The Great Healthcare Re-bundling Is Here
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Today's High-Tech Exam Room
Picture this: It's 2025, and while everyone's busy arguing about whether AI will replace doctors (spoiler: it won't), a much quieter revolution is happening in exam rooms. Patients are showing up with their Apple Watches displaying heart rate variability, their Dexcom G7 beaming glucose readings to the cloud, and their GLP-1 prescriptions from a DTC telehealth company they found on TikTok. They're also seeing a therapist through their employer's digital mental health benefit while getting nutrition coaching from an app their insurance suddenly decided to cover.
Welcome to the messy, beautiful chaos of modern chronic disease management, where the old playbook of "take this pill and see me in three months" has long since been deprecated.
Unbundling and Re-bundling Healthcare
As an industry, we’ve been moving down the path of unbundling healthcare services. Remember when you had to go to your primary care provider for everything? Now you can get your Wegovy from Ro, your therapy from Headspace Health, your continuous glucose monitor from Levels, and your primary care from One Medical. Venture capitalists may call it "disruption", others may give it the moniker of “consumer empowerment”, but patients are likely to call it "confusing as hell".
Approximately 1 in 3 adults live with multiple chronic diseases, and guess what? Their pancreas doesn't care that their endocrinologist uses Epic while their cardiologist is on Cerner. Their mental health issues don’t politely wait for their diabetes to stabilize before flaring up.
As a result, we're watching the great re-bundling of healthcare happen in real-time, except this time it's not the integrated delivery network of times gone by. It's something altogether different.
The Integration Reality Check
As an example of national-level integration success, Ireland's HSE rolled out a nationwide GP Chronic Disease Management (CDM) Programme that's delivering real results. The program takes a population-level approach – instead of treating patients one by one, they're identifying at-risk groups and intervening early. The payoff is that only 8% of enrolled patients needed hospital care for their chronic conditions. Compare their 2019-2023 data and you'll see a 30% drop in emergency department visits, 26% fewer hospital admissions, and 33% reduction in after-hours GP visits. They're bringing care closer to people's homes, proving that when you actually fund community-based care, people stop showing up at the hospital.
So what does 2025's version of integrated care actually look like? Let’s get rid of the old model of siloed specialists sending referral letters into the void. This is:
1. AI-Powered Integration That Works
The AMA reports ambient listening has become table stakes, with most organizations using it and physicians loving it. New digital solutions address gaps in care for heart failure, diabetes, and mental health.2. Behavioral Health as Main Character
A host of smart implants and wearables on the market monitor cardiac activity and glucose in real-time, enabling better chronic disease management. Mental health isn't just a side quest anymore.3. The Direct-to-Consumer (DTC) Movement
Eli Lilly launched LillyDirect for weight-loss and diabetes treatments. Pfizer followed with PfizerForAll. Pharma giants are essentially admitting that traditional healthcare delivery is broken – why else would Eli Lilly and Pfizer build their own direct-to-consumer platforms to bypass the very system they've worked with for decades?4. Government Meets Consumer Tech
Even the feds are catching on. RFK Jr. just announced he wants every American sporting a wearable within four years, with HHS launching one of its biggest advertising campaigns ever to promote health trackers. His vision is to replace $1,300-a-month Ozempic with an $80 smart watch. Of course, not everyone can drop $80 on a fitness tracker when they're choosing between groceries and gas. However, the message is clear, Washington thinks personal responsibility and self-monitoring can fix healthcare costs. Meanwhile, those who can afford it are already five steps ahead, building their own digital health ecosystems without waiting for federal campaigns.The GLP-1 Effect
One in eight adults report taking a GLP-1 medication. Per member per month spending on these medications nearly doubled each year since 2021.
The kicker? With employers limiting coverage, members use DTC telehealth solutions for prescriptions, creating an entirely separate healthcare system. We're talking about patients paying several hundred dollars per month out-of-pocket for GLP-1s while their insurance-covered doctor has no idea they're on it. "It's healthcare's version of a shadow economy – less regulated, cash-based transactions happening completely outside traditional insurance channels, with no coordination between providers.
The New Integrated Care Stack
Who's Writing the Checks?
GLP-1 prescriptions grew 38% annually from 2022-2024, with sales expected to reach $100 billion by 2030. But this explosive growth is creating a financial reckoning across healthcare. Employers are getting selective with 14% of those covering GLP-1s for obesity now considering dropping coverage entirely, while 20% now limit coverage to patients with BMI over 35. Health systems are feeling the squeeze too, with BCBS Massachusetts reporting a $114 million loss partly due to a 250% surge in GLP-1 claims. Meanwhile, patients are bypassing the system entirely, turning to DTC telehealth options and compounded medications when traditional coverage fails them.
The most surprising development? We're witnessing a great GLP-1 coverage retreat. Major insurers are dropping coverage for weight loss in patients with lower BMIs, effectively creating a two-tier system where access depends on your wallet, not your medical needs.
At the same time, Big Tech is pouring unprecedented capital into healthcare. Amazon, Google, Microsoft, and Meta are collectively spending over $320 billion on AI and data infrastructure in 2025 alone – much of it aimed at healthcare applications. Amazon's going deeper into primary care delivery, Google's amassing health data for its biotech bets, and Microsoft's pitching itself as the cloud platform of choice for health systems. When tech giants start outspending pharma on healthcare infrastructure, the game fundamentally changes.
Perhaps most telling is the prevention paradox that remains unsolved. Administrative costs alone eat up 8% of U.S. healthcare spending versus just 1-3% in other countries. Until these fundamental inefficiencies are fixed, all integration efforts are essentially playing catch-up to a system designed for treatment, not prevention.
The Bottom Line
If you still think integrated care means getting specialists to talk to each other, you're subscribing to an integrating care model equivalent of a Yellow Pages. The future will warrant a complete reimagining of care delivery for a world where patients have agency and options (including DTC prescriptions), AI actually makes clinicians' lives easier, and care happens, everywhere, continuously.
The integrated care leaders who win won't be the ones with the fanciest EHR system or the most care coordinators, they'll be the ones who recognize that patients are already creating their own integrated care networks – cobbling together solutions with apps, wearables, and yes, those DTC GLP-1 prescriptions. The winners will be those who lean into this reality rather than fight it.
Ready to dive deeper? Join the HLTH Think Tank "Connecting The Dots – Integrated Treatment Solutions" in partnership with Novo Nordisk. This exclusive gathering brings healthcare leaders together to challenge traditional boundaries and push toward a connected, patient-centered model.
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