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By Alexis Kayser

Healthcare Editor

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This is a preview of the October 22 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursdays.

Good afternoon. On Tuesday, Newsweek and Statista released our ranking of the World's Best Smart Hospitals for 2027, recognizing 410 hospitals worldwide for their use of advanced technologies.

Read More on Access Health Newsletter

I joined Matthias Hirsch, vice president of health care at Statista, virtually from Chicago for the announcement at Sheba Medical Center's ARC Summit in Tel Aviv. Mayo Clinic claimed the top spot, followed by Cleveland Clinic and Mount Sinai Hospital.

Hirsch shared some interesting findings from Statista's annual smart hospital maturity survey, which now includes more than 200 hospitals. Participation has more than quadrupled over the past three years, providing an increasingly detailed picture of how hospitals are progressing in their digital transformation.

The results suggest that hospitals have made relatively consistent progress on foundational capabilities, including infrastructure, governance and auditing. AI, however, is a different story.

"We have this huge spread in artificial intelligence, [but] we have big differences across the regions," Hirsch said, noting that the highest-performing hospitals are considerably further along than their peers.

Hospitals in the Americas and Asia-Pacific regions made the greatest gains in AI adoption among institutions participating in both this year's survey and last year's, he added.

Today, Hirsch and I explored some of those differences in greater detail during a panel on building smart hospitals that last. We were joined by four health care leaders working in vastly different environments: Dr. Anke Diehl of University Medicine Essen in Germany; Dr. Yaron Elad of Cedars-Sinai in the U.S.; Henrique Sutton de Sousa Neves of Einstein Hospital Israelita in Brazil; and Dr. Sai Praveen Haranath of Apollo Health Axis in India.

Their experiences illustrated how hospitals are adopting AI at different speeds and for different purposes, often shaped by the needs of their patients, clinicians and broader health care systems.

At Cedars-Sinai, for example, Elad described how an early implementation of AI-generated patient messages had unintended consequences. Patients appreciated the detailed, polite responses, but clinicians found them too lengthy and said they created additional work. The health system subsequently shortened the responses based on physician feedback.

"One size doesn't fit all," Elad said, emphasizing that even within a single hospital, the success of AI depends on how well it meets the needs of the people using it.

In India, meanwhile, Apollo is applying AI to a different challenge: expanding access to care beyond traditional hospital settings. Haranath said the health system has used wearable devices to monitor approximately 300,000 patients outside intensive care units over the past two years, helping prevent cardiac arrests in several patients.

Apollo's approach is also shaped by the need to deliver care affordably and at scale. Haranath described how the health system has developed lightweight, modular technologies that can be deployed across its network, rather than relying exclusively on solutions designed for other markets.

Despite those differences, Haranath offered a reminder that applies across health systems: "At the end of your keyboard is a patient."

The discussion also brought some news. Statista and ARC Global announced plans to develop a global smart hospital database, allowing institutions to benchmark their digital transformation efforts and identify opportunities for improvement. The first version is expected to debut at the 2027 ARC Summit.

You can explore the full Best Smart Hospitals 2027 ranking here. Congratulations to this year's honorees.

P.S., I'm heading to Nashville today for eClinicalWorks' National Conference. I hope to see some of you there; expect a recap in next week's edition!

In Other News

Major health care headlines from the week

• CMS is withholding an additional $1.2 billion in Medicaid payments from California amid concerns about potential fraud in the state's personal care services program, Fierce Healthcare reported.

  • On Tuesday, CMS Administrator Mehmet Oz said spending on the program, which provides in-home assistance to beneficiaries, has grown 24 percent over the past three years.
  • The announcement follows earlier federal actions to defer Medicaid funding from California and Minnesota over suspected fraud and noncompliance. CMS has said the deferrals are not permanent funding cuts and that states can recover the money by providing documentation supporting the claims.
  • Meanwhile, federal and state officials raided about a dozen adult day care facilities in New York City as part of an investigation into allegedly fraudulent Medicaid billing, according to a Tuesday report from the New York Times. CMS also warned New York officials that the state needs stronger oversight of long-term managed care organizations, which administer many of the services under scrutiny.

• Oklahoma's INTEGRIS Health has signed a definitive agreement to join Risant Health, the nonprofit organization created by Kaiser Permanente to expand value-based care. Pending regulatory approval, INTEGRIS would become Risant's third health system, joining Geisinger and Cone Health.

  • INTEGRIS, Oklahoma's largest nonprofit health system, operates 10 acute care and 10 specialty hospitals and employs 13,000 people. The system will retain its name, leadership and medical staff while gaining access to Risant's value-based care infrastructure and additional investments in technology, hospitals and clinics.

• Nigeria confirmed its first Ebola case this week as an outbreak continues to spread across Africa. The patient, who traveled from Uganda to Abuja, is receiving treatment in isolation, while authorities are tracing 44 potential contacts. Kenya has also reported nine cases, all linked to a single cluster.

  • The outbreak, the second-largest on record, has been concentrated in the Democratic Republic of the Congo, where the World Health Organization reported 9,066 confirmed cases and 4,381 deaths as of October 11. The virus strain has no approved vaccine or specific treatment, although the CDC maintains that the risk of transmission to the United States remains very low.

• Nearly half of Medicaid beneficiaries say they are unprepared for new federal work requirements taking effect January 1, according to a new survey commissioned by Aeroflow Health, reported by Newsweek.

  • Under the rules, certain adults ages 19 to 64 will need to document at least 80 hours per month of employment, education, community service or other qualifying activities to maintain coverage.
  • Aeroflow’s survey found that 44 percent of respondents were unprepared to submit the required documentation, while 46 percent said they had received no reminders about the changes. More than half reported already delaying or altering medical care because of coverage concerns.
  • CMS estimates that 2.3 million people could lose Medicaid coverage in 2027, with annual losses reaching approximately 3.2 million thereafter. Other projections are higher, with Manatt Health estimating average annual coverage losses of 8.2 million people between fiscal years 2027 and 2034.

Pulse Check

Executive perspectives on key industry issues

This week, Epic announced Connectors, a new way for third-party applications to communicate with its AI tools.

On Wednesday, I spoke with Johnston Thayer, vice president of health informatics at Epic, and Derrek Seif, chief strategy and product officer at VPL—a provider of pharmacy logistics and medication delivery technology—about what the technology could mean for clinicians, patients and health systems.

Find a portion of our interview below.

Editor's Note: Responses have been lightly edited for length and clarity.

What is the larger vision behind Epic's Connectors announcement? What do you envision it making easier for Epic customers?

Johnston Thayer: At a high level, what we're trying to accomplish is bringing together the experience for patients, clinicians and health care staff so that when they're interacting with AI or agentic AI in the system, it brings together the full breadth of the health care experience. That can include information from many different points of care or information about what's happening for that patient.

Broadly, we want to make it easier for groups to bring those insights to where staff and patients are already interacting today, inside Epic, so they can be more informed about what's taking place and have more capabilities available there.

There are a number of different ways that'll happen, and one that I think is very important is around medications.

Is Connectors live yet? Derrek, have you had an opportunity to test it?

Derrek Seif: We are actively working on it. We haven't tried it yet. We're preparing the development on our side for early next year, when Epic is going to be releasing this.

We have over a decade's worth of pharmacy delivery data. With this technology, we can add additional AI on top of that to provide insights for pharmacies and bring complex logistics decisions closer to the patient.

Especially for specialty medications, patient care coordinators have to communicate with patients on a regular basis. We want to enable intelligence about how and when to ship medications so that we can ultimately deliver a really good patient experience.

For health system specialty pharmacies, the new front door is actually the patient's front door, because so much of the medication is being delivered.

Thayer: We just announced Connectors today, including some of the details about what they'll allow organizations to do. We gave some advance notice to groups we're working with to assess interest, but the technical work will happen through the end of this year. We're hoping to have some use cases live early next year.

Derrek, can you walk me through an example of how this could improve the patient experience from beginning to end?

Seif: Today, the medication goes through dispensing, and then it moves into shipping. The decision about how to ship it is made after dispensing.

What this technology will enable within Epic is making that decision before dispensing, closer to the patient.

Patient care coordinators working in Epic will be able to take the patient information and medication information, and an agent will send it to our technology. We can then determine when and how the medication should be shipped.

That decision will move from Epic through dispensing and fulfillment to the shipping provider, whether that's a carrier or courier, which delivers the medication directly to the patient. We then send that information back so it's ultimately stored within Epic.

Thayer: Another example is a patient chatting with Emmie in MyChart about symptoms they've been experiencing or questions about their chronic condition.

They might wonder when they're supposed to receive a medication they discussed with their doctor, whether it's a refill or their first prescription.

Rather than needing to figure out where to find that information online, go to another portal or look up a number, we could bring those insights directly into the conversation they're already having with Emmie. That would be tremendously powerful for patients trying to understand what their care looks like.

Is that information currently stored in applications outside Epic?

Thayer: Yes. We don't have shipping information within Epic because Epic doesn't provide shipping functionality. That's something we rely on other companies to provide today.

In some cases, that information ends up stored somewhere else. When it's something we can connect with, it allows us to bring those insights back to the patients and clinicians working with them.

Seif: Today, we have a bidirectional integration with Epic to exchange information, but users have to go to a separate system to make that happen.

With this technology, that separate system can go away because the Agent Factory is automatically communicating with our technology to provide the answer.

There's a lot of conversation around reducing the "swivel chair" effect within pharmacies.

Thayer: "Swivel chair" means I'm working in Epic, and then I have to swivel my chair to look at another system to get information.

Integrating with other systems is something we've been doing for a long time at Epic. We have open standards for connections published on open.epic.com, including FHIR and HL7.

But agents work in different ways and need access to information in different ways. To support these new AI use cases, we need to support new standards for retrieving and using that information.

That's what Connectors represents: an opportunity to embed information from other systems into a deeper, richer experience for agentic AI use cases.

Could Connectors eventually make the underlying applications less visible to users? Could clinicians accomplish most of their daily work in Epic without opening separate applications?

Thayer: Where it makes sense, that would be a real win for clinicians.

There may be situations where it makes more sense to be somewhere else, but especially if it's part of your clinical workflow and you're interacting with a patient in the exam room, you don't want to be going somewhere else.

Being able to retrieve those insights and have everything show up in the same place is a better experience for everyone involved.

Because this product involves agentic AI, how can health systems ensure the information being retrieved is accurate, up to date and trustworthy?

Thayer: The first thing to note is that health systems will be fully in control of what types of integrations they want to turn on.

Connectors allows information to flow more easily between systems, but each integration needs to be approved by the individual health system before it goes live. That's on purpose.

We want health systems to have a chance to understand the security, the use case and the data validity before anything goes live. They can make those decisions through their standard governance processes.

Seif: Trust is a big thing for us.

Today, when pharmacy staff make decisions about when and how to ship medications, they have all the information in front of them. They're making the decision, but the mental load is very high and complex.

As we develop this technology and make the decision-making process less visible to the clinician, we have to make sure we present not just the decision but also the reasoning behind it.

They need to understand why the system is making a particular decision from a cost, time and risk perspective. Those are the main factors in getting medication to the patient.

We have to earn their trust. Over time, if the results are accurate and patients are getting their medications, we believe we can adjust how much information we provide upfront.

How open will this ecosystem be? Will third-party developers whose products might compete with Epic have equal access to Connectors?

Thayer: The goal is for health systems to decide what's valuable. We're creating a way for them to connect with other systems for any number of reasons.

A basic example is bringing in weather data. When you're addressing a patient's social needs, they might need transportation to an appointment, and you might want to factor in what the weather will be like that day.

Another example is wayfinding. In a complex hospital or multispecialty clinic, getting through the front door is often just the first step. Patients still need help finding where they'll actually see their doctor.

Working with third-party wayfinding applications could allow us to embed that functionality into MyChart, where patients are already interacting.

How exactly would that wayfinding application work for patients? Would they be communicating entirely with Emmie?

Thayer: Exactly. Today, health systems can already upload their own knowledge bases.

Parking is a good example of information that's relatively static. A patient can ask where to park when they're checking in for an appointment.

But once they arrive, navigation isn't static. It depends on where they are in the hospital and where they need to go next.

That's where wayfinding applications can use contextual information about what's happening with that patient.

They could return to the same conversation they had earlier about their visit and parking, and pick it up by saying, "Help! I'm lost. Please get me to where I need to go."

Is there anything else you want hospital and health system leaders to know about Connectors?

Seif: The main thing I'd want them to know is that we're listening to them.

A lot of our customers are focused on making medication delivery the best patient experience possible.

They want a consumer-grade experience when delivering medications. They want to extend their brand, and they want complex logistics decisions to become more automated and move closer to the patient care coordinator.

We're taking that feedback to Epic and working together to innovate in specialty medication delivery.

Thayer: Health care can be better when we work together.

As we look at the ecosystem and all the work being done out there, we're excited to see what groups will build, what capabilities they'll make available and how that work will affect clinicians and patients.

C-Suite Shuffles

Where health care leaders are coming and going

• Jeff Park was named president of Carelon, the health care services subsidiary of Elevance Health, effective December 1.

  • Most recently, Park served as president of Waltz Health and continued to lead its business after the merger with global life sciences company EVERSANA last summer.

• Providence tapped Justin Montoya as chief real estate officer, a role he’s held in an interim capacity since April.

  • Montoya has been with the Renton, Washington-based health system for more than 20 years, and was chief real estate officer for its South Division in California before assuming the enterprise role.

• Chris Shea is joining Longitude Health as chief legal and administrative officer.

  • Longitude Health is an innovation collaborative composed of five health systems: Baylor Scott & White Health, Memorial Hermann Health System, Michigan Medicine, Novant Health and Providence.
  • Shea previously served as deputy general counsel and health plan general counsel at Memorial Hermann. Most recently, he was chief legal and administrative officer at MedQuest Imaging, a multi-state imaging diagnostic organization.

This is a preview of the October 22 edition of Access Health—Tap here to get this newsletter delivered straight to your inbox on Thursdays.

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