Tower Health COO and President Michael Stern has been promoted to CEO, effective February 24, 2025. Stern will oversee the next stage of Tower Health's progress, including implementing our three-year strategic plan and new Tower Experience initiative. Current CEO P. Sue Perrotty will return to the Tower Health Board of Directors. Her final day as Tower Health CEO will be February 23, 2025 – a full-circle moment as the date will mark the fourth anniversary of her tenure.
Starting in January, California will regulate how AI is used by insurers in granting prior authorization.
Capitol Hill has its eye on California's new law that regulates how artificial intelligence is used by insurers in granting prior authorization for treatments, Chelsea reports. Rep. Ami Bera (D-Calif.) told Pulse the House Task Force on AI he sits on has discussed the law, along with doctors who’ve met with the group. What the California law does: Starting in January, it will require insurers to oversee prior authorization requests processed using AI.
Why It Matters
Health plans have used AI in recent years to streamline processing claims and prior authorization requests, but concerns have arisen about wrongful denials. Last year, insurers like United Healthcare and Cigna were hit by class-action lawsuits claiming they were using AI without doctor oversight, leading to improper denials of medical coverage.
A staffer for state Sen. Josh Becker, a Democrat from a district just south of San Francisco who introduced the bill, told Pulse that the American Medical Association backed the measure. The staffer added that Becker’s office has spoken with congressional offices, as well as a member of the Task Force on AI, about possibly introducing legislation that mirrors the state law.
"We will probably approach it by seeing the impact of the law," Bera told Pulse. "Does it streamline lower costs? Does it not hinder lower costs? If it does all of those things, it could be a model nationwide or in the other 49 states."
Task force co-chair Rep. Jay Obernolte (R-Calif.) didn’t comment directly on the California legislation. But his office said he supports consistent, nationwide standards for AI that also allow smaller AI companies to thrive. The office of co-chair Rep. Ted Lieu (D-Calif.) declined to comment.
Gaining Traction
The AMA's House of Delegates adopted a policy on AI’s use in prior authorization in October that’s similar to California's. It says a doctor should review any care denials recommended by AI and asks insurers to provide evidence that their algorithms don’t discriminate or increase inequities.
The bigger picture: Lawmakers have scrutinized prior authorization in recent years, concerned it’s being used too readily to deny care, particularly in Medicare Advantage, the privately run alternative to traditional Medicare. A growing number of hospitals have dropped MA plans, citing the denials. A bicameral, bipartisan bill reintroduced in June would mandate insurers more quickly approve requests for routine care.
Amazon's One Medical, a national primary care brand, is using AI to combat physician burnout. Artificial intelligence is supposed to transform medicine. But with AI tools flooding the market, health systems are grappling with where AI might best fit into their workflows.
In the first head-to-head test, Eli Lilly's Zepbound obesity drug helped people lose significantly more weight than its main competitor, Novo Nordisk's Wegovy.
The details
People taking Zepbound lost 20.2% of their body weight on average after 72 weeks of treatment in the Lilly-sponsored study, compared with a 13.7% loss for Wegovy patients, Lilly said Wednesday.
That translated into an average 50-pound loss for people who took Zepbound, while Wegovy users lost 33 pounds.
The significance
Lilly's new study is the first randomized clinical trial to demonstrate that Zepbound could induce more weight loss than Wegovy in head-to-head testing.
Previous studies sponsored by Lilly and Novo Nordisk found that each of the drugs helped people who are obese lose significant amounts of weight, but those trials didn't compare Zepbound and Wegovy against each other.
Lilly will probably cite the results from its new study in the company's Zepbound marketing. It could give Lilly an edge with doctors and patients in one of the fastest-growing and most lucrative prescription-drug markets.
Novo Nordisk responded by saying Wegovy is the only anti-obesity medicine proven to reduce the risk of heart attacks and strokes in people with heart disease and obesity.
Federal law requires that all nonprofit hospitals have financial assistance policies to reduce or expunge people's medical bills.
New research from Dollar For, an organization dedicated to helping people get access to charity care, suggests that fewer than one-third of people who qualify for charity care actually receive it.
