The Grand Roundup: Q3 earnings from Centene to Lilly, HCA’s ACA-to-uninsured problem, Walmart and AI agents, Alignment’s miss, Medicaid frailty ruling, and more

Kevin and Martin dig into a busy Q3 earnings week where payers keep winning and providers keep absorbing the affordability squeeze. Centene beat and raised, hit MA breakeven a year early, and barely mentioned ICHRA. Alignment stumbled on a claims platform migration, high-cost cases and a Stars drop in its core California plan. On the hospital side, more of HCA’s ACA members went uninsured than it expected. CHS says commercial patients are pushing hip and knee replacements into next year, and Tenet keeps doubling down on ASCs. Teladoc had a huge week, DaVita’s kidney care business raised guidance again, and Kevin checks the math behind Lilly’s claim that GLP-1 Bridge saves Medicare $20 billion.

Next comes Medicaid. A judge blocked CMS’s medical frailty rule less than two months before work requirements start, and Martin explains why 2027 is the hospitals’ problem and 2028 is the payers’. They wrap with AI agents shopping for care through Zocdoc and Walmart’s Better Care Services, a study finding AI recommends roughly three times what physicians do, and what happens when your health agent is free.

Links referenced
Wall Street Journal: “Investors Are Betting a Blue Wave Will Hospitals. Don’t Count on It."
Michael Albert Substack: a breakdown of the USC preprint
USC preprint: the $20B Medicare savings from GLP-1 Bridge
NEJM AI study: AI care recommendations vs. physician costs

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