The Grand Roundup: Elevance CMS update, healthcare AI bundling vs. the $100B benchmark, Clover Stars ruling, D-SNP upcoding, No Surprises Act, CVS/Tennessee PBM split, and more

News & Analysis from Health Tech Nerds
Kevin and Martin open with Elevance's "thumb drive gate" CMS update, a $935 million accrual, and questions about what they ultimately owed. They debate how many $100 billion healthcare AI companies the market can support, using Commure's $7B valuation and Rockefeller-esque platform ambitions as a case study. In health law: the Clover Stars ruling and post-Chevron MA bid uncertainty, the Massachusetts AG's D-SNP upcoding lawsuit against UnitedHealthcare, No Surprises Act IDR enforcement chaos in Texas, and CVS suing Tennessee over PBM-pharmacy separation. They close by talking about Providence Health Plan and PacificSource exiting markets and the persistent struggles of regional non-profit health plans.

Amit Shah, President of Virta Health, makes the case that the GLP-1 era is actually Virta's moment, with ten years of clinical data on reversing metabolic disease through nutrition showing that Virta is uniquely positioned to serve patients before, alongside, and after drug-based treatment.

Michelle Turner, founder of Here Now Health, introduces the niche but consequential world of foster specialty Medicaid plans and the high-acuity, high-transiency population they serve. She explains how Here Now was built from the ground up to get kids into care fast, keep them there through instability, and give health plans a far cheaper alternative to crisis care.

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Referenced:
Commure CEO on the Sourcery podcast: https://www.youtube.com/watch?v=Vd4HHQ1l9mM

Willamette Week: Inside the Collapse of Providence Health Plan: https://www.wweek.com/news/2026/05/27/inside-the-collapse-of-providence-health-plan/

Tennessee Lookout: CVS sues Tennessee: https://tennesseelookout.com/2026/05/26/cvs-sues-tennessee-over-pharmacy-benefit-manager-monopoly-law/

JAMA article on growth of provider-sponsored health plans, 2018–2023: https://jamanetwork.com/journals/jama/fullarticle/2849517?guestAccessKey=1784f8b9-4583-4e15-a622-2d458bce7e11

Virta peer-reviewed papers: https://www.virtahealth.com/research

Here Now Health: herenow.health / michelle@herenow.health