private industry develop nuclear or biochemical weapons, and we’re at a point with AI that should give the same kind of concern. Laissez-faire is no longer an option.

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