The Grand Roundup: Molina’s rate vs. trend math, Elevance’s ASO IDR squeeze, reinventing insurance from scratch, the Bon Secours deal, and more

Kevin and Martin open with the surprise news that Bon Secours is buying Surgery Partners, plus the Advocate headache of patients linking MyChart to ChatGPT, which sent Epic API calls up 7,000% and left Advocate paying for them. Then it’s Q3 payer earnings. Elevance beat, but mostly on investment gains, and says IDR costs are landing on its ASO book, which means employers are paying them. Molina’s 7% Medicaid rates against roughly 4.5% trend back up the “trough year” story. The guys also ask why Molina is staying in the ACA, and whether D-SNP or C-SNP is the more durable bet.

On the employer side, they go through the KFF survey, Oxbridge’s $45M raise for employer episode bundles, and Aon’s  Access Choice marketplace. Along the way they accidentally invent insurance companies from first principles. They also dig into STAT’s reporting on iMPROve Health, an IDR arbitrator whose financials have turned into a hockey stick.

To close, they cover Bob Wachter on who AI should serve and the coming “AI death panels” fight, General Medicine’s own medical group and its new Walmart partnership, Daniel Nadler’s drug discovery pitch for OpenEvidence, and Horizon buying Summit for about $1B.

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Links referenced
LRV Health and CVS paper on the AI agent explosion
Becker’s: “Patients linking MyChart to ChatGPT jumped 7,000% at Advocate. Who pays?”
Trilliant Health 2026 market trends report

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