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Data Book examines how artificial intelligence could have helped one of the leading physician-scientists of our time.

The Future of AI in Healthcare: Eric Topol's Story

The companies, along with Merck & KPMG, will help develop a legally mandated interoperable prescription-monitoring network.

FDA Picks IBM, Walmart & Others for Blockchain Medication-Tracking Program

By 2050, it's estimated that 139 million people worldwide will have dementia, but by today's standards, 60% will be undiagnosed. It's clear that there's a significant gap in dementia detection and care, but what can your organization do about it?

Get perspectives from clinical leaders and neuroscience experts about the underlying causes and consequences of these gaps, practical opportunities to address them, and a proven roadmap that shows how leading health systems have successfully transformed their dementia screening and care processes.

Closing the Dementia Care Gap: Expert Insights and Proven Strategies for Health Systems

The Supreme Court on Thursday tossed a lawsuit that once again threatened the Affordable Care Act (ACA), ruling 7-2 that Republican-led states who brought the case lacked legal standing to challenge the law.

For the third time, an increasingly conservative court left intact the law’s protections that require coverage for preexisting conditions, created Medicaid expansion, promote health screenings and preventive care, and launched novel, value-based payment strategies within the agency that manages Medicare and Medicaid.

The ruling comes as President Joe Biden has tried to build on the ACA and create new incentives for states that have not expanded Medicaid to do so, amid mounting evidence that having health coverage reduces mortality.

 and was joined by Justices Elana Kagan and Sonia Sotomayor, as well Chief Justice John Roberts and two appointees of President Donald Trump, Justices Brett Kavanaugh and Amy Coney Barrett. The opinion focused on the fact that individual states governed by Republicans, along with individual plaintiffs, had failed to show “a concrete, particularized injury fairly traceable to the defendants,” and thus could not challenge the law on constitutional merits.

The latest challenge, led by Texas, began after Trump’s 2017 tax law eliminated the enforcement mechanism for the ACA’s individual mandate. On those grounds, the Republican-led states tried to assert that the entire law must fall, even provisions unrelated to the requirement that all Americans have health insurance.

Today, the Supreme Court’s majority found that the states failed to make their case that the de facto end of the mandate would cause them harm, which would create grounds to challenge the entire ACA.

“Unsurprisingly, the States have not demonstrated that an unenforceable mandate will cause their residents to enroll in valuable benefits programs that they would otherwise forgo. It would require far stronger evidence than the States have offered here to support their counterintuitive theory of standing, which rests on a ‘highly attenuated chain of possibilities.’”

Justice Clarence Thomas wrote a concurring opinion, stating, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."

An estimated 20 million people had gained coverage under the law at a peak in 2017, but there was some loss of coverage during the Trump administration. More recently, more than 1 million people signed up for coverage through the ACA under a 

 authorized by the Biden administration due to the COVID-19 pandemic. The American Rescue Plan reduced premiums, and additional proposals would make those premium cuts permanent.

While many legal experts had questioned the merits of the Republican states’ challenge, the addition of Justices Neil Gorsuch, Kavanaugh, and Barrett to the court raised concerns among the law’s supporters about what would happen once the case reached the highest court. Gorsuch and Justice Samuel Alito dissented, but the other Trump appointees ruled with majority on the narrower question of standing.

The latest challenge was argued in November, just after Barrett joined the court, and the defense was organized by a group of officials from Democrat-led states. Their leader was former California Attorney General Xavier Becerra, recently confirmed as Biden's HHS secretary.

The ACA is now one of the most litigated pieces of legislation in history. It survived an initial challenge after its passage in 2010, although the court did reshape the law by allowing states to opt out of Medicaid expansion.

However, that decision ended up creating an environment for research comparing health outcomes between expansion and non-expansion states, and now data are pouring in that show how populations with health coverage benefit in multiple ways—those 

 who are able to manage their disease suffer fewer complications.

Veterans of the Obama administration who helped write and implement the ACA were surprised and pleased this morning, and said the decision opens the door for the Biden administration to improve the law.

“Bottom line—this is incredible,” former Obama administration policy official Kavita Patel, MD, told MSNBC. “It’s a chance for the Biden Administration to try to take back some of what the country lost when the individual mandate was taken away. … Not being a lawyer, I don’t think you could have a clearer path saying, ‘this is it.’”

“It’s not a close call in terms of the law, and not a close call in terms of who we are as a country,” said former Acting CMS Administrator Andy Slavitt.

Chiquita Brooks-LaSure, now CMS Administrator with chief responsibility for implementing the law, recalled her work on its passage during her tenure with the House Ways and Means Committee. 

"Millions of Americans can breathe a sigh of relief following today’s Supreme Court 7-2 ruling upholding the Affordable Care Act," she said. "This victory assures access to affordable and comprehensive health insurance for patients and families across the country."

She pointed to the fact that 12 states have still not expanded Medicaid, but the Biden administration hopes that will now change.  "Through the ACA, and hand-in-hand with CMS, dozens of states have expanded Medicaid – bringing quality coverage to our family and neighbors who need it most. We will continue to partner with states because we know 4 million more Americans stand to gain access to quality health coverage in the remaining states."

Other supporters of the ACA also called for working to improve the law.

"CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans,” said Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield. “CareFirst looks forward to continuing our work with federal and state policymakers to maintain and improve access to healthcare throughout our region."

Officials from the Robert Wood Johnson Foundation called for an end of “meritless attacks against a milestone law. … It is time now for our nation to resume its path toward achieving universal health care coverage.”

Topic

Supreme Court Upholds ACA, Says States Lacked Standing

Hospital mergers are a prime target in President Joe Biden’s expansive executive order that calls on federal departments and agencies to reshape what he called a “booming” economy by putting workers first and ensuring consumer protections.

The order spans sectors from banking to transportation with 72 specific initiatives, including several that target healthcare, which is already undergoing upheaval amid the COVID-19 pandemic, which has exacerbated shortages of doctors and nurses, strained supply chains, and pushed veteran administrators into retirement.

“For decades, corporate consolidation has been accelerating,” a statement issued with the order reads. “In over 75% of U.S. industries, a smaller number of large companies now control more of the business than they did twenty years ago. This is true across healthcare, financial services, agriculture and more. That lack of competition drives up prices for consumers.”

The statement cited data claiming that mark-ups have tripled, raising costs for necessities like prescription drugs, hearing aids, and internet service—which became essential during the pandemic as telehealth became the only way to see a doctor.

Key items in Biden’s executive order include:

Empowering antitrust agencies, including the Federal Trade Commission, to address problems surrounding consolidation in certain industries, including healthcare, where mergers have left some rural areas with no hospital.

Making it easier to change jobs, including between states, by reducing occupational licensing requirements and limiting non-compete agreements.

Reducing prescription drug prices by allowing programs run by states and tribes that import drugs from Canada.

Promoting more procurement opportunities for small business with federal agencies.

The order creates a White House Competition Council the track progress on the initiatives and agencies’ response.

Consolidation in healthcare over the past decade—mergers of hospitals into larger systems, acquisition of practices, and vertical integration of health plans and pharmacy benefit managers (PBMs)—has drawn fire from consumer and antitrust advocates who say the trend works against keeping down costs, especially when one looks at some individual markets.

The order directs the Justice Department and the FTC to examine guidelines on hospital mergers to ensure that patients are not harmed.

Recent trends also work against reining in the price of prescription drugs, because powerful PBMs can dictate which drugs appear on formularies, demand rebates, or impose fees. Just this week, a study by authors at USC’s Schaeffer Center found that Medicare overspent by $2.6 billion in 2018 on commonly prescribed generic drugs compared with prices charged by Costco.

Biden’s order directs HHS to do the following:

Support hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing. This is significant, because many wondered the fact of the transparency rules imposed at the very end of the Trump administration.

Restore a rule from the Obama era that insurers selling plans under the federal marketplace, created by the Affordable Care Act, must have at least one standard design to serve as a benchmark for consumers to compare with other companies. This concept was scrapped under the Trump administration.

Directs the FDA, which is part of HHS, to work with states and tribes on safe import practices under the Medicare Modernization Act of 2003.

Increases support for generic and biosimilar drugs and allows 45 days for a comprehensive plan to combat high prescription prices.

Empowers FTC to ban “pay for delay” and similar practices that keep low cost drug or biosimilar options off the market.

Hospital Mergers Targeted in Biden Executive Order

People who are given opioids in the hospital for pain relief sometimes develop respiratory depression, a condition that occurs when the lungs fail to properly exchange oxygen and carbon dioxide, causing a buildup of carbon dioxide that can lead to a host of other health problems, from rapid heart rate to seizures; untreated, the condition can cause respiratory arrest, brain damage or even death.

Previously, the PRODIGY study found that opioid-induced respiratory depression is a problem in medical and surgical wards, and that patient monitoring is needed to prevent these cases when patients receive opioids after surgery—however, using tramadol or epidural opioids may reduce the risk.

 of the PRODIGY data has quantified just how costly the phenomenon can be in the United States. Published in 

and led by Ashish K. Khanna, MD, of Wake Forest School of Medicine, the study examined cost data collected from 420 of the 769 U.S. patients enrolled in the original study. The research team looked at the differences in the amount of health care use and costs for patients with and without at least one respiratory depression episode.

Patients who had at least one respiratory episode during their hospitalization ended up with longer stays—6.4 days on average for those with an episode, compared with 5.0 days for those without one. Costs were higher for those with an episode, too; $21,892 on average, compared with $18,206 on average.

In the earlier study, researchers had used a risk prediction tool to evaluate which patients were most likely to have respiratory depression during their stay. Those at high risk, as predicted by the tool and had at least one episode had higher costs compared with high risk patients without respiratory depression: $21,948 vs. $18,474.

The longer a patient stayed in the hospital, the more the stay drove up costs, “with the cost increasing exponentially” for patients with at least one respiratory depression episode as length of stay increased.

The study drilled down on individual factors that contributed to length of stay and, in turn, higher cost. “Use of multiple opioids; longer, high risk, or open surgery; respiratory depression; and medical conditions including chronic heart failure, hypertension, and sepsis, all contributed to increased length of stay,” the authors wrote.

The calculation method used in the study accounted for heart failure and a patient’s history of opioid use, and found that that both respiratory depression and length of stay continued to cost. Authors suggested their findings would be of use to payers and would point to areas where hospitals needed to implement quality metrics to reduce costs. Notably, the analysis excluded extremely high cost outlier patients; thus, the study reflects the differences “between typical general care floor patients with and without respiratory depression.”

The calculation method used in the study accounted for heart failure and a patient’s history of opioid use, and found that that both respiratory depression and length of stay continued to cost. 

Study Details Costs of Opioid-Induced Respiratory Depression in Hospitals 

Simplify Section 1557 Compliance with This Comprehensive Toolkit

Artificial intelligence is playing a bigger role in cybersecurity, and hospitals and healthcare organizations are using AI tools to improve their defenses.

Limor Kessem, IBM Consulting’s global lead for cyber crisis management, says the growing use of AI in their cybersecurity strategy 

is helping healthcare organizations reduce the expense and disruption of breaches

. The average cost of a healthcare data breach over the past year was $7.4 million, still the highest of any industry, but down from $9.7 million, according to 

IBM’s new annual report on the cost of breaches

Kessem says the use of AI is “paying dividends.”

“That's just containing and detecting and doing stuff a lot faster than the organizations would, and the more you cut the time to do things, the more money you save,” she tells Chief Healthcare Executive®.

But ransomware groups are also employing AI technologies in their efforts to infiltrate organizations, and they are having success as well.

“AI is doing good things for everyone,” she says. “It's doing good things for the security teams. It's for organizations, for people's productivity, and for everyone. It also includes the attackers who are able to build better phishing very quickly.” 

(See part of our conversation on AI and cybersecurity in this video. The story continues below.)

Limor Kessem of IBM talks about how AI is being used for good and bad purpsoes

AI and cybersecurity: Hospitals see promise, but attackers have new tools

These are the biggest health data breaches in the first half of 2025

In the past, it was easier to detect suspicious emails, since some had five typos in the first two sentences. Such messages often contained awkward phrasing that made it clear the author’s first language wasn’t English. But with AI tools, ransomware groups are sending polished, authentic messages.

Kessem also notes that phishing was the top attack vector used to get into healthcare systems.

“It's a big deal, and it's just getting a lot harder to recognize a phishing attempt from attackers,” she says.

Beyond that, cyberattackers are using AI tools to write malware, making it easier and quicker for ransomware groups to try and hack into organizations.

“Attackers are doing better with AI,” Kessem says. “They're doing things faster, and it’s something we have to contend with.”

“They could write malware without knowing how to write malware,” she says. “Just get the code, make sure it works, and proceed. So they're doing things a lot faster. And especially, I think it is for people in the cyber crime arena who already know how to write code like that, it just speeds them up so much, just like it does everybody else that writes code.”

Kessem says the growing use of AI by both healthcare organizations and criminal groups is only going to continue.

“It's kind of like an AI against AI sort of situation right now, but I think it's inevitable,” Kessem says. “It's just like when we kind of went mainstream on the internet, and now, AI is at everybody's fingertips, and everybody's using it for everything.”

Kessem says she's worried about the prospect of attackers developing AI agents that will be inserted into organizations.

"I am afraid to see, them bringing a rogue agent into an organization and letting it loose, and connecting it to things, and letting it loose on the organization," she says. "That's what I'm scared of, and this is what I think organizations should be looking out for in the next couple of years."

More attackers are also developing more credible “deep fake” ploys, as they use AI to mimic the voices and faces of organization leaders.

“They'll do a really good deep fake, which is very scary, because that's totally eroding trust everywhere, and the concept of trust,” Kessem says.

While some deep fakes in the past were less convincing, Kessem says the technology is improving.

“It's becoming better and better,” she says. “A few years back, five years back, it was a little clunky. It started getting extremely good, extremely accurate, and it looks and feels right. And beyond just the voice cloning, there's also the images, the real time images, where it could look like the person.”

“So these are definitely things that are really shaking the foundations of trust of what we see in general, and of course, in terms of security,” she adds.

Healthcare leaders have been worried about the prospect of deep fakes. Lee Kim, senior principal for cybersecurity and privacy at HIMSS, said in a September 2023 interview with Chief Healthcare Executive® that 

she expects health systems will see more deepfakes

“Deepfakes, I predict, will make a significant entry point into healthcare as well as other industries,” Kim said in that interview.

Cyberattackers target physician practices, specialty groups

While AI tools can help companies detect attackers attempting to hack into systems, she says AI can only do so much to help a system recover from an attack. Healthcare organizations took 279 days, on average, to identify and contain breaches, more than five weeks longer than the worldwide average of all industries, according to the IBM report.

Once an attacker has hacked a system, if organizations have to take key systems such as electronic medical records offline, then staff are going to be facing a lot of manual work.

“Recovery from the disruption is still taking very long, and the times are not going down,” Kessem says. “You think, Well, can we use AI to do that? Can we, like, speed that up with AI? I mean, we're speeding all the other parts of the life cycle with AI.”

But she says, “Actually, it's not as easy, because the recovery, a lot of times, tends to be very physical.”

Kessem says healthcare organizations need to brace for more disruptive attacks powered by AI.

“I think AI is going to make cyber attacks larger,” she says.

Organizations must govern their own use of AI tools carefully, and Kessem says health systems need to bring AI staff into discussions about bolstering cybersecurity. Hospitals and health systems need detailed plans for maintaining operations if and when a breach occurs.

Health systems need “a playbook for disruption and should be planning ahead for everything,” Kessem says.

Why LLMs demand a rethink of healthcare AI governance | Viewpoint

More health systems are using AI tools to improve defenses, but ransomware groups are using it for phishing, writing malware, and deepfakes.

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