The Grand Roundup: Anti-tiering contracts and the OhioHealth ruling, Thoreau/Ensemble update, 340B and Eli Lilly, OpenLoop's D2C play, Cleveland Clinic on AI trust, and more

Kevin and Martin by discussing the OhioHealth DOJ settlement and what banning anti-tiering, anti-steering clauses in hospital contracts could mean for employer plan design, narrow networks, and upstart insurance models. They talk about the $12B Ensemble Health Partners deal: what it says about the RCM market's appetite for holistic versus point-solution approaches, and where it might fit into Matt Holt's broader Thoreau acquisition agenda. The Clover-Stars recalculation gets a full breakdown: what the judge sided with, what CMS did next, who won, and the uncertainty now rippling through payer teams, provider comp models, and the whole vendor ecosystem built around Star scores. Martin digs into the 340B program via Minnesota's annual state report, explaining Eli Lilly's decision to freeze discounts for non-compliant hospitals, the FQHC access problem at the center of it, and whether a rebate model actually helps or just punishes the safety net players the program was designed for. And Kevin walks through OpenLoop's Shopify-for-telehealth launch, what it would actually mean if anyone with an audience could create a D2C GLP-1 brand in hours, and why the economics of that model are an interesting question.

Then JD Friedland, Executive Director for Ventures at Cleveland Clinic, joins to walk through how one of the country's flagship health systems is thinking about AI deployment. JD talks about what Cleveland Clinic has actually built with ambient listening, clinical trial enrollment via Dyania, and surgical documentation through Theator. He gets into the data consortium question—why your institution's data is most valuable when you’re an early contributor—and the liability and brand risk that makes health systems cautious about deploying forward-facing AI solutions they don't fully control.

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Links referenced

OhioHealth / DOJ Settlement: https://www.justice.gov/opa/pr/justice-department-requires-ohiohealth-stop-using-anticompetitive-healthcare-contract-terms

Minnesota 340B Report: https://www.health.state.mn.us/data/340b/docs/2025report.pdf

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