The Grand Roundup: $12B Matt Holt/Ensemble deal, Hawaii's payvider bet unravels, PwC's highest commercial trend in 18 years, Clover Stars win, clinical AI regulation, and more

Kevin and Martin chat about Matt Holt's return with a reported $12 billion bid for Ensemble Healthcare Partners. They unpack what it means that Thoreau, Holt’s AI-forward play, is interested in a business whose CEO explicitly pitched a more human-centric approach to RCM. From there, they do a deep dive into what’s going on in Hawaii: HMSA's decade-long VBC experiment is unraveling, providers have done a complete 180 on whether they want it, and the state is now pushing a payvider merger that makes even less sense given the backdrop. Kevin traces it all back to the same payer-provider adversarial dynamic playing out across the country. Then they take a look at PwC's 2027 commercial trend report, which projects a 9% increase in medical costs, the highest in 18 years, with AI-driven billing optimization leading the charge, followed by behavioral health volume, GLP-1s, No Surprises Act fallout, and hospital services inflation. The politics aren't subtle: AI that helps providers bill more is innovation, while AI that helps payers deny more is bad. They also touch on recent stock moves for Clover and Alignment as signs that managed care is trending upward again.

John Kao, chairman and CEO of Alignment Health, joins to explain why he always says not to bet against Medicare Advantage. He walks through what's made Alignment's California model work, why expanding outside the state is harder than it looks, and how health systems are increasingly coming to them — not the other way around — because keeping MA patients out of beds is good for all parties.

Hashem Zikry from Counsel Health closes the show with a discussion on clinical AI regulation. He frames the current U.S. landscape as a laboratories-of-democracy experiment — Utah running a live sandbox, New York and Colorado pulling back — and argues the federal government should set a floor, not a ceiling. He also breaks down Counsel's new partnership with Oura, which this week begins integrating biometric data into clinical decision-making for the first time, and pushes back on the concern that wearables just generate more utilization.

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Links referenced

PwC report: https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html

Follow John on LinkedIn: https://www.linkedin.com/in/johnkao1/

Hashem’s LA Times story: https://www.latimes.com/opinion/story/2026-04-25/ai-democratize-medicine-regulation

Follow Hashem on LinkedIn: https://www.linkedin.com/in/hashem-e-z-87243529a/

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