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1,700 Members, Few Patients: The Medicare Slack Big Tech Shaped · DX Today | No-Hype Podcast & News About AI & DX

• 0:00
  SPEAKER_00: Welcome to the DX Today Podcast, your daily deep dive into the AI ecosystem.
• 0:05
  SPEAKER_00: I'm Brian, and joining me as always is Jessica.
• 0:08
  SPEAKER_01: Thanks, Brian, and today we have a story that sounds a little boring at first.
• 0:12
  SPEAKER_01: A Slack workspace, but it turns out to be one of the more consequential health policy stories of the year.
• 0:17
  SPEAKER_00: I'll admit that when I first saw the headline, my reaction was that every organization on Earth runs a Slack.
• 0:24
  SPEAKER_00: So walk me through why this particular one deserves a whole episode.
• 0:27
  SPEAKER_01: So this comes from reporting by KFF Health News, published on CBS News last Thursday.
• 0:34
  SPEAKER_01: It describes a Slack workspace run by CMS, the Centers for Medicare and Medicaid Services, with roughly 1,700 members.
• 0:42
  SPEAKER_00: 1,700 members is a lot of people for a government chat room.
• 0:46
  SPEAKER_00: So I think the obvious next question is who exactly those 1,700 people actually are?
• 0:51
  SPEAKER_01: That's the heart of it.
• 0:53
  SPEAKER_01: The members are overwhelmingly technology companies, AI startups, investors, and federal health officials.
• 1:00
  SPEAKER_01: The reporting names Microsoft, OpenAI, ORA Health, Palantir, and the venture firm 8VC among the participants.
• 1:07
  SPEAKER_00: And who is noticeably missing from that list?
• 1:10
  SPEAKER_00: Because I suspect the answer to that question tells us more about this workspace than the list of who was invited in the first place.
• 1:16
  SPEAKER_01: You guessed it.
• 1:17
  SPEAKER_01: According to the reporting, only a handful of patient advocates, doctors, and hospital representatives were in the room.
• 1:24
  SPEAKER_01: The people who actually deliver care and the people who receive it were a tiny sliver of the membership.
• 1:29
  SPEAKER_00: Okay, give me the timeline here, because I want to understand whether this was a quick working group that got out of hand or something that ran for a long stretch of time.
• 1:38
  SPEAKER_01: It started in August of 2025, so it has been running for more than a year.
• 1:43
  SPEAKER_01: Participants were welcomed by Amy Gleason, the former acting administrator of Doge, who is now chief product officer for a newly created CMS office focused on health technology and products.
• 1:54
  SPEAKER_00: So this is not some side project from a junior staffer.
• 1:57
  SPEAKER_00: It's tied directly to a senior official whose job is literally to build and ship health technology inside the agency that runs Medicare.
• 2:05
  SPEAKER_01: Exactly.
• 2:06
  SPEAKER_01: And it connects to a broader effort that HHS brands as the health technology ecosystem.
• 2:11
  SPEAKER_01: That's the administration's plan to push AI and modern software throughout the health system, including letting apps bill Medicare for services like wearable tracking.
• 2:20
  SPEAKER_00: I want to be fair here, because I've run systems inside large organizations, and getting vendors and engineers into one channel is often the only way anything ships on a reasonable timeline.
• 2:31
  SPEAKER_00: Why is this different from a normal technical working group?
• 2:34
  SPEAKER_01: That's the fair question.
• 2:35
  SPEAKER_01: And the answer is a law from the 1970s called the Federal Advisory Committee Act.
• 2:40
  SPEAKER_01: When the government gathers outside parties to give it advice on policy, that group generally has to meet in public and have balanced membership.
• 2:47
  SPEAKER_00: And let me guess, the workspace had some kind of document saying very clearly that it was not one of those advisory committees, because that's usually how these things get structured.
• 2:57
  SPEAKER_01: Right on.
• 2:58
  SPEAKER_01: The Code of Conduct explicitly said the group is not an advisory committee.
• 3:02
  SPEAKER_01: And it also said federal employees could not endorse products.
• 3:06
  SPEAKER_01: But legal experts, including a former FDA lawyer named Joseph Duvall, told reporters it looks a lot like one anyway.
• 3:14
  SPEAKER_00: So the label says one thing and the behavior arguably says another.
• 3:18
  SPEAKER_00: What did CMS say when the reporters asked them directly about whether this arrangement was actually legal?
• 3:24
  SPEAKER_01: They declined to answer questions about the legality.
• 3:26
  SPEAKER_01: Amy Gleason has described the whole health technology ecosystem as an open, voluntary technical collaboration, which is the framing the administration prefers, and it's not a crazy framing on its face.
• 3:37
  SPEAKER_00: Let's get into what actually happened inside the channel, because a chat room by itself is just people talking.
• 3:43
  SPEAKER_00: I care about what decisions or real-world outcomes came out of all that conversation.
• 3:48
  SPEAKER_01: There are three big outcomes worth walking through.
• 3:50
  SPEAKER_01: The first is an FDA listening session held in February of this year on conversational AI for patients.
• 3:56
  SPEAKER_01: Basically, chatbots that talk to people about their health and their symptoms.
• 4:00
  SPEAKER_00: That sounds like exactly the kind of meeting the public would want to know about.
• 4:03
  SPEAKER_00: So I'm guessing there's a catch to how that particular listening session was organized and announced.
• 4:08
  SPEAKER_01: The catch is that the invitation went out through the Slack.
• 4:11
  SPEAKER_01: Microsoft, Anthropic, OpenAI, Apple, and Google were invited.
• 4:16
  SPEAKER_01: At least 35 industry organizations attended, and the meeting was not on the public FDA calendar.
• 4:22
  SPEAKER_01: The public simply wasn't invited.
• 4:24
  SPEAKER_00: That bothers me more than the Slack itself.
• 4:27
  SPEAKER_00: Talking to industry is normal and frankly necessary, but holding the substantive conversation where only industry can hear it is a very different thing.
• 4:35
  SPEAKER_01: And that's the second order effect I keep coming back to.
• 4:39
  SPEAKER_01: Whoever is in the room early shapes the first draft.
• 4:42
  SPEAKER_01: And the first draft of a regulation tends to become the final version with only modest edits.
• 4:46
  SPEAKER_00: What's the second outcome?
• 4:48
  SPEAKER_00: You said there were three, and I want to make sure we cover all of them before we start arguing about what any of this ultimately means.
• 4:55
  SPEAKER_01: The second is the Medicare App Library.
• 4:57
  SPEAKER_01: It promotes about two dozen commercial AI apps to seniors and people with disabilities.
• 5:02
  SPEAKER_01: And officials told industry participants that apps in the library would be prioritized for the new reimbursement program.
• 5:08
  SPEAKER_00: Now that is real money and real distribution.
• 5:11
  SPEAKER_00: If Medicare.gov puts your app in front of tens of millions of beneficiaries and then pays for it, you've basically won the lottery as a health startup.
• 5:19
  SPEAKER_01: And the officials seem to know it.
• 5:21
  SPEAKER_01: Jacob Schiff from the CMS Innovation Center described the effort as a potential sales engine for these apps.
• 5:27
  SPEAKER_01: And a recording of those remarks was made private after the reporters asked about it.
• 5:32
  SPEAKER_00: That detail is going to stick with people, and not in a good way, because quietly hiding a recording after a reporter calls tends to look worse than whatever was actually said on the recording.
• 5:41
  SPEAKER_01: There's another quote that I think matters even more.
• 5:44
  SPEAKER_01: A CMS official named Morgan Taylor said that if Medicare.gov promotes an app, enrollees would trust it.
• 5:52
  SPEAKER_01: That's the whole value of the government seal.
• 5:54
  SPEAKER_01: And it's also the risk.
• 5:56
  SPEAKER_00: Give me a concrete example of an app that's actually in this library, because I want to understand what kind of product we're really talking about when we say AI Health app for seniors.
• 6:06
  SPEAKER_01: One example in the reporting is an app called Slothwise, priced at$9.99 a month.
• 6:12
  SPEAKER_01: Its chief executive told reporters the app is informational only, which is a careful phrase in healthcare.
• 6:18
  SPEAKER_00: Informational only is the kind of phrase that lawyers love and patients rarely read.
• 6:22
  SPEAKER_00: My 80-year-old neighbor is not going to parse the difference between information and advice when the government website recommends it.
• 6:29
  SPEAKER_01: Which brings us to the American Medical Association.
• 6:32
  SPEAKER_01: Its chief executive, John White, said some of these tools aren't ready for prime time.
• 6:37
  SPEAKER_01: And he pointed out that there's no liability if they get something wrong.
• 6:41
  SPEAKER_01: Nobody is on the hook.
• 6:42
  SPEAKER_00: Okay.
• 6:43
  SPEAKER_00: What's the third outcome?
• 6:45
  SPEAKER_00: I have a feeling it's the one that matters most, because you saved it for last and you've been building towards something bigger the whole time.
• 6:52
  SPEAKER_01: It's medical records.
• 6:54
  SPEAKER_01: Tech vendors lobbied for a rule where a health app, once it's vetted by a third party, is treated exactly like a patient requesting their own records.
• 7:02
  SPEAKER_01: That would open access through a national exchange network called TEFCA.
• 7:07
  SPEAKER_00: Let me make sure I follow that.
• 7:08
  SPEAKER_00: Today, if I ask my doctor for my records, they generally have to give them to me.
• 7:13
  SPEAKER_00: The vendors want an app acting on my behalf to get that same automatic right of access.
• 7:18
  SPEAKER_01: Exactly.
• 7:19
  SPEAKER_01: In a formal meeting this past May, tied to an HHS rulemaking, they argued that apps should stand in the shoes of the patient.
• 7:26
  SPEAKER_01: Inside the Slack, people talked about a frictionless pathway to unlimited record access after a one-time consent.
• 7:32
  SPEAKER_00: I've spent enough years around production systems to get nervous whenever someone says frictionless and unlimited in the same sentence, especially when the data in question is the most sensitive information most people will ever have.
• 7:44
  SPEAKER_01: And to be fair to the conversation, not everyone in the room agreed.
• 7:48
  SPEAKER_01: Jason Kulatunga from Fasten Health warned that any security model has to account for malicious actors because a fake app with patient-level access is a nightmare scenario.
• 7:58
  SPEAKER_00: Who was pushing hardest for the easier access model?
• 8:01
  SPEAKER_00: I'd like to know whether those voices had any financial interest in the outcome they were advocating for inside that workspace.
• 8:07
  SPEAKER_01: Ryan Howells of the Karen Alliance and Kristen Valde of B.well were among the strongest advocates.
• 8:13
  SPEAKER_01: And notably, Howells sits on the board of a third-party organization that does the vetting of these apps, which is a structural conflict worth noting.
• 8:21
  SPEAKER_00: So the person arguing that vetted apps should get access also helps run the vetting.
• 8:26
  SPEAKER_00: I'm not accusing anyone of bad faith, but that's exactly the arrangement public process is designed to surface and examine.
• 8:33
  SPEAKER_01: And here's the line that will probably define this story.
• 8:41
  SPEAKER_01: She meant it as a point of pride, a sign of speed, but critics hear it as the problem itself.
• 8:46
  SPEAKER_00: I want to push back a little now because I've watched health technology stall for decades.
• 8:51
  SPEAKER_00: Patients still fax records between offices.
• 8:54
  SPEAKER_00: Isn't there a real argument that moving fast and skipping the slow process is actually good for patients?
• 9:00
  SPEAKER_01: There absolutely is, and I don't want to dismiss it.
• 9:03
  SPEAKER_01: The kill the clipboard idea, which Gleason championed, is popular for good reason.
• 9:07
  SPEAKER_01: People hate filling out the same forms ten times.
• 9:10
  SPEAKER_01: Speed has real value for real people in waiting rooms.
• 9:13
  SPEAKER_00: Then where do you land?
• 9:15
  SPEAKER_00: Because your numbers seem to cut both ways.
• 9:17
  SPEAKER_00: Faster access helps patients, but a closed room full of vendors deciding the rules does not exactly inspire confidence either.
• 9:25
  SPEAKER_01: I land on process, not outcome.
• 9:27
  SPEAKER_01: The goals might be right, but when 1700 mostly industry members shape rules for medical records, and only a handful of patients and doctors are present, you get rules optimized for the companies who showed up.
• 9:39
  SPEAKER_01: That isn't a conspiracy.
• 9:40
  SPEAKER_01: It's just how incentives work when one side has full-time lobbyists, somebots, sociest, and the other side has a waiting room.
• 9:47
  SPEAKER_00: There's also the family connection you mentioned earlier with 8vC.
• 9:51
  SPEAKER_00: And I think we have to address it plainly rather than leave listeners guessing about what exactly the reporting actually said there.
• 9:58
  SPEAKER_01: The reporting says 8VC is a venture firm associated with Finn Kennedy, who is the son of Health Secretary Robert F.
• 10:05
  SPEAKER_01: Kennedy Jr.
• 10:07
  SPEAKER_01: The reporting doesn't allege wrongdoing, but it's the kind of overlap that public advisory rules exist to make visible.
• 10:13
  SPEAKER_00: So what actually changes on Monday morning for the people doing the work?
• 10:17
  SPEAKER_00: I'm thinking about hospital information officers, health startups, and frankly, the folks at Medicare who have to answer for all of this now.
• 10:24
  SPEAKER_01: For startups, the signal is that access to CMS officials is worth a fortune.
• 10:29
  SPEAKER_01: And you should expect scrutiny of how that access was granted.
• 10:33
  SPEAKER_01: For hospitals, expect pressure to open record pipelines to apps, possibly before security standards fully catch up.
• 10:39
  SPEAKER_00: And for listeners who are on Medicare or who help an aging parent with their health care, I think the practical takeaway is simple.
• 10:47
  SPEAKER_00: A government listing is not a guarantee of quality or a promise that anyone is liable.
• 10:52
  SPEAKER_01: Agreed.
• 10:53
  SPEAKER_01: Read what an app actually does with your data before you consent, especially any one-time consent that grants ongoing access to your full record.
• 11:01
  SPEAKER_01: Ask your doctor before relying on an AI tool for anything that affects treatment decisions.
• 11:06
  SPEAKER_00: Last question for you.
• 11:25
  SPEAKER_01: And watch the medical records rulemaking closely because public comments on that rule are where ordinary people still get a vote.
• 11:32
  SPEAKER_00: That's a useful place to end.
• 11:34
  SPEAKER_00: The tools may be genuinely helpful, but the way decisions get made matters just as much as the decisions themselves, especially when the data is your own medical history.
• 11:44
  SPEAKER_00: If you have thoughts on this one, or you work inside a hospital or a health startup and see this differently, we'd genuinely love to hear how it looks from where you sit.
• 11:53
  SPEAKER_00: That's all for today's episode of the DX Today Podcast.
• 11:57
  SPEAKER_00: Thanks for listening, and we'll see you next time.