You're reading this because someone forwarded it to you — that's our entire distribution model. No Constant Contact, no email blast lists, no SEO, no LinkedIn. Once a month I'll send you a few things worth your time, based on the conversations we're having across the country: something we're building, a client driving meaningful, worth-noticing improvement, and a piece of ground truth we don't put on any homepage.
If any of it resonates with you, please pass it along.
We used to have a paragraph on our website that started like this:
We have lost people very close to us because the system was inefficient and broken.
I don't know when we changed our website and removed that statement — but it's still true, and it's still why this company exists.
It's also why we organize the company around four pillars. The first two — Increased Patient Access and Improved Outcomes for Patients and Families — sit at the top because the people we lost were not let down by the science — the science didn't fail them. They didn't survive their illnesses because they couldn't navigate the system to get timely, accurate care. Access and outcomes aren't marketing language for us. They're the unfinished assignment.
I think about my wonderful friend and mentor Sue Pelatzke every day. She is my daily inspiration to fix the machine.
Each month this column will carry one thing the homepage stopped saying that probably shouldn't have.
Every health system in the country is buying ambient scribes right now. Almost none of them can tell you whether the tool is moving patient access, clinician burden, or neither. Here's the chart we use.
Kate Nisbet and I have been colleagues, on and off, since the mid-1990s — which makes this our fourth decade working together! She is the Felix Unger to my Oscar Madison; if you have sat in on one of our working sessions, you know which of us has the color-coded binder.
Here, we're on our Arizona Board of Nursing engagement — our clinician well-being pillar in the real world, where policy, operational reality, and patient-centric care are all the same job.
Joe joined us earlier this year. I've known him about eight months, and I've liked how he thinks since our first conversation. Engineer by training — he's spent a career turning data companies into real businesses across SaaS, analytics, and higher ed. What I'm watching: what he does with our bilingual posture between claims and clinical data, because he's one of the few people I've met who can talk about it without hand-waving.
FHG speaks both clinical and claims. Clinical tells you what happened inside the chart. Claims tell you how the system actually behaves — every duplicated visit, every avoidable transfer, every patient the network is losing track of.
If you work on the delivery side, the most important data you can bring in is the claims feed from your health plan partners, or from Medicare-proper. That's where 135 becomes 200. That's also where the path to fewer 135s starts.
The 135 is real. Real physicians. Real patient. Real family. FHG takes no rights in our customers' data — it always belongs to them. This is what we are learning about U.S. health care.
That's one company's profit line for one quarter, spread across every person in the country. About nineteen dollars each. Six dollars and change per month. One Starbucks latte, every thirty days, from every American into UNH's pocket.
That's not literally how the money moves. Most of it flows through employer premiums, Medicaid and Medicare Advantage contracts, and individual ACA plans. Not everyone pays UNH. But the scale is real, and this is the profit line — what's left after the care was paid for, after the claims were processed, after admin, after taxes. It's the money leaving the U.S. health care economy for one company's shareholders, every ninety days.
Pillar 4 is “reduce the expense of U.S. health care.” This is what the expense looks like.
I don't think the country is fully aware of what the One Big Beautiful Bill's cuts to Medicaid are going to do — or how close the dominoes are to falling.
Most of my conversations right now are with clinical leaders, their CEOs, and their health plan partners that need to find a way to pull in the same direction. All of this is buttressed by the policy leaders we are brainstorming with to find the paths forward. Everyone acknowledges that taking $1 trillion of spend out of the system will have enormous unintended consequences. Very few are pricing in the scale.
I was in California the week before last. California's health care economy is the largest service industry in the country, and the exposure there runs into billions and billions and billions. Out in the Twin Cities, HCMC — our first client — paired with the pressure on North Memorial, we could be watching a safety-net collapse. In a blue state. In a Medicaid waiver state.
And the rural picture is worse.
If the rural hospital closes, the Walmart closes. If the Walmart closes, we're done with rural communities.
Governor Tommy Thompson — our board member, former four-term Wisconsin governor, former HHS Secretary — tells me every time we talk: we have to solve for the rural communities. He's right. That's the story of the next eighteen months, and it's the one I think FHG should be loudest about.
Next issue I'll walk through what we're actually seeing in the data.